29 October 2007

Drug Testing Times


Another big merger in the drug testing market - and testing spreads in to more arenas. Is it time for clear legislation and policy to regulate this growing market?

At the end of September 2007, AIM listed company Concateno bought the drug testing company Cozart. Since 2006, and following a rapid spending spree, Concateno has acquired most of the drug-testing companies in the UK, and now controls a portfolio including Medscreen Ltd, Altrix HealthCare, Euromed, TrichoTech, Marconova, CPL, and Cozart Bioscience.

Part of the rationale for the acquisition of Cozart was to gain access to the Cozart Rapiscan technology which allows for portable drug testing in places such as road-side testing.

Concateno is now a hugely powerful player in the international drug-testing field, covering most aspects of testing (except Ion Scan technology). Having gained control over the key testing companies, logic suggests that we will now see an increase in lobbying to expand drug testing in a variety of settings. At present drug testing has been focussed on safety critical, criminal justice and drug treatment settings. The next expansion is likely to be in non-critical settings - general workplace, education and social settings.

We've already seen the start of this expansion - the random drug testing of school-children, for example. But this is only the start. At the moment, most of the testing technologies are, to a greater or lesser extent, invasive. The exception, and one of the companies not yet owned by Concateno is the Ion Scan.

It is this last technology, probably the most controversial of all the drug testing modalities, which is the greatest cause for concern. As the cost of Ion Scan technology has decreased, and as the availability of the equipment increases, we are seeing this technology being used in a range of settings.

Alongside the use of Ion-Scanners in school settings as part of so called "drugs awareness sessions" they are also increasingly being used in pub and club settings, random (consensual) testing of motorists and other public arenas.

Some police forces have even approached and 'encouraged' hostels and direct access services to allow the use of testing equipment on residents.

All this leads to a couple of inexorable conclusions: the first is that the use of the Ion Scan technology is going to increase and the second is that there is insufficient regulation or protection in place as to how and when it can be used. Given that results from Ion Trace technology are especially prone to generating "false positives" due to extraneous contamination, the unmoderated and unverified use of this technology has to be a cause for concern.

At present there is no obligation to consent to scanning with an Ion Trace detector in a public place. However, there is less clarity as to whether or not refusal to consent to a trace should be reasonable grounds for a stop and search. PACE needs to be amended to make it clear that refusal to be Scanned should not, of itself, be considered grounds for a search.

Likewise, to date much of the testing has taken place in semi-voluntary settings such as pubs and clubs. But its imposition in involuntary settings such as schools, or essential services such as hostels changes this dynamic. In these settings the 'choice' to be tested or not is severely restricted.

Finally, the status of Ion Scan test results are not well established in the UK. But given the rise and rise of this testing technology, we are long overdue legislation and guidance to manage this burgeoning technology.

Dr Kay Lumas' book "Drug Testing in the Workplace - A Pilot study on trace detection technology is now available. For information and review see here

Concateno buys Cozart: http://www.hemscott.com/news/latest-news/item.do?newsId=51002736731140

18 October 2007

Can Frank still tell the Truth? - our lying drugs propaganda service

Frank is starting to develop real problems with the truth. Frank has often been a stranger to accuracy in the past, but some of Frank’s recent pronouncements have seen Frank drift further from the world of drug facts and into the heady worlds of drug propaganda.

Before we go any further we should disabuse ourselves of the manufactured image of Frank being some kind of avuncular character who understands the foibles of youth but was old enough to impart sage advice. Frank is no such thing. Frank is a branding concept, developed by marketing consultants, tested in focus groups, assessed, reviewed, honed. The brief: hip, but not too hip; funny, but serious; accessible to the youth but don’t alienate the parents; understanding but not overly tolerant.

The evidence is that the marketing consultants succeeded in their aim. Brand Frank was created and supplanted the “National Drugs Helpline” with the Frank logo, website, helpline and campaigns.

Frank however, attempts to fulfil two very different roles. On the one hand, Frank is responsible for delivering the phone-service that was once the National Drugs Helpline. The Government has funded Essentia Group to the sum of £1.45 million in 2006-07 for FRANK (drugs), Sexual Health Line, Drinkline and Know The Score, the Scottish helpline on drugs. The Government can’t say how much Frank helpline actually costs specifically but estimates the cost at around £800,000 in 06-07. To put this spend in to some sort of context, the previous year the Home Office spent almost twice this amount (£1,588,007) in advertising FRANK http://www.publications.parliament.uk/pa/cm200506/cmhansrd/cm060911/text/60911w2347.htm

According to Government figures, and despite extensive advertising spending, the number of people accessing the Frank Helpline has not increased over the past three years, and the figures for 2006-07 are lower than the previous year, http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070719/text/70719w0032.htm

Despite spending significant sums on advertising, only 4,444 under sixteens phoned Frank in 2006-07 – despite the fact that more that at least 40% of young people in this age bracket have experimented with drugs.

The Ask Frank service can deliver good quality information and does, at times, demonstrate a level of imagination and free-thinking. But, too often, Frank call handlers limit their responses to the on-screen information, referring anything more complicated to local drugs services. Frank really doesn’t want to get bogged down on a thirty minute call; Frank’s not set up for it. So Frank would rather signpost the caller on, send some information out or bring the call to an end, rather than undertake more open-ended telephone support.

Such a limited service would be just about acceptable were the Government still funding other services such as Release to undertake more in-depth, open-ended or longer interventions. Unfortunately the Government is no longer willing to do so. They claim that the funding mechanisms that hitherto supported Release no longer exist – and argue that there is no need to fund two drugs helplines. Either way, the Ask Frank service is now the lynchpin of low-level drugs advice to young people and their families in the UK.

But the Frank helpline is just once facet of Frank’s many faces. Because Frank also runs campaigns, places advertisements, and has the Ask Frank website. Frank also lends his name to any of a range of information, resources, materials or events produced locally or regionally.

Frank (the Helpline) and Frank (the advertising and campaign machine) are two very different beasts. Frank (the Campaign Machine) is effectively a manifestation of the Home Office’s drug strategy. Rather than branding resources with the Home Office logo, and making it clear that the information is prepared, vetted and distributed by the Home Office, the illusion is created that it is more independent, more free-thinking, less agenda driven.

But raise questions about content on the Frank Website, in adverts or in publications and all enquiries inexorably lead back to the Home Office. Some content has been externally commissioned; others has been drafted in house and then signed off by other bodies such as the Police or the Department of Health.

Take as an example the recent Frank Action Update, which focussed on Cannabis but was subsequently withdrawn due to serious factual errors. The legal sections (some of which were incorrect) were meant to have been produced by a senior police officer on Merseyside; the sections on reducing cannabis related harm were referred back to Health Advisors in the Home Office.

Ironically, the Frank phone advisors were unaware of the Action Update and, when it was brought their attention, disagreed with the content.

Does it matter that Frank has a Home Office run campaign arm? The answer to this should be a resounding “yes!” It is imperative that people who use drugs, especially young people, should have a source of information that is balanced, impartial, non-judgemental, and above all accurate. This may mean giving people information which is politically sensitive, which runs counter to Government policy, or which is in other respects controversial. Such an approach assists the credibility of the information, and the extent to which young people will retain – and act on this information. To do this information should not be slanted to serve a political agenda, or watered down to make it acceptable to Government.

The Frank branding exercise are intended to create the illusion of this credible, trustworthy and balanced information source. And certainly some call handlers at the Helpline work towards these standards where they can.

But, cynically, having created the illusion of Frank, the Home Office seeks to impart partial truths and untruths about drugs and bolster their credibility by putting Frank’s name on it.

This is a short-sighted approach and hugely damaging. Because as people become aware that the Frank adverts are simply the Home Office dressing up the Government’s messages in yoof clothes, why should anyone trust the Helpline? And if trust in the helpline is diminished, where can young people get this independent and impartial information?

Trust – in organisations like Release (for example) was cultivated over a number of years through action and words. Frank has attempted to nurture the same sort of trust in a fraction of the time through branding and image management.

Having done so, the Home Office seeks to use this trust to promote anti-drug messages, under the guise of the ersatz-honesty of Frank.

Trust in services should be developed over time, through a framework that ensures integrity, accuracy and independence. Trust cannot and should not be manufactured by marketing consultants. Frank hasn’t earned out trust, and doesn’t have these hallmarks to ensure that further pronouncements reach the high standards of accuracy and impartiality we so badly need.

KFx: October 2007

03 October 2007

War Amongst the Angels: How Caroline Coon's attack on Release is ill-judged and ill timed

Caroline Coon launched a wordy and savage attack on Release, through the medium of her website. Entitled "the Plight of Release" she lays in to the organisation that she cofounded, describing it as "irrelevant," and accusing it of simply being an aspect of the "prohibition industry" She argues that the organisation should either close or substantially restructure to become viable and relevant.

Having worked for Release and having had contact with Caroline in the past, I certainly can't claim to be objective. But Coon's diatribe is ill-judged and had the potential to be hugely damaging.

Release was co-founded by Caroline Coon, but she has had little engagment with the organisation over the past couple of decades. It seems strange that she should choose to break her silence now, and in such a public and damaging way. Over the past forty years the organisation has had to evolve and change. It ceased to be a collective, had to fight harder for funding, needed to ensure that it operated within the contraints of charitable law.

Coon rails at the "ludicrously unambitious Directors" but her bile would have been better directed at previous Trustees, who undermined and hounded out former Director Mike Goodman, obstructed and hampered the refocussing of the organisation and, without discussion with existing staff imposed the ill-fated "Forward Thinking on Drugs" project on the organisation. Coon's opinion was that these Trustees operated with "wise discernment in the interests of the organisation." Nothing at this point could have been further from the truth.

Release is increasingly operating in a hostile environment, with Government policy moving further and further away from any revision to the drugs legislation. Funding of helplines has been focussed on Frank, which has become less independent and more a voice of Government strategy.

Revision and lobbying on drugs law has become equally competitive. There has been a recent proliferation of bodies lobbying for change. Whilst one would hope that this proliferation would result in more widespread and unified lobbying on legal change this has not happened. Instead, different fiefdoms, keen to garner profile and support, choose not to cooperate and stress difference from their peers, rather than working together. Release has suffered badly within this increasingly crowded field.

But (and this is the is a big but) Release is undoubtedly one of the "good guys." Profile may have dropped, it may not shout as loudly as it once did. But that is no reason to spuriously accuse it of being part of Prohibition industry. Such an accusation is deeply offensive, especially given the history of Release staffers such as Sebastian Saville and Gary Sutton.

Something has prompted Coon to think that Release should now be taken down. Perhaps it stems from conversations with Release staff. maybe she has been the subject of external pressure. Possibly, she thinks she is doing the best thing. She is not stupid. She may think that her contribution could be a needed kick up the behind. She should also be aware that it could be the knife in the back. If she is indeed trying to kill off the organisation that she co-founded, then she does the field a huge disservice.

12 July 2007

If at first you don't succeed - have another go at cannabis reclassification until you get the result you want

Gordon Brown announced today that he intends to review the reclassification of cannabis with a view to moving it back to Class B. This is purely political. Charles Clarke sought the same outcome, and referred the matter to the ACMD to do as he is required to do. The ACMD made their recommendations, which was that cannabis should remain a class C drug and the Home Secretary complied with their recommendations. So all Gordon Brown can do is refer the matter back to the ACMD. Will there be any substantial new evidence for them to consider? Will they be able to hold their nerve and not be browbeaten into acceding to the Government.

No suprise this; there's the draft drug strategy due out soon. But why wait on public consultation. Make policy on the hoof! Or as seems more likely make policy as a direct response to the conservatives newly published "Breakthrough Britain" strategy document. They wanted reclassification and by reviewing the issue again, the Government seeks to steal their thunder.

All this does not bode well for drug strategy. It looks like the issue will be as political and reactionary as ever.

KFx July 18 2007

First They came for the crack users..pt 2: Closure orders extension

First they came for the crack users... pt 2

Brown announces intention to proceed with Criminal Justice and Immigration Bill 2007 - Measures to extend Closure Orders Proposed

Right at the very end, just before the demise of the old Goverment, the pulication of the Criminal Justice Bill 2007 was announced. Then the people behind it, John Reid at the Home Office and Tony Blair, stood down. Leaving the bill behind.

At the time the Bill didn't get a lot of attention. The section that received the most publicity was a section relating to prostitution. No-one seemed to mention the proposal to extend the power to close premises.

Any hope that Brown would drop the Bill was dashed on the 11th July when, in a speech describing the Government's business for the coming term, the Criminal Justice and Immigration Bill was included in the list.

The Section of the Bill of most interest to KFx is S.17 which extends closure orders to cover non-drug related premises.

The proposal is not dissimilar to the existing powers for closing houses associated with Class A drug activity.

A first striking difference is that the power to issue a Closure Notice and apply for a Closure Order is not limited to Police; it has been extended to Local Authorities too. This is a substantial change and should be the source of some concern. Given in many situations the Local Authority will be the Landlord, and the person seeking the Closure Order, this is likely to represent a conflict of interest for the Local Authority. Likewise, it means that the same workers who are providing support may also end up in court providing evidence of nuisance or disorder.

The power can be applied to premises as follows:

(1) This section applies to premises if a police officer not below the rank of superintendent (“the authorising officer”) or the local authority
has reasonable grounds for believing—
(a) that at any time during the relevant period a person has engaged in anti-social behaviour on the premises, and
(b) that the use of the premises is associated with significant and persistent disorder or persistent serious nuisance to members of the public

This bill, if enacted, would hugely undermine existing housing rights and laws. It undercuts licenses, tenancies and centuries of property ownership. It will result in exclusion from housing, increased homelessness and affect many families, including those struggling with drugs, alcohol, mental health problems, children with special needs and so on. It allows for a situation where the behaviour of a child with behaviour problems could see the family removed from their home, even though no offence has been caused.

This is hugely loose wording. "antisocial behaviour" is loosely defined, and so will affect numerous people where behaviour could have caused alarm or distress to another person. The words "persistent" will need to be further defined. But the "relevant period" will be activity that has taken place over the preceding three months. Defining significant and persistent nuisance will be a challenge!

The net effect of this, as with the Antisocial Behaviour Act (Power to close Premises) is that if the Magistrate's Court is satisfied that antisocial behaviour and nuisance is taking place, a Closure Order can be issued, and any body resident in the property will be required to leave, made homeless or face arrest if they refuse to leave.

Despite protestations in the past that this measure was to be used as a "last resort" where other measures had failed, this is not reflected in the legislation. The Magistrate is not required to consider if other measures have been used, or that they have failed. They are only required to consider if they think issuing an order: (c) the making of the order is necessary to prevent the occurrence of such disorder or nuisance for the period specified in the order.

This does leave some room to move for a magistrate and is probably a better wording than the one in the Antisocial Behaviour Act. A sensible magistrate could find that it was not "necessary" if there were other measures available which might work.

As before, the Closure Order doesn't determine a tenancy - it merely denies access. The Tenant has the choice of surrendering their Tenancy (and risking being found intentionally homeless) or refusing to surrender it, not being eligible for alternative housing, and challenging the order through the courts.

And as before, the status of those thus evicted is not clear - in many situations the people evicted will need further housing, and may well be in priority need. So the simple locking out of one house will be a fatuous gesture when the people in question will still need to be housed, probably by the same local authority.

When the Antisocial Behaviour Act was passed, there was hardly a mutter about it because it was aimed at "crack dens" the new bogey-men of UK society. They were considered fair-game and unworthy of rights afforded to the rest of society. This extension may prove more contentious - as people start to realise that what one person considers a normal lifestyle may, by a neighbour, be considered "significant and persistent nuisance." Repeated mowing of lawn in the morning? DIY in the evening? One barbecue too many when smoke blows over the neighbours fence?

This is an illiberal, draconian piece of law, and as before with the Antisocial Behaviour Act removes important protections from individuals and places huge powers in the hands of the State. This time, the legislation must be challenged and concerted lobbying by all agencies will be required to prevent the passage of this Bill. In theory and in practice it is too important to stay silent on this Bill.

To read the full text of the bill click here: http://www.publications.parliament.uk/pa/cm200607/cmbills/130/2007130.pdf

Speaking Frankly! - frank confused on cannabis

At the end of May 2007 FRANK published their Action Update, "Cannabis Explained." It was made available as a hard copy, distributed to DATs and drugs services, and available as a download from the Home Office website.

At the end of June, a month later, the document was withdrawn from print and off the Government websites. This withdrawal was not accompanied by any notification or official explanation. Indeed, if you didn't know that the document existed, one might not have known that it had ever been there. But the short life of the "Action Update" and the tale of how it came to be removed from circulation raises some important questions about Quality Standards and accountability at Frank.

When the Action Update came out, KFx, alongside other organisations such as the UKCIA noticed some rather glaring errors. These are discussed here. Now while we would accept the interpretation put on Frank to be partisan and loaded, we don't expect it to be factually wrong. But on this occasion there were a number of errors and ommissions which were both obvious and serious. So for example, the document misrepresented the law on cannabis as applicable to under 18s; it said that smoking cannabis in a joint was the least hazardrous, and it didn't mention cannabis contamination at all.

We, alongside the UKCIA and others made representations to the Home Office about these errors and ommissions. And a long and fairly convoluted process began.

For the first couple of weeks, the document remained available on the Home Office website; although serious concerns about its accuracy had been raised, there was not attempt at this stage to suspend distribution while it was reviewed. Given that at least two of the errors were so obvious and so easy to check, this seemed inexcusable. All we got was reassurance that it was being looked at.

A phone call to Frank at this time was illuminating: The initial call handler referred the case swiftly to her senior call handler. The senior handler didn't know about the Frank Action Update, and was unaware of its content. He was suprised at what the action update said about spliff smoking and said that was different to the information on his screen. He said I should contact the Home Office to discuss this.

Frustrated by lack of action - and that the Home Office still hadn't retracted the document, we followed up the initial emails to the Home Office with a phone call. As a nice factual example of a serious inaccuracy, we used the coverage of under 18s and the legal process in relation to cannabis. This was a fairly charged discussion, with the contact at the Home Office not understanding the legislation and explaining that the relevant section had been "signed off" by a Senior Police officer and so had to be right.

Undaunted, emailed to the PA of the senior police officer in question; this email was forwarded to several officers in the relevant force until a helpful Officer emailed me back. after a couple of to-and-fro emails he emailed me back, confirming that he thought the position in the Frank document was wrong.

Back to the Home Office with this information, and after a short delay, they came back describing this information "of concern" and suspending distribution from the website. But in practice the update could still be found after a quick Google search.

A week later, the person in the Home Office wrote back again; this time, followig feedback from the Department of Health, they said

"In the interest of ensuring FRANK provides up-to-date and credible information, DH have recommended that some of the contents of the pack be amended or the issue explored further...As you are aware we have suspended distribution of the pack and removed it from the drugs.gov.uk website. We intend to re-issue the pack later in the year."

This was the right decision by Frank, and should be applauded. But it was a slow decision and an unpublicised one. While the LCA issued a press release about the withdrawal FRANK didn't. Unfortunately few agencies picked up on the LCA announcement. Unfortunately the Daily Dose, who now receive sponsorship from Frank, either didn't get it or didn't consider it sufficiently newsworthy.

There are a number of things about this story that cause concern. How did this flawed document slip through various proofing stages, why were the Home Office so slow to suspend distribution, and why was the suspension so low key when they did decide the document was flawed?

Authorship of the document is not clear; some of it appears to be cut and pasted from other sources. It has the same spellings (and even the same typo at one point) as other FRANK written documents so it suggests that some of the information has merely been recycled from other sources and not been reviewed.

One would hope that a final draft of the document would then be passed to others for scrutiny but clearly this didn't happen or if it did, the scrutiny was severely flawed. The information that we have gleaned suggests that the senior police officer would have understood and checked about the new ACPO guidance on cannabis - which was accurate, but wouldn't have checked the sections on Under 18s and processes under the Crime and Disorder Act, which were wrong.

But most worrying, we would hope that Frank would have a rapid and effective method of first suspending distribution and then informing readers of their errors. They were slow to do the first; they simply didn't bother to do the second.

Despite the branding and publicity material, FRANK is merely a vehicle to distribute drugs information. This epidode has demonstrated that the arbiters of this content are the Home Office. And on this occasion the Home Office have demonstrated their difficulty in commissioning and distributing accurate copy on an important subject.

And let's be clear, this is not the first time that FRANK's content has been found to be wanting. The initial content of the FRANK website was riddled with factual inaccuracies. The revised information still has many items which are of dubious accuracy. So, as one correspondent to KFx noted, if you go to DF118s you get taken to information on Methadone. Different compounds, different information?

FRANK urgently needs to review how it manages content. Remember that the FRANK image includes marketing and branding "experts" who know nothing about drugs. There's the call handling service, which knows something about drugs but has a tendency to regurgitate what is on the screen. And there's the Home Office and DoH which so far haven't managed to produce the level of accuracy that users and workers need.

Perhaps Frank would be best served bringing together an independent panel which could proof, review and advise on their output. That, and an improved system for responding to serious errors, would go some way to ensuring that they do not spend their million-pound budget distributing factually wrong information.

KFx: 12.7.06

01 May 2007

Turkeys voting for Christmas

How Region Wide Drugs Protocols are exceeding the law - and abandoning the gains of the past ten years.

Next year, it will be a decade since Ruth Wyner and John Brock were arrested and charged for offences under the Misuse of Drugs Act 1971.

During and after their case, many organisations and individuals worked long and hard to ensure that their dreadful experience would not result in the mass exclusion of drug users who were homeless from the limited provision available to them.

The ‘Wintercomfort’ case threw up some difficult challenges. Was it possible to have known drug users on site? To what extent could organisations preserve client confidentiality? Did all known suppliers need to be reported to the police? Was it legitimate to place sharps bins in hostels?

In the face of this uncertainty, the response from the Government and other key bodies was pitiful. Senior staff at the Rough Sleepers Unit refused to countenance the use of sharps boxes in hostels. Government advisors would not endorse models of working with ongoing users which would acknowledge use on site. And in 2001 the Government worsened the situation by passing the “Police and Criminal Justice Act” which extended Section 8(d) of the Misuse of Drugs Act 1971. This measure extended the obligation on occupiers and managers to stop the use of all controlled drugs on site rather than just the use of cannabis and opium.

In the face of unhelpful bureaucrats, intransigent Government ministers and voluntary sector workers turned Government lackeys, the situation for housing organisations working with drug users looked terrible.

But thanks to effective networking, proactive lobbying and dedication on the part of a small number of organisations, the legal and practice situation was salvaged,

• Thanks to campaigns of lobbying and letter writing, the amendment to Section 8 was suspended and ultimately repealed. It never came in to force;

• Thanks to the brave and innovative provision developed by a number of housing providers, a model of provision working in a “Eyes Wide Open” manner with active drug users;

• Thanks to resource development and training provision, a huge number of housing providers are aware of what they can and can’t legally do.

• Organisations can and have been able to work with ongoing drug users, whilst maintaining client confidentiality and maintaining good relationships with service users, the local community and the Police.

So where’s the problem?

Given the above battles that have been fought and the success of them, it seems inconceivable that organisations would voluntarily surrender these hard-won gains.

Yet they are.

The new and worrying development is where region-wide drugs protocols have been put in place. Several areas are in the throes of developing such a protocol. There is nothing intrinsically wrong with doing so. Indeed, such a Protocol can and should provide a safe umbrella under which all providers can legally and safely operate.

But at least one of these new Drugs Protocols imposes restrictions not currently required under the law. There is an expectation that local agencies sign up to the protocol. The requirements of the Protocol exceed the legislative requirements. And the Protocol restricts models of provision that other services have implemented lawfully and successfully.

A case in point is the Newcastle Temporary Accommodation Drug Management Protocol. Recently rolled out across all temporary housing providers, the protocol makes the following demands of signatories:

• Reporting all episodes of people possessing illicit drugs on site to the police;
• Confiscation and reporting of all paraphernalia to the police;
• Reporting any suspicion of supply to the police;
• Report use of any class A drugs to the Police

None of these requirements are current legal requirements and it is perfectly feasible to implement safe, lawful and effective drugs policy without such rules being in place.

If an individual organisation chooses to adopt a strict drugs policy, or exceed the demands of the law in terms of sharing information with the police, that is very much up to them. Some organisations do not wish to adopt more flexible and inclusive policy and that is their right. A good few of these have adopted exclusionary policies because it reflects the needs of their clients. They are seeking to work with people who are now drug free, usually after a period of dependency. Their policy and practice reflect the needs of their clients and rightly so. But this is not always the case. Other organisations have adopted harsh policies out of ignorance, others out of fear or prejudice. But to date it has primarily been on an organisation-by-organisation basis.

The idea that a City-wide or County-wide policy should turn its face on the gains of the past few years is deeply depressing. And it makes one wonder have the last few years all been in vain. So it seems now that the Government no longer needs to pass new, restrictive legislation – the turkeys are basting themselves and jumping in to the oven.

To view a copy of the Newcastle Temporary Accommodation Drug Management Protocol and supporting documents please click HERE.

To view a critique of this Protocol by Kevin Flemen/KFx click HERE and scroll down to the relevant policies.

Coming soon: a model sample drugs policy…details coming soon.

26 March 2007

The Independent - shamefully wrong on cannabis

The Independent is ill-informed, publicity hungry or utterly craven. Nothing else can explain their decision to abandon their ten-year campaign to legalise cannabis.

But, to be fair, their original rationale for legalisation was not especially well-thought out, so their retraction was never likely to be.

The Independent's old and new arguments seem to run as follows: ten years ago cannabis was not as dangerous as everyone thought, and so it was stupid that it was illegal. Now it's become more dangerous so it should be illegal.

Let's ignore, for now, the shaky evidence base that props up the claims that cannabis is ten, twenty, thirty times stronger than it was a decade, two decades or three decades ago. These arguments are not evidence based, and the relative strengths of available strains of cannabis have historically varied massively.

Let's also, for now, side-step the contested evidence that says THC 'causes' severe mental illness and, according to images offered up by the Indie, physical damage to the brain.

Even the statistics offered by the Independent on the number of young people "entering treatment" for cannabis are misleading. Yes, a significant proportion of young people "entering treatment" do so for cannabis. But let's not forget that more than a third of these young people are refered in to treatment via Youth Offending Teams. And that any young person receiving a "Final Warning" is referred to a Youth Offending Team. So thousands of children are receiving final warnings for cannabis use - thanks to an iniquitous policing system that means that they cannot receive "cannabis warnings" unlike adults. In turn they are refered to YOTs and then, on to drugs agencies so their cannabis use can be properly addressed. Each of these admissions is dutifully recorded as entering "treatment" for the purpose of the NDTMS, creating an illusion that thousands of young people are developing cannabis problems.

But even this isn't the worst aspect of the Independent's volte face.

Instead, let's look at the gaping philosophical flaw at the heart of the Indie's argument. The purport to be worried about the risks of 'new' 'strong' strains of cannabis. And these new, strong strains emerged within a period of prohibition. Cannabis they say, got stronger and more dangerous under prohibition. So what do they propose to deal with this? A continuation of prohibition.

As with alcohol in America during prohibition, so cannabis has become more hazardrous under prohibition, lacking as it does, any proper regulatory or scrutiny framework. We have ended up with contaminated resins, adulterated herbal cannabis; we have growing arenas which represent fire hazards, and we have cannabis of variable strengths which can be unpredictable.

Thanks to enforcement, relatively good quality, balanced compounds such as quality resins have been supplanted by skunk and soapbar.

And this is the stupidity of the Independent's new position. They should have continued to argue for legalisation. And probably argued more vociferously than ever before. Not because cannabis is a 'safe drug' which it patently is not. But because the best way to manage the hazards to bring it within a licensed and regulated framework. Concerned about the proliferation of super strength skunk? Then introduce a taxation system structured around potency, as we do with alcohol. Low strength products could be taxed at a lower rate, and higher strength products taxed at a punitively high rate. Suppliers would, as with alcohol sales, have to be trained and licensed. Products would need to be sampled, quality and strength assessed and properly distributed.

But the Independent cannot see this. They have abandoned their campaign. Not, to be honest that they had done anything with it in the past five years. In doing so, they have substantially boosted the cause of prohibitionists everywhere -as the comments of Antonia da Costa of the UNODC make all too clear.

Never has the phrase "yellow journalism" been so aposite. The Independent has really shown its true colours.

KFx March 2007

13 February 2007

No Justice for Youth Justice - anyone but Louise Casey

The Guardian has reported that Blair fancies Louise Casey to head up the Youth Justice Board - using it as a platform from which to take forward his Antisocial Behaviour Agenda after he is deposed in May.

This would be a worrying development - and one that everyonce concerned about youth justice should hope does not come to pass. Louise Casey has led something of a charmed life since leaving the world of the London homelessness sector. While she headed up the rough sleepers strategy, there were repeated, well substantiated allegations that rough sleeper counts were manipulated to 'prove' a reduction in rough sleepers. Approaches such as changing the count criteria, temporary opening of shelters on the nights before counts, food and quiz nights - all these and more were reported as ways of pushing the count down.

Unfortunately, few organisations had the confidence or resources to speak out: those that did were threatened with having their funding cut. those that made supportive comments and kept schtum about the manipulated counts were awarded new contracts.

Such strategies have endured since she moved on to the Antisocial Behaviour Unit. But rather than trying to reduce homelessness, Casey has done a 180 degree turn and is now endorsing policies that put people out of housing and on to the streets. In moves that would, one would hope, appall old stable mates at Shelter, Casey has taken forward an agenda which has seen people removed from housing and put directly on to the streets. Centuries of property right and hard-wons gains like tenancies have been overturned by new civil powers incorporated in to anti-social behaviour legislation.

If past experience is anything to go by, Casey, is appointed to the Youth Justice Board, would put punitive measures to the fore: in a 2004 interview she made her stance clear: "Not to challenge behaviour is a very British thing, and we have at times felt sorry for the minority of perpetrators. We think the way to deal with them is by feeling sorry for them and providing more and more services to them in the hope that maybe then their behaviour becomes checked. What is missing is the community saying we have had enough, we have rights too and we have a right to a decent honest way of life with our kids being able to be brought up in peace." [http://www.together.gov.uk/article.asp?c=32&aid=1093]

In the same interview, Casey dismissed concern about ASBOs, saying "I think the criticisms recently have been in the minority. If you read the newspaper coverage of ASBOs, it is immensely positive, and I now find it interesting that even publications like the Guardian are struggling to find holes in them."

This attitude sums up both the Government's and Casey's approach - that if it's well received by the media and popularist it should carry on. In practice there are far bigger holes - such as those reported by the Youth Justice Board:

"Nearly half of the young people whose case files were reviewed, and the vast majority of young people who were the subjects of
in-depth interviews, had been returned to court for failure to comply with their order. The majority had ‘breached’ their ASBO
on more than one occasion. Eighteen young people were sentenced for breach of an ASBO as the sole offence: for one young person,
the outcome was a custodial sentence." [http://www.yjb.gov.uk/publications/Scripts/fileDownload.asp?file=ASBO+Summary%2Epdf]

One suspects that, should she take over at the Youth Justice Board, such criticism would be a thing of the past.

More recently, the Runnymede trust noted that there had been a failing on the part of those delivering, enforcing and monitoring ASBOs to monitor ethnicity - as such this is a failing under the Race Relations Amendment Act and ultimately the responsibility of the Antisocial Behaviour Unit for failing to instruct that such monitoring should take place.
[ http://www.runnymedetrust.org/publications/pdfs/Final%20Report%20Equal%20Respect.pdf]

There has been a growing level of concern about the misuse of ASBOs, and the high breach rate. The Home Office has been reluctant to release accurate figures, despite requests under the Freedom of Information Act from Asboconcern and others.

But despite this we know that:

British Institute for Brain Injured Children (BIBIC) found that up to 35 percent of asbos imposed on young people are given to children with a diagnosed mental disorder or accepted learning difficulty. This represents approximately 1100 cases since asbos were introduced.

As at October 2006, the Home Office had still refused to release breach rates for ASBOs despite repeat requests. Figures up to the end of December 2004 showed a breach rate of 40%.

But reports from some councils (e.g. Westminster) showed a breach rate of 60%.

So despite the claims made for Antisocial Behaviour Orders and the Respect Agenda, they have, to date, been a collection of media friendly, populist measures. But the Home Office has obfuscated on the evidence, and failed to look beyond the headlines. It hasn't looked at the level of breaches for people receiving orders. It has stigmatised and criminalised children with mental disorders. It has legitimised "naming and shaming" of children as social policy. It has taken people with dependencies and made them homeless. And it has prohibited vulnerable people from carrying harm reduction equipment such as condoms.

Louise Casey has been the leading light and champion of these measures and as such is not fit to lead as essential a body as the Youth Justice Board.

05 February 2007

Getting us hooked on Suboxone

We at KFx Towers like a good pharmaceutical success story as much as the next person. So the news that Schering Plough received an EU-wide licence for Suboxone before Christmas must have been good news for the good people at said company. Indeed, so happy were they at their success, that they decided to make their new medicine available at knock-down prices, so that more people could start on this new treatment. We understand in some areas that Suboxone is being made available more cheaply than Subutex, which shows how much they care about the little people....

Only the truly and despicably cynical would think anything else, but we've had several emails about Suboxone so we thought an article would be in order.

Suboxone is a 'cocktail' of Buprenorphine (Subutex (r)) and Naloxone. The idea is that Naloxone is badly absorbed sublingually, but the amount reaching the brain is very high if the drug is taken intranasally or injected. 100% bioavailability is achieved if Naloxone is injected, and levels as high as 100% are claimed for snorting, but this may not be the same in street settings.

If a patient takes their suboxone sublingually, as directed, they should only get the subutex. But if they are tempted to snort or inject the tablets, then they will get the subutex, but also a dose of Naloxone. This should, the theory goes, act as an opiate blocker, making it ineffective to inject it.

The very pretty Suboxone website explains it thus:

"The naloxone component in SUBOXONE is included to help discourage diversion and misuse. Naloxone has very limited bioavailability when administered sublingually, as intended. However, if SUBOXONE is crushed and injected, the naloxone will precipitate opioid withdrawal. In the absence of an opioid, the antagonist has no effect."

But if we pause for attention and recap some important facts, the situation is less clear.

The NIDA took a leading role in the development of Suboxone: they reported
"the medication buprenorphine/naloxone (marketed as Suboxone), developed by NIDA in collaboration with the pharmaceutical industry for the treatment of opioid addiction..."1

The US department of Justice goes further, explaining "In fact, Suboxone was designed specifically to meet FDA requirements for a more diversion-proof drug for use in opiate addiction therapy."2

But ironically the NDIC reports ongoing abuse of Suboxone, saying
"Suboxone also can be diverted and abused; however, it is more likely to be abused by individuals who are addicted to low doses of opiates since it can precipitate withdrawal symptoms in high doses. The naloxone in Suboxone guards against abuse by causing withdrawal symptoms in abusers who crush and either inject or snort the drug; however, law enforcement and pharmacist reporting indicates that Suboxone is being abused successfully when snorted.

Using buprenorphine and heroin in combination does not produce increased effects, but if buprenorphine and methadone are abused together, the effects of both drugs are enhanced. Consequently, diverted buprenorphine may be attractive to patients currently using methadone for opiate addiction therapy."3

All this talk of precipitating withdrawals can get confusing. So what's really going on?

1) the ratio of buprenorphine to Naloxone is 4:1 - a very low level of Naloxone.

2) Buprenorphine is a partial opiate antagonist - it will block heroin from reaching opiate receptors reasonably well. But it is a less effective antagonist than, for example, Naloxone

3) Buprenorphine can and does cause respiratory suppression; especially when injected in large doses, and especially if mixed with benzodiazepines.

4) If a user has heroin in their system, and they use a dose of buprenorphine, this may produce withdrawal symptoms. The severity of these symptoms will depend on the levels of heroin in the system, the amount of buprenorphine used and the quantity of buprenorphine used.

5) but if a person has no opiates in their system (i.e. in withdrawal) and they take buprenorphine, they will get the opiate agonist effects of the buprenorphine, as in relief from withdrawal and mild opiate effects.

6) Naloxone is less effective at blocking or reversing buprenorphine than it is heroin. The literature says that a higher dose of Naloxone will be required, and attention given to maintaining breathing as Naloxone alone might be inadequate.

7) the amount of buprenorphine reaching the brain via snorting is around 49% compared with 29% sublingually, meaning that if someone were titrated and tolerant to a sublingual dose, they would be getting almost a 1/5th more drug by snorting. The time to reach peak levels would also drop from around 200 mins sublingually, to 30mins nasally, according to sources at Schering Plough.

So let's put all these pieces together.

If crushed and snorted, the subutex in suboxone is reportedly still effective. It is possible that the low doses of Naloxone, combined with the higher effective dose of burprenorphine and the relative poor blockading of Naloxone against burprenorphine make snorting the drug effective.

Schering Plough say "Currently no studies have been carried out looking at the effects of nasal snorting of Suboxone tablets." So it would be curious for them to claim that it cannot be effectively snorted.

If injected then all the subutex and all the Naloxone reaches the brain. If the user has heroin still in the system this will precipitate rapid and marked withdrawal symptoms. In fairness, this is likely to have happened even if the naloxone was not present, as the buprenorphine alone would have precipitated withdrawal.

But if the user has no other opiates in their system and inject crushed suboxone, what happens? Well it won't precipitate withdrawal if there's no opiates in place, that's for sure. So for someone not dependent or already in withdrawal, there won't be a sudden reversal into unpleasant symptoms.

It may be that nothing will happen - the naltrexone component will block the buprenorphine from working.

What could also happen is that the nNaloxone partially blocks the subutex - but not wholly. And so by taking a large dose of suboxone by injection, the person could still overdose, as the low dose of Naloxone would be a poor antagonist in such an overdose.7

The risk of buprenorphine-induced overdose would go up if use were taking place alongside benzo use.

So suboxone appears to be of limited value in preventing snorting, and of questionable benefit in preventing injecting. It will still be good for preventing use on top - but then if used properly no better than Subutex alone.

In which case why the big sell on Suboxone? If it isn't being driven by its clinical superiority, what's the appeal?

Firstly, this drug was developed to meet the demands of the US drug treatment and enforcement bodies. By complying with their demands, Schering Plough have a drugs which is the only one to receive federal approval for the treatment of heroin addiction - which is a huge cash-cow however you look at it;

But it should also be noted that away from the US, the patent period for Subutex has expired 4 leaving the way open for cheaper competitors.

To get an idea of the impact of this, the NHS pricing tariffs demonstrate the difference in costs between generic methadone, generic buprenorphine, and branded Subutex:

buprenorphine: 50x 20mg sublingual tablets £5.33
subutex 7 x 2mg £6.72
methadone 1 x 50mls 75p

Given these price differences it would be imperative that Schering Plough get a newer Patented product on the market and quickly - and the advent of Suboxone appears to meet that need.

Thanks to EU wide approval 6
Suboxone is now in a privileged position to become the prescribed drug of choice, regardless of cost or relative effectiveness. And by providing subsidised early "trials" which won't be randomised or controlled, Schering Plough can accrue claims to effectiveness which wouldn't survive rigorous academic scrutiny.

So on balance, and until we have independent and rigorous evidence to the contrary, Suboxone is more expensive than generic buprenorphine, can still be snorted, and won't induce withdrawal when injected unless the person already has opiates in their system. Further, it will still leave people at risk of overdose when injected, as the Naloxone won't effectively or fully reverse the buprenorphine.

Now why exactly is your rep pushing your patients on to Suboxone???
Don't you think you should ask?
Let us know what they say.

KFx 2007
[thanks to Kate for getting me started on this one]

DOI - Doh!

New drug doing the rounds (again)

While the media was frothing over the reclassification of methamphetamine, four people were admitted to hospital in Bedfordshire following ingestion of an unknown substance.

The Media were quick to report this as being due to a "new drug" called DOI or D09.

The Beds police were a little more cautious saying "Speaking to other party-goers at the scene, officers were told that the two men may have taken a drug called DO1, DOI or DO9."

Importantly, it has not been verified that the people in question had indeed taken DOI, or what they believed to be DOI. No independent toxicology reports have been made available at this time, so the suggestion that the substance involved is DOI is highly speculative.

Having said that, other sources have noted some availability of DOI - especially amongst communities with a keen interest in hallucinogens and stimulants. These sources suggest that there is at least a batch of DOI doing the rounds. This, they speculate, may have been a UK based chemist who has cooked up this batch, or an imported batch from an overseas chemist. This would seem more credible than DOI becoming more popular as a rave drug.

DOI is short for 2,5-dimethoxy-4-iodoamphetamine

It was one of a number of compounds developed by Alexander Shulgin and listed in Pikhal. It binds strongly to various serotonin receptors and has been widely used as a research chemical to help identify the location of these receptors.

It is a powerful and long-lasting hallucinogen. Sources suggest periods of effect as long as sixteen hours, with a similar level of hallucinatory effect to LSD, but with the user also feeling more active.

It has not proved hugely popular as the hallucinogenic effects last a long time, and are not that good compared to other, shorter acting, more readily available compounds.

Dose ranges are small - 1-3mg. People undertaking experimental use in controlled conditions have typically had it in refined, powder form for carefull self-administration - e.g. snorting.

Generally such low-demand research chemicals would be in pure powder form for the user to dose at their own level, knowing exactly how much they were taking.

A source from Milton Keynes says that the DOI taken at these events was in tablet form,as E's would be.

no literature is clear on risks and none mention risk of convulsions, though, as this is an amphetamine-type compound this risk is not inconceivable. This would be especially hazardrous at high doses.

Suspicion is at this time that it could be (a) real DOI and some users have taken massive doses, not knowing its strength or (b) it's poorly made DOI with some additives of unknown type/action or (c) it's not really DOI at all but some unknown compound knocked up and flogged to users at a rave (d) it's MDMA or another E-type compound with DOI or something similar in their too, to increase the trippiness...

If you have anything to add please email so we can keep people informed...

Beds Police
Wikipedia on DOI

[thanks to Carly for bringing this one to my attention]

Testing Times

Consolidation of Drug Testing Companies - profit over privacy?

There's been a flurry of shopping activity in the world of Drug Testing - and it's not for testing on arrest!

Concateno PLC, an AIM listed company with no history in the field of Substance Misuse, has been buying up a motley collection of Drug testing companies. This has included Medscreen (November 2006) Altrix (January 2007) Trichotech (February 2007) effectively meaning that one company now owns the major urine, mouth swabbing and hair testing companies in the UK. Concateno PLC is a cash-shell company, headed by Keith Tozzi, former Group Technical Director of Southern Water, CEO of the British Standards Institute and former Chairman of Mid Kent Water...

Why does this matter? The risk is that, in a profit-driven market, the ethics of drug testing will gradually be eroded. To date, most UK testing companies have taken a responsible approach to drug testing by parents and carers. But the worry is that, as the need to create greater shareholder value grows, so the push towards large sales, more widespread testing and more frequent testing grows too.

Any one selling drug testing products has a vested interest in seeing them routinely rolled out in schools, the workplace, and other non-criminal justice settings. This is where the big money lies.

This is something Altrix has been especially keen on. They "passionately believe..." drug and alcohol misuse...are reaching epidemic proportions," and as such drug testing should be embraced to confront these "threats in society." Hence their willingness, enthusiasm and support for such initiatives as the Drug testing in schools rolled out in Kent. No evidence that it reduces use of course, but massive profits for companies.

It will be interesting to see how well these smaller companies can maintain any kind of ethical stance as they become just another part of a larger company.

As there is virtually a monopoly now on drug testing in the UK, it must surely be time for a review of these last purchases and ensure that they continue to act in the interest of the market and consumers.

BBC coverage of Tricho-tech buyout here

28 January 2007

ACPO on Cannabis?!

The Association of Chief Police Officers (ACPO) drew up new guidelines on the policing of cannabis in November 2006 which saw the light of day at the end of January.

This guidance was published following an ACPO review of cannabis policing. Hopefully it was also influenced by the recent JRF review of cannabis policing, but this is not necessarily borne out by the content of the revised guidance.

And if people were confused by the policing of cannabis before the review, the new guidance will convince people that they have toked on something especially potent.

One of the key changes is that the new guidance instructs a very clear "three strikes" policy. All 'cannabis warnings' issued are meant to be recorded on a force-wide basis. If a person has already received two 'cannabis warnings,' the ACPO guidance says that a third warning should not be given, but more formal action such as arrest and charge should be undertaken.

This change will be heavily dependent on accurate record keeping, and will require expenditure on record keeping. It will also mean that, unless police are able to verify a person's identity, it will a hit-and-miss process to enforce.

The other key change affects Under-18s. In the previous guidance, police had been instructed to arrest under-18s for cannabis possession. But in the revised guidance, this position has been reversed - police are now instructed NOT to arrest young people for cannabis offences unless there are other aggravating factors.

While, on the face of it, this represents a liberalisation of policing, it is in reality a cosmetic change. Young people will still be dealt with under the Crime and Disorder Legislation, resulting in a reprimand, warning or charge. This processing must take place at a Police Station so while the young person may not initially be arrested, subsquent action will take place in a Police Station.

It is essential that under 18s realise that while they will probably no longer be arrested, they will still end up engaged with the criminal justice system, and liable to getting a criminal record.

The release of the ACPO guidance coincides with publication of the Joseph Rowntree Foundation report on policing cannabis.

This piece of work reviewed the impact of cannabis reclassification on police and users.

It highlights that significant numbers of people are still being arrested for cannabis and that the policing of cannabis was variable - with street warning been used for betwen 22% and 42% of cannabis incidents. Given that the presumption should be against arrest, it is clear that arresting users is still the norm, not the exception.

The JRF report also notes that Black and other Minority Ethnic groups were more often given street warnings. This suggests that racial profiling plays a role both in who is searched, and also who is warned.

The report notes that almost half of police officers interviewed wanted to be able to give street warnings to Under-18s when the situation warranted it.

And finally the report notes that, as cannabis warnings could be counted as "sanction detections," there was evidence that senior police officers may use "street warnings" as a quick and easy way of bumping up detection figures.

The new ACPO guidance does address some of these concerns. Under 18s will not automatically be arrested, but they will still be criminalised; police officers are reminded not to arrest unless it is necessary, but this will still be at the discretion of officers; and police forces can count these as sanctions detected, although of course no force would be so craven as to use this as a way of improving crime figures for Home Office statistics.

Would they!

ACPO Guidance at:
JRF Report at:

21 January 2007

Glass and Grass - The Sequel

Back in November 2006 KFx reported that an increasing number of people were finding herbal cannabis which was being adulterated with glass. This adulteration came on the back of the ongoing police clampdown on cannabis-growing in the UK.

Two months later, the Daily Dose, Department of Health and Drugscope have also started to report this contamination - better late than never.

It was cannabis activists - not the Home Office or DoH that took a proactive lead, getting cannabis samples analysed by a friendly toxicologist. These reports were publicised by activists including UKCIA and Cannaprag

This supported the increasingly well-founded assertion that cannabis was being contaminated - probably by some sort of reflective glass beads in a solvent - based spray. It looks like this:

Belatedly, Department of Health realised that this was an issue and on the 16.1.07 released a bulletin. This was circulated to PCTs and others.

Unfortunatley, while this Bulletin highlighted the risk, it didn't see fit to propose suggest any harm reduction interventions.

Frank, the Government-run helpline recycles the same information and also fails to offer any harm reduction information.

So the outcome so far has been ACPO create a shortage of cannabis through operation Keymer. Growing and supply has been concentrated in the hands of a smaller number of illegal suppliers and, in turn they have started to bulk up supplies with contaminants, passing off lower grades of grass as being high in THC with adulterants.

This is a fine example of prohibition and its impact on health. So just as alcohol prohibition results in people choosing to drink toxic alcohol concoctions, so cannabis prohibition has resulted in an unregulated market and the increased availability of highly contaminated soap bar and now contaminated herbal cannabis.

For people left with contaminated cannabis to smoke, here's the choices:

- don't smoke or eat any contaminated drugs at all;
- if you really feel you have to, don't smoke in a straight spliff - use a water pipe, fine gauzes, filtered pipe or another method of smoking;
- don't take large lungfulls from any unfiltered sources such as chillums, pipes without filters, or spliffs;
- take more shallow puffs, don't such to hard - it increases the chance of glass being take deeper in to lungs.

and above all, remember that this situation arose out of prohibition...