16 November 2008

Eyes Wide Open Housing - Awards Not Courts

Ten years after the first Eyes Wide Open housing was trialled in the UK, a hostel working with ongoing users has received national awards. It is long overdue. And now there can be no excuse for others not to follow suit

We are immensely pleased to report that the King Georges Hostel in London, part of ECHG, were the recipients of two awards at the Chartered Institute of Housing/Inside Housing Awards for Outstanding Achievement In Housing (England) and Meeting the Needs of Vulnerable People. King Georges are one of the growing number of housing providers who have adopted and adapted the “eyes wide open model” of housing provision that has been pioneered here for a number of years.

The Gateway Programme at King Georges Hostel is a pioneering initiative to provide housing, drugs education and harm reduction interventions to some of the most vulnerable dependent drug users in housing need.

The Programme takes in dependent drug users in housing need, provides housing in attend education and awareness sessions on injecting, overdose, and blood borne viruses. Despite the low level of obligations at admission, residents have been engaging with a wide range of initiatives, including Turning-Point provided drug treatment, nutrition and cooking programmes, outdoors fitness sessions and football clubs. The take up of interventions such as Hep b vaccinations is exemplary and despite the high-risk client group drug deaths have been prevented.

King Georges has made use of the resources, policies and guidance produced on the KFx website to help shape and develop this provision and we are pleased to have contributed in this small way to the establishment of the project.

Whilst offering King Georges staff and residents our congratulations for their win, this award is pleasing as it is, at last, recognition for a model of work which has been increasingly widely adopted or considered but has lacked the imprimatur of “official” recognition.

Ten years ago, Single Homeless Project (SHP) in London became the first housing provider in the UK to deliver inclusive housing to active drug users, where drug use was not only fully acknowledged, but fully engaged with, including access to sharps boxes, needle exchange, harm reduction services, and treatment modalities.

Whereas previously organisations had turned a blind eye or prevented drug use, SHP were early adopters of an “eyes wide open” model which they have used successfully used in their housing provision in several London Boroughs.

Since then a growing number of Housing Providers across the UK have been working within an “eyes wide open model.” Many have found marked benefits from this approach – better engagement, more openness, increased referral to treatment, reduction in public drug use, reduction in overdoses and drug deaths.

These agencies, including Brighton and Hove Housing Trust, Thamesreach, Look Ahead, Society of St James, Wallich Clifford Community, Manchester Methodist Housing Group, Foundation Housing, St Mungos and a number of others were courageous early adopters of such an approach.

It should be remembered that at this stage there was no official endorsement of such a model of work. Ten years ago, at a conference, it wasn’t even possible to get Ian Brady, then of the Rough Sleepers Unit, to publicly endorse the placing of sharps boxes in hostels! The Home Office was pursuing a policy of extending the Misuse of Drugs Act 1971 which would have made such provision illegal. And the repercussions of the Wintercomfort case made many housing providers wary of pursuing such an approach.

Since then there has been moderate progress. Norfolk DAAT embraced and endorsed an eyes wide open model in their superb document The Spectrum of Possibility. Research from Shelter demonstrated the benefits of the model in “Safe as Houses.” Papers from Cymforth Cymru reinforced the message that full spectrum, eyes wide open housing was a safe, lawful inclusive model of working with housing drug users.

Unfortunately, official recognition has been slow in coming. In 2006, an agency receiving a Housing Corporation Gold Award for Homelessness Strategies was pursuing a policy where suspicion of use (including drowsy symptoms or paraphernalia) was grounds for eviction – and this from an agency purporting to work with ongoing users.

But despite the absence of official endorsement, support or sanction, the work has crept on.

Even amongst organisations working in this way, all too often it has felt like a “dirty secret” where organsisations don’t explicitly acknowledge that they house ongoing users and manage use on site. All too often, the same organisations starting to undertake the work have to battle not just NIMBYism, public and political barriers but also too often their own organisational policy and hierarchies.

The decision by the DCLG to (quietly) endorse the “eyes wide open” model in their paper Improving Practice in Housing Drug Users was of course highly welcome, albeit that the paper fell short of an unequivocal statement acknowledging the importance of managed use on site.

So the presentation of two awards to King Georges Hostel is hugely welcome. It is not just an important acknowledgement of their work, and the progress that they have made in working with drug users.

It is also an endorsement of a model of work developed and pioneered here. From the early days, developing a model after leaving the Big Issue, through the time working and promoting it at Release, and over the past five years working with the growing number of organisations who took the work forwards, it has been a decade of change, innovation and progress.

For agencies thinking about adopting ‘eyes wide open’ models, the award to King Georges should provide the impetus to move from contemplation to decision. The resources on this site and the Drugs and Housing website provide some of the tools that such agencies will require to take this work forwards.

Eyes Wide Open housing has been a rare step change in the provision of services to drug users. In its own way it has proved as significant as the provision of needle exchange in representing a brave break with orthodoxy and the provision of pragmatic, life saving and life changing interventions.

One of the managers at King Georges got in touch a while after putting in place a lot of the changes and expressing thanks for the support and inspiration. He described what he’d got from here as “lighting the touch paper a few years ago that made me realise it could and should be done.” I am immensely pleased, proud and gratified that after ten years of work the “eyes wide open” approach is gaining acceptance and endorsement.

For myself, the drive to establish a new, inclusive model of housing which would take people who still used drugs and move them in to appropriate, supported housing began because of the tragic, senseless deaths of two young men on the streets of London, Chris Crowther and Chris Readman (aka Cockney Chris and Geordie Chris). They were murdered on Berwick St, London, on the 24th June 1997. Then, appropriate, suitable housing didn’t exist. They’d been routinely excluded from housing because of their drug use. They could and should have been housed in the right housing with the right support. There wasn’t anywhere for them then. Now there is. It’s a legacy worthy of them. And I wanted to make sure that amongst the awards, the professional congratulations and the backslapping, the small, personal tragedy that was the spark that lit the touchpaper is not forgotten.

11 November 2008

More Hash Fudge!?

As Jacqui Smith blunders on with her re-reclassification of cannabis we look at how she's managed to end up with a position which fails to meet the expectations of everyone with an interest in cannabis.

On the 7th May 2008, the Home Secretary, Jacquie Smith, acceded to the demands of the tabloid media and reactionary drug prohibitionists such as Talking About Cannabis. Despite recommendations from the Advisory Council on the Misuse of Drugs (ACMD), Smith decided to move cannabis from Class C back to Class B.

Five months later, Jacquie Smith release more details as to proposed policy and policing changes that would accompany this reclassification. These proposals added yet another layer of confusion and fudge to the ongoing mess of cannabis reclassification.

The Home Secretary faced something of a challenge. On the one hand, to satiate the media's demand for action, the decision was made to move cannabis back to Class B. This decision was reached despite the fact that the ACMD, whose opinion had been sought by the Home Office, recommended that cannabis should not be moved back to Class B. It was also despite a documented decline in cannabis use amongst young people, and no new evidence that cannabis was responsible for an increase in mental health problems.

Undaunted by an absence of evidence, she instead drew on various other evidence sources, saying "In reaching my decision, I have also taken into account the views of others, particularly those responsible for enforcing the law, and the public-58 per cent. of whom, according to a survey carried out for the council, favour upgrading cannabis from class C."

The ACMD commissioned a small piece of research to inform it's report. Amongst other things, the research showed how hopelessly confused and ill-informed about cannabis and the law respondents were.

Of those polled, 80% were aware that cannabis was an illegal drug, 4% thought it was legal and 16% "did not know".

Of those who knew that cannabis was illegal, 12% thought it was in Class A, 31% in Class B and 52% in Class C.
[Cannabis: Classification and Public Health: ACMD: 2008: p26]

So, of the sample of a thousand, only some 400 knew the current legal status of cannabis.

When asked about in what class cannabis ought to be,
32% considered that it should be in Class A, 26% Class B and 18% Class C, while 13% stated that they "did not know".

However, when they were asked to consider what penalties ought to be applied for possession, 11% considered seven years' imprisonment (equivalent to Class A), 13% five years (equivalent to Class B) and 41% two years (equivalent to Class C), and 27% considered that there should be no penalty [ibid: p27]

So while the ACMD's public survey did show that the majority thought cannabis should go up in class, the vast majority felt that the penalties should stay the same or go down.

Interestingly these results are the opposite of the Home Office's consultation on drugs which took place prior to the launch of the new Drug Strategy. This was also quoted in the ACMD report, which noted "Of the 639 individuals and organisations responding to these questions, 44% wished cannabis to remain Class C; 19% wished it to become a Class B substance; and 19% wished it to be legalised. One hundred and sixteen respondents were undecided." [ibid: p26]

It's a fine example of the selective use of consultations and research. The Home Office public consultation, which came down against cannabis reclassification, was disregarded, along with the ACMD's recommendation. The small sample of confused respondents which supported the Home Office's opinion is cited to bolster the Government's position.

Jacqui Smith went on to say "My decision takes into account issues such as public perception and the needs and consequences for policing priorities. There is a compelling case for us to act now rather than risk the future health of young people. Where there is a clear and serious problem, but doubt about the potential harm that will be caused, we must err on the side of caution and protect the public. I make no apology for that. I am not prepared to wait and see".

Jacqui Smith goes on in her statement to outline how keen she is to see police enforcement increased, saying "To reflect the more serious status of cannabis as class B, I am clear that a strengthened enforcement approach for possession is required."

Five months later, the Home Office issued a Press Release "Next steps for tougher action on cannabis" http://nds.coi.gov.uk/Content/Detail.asp?ReleaseID=381162&NewsAreaID=2 which detailed the proposed enforcement measures that the Home Office wished to take forwards.

This included the introduction of Penalty Notices for Disorder for second offences. The press release proposed "those caught with cannabis on a first occasion could still get a cannabis warning, but on a second occasion are likely face a fine of £80 and arrest if caught for a third time."

The main body of the Press Release fails to mention (though it is included in the footnotes) that the policing situation for under 18s remains unchanged, with them being subject to the reprimand/final warning/charge system incorporated in the Crime And Disorder Act.

The idea of PNDs appealed to the Police because they allowed for enforcement action without the time consuming processes of arrest, charge, courts and suchlike. The appeal for the Home Office was that they provided an escalation after an initial warning, thus saving police time and ramping up the sanctions.

On the Home Office website the message was a bit bolder "Once that change takes effect, anyone caught in possession of cannabis will receive a penalty notice. If they're caught in possession on more than one occasion they could face an on-the-spot fine of £80. Those who are caught a third time, could go to jail." http://www.homeoffice.gov.uk/about-us/news/tougher-action-cannabis
It's not really clear what this reference to a "penalty notice" means. Presumably it is a "cannabis warning" renamed to make it sound stricter. Then there's the fine. The last bit is certainly true in theory, but as the full press release makes much clearer, a third time would mean arrest, followed by a range of outcomes including "release without charge, caution, conditional caution or prosecution."

Depending on their stance and their intelligence, various media outlets interpreted the news in different ways. Some (e.g the Telegraph) interpreted this as meaning that users couldn't be arrested until a third offence. http://www.telegraph.co.uk/news/newstopics/politics/lawandorder/3191025/Cannabis-users-will-have-to-be-caught-three-times-before-they-are-arrested.html

The Daily Mail, who had lobbied consistently for a reclassification of Cannabis, once again displayed their unerring love of a headline and failure to understand the law with their banner "Cannabis users face 'three strikes and you're jailed' http://www.mailonsunday.co.uk/news/article-1077254/Cannabis-users-face-strikes-youre-jailed.html

But as both the Mail and later the Times noted, there was a gaping problem with the Home Office's proposals.

The Times said "The approach was undermined immediately, however, when the Home Office said that warnings for a first offence would not be placed on the police national computer. This would make it difficult for police to check whether someone found with the drug was a first or second-time offender, particularly if the cannabis user was caught in a different police force area from where he or she lived." http://www.timesonline.co.uk/tol/news/politics/article4938527.ece
The proposals were that a first offence would only receive a reprimand but, unless this were recorded nationally, on the PNC, it would not be possible to implement a system of PNDs for second offences. If a PND could only be issued for a second offence, the Police would have to be certain that the person had previously received a cannabis caution.

At present, cannabis cautions are only recorded locally, not on the PNC and there is no requirement to verify the person's true identity or address.

The Home Office has said that it will look in to this issue, but it alone is unlikely to prevent the implementation of the proposed tiered sanctions sought by ACPO and the Home Secretary. However, in one of the rare glimmers of good news in the whole sorry proceedings, there should a be a consultation period at the Ministry of Justice on the implementation of PNDs for cannabis and this may allow a chance for saner heads to prevail.

It is hard to get a good sense of how many people would be affected by PNDs. The National Criminal Justice Board publishes figures as to how many people received PNDs and cannabis warnings over the past two years.

In the year ending March 2008, 102,467 cannabis warnings were issued. http://lcjb.cjsonline.gov.uk/ncjb/perfStats/pnd_formal-warnings.html

It is not clear how many of these warnings were for first or second cannabis offences, but based on these figures it's reasonable to assume some 50,000 people per year would receive these PNDs for cannabis. Outside of London, the police force issuing the greatest number of Cannabis Warnings was Merseyside, issuing some 7000 warnings. This is a little worrying, especially as the newly appointed Cannabis Coordinator was formerly a chief Superintendent on Merseyside, and one of the ACPO leads on cannabis.

It's also worth noting that an £80 PND cost £91 pounds to administer, and less than half of PNDs are paid in the required 21 day window - meaning that many still end up in arrest and court action. So if these procedures are followed we can expect more police and court time being tied up chasing up PNDs for cannabis.

In reality, the proposals surrounding the reclassification of cannabis are, once again pleasing no-one and Jacqui Smith must be questioning the wisdom of this fresh bodge job. In practice, little will change, and Smith has not received the plaudits that she must have hoped for in reclassifying cannabis.

In the list below, we highlight how very little will change when cannabis goes back to Class B. (click on the image to view at full size)

In practice, although cannabis will exist back in Class B, it will effectively be in a class of its own. The penalties and policing of cannabis will be unlike other class B drugs (such as amphetamines) or Class C drugs (such as benzodiazepines).

One could argue that as such, the Home Office is partly moving away from the Classification of system, designing a set of legal and policing responses on a drug by drug basis rather than on the widely discredited Classes of drugs. However, the Government has not had the courage to break fully from the sytem introduced in 1971.

In the meantime, adulterated, unmanaged cannabis will continue to be widely available in the UK and unfortunately, the latest Government fudge will only create more confusion, frustration and bafflement with this unworkable system.

03 September 2008

“No-one Written Off” – The Perils of the DWP Green Paper

First they came for the crack users…(part 4)

A long time ago, I used to work with the homeless people in Central London, back in the days of the “Cardboard Box City.” The vast majority of people with whom I worked had a range of factors that contributed to their exclusion: drug and alcohol dependency, mental health problems, basic skills needs, long offending histories and so on.

However, the initial biggest obstacle to helping these people re-integrate with any services, including housing, was the need for some identification and the need to start a claim.

For some clients, this initial hurdle was massive: a person had to regain their identity: their full name, date of birth, NI number and an address. For younger people this was easier, but for older people, and those with the most enduring health problems, this was a massive issue.

Many people needed some initial help to get a copy of their birth certificate, then support and encouragement to put in a first claim for benefit. This step was critical for so many reasons. Without it, securing stable housing was impossible. But it also represented a stepping stone away from begging, away from the street culture. For some people it also might mean “facing up” to the past. It might mean surrendering to an arrest warrant, to previous debts, or to previous failures.

Having secured the holistic trinity of ID, benefit and housing, the next step – access to treatment – became more realistic. Over the past ten years, there are only a very small number of people who are cut adrift – the massive visible street population has dwindled and the vast majority of people who are drug dependent are in some sort of housing, and have a greater level of stability than was hitherto the case.

The Department of Work and Pensions, with their Green Paper “No-one Written Off,” seems determined to reverse this process. They appear to believe, based on this paper, that mandatory referral and engagement with treatment, and the threat of benefit-related sanctions will act as a spur away from drugs and in to work. What it will do for most problematic drug users is push them away from benefits (as desired) but back to street-existences instead. The prospects of going full circle, back to the cardboard box cities of last century, are all too real.

The DWP Green Paper is a long document but the section related to drugs is in Chapter 2 The report claims that 75% of problematic drug users are in receipt of benefit (some 240,000 people) and of these some 100,000 are not currently engaged in treatment.

The report explores a number of proposals. The least tendentious of these is investing and promoting better joined up working between drugs services, benefit agencies, housing and employment. This would be a welcome development, and experience elsewhere shows that this can have a positive impact.

But the Paper doesn’t stop there and with a rallying cry of “we must go further” the report proceeds to outline the draconian sticks to get problem drug users off benefit.

These proposals include:
Where claimants are identified as having a drug problem, they will be referred to a drug treatment provider. Failure to meet that provider could result in a benefit sanction.

This proposal is featured in the 2008 Drug Strategy and does not appear to be a “consultation item” but a firm Government commitment.

This proposal is very ambiguous in the paper. At some points the paper says that there should be a requirement to “meet that provider.” However, only a couple of lines later the paper goes further and says “where drug treatment is available and considered appropriate, then there should be an obligation that individuals will take it up.”

These two proposals are radically different: one requires a person to attend a meeting or an assessment; the other obliges the person to take up a treatment package, even if a local provider offered a limited range of treatment modalities.

In response to an article in the HSJ Paul Hayes wrote a letter (reposted in full on the NTA website here) that describes as misleading the assertion that the Government “intends to force people in to treatment.” It is hard to see how the line from the paper that “there should be an obligation that individuals will take [treatment] up” can be viewed as anything other than forcing people in to treatment.

The Paper then go further outlining how Job Centre Plus will be able to identify problematic drug users before imposing treatment requirements. Several approaches are mooted:

A requirement to make all applicants for benefits declare whether they are “addicted to heroin or cocaine” and face sanctions or prosecution for a failure to disclose.

This wording deserves close attention. A willingness to admit to a drug problem is a huge problem for people with a drug dependency who are not engaged with treatment. As a group, they are one who are most likely to be unable to admit to having a drug problem. This problem or reticence is likely to be compounded in a Job Centre interview setting where the client has not had a chance to build up a trusting relationship with their interviewer yet is expected to disclose personal information of a deeply personal and illegal nature. The majority of Job Centre staff are still ill-trained to deal with problem drug users.

This proposal also becomes embroiled in a semantic argument about the definition of addiction, and the substances involved. If a person views themselves as being in control of their substance use, would it be feasible for them to be sanctioned for “misleading” the Job Centre if their assessor felt otherwise?

Job Centre Plus to be notified of all cases where person has tested positive for heroin or cocaine and been referred for a Required Assessment, those who have agreed to a Drug Rehabilitation Requirement and those leaving prison who have an identified drug problem.

To make these information sharing schemes work, legislation would be required. While the DWP already leads the way in behind-the-scenes information sharing, substantial expansion of the existing databases would be required to store and process the 200,000 plus notifications per year that such a scheme would generate.

Before even contemplating the practicalities of such a scheme, it’s worth stressing the extension of State power and information sharing that this represents. At present, a positive drug test triggers a Required Assessment; it does not mandate an engagement with treatment. Only 35% of people tested received a Care Plan following an assessment within two months, and of those receiving a care plan 47% of people attending enter a treatment plan. (http://www.homeoffice.gov.uk/rds/pdfs07/horr02b.pdf) The green paper claims that “those who test positive (there are around 80,000 positive tests a year) are referred for a Required Assessment by a drugs worker which in nearly half of cases leads to an agreement to engage with drugs treatment and support.” This assertion is not evidence based and probably misinterprets the facts. The Paper purports that some 40,000 of the 80,000 positive tests engage with drug treatment. In fact it would probably be closer to 15,000, although no comprehensive assessment of Tough Choices is currently available to the public.

In this respect the Green Paper goes further than Tough Choices; a Required Assessment merely requires attendance at an assessment, not engagement. The Green Paper threatens benefit sanctions for a failure to engage with treatment.

The Paper makes no bones about this: it says “in return for this access to drug treatment and specialist employment support, there will be an obligation on individuals to take it up. Failure to do so without good cause would result in a referral back to Job Centre Plus and a potential benefits sanction.”

At present the proposals relate only to opiates and crack cocaine. While most of the text refers to heroin, the later reference to opiates could have implications for people who are dependent on prescription opiates. This is unclear. However, the paper ominously concludes that “over time we will consider the case for extending this approach to others – for example, those dependent on cannabis, powder cocaine, or dependent on alcohol.

But ultimately, why stop there? Hampered from re-entering work by a weight problem? Why not sanction people who fail to join a dieting club and cut off benefit. Smoking-related respiratory problems contributing to worklessness? Get those nicotine patches on or lose benefit! This is a wonderfully clear example of “first they came for the crack users…”

Without any evidence, the authors of the paper seem to think that the threatened sanction of benefit removal will act as a spur to engaging with treatment. But as those who have had extensive contact with problem drug users will attest, the stick, all too often doesn’t work as hoped. Rather than driving people towards treatment it is more likely to drive people away from benefits. And while this may have some statistical appeal to the DWP it will bring with it a slew of attendant problems; increased homelessness, further distancing from treatment and increased offending. It is to be hoped that wiser heads and evidence will prevail in the face of these measures. But given the Home Office’s resistance to listening to the experts when reclassifying cannabis, one has little hope that they will do so in this case.

The green paper No-one Written Off is a consultation document and comments are invited until the 22nd October 2008. The body of the text invites comments on specific questions. It does not ask the question “should benefits be removed from people with drug problems who are not engaged with treatment?” Respondents will want to answer questions and pose challenges which are not currently invited by the (limited, specific) questions in the Paper.

The Paper can be viewed here. http://www.dwp.gov.uk/welfarereform/noonewrittenoff/

28 August 2008

Playing House!

A lukewarm welcome for new Paper on Housing Drug Users
August 2008

It can't have been easy for Gregory Green and Martin Nugent to write a paper on housing drug users which would satisfy the Home Office Drugs Intervention Project, Communities and Local Government, NOMS, The Housing Corporation, NTA and others. Nor can it have been easy to write the report with a single reference to the Misuse of Drugs Act, or Section 8 of the act. But in the 200 odd pagesof Improving Practice in Housing for Drug Users, there's not a mention of this legislation, or the antisocial behaviour act. In short, in this sprawling piece of work, there's not a single line that stresses the legality of working with use on site.

The paper is built around a series of case studies. These include a number of agencies working inclusively with ongoing drug use and injectors, including SHP, In Partnership Project, Norfolk Drug and Alcohol Partnership, New Steine Mews Brighton, and Thamesreach. These are fine projects, each doing innovative work with ongoing users, and who have done so for a number of years. It is highly welcome that there work is finally receiving a level of official recognition and endorsement. It is long overdue; these projects have developed and emerged despite a lack of Governmental backing or endorsement. Remember, this was a Government that sought to expand Section 8 of the Misuse of Drugs Act 1971 which would have ended this type of housing in the projects listed. As Deputy of the Rough Sleepers Unit, Ian Brady repeatedly refused to officially endorse the use of Sharps Boxes in hostel settings. So the Government embracing an "eyes wide open" model is to be welcomed.

Except that the Government doesn't appear to be embracing the report and its presentation and release seem intent on keeping the report out of sight. On the "Tackling Drugs Changing Lives" website, the report isn't mentioned on the "News and Events" sections, and even after going in to the DIP section there's no obvious link through to the paper. It is mentioned in the DIP August 2008 E-Bulletin which also mentions the National Seminar that took place the month before. The previous e-bulletins hadn't mentioned this seminar, making it rather difficult to know that it had happened. But, if you missed this E-bulletin, there's no other direct link to the Papers. The Papers themselves don't represent Government policy and there is a footnote disclaimer in the document to this effect.

The Paper itself is slanted heavily towards an organisational and strategic perspective. It stresses the need for a mult-disciplinary partnership approach, with key players involved and proper assessment of need, provision and outcomes. Search for the word "strategic" in the Paper and you get more than 100 uses of the word; look for references to "injector" and there's not a single use of the word. The report does stress the need, too, for a full spectrum of housing provision covering the full spectrum of drug use. The need for housing for ongoing users as well as for those in treatment, and those now abstinent is well made and welcome

What the Paper does not do is provide a clear vision or endorsement of how work with ongoing users on site can take place. This area feels fudged, and as it is the area which causes the most concern and confusion to providers, the police and commissioners, the lack of clarity here is damaging. Nor does it offset some of the concerns or direction that has been established by other, contrary, Governmental initiatives - most notably the Respect Standard for Housing Management. This model locates substance misuse firmly within a context of anti-social behaviour and primarily promotes an enforcement response to it, through use of demoted tenancies, ASBOs and injunctions, whilst paying lip-service to support and treatment interventions. Similarly, no mention is made in the Paper of the Antisocial Behaiour Act (Power to Close Premises) or its impact on housing drug users.

What there is, within the case studies is reference to "proactive harm reduction approach to managing drug use within premises that they manage." How you do this is not addressed by the paper, and the level of detail provided by the case studies is inadequate and vague. For example, the report says "the case studies have demonstrated that improving understanding, knowledge and skills of workers and service users were important elements of capacity building. This includes awareness and understanding of...drugs, housing and the law."

Ironically, despite asserting that this is an important element, the Paper does not make a single reference in all its pages to where this information could be obtained. No mention of the legislative framework, no mention of the resources available on this site or www.drugsandhousing.co.uk regarding lawful, safe, eyes wide open working. No mention of the Sample Drugs Policy or associated resources. This is not mere sour grapes. Of the projects mentioned in the report, nearly all the service providers mentioned drew significantly on the models that were outlined in Room for Drugs and the Sample Drugs Policy. Certainly, they have developed and evolved their own character, policy and practice since. But the kernel of these initiatives was built on working in an "eyes wide open" model as outlined in these and related papers. The decision by the report authors not to mention this, or to reference these resources is inexplicable.

One of the stragegic documents mentioned in the report is the "Safe Newcastle Policy on Drug Use Within Accommodation." This document has been reviewed previously (see Blog passim) and is at odds with a harm-reduction approach. It requires all known episodes of possession to be reported to the police, requires the removal of drugs and paraphernalia found in resident's rooms, and requires warnings to be issues for all suspected use on site. It would be interesting to know if one of the projects cited as a case-study, Tyneside Cyrenians, follows the Policy as written, because it would be hard to see how on-going use on site were managed in a harm-reduction manner where known use was automatically reported to the police, and rooms were searched on "strong suspicion of drug being used."

After a long wait for a Governmental report which embraced and endorsed full-spectrum, eyes wide open housing models for drug users, the Paper goes some way to fulfilling this need. On balance though, the Paper delivers a few crumbs of welcome recogntion for these models of housing. But buried as they are beneath reams of strategic vision, and obscured by a lack of clear illustration and clarity, it seems that we must wait longer for the report we had hoped for to arrive.

The complete set of papers for Improving Practice in Housing Drug Users - A Partnership Approach can be found here.

The complete Seminar notes are here.

Shelter have organised a Seminar on the back of the publication and details are here.

06 August 2008

Cannabis Reclassification - a pawn in the Prohibition war?

Back in May, we looked at how the reclassification of cannabis had become a political pawn. We reflected on how a Government under attack and with plummeting popularity used the decision to move cannabis back to Class B as a political tool in the face of expert evidence.

But above and beyond the UK Government, numerous other interest and lobby groups were promoting their viewpoints. And so while cannabis had become a pawn in the battleground of UK politics, it had also become a key piece in a conflict between the polarised camps of prohibitionists and legalisers.

When cannabis had been initially moved from Class B to Class C, it had been heralded by some as a first step in the liberalisation and reform of the drug laws. Given that it was the first time a drug had been reclassified down, it is understandable that some would view this as a sign of things to come.

Conversely, the move was viewed less positively by a range of prohibitionists. From the International Narcotics Control Board down through to the various pressure and lobbying groups such as Europe Against Drugs and the Drug Prevention Alliance, the downgrading of cannabis represented one of the biggest setbacks that they had experienced, and elicited howls of outrage.

So when the discussion about cannabis resumed and the Government contemplated a move back to Class B, the prohibitionists went to battle with a furore which had less to do with the case for cannabis per se but more to reassert the prominence of the prohibitionists’ message.

The final decision to move cannabis back from C to B was therefore welcomed by prohibitionist groups, less because of the fears about cannabis safety and more because it put (they believe) a prohibition tendency back in the ascendancy.

Unfortunately, truth was once again the first casualty of this drugs war, and the nuanced evidence and arguments relating to cannabis were lost within a slew of hyperbole, claims and counter-claims. Individual experience and small studies were cited as evidence of greater harm. The tabloid press, especially the Daily Mail, ran headline after headline citing the increased risks of strong cannabis.

Key progenitors of these hyperbolic arguments included Europe Against Drugs (EURAD) who have been vocal in their demands for cannabis to be reclassified. Key amongst these was Mary Brett, a former secondary school teacher from Amersham who now spends her time culling journals for negative cannabis stories, and promoting these as “facts” to support the prohibitionist arguments.

Her document, “Cannabis – The Facts” is in turn used by Debra Bell of “Talking About Cannabis.” TAC was initially set up by Bell, a journalist, as a way of exploring and discussing her family’s experience of cannabis. This role morphed in to a lobbying group demanding that cannabis be moved back to Class B and in an amazingly short time, TAC had face time with the ACMD and were being routinely cited by the media. TAC say that they are “currently preparing educational packs for schools with a strong prevention message, written by drug experts.” Presumably, with contributions by Brett, and following the line established by EURAD.

TAC are now members of EURAD, and as such presumably endorse EURAD’s other articles of faith, which include the abolition of needle exchange, and other harm reduction approaches.

Also beavering away at the cannabis issue, though less prominently than TAC, was the Drug Prevention Alliance, led by Peter Stoker with the assistance of former customs officer David “Claude” Raynes. Interestingly, these two well-established prohibitionists are now very active within the Foundation for a Drug Free Europe – a Scientology-derived campaign group which promotes Narconon treatment models and is staunchly prohibitionist. They are joined here by regular Drink and Drug News magazine contributor and long-standing Scientologist, Ken Eckersley.

Following the Home Office’s announcement regarding cannabis reclassification, a congratulatory letter in the Times was co-signed by, amongst others Bell, Brett, Raynes and Stoker, bringing together an alliance of Prohibitionists whose primary interest is not in Cannabis, but in wider prohibition.

The irony of all this is that it has been that cannabis has flourished and increased in potency under a regime of prohibition. Despite the fact that production and supply has consistently carried a maximum sentence of fourteen years in the UK since 1971, the sentence has not prevented first importation and then home-growing in the UK.

Cannabis became stronger and less safe within a prohibited, unregulated under-researched market. Just as under alcohol prohibition people were at risk through stronger, impure bootleg drink, so people were put at risk through illicit cannabis in the same way.

Producer countries such as Morocco and Algeria, who had historically produced cannabis resins with a good mix of THC and CBD saw home production curtailed to meet the demands of the INCB. Rather than risk importation, home-growing became the more profitable, lower risk alternative. And the end-product – high THC/low CBD herbal cannabis was the net result.

All this happened under prohibition – the stronger, imbalanced strains of cannabis that dominate the market were a result of an unlicensed, un-regulated market. The process of prohibition contributed to the increase in cannabis-related mental health problems.

It is only now, through legal research under Home Office licence, that researchers are becoming aware of how important the ratio of THC to CBD in cannabis is, and how CBD may cushion or protect against some of the negative effects of high THC levels in cannabis.

Left to an illicit market, the safety of a product will tend to take a secondary position to other factors such as potency or ease of production. Given a legitimate framework, it is feasible to produce a product with a lower risk profile.

Given, for example, licensing and regulation, it would be feasible to specify minimum CDB contents, maximum THC contents, and impose higher levels of excise duty on stronger strains.

By clear product labelling and allied information campaigns, the product available (age-restricted and licensed) would be the least hazardous option that could be made available.

By opposing this approach, and pushing the Government away from such a model, the Prohibitionists have ensured that the cannabis on the street will remain as unsafe as it can be, and exposed to risk the very young people that they claim so passionately to want to protect.

21 April 2008

Brown v the ACMD - cannabis is the side show

Within the next week, we can expect the Advisory Council on the Misuse of Drugs (ACMD) to publish their recommendations regarding cannabis. They have been asked to consider if, in light of existing research, they feel that it should remain in Class C or if it should be moved back to Class B. Following their report, the Government should make a decision as to whether it will follow or reject the ACMD’s recommendations.

According to media reports, both the Home Secretary and the Prime Minister have made it clear that they favour a move back from Class B to Class C. And media reports have also suggested that the ACMD is satisfied with cannabis in Class C. The truth of all these media assertions will, doubtless, be resolved very shortly.

What the ACMD actually decides is almost, now, a moot point. Thanks to the Home Office’s tinkering with the Classes when cannabis was reclassified, there is precious little difference between Class B and Class C anymore. They both carry a maximum sentence of fourteen years for supply (it used to be 14 for Class Bs and 5 for Cs) and possession of either Bs or Cs is an arrestable offence – previously possession of Class Cs was not an arrestable offence.

The only significant change with a move from C back to B would be an increase in the maximum penalty for possession increasing from two years to five years. But in practice these larger sentences would not be used for simple possession.

Everything else – how cannabis is policed, the awareness raising that accompanies it, the market that produces and supplies it – will remain the same.

The production and supply of cannabis can carry a maximum of fourteen years: this penalty will remain the same even if cannabis is reclassified. So there will be no increased deterrent by moving it from C to B as far as production is concerned. In a country now dominated by large-scale organised growers, reclassification will have no impact on the production end.

Use of cannabis has not increased in the past four years; indeed there is some evidence that it has declined, and there is no evidence that a move back to B would hasten this decline.

But really this is all a side argument. The real question should be whether the Prime Minister will follow the advice of the experts at the ACMD or for one of the handful of times in the past 30 years, he will ignore their advice and follow his own feelings on the matter.

In a field currently swamped by lobby and campaign groups with a variety of vested interests, the importance of the ACMD cannot be underestimated. Unlike the rest, this is not merely a lobbying group with a drum to beat. Established by Statute under the Misuse of Drugs Act, the ACMD is intended to provide a neutral, expert and influential body to advise Ministers. The drafters of the MDA clearly recognised that drugs policy was a political and moral hot potato. To avoid it being thrown around in the interests of political expediency, the ACMD provides expertise. Government has no obligation to follow this advice, but if they don’t they presume to know better than their own experts.

Given the current political climate, it has probably never been more important that there is an independent body to advise on drugs. We have the perfect storm of a party slumping in the polls, days before the local elections, and a leader who is unpopular and indecisive. How Brown must yearn to reclassify cannabis tomorrow – to garner some positive media coverage as a decisive protector of youth.

Unfortunately for him and fortunately for us, the ACMD report may only come out at the end of April. This will probably be late in the day for Brown to use any decision therein to bolster Labour’s political chances. Not that this will stop the leaks or media briefings that indicate Brown will reclassify regardless of the ACMDs stance. In the run up to the election this could be the ONLY comment emerging from Downing Street.

Post election, maybe, just maybe, cooler heads will prevail. Good or bad election result, the reclassifying of cannabis will be a moot point from an electoral point of view (unless the election result triggers a decision to call a snap general election – though this doesn’t seem likely.) In such a less fraught environment, Brown can side-step the controversy by following the ACMDs advice.

If the Home Secretary decides to disregard the ACMD the reaction of the ACMD is of critical importance. They cannot simply stand by and brief anonymously. There should instead be a whole-scale set of resignations by the Chair, and other members. This should send a clear message to the Government – the ACMD is there for a reason and it must be heeded.

Such a decision for mass resignations should not of course be taken lightly, and nor is it anything to do with cannabis. It must be done to highlight that when a Government decides to disregard the evidenced position of their own experts, then those experts should recognise that this Government considers them superfluous. If the Government would rather choose to listen to Daily Mail columnists, parent-activists and pollsters rather than a diverse panel of experts, then those experts should show their disdain for the process by resigning. To carry on without any such complaint would be to provide endorsement to this decision and facilitate the next decisions made in the face of the evidence.

In tendering their resignations, the ACMD can demonstrate just how critical it is that decisions on drugs policy are not left to politicians.

27 February 2008

New Drug Strategy - Oh come on, what did you expect?

We saw the launch today (27.2.08) of the new Ten Year Strategy. Predictably, there has been a sharp swing towards enforcement strategies including much touted proposals to increase confiscation powers, and coerce engagement with treatment via the benefit system.

Equally predictably, the Strategy has received a range of responses, from outright condemnation to mixed welcomes. The response so far has been muted. The responses over the next few weeks will be far more interesting.

But let's take a wider view. None of this should come as a surprise. Did anyone truly expect an embracing of true harm reduction, and admission of failures of past strategy, a consideration of wholescale review? Oh come on! Only the truly deluded could have envisaged anything other than more of the same, with bigger sticks and more mealy carrots.

Those who have predicted reform, or review of the drugs laws, or new developments have singularly failed to recognise that the "war on drugs" far from being over, is just gearing up for its next phase. Bigger powers, less rights, more enforcement, new weapons. This will only be the start. There will be more punitive measures to come.

I don't expect bravery and great things from the Home Office or the machine of Government. They are well past the stage of rational and balanced debate on drug strategy. But what amazes and depresses is the huge range of players who facillitate and legitimise the war on drugs while at the same time decrying its choice of weapons.

Take for example the much-derided "consultation" that led up to the new drugs strategy. Look at the energy that went in to it - Drugscope's series of regional events, the contributions from Transform, Release and others. Some of these organisations must have believed that their contributions would be read, evaluated, pored over. Others knew it was a sham. But still they participated.

In doing so they legitimised both the consultation and the resultant strategy. Rather than, en masse, boycotting the consultation as the farrago that they surely knew it was, they made their contribution. They had their say. Surely more powerful, more striking for a big group to withdraw from the process? But no. And so the new strategy, flaws and all, gains legitimacy from the consultation.

What if? What if as a group Addaction, Turning Point, CRI, Compass, RAPt, Drugscope, EATA, FDAP, Release and Transform had said NO! Said "we won't participate unless we are convinced that the resultant strategy will take real account of our views." They could have done. Once.

Now of course it becomes too dangerous for many of these bodies to bite the hand that feeds. Dependent on contracting culture, the good will of the Home Office, they can't and won't speak out significantly. A finacially weak Drugscope, other contract-dependent providers, political access achieved by compliance and silence.

Any new measure, punitive or otherwise, demands organisations to implement it. Look at the example of the threat to suspend benefit payments to clients who fail to attend an Assessment. This alone could be scuppered overnight if the big drugs agencies said, as a block, that they would not undertake assessments that were achieved at the threat of benefit suspension. So while we watch to see which agencies make the most show of condemning the measures in print, watch with equal care the number of agencies who refuse to take the contracts. No-one will refuse this dirty work because it pays, and refusal will result in decomissioning.

Historically the drug field was diverse, fractured and independent. This did result in a wide variance of provision. But it protected the field from the sort of Stalinist planning and control that we now see.

Having stripped away this independence, consolidated and centralised provision, agencies now have little choice but to comply with directives.

For drug policy to change the drugs field needs to change, and rediscover its voice and independence. This can only happen from the grass roots. We have ceased to be able to reply on the independence of the ACMD, or the representation of the field, to stem the political excesses of Government strategy. In the war on drugs, we have never, so badly, needed some effective resistance.

04 February 2008

alcohol - short term memory loss?

The BBC reported that the Government proposes to introduce new police powers to confiscate alcohol from young people found drinking in public.

Media, Police and groups such as Alcohol Concern all welcomed the measure.

Which is strange because, as far as we can see, the Home office is simply re-announcing a power created more than a decade ago, with the Confiscation of Alcohol (young Persons) Act 1997:
This empowers police to require under 18-s to hand over alcohol in a public place. Failure to do so (without reasonable cause) and to give a name and address when requested summary offence and carries power of arrest.

The Act was slightly amended in 2001 but, to our knowledge remains in force.

We are slightly concerned that Alcohol Concern's spokesman, who had done the media rounds the day before welcoming the new legislation was unaware of the old one. But we were far more concerned that the Home Office seems to have experienced total short term memory loss as to what legislation has already been enacted. Alternatively they may be hoping that the UK population is so stewed that they simply won't spot this blatant attempt at legislative recycling!