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.