21 June 2010

The Perfect Storm will engulf the Drugs Field: expect casualties

The UK drugs field is about to be engulfed by a collection of circumstances which have come together at the same time. The net result of these will lead to seismic shifts within the field. Whilst some changes are undoubtedly needed, the net result is likely to be a disaster for those dependent on substances.

The first key element is of course the change of Government, and the extent to which this will in itself herald a change in drugs policy.

Almost inevitably, not least so that the Conservatives can portray the previous Government as profligate and incompetent, the National Treatment Agency is almost certain to be an early victim of change.

The change of Government and inevitable change of policy is going to take place against a backdrop of swingeing financial cuts. These two issues coming together possibly facilitate more dramatic interventions than would otherwise have been feasible, especially early in a parliament. Politically and ideologically motivated changes can be passed off or pushed forward under the guise of financial necessity. Some of the financial cuts will take place centrally. But most of them will trickle down to the drugs field via more general cuts – to local authority and health service budgets.

There’s a third factor that will facilitate dramatic change alongside the change of Government and the new climate of austerity. The increasingly vocal Recovery movement is likely to provide the public support for many of the changes likely to be proposed. And while the Recovery movement is ostensibly a broad church which welcomes a complete spectrum of interventions, some of the loudest voices therein are less pragmatic. For them the advent of a new Government is the chance to sweep away substitute prescribing and promote abstinence-based models instead.

Allied to this is the likely willingness of peer and mentor-led recovery organisations who profess to be able to offer the wholly grail of abstinence-based recovery at a lower cost than current treatment modalities. Such promise will be manna to the new Government, keen to deliver abstinence at low cost within the paradigm of the “big society.”

The next concern is the lack of any concerted opposition to dramatic and potentially damaging changes in provision. Historically, there had been a reasonably loud and organised range of drugs services who had lobbied, with varying degrees of success, to maintain balance within drug strategy. The number and stridency of these voices has been hugely reduced over the past few years. Some of the largest drug treatment providers, all too conscious of where their contracts have come from, have been hugely reticent of speaking out. Some of the largest, while assiduously securing contracts, have been far from keen on commenting on the politics of the drugs field.

In the meantime, the Advisory Council on the Misuse of Drugs, which demonstrated a new ability to deliver recommendations in a manner to the liking of their political masters, seem unlikely to suddenly demonstrate their mettle and act as a bulwark against Government excess.

With organisations like Drugscope still relying significantly on support from Government, it is placed in an awkward position when it comes to robustly defending the needs and interests of its members. And with the number of independent drugs services dwindling as tenders are increasingly won by a small number of organisations, criticism of strategy is not likely to come from this quarter either.

The next aspect is the wider economic and political situation affecting the UK as it attempts to escape recession. With cuts in public spending imminent, both an increase in unemployment and a reduction is spending on support services is inevitable. And on the back of this there is every likelihood of an increase in substance use and therefore a need for these self-same support services. This scenario could be worsened if the draw-down in UK and US troops from Afghanistan results in an increase in opium production and distribution. Levels of heroin use had been stable and probably reducing in the UK over the past few years – increased availability and reduced cost at a time of increased unemployment and reduced services would be a disastrous cocktail.

Each of these factors alone could have a dramatic effect on drug strategy and services in the UK – put them all together and the consequences are likely to be dramatic – and fills us at KFx Towers with trepidation.

The most obvious and significant change is of course a change of Government. The advent of the Conservative/Liberal Democrat coalition inevitably heralds a change in drugs policy. To date, little has been announced as to Conservative policy on drugs.

The only concrete proposal, in “The Coalition: our programme for Government” is the following:

We will introduce a system of temporary bans on new ‘legal highs’ while health issues are considered by independent experts. We will not permanently ban a substance without receiving full advice from the Advisory Council on the Misuse of Drugs.

However, it doesn’t seem likely that this is where matters will rest.
The Conservative Party manifesto prior to the election announced that “abstinence-based Drug rehabilitation orders” would be introduced. Likewise, the Conservative strategy paper “A Healthier Nation” lacks any concrete proposals relating to Drug Strategy.

James Brokenshire MP, the Home Office Minister with responsibility for crime reduction, is the minister with responsibility for drugs. A couple of key proposals he intends to take forward include changes to the drugs legislation to allow for a 12 month ban on new substances to allow for full assessment of risk, and widening of categories to allow chemical analogues to be controlled more easily.

Of greater interest is his views on treatment and abstinence. In January 2010 on his blog he noted that the NDTMS had a classification of “'Treatment completed free of dependency (occasional use)” for people who completed treatment, were no longer using heroin or crack, but still used other substances on an non-dependent basis such as cannabis or cocaine powder.

Brokenshire railed against this in his blog, lamenting that “it's astonishing that someone can complete drug treatment apparently free of dependency even though they may be … still taking cannabis or cocaine, provided it's not crack cocaine. Sadly, it underlines just how far adrift the Government has become in getting to grips with the problems of addiction.
It's a failure for society, to which drugs do so much damage and a failure to the individuals, who are clearly not getting the help they need to beat their drug problems. We can't carry on like this and we need a change of approach with much greater emphasis on abstinence based rehab to get more people drug free - and mean it

This provides a very clear indication of where the strategic vision for drug treatment lies in the eyes of this Minister. This approach was also being promoted by David Cameron immediately before the Election. In a written reply to a drug treatment service, reported on UKHRA and vouched for by a number of posters, Cameron’s office said:
A Conservative government will send an absolutely clear message on drugs. We
will take concerted action to tackle the scourge of drugs on our streets.
We would introduce an abstinence-based Drug Rehabilitation Order to break the cycle of addiction and offending. The focus on abstinence is a fundamental distinction between Labour's approach of maintenance and management, which has failed, and ours.”

Future direction is also clearly signposted on the Addiction Today website where Ian Duncan Smith, in his role as Founder of the Centre for Social Justice, made a speech in January to the CSJ regarding addiction policy – including scrapping the NTA and proposals for reforming the ACMD.

These measures have been heartily endorsed by Deirdre Boyd of Addiction Today who has led vigorous campaign against the NTA – drawing on a range of eclectic bedfellows to support her case.

Boyd in turn is closely involved not just with Addiction Today but also the Centre for Policy Studies. This group is described by Boyd as an “apolitical” think-tank. Even by Boyd’s standards this is a stretch, given that the CPS would probably be far more proud of its political Conservatism. They highlight their history thus: 1974: CPS established by Keith Joseph to "convert the Tory Party" to economic liberalism. Margaret Thatcher joined the Centre as Deputy Chairman. Given nine Conservative MPs on their Council, and the presence of Tim Montgomery, former Tory Chief of Staff, claims of being apolitical or independence from Political parties seems a bit of a stretch.

The CPS also published Kathy Gyngell’s widely distributed paper “The Phoney War on Drugs.” It seems very likely that the CPS and the CSJ will have play a critical role in influencing future drug strategy. And in turn these organisations will be influenced by the organisations with which they are inter-twined: the Addicition Recovery Foundation, Europe Against Drugs (EURAD) et al.

So far these measures haven’t yet materialised in Coalition proposals. The rationale for the non-appearance of such measures may be that Conservative abstinence-based doctrine has been attenuated by the counsel of Lib-dems. Or it may be that such measures have merely been postponed in the current financial climate. We will have to wait and see.

Prior to entering a coalition with the Conservatives, some relatively radical proposals had been included in the Liberal Democrat manifesto, including the following:
• Ensure that financial resources, and police and court time, are not wasted on the unnecessary prosecution and imprisonment of drug users and addicts; the focus instead should be on getting addicts the treatment they need. Police should concentrate their efforts on organised drug pushers and gangs.
• Always base drugs policy on independent scientific advice, including making the Advisory Council on the Misuse of Drugs completely independent of government...
• Move offenders who are drug addicts or mentally ill into more appropriate secure accommodation.

Just as some of the Tory policies seem to have gone in to hiding, there’s little evidence that the Lib-Dem’s ideas have been advanced. We will have to wait and see if any of the Lib-Dem proposals see the light of day from their second-rate position within the coalition. The second proposal, to provide the ACMD with greater autonomy is almost certainly a non-starter. The Conservative position on this may partially have emerged in a series of questions asked of the Conservative party by the Guardian newspaper; in response to David Nutt’s question on the subject, Conservative science spokesman Adam Afriyie said “Drugs policy, like all policies, should have a basis in evidence. We have no desire or intention of ignoring scientific advice. There may be times when ministers decide to take account of other considerations.”

This certainly suggests that while the Conservatives are keen to put scrutiny of the economy beyond the meddling hands of politicians, they don’t wish to extend such independence to the world of drugs.

So all the pieces are in place: right wing think tanks providing the theoretical models, the burgeoning Recovery movement who will become the cheer-leaders for the new regime, a bought third-sector, unable and unwilling to effectively challenge the changes that will come, a new Government, keen to sweep away what went before, all against a back-drop of austerity and rising joblessness. This is the worst of times.

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