Please look after these drug services!

With the LibCons embarked on a whole scale razing of 'that which went before,' huge swathes of health-care are set to be restructured. Proposals in the White Paper have already been made including proposals to:

• dismantle Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs)
• abolish the National Treatment Agency
• abolish the Health Promotion Agency
• establish a national Public Health Service, with Local Authority planning and delivery under local Directors of Public Health
• Increase the role of GP Consortia in commissioning services.

At this stage, details are scanty. Details, for example, of the structure and role of the Public Health Service are yet to be published, and the NTA business plan, published at the start of October, can't yet reflect changes that have yet to be announced.

This lack of detail hasn't (of course) stopped charities welcoming the changes. Addaction for example endorsed the White Paper on NHS reform straightaway, and likewise endorsed proposals for time-limits on methadone prescribing. Given the profile of Michael Howards wife Sandra Howard on their board of trustees, one must suspect that Chief Exec Simon Antrobus is playing nice to the Conservative top brass.

It will be a while before more details emerge. But a key concern in all this is where services for drug users will end up. And this includes the full spectrum of drug services from education and prevention initiatives for young people and non-users through to substitute prescribing, counselling and residential treatment options. It includes harm reduction interventions like needle exchange and longer term interventions that support the journey from problematic use to recovery for dependent use.

Some aspects of service, such as Needle Exchange, will most likely fall within the remit of the Public Health Service and be delivered via local authorities. One worries that in areas with small budgets and high demand, this will result in an increase in delivery via Pharmacy Needle Exchange as the lowest-cost option. Needle exchange has been over-stretched, underfunded and lacked a coherent set of quality standards. It will be incumbent on the new Public Health Service, in conjunction with bodies such as the National Needle Exchange Forum, to develop minimum standards for Needle Exchange in England and Wales in much the same way that Scottish Needle Exchanges are being reshaped thanks to the Guidelines on Injecting Equipment Provision in Scotland.

It's less clear where non-treatment initiatives, especially education and prevention, will come from. Where will Frank end up for example? Will he be run straight from the Departments of Health and the Home office (as is currently the case) or will he find a new home at the Public Health Service. That is of course if he survives at all. Frank could be culled as well - it would be a suprise if he survived unchanged and unscathed.

But the most vexed question is to where drug treatment services will be located. Will they be something that is commissioned and contracted by GP consortia? Or will they be one of the few aspects of patient care deemed not suitable for this model and an alternative will be developed. Almost certainly, Cameron's Big Society will be expected to play a role. This will certainly be of huge benefit in terms of involving peer support groups, mentoring and mutual aid. But it is of less use when it comes to the vexed issues of prescribing and residential treatment. Prescribing, time limited or otherwise, demands the involvement of Doctors in some capacity and so can't be done by a willing army of volunteers. Not that, on the whole, this army of volunteers would have much to do with prescribing, especially methadone.

We don't know at this stage if the funds for treating drug users (or "Problem Drug Users") and distributed as the "Pooled Treatment Budget" will be retained or not. Let us assume for a moment that such a budget is, for now, retained though possibly subjected to the same cuts being made elsewhere in the budget.

While the budget may be retained, it won't continue to be distributed or spent via PCTs as is currently the case. So where would it go? Would it go directly to GP consortia? This would be as close as one can envisage to actually putting control of the budget in the hands of the actual patient. But as some of this would need to be spent on prescribing (something currently done by GPs) there is something of a conflict of interest here - giving the GP Consortia a budget for drug treatment and then expecting them not to spend a large chunk of it on continuing to dispense methadone.

Or would the money end up being controlled by the new Directors of Public Health. And would the budget for treatment for drugs then end up as a ring-fenced fund within the wider Public Health Service budget. Were this not the case, drugs money would end up being spent on other aspects of Public Health - including prevention, smoking cessation and obesity.

Wherever the money ends up, and whoever controls it, part of the expectation at least on the Government's part, is that payment will be made by results. But this creates something of a dilemma. If as seems likely the money which was previously in the Pooled Treatment Budget is transferred across to the control of the Public Health Service, it would then end up being distributed to local authorities according to need based on the scale of the drug problem in that area. It would then need to be used to pay for drug treatment services of whatever persuasion as is the case now. The only big difference is that in theory the treatment provider would be paid by results - which using the current yardstick being brandished by the Government, would be abstinence and getting a job.

This then seems a far cry from a personal health budget which patients can use to purchase whatever treatment they want, where they want, provided it is evidence based. It will be easy for the motivated, for the "ready to quit" to access treatment - they will be manna for the "payment by result" services. Indeed the development of screening tools and profiling (or segmenting as it's now being called) will make all the difference to the profitability of these services. But for the most vulnerable, those with the most complex needs, the most entrenched habits, the risk is that they are more likely to be written off than before. Because the services that are paid by results don't want people on their books that make them look less than successful. And prescribers won't want to be drawn in to a constant battle to justify (or not, as the case may be) long term prescribing even where it may have been beneficial.

How it would be spent - and how this will be directed - may come from within the Public Health Service. But its ideological basis - that may come from another source. Some will hopefully come from evidence-based research, rather than whatever whimsical notion is currently flavour of the month on a discussion forum. But it may end up coming from just such a quarter, given shape and form by a "Addiction Recovery Board." Such a body was proposed by the Tory "Centre for Social Justice" think-tank, the brain-child of Ian Duncan Smith. So while coordination in the short term will be taken within the new Public Health Service it may well be that within this an Addiction Recovery Board will be formed to supervise and direct how money is spent and shape policy. The ideology of this post will be critical - a rigorous abstentionist in this position would have a huge impact on treatment models.

The next few months will be an interesting time. An awful lot of services are petrified that they will be decomissioned and will be jockying for position to ensure that they don't lose favour at the LibCon court. The vocal neo-abstentionists already have a ready ear in the Conservative party. They are likely to receive only muted complaints from a field that looks set to be swept away.

But these plaudits from the neo-abstentionists and quiescence from the mainstream drugs field should not be taken as a sign that all is well. There is no clear structure and the ideology is still being fought-over. It's early days and the feathers in the wind do not bode well.

be careful what you wish for...

The new NTA business plan was published today and one can see the tensions between the old and new guard being played out between the lines of the document. Though in truth this document is going to be less significant than the changes that it heralds - and the structures in which they will be implemented.

There are three things that leap out at a quick initial reading:
- the priority given to abstinence is very obvious: the word is used twenty times, and most strikingly in the line "New clinical protocols will focus practitioners and clients on abstinence as the desired outcome of treatment." But desired by whom? And what of those people who wish to stop using the drug on which they are dependent, but not other substances? "Harm reduction," by comparison warrants only three mentions, one in the budget, one in relation to young people and a generic mention. "Reducing harm" has gone.

- Payment by results: the Business Plan says "We will continue to drive unit costs down by a combination of matching resource allocation to performance, progressive implementation of
payment by results..."

This throws up two substantial challenges. The first - what is the "result." Given the priority given to "abstinence" one must suspect that payment by result will be tied to abstinence as an outcome.

The second is that payment by results can result in very long timescales for payment. They tend to work in the favour of large corporate bodies who can afford the up-front costs of treatment and can await later payments. They don't work so well for small third sector organisations with limited cash flow and small reserves.

Time-limits on substitute prescribing: The business plan stresses that open-ended prescribing will not be an option most of the time and the presumption is against it. The Plan says "substitute prescribing is planned to be a time limited intervention." What the stated time limits will be are not yet clear and guidance has still to be issued.

There is at least grudging acknowledgement that some people will warrant and benefit from long-term prescribing. The Plan says "Those who need substitute prescribing beyond an initial time limit should, in turn, be reassured that it is only on the basis of a rigorous, multidisciplinary review of their ongoing needs." Reassurance really depends on your perspective. For those who argue that it is too easy for people to be left on methadone without other interventions, this review and reassessment is welcome. But for others, "reassurance" will mean a three-monthly battle to justify ongoing prescribing because they are not yet ready to reduce or stop - irrespective of the other interventions being offered to them.

In a lot of respects the Business Plan will get cautious approval from a lot of people who will see what they want in it: mutual aid groups get a mention and will be more involved; abstinence is reprioritised; there's mention of residential rehab than before though probably not as much as this Sector would have liked. But there'll also be bouquets for the mentions of time-limiting substitute prescribing and some will even cheer for payment by results.

But at the heart of this a couple of unresolved issues still remain, potent and toxic. The first is the remaining tension as to what "recovery" really means. And the Plan doesn't resolve this. On the one hand it says that "treatment gives individuals the opportunity to overcome their dependency and achieve abstinence" suggesting that it's all about abstinence.

The other says "The purpose of treatment is to enable individuals to overcome addiction. This is fully achieved when someone has completed treatment and been rehabilitated back into their community as an economically active contributing citizen." And given that we are entering terrain which will include payment by results, the definitions are all important.

Ultimately it won't be the NTA who ends up resolving these questions: but some of the voices that will be shouting loudest will be the ones who tie it to abstinence for ideological, not evidentiary reasons.

One of our Drugs Acts is Missing!

It's strange, that, if you try finding a complete list of drugs which are 'controlled' under the Misuse of Drugs Act, it simply doesn't seem to exist on line.

It's a broken up, jumbled mess spread across numerous websites and documents. It's not of course helped that The Misuse of Drugs Act 1971 is interlinked with the Misuse of Drugs Regulations (2001) which in turn were an update an consolidation of the Misuse of Drugs Regulations (1985). So there are two primary pieces of legislation. When drugs have been added, removed, moved down, or, as is more likely moved up the categories, parliamentary "Statutory Instruments" have been used to insert the changes.

But unfortunately these changes haven't been consolidated in the main legislation, and so to get a complete list of all the drugs you have to trawl across numerous pieces of legislation.

So look, for example at the Misuse of Drugs Act 1971 as posted on the Statute Law Database, Thi, unfortunately hasn't incorporated changes since 2003.

Or the Misuse of Drugs Regulations 2001 on the Office of Public Sector Information - none of the numerous changes to the Regulations obvious here either.

Most of them took place through Statutory Instruments - a directory of these can be found on the OPSI website too, but searching within these for "Misuse of Drugs Act 1971" throws up some 720 results which can, with a bit of filtering be reduced to some 35 or so SIs.

There's another list which is a bit more accessible on the Home Office website which is snappily titled "List of Drugs Currently Controlled under the Misuse of Drugs Legislation" which is almost up to date (it ends at March 2010) and is fairly comprehensive - but doesn't include all the various analogue clauses.

But if you want a list of all the drugs, with all the analogue clauses, which reflects all the changes - well there isn't one officially available.

This strikes me as fairly shoddy. People should at least be able to find out which substances are currently legal or illegal in a relatively straightforward way. If people are to make informed choices, a key choice is to know if what they are going to do is illegal or not. After all, possession of these substances can carry a long custodial sentence. And ignorance of the law is no defence.

So, for want of anything better to do I spent a couple of days cutting and pasting the list of drugs together from the two base lists of the Misuse of Drugs Act 1971 and the Misuse of Drugs Legislation 2001. I went through all the Statutory Instruments and inserted the relevant additions and ammendments in the right places. And to finish off I colour coded the additions to the Statutory Instrument which introduced them, so you can see which changes were introduced by which legislation.

I don't know how useful it is but it's certainly very pretty now. And I thought that,somewhere on the Net there should be a complete list of the Controlled drugs in the UK by Class and Schedule.

I'm going to update the version off the Home Office website next (with some better annotation) but first I need to get rid of the splitting headache that this has given me.

Enjoy the full colurful list here on the KFx Website.

The Most Expensive Weed in The World...

With the price of cannabis, especially herbal cannabis, hurtling upwards people are starting to pay silly prices for cannabis - prices of £250+ per ounce are being quoted. In these desperate financial times it seems that cannabis dealers are determined not to succumb to austerity measures.

But their inflated prices are nothing compared to the prices being charged by GW Pharmaceuticals and Bayer - who were recently granted a licence for their cannabis spray, Sativex. The price to the NHS of this new drug will be £125 for a 10ml vial. Sativex contains THC at a level of 27mg/ml. So a 10ml vial would contain 270mg. Or £125 for just over a quarter of a gram of THC. Or £600 per gram for THC.

Now compare this to an ounce of herbal cannabis. For the sake of argument (and easy maths) think about an ounce (28g) of strong skunk (say 25% THC). That's 7g of THC - probably selling at around £250/ounce. Or £35/g for this THC. Which is a fair bit cheaper.

Of course, there's GW Pharmaceuticals R+D costs to cover - although the original plants were bought from Dutch growers, and Bayers shareholders to pay. And there's the perks for the board.

But when the NHS is so strapped for cash, surely every little helps!

THC and CBD to be Rescheduled - Home Office confirms

In June 2010 the cannabis-derived medicine Sativex received its licence in the UK. This meant that it had received approval to be used as a medicine. The active compounds in Sativex are THC and CBD.

This is problematic from a legal point of view. Cannabinol and its derivatives are currently Schedule 1 drugs under the Misuse of Drugs Regulations 2001. Drugs under Schedule 1 are generally cannot be prescribed and their possession, supply or administration is not permitted without a licence being granted by the Secretary of State.

This put THC and CBD in a somewhat invidious position. Licensed as a medicine but still in the most restrictive category of the Misuse of Drugs Regulations.

At present the Home Office has adopted a work-around. The Secretary of State has granted an open general licence to allow this specific medicine to be prescribed. This an interesting work-around, of dubious legality. It probably doesn't extend to all the other parties who need to be able to handle the drug - such as pharmacists for example. This would require more substantial revision of the legislation.

And indeed the Home Office has confirmed to us that it intends to undertake just such a revision - to move THC and CBD from Schedule 1 to a lower schedule which would allow it to be lawfully prescribed at a POM (prescription only medicine) and CD (controlled drug). This would probably mean it moving to Schedule 2 (same Schedule as Methadone) or Schedule 3 (the same as Buprenorphine).

But the really interesting part of this is that the legislation will not be able to specify the brand "Sativex." It would have to specify the specific compounds THC and CBD. Which means that the key active ingredients of cannabis will be recognised as having a legitimate medical use.

This doesn't mean a huge cause for celebration. It doesn't mean that herbal cannabis or cannabis resin will also change schedule. It will be very easy to specify that herbal cannabis and resin stay in Schedule 1 while certain cannabinoids drop down to Schedule 2.

But why it is so interesting is the issues of patent and trademark this throws up.
GW Pharmaceuticals coined the terms Tetranabinex and Nabidiolex and registered these as Trademarks. So these names, along with Sativex are protected. Similarly, the specific strains of cannabis hybridised by GW Pharmaceuticals are also Patented in some countries. So growing these specific strains without licence would be illegal.

But the underlying compounds - THC and CBD are not patented. And so while GW and Bayer now have a patent, license and trademark for Sativex, this is not in itself an obstacle to other producers developing their own products which are based around finding an effective balance of THC and CBD in an effective delivery mechanism.

It is to be hoped that, when THC and CBD are rescheduled, as they inevitably will be, this will open up the scope for more groups to explore the medical uses of cannabinoids, rather than them being consolidated in the hands of a big pharmaceutical giant like Bayer.

NRG -1: analysis indicates batches contain MDPV

Thanks to the previous Governments rush to prohibit MMCAT and MDPV manufacturers were left holding stockpiles of their now-illegal drugs. What to do? Emerging test results suggest that they are repackagaging and relabelling it as NRG-1 and passing it off as the still-legal drug Naphyrone.

Reports that batches of "NRG-1" in Scotland had been analysed an found to contain MDPV were reported at the start of June by ACPOS.

Further and more detailed work was undertaken by Drugs-Forum who confirmed and expanded on Police reports.

Drugs Forum have once again been outstanding. There is a detailed report and recommendations on the website, a stark difference to FRANK's somewhat anodyne observation "it is likely that substances sold as naphyrone or “NRG-1” actually contain one or more Class B cathinone derivatives, the most well known one of which is mephedrone.

It is not clear who in the supply chain knows that drugs being passed off as legal Naphyrone are in fact illegal MDPV. The suspicion is that dealers left holding stock of MDPV are passing it down to smaller retailers as NRG-1, who then sell it under the misaprehension that it is lawful NRG-1. ALternatively it could be that the smaller internet retailers are aware that they are selling end users MDPV under the guise of NRG-1, to get rid of old stock.

At this stage it is not clear how much "real" Naphyrone is on the market; user reports as to the appearance and effect of substances sold as NRG-1 vary widely and little consistency has emerged. With the summer festival season on us, this is a dangerous situation.

Two key pieces of advice must get out to end users:

1: any substance containing MDPV or MMCAT can result in action being taken for possession of a Class B drug; people in possession of large quantities could be charged with Supply.

Ignorance or confusion as to the nature of the substance will not be a defence and so anyone in possession of a compound that they bought in the belief that it was legal NRG-1 and in practice turns out to be MDPV could be prosecuted.

2: The dose ranges for NRG-1 are far smaller than those for MDPV. The size of a dose of MDPV that would provide a reasonable effect would be far too strong if the batch contained Naphyrone. A normal MDPV dose would be probably ten times the range suitable for naphyrone.

Conversely, the low doses advised for taking NRG-1 would not provide an effect if it were actually Naphyrone.

So anyone offered or buying white powder should exercise extreme care regardless of the label on the packet. The best advice is to stay away from any compounds unless you are certain of the composition and strength, and how to take it with as much safety as possible.

Remember: a 'normal' size dose of powders such as ketamine, speed, coke, mmcat or mdpv could be fatal if the powder in question contains naphyrone.

If you are uncertain of the constituents of a powder, or think you have bought NRG-1 take a tiny dose first - a dose about the size of a grain of rice AT MOST. It would be safer to use a professionaly-calibrated set of scales but this will not be feasible for most people. The cheap scales you bought of E-bay are not accurate for this sort of thing and won't be callibrated properly so don't leave you in a safe position.

Keep up to date with news on NRG-1 at Drugs Forum.

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.

meow!

Only the most optimistic (or intoxicated) observer could have expected a different outcome, but in a very short period of time, mephedrone (MMCAT, Meow, Bubble etc) will have been added to the rapidly expanding list of "Controlled Drugs." The only thing that may have been a suprise was the speed with which the Government managed to push through legislation in the Parliamentary 'wash-up' period. That, and, perhaps the spineless compliance of the ACMD and a collection of Politicians who saw fit to rubber-stamp the whole process in the hope that they may garner a few votes on the back of this prohibition.

Having driven itself in to a full state of rabid, indignant, hysterical and ill-informed froth over Mephedrone, (see previous post MMCAT Madness) the media calls for it to be banned "immediately" were clearly being heard loud and clear within Government. But what could the Government do? With a Statutory obligation to consult the ACMD, the Government could not simply legislate. And the recent travails at the ACMD would normally have slowed the process a little. But the timescales here were tight and critical: receive advice from the ACMD AND put legislation before the Commons and then the Lords and then secure an Order in Council, all before the Prorogation of Parliament on the 8th April 2010.

But the Government appears to have done it. The Home Office widely announced that the prohibition of Mephedrone and related compounds would come in to force on the 16th April 2010. This announcement, made on the 29th March, was two days before the ACMD Published their reccomendations, and a week before the matter went before Parliament. It was very clear at this stage that the matter was a "done deal" and that Parliamentary approval was a mere formality.

The ACMD appears to have dutifully played their part. Interim Chair, Les Iversen, formally wrote to the Home Office on the 31st March 2010 to offer the ACMD's consideration and on Mephedrone. It had presumably been offered to the Home Office, privately, sometime before this.

The drafted legislation was put before the House of Commons on the 7th April (see HANSARD) and a Motion to approve it was passed; then it went before the Lords, and was briefly discussed (Hansard record) where it was similarly rubber-stamped.

Contributions from Victor Adebowale, a member of the ACMD, Chief Executive of Turning Point and a member of the Lords were noticeable by their absence. One would hope that his reticence was a reflection of his shame at having been a part of this wholesale abandonment of evidence-based legislation and policy making.

The whole process, and the media storm that has driven it, is deeply depressing and distasteful. It may well be that Mephedrone will ultimately prove to be a harmful and dangerous substance. But at the time of the drug being added to the list of Controlled Drugs, not one fatality in the UK had been conclusively attributed solely to Mephedrone. The jury was still out on how risky the drug was, and how to manage this risk. But the Government clearly felt that, with a close-fought general election looming, they could not allow for the perception of being soft on drugs to offer a soft target for electoral attacks. And likewise, the Conservatives and Liberal Party could equally not appear to oppose legislation that would prohibit Mephedrone. So all three parties signed up to a process that abandoned an evidence base and proceeded on the basis of supposition and assumption.

The complicity of the ACMD, with the notable exceptions of Eric Carlin and Polly Taylor who resigned rather than participate in the charade is disappointing. It does not bode well for the future if the Interim Chair and remaining members feel sufficiently cowed by an outgoing Goverment at the end of a Parliament that they need to rush through their recommendations - without them being put to the full Council. In the end only the Technical Group of the ACMD looked at the drug.

This matter was forcefully brought home by LD MP Dr Evan Harris who, along with Dr Brian Iddon are the only politicians to appear to have come out of this with any integrity. Harris stressed the extent to which the rules on consultation had been disregarded and warned of possible consequences, saying "the Government, who acted not just without considering the report-which they were bound to consider under the Government principles issued on Budget day-but before it had even been published. In fact, according to Eric Carlin, who resigned last week, when the chair of the ACMD left to brief the Home Secretary for a press conference the ACMD had not even finished the report. The Government responded to the press not only on a report that had not been considered, that had not been published and would not be published for three days, but on a report that had not yet been completed. That makes a travesty of the advisory process.

If, as a result of that, this statutory instrument, if-or rather, I suspect, when-it is passed by both Houses-is challenged in the courts as being ultra vires and the Government lose the case, something which, as has been said, should have been done much earlier, will be delayed by months." (Hansard)

Ironically, in the small window between deciding to prohibit Mephedrone, and being able to enact legislation, the Government suddenly found a collection of measures that they could use to restrict and reduce availability without needing to Schedule the drug. They could stop the compound being imported outright; Trading Standards could act where the drug was being "mis-sold" as Plant Food or Bath Salts; Frank could be used to provide more awareness and publicity rather than whittering on about Pablo the Drug Mule Dog. Further, schools could confiscate the drug if pupils brought it in; head-shops could be visited and warned. So without any changes to the MDA 1971, measures could be taken.

It's a worry that almost a year after Mephedrone became an issue, the Government only now arrives at these measures. None of them require ACMD guidance; none required Parliamentary time. All that was required was the imagination and will to act, which seems to have emerged late in the day and coincidentally close to an Election.

Historically, when the Government wants to add or reschedule drugs, there is a period of consultation prior to legislation being passed. While the Government has a statutory obligation to consult the ACMD, the wider public consultation is not mandatory, but has happened with all previous drugs legislation. Most recently, when the Government was considering adding GBL and synthetic cannabinoids to the list of Controlled Drugs, public consultation took place. Ironically, even though the drug has been conclusively attributed to at least one fatality, the demands of Industry were held of greater importance than the risk to users. Although a decision was made to make GBL a controlled drug (Class C) because of its uses by industry a decision was made to make it "illegal to possess, supply, produce and import/export GBL and 1,4-BD for purposes of personal ingestion." http://www.opsi.gov.uk/si/si2009/em/uksiem_20093209_en.pdf


The irony of this outcome cannot be under-played. In order to protect jobs, industry and the economy, GBL is added to the list of controlled drugs but provided it is not supplied for human consumption, such supply will remain lawful. In this regard, the Government has created a "plant-food" model akin to the Mephedrone situation. Supply GBL "not for human consumption" and require people to sign some sort of statement and it would be difficult, if not impossible, to prosecute suppliers for selling GBL. Prosecuting users for possession is also well-nigh impossible, as any savvy user will know to say that their possession is for alloy cleaning, nail-polish removing or some other purpose and the onus is on the CPS to prove that the purpose of possession was ingestion.

The "mephedrone as plant-food" problem contributed directly to the risk and lack of information relating to the drug. The situation arose thanks to the MHRA's "borderline products" category which created and caused the problem.

Products which may contain pharmacologically active substances, but are not intended for medicinal use may fall in to this category of Borderline Products, which the MHRA assesses on a case by case basis. They take in to account "any information which may have a bearing on the product's status, for example, the claims made for the product, the pharmacological properties of the ingredients, whether there are any similar licensed products on the market, and how it is presented to the public through labelling, packaging, promotional literature and advertisements."

Selling a medicine which has not been approved can carry a two year sentence. But by ensuring a product is not labelled or sold or promoted for ingestion, this problem can be avoided. Hence the "plant food" or "bath salts" labelling.

But the problem that came on the back of it was that the dodge of labelling effectively prevented retailers from providing dosing or harm reduction information. With a licensed product, information about not mixing with other drugs, hydration or health risks could have been provided. But having been boxed in to a position of selling it as "plant food" no chance of providing dosing information was possible.

It's worth contrasting this with how magic mushrooms were sold prior to them being made illegal. Then, information about the relative potency of mushrooms could be offered, and guidance on dose ranges was offered. Instead the MHRA creates an incentive to "prove" a substance is not a medicine, and hence create increased risk when such substances are used as intoxicants. Strange then that the Home Office should endorse exactly the same model for GBL control. Money talks - money walks.

The GBL situation emerged in part thanks to lobbying by Industry during a consultation period before the legislation being drafted. The ACMD recommended consultation, and the Government, without the incentive of an election, consulted over a three month period. However, with Mephedrone (callow ACMD, media storm, election) the Home Office felt that there was such danger that "in light of the urgent need to act to protect public health, no public consultation has been carried out prior to the laying of this Order. In providing its advice, the ACMD consulted a range of experts in this field and concluded that the drugs subject to this Order have no legitimate use (ref)

But the story doesn't wholly end with the passing of the legislation. Buried in all the papers that have started to come out from the ACMD, from the Home Office and the Parliamentary Stationery office, a few little gems have come out which are worthy of further comment.
The first is the significant amounts of Revenue that the Government has received from what Gordon Brown described as "evil" drug.
A Written Question from Mr Burrowes MP on the 7th April 2010 asked "how much has been collected in import duty on mephedrone in each of the last three years."

The figure for 2009 was just over £250,000 - representing a taxation at a rate of 6.5%. This means that the minimum declared value over Mephedrone imported in 2009 must have been in the region of £4m.

The figures for 2010 haven't been made available yet, and will obviously be incomplete as will only be for the first three months of the year until imports were banned. But it will be interesting to learn the 2010 figure, as it will indicate how much volume of imported mephedrone changed. Interestingly, The amounts collected in 2007 and 2008 were also significant - between £150-170,000.

It will be more interesting still to learn if the Treasury will take the £1m plus earned from Import duties, and the income from VAT received from Mephedrone sales, and will be donating that money to drugs education or treatment. Given the swingeing cuts faced by drug services in the coming financial year, such a modest windfall could be highly useful.


Alternatively the money could be refunded to the numerous retailers who paid the money to the Government in Import Duty. Given the news that the Local Government Association is trying to impound remaining stocks prior to a ban coming in to force, it would seem only reasonable that import duty paid on a legitimate product should be refunded if the state arbitrarily deems the substance illegal, especially without a reasonable notice period,


The other paper which is worthy of comment is the appalling Explanatory Memorandum and Equality Impact Assessment which the Home Office was required to carry out prior to putting the Legislation before Parliament. This document recaps the legislative proposals and looks at the potential impact of them. The document is dated March 2010. Importantly it is signed off by the Minister David Hanson on the 30th March 2010. This is the day before the ACMD published their advice on Mephedrone, which were dated 31st March 2010. Given the content of the Equality Impact Assessment, and the drafting time required, it is obvious that the Home Office received the ACMD reccomendations in a draft form prior to their official publication - in order presumably to prepare the required legislative paperwork within the tight timeframe of the dissolution of Parliament.

A close look at the Explanatory Memorandum and Equality impact assessment highlights how quickly and badly this piece of legislation has been prepared, and with how little consideration.

The first thing that is woefully apparent is the extent to which this is legislating without a clear idea of the scale of the problem, or the impact of the solution; so the report says "Any real costs associated with [prohbition] cannot be predicted. Not only is the scale of the availability of mephedrone and other cathinone derivatives unknown, but the impact on the police and consequently the CJS is dependent on the policing response to its control as Class B drugs." So in short we don't know how many people use mephedrone, how it should be policed post prohibition, and how many people, especially young people will be criminalised as a result.
The report admits that "there is no current direct evidence that mephedrone cause any significant social harms such as acquisitive crime and anti-social behaviour."

The Equality Impact Assessment is meant to look at if any particular population is disproportionately affected by the legislation. The only group noted is young people; the EIA says "Age Indications: from small-scale surveys (e.g.Mixmag, Frank Website) and anecdotally suggest young people are the largest consumers of these substances. The change in policy will protect the huge number of young people currently using these substances or intending to do so fromthe harms caused by these substances."

This is a very loaded assertion. Having already acknowledged that we have no evidence of the scale of mephedrone use, the EIA makes the unwarranted assertion that there are "huge numbers" currently using the drug, and that prohibition will protect them from harm. There is no acknowledgement that prohibition may criminalise young people, drive up the price, or bring young people in to contact with other controlled drugs. Indeed the evidence that was available suggested that the biggest user groups were young adults with a mean age of use of 23, and the biggest group contacting helplines about Mephedrone were 19-25 year olds. So the primary user group were young adults. It's probably one of the benefits of products primarily sold to people who hold credit or debit cards, or PayPal accounts. It makes it that much harder for young people to access.

The EIA goes on to say "It is not anticipated that the change in policy will have any significant adverse impact on this group of users." Which given that some young people will receive criminal records as a result of the change is hard to fathom. Maybe this isn't counted as an "adverse impact."

One of the areas where the EIA is most misleading is in the section entitled "How did your engagement exercise highlight positive and negativeimpacts on different communities?" This section says, in the age section "No concern expressed in response to the public consultation over the impact of controlling these drugs on age." This is a complete misrepresentation. There was no Public Consultation, and so it is disingenuous to say that no concern was expressed.

The deliberately misleading statements continue, in the section asking "What were the main findings of the engagement exercise and what weight should they carry?" The answer given is "The engagement exercise showed support for control measures for these drugs, but did not raise any findings associated with equality issues." Again, a lie. There was no "engagement exercise." So to claim that is showed support for the measures is not true.

And while no consideration has been given to the direct impact of prohibition there was no awareness or consideration of the indirect impact - that as a controlled drug the cost of mephedrone will go up, quality will drop, and trade will switch to people prepared to take the risks of dealing in controlled drugs. Mephedrone won't go away; it will shift to a different market. And as availability drops, we will probably see a switch back to cocaine. The cartels will be celebrating even while a credulous media congratulate themselves on bumping a Government in to action.

This isn't the first time that rushed drugs legislation has been pushed through prior to an election: the proposed revision to Section 8 of the MDA was squeezed through in the wash-up period, and later revoked. Likewise, the Drugs Act 2005 received assent in April 2005, the month before the General Election. Much of it has never been used since, or was since abandoned.

The only thing robustly evidenced base is that the Government has a poor track-record of passing drugs legislation prior to elections. They've done it again with mephedrone. And, sadly, will not be in office in a month's time to be held to account for it.

MMCAT Madness

The bulletin boards of the UK drug scene, the media and drug agencies are all talking about the same drug MMCAT (also known as mephedrone). For those readers unfamilar with this drug there's a briefing on the KFx website at http://www.kfx.org.uk/mmcat2009.pdf

MMCAT is a relative newcomer to the drugs scene and is probably one of the best examples of a true designer drug that has gone global in a couple of years. Developed and marketed in Israel in 2007, it started to crop up in the UK early 2008 and by late 2009 has reached a high level of market penetration.

Drug discussion boards, music and party sites are full of mephedrone discussion. It's become an increasingly popular stimulant, lawful to possess, Ecstasy-like effects and perceived safety all make it a drug likely to be the must-have as the festive season approaches.

The emergence of MMCAT highlights the inadequacies of current Government drugs policy and strategy. Despite the fact that MMCAT has been available for over two years, it has not been the subject to any assessment of risk, review, or any efforts made to regulate or control the trade.


In March 2009 the ACMD wrote to the Home Office http://drugs.homeoffice.gov.uk/ACMD_Letter_to_Home_Secreta1.pdf partly to tellthe Home Secretary that they had an Early Warning system to provide information about trends. On this occasion the system appears to be sadly lacking as, while the letter speaks of looking at Spice, it doesn't mention Mephedrone at all.

However, prodded in to action by a recent flurry of media interest, the Home Office was reported on Sky as saying "The ACMD are looking into it as a priority as part of their review into legal highs....they will report back next year and their advice will inform our response to these substances." http://news.sky.com/skynews/Home/UK-News/Party-Drug-Meow-Meow-Sold-Online-As-Mephedrone-Teenager-Gabi-Prices-Dies-After-Taking-Legal-High/Article/200911415468664?lpos=UK_News_First_Home_Article_Teaser_Region_7&lid=ARTICLE_15468664_Party_Drug_Meow_Meow_Sold_Online_As_Mephedrone%3A_Teenager_Gabi_Prices_Dies_After_Taking_Legal_High


However, with the ACMD currently without Chair, following the Home Office intemperate decision to sack Professor David Nutt, the festive season approaching and a general election after this, the odds are that it will be a good six months before any legislation can be put before Parliament.

The legislation alone could prove challenging. The UK has relatively wide ranging catch-all drug clauses within the Misuse Of Drugs Act, which covers many of the Phenylethylamine family of drugs. This legislation, widened after Ecstasy (MDMA) became popular, was intended to ensure drugs based around the same 'parent' as Ecstasy would also be illegal, even if they had molecular differences.

Now MMCAT is built on a cathinone base; this is the same compound present in Catha Edulis, the African plant Khat which is widely used in Sub-Saharan Africa. While Khat is currently legal in the UK, specific components and related compounds are not: so cathinone and methcathinone are controlled drugs. But compounds built on this base are not controlled. So chemists have been exploring a whole family of drugs - the beta ketones, which are not currently as tightly controlled as the Phenylethylamines.

So any legislative changes would need to be drafted carefully to ensure that they didn't simply create lots of new loopholes.



But this isn't really about legislation to 'control' MMCAT. More than anything MMCAT (and Spice before it) highlight the complete failure of the current control systems. The speed and development of new synthetics will continue to outpace the lumbering progress of Academics, media and politicians. Even if MMCAT is added to the list of controlled drugs, new products will not be far behind. The spread of knowledge, tools, markets and producer countries far outstrips the ability of States to control and remove them.

So for example, although precursor chemicals for many drugs (like Ecstasy and Amphetamine) are closely watched, the precursors for MMCAT are not, making it a relatively easy product to synthesise.



The extent to which producers and users are ahead of the curve, and the researchers and enforcement behind it is well illustrated by a look at some websites. So, for example the site Drugs Forum (http://www.drugs-forum.com/) has a massive compilation of user reports, product descriptions, advice, harm-reduction and dangers. It runs to several hundred pages of resources. In comparison there's a single page on the Government funded Frank website. In comparison you could probably count the number of academic texts or journal articles on one hand without using your thumb.



The inadequacies of the current system are also exemplified by the "no man's land" in which MMCAT suppliers find themselves. It's not a controlled drug so it can be lawfully supplied BUT it can't be supplied for consumption as it runs the risks of falling foul of the regulations relating to the supply of medicine. But the work-around - of labelling the products as "bath salts" or "plant food" and marking them "not for Human consumption" leaves users at greater risk. Rather than being able to accurately label products with dosage information and risks, suppliers use code to suggest how to use the substance. But this leaves much confusion.

Further, as the substances are not sold for "human consumption" there's no protection for consumers - and no holding suppliers to account. So we end up with the worst of all worlds: an unregulated market, no clear information on harm reduction, no consumer protection and a grey area that is in no-ones interest.



But if Government and the ACMD have acquitted themselved badly in the face of Mephedrone, little could be worse than some of the hyperbolic, inaccurate and hysterical media reporting over the past few weeks. Given a new drug, some linked fatalities and an absence of "authoritative information" the media has gone in to overdrive.



So for example the "Sun" reported that "Legal Drug Teen Ripped His Scrotum Off"

but the article backs this up by quoting the police who in turn support their claim, rather than through toxicology reports but through website chatter. So we don't know for example if another drug (e.g. Ketamine) was involved.

The Daily Mail have been worse still. When reporting the tragic death of 14-year old Gabrielle Price they reported that she had taken "plant fertiliser Mephedrone." It may be many things to many people, and although sold as a plant food is not any such thing.

But the Daily Mail is a shining light of journalistic excellence compared to the Evening Telegraph and Post

It quotes local councillor Bill Sangster who flies in the face of Police and Home Office opinion and says "It is illegal, harmful and can become addictive.” Well, two out of three ain't bad.

More ludicrous are the claims "According to the Levenmouth-based Drug and Alcohol Project Ltd., the mixture in the capsules is produced in varying colours to signify its composition and strength, although cocaine is believed to be the main ingredient.
Capsules are broken and the contents are snorted, placed on to the eyeball, or swallowed by the user, who experiences an immediate high described as mix between ecstasy and LSD."

This is either the most ill-informed drug service in the UK or the worst journalism, possibly both.

The article goes on to report that the tested capsules contained a low dose (0.191g) of MMCAT but this fact seems to have escaped the sub-Editor who allowed the rest of the drivel to be printed.

So given an ill-informed media, an unregulated substance, an ill-prepared Government and an impending festive season, we have an almost perfect storm. In the aftermath, there will almost certainly be moves to make MMCAT a controlled drug. But the wider systemic changes that need to be made won't be forthcoming and so this situation will happen again and again and again.

Seeds of Destruction...

Hemp seeds, THC, False Positive Tests and Intransigence.

This is sad, cautionary, true story. It is intended to highlight a little-known hazard of hemp-seed products. The names the people and organisations involved have been changed.

In March 2009, a woman called Anna got in touch. She had lost her job, she claimed, because she had failed a random urine test at work. She had tested positive for cannabis metabolites. Her employer, a large national company with a strict drugs policy and testing regime, had dismissed her. With the help of her Union Rep she planned to challenge the dismissal. Could, she asked, we help?

She was adamant that she had not used any illict forms of cannabis. She was however a regular user of Hemp Seed Oil, a legal and highly regarded dietary therapy. Hemp Seed Oil is reputedly high in Essential Fatty Acids and Omega 3,6 and 9 EFAs. Could this have been the cause of her positive test result?

Anna had been using Hemp Seed Oil from a reputable herbal therapies supplier. They said that the amount of THC in their product was 6 ppm (parts per million). This alone would come as a suprise to most people, who assume that there is simply no THC in seeds. However, in cropping and processing, resin can adhere to the outside of the seeds. While careful washing and processing will remove the majority of this THC, a small amount will survive the processing and get incorporated in to the final product, albeit at very low doses. However, the website of the Herbal Remedies supplier makes no mention of this, even after Anna's experience, of which the company are aware.

Anna was taking up to six table-spoons of Hemp Seed oil a day - some 60ml/day at 6ppm THC. This would mean she was consuming around .35mg THC/day. This is well below a psychoactive dose, but would it be enough to trigger a positive urine result.

There is very little robust research on the subject of THC levels from use of Hemp Seed. Much of the research has been funded by manufacturers of Hemp Seed Oil, keen to disprove that Hemp Seed Oil could result in positive THC results. Attendant negative publicity would have damaged the Hemp Seed Oil market, something manufacturers were keen to avoid.

Fortunately one piece of robust research had addressed this problem, in a paper snappily entitled "Urinary Cannabinoid Detection Times after Controlled Oral Administration of 9-Tetrahydrocannabinol to Humans" Clinical Chemistry. 2003;49:1114-1124.
This paper reported that "The 0.39 and 0.47 mg/day doses produced maximum urine THCCOOH concentrations (cmax) of 7.3–38.2 and 5.4–31 µg/L, respectively, with mean times to the highest THCCOOH concentration (tmax) of 99.9 and 85.9 h, respectively."
The cut-off for a positive result used by the Labs used by Anna, and by her employers, was 15 µg/L, a level that Anna had just exceeded. But based on the Journal of Clinical Chemistry, a dose range of 0.39mg/day (a fraction higher than Anna's 0.35mg/day) produced results that ranged from 7.3-38.3 µg/L. At the high end this means the results would be more than double the cut-off used by her employees.

Based on these results it seemed very apparent that the Hemp Seeds could well have caused the positive results, especially when at high doses for a sustained period of time. In Anna's case this was more than six months: far longer that the time frame used in the clinical trials.

These results were submitted to the Appeals Board on Anna's behalf. We were optimistic that the Appeal would be successful based on the evidence submitted which was robust and scientific.
Amazingly, the appeal was not allowed. Her Employees didn't reject the evidence about the test results. Instead the company used their policy demand that "any medication which may affect a persons ability to undertake their duties must be disclosed at the earliest oppertunity." Anna hadn't disclosed her use of Hemp Oil. Why should she have done so? Nothing she had been told by the herbal supplier suggested that it would produce a positive drug result. And the THC levels present in the Oil wouldn't have affected Anna's ability to undertake her duties. So there was no need and no reason for her to have notified her employee of her Hemp Seed Oil usage.

Unfortunately her employees didn't see it this way; they argued that the Hemp Seed Oil, which resulted in a positive drug test, may have affected her ability to do her job, and so should have been disclosed to her employees at the earliest opportunity. As this hadn't happened, the dismissal was upheld.

As a result the woman in question lost a job that she enjoyed, and entered unemployment thanks to a flawed drug testing regime and an inflexible drugs policy.

I was furious on Anna's behalf. Her employer's inflexibility was astounding and an appeal to an Industrial Tribunal for unfair dismissal seemed the only way forward.

And at this point Anna taught me an important lesson. She decided that she wasn't going to let battling with her former employees ruin her life. After deciding not to appeal she wrote saying "So, now I can concentrate on finding a wonderful new job and of course carry on enjoying the life of a lady of leisure going for long summer walks and sitting in the garden reading long novels!"

Frankly I was blown away by Anna's ability to overcome the injustice and move on. So following her lead I have tried to do the same rather than raging on. But her story still needs to be shared. Because there may be other people who are using Hemp Seed Oil at risk of false positives. And there are still manufacturers of Hemp Seed Oil that don't warn there products can cause a positive drug test result; and there are Testing Labs that will swear blind that the positive test results and cut-offs could only come from cannabis abuse when this is just not the case. And there may be other employers who share the inflexibility and intransigence of Anna's.

On which note if, perchance, Anna's former employeres read this article, I hope that they will spare a moment for the wonderful person that they sacked, and ponder the stupidity of a policy that can't flex enough to cope with an unforseen situation like this in a sensible and humane way.

First they came for the terrorists…

The news that Police Officers in Enfield have been suspended while investigations take place in to allegations of assault, ‘torture’ and misappropriation of property has been widely reported in the press. Coming on the back of reported Police excesses at the G20 protests, it is all too likely that it will get dismissed as just another local example of poor policing, an ‘isolated incident,’ rather than viewed as more of a systemic problem.

Because there is a bigger problem here. It’s one that organisations such as Liberty constantly warn us about, but is too often dismissed as liberal softness. It’s the risk that when ill-treatment, brutality or a suspension of Human Rights is suspended in one context, it starts the process of legitimising the same abuses further away from the original case. So behaviour that has become increasingly acceptable to some in the “war” on “terror” seeps, inexorably into the “war” on “drugs.”

Of course, the constant demonisation of drug users by politicians and the media has contributed to this process. Legislation has eroded the legal rights of drugs users to a greater extent than any other group in society, apart, possibly, from terrorists. While the police have largely balked from setting up Itemisers at the door of McDonald’s to search for people who have had contact with explosives, there’s no such hesitation at setting up such testing points at pubs and clubs. Thanks to the power of Closure Orders, a person can be evicted from a house associated with nuisance and Class A drug activity although they have not personally used any drugs or convicted of any offences.

In a world where “Rat on a Rat” is an acceptable police campaign to encourage reporting drug suppliers, it can come as little surprise that some Police officers will reduce the rights of suppliers to a similar level.

There may also be another parallel here with the way that torture crept in to the war on terror. Commentators have highlighted how fictional torture (in, for example 24) may have inspired, legitimised and promoted the use of torture in extreme situations, justifying the ends against the means. Perhaps, in a similar way, fiction such as the Shield and, closer to home, Ashes to Ashes has inspired (or created nostalgia) for the torturing of suspects and profiting from the seizure of goods.

But in practice this is neither a nostalgic throwback to smoke-filled basements and giving the suspect a good going over, nor is it turning over the Armenian money-train. This what happens when the Government and successive mayors in London sanction brutality against protestors, strikers, demonstrators and suspected terrorists, and the media and politicians create a folk devil out of drugs and those who use them. You reap a whirlwind.

You wait for ages for a Drugs News service and then three come along at once!

The strange saga of Daily Dose and DS Daily...

It’s been a funny few months for drug news services. For a long time the Daily Dose, established by David Clark, was the first daily Drugs News bulletin. Compiled by the industrious and diligent Jim Young, it built up a significant number of subscribers.

But, in April 2009, Jim Young left the Daily Dose. Editorials on the Daily Dose website suggested that attempts by the NTA to interfere with editorial content was the cause of this, a claim refuted by the NTA. The Daily Dose was briefly suspended, before reappearing with a new format at the end of April.All this must have been manna to Drink and Drug News who launched their own email Drug News service at the end of March. This subscription service (at http://www.drinkanddrugsnews.com/Register.aspx) is a relatively slim affair compared to Daily Dose, focussing as it does mainly on UK news services.

As if all this wasn’t enough, Drugscope then launched their own news service DS Daily – (http://www.dsdaily.org.uk/) in May 2009. Previously, their news had come from their regular Members Briefings but the DS Daily represented a new development, currently not dependent on Drugscope membership. But the biggest surprise of the launch was that Jim Young had moved across to Drugscope and was editing/running the DS Daily. First impressions of DS Daily is that it looks to be an excellent service, well-edited, and covering important stories. It is also much tidier and not overly cluttered either by advertising or by op-ed pieces.The launch of DS Daily, and the re-emergence of Mr Young within the Drugscope team, suggests an interesting back-story. The website name was only registered on the 7th May 2009, and the website was up and running a couple of weeks later. This all suggests some nimble footwork on the part of Harry S at Drugscope and some fast work by Jim. As an aside, site admin appears to have been done by Ash Whitney of Wired Up Wales, who had previously been the webmaster for Daily Dose!

However, three similar news aggregators would seem to be too many to be sustained. Few people are going to want to receive all bulletins as they will contain much duplication. Some will lose subscribers. This probably won’t be fatal. The bigger challenge will be funding, and which provider can garner sufficient funds and clout to survive.At present, Daily Dose has a far higher profile than DS Daily. But then it has been around since 2001, and so has a major headstart over the Drugscope upstart. And even if there is a drop off in subscriptions, the number of organisations linked to Daily Dose assures it a high search-engine rating for the foreseeable future. But it isn’t all about traffic. The funding is crucial and here, Daily Dose has probably shot itself in the foot.

Following their contre-temps with the NTA, Daily Dose decided to decline further funding from the NTA. We don’t know how much this was scheduled to be; in the year 07/08 it appears to be £50,000. For a charity that reported sponsorship of only £80,000 in financial year ending May ’08, such a drop off in funding could be catastrophic. Ominously, the NTA email hinted at the role that other could play, saying “However, the shut-down provoked some people to start asking questions, and others to suggest that they could step into the breach to provide an alternative”

Drugscope’s sponsorship of Daily Dose was scheduled to end anyway; the NTA’s has now gone, and it will be interesting to see how long sponsorship from the Home Office (which results in the FRANK logo and Tackling Drugs Changing Lives) remains.

It may well be that we end up with three distinct ‘products:’ the Wired-In community site which ends up primarily promoting a recovery model, Drink and Drug News bulletins, which includes some news stories and importantly recruitment opportunities and field-specific developments, and DS Daily, which will concentrate on the dissemination of news and bulletins. We will have to wait and see.The only thing that also remains unclear is what really went on behind the scenes in late April at Wired-In resulting in Jim’s departure and rapid reappearance at Drugscope. While the NTA’s email may have been significant, the developments point strongly to internal issues at Wired-In and the direction in which Daily Dose was going. But, as with which of the drug news services will survive this year, only time will tell.

Last twist of cannabis reclassification travesty

In the last post on cannabis reclassification it appeared that there would be a delay before Penalty Notice Orders (PNDs) for cannabis possession were introduced.

The Statutory Instrument that would have brought PNDs in for a variety of offences had been scheduled for introduction on the 26th January 2009 but, faced with a rising chorus of opposition from bodies such as the Magistrates Association, the introduction was suspended.

This was to allow the Ministry of Justice to undertake a proper consultation with stakeholders about the offences covered, something that, up until this stage hadn't happened.

However, in their desire to introduce PNDs for Cannabis Possession, the Government then decided that consultaton on this specific PND was not actually required and asked the House of Lords to pass a motion introducing PNDs for Cannabis possession.

After a mere fifteen minute discussion on the subject (most of which was of little value) the Motion was passed and, it seems PNDs for cannabis came in to force. The passing of the Lords motion took place on the 26th January 2008 between 7.55 and 8.20pm. Two Lords spoke. The Motion was then passed. This it seems was all that was required to bring the PND in to force.

The record of the debate is here

Ironically, Lord Bach, proposing the Motion for the Ministry of Justice had the temerity to assert "The proposal that cannabis possession should be added to the penalty notice for disorder scheme was made public last October. We believe that there has been plenty of opportunity for people to comment on it."

This is a laughable assertion. There was no formal consultation on the subject despite the fact that Home Office had previously assured that there would be a consultation. There was a complete failure to consult. We asked the Ministry of Justice in November 2008 when the consultation would take place. In January 2009, two weeks before the motion was passed we finally received a reply from the Ministry of Justice, letting us know that no formal consultation would be taking place.

If Lord Bach therefore truly believes that this represented "plenty of opportunity for people to comment on it," then there is something truly rotten within the MoJ.

Further it seems that while other less serious offences being considered for PNDs are now on hold, pending consultation, one of the most serious, cannabis use, is not considered worthy of consultation or proper debate and has been fast-tracked for political expediency.

While it seems almost certain that PNDs for cannabis have come in to force, we are double checking this; while ACPO and the Home Office have released guidance, information and resources which state that PNDs can now be issued, there may still be some confusion. Certainly two days after the Lords Motion on the subject, Maria Eagle MP, providing a written answer said "When, penalty notices for disorder become available for the offence of possessing cannabis, my right hon. Friend the Secretary of State will issue guidance under section 6 of the Criminal Justice and Police Act 2001 about their issue." (ref)
Which certainly gives the impression that either the Parliamentary Secretary for the Government Equalities Office (!) doesn't have a clue what she is answering questions about OR further action needs to be taken before the PNDs come in to force.

Frankly, who knows? Maybe FRANK does? But in an interesting departure the new information leaflet on cannabis reclassification comes not with FRANK's usual happy banter and warm graphics. Instead there's a formal HM Government/ACPO document (see here) which explains the changes in fairly formal terms.

Given the millions being spent on Frank it seems a little strange that the vehicle for publicising the change would be such a utilitarian one. It could be that given that the move to reclassify cannabis is not popular with young people, there is an attempt to "insulate" Frank from negative associations by creating the illusion that this is something that the Government is doing and nothing to do with avuncular, independent Frank. Alternatively it could be that in the current financial climate there wasn't enough time or money for a swarm of designers to make the document look hip.

All this confusion should come as no suprise. It's the tail end of the actions of a home secretary who first decided to ignore the guidance of the ACMD and push ahead with reclassification, who decided to pursue PNDs for cannabis possession without consulting, and then decided to push through the required legislation by sidestepping the elected houe and getting the Lords to do it late in to the evening. So much for evidence based policy. So much for consultation. So much for democracy.

The ACPO guidance is here

The Home Office FAQs are here

To B or not to B - the chaos of Cannabis Re-reclassification

Cannabis moves back to B while everyone tries to work out how policing will now work

On the 26/1/09 Cannabis moved back to Class B. To accompany this move, new policing strategy and guidelines should have also come in to force, which included a series of escalating penalties for cannabis possession. This should have included the introduction of Penalty Notice for Disorder (PNDs) for second offences of Cannabis Possession.

However, as with every other aspect of cannabis policy, the reclassification has ended in farce, confusion and recrimination.

As we previously reported, the proposal to introduce PNDs has had to be postponed as the spectrum of offences to be covered by PNDs has met with the disapproval of the Magistrates Association, amongst others.

So PNDs will not now be introduced until the Ministry of Justice has undertaken a proper consultation on the subject, something that as early as last week they maintained was neither required or possible.

As a result of this, PNDs for cannabis possession will not now come in to force at the same time as cannabis moves back to Class B.

At present, neither ACPO nor the Home Office has indicated how cannabis should be policed in the meantime. It is likely that the existing regime - of two cannabis warnings at most followed by arrest - is the most likely course of action. This would mean that, in the short term at least, the move back to Class B would have no meaningful impact on cannabis possession.

The media coverage of the reclassfication today has been as confused as the reclassification itself. Interviewed on the Today programme, John Fassenfelt of the Magistrates Association railed against the way reclassification had been conducted. He argued that cannabis was, illogically, being treated differently to other class B drugs and that the power of magistrates to look at cases was being circumvented by the decision to allow PNDs for cannabis possession. He somewhat undermined his case by being unable to think of another Class B drug, but the principle remains.

However, the most poor performance came from the woefully underprepared Home Office Minister Alan Campbell. He was challlenged on why cannabis should be treated differently to other Class B drugs - and be the subject of PNDs when other drugs weren't. One of the reasons he offered was that each drugs really should be treated on its own merits and that, even within Classes drugs should not be treated the same. Which, when you think about it, is a pretty damning indictment of the current classification system.

However, the most laughable suggestion as to why cannabis should be policed and treated differently was that cannabis was easier to identify in the street (unlike other Class B drugs such as Amphetamine) and so could be handled differently as nothing needed to be sent off for analysis. Presumably, the same bizarre logic could be applied to a host of other drugs, such as Magic Mushrooms.

Unfortunately, Campbell wasn't pushed as to why the Home Office and MoJ had botched the introduction of PNDs quite so badly. So instead he spent a lot of time stressing that the first option available to Police Officers was to arrest and charge, and that they had the discretion to use other interventions.

This was somewhat disingenuous as ACPO guidance on cannabis to date has stressed a presumption against arrest. Further, the onus has been on the police to demonstrate that an arrest was warranted as opposed to it being an approved intervention in all cases.

So at present, cannabis has moved from Class C to B, with no guidance to explain how it will be policed in the short term, and uncertainty as to how the rollout of PNDs will take place now. Now that's what you could call sending out clear messages about cannabis!

PNDs for Cannabis on Hold

Cannabis back to Class B but PNDs will have to follow later

Hot on the heels of the last post, lamenting the Government's failure to consult properly on the introduction of PNDs, there has been a change of heart at the Ministry of Justice and there will now be a period of consultation.

However, this is not a cause for jubilation. Nor does it appear to be directly related to cannabis. Instead it seems to be a result of Magistrates raising objections to the PNDs on the grounds that many of the offences were considered by Magistrates too serious to be handled with PNDs. Their focus (according to the Daily Mail) was the addition of unlicensed cabs to the list of offences which could receive a PND.


As a result, the Ministry of Justice has now said "the government has listened to concerns about certain aspects of extending the penalty-notice-for-disorder-scheme and has decided to consult more widely on the new offences to be included."


So last week, according to the Ministry of Justice, a consultation had taken place, (albeit of a limited nature) and there was no scope for wider consultation, and a week later, a wider consultation is required.

Now, hopefully, this will be a proper, open, public consultation. Then again, who knows what will happen next week.




http://news.bbc.co.uk/1/hi/uk/7838928.stm

Cannabis Fines - Home Office Misleads regarding Consultation

No Consultation on PNDs for Cannabis Possession despite Home Office Assurance.

In October 2008, in their press release entitled "Tougher Action on Cannabis" the Home Office said that prior to Penalty Notices For Disorder (PNDs) being introduced, consultation would take place.

They said "Under penalty notice for disorder proposals, on which the Ministry of Justice (new window) will shortly run a consultation."

We wrote to the Ministry of Justice in November asking when this consultation would be taking place. A long period of silence followed.

Last week we finally received a reply from the MoJ saying that no consultation would take place, and suggesting that responsibilty for this lay with the Home Office. They said:

"Possession of cannabis is included on a list of proposed new offences drawn from a longer list on which we consulted stakeholders in 2006. The Government decided that the PND should be available to officers, subject to Parliamentary approval, on re-classification of the drug to Class B on 26 January 2009. In the light of this decision, it has not been possible to carry out a full consultation."

This response is astonishing. The Home Office clearly stated a consultation would take place. This would have been an opportune time to explore how impractical the introduction of PNDs would be, what safeguards would need to be in place, and give stakeholders a chance to comment and critique the proposal.

In 2006, a small scale MoJ consultation looked at adding certain offences to those which could be dealt with by PNDs. However, this consultation was restricted to ACPO, Justices and Magistrates Associations but not the public.

In the Explanatory Notes which accompanied the Criminal Justice and Police Act Ammendment (2009) which included adding cannabis to the list of PND offences the MoJ said:

"More recently, Departments with substantive policy responsibility for the various offences now being added have conducted consultations with their own stakeholders Therefore, although
there has been no formal public consultation, all those most involved and affected have had ample opportunity to make their views known." http://www.opsi.gov.uk/si/si2009/draft/em/ukdsiem_9780111471876_en.pdf

So in effect the MoJ are saying that, as far as they are concerned, the Home Office consulted their Stakeholders regarding PNDs for Cannabis. And the Home Office said the MoJ would consult.

More worryingly, these proposals were never debated in Parliament. The Statement made by the Home Secretary on the 7th May 2008 made no mention of PNDs. They were mentioned in Written Answers in October 2008, and again they were mentioned in the Lord's Debate on the subject in November 2008.

Th upshot of this has been the introduction of PNDs never taken before the House of Commons, and no public consultation on the subject - just a RIA which was not available when the proposal went before the Commons.

Conspiracy or confusion? Who knows. The end result is the same.

January 2009

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.