Omissions, Contradictions, and Confusion: The 2010 Government Drug Strategy reviewed

“Gone are the days,” reads the introduction of the new drug strategy “when central Government tells communities and the public what to do.” (p2). Yet a mere seven pages later the Government does exactly that, saying “People should not start taking drugs and those who do should stop.” (p9).

Such contradictions are a recurring theme within the 2010 Government Drug Strategy. Given such contradictions and the serious omissions within the Strategy, it’s a shame that the Strategy received such an uncritical response from the drugs field. The sense of agencies keen in a time of austerity to make nice rather than challenging the Strategy was palpable.

Vanishing Harm Reduction:  In a Stalinesque linguistic purge, the terms “harm reduction,” “risk reduction” or “reducing harm” have been wholly expunged from the Strategy. I wonder to what extent this wanton abandonment of the term “harm reduction” is as much a rejection of the terminology of the previous drug strategies as an ideological rejection of harm reduction by the current Government. But whatever the rationale there is precious little space within the Strategy for pragmatic harm reduction with on-going users. The approaches are supply and demand reduction to prevent use, and abstinence-focussed treatment to end dependent use. But between these two poles there is a gaping void where effective harm reduction measures would have sat.

The sole reference to harm minimization is on page 29 where, in somewhat garbled terms the strategy says:
“We will achieve better outcomes for those entering treatment by:…continuing to promote harm minimization measures including needle exchange and drug-assisted treatments that encourage drug users to enter treatment, in order to reduce the risk of overdose for drug users and the risk of infection for the wider community…”

It’s not entirely clear from this wording if “drug assisted treatment” has now been demoted to an intervention “that encourages drug users to enter treatment” rather than being a treatment in its own right. But the overwhelming sense I get from the amount of space and time given to NSP in the document is that it is not considered a priority within the Strategy. The fear must be that this reduction in priority will give commissioners and fund-holders the green light to cut spending on this area to the bone.

Recreational users: Whilst this (limited) acknowledgement of the role of needle exchange is welcome, and the implied retention of overdose-prevention strategies is also welcome, this still leaves a substantial population with their needs wholly unmet: non-problematic, non-dependent users. This group, the largest proportion of people within the drug using population don’t seem to be effectively considered within the drug strategy – certainly not from a harm-reduction point of view.

The Government drugs information service “FRANK,” is presented in the strategy less as a way of making people “aware of the consequences of their actions” and as a way of providing “accurate and reliable information on the effects and harms of drugs…” Whilst it will be a welcome development of Frank succeeds in providing “accurate and reliable information” it seems likely that Frank will be required to become much more partisan – promoting behavior change and stressing risks much more than providing any harm reduction information in literature or on the phone.

This development is certainly in keeping with the expectations of the Centre for Social Justice who demanded reform of Frank saying that this was "imperative if we are to prevent young people from engaging in drug and alcohol abuse so we urgently call for wholesale reform of Talk To Frank and the messaging within it."  (ref)

With the Release drugs helpline facing closure, and Frank heading more firmly in a “drugs are dangerous, don’t do them” direction, it becomes harder to see where accurate, pragmatic harm reduction information for the vast majority of recreational users is going to come from.

Power of evidence – or just power? Given that the Conservatives now form part of the coalition Government, it’s interesting to see how the Government’s strategy on drugs has abandoned some of the measures that the Home Affairs Select Committee recommended in 2002. Back then, a more-radical, not-in-power-at-the-moment David Cameron advocated, with the committee, several things, including:

·         "We recommend that an evaluated pilot programme of safe injecting houses for heroin users is established without delay and that if...this is successful, the programme is extended across the country"

·         We recommend that a target is added to the National Strategy explicitly aimed at harm reduction and public health;

"·      We recommend that Section 8 of the Misuse of Drugs Act 1971 is amended to ensure that drugs agencies can conduct harm reduction work and provide safe injecting areas for users without fear of being prosecuted;" (ref)

It is a shame that none of these worthy interventions survived Cameron’s journey from opposition to Prime Minister and that have not featured in the new Strategy.

While these evidence-based interventions have not survived to see inclusion in the Strategy, some interventions which have no evidence base have been included. So for example the strategy exhorts a return to the days of ex-users going in to schools to do prevention work. It has been reframed as “Community Recovery Champions – people who are already in recovery…who will be encouraged to…contribute to prevention in communities and schools.” (p21)

This is a real retrograde step and one for which there is no evidence base of effectiveness.It is effectively a return to the old-days of ex-users telling young people "not to do what I did," but presupposes (I hope) that people in recovery will be slightly more subtle than some of the shock tactics that were used in the past. It was always a useful tool against those who were not going to use anyway, but short of simply rescreening "Better Off Dead" (which was the sum total of my own drugs education at school) the Strategy couldn't be much less use than those already using or inclined towards use.

Contradicted and Confused:

Behind the scenes, when the Strategy was being drafted, there must have been some serious horse-trading going on as various factions tried to get their perspectives incorporated. The Lib-Dems appear to have sacrificed any hope of liberalisation of the drug laws as the price of becoming “coalition prank monkey.” Certainly the Lib-Dem manifesto aim to “ensure that financial resources, and police and court time, are not wasted on the unnecessary prosecution and imprisonment of drug users and addicts” has vanished and instead the Strategy promises that this will be decided locally by Police and Crime Commissioners and that drug possession will appear on Crime Maps. “Drug dealing and drug possession,” the Strategy ominously (and ungrammatically) warns “is a crime.”

The other key area of tension that was played out behind the scenes was the turf war between Ian Duncan Smith who has had a longstanding interest in drugs and wanted to see the DWP take a leading role in drug strategy, and the Home Office with whom drug strategy has typically rested. Others lobbying hard to influence drug strategy was the Centre for Policy Studies the Conservative think-tank where Kathy Gyngell gave the Strategy the most luke-warm of receptions saying “Fair words about recovery are just not enough. Nor is hope of a ‘recovery contagion’ unless many, many more people are paid for to go into abstinence based therapeutic programmes like those run by The Providence Project and the Ley Community, unless methadone prescribing is capped.” (ref) 

The manifestation of these tensions is apparent within the strategy, and when the Drug Strategy is considered in context of the wider policy picture, these contradictions and confusion become all the more apparent and concerning.

Contradiction 1: “commitment to an evidence-based approach.”
Page 9 of the strategy affirms that the Government “values the work and the independent advice of the ACMD, which has experts from fields that include science, medicine, law enforcement and social policy. We are committed to both maintaining this expertise and ensuring the ACMD’s membership has the flexibility to respond to the accelerating pace of change.”

These are fine words, but the stated commitment rings hollow when considered alongside clause 150 of the Police Reform Bill (ref)  which would remove the obligation to maintain those representatives from medicine from the ACMD.

Contradiction 2: “vulnerable young people”
The strategy highlights that “vulnerable groups – such as those who are truanting or excluded from school” face increased risks in relation to drugs. Reducing school exclusion should therefore be a critical aim of any intervention to support vulnerable young people.

It will be interesting to see how the needs of vulnerable children and the need to reduce school exclusion sits alongside proposed powers discussed on Page 10 of the strategy to “tackle problem behaviour in schools, with wider powers of search and confiscation. We will make it easier for head teachers to take action against pupils who are found to be dealing in drugs…”

The proposed White Paper on Schools, The Importance of Teaching  proposes increasing the authority of Heads to exclude, but at the same time increasing their obligation to take responsibility for excluded pupils.

Contradiction 3: “rehabilitiation in a Payback Jacket.”

On the one hand, there is a clear desire stated within the strategy to use community interventions such as Drug Rehabilitation Requirements, to help move people away from dependency and offending. However, this desire is at odds with the Government’s desire to ensure that justice is seen to be done – and so the Strategy proposes “combining drug and alcohol requirements with other sentencing options, such as Community Payback, to make sentences more robust and ensure that punishment is visible to the community.”

Whilst some form of reparation and payback is clearly essential, the priority surely must be to address drug dependency first and foremost. And it is hard to see how a day of highly visible “community payback” in a fluorescent jacket will represent a contribution towards recovery capital.

Contradiction 4: “forensics”

As part of its response to ‘legal highs’ the Strategy says the Government will “improve the forensic analytical capability for new psychoactive substances and will establish an effective forensic early warning system.” (p15)

Such a system would be very welcome indeed – and would be better still if it would also provide early warning of contaminants in heroin and such like. Unfortunately, however, since the Drug Strategy was published, the BBC reported   that the UK Forensic Science Service would be wound up from 2012. It is not clear, therefore where a forensic early warning system of the type proposed in the Strategy would come from, and if indeed it can ever happen now. With Forensic analysis shifted to either cash-strapped police forces or private enterprises it is hard to see where the money for such a scheme would come from.

Contradiction 5: “housing need”

The recognition of housing need from page 22 of the Strategy is very welcome, and the report stresses  “the importance of providing accommodation for these people.”  The importance of Supporting People in this context is noted and the strategy mentions that the Programme will have £6.5  billion investment over the next four years.

What the strategy doesn’t mention is that this money represents a 11.5% reduction in SP money, is not drug-specific and is not ringfenced (ref). So in some areas of the UK we have already seen swingeing cuts to SP funding and provision with budget cuts of 40-50% being announced in some areas and entire services being culled. So the proposal in the strategy and the reality on the ground are substantially at odds.

The Great Unresolved Issue:
At the heart of the Strategy is a commitment to “recovery.” The strategy title includes “building recovery.” But within the addiction field the term “recovery” is argued over and defined in various ways, so within the Strategy too the term “recovery” is subjected to various interpretations and indeed it is hard to find two consecutive sentences where “recovery” has the same meaning in both.

A clue to the Government’s interpretation of “recovery” is the subtitle to the strategy – “supporting people to live a drug free life.” So here the aim of recovery is equated with abstinence.

But the Strategy seems unwilling to commit to this interpretation. On page 18 of the Strategy the ambition is for “individuals to leave treatment free of their drug or alcohol dependence so they can recover fully.” This would mean that the result of treatment is an end to dependence, but not necessarily abstinent. And “recover fully?” Well in the next paragraph this is expanded on with the words “into full recovery and off drugs and alcohol for good. It is only through this permanent change that individuals will cease offending, stop harming themselves and their communities and successfully contribute to society.” [emphasis added].

So within this interpretation, full abstinence is the only solution. Not managed use, controlled use, or substitution. Ironically this interpretation of “recovery” is at odds with many recovery advocates who would argue that abstinence alone does not equate – or even lead to full recovery and the sense of personal and spiritual wholeness is an essential component of true recovery, not mere abstinence.

 In the next paragraph, the Strategy offers a different interpretation: “wellbeing, citizenship and freedom from dependence.” So abstinence is not essential here. And a sentence later the definition has shifted again: “it is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people.”

So in the space of six lines the Strategy has veered from a position that expounded that the only outcome should be “off drugs and alcohol for good,” and moved to a “person centred journey as opposed to an end state.”

A couple of sentences later the Strategy changes course again and defines an end-state saying “our ultimate goal is to to enable individuals to become free from their dependence.” All crystal clear then except that, a sentence later the ground has shifted again. “Supporting people to live a drug-free life is at the heart of our recovery ambition.”

Such confusion and ambiguity at the heart of the drug strategy should be a cause of huge concern. As we move towards payment by results, the interpretation of a successful result becomes more and more important. Is the successful result complete abstinence? Or is it an end to dependency? These are not the same and, if the past is anything to go by, can become the source of huge controversy.

Certainly in her ongoing battle against the NTA, Deirdre Boyd of Addiction Today has repeatedly argued for abstinence as a core feature of recovery and so is unlikely to settle for less as a “success” for the new strategy.

Recovered enough to work?           The definition applied to “recovery” is not, however, merely of ideological importance or for providers who will be paid by results.

It is also critically important in terms of eligibility to benefits and readiness for work. So, for example, on page 23 of the strategy, the document says “we will offer claimants who are dependent on drugs or alcohol a choice between rigorous enforcement of the normal conditions and sanctions where they are not engaged in structured recovery activity, or building appropriately tailored conditionality for those that are.” [emphasis added]

There are two phrases here to which are hard to decipher. “Structured recovery activity” is a loaded phrase. It hinges in part on what interpretation is being applied to “recovery.” And the idea of “structured activity” begs the question “what activity?” and “whose structure?” It suggests that someone who is starting to engage in recovery-oriented interventions (such as, for example, starting to attend a self-help group on a sporadic basis) would not be involved in “structured recovery activity” and so would be subject to “rigorous enforcement of normal…sanctions.” But if the definition of “recovery” is not defined, then how can job centre staff be clear if a claimant is involved in “structured activity?” Elsewhere it is accepted that substitute prescribing is both an aspect of recovery and structured. So would this measure mean that someone was engaged in “structured recovery activity?” Given that on such questions a person’s receipt of benefit and in turn things like housing may hinge, it is a critical question.

It seems inevitably that, without very explicit clarification for job-centre staff here, claimants will be exposed to local and arbitrary interpretation of what level of compliance is required – meaning that people engaged in the “wrong” kind of recovery, or taking too long to recover in the “right” way will be removed from the benefit system.

Challenge Now!

So that’s our muddled, contradictory, drugs strategy. Maybe it’s no bad thing. Maybe the fact that it is in a state of flux – even though it has now been published – means that it is more malleable and can be more easily challenged, refined, adjusted and improved. Because at the moment it is contradictory, muddled and confused. It is more of an optimistic wish list – where the Government wished to get to, rather than a map of how to get there. But it will require a great deal more critical analysis rather than the warm words of endorsement from the field if the Strategy is to resolve the issues that are currently unresolved.

Council Cuts Cornwall

Reports in the media suggest that at Cornwall Councils emergency budget meeting, today, the Supporting People budget could be cut by £5.6m - around 40% of their budget.  The Government have cut the grant to the Council by a much smaller 12%.

Regardless of the reports and today's meeting, it has already been decided that there will be no more funding for the Floating Support service provided accross Cornwall by Stonham Housing after 31st march.  Thats a quick saving of £3m, about 100 redundancies and huge numbers of vulnerable clients left without vital support to enable them to maintain their tennancies. 

No other services do this same job in Cornwall, and being surrounded on three sides by the sea, there are no similar services in neighbouring areas. 

The client group is wide ranging but includes drug users.  The Government's Drug Stategy acknowledges the important role Supporting People services play with this group, but this important Floating Support service can be wiped out locally in one hit.

Its clear that this quick saving will be a short term gain to the local authority and will probably cost them (or the tax payer) dearly over time, and cost other services like the NHS etc..

Other Supporting People services have yet to decided on but face 're-stucturing' at best. 

Things seem to go from bad to worse and can't even be entirely blamed on our new coalition government!

If you are running winter provision for the Homeless - assess for overdose risk

It's going to be a very cold winter and, mercifully, emergency cold weather provision will be opened up around the UK to provide much needed respite for people who are homeless this winter. Such provision is, of course, a life saving intervention and is often provided on a shoe-string by voluntary organisations and faith-groups.

In order to make the provision still more safe and life-preserving, organisers should be able to assess and respond to people who are at risk of overdose. Early identification of people at risk, and intervening with education, support and staff awareness can help reduce the incidence of overdose, and reduce the risk of fatality in the event of overdose.

To assist this process, KFx developed the Housing Opiate Overdose Risk Assessment Tool (HOORAT). It is a simple assessment tool which can be completed with a resident to assess level of opiate-related overdose risk. The tool was originally developed a couple of years ago. Thanks to the support of Homelesslink it has been slightly ammended and the supporting notes have been expanded to make it more self-explanatory. It is being jointly promoted by KFx and Homelesslink as part of their Evictions and Abandonments project.

The tool will take less than five minutes to administer and can help identify residents most at risk of overdose. The document explores strategies for reducing this risk and how housing providers can ensure that they have interventions in place to address this risk.

HOORAT can be downloaded free of charge from the KFx-run Drugs and Housing Website

Why the Release Helpline is still essential!

It's depressing news that the Release helpline is facing a funding crisis and faces closure imminently if funding can't be secured.

It can't really be stressed how unique and essential the Release Helpline is. From an outside perspective, Government and funders may well think that the Release helpline is no longer required due to the presence of Frank, the Government-funded helpline. But in practice, Frank is only able to provide a superficial service, skimming across the top of key issues and providing a basic level of information to children and young people. Anyone requiring anything more complex needs to be referred - and all too often the Frank helpline operator will redirect the person to Release.

Frank has been a huge money-pit. Between 2006 and 2008 Frank blew more than £3.5m in advertising alone - more than Release's income for the entire period 2005 through 2009. And it is an ongoing scandal that the rebranded service has had so much money lavished on it and yet cannot deliver a proper telephone help service for drug users. In a situation where the state-funded drugs helpline is unable to manage complex calls, and indeed acknowledges this by referring such calls, it seems only fair that proportion of the money lavished on it are diverted to fund helplines capable of delivering such work.

Sadly, this situation is not new, and while it is to be hoped Frank's funding and running will be reviewed, any such review is likely to come too late for the Release helpline.

In the months and years to come, the Release helpline will be needed more than any time since its inception in the late Sixties. Changes to prescribing practice are likely to see patients on opiate substitutes having to fight for treatment, especially as time-limits on prescribing become more wideplace and prescribers become more rigid in relation to use on top. Changes to welfare rules and housing strategy will also see more drug users seeking help as they encounter benefit or housing problems. While local services such as CAB offer an indispensable service (but are themselves terribly over stretched) callers desperately need a service that understands drugs,treatment, law, housing, benefits, employment and is able to access this service for free and by phone.

Release has had a number of funding scares and but this one, coming as it does at  a time of increased need and huge austerity is the worst for a long time. It is imperative that the Helpline survives this crisis.

Support Release here

Dopey Journalism # 1: The Price of A Plant

There's been a lot of cannabis "factory" raids of late which has given journalists and the police the chance to go wild with their estimates of the relative value of the crops seized:

So for example the Belfast Telegraph reported a raid in which sixty plants were seized: stated value: £30,000 or £500/plant.

This figure is presumably based on each plant producing a notional 5oz per plant, with a (cheap) street value of £100/oz
Compare this, though, the a reported raid in Essex, reported in the Mirror: 8,000 plants seized with a stated value of £2m. So the value of these plants has dropped to a mere £250/plant. In nearby Cambridge, 1,300 plants were reported to have a street value of £750,000 or almost £600/plant according to the BBC.

In Liverpool, the media stated the value of plants at almost three times this; the Liverpool Daily Post cited the value of 275 seized cannabis plants at an amazing £223,000 - or £810/plant.

It's fortunate then that the same valuation wasn't applied to a Wolverhampton man reported in the Stourbridge News (in a piece of journalism which is odious in its own right) who had two plants in a wardrobe with a reported value of £300.

So from £150/plant up to £800/plant, it seems that dopey hacks will report any figure given to them by the Police. But in turn the risk is that the courts will be equally credulous of inflated figures.

If you spot a reported figure for a plant of higher than £800/plant let us know!

Ashes to Ashes

I am sure that I am not the only person who suspects that they have been involved in some horrific accident and have somehow woken up in the 1980's just like that programme on the TV. I constantly have to scan for modern cultural references to reassure myself. Only the other week when I was confronted with a picture of La Snatch - aka Maggie Thatcher milk snatcher (ask your parents) on the front page of a newspaper I thought; 'It's ok I am in a Cafe Nero - we didn't have coffee shop chains in the 80's'.

But seriously we are hurtling back to the values and attitudes of that decade; the 'rolling back of the state' with the most vulnerable in society being cast out, where not for profit is is being replaced by run for profit.

My most immediate concern is for those people who are currently rough sleeping and those being supported either in hostel accommodation or self contained via Supporting People money.

For those of you who don't know Supporting People funds all supported accommodation to a number of vulnerable groups; Learning Difficulties, Physical & Sensory Disabled, Mental Health, Older People and Homelessness, which in itself encompasses offenders, substance misuse etc.

Supporting People was comprised by amalgamating a lot of disparate streams of funding in to one central pot to be administered by the Local Authority and this pot of money was ring - fenced.

There had always been a bit of tension as being in a 2 tier authority area the county council controlled the pot of money, but despite this a lot of good work was done especially in improving access to a range of accommodation options for drug users at all stages of their recovery, including actively using. (Of course all this was helped by the great resource that is the KFX Housing and Drugs Website sample drugs policies and other materials, but I digress).

Last year the ring fence was removed, but the grant was protected albeit a 10% cut. This coming year the grant will not be protected and will make up part of the Area Based Grant. Therefore we always knew that we were in for a rocky ride especially as the county council were proposing a move away from block contract agreements with accommodation/ support providers to 'variable volume contracts' (Newspeak for Spot Contracts). However this was always discussed as an incremental change and there was an understanding that some providers would still need an element of a block contract. Indeed there were proposals for some joint commissioning between SP the DAAT Probation and Mental Health, change was in the air but there were proposals to manage it.

Meanwhile in the background, trouble was looming; 2008 had seen a change in administration at the County Council with the Tories taking overall control. At first, nothing much happened; like when a nuclear bomb is dropped - first silence then a blast followed by fallout.

I can't remember the exact order of things but it happened something like this; first the portfolio holder for Adult and Community Services disbanded the Joint Commissioning Body (made up of representatives of the District Councils and Partner Agencies such as the DAAT, Probation etc), he also disbanded the next tier down. Then all work-streams were cancelled such as the review of Women's Hostels. Money pledged from an underspend to support accredited training in complex needs and work with Rough Sleepers was withdrawn without any notice or discussion. The proposed JSNA for Homelessness was also postponed.

Next we were informed that Supporting People would cease to exist after March 2011. The monies would be subsumed into Adult Social Care and a framework agreement and Pathway would be set up. No discussion. No debate.

The problem with SP being controlled by County Council is that, of course they have no statutory duty towards preventing or dealing with homelessness, that is the duty of district councils, so once the ring- fence is off there is absolutely no onus upon them to spend it on what was intended. Another 'worry' is the money moving into Adult Social Care; anyone who works with people who are homeless know how difficult it is to get adult social care to accept a duty to their clients, especially if (god forbid) they take drugs or are non compliant, indeed social services are often referred to as the 'empty chair' at Multi Agency Meetings.

If the situation wasn't dire enough we then had the General Election and the Con-dems with their attack on the Public Sector. This gave the County Council the excuse to cut (sorry prioritise) 50% of current SP services by March 2011 all this before George Osborne uttered a word on the 20th October. Of course Tory central are saying that they have limited cuts to SP budgets and they are committed to ending rough sleeping BUT THEY HAVEN'T RING FENCED ANY OF THE MONEY!!!!!! so Local Authorities faced with an overall cut of 25% of their budget will spend as they see fit on and guess who will be at the back of the queue, the homeless the already chronically excluded. We can't even offset some of the losses by getting creative with Housing Benefit because they are cutting that as well.

I was told yesterday that the County Councils' 'Corporate Leadership Team'. Will be meeting to discuss budget levels in November and that it will be possible to watch this live on the internet.
Is this an example of local democracy - We have access so that we can passively observe the decisions they will make.

Any way enough for now - next time Framework Agreements - the truth

Penelope P-S

KFx Regional Bloggers

As drugs and housing care in the UK looks like it's on a fast rewind to the early eighties, it was clearly time to revert to time honoured approaches to activism. So we have been recruiting regional bloggers to provide news and commentary about relevant regional developments which are having a real effect on the ground.

All the regional bloggers are people who have been approached to take part because of their integrity, passion and belief in the need for high quality interventions for people affected by drugs and/or in housing need.

Our first regional bulletin is going up now.

Knowledge is Power.

6-APB Briefing

Although you won’t know it from visiting Frank, Drug Discussion forums and on-line drug retailers have been a-buzz since the Summer, excitedly discussing and promoting the latest “legal high” – 6-APB. As with Mephedrone before it, the lack of reliable and factual information, especially analysis, is once again creating a hugely unsafe environment. This briefing attempts to summarise the current confused situation.
Names:
6-APB is short for 1-benzofuran-6-ylpropan-2-amine or 6-(2-aminopropyl)benzofuran. Unfortunately, due to the drug containing the benzofuran molecular ring, some on-line retailers decided to give it the name benzo-fury. This is confusing as 6-APB is not an benzodiazepine, and shares none of the effects of a benzodiazepine. So the slang name is deeply unhelpful. The more sensible of the drugs discussions forums have tried have some influence here by refusing to use the term ‘benzo fury,’ but despite this it is listed for sale on many sites by this name. There is no relationship between “benzo-fury” and the (currently) unrestricted benzodiazepine phenazepam which is being flogged on some sites. The latter is really a benzo and 6-APB isn't!

There is a molecularly very similar product 6-APDB or 6-(2-Aminopropyl)-2,3-dihydrobenzofuran. This product has been offered for sale by vendors aswell as or instead of 6-APB. In the absence of laboratory analysis it is not possible to say which of these products has been actually sold – or in truth it is either of these products.

Early suggestions are that retailers initially may have believed that they were selling 6-APDB but early forum discussion raised concerns about the legality of 6-APDB and the suggestion that many people experience severe nausea when coming up on 6-APDB. This may have led to the conclusion that marketing 6-APB was an easier proposition.

Routes and Effects:
The very few credible trip reports for 6-APB suggest that the drug is a relatively powerful psychedelic drug causing significant visual distortion. It has been described as more MDA-like than MDMA – so less energetic and more trippy. Users also report MDMA-type effects such as gurning and urine-retention.

It has been snorted and swallowed; some reports suggest that swallowing is more effective. Dose ranges have been at around the 100mg mark.

The available evidence suggests the drug causes elevation of serotonin levels (probably by blocking reuptake) with low levels of impact on nor-adrenaline and dopamine levels.

The early reports indicated effects from 4-6 hours with little urge to redose during or afterwards.

The early users who wrote trip reports were very positive about their experience.

Availability and Supply:
These early reports, dating back to July triggered a significant interest in 6-APB and attention turned to a number of on-line vendors who claimed that they would have the drug in stock shortly, some of whom were taking advanced orders. As has become more common with some of the on-line vendors, some distributed samples, especially to those people who were writing trip-reports or would otherwise promote the drug.

Since then a number of companies have offered to supply a range of products, under the name 6-APB. A quick trawl suggests between 10 and 20 online vendors all offering products of different appearance. It is not clear how many, if any of these contain 6-APB.

User reports of many of the products being sold range from non-active products, through those which have a low level of potency, up to reports of people being sold very long-lasting stimulants with unpleasant side effects. There is little consistency either in terms of the products sold or reported effects.

Appearance of 6-APB:
Early supplies of drugs reported to be 6-APB and used in early trip reports discussed a tan-coloured powder. However, later on this was replaced by an off-white, creamy coloured powder. None of the early reports described a crystalline white powder.

After the initial availability of powder, the products that came to market were either “pellet” form or capsule form. And at this point the supply side and the discussion side both seemed to go in to what can only be described as melt-down.

Discussions, partly it seems fed by vendors, talked about “official” 6-APB supply chain and so a distinction started to emerge between “official -6-APB” and other stuff. It should be stressed at this point that the idea of “official” or “authorized retailers” in the context of any so-called legal high is bogus. There is no quality control or monitoring body. It’s all equally unofficial.

The pellet forms of 6-APB sold in a professionally produced foil bag were orange in colour; some had a chemical, TCP-esque smell. The alleged dose range was 100mg. Pelletised drugs bring a couple of new challenges – they make it harder to take an initial “allergy test” sample to check for bad reactions. And they increase the chances that people will take several pills in a sitting, and thus increase dosing in 100mg increments, increasing the risks of overdose.

Since then a large range of capsules have been marketed and sold as 6-APB. These have included red capsules, blue capsules, translucent capsules, orange ones and so on. The early availability of red and blue capsules and fierce arguments about which were better led to some commentators referencing the Matrix. Either way, the consensus was that the capsules did not contain 6-APB and the actual contents were unknown. There is at least one trip-report of a person who, taking white capsules containing a white powder sold as 6-APB had very negative, long acting effects off it more akin to a strong stimulant than 6-APB.

The bottom line at present has to be the vast majority of compounds being sold as 6-APB do not contain this drug. There is no evidence that any of the capsules being sold contain this drug. The odds are that if you go to an on-line vendor and attempt to buy this drug you will not receive 6-APB.

What is being sold as 6-APB:
Quite simply, we don’t know. A report in August 2010 published in Drug Testing and Analysis titled “Analyses of second-generation ‘legal highs’ in the UK: Initial findings“ analysed a range of products being sold by online retailers and found that the majority contained now-banned compounds such as mephedrone or relatively low-acting stimulants such as caffeine. Unfortunately this research was conducted before the upsurge in sales of 6-APB so these were not analysed.

So we cannot be certain what is in any product being sold as 6-APB including those tested early on and described as more MDMA-esque.

Reducing Harm:
It is difficult to offer harm reduction information when we know so little about what is being sold, or the risks attached to that substance. So harm reduction information needs to be loosely couched to ensure it is relevant not just to the substance allegedly being sold, but also likely substances being sold in its place.
• If using powders swallow rather than snorting;
• If using a new substance take a small amount first. Take a very small amount (e.g. no more than 10mg) as an “allergy test” to check for unexpected adverse reactions; wait at least an hour. If there are no adverse effects use a larger dose if you are still convinced you want to.
• You should use on-line forums to assess the range of doses being sampled and start at the low end of this range. And then half this. So for example if people are using a substance at the 100-150mg range start at 50mg. Wait at least an hour. Then and only then increase dose cautiously and not exceeding the upper dose range.
•Don't use if you are prone to poor mental health, especially depression or psychosis.
• Don’t use on top of other substances including alcohol. Don’t mix with other stimulants or anti-depressants
• Seek medical help if you experience serious unpleasant symptoms.

Legal Status:At present 6-APB is not believed to be covered by the Misuse of Drugs Act 1971. Sale for human consumption would probably put it within the terms of the Medicines Act hence being sold once again labelled as "plant food" or "for technical use." As with MMCAT before this is not a plant food. Some commentators suggest that the decision to sell it in pelletised form (and to call it pellets, not pills) is to further reinforce the illusion that it is a plant food, and not for human consumption.

The situation regarding 6-APDB is more confusing with a number of sources suggesting it may fall under the Misuse of Drugs Act, but in lieu of a ruling from a court or the Home Office this is mere speculation.

It is likely that some of the compounds sold as 6-APB are, in fact, Controlled Drugs, and possession of them will be illegal.

To summarise:
• Compounds sold as 6-APB could contain a range of different chemicals. The one thing you can be reasonably certain of is that it won’t contain 6-APB;
• We do not categorically know that any 6-APB has been sold in the UK at all; early samples could have been any of a range of compounds;
• The products sold as 6-APB may contain hazardous substances which may also be controlled drugs;
• It is possible to be prosecuted for possession of a Controlled Drug even if you bought it believing it to be legal;
• A flashy website does not ensure they sell what they claim to sell; what they claim to sell may not be safe.

Sources for this article include but are not limited to:
Drugs Forum, Bluelight, Partyvibe, Legal Highs Forum
Liverpool John Moore University
Wikipedia
Frank

Training: If you need a workshop or training on new, legal or herbal highs get in touch to discuss our course "Cats Bees and Dragonflies." Can be delivered anywhere in the UK.
To download this blog as a PDF for reproduction and distribution click here www.ixion.demon.co.uk/6apb.pdf

Project Prevention: Beams and Motes

“We now have such a crisis…that we ought to give active consideration to paying female drug users to take long-term contraception.”

Ah-ha! You think – another diatribe against Project Prevention.

Sections of the drugs support and treatment community have been up in arms as Barbara Harris came to the UK and used her model of cash incentives to promote long-term contraception and sterilisation for drug users.
Nowhere was this state of high dudgeon more apparent than on the pages of the Wired In community where diatribe after diatribe has appeared. Which is ironic as the quote at the top of this article is not from Project Prevention but from the UK’s own Professor Neil McKeganey in an article from the BBC  in 2004. And Professor McKeganey is also one of the Advisory Board of Wired In.
Despite the Professor’s apparent support for at least some of the measures promoted by Project Prevention, he doesn’t seem keen to step in to the current fray and defend the idea of incentivised long term contraception to Wired In members or the wider public. Conversely, despite McKeganey’s stated views on the subject, Wired In don’t seem to have any problem with him being on their Advisory Board.

There are of course significant differences between the views espoused by McKeganey and Project Prevention. McKeganey drew the line at long term contraception while Harris goes further and promotes these measures and sterilisation. And to my knowledge McKeganey only promoted measures for women, not for men.


Of course he is not the only person to make such proposals in recent times: a Greenock MSP made suggested adding oral contraceptives to methadone .

The approach and measures suggested by Barbara Harris are odious and the promotion and incentivisation of non-reversible or permanent sterilisation, to a client group ill-equipped to make such a fundamental decision, is ethically and morally repugnant. It is right that her appearance in the UK has attracted such a wide range of condemnation.


But mere condemnation of Project Prevention is not, in itself, an adequate response. We need to look at some of the failings of interventions in the UK which have created fertile ground for the sterilisation policies of Project Prevention. The wider social picture is one where drugs users are demonised and denigrated in the media. Judgemental and stigmatising language is routinely used and the type of language and attitude which is now unacceptable when discussing mental health, ethnicity or sexuality is commonplace when considering drug use.

This stigmatisation helps foster a climate where measures that would be unacceptable if  promoted for any other social group become more acceptable when applied to drug users.

The wider social context is important, but beyond this, the issue of contraception and family planning for drug users in chaos is something that does warrant proper and detailed discussion. It is a serious and sensitive subject, and one of the tragedies of the Project Prevention backlash is that it will be harder to have this discussion now without people resorting to end-arguments like “Hitler” and “Eugenics.”

It is also a subject that has been considered before, most sensibly in the 2003 ACMD report Hidden Harm, which advocated:

“Contraceptive services should be provided through specialist drug agencies including methadone clinics and needle exchanges. Preferably these should be linked to specialist family planning services able to advise on and administer long-acting injectable contraceptives, contraceptive coils and implants.”

This is an eminently sensible proposal – and one that most right-thinking people would have little problem with. A “belts and braces” approach – temporary barrier contraception (i.e. condoms) to address the risk of STDs combined with effective long acting contraception seems like a balanced approach provided that it is undertaken with the patient’s informed consent and there is sufficient consideration for follow up and referral and support in to drug treatment.

But we haven’t really done this properly. Too much contraception is delivered in a half-hearted way – a couple of condoms given out with a bag of needles, the basket of condoms in the reception of a drugs project – rather than a proper assessment and contraception care plan.

If this were done, and were done properly then the number of unplanned and unwanted pregnancies amongst drug users in chaos could be addressed. And by doing so we can demonstrate there is no place for the bribed sterilisation of Project Prevention. Just as badly delivered needle exchange or badly executed drugs education helps create a climate which embraces “just say no” or “abstinence” models so a failure to adequately address family planning with drug users creates a climate which is ready for Project Prevention.

So instead of just sending off angry letters about how wrong Project Prevention is (and it is very wrong) it is equally important that the field engages with a sensible discussion about how to ensure that the contraception – effective and reversible – is made accessible to drug users, especially those in chaos.

So This is What a Sucessful Policy on Cannabis Looks Like!

The ACPO report on Cannabis Policing "Three Years On" makes depressing reading. It looks at the way that the UK cultivation of cannabis has changed over the past three years and should represent compulsory reading for anyone who believes that the prohibition of cannabis has been a success. These developments over the past three years, considered alongside the developments over the past thirty plus years, highlight just what a disaster the prohibition of cannabis within the Misuse of Drugs Act (and before that the Dangerous Drugs Act) has been. The policy has seen:

• between 1974 and 2002 there was a ten-fold increase in people found guilty or cautioned for cannabis offences (1)
• increase in levels of cannabis use in the UK which have only recently dropped off slightly since their reported peak in the mid 90s;(2)
• a drop in the age of onset of cannabis use; (3)
• increased potency in terms of THC levels (4)
• the emergence of imbalanced forms of cannabis containing high levels of THC and minimal levels of CBD (5)
• concentration of cannabis production in the hands of criminal gangs who are also involved in other drugs, people traficking, weapons, counterfeiting and other offences;
• yearly increases in number and quantity of cannabis seizures but without a significant impact on the availability of cannabis in the UK (6)

By any measure, it is hard to view as a success a strategy of prohibition that has seen the substance being controlled become more potent and less safe, be used more widely, by younger people, despite a non-stop policy of crop and drug seizure, arrest and criminalisation of users and producers.

The evidence from the ACPO report on cannabis production is the latest evidence that in addition to prohibition acting as a driver for less safe, unregulated cannabis markets, prohibition and the profits associated with it have concentrated the production and distribution of cannabis in the hands of a smaller number of large producers, controlling the market with increased force, and with crossover to other offending.

Historically, before gaining power, both David Cameron and the Liberal Democrats wanted to reform the law on cannabis. David Cameron, who it is widely accepted had dalliances with at least one controlled drug when younger, endorsed the moving of cannabis from Class B to Class C. Once elected leader of the conservative party is belief in evidence based policy seemed to evaporate and argued instead for Cannabis to return to Class B.

The Liberal Democrat policy historically was for radical reform of drugs legislation, and in terms of cannabis proposed "adopting a policy of not prosecuting possession for own use, social supply to adults or cultivation of cannabis plants for own use." (7)

However, since entering the ConDem coallition, the Liberal Democrats have been silent on this subject, and it will not be a suprise if, when the Government drug strategy is published in October, all mention of cannabis reform is lost.

But even the Liberal Democrat's old, relatively progressive stance is inadequate and by leaving production and supply in an unregulated market, perpetuates the problems in terms of criminal production, unregulated strength and unmanaged supply.

Given the ongoing disaster of cannabis prohibition the need for Government to fully revise the laws on cannabis are long overdue. Cannabis needs to be licensed and regulated to make it safer. Features of a regulated cannabis market would include:

• licensed, registered outlets with staff who receive training on cannabis use and risks
• age-restricted sales to people aged over 18 only
• sliding bracket of taxation on retailed cannabis with higher strength products being taxed at a higher level;
• products labelled to indicate THC and CBD content, with appropriate health messages
• taxation from cannabis sales ring-fenced to fund awareness and treatment interventions
• personal possession of up to three cannabis plants, by persons over 18 no longer a criminal offence
• licence production in UK and overseas, to encourage (for example) Afghani opium producers to produce hashish not heroin.

Given the current resurgent abstentionist climate, the puritanical approach of the Conservatives to drugs, and the apparent willingness of the Liberal Democrats to trade belief for power, it is vanishingly unlikely that any changes will be forthcoming. So in the meantime, it is back to the prohibition hole and time to keep digging. Sanity, anyone?

The Straw Man of Recovery

The Times today reports that The Home Office will be pushing ahead with a drug strategy focussed on achieving abstinence from both illicit controlled drugs and prescribed substitutes. The article also reinforces the impression that the strategy will include payment by results and that it may include coercive measures like removal of benefits.

The Times' article doesn't offer any substantive new evidence for this. There has already been a significant amount of information (e.g. the NTA business plan, comments from Cameron et al, and the consultation on the Drug Strategy) which strongly indicate the direction of travel.

The Conservative predilection for abstinence-based interventions should come as no suprise. Nor should the threat of coercive measures.

The real icing on the cake though, has been the idea that abstinence is readily achievable. This is where the newly vocal and high profile neo-abstentionists in the Recovery movement have been so successful. A core message that has been promulgated in a number of forums is the idea that the treatment of people with drug dependency is a conspiracy primarily cooked up by pharmaceutical companies and drugs workers out of some sort of self interest. This straw man, as repeatedly offered on recovery forums suggests:

- that a key driver for the ongoing prescribing of methadone is the financial interests of the manufacturers of methadone;

- that drugs workers don't really want to assist people to end their drug use because either (a) they don't believe people can stop or (b) they don't want people to stop because they will lose their jobs

- that the combination of medical dogma, professional self interest and big-pharma is active in keeping people in addiction.

Having created this simplistic model, the argument seems to then extend - these services and structures are a barrier to recovery and by sweeping these away and replacing them with user-led, recovery focussed projects drug users will see the recovery of others, be "infected" by the contagion of recovery and then learn from others how to live productive drug free lives.

It's a very simple and very seductive message. And it has found a ready ear with the Conservatives who are using the recovery mood music to say that the previous Government merely offered substitution not freedom and for the first time this Government will offer true Recovery.

Ignore the history - that the earliest drug treatment services in the UK were mostly established by ex-users in recovery themselves - and while they successfully helped some people they were not a panacea for all. Ignore the fact that the UK drug field has a significant number of people with histories of dependency who can and do believe and know that people can achieve lasting recovery, sometimes with medication, sometimes without. The idea that drugs workers want to keep people addicted for their salary is a vicious lie.

Ignore the practicalities - that payment by results will disadvantage small and independent charities and start ups who can't afford the overheads.

Ignore the safety considerations - that supervisory frameworks from, for example the Care Standards Commission helped ensure minimum levels of safety in residential treatment. Remember that not every residential drug service offers or offered a safe, therapeutic or high quality service and stripping away safeguards leaves the most vulnerable at risk;



Ignore the casualties - that on the one hand reduced, time-limited abstinence driven models will assuredly deliver a larger number of people who are drug free at the end of treatment (and this will be the measured success) but there will be the people who are driven out of or drop out of treatment, some of whom will die. They will not be a measure of success.

Ignore the lost - the people who will lose their benefit, lose their housing, their medical care and their toe-hold in society. Forget that the route back to recovery for these people will be that much harder and some won't make it. Except of course unless you believe in a Jellinek-type model where people have to hit rock-bottom before they will turn to recovery;

Ignore the inconsistencies: that some people will consider Treatment a "failure" if the person has stopped using heroin and crack but continues to use cannabis, even if this is under control. Abstinent from what - and by whose standards? Addiction Today's?

Ignore the cost: the DCLG proposes cutting costs by up to 40% and this will affect budgets including Supporting People - which does a huge amount to help people with drug and alcohol problems secure housing and sustain independent living. The work of some residential social landlords to support people with drug problems has been a shuge success story in some parts of the country. The feared cuts to SP money will destroy this work. And trying to help people with drug problems sustain change without housing is a fools errand.


But hey, who needs these petty problems. Just bathe in the mood music from the Recovery Community and ignore the real-politick of the situation. and when it all comes crashing down make sure that the people who are held to account are not just the policiticians who introduced the policy, but also the neo-abstentionists whose evangelism is rapidly becoming the new dogma.

Something wicked this way comes…

The proposals by Kit Malthouse, Deputy Mayor of London for a new and robust approach to sobriety enforcement for problem drinkers was reported in the media but has received little comment.

The model promoted by Malthouse is based on a scheme in the States. I remember first becoming aware of it during an episode of CSI Miami which featured an alcohol-detecting leg bracelet, which would identify if the wearer had consumed alcohol, and automatically send a message (e.g. to a Blackberry) informing authorities that the wearer had consumed alcohol, where, and when.

A quick search highlighted that not only did the technology exist, but it was being used extensively. The SCRAM system States including Florida, South Dakota and Michigan were amongst those in the US adopting the technology which came to market in 2003.

Malthouse proposed a system of punitive enforcement of abstinence. His model included:
- a sobriety requirement
- 24 hour incarceration for people breaching the requirement, as evidenced by the detection tag
- self-financing by people required to take part in the scheme.

The proposals as outlined by Malthouse couldn’t come in to power as outlined – they would need legislative changes that, fortunately, fall outside the powers of either the London Assembly or the Metropolitan Police. While ‘alcohol asbos’ introduced in August 2009 can impose restrictions on buying alcohol or drinking in public, they don’t enforce sobriety and as such wouldn’t as they currently stand be suitable for Malthouse’s plans.

Likewise Drug Abstinence orders, as they currently stand, relate only to Class A drugs and so wouldn’t fit with Kit’s ideas.

The use of alcohol-detection bracelet systems in the UK hasn’t yet been approved. This, however, is probably less of an obstacle. The use of drug-testing equipment is a growing and hugely lucrative business and there is every reason to believe that a constant testing system which is worn by users will be adopted at some stage in the UK.

At this stage, the system detects ethanol excreted through the skin, but does not work with other drugs. The Guardian article reports “The structure of the programme is being adapted to include drug abusers,” but at this time there have been no announcements that the technology has been successfully adapted to detect drugs of abuse transdermally. While ion-track technology (e.g. Itemizer machines) can indicate contact with controlled drugs, this is markedly different to proving intake, which, at this time requires more invasive procedures such as oral swabs, blood or urine testing. Even the most recent developments, such as proposed roadside drug-driving tests are based on saliva testing.

But it is the third aspect of Malthouse’s proposals which are the most interesting and should ring the most alarm bells – the adoption of “offender pay” systems in the UK. A number of US states, including Indiana, Oregon and Texas have adopted some elements of an “offender pays” system whereby a proportion of the subjects earnings are deducted to pay for the cost of alcohol monitoring units, and associated staff costs.

The costs of these are typically applied on a sliding scale depending on earnings, but in most situations allow the scheme not only to break even, but even generate a small return.

And this is the point where the schemes become most worrying – because they create an incentive firstly to get more people on the scheme and secondly to keep them on the scheme. One hundred people on the scheme, each generating a $5 surplus per day for the scheme - $182,000 a year.

It is easy to see the appeal of introducing offender-pay schemes in the UK – especially when we have seen proposed cuts to the Department of Justice which will radically affect the management of offenders in the community.

Although Malthouse may be keen to take forward measures such as these radical plans for tackling alcohol-related disorder, he can’t do it without the support of the Government. While Boris and Malthouse may have effectively gained political control over the Metropolitan Police, even this won’t give them the resources and legal powers required for such a change of offender management. What will be critical is how much power and influence Boris and Malthouse have within the coalition Government and the extent to which policies which fall further to the right will find a willing ear at least for pilot programmes within the capital.

If I can’t dance I don’t want to be in your Big Society.

This blog probably shouldn’t really start with a misquote of something that Emma Goldman never said. Instead it would have been better to start with Milan Kundera from the Unbearable Lightness of Being: “The struggle of man against power is the struggle of memory against forgetting.”Since the advent of the Coalition Government the media and numerous groups and individuals seem to be engaged in an orgy of forgetting, especially when it comes to the analysis of the putative “Big Society.”

Roll back twenty years when to the advent of John Major’s Conservative Government. We saw the development of an astonishing array of small, grass-roots initiatives set up. There was creative use of abandoned buildings. Land that had been abandoned by industry was used for cultivation, to produce locally grown vegetables for communities. Initiatives to protect local assets such as woodland gained profile. Self managed, self-funded and self-policed recreational activities became more widespread across the UK.

But these initiatives were not heralded as an example of an embryonic “Big Society.” It became known as DIY-culture and unfortunately it did not fit with other aspects of Conservative Ideology.The use of derelict land or empty buildings ran counter to Conservative views of land and property ownership and so they passed laws to make it easier to clear the occupiers off that land and from those buildings. Autonomous cafes, galleries and community spaces were established and briefly thrived, then closed by Police and Bailiffs.

The importance of industry and cars was rated higher at a national level was considered far more important than the views of local residents and communities, so bypasses were authorised by the Government despite local opinion and protests. The Government purchased an independent, unaccountable security force using commercial agencies such as Reliance to deliver this agenda.

The proliferation of the “Free-party” movement, its association with controlled drug use and the non-approved use of land for such parties again ran counter to Conservative values and culminated in the end in the much-loathed Police and Criminal Justice Act being passed in 1994. It was the death knell of this period of DIY-culture in the UK.

So does Cameron’s much-discussed “Big Society” share common cause with DIY culture? The answer to this has to be a resounding “no!” The Big Society is a straight Thatcherite agenda presaged in Thatcher’s much misquoted line saying “there is no such thing as society.” Her wider comment at the time shows the continuity from her views to those of Cameron: “There is no such thing as society. There is living tapestry of men and women and people and the beauty of that tapestry and the quality of our lives will depend upon how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate.” http://www.margaretthatcher.org/document/106689

And herein lies the problem; the Big Society as proposed is inherently Conservative. It is attempting to create and engender a conservative model of society, seed-funded and driven from the top and delivered from the bottom.

Provided that the hopes, dreams and aspirations of a community fit in to this Conservative ideological world-view, then the Big Society will serve you well. But for those who fall outside it, then there’s no place for you in this Society.Look at some of the examples that have been cited as examples of the “Big Society.” The reduction in sex work in Birmingham’s Balsall Heath is held up as one such example.

What the example as cited neglects to mention is that alongside the passive recording of kerb-crawlers, local activists also allegedly threatened and harassed women involved in sex work – a house was fire-bombed, windows had bricks thrown through them, and women believed to be prostitutes were sent poison pen letters by local activists. So it’s a Big Society that fetes you if you want to set up a self-policing vigilante movement that removes kerb-crawlers and sex work from a community. But take this specific issue a little further. What if a local community, in a fit of pragmatic liberalism, decided that the best way forward was rather than simply trying to wish the problem away. If this grassroots, locally agreed, locally relevant initiative approach were mooted, what would Cameron say then? Would it be embraced within the Big Society as an example of local empowerment. Or would it be stamped out as not really the sort of Big Society we want. There is evidence, such as models of tolerance that were trialled in Edinburgh, that show tolerance models can result in a marked reduction in attacks on sex workers.

David Cameron signalled a desire to review the laws around prostitution in the UK, following the murder of three women in Bradford. But if he decided against full legalisation or tolerance zones, what then for a local community wanted to pursue such a route?

And what of drugs (for this is, if nothing else, a drug-focussed blogging site)? What would the Government do if a local authority, in conjunction with the local police and local community, decided that a supervised drug consumption room was the most sensible response to the issue of public drug use? Would this be something that would be resourced and funded by the Big Society Bank? Would it receive the endorsement of the Government as an example of local solutions for local problems. Or will it be given a firm “red light” from Number 10, as has previously been the case. This is an especially loaded issue as, when he was part of the 2002 Home Affairs Select Committee, Cameron came out in favour of drug consumption rooms. The report unequivocally demanded that “…an evaluated pilot programme of safe injecting houses for [illicit] heroin users is established without delay…”

It would be an interesting test of integrity to see what would happen if a local area trialled such an approach now. Would David Cameron support such a move in practice, as he did in theory in 2002. And would such a thing be tolerated within the Big Society.If it does then the Big Society could genuinely be something inclusive. It could represent a tolerant, informed, flexible and liberal model of community empowerment. But if this isn’t the case, and such approaches are blocked by Central Government then this isn’t such a big society after all. It’s the same conservative view of Society that crushed the DIY Culture almost twenty years ago. It’s learned a new language and it’s changed its clothes, but it still won’t be a revolution that everyone can dance to.

Cannabis: B but no PND says the Met PC

It's just got more confusing on the cannabis front. The Metropolitan Police is reported to be abandoning the use of Penalty Notices for Disorder (PNDs) in a number of London Boroughs. This was reported in the Evening Standard and then on the BBC.

These powers had been used for a number of offences such as shoplifting and drunken behaviour. But the use with which we are interested here is there use for second offences for cannabis possession.

The current ACPO guidelines on handling cannabis possession, since cannabis moved back to Class B, was that for a first offence, the person should be given a "cannabis warning." As part of an escalating series of responses, second cannabis offences aren't meant to be given a cannabis warning but should have resulted in a Penalty Notice for Disorder. A third offence would then mean arrest and charge, and a resultant criminal record.

It is not immediately clear if the decision to abandon PNDs will extend to cannabis enforcement. If it does, the decision could be good news or bad news as regards cannabis enforcement (depending of course on your point of view).

The BBC reported a Met Police spokersperson as saying "We are seeing if there is a more effective way to deal with them, such as through cautions, through the courts or, in minor cases, words of advice."

Given that cannabis users already receive "words of advice" in the form of cannabis warnings already, it doesn't seem likely that further "words of advice" will be offered to people repeatedly found with cannabis. So it seems more than likely that for second and subsequent offences, arrest and charge, and court action look more likely.

We have written to ACPO to seek clarification on this important issue. more news as it happens

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.