14 February 2011
Bulletins from the front: deep cuts, unplanned cuts, malicious cuts?
08 February 2011
Reporting in - News from the South West
I have maintained radio silence for the last couple of months watching how things unravel, but now it is time to break cover.Between now and the end of February councils will be setting their budgets for next year and then we will have a much better idea of the fate in store for some of the most vulnerable members of our society.
It seems that unitary authorities are being as short sighted as the executive councils when it comes to removing the funding for a whole swathe of services which currently provide a safety net for those people with multiple vulnerabilities, none of which hit a threshold for a statutory service. Admittedly a lot of the statutory services are being cut too probably by setting the priority criteria even higher.
A colleague of mine who works for a district housing department bemoaned that it is as if this government have decided on a full on attack on housing;
The grant given to Housing Associations to build new social and affordable housing has been completely cut, but they are still supposed to deliver new housing stock, how? by taking out loans - but how will they repay the loan I hear you ask - through the rent they charge. "affordable" rent = 80% of the market rent, social rent can be whatever (interestingly, I saw a bedsit for rent from a housing association for £103. per week today how affordable is that!!).
The bottom line is with loans to repay the Housing Associations are going to take less risks on who they give a tenancy to; the young and upwardly mobile for "affordable" housing or those on 100% benefit (social housing).
Already the place of last resort social housing will become the sole residence for the sick, unemployable and the dispossessed with that social calamity of the sink estate making an unwelcome reappearance.
Changes to housing benefit will shut yet another escape route for those trying to dig themselves out of the poverty hole. Changes to the Local Housing Allowance will mean that those receiving Housing benefit will only be able to afford property with a market rent that falls in to the lowest 30% (so that will be all the crap accommodation then). but if you are under 35 and single then you will only qualify for the rent for a single room in a shared house.
All is not doom and gloom. If there is a will there is a way.
In the face of cuts to the Supporting People budget Exeter City Council are looking at innovative and cost effective ways to maintain some housing in the city for non priority homeless. The STAR scheme which has been running for 2 years can offer a temporary flat to someone rough sleeping giving them among other things a reference for a rent deposit scheme. This scheme uses part of the housing act which says a council can house someone without accepting a duty toward them, it counts as temporary accommodation so the council can claim top rate housing benefit and the excess is then used to buy in a bit of floating support. Any local authority could do this even if they don't own their housing stock.
I guess what I am trying to say is things are bad, the outlook for the year ahead is grim, but there are ways to keep on ensuring that there is some support available for those people who traditionally slip through the net and we have to keep trying.
The time for moaning is over, the time for action is now
Over and out.
10 January 2011
Omissions, Contradictions, and Confusion: The 2010 Government Drug Strategy reviewed
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.
“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.
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.
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.
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.
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.
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.
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.
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]
23 December 2010
Council Cuts Cornwall
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!
15 December 2010
If you are running winter provision for the Homeless - assess for overdose risk
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
28 November 2010
Why the Release Helpline is still essential!
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
14 November 2010
Dopey Journalism # 1: The Price of A Plant
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!
02 November 2010
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
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.
31 October 2010
6-APB Briefing
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
24 October 2010
Project Prevention: Beams and Motes
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.
25 August 2010
So This is What a Sucessful Policy on Cannabis Looks Like!
- 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?
23 August 2010
The Straw Man of Recovery
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.
20 August 2010
Something wicked this way comes…
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.
17 August 2010
If I can’t dance I don’t want to be in your 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.
10 August 2010
Cannabis: B but no PND says the Met PC
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



