From Pay Day loans to the Pot-Trap

How poverty and pay-day loans are driving people to the cannabis cultivators.

As austerity bites, bills soar and Christmas hoves in to view, the legitimised high street “loan-sharks” – the pay-day loan companies, are minting it. But as CABs around the country will attest, more and more people are struggling to meet repayments or astronomic interest rates. People already in debt face losing more and more under a burden of crippling debt.Outside the same CABs, an offer of salvation is at hand - Cannabis cultivation.

As Police enforcement activity against large cannabis farms has become more and more effective, some cannabis cultivators have adopted a different strategy: instead of growing 500 plants in one house, why not grow 50 plants across ten houses? That way, it’s less likely that you lose the entire crop, and it requires ten times as much police research, ten warrants and ten raids. All of this needs to be executed in the limited germination-to-harvest time-frame.

Whereas previously, growers would have rented properties themselves for larger grow-houses and installed their own gardener, with smaller growing set-ups, there’s no need to rent a whole property. It’s easier to find someone who has a spare room and install the plants in there. For a while, people wanting a bit of extra money provided much of this space. But, of late reports from a number colleagues highlight that it is people falling deeper and deeper in to debt are being approached by growers. The offer is typically to have debts cleared in return for growing space. Significantly, some workers suggest that those in debt are being targeted with these offers; a colleague in the Midlands said that he knew of people being approached in the queue outside the CAB being approached with a view to housing a grow-room.

From the growers’ point of view, it’s a minimal risk, maximum return situation. They may get grow space for little outlay. The person who lives in the property, afraid of repercussions, is unlikely to share information with the Police. If there is enforcement action, the grower is insulated from risk of prosecution. The Occupier ends up running the risks, for minimum, if any reward.

For the people caught in this position, the situation is dire. On the one side, there is escalating interest if pay-day loans go unpaid. This could result in court action or loss of housing due to mounting debt. On the other hand, there is the risk of criminal proceedings and possible custodial sentences for cultivation of cannabis. If this wasn’t bad enough, there is the additional risk of reporting the growers or failing to cooperate in delivering the harvest.

Another worker working with a woman in this situation described her client’s intense fear as the plants grew bigger that someone would discover her harvest. But stuck in a triangle of debt, fear of police and fear of growers she felt utterly trapped and couldn’t see a resolution. Her only hope, as she saw it, was to get to harvest time, clear her debts and start over.

It seems likely that as more people are forced deeper in to debt and end up taking out loans that they can’t repay, there will be a growing pool of desperate people for the cannabis cultivators to draw on. For those facing this situation or already trapped in this position we need some responses. These could include:·        

• Education and awareness raising within debt-advice services to highlight the perils of being drawn in to cannabis cultivation as a solution to unmanageable debt
• A police amnesty so those who have been drawn in to allowing cannabis cultivation can get out of the situation without criminalisation and with regard for personal safety;  
• Housing providers taking a supportive view of people coerced in to such cultivation so enforcement action doesn’t result in homelessness.

 At this stage it is hard to know the extent of debt is driving people to be unwilling hosts for cannabis growers. But anecdotal evidence says it is on the increase. It is important that those stuck in this situation are recognised not as villains but as victims.

Anabolic Steroid Users, Needle Exchange and the Peril of Publicity

There have been a fair few media stories over the past few years about the increase in Needle Exchange usage by people using Performance Enhancing Drugs – especially anabolic androgenic steroids.

A classic of the genre is this one from the BBC: http://www.bbc.co.uk/news/uk-england-bristol-19650743. In truth through, the stories are highly interchangeable – usually some statistics about increased usage from a Needle Exchange, comments from drugs workers and experts, and some comment from a user about their use.

Inaccuracies and sensationalist reporting aside, the ongoing news stories originating from Needle Exchanges about steroid use is something or a double-edged sword.

On the one hand, needle exchanges and drug projects need to ensure that they retain the funds and resources that allow them to continue. As the welcome downward trend in heroin injecting continues, it is essential that funders and commissioners are aware that other populations need access to needle exchange. And so identifying and publicising the level of service usage – and the level of need is essential.

Indeed, some services, researchers, harm reduction advocates and academics are clearly of the mind that highlighting the level of use is one of the key tools for securing the funds required to develop and expand services to steroid users. Such expansion could include better specialist services – highly trained staff, opportunities to have blood analysis undertaken and better health care. To secure such funding, demonstrating a level of need is essential.

In order to do this, agencies need to record drug of choice. It also helps to identify and respond to trends, and also so that they can ensure staff are trained and resources. The agency needs the profile of their clients, funders demand it and resources hinge on it.

People who use Anabolic Androgenic Steroids often view the situation differently. They are acutely conscious that their drugs of choice occupy an unusual position within the Misuse of Drugs Act 1971. The drugs are currently legal to possess, even if not prescribed, putting them in a privileged position compared to most other Controlled Drugs. There have been changes to this in the past year – introducing a requirement to be in personal possession at the point of importation, but the removal or a requirement for the drugs to be “in medical form” to be lawful. These changes make it theoretically harder to purchase and import high quality “licensed” products on-line, whilst making the possession of counterfeit or underground products now wholly lawful.

As such some people using steroids think that they have a vested interest in keeping steroids “off the radar” and trying to reduce the extent to which it comes to wider public attention and certainly off the agenda of legislators. Even the argument that better evidence of need could result in better service provision cuts little ice here. Whilst we don’t know the exact figure, a fair proportion of people injecting steroids elect to purchase their elected equipment on-line rather than using needle exchanges. For some this is merely practical: not all needle exchanges give out the range or quantity of equipment that some users want. Others just don’t want to be seen using needle exchanges. A few argue that if they can afford it they should buy it rather than using a free service they view as being in greater need. But of the needle-exchange refuseniks, a fair few are making a very deliberate decision not to use needle exchanges to avoid contributing to statistics which could reveal the nature and extent of steroid use.

One of the recurring responses, from moderators on a leading UK body-building website makes the case thus:

Steroid users should never, EVER use an exchange.
 
Steroids are class C atm. They govt are always looking for the next "vote winner". Let's re-classify steroids to 'save the children' will be the call. How will they manipulate this change? From spurious data and figures that would be used to drive home a message to joe public that "the UK has a massive steroid problem". Look how many users there are compared to year xxxx etc etc. The more people using exchanges, the more convincing their argument, even when you and I both know relatively speaking it is no-where near problematic proportions.
 
As such, needle exchange discussion is not encouraged on [this bulletin board.]

Judging by the various threads and discussions this view is on the increase with more and more people electing to use on-line suppliers rather than needle exchanges.

In an (admittedly) small on-line poll less than one in four people using injectables said that they used pharmacy exchange all the time. A staggering 63% voted “I never have, and never will use an exchange.”

Given the track record of Government on drug prohibition, I can’t help feeling that some of the concerns of those who caution against needle exchange are well founded. One would hope that a rational Government would recognise that criminalising and driving a group underground would be counter productive. So far, in no small part due to careful presentation of evidence by leading lights in the UK, the ACMD has shied away from rescheduling steroids and the Government, despite the obvious temptation of the Olympics, has not seen an urgent need to do so. But against an ongoing drip-drip-drip of negative steroid media stories, I wonder how long until the status of steroids is renewed again.

Why, some will ask, does it matter if steroid injectors don’t use needle exchange? If this population can afford and are willing to purchase their own equipment, why should agencies be at all concerned?

Some workers (and indeed some commissioners) have endorsed this approach, saying that needle exchange isn’t really “for” steroid users and as such if they can afford their own equipment they should really buy it not use Needle Exchange.

Personally I have no truck with this analysis. I don’t remember a similar argument for means testing needle exchange being made for other drugs. Needle exchange is intended to be available to all who inject non-medical drugs, because of the public health need of such a service, irrespective of ability pay.

We want people to use services because that way we can ensure people get advice about injecting technique, access to advice, woundcare, BBV testing and vaccinations. Certainly many steroid injectors have a good understanding of what they are taking and how to use it. Others don’t and they need access to this information.

Not all steroid users are sourcing equipment on line; almost a quarter, for whatever reasons, needle exchange represents an essential source of equipment.

So here’s the catch 22.

In order to demonstrate need and to attract funding to provide great services agencies need steroid injectors to attend. But those same injectors are concerned about attending and being counted because, rather than seeing this resulting in better services, they fear that the aggregated statistics will be used to justify criminalising steroid use.

Agencies don’t help their case by stressing the confidential nature of their service and then ending up all over the front pages of the local press, highlighting how much steroid use has increased. If there were ever a way of reinforcing the fear that use of needle exchange puts steroids more firmly in the public eye and increases risk of prohibition, this is surely it.

So what’s the solution? In the short term, needle exchanges and other commentators need to think carefully about the pros and cons of highlighting increases in steroid use to the media. Not, I should stress, because this directly impacts on UK policy, but because the same steroid users who read the papers today are the ones who, tomorrow may be disinclined to use needle exchange.

More fundamentally, it highlights the importance of drugs policy being independent of political ideology. If users feel that they can’t trust how statistical data is being used, and they can’t believe in an evidence-based drugs policy it’s hardly surprising that they will seek to keep their use “off-radar.” Rather than viewing wider recognition of use as a way of garnering resources and better services, it is viewed with great fear.

People using anabolic androgenic steroids and discussing this issue on forums are deeply suspicious of the use of statistics and research by needle exchanges and how it impacts on the media and wider policy. Agencies need to recognise and respond to this suspicion and work to undo the damage.

Changes to Steroid Legislation - swings and roundabouts

Changes come in to force today which affect steroids and other performance enhancing drugs and ancillary compounds.

The key changes are:

• to remove the requirement that drugs are in a "medicinal form" making possession of non-pharma products lawful and 
• to introduce a requirement of personal custody at time of importation, making purchasing on line unlawful.

 The changes which affect drugs in Schedule 4ii of the Misuse of Drugs Regulations can be found here: http://www.legislation.gov.uk/uksi/2012/973/contents/made and a more helpful Explanatory Note here: http://www.legislation.gov.uk/uksi/2012/973/pdfs/uksiem_20120973_en.pdf
The Explanatory Note explains:

Amendments relating to Schedule 4

7.7 At present the provisions specified in regulation 4(2) of the 2001 Regulations (the prohibition on importation and exportation of controlled drugs) are disapplied in relation to drugs listed in Part II of Schedule 4 to the 2001 Regulations in respect of the prohibition on importation and exportation when imported or exported “by any person for administration to himself” and when contained in a medicinal product.

7.8 The instrument will make clear that regulation 4(2) of the 2001 Regulations is limited to importation and exportation of drugs listed in Part II of Schedule 4 when carried out in person by the same person who then administers such drugs to himself. The instrument also removes the term “medicinal product” from the 2001 Regulations (including by omitting the definition of such term contained in regulation 2(1)) with the effect that the term “medicinal product” no longer applies to provisions under the 2001 Regulations in general.

The change made to remove the requirement for the products to be a "medicinal product" represent an interesting shift. The rationale for doing so when the ACMD advised the Government to remove this wording was that  

"The ACMD do not believe the term ‘medicinal product’ assists in the enforcement or legal framework for anabolic steroids under the Misuse of Drugs Act 1971. The ACMD consider that the term ‘medicinal product’ should be removed from the legislation as the term does not serve a recognised purpose"

http://library.npia.police.uk/docs/ACMD-anabolic-steroids-2010.pdf

This was clearly not a view shared by the Crown Prosecution Service or, for that matter the Court of Appeal who in R. v Foster upheld the conviction of Foster who was found to be in possession of Stanozolol in a non-pharmaceutical form (capsules branded "No Bull".) The case summary is here

Foster's case, and the later prosecution of Graham McAdams  whose guilty plea was largely influenced by the precedent set by Foster, seemed to indicate a willingness on the part of the CPS for possession of non-pharmaceutical steroids.

These two cases made it more likely that any compounds produced by Underground Labs (UG) would be held to be prohibited under UK law.

 The decision to remove the term "Medicinal" from the legislation means that henceforth, possession of UG lab-produced steroids will not be an offence in the UK if this possession is for personal use. This is a mixed blessing. On the one hand it means that prosecutions arising from legislative confusion such as Foster and McAdams should be a thing of the past. However, as such cases were rare, this has no huge implications.

More importantly, it means that there is no legal disincentive to possessing UG labs drugs, which may not be produced to the same standards as pharmaceutical products. The worry therefore is that this legislative change will increase the popularity of UG compounds, despite the increased risk.





The other key legislative change is to introduce a requirement that importation of Schedule 4ii drugs be undertaken by the person using the compound. Effectively this means that the user needs to have the drugs in their personal custody at the time of importation. This in theory makes it unlawful to import by post and restricts people being able to buy compounds on-line.



It will probably result in an increase in seizures of drugs being imported in to the UK, especially in bulk. But I suspect in terms of individuals ordering on line, the impact may not be so profound, especially where postage is taking place within the EU. Small quantities of packaged steroids, with a low odour, are not going to be massively easy to detect and so the quantity that slip through are likely to be significant. Those that are seized will be destroyed but it is unlikely to result in an upsurge in prosecutions for unlawful importation.



The bigger risk that concerns some commentators in the field, is that it will result in an increase in UK-based manufacture to avoid the issue of importation. This would mean more labs being set up in the UK either making steroids from scratch or packaging imported powder testosterone.



Only time will tell if these fears are well founded or not. But it is certainly a cause for concern that the legislative changes could see an increase in UG lab drugs whilst at the same time depenalising the use of such compounds.

Advocates of the legislation will probably argue that the previous legislative wording had resulted in a proliferation of steroid availability in the UK. However, with no effective research in to the current levels of steroid use in the UK, the incidence of complications arising from steroid use, and the current ratio of UG to Pharma products used, it will be well nigh impossible to demonstrate if the legislative changes have had a benign impact or not.

drugs and radicalism: it was ever thus (part one)

The Occupy movement in London was the subject of significant negative publicity which related to drugs. While some of the allegations made were undoubtedly made by those with a vested interest in denigrating protesters http://www.guardian.co.uk/uk/2011/nov/21/occupy-london-camp-eviction-bid other, first-hand information confirms, to my satisfaction at least, that drug and alcohol problems were an issue amongst some of the people staying at the protest site.

This is not a new development. It's an old, old problem. It's probably a century old problem, but it's certainly one that has dogged radical politics in the past half century. And it's one that we have yet to engage with successfully. The creation of autonmous spaces - or what Hakim Bey termed Temporary Autonmous Zones - can be a time of positivity and constructive change. But the energy and creation of temporary autonomous space has, all too often, been negated by the arrival of significant drug problems, including problematic alcohol use.

This has been a very obvious issue for several decades. The issue for Occupy London is only the most recent manifestation of the same problem that dogged road protest sites, especially the M11 campaign, land-squats such as Pure Genius and squatted venues such as Kentish Town's "Rainbow Centre."

Here's the problem: create autonmous safe space outside society's normal rules, and a collection of people arrive to fill that space. Included in this rich mix are those for whom society's strictures are problematic, including those with prodigious levels of substance use. the TAZ may represent a safe space, free of judgement. It may also represent a place where there may be food, tolerance and opportunities to use a lot.

The presence of problematic substance use in TAZs is a problem, and one that has never been adequately resolved. As a manifestation of radical politics, those within the TAZ seldom want to involve forces of law and order to address their problem. But the issue left unaddressed almost invariably causes problems for the TAZ. At its most prosaic, it may be the draining of energy, where time and effort that should have been spent on radical action is instead spent trying to resolve internal problems. The tensions between the activists and the "lunch outs" at protest sites like the M11 were the stuff of legend and highlight the energy wasted over these issues.

The ability of substance use to undermine radical movements isn't limited to TAZs. We could look to at the way that amphetamine and barbiturates chewed through punk, or alcohol and smack through the 'new age' Traveller movement. We could probably look further back - wine and hashish during the Paris Communes, psychedelics during the Summer of Love? At each stage the fine edge between liberation and creativity in acts of rebellion grates uneasily against the way that radical movements are undermined and ultimately sunk by their proclivity for substances.


Those involved in TAZs have yet to develop a credible response. There is an understandable unwillingness to involve the Police. This is perfectly reasonable given that any embryonic radical movement needs to develop its own responses independent of the powers of the system Individuals may try and refer the person to support and treatment agencies but these often meet with limited success. The day centres and treatment agencies can offer some interventions but don't mean that they can resolve an issue rapidly or even successfully.

So what is the TAZ left with? Threats? Exclusion? Demanding the person leaves the site? Is all we are left with hand wringing on the one hand, or the time-honoured vigilante response of the boot and fist to that we cannot incorporate? All these things sit uncomfortably with the politics and morality of a Zone that declares itself outside the normal rules of the system. But the alternative - to accommodate and tolerate - doesn't always seem feasible.

This is a problem that those with an interest in radical politics have to engage with and resolve. A cohesive, practical and workable set of responses to problematic drug use are essential for a radical movement which seeks to carve out autonomous space. Do we tolerate? Treat? Or do we replicate the same responses that the state has followed - to exclude and criminalise.

I wish I had an answer to this. One solution - the utopian one - is that on the other side of the TAZ is a place where such problems just cease to be. This is an issue I want to come back to in a later blog. But on the journey to these sunny uplands, we still need to make the TAZ workable whilst addressing problematic substance use. And we haven't yet.

Whose Duty - What Duty: Overdose, Naloxone and Acts of Omission

A recent piece I penned for DDN's "Soapbox" Column provoked a stream of angry responses. Some of these appeared in DDN's letter page the following issue.A few wrote to me directly. A few tweeted about it. I wrote to each of the respondents because I wanted to expand on the issue of acts of ommission and duty of care. This blog piece takes the gist of what I wrote and expands on it. As it draws on case law from the UK it is of limited relevance to other countries.

Let me be clear – I don’t think that a much-expanded use of naloxone per-se and an massive increase in take-home Naloxone is a bad idea. Quite the opposite. It has, can and will save lives. I also believe in the distribution of foil, crack-pipes, Water for Injection and the opening of Supervised Consumption Facilities. Each bring with them legal and ethical issues which need to be carefully explored. 

In the case of Naloxone, some of these could be concerned with the administering of Naloxone. But my concerns are not primarily to do with the administering of naloxone which I recognize is a very safe activity and when done properly, within the framework within which people are trained should not create significant problems.

 

So when one advocate of Naloxone states “the law protects those who administer naloxone from prosecution,” I largely agree - though would add that there could still be scope for litigation if an aspect of the administration were negligent. Others may disagree with this. It would be for a court to decide as there isn't a clear precedent for this. Where I think my views diverge is when the same advocate makes the assertion “it doesn’t punish those who fail to administer it.”

I think this is an area that warrants further discussion and exploration, not least because of the case of sad and troubling cases of Evans and Townsend which I think has significant implications here. 

The cases of Evans and Townsend are deeply unfortunate.

The case dates back to the death in 2007 of Carly Townsend, in Wales, from a heroin overdose. Her mother, Andrea Townsend, and her half-sister Gemma Evans, were prosecuted, convicted and imprisoned for manslaughter on the grounds of gross negligence. Evans and Townsend is an important case because it potentially expands and certainly reinforces the concept of duty of care, especially  in overdose cases, what could constitute negligence.

Carly had taken heroin which her sister and been instrumental in procurring. In court it was reported that "[Townsend] said she was frightened after Carly's lips turned blue but this only lasted for seconds so she and Evans placed Carly on a bed and she "listened to her snoring from downstairs where she watched television.
She said repeatedly she thought her daughter would "sleep it off".

Although neither party had specific overdose training, they had placed the victim, Carly, in the recovery position but, critically had failed to call an ambulance. A duty of care was held to exist for both parties for differing reasons – for Townsend (the mother), a familial duty of care existed and for Evans (step-sister), because she had been involved in the supply – although not charged or convicted with supply of the drugs herself.  

I think this is a significant point. We accept and recognize the duty of care that can be applied to professionals, it also applies to familial duty of care, and based on Evans, it applies where there is some involvement in the supply (and by extension the administration.)

At the risk of speculating (which seems to be frowned on by some parties) the older case of Stone and Dobinson (1977) has a bearing here too, because it established that “a duty exists where a person assumes a responsibility for another…” I don't want to follow this line of reasoning too far - Stone and Dobinson is quite an old case and probably should not be relied upon. The idea that a duty of care can exist for bystanders who try to render help has not been supported elsewhere and so such an extension is probably not that useful.

Having accepted the duty of care owed by professionals, some family members, and those involved in the supply and administration to my mind it doesn’t seem to me unreasonable that a person, familial or otherwise, who has taken on the role of a “carer” (in the context of undertaking THN training with a view to administering to an opiate user) could be considered to have a duty of care in law. This would seem a logical extension of Stone and Dobinson, creating a category above that of mere bystander but withouth the established roles of professional or family members.

Based on this, the next question is this: could a failure to administer naloxone or the failure to call an ambulance after giving naloxone be considered a gross breach of duty of care if the person died of an overdose? Assume firstly that the person (professional or otherwise) has been trained, and that they are in a potential overdose situation. Naloxone is available. For whatever reason the person fails to administer naloxone. Why? Uncertainty, intoxication, fear, dissuaded by another. I don't know. It's a hypothetical. But anyway they don't administer and the person dies.

Based on existing case-law if we take naloxone out of the equation, and we simply leave it with the issue of calling an ambulance or not, then the failure to call an ambulance by a person held to have a duty of care, which resulted in the death of an overdose casualty has been held to be manslaughter on grounds of gross negligence. This is the legacy of Evans and Townsend.

By extension if a person with a duty of care administered naloxone but then failed to call an ambulance and the casualty then died, I can't see a reason why the same wouldn't apply. 

The remaining question relates then to the failure to administer naloxone.

So far, based on everything I have read and every analysis and discussion I have seen, the discussion has hinged on the risks and ethics of administering rather than not doing so.As I have said already, I have few concerns relating to administering, although I would still prefer to see a “good Samaritan-type law” to put the issue firmly beyond doubt.

My issue, and the one that stems from Evans and Townsend is the failure to administer and, so far, I am not satisfied that this has been adequately considered. While I acknowledge that legal action stemming from a failure to administer naloxone or  a failure to call an ambulance post-naloxone which resulted in fatality  is unlikely, I am not aware of any ruling, guidance or even a legal opinion which says it can’t happen. Based on current caselaw I think it can. So on that basis I don’t know that the statement “[the law] doesn’t punish those who fail to administer it…” has been demonstrated to be true.

In most settings this isn't a huge issue. It shouldn't preclude roll out of THN especially to family and friends of opiate users. It is simply to highlight that the very process of recruiting and training users, their families and peers to administer THN is a potential double edged sword albeit one with one side larger than the other. 

On the one hand it massively reduces the chances of a fatality – which is overwhelmingly important. But by virtue of the process of taking on a caring role and attending training, the extent to which a duty of care can be said to exist increases, and as such the resultant implications of any omissions – the failure to call and ambulance (or potentially the failure to administer naloxone) go up. It doesn’t mean it shouldn’t go ahead. It means for me that the legal issue should ideally be resolved or at the least those undertaking such a role being made aware of the risks of failing to act, in addition to risk of death.

All these issues take me full circle back to an area of concern which related to hostels, an area that has been of overwhelming interest to me for over ten years. In the small number of hostels that work from an “eyes wide open” basis and actively manage use on site, drug related fatalities have been reduced to zero (including in high-risk, heavy using populations). This has been as a result of careful assessment, trained staff, sensible policies and such factors. This has been a significant success.

My concern (and I recognize that it is a hypothetical) is the issue of Duty of Care (post Evans) is again important. Based on everything I have said so far, I think it is possible for a trained member of hostel staff to be prosecuted under criminal law (or sued by a victim’s estate) for a failure to call emergency services. I doubt you would disagree with this. By extension, if at some point hostels start to hold naloxone and receive training on its use, would a failure to use naloxone be a similar breach of duty? I think they would, hence the need for hostel staff to err on the side of caution and administer “to be on the safe side.” If a hostel is “over-zealous” does this mean people would go and use elsewhere? Maybe. I accept that this hasn’t happened yet – but then in the UK naloxone hasn’t been expanded in to hostel settings on the whole. When it does I hope that the issue is monitored very closely. I am aware that these same issue are now being explored very closely in terms of Police carrying and using naloxone. It will be interesting to see how these discussions resolve.

For a detailed analysis of Evans and Townsend, see the following
http://www.peterjepson.com/law/Special%20Study%202013/Evans%20%5B2009%5D_1_W.L.R._1999.pdf

http://www.e-lawresources.co.uk/R-v-Evans.php

Gross Negligence Manslaughter and Dury of Care in Drugs Cases: R v Evans: Glenys Williams: Crim LR

Getting needled #1

How much needle exchange equipment is wasted? I don’t mean how much ends up not getting returned. That’s an issue I want to return to at a later date. But how much of it gets discarded unused?

This has been an issue since the early days of pre-packaged equipment. I remember when, long ago in the West End of London we moved from pick-and mix equipment to prepacked bags of 10 needles/syringes one of the big discards wasn’t used equipment but large amounts of unused equipment. People wanted one or two needles, we insisted on giving them ten needles and so, predictably, most of the equipment was chucked away, unused.

Anecdotal information suggests that this situation has not get better and, in some areas, has got much worse. Discussions and training sessions with housing organisations and community wardens has, in some areas, raised the issue of larger quantities of unused equipment being discarded. This has included virtually complete needle exchange packs, suggesting users only wanted one or two syringes and on other occasions discarded spoons.

As the range of needle exchange equipment has increased, with the advent of (for example, sterile spoons) and more distribution takes place with prepackaged equipment from pharmacies so, the risk is more equipment gets discarded unused.

The rationale for such bundling is to reduce cost – bulk purchasing reduces costs and prepackaging makes distribution faster. In theory giving out more equipment in bigger bundles should be a winning situation: less episodes of exchange reduces the burden on pharmacies, should mean each episode can be more intensive, and by giving more equipment out should reduce episodes of sharing or reuse. But has this happened in practice?

In one area for example the package size is 20 syringes per bundle with associated paraphernalia. It makes for a fairly large and obvious package – not discrete. And anecdotal feedback suggests that it is not uncommon for significant amounts of these packs to be discarded unused.

We don’t know how much equipment is discarded unused. It might be things that the person simply never wanted – such a person who didn’t want to use the provided sterile spoons. It might excess be excess syringes when the person, for whatever reasons, didn’t want all twenty, just one or two for use today. Or it could be the “other” needles – the twenty orange 25G needles that the person didn’t need because they were using the 23G blue needles in the same pack. They had to be provided together as a compromise necessitated by prepackaging equipment, in the knowledge that one lot of needles will be surplus and discarded unused.

Without knowing how much equipment is being discarded unused, we can’t start to put a price on it. This is bad enough. Worse, without a clear picture of how much equipment is distributed but not used, we risk working under the false impression that we are getting more equipment out to injectors and that it is being used. So we may end up looking at the headline figures – how much equipment is going out – where this figure has gone up, assume that our injectors are getting more clean equipment.

In the statistics for one area that I was looking at, the quantity of injecting equipment distributed almost doubled in the period from last year to this. We know in the same period that the number of injectors hadn’t gone up. In fact it had gone down. So the doubling in quantity of injecting equipment distributed should mean that the reuse or sharing of equipment would halve, which would be a great outcome. The fear though should be that a significant proportion of this additional equipment distributed is not being used, but discarded.

Perhaps the reason for the doubling of the distribution is in part because of large pre-packaged bags.

Across the same time frame in South Wales, pack sizes reduced instead of increasing (from ten needles per pack to three.) And while the number of packs distributed increased by around 30% the net result was an overall reduction of the number of needles distributed. Did this mean that the level of sharing and reduce increased? Or did it result in a reduction in wasted equipment?

We need to know the answers for two key reasons:

• We can’t start to accurately assess the extent to which distribution meets need, if we can’t say with any confidence what proportion of distributed equipment is actually being used;
• We could be wasting significant resources if we are distributing equipment which is being discarded unused.

There are several things we can do to try and better understand and address this issue.

The first requires some detailed research. There is a huge information gap that needs to be overcome. In many needle exchange areas the return rate is low, coming in below 50%. But at the same time the level of public discards is (mercifully) very low. This makes it very difficult to assess whether non-returned equipment is being discarded used or unused. We don’t know where it is going. Domestic waste? Building up at home? Public bins? Not known. And this isn’t the key question to be honest. It just means that it makes it harder to assess how much equipment is being discarded unused.

The only reliable way of eliciting this information will be research with needle exchange customers to assess what proportion of collected equipment is used, and what proportion is discarded, unused. Such research should ideally be cross-correlated against model of needle exchange, and type of equipment. Does large pre-packaging, for example increase the amount of unused equipment discarded. Is there less discarding with pick and mix?

A less reliable, but useful interim measure will be more accurate monitoring of drug litter and discards to ensure that all such monitoring differentiates between used and unused equipment. While some areas do this it is not universal, and to do so would help monitor trends over time and the impact that changes in provision have on discards.

If research shows up high levels of equipment is discarded unused, it will highlight the need for changes in practice and policy to reduce this senseless waste. But in the meantime some measures can be taken to maximize the chances that equipment taken from exchanges is used, and not discarded unused:

•  Maximizing pick and mix distribution to ensure people can take as little equipment (or as much) as they want
•  Avoiding prepackaged equipment exclusively in large quantities
• Ensuring that local policing policy and practice does not discourage people carrying quantities of clean equipment
• Ensuring that policies in hostels and supported housing is supportive of injectors storing clean injecting equipment on site
•  Provision of suitable bags to carry injecting equipment discretely (such as backpacks) rather than pharmacy carrier bags
•  Provision for homeless injectors and those for whom carrying large quantities is impractical – including distribution of small quantities of equipment with suitable means of disposal.
•  Raising awareness amongst injectors of the cost of equipment distribution with a view to reducing avoidable waste.

dope hyper inflation

Just over a year ago, I wrote about the wide variance in the value ascribed to cannabis plants during court proceedings. In the article the range of cited values was from £150 - 800 a plant.

So a piece in the Sheffield Star caught my eye as it highlighted that the values ascribed to cannabis had increased massively - with a meagre haul of five plants valued at £9050 - a staggering value of more than £1800 being ascribed to each plant.
 
It's just as well that the values placed on cannabis aren't included in the RPI because we'd then see inflation heading towards the 10% mark in no time.

Publish Post

Is your Drugs Policy fit for purpose?

I've been doing a lot of work lately reviewing organisation drugs policies. Some of these have been big organisations, some small. But a clear issue to emerge is the difficulty organisations still seem to be having in writing their Drugs Policies and the accompanying procedures.
The problems seem to fall in to three main groups:

1: No policy: I remain astonished that so many organisations still don't have drugs policies at all. It's almost fifteen years now since the Wintercomfort trial which saw senior Day Centre staff in Cambridge prosecuted for offences under the Misuse of Drugs Act, and this case should have ensured that every organisation engaging with people who use controlled drugs would have a workable policy in place. But this isn't the case. And the worst offenders? Local Authorities! On numerous training sessions, the social housing providers and day centres tend to have a drugs policy, but the Local Authority staff don't. All too often, the explanation is that the Local Authority has a "zero tolerance" approach to drugs and this is meant to form the basis of the drugs policy. Which leads on to...

2: Unworkable policy: where policy is in place, all too often it is so keen to demonstrate its anti-drug credentials, that it introduces unworkable clauses that are wholly unrealistic. These policies, if implemented, would see Police being called out for any suspicion of drug activity, and empty buildings where transgressors had been evicted. In truth such policies are never adhered to, leaving a void of confusion where staff, managers and residents interpret their policies as they see fit.

3: Mismatched Policies: sometimes, the policy itself is fine - but is at odds with the organisation's stated aims. All too often an organisation which should be working in an accessible and flexible way with homeless drug users has a robsutly zero tolerance policy which drives drug use underground or sees people being evicted - the very people the organisation is seeking to house.

The problems organisations have with their drugs policies are going to be compounded at present by the financial climate and funding cuts. To provide safe, supportive housing in an average sized hostel with people with significant drug related need, higer staffing levels are essential. Realistically three members of staff should be on shift at all times - less than this makes it hard to manage a crisis safely. One member of staff to tend casualty, one to go and summon help and admit emergency services and one to ensure that the rest of the building and residents are safe. Less than this is an accident waiting to happen. And "less than this" will increasingly become the norm.

Low staffing levels are likely to be worsened by under-trained staff. As budgets are slashed,. so is staff training and so organisations are likely to reduce the amount and quality of staff training which leaves both staff and residents at risk.

This is all happening at a time where, as part of the BS (Big Society, but interpret as you see fit), we are likely to see more wholly-volunteer run provision for the growing homeless population - including drop-in provision and nightshelters. While such provision my represent a much-needed response in areas of high need and low provision it brings its own risks. The well-meaning, but undertrained and under-resourced provision can become unsafe. Again, it is imperative that such provisionhas suitable training and policy in place so that it can run both safely and lawfully. The spectre of Wintercomfort hangs over provision that fails to do so.

There is one more factor that may drive some organisations towards ill-considered and mismatched policies. This is the increasingly common elision of "recovery" and "abstinence" and the proposal in the new Government drug strategy that housing provision for drug users should, along with treatment providers, increasingly receive payment by results.

The need for suitable and stable housing, with appropriate support, represents a critical aspect of the recovery journey. A lack of housing, or the wrong housing can make it much harder for people to start and sustain the process of change. BUT, and it's a big but, refusing housing to people who are not yet abstinent, or returning people to homelessness when they lapse is not beneficial.

Let's be clear: there is a need for housing which is wholly drug free and has minimal tolerance to drugs. This housing is urgently needed for people who are in recovery and abstinent and are striving to remain so. In such cases a minimal tolerance drugs policy would be wholly in accordance with the organisations aims. But where the primary aim is to provide housing to people who are homeless, and who may also use drugs, such a policy is misplaced. Organisations can and should support and nurture and aspire to the prospect of change and as this happens move people in to appropriate housing. But to use the threat of eviction to stimulate the process of changed hasn't been demonstrated to work. It just drives use underground, increases overdoses and hampers honest dialogue regarding use.

Given all these challenges and problems besetting housing providers working with drug users, it seems an opportune moment for us to relaunch the Sample Drugs Policy - a document that was originally written after the Wintercomfort Trial and has been revised regularly since then. This version - the seventh - is substantially rewritten with a longer introduction about how to develop a drugs policy. There are some more extensive procedures and flowcharts to help understand how to implement policy.

This version of the Policy is unashamedly a "high tolerance" model, aimed at organisations working with ongoing users. It will shortly be joined by other models - a moderate tolerance, low tolerance, and minimal tolerance version for use in different settings.

The development of this version has been much assisted by Homeless Link, and by Stoke On Trent Supporting People, without whom this revision wouldn't have seen the light of day.

The Sample Drugs Policy 2011 can be downloaded here

Give me your tired, your poor, your huddled masses: just not in Westminster

Throughout mythology and folk tales, a tried and tested method for Gods and Kings to test the state of their kingdom was to don the rags of a beggar and walk the streets to see if the great and the good were indeed so great or good.

Were a latter-day deity or monarch to pitch up in Westminster, then far from hoping to get fed and tended, they may well in the future fall foul of a Council by-law which would make it an offence to give food to the hungry or for the tired or sick to lie down.

Similarly, if the sermon on the mount were relocated outside Westminster Cathedral, the redistribution of fishes and bread would be a fine on conviction.

It would be hard to miss the proposals from Westminster City Council to criminalise the distribution of food and lieing down or sleeping in an area of Westminster.

The Council's website describes this as a move "backed by Homeless Charities" and the text on the website focusses on the issue of Soup Runs, asserting that the soup runs turn the area "into a no-go area for many residents and businesses with issues around litter, urination, violence and disorder."

Few people would disagree that there has been a long-standing need to ensure that any agencies distributing free food are well co-ordinated and take responsibility for ensuring that mess is cleared up afterwards. This concern is nothing new and the same discussions were taking place back as far as the early 90s when Homeless Network attempted to provide some coordination amongst the soup-run providers.

But the proposals from Westminster Council go far beyond criminalising the distribution of food. They prohibit lieing down or sleeping in the public places covered by the order - making it an offence to "lie down or sleep in or on any public place."

If the legislation is passed - and at present it is only the subject of consultation - anyone distributing refreshment or lieing down in the designated area would comit an offence and could be fined.


When the Council asserts that this move is "backed by Homeless Charities" it is hard to find a queue of them supporting the measure. St Mungos for example fall far short of backing the measure and instead state that they do not support the proposed ban on rough sleeping.

The main cheerleader for the measure in the voluntary sector seems to be Thamesreach whose Chief Executive Jeremy Swain is quoted on the Westminster Council website as saying: 
"The Westminster cathedral piazza and surrounding area has been the focus for soup run activity and rough sleeping for many years and this has inevitably had a detrimental impact on the lives of people living and working in the immediate vicinity.
“It is reasonable that the council should seek to introduce a bye-law covering this specific area whilst at the same time continuing to commit resources towards ending rough sleeping in the borough."

It is not clear from this statement if Mr. Swain is endorsing both the criminalisation of soup runs and the further criminalisation of rough sleeping. So far he has not deigned to cover the issue in his Blog. In the Guardian he is quoted as defending the proposal, but with the caveat "This is not a borough-wide ban, which I would oppose." We look forward to Mr Swain joining the protests when such a borough-wide extension takes place as it surely will if this initial bye-law is passed.

Nor is it entirely clear how fining people who sleep rough helps anyone. Unable to pay fines, people will be required to beg more or face short prison sentences for unpaid fines - which will simply eat in to Police and court time and increase the isolation and stigma faced by people who are homeless or vulnerably housed.

But in truth there are others whose stated stance (or lack thereof)  in relation to this legislation is more craven. Of these the most notable must be Westminster Cathedral. The deafening silence from this quarter, other than to lament:
"Of those homeless people who congregate in the area, there is a minority of hard drinkers and drug takers who cause residents and visitors distress, which I have witnessed and been told about," a Westminster cathedral representative told the council. "During the day they can often be seen in groups of up to 15, and this can dramatically increase in the evenings with the soup runs."

Given such an abandonment of the poor and huddled masses of South Westminster, it is hard to read the Westminster Cathedral website without astonishment at the hypocrisy therein.

In the news section, Father Witon happily burbles: 
"CAFOD believes that all human beings have a right to dignity and respect, and that the world's resources are a gift to be shared equally by all men and women, whatever their race, nationality or religion”.
One of the saints said: “the best place to keep your money safe is in the stomachs of the poor”. It is in this spirit that we are all invited to be generous with those who can never say that they have too much on their plate ."

Clearly this sentiment doesn't extend to the poor of South Westminster.

This is perhaps where localism and the Big Society have their first head-on clash: the Big Society expects people to give their time and their energy to take on rolls which the state is increasingly unable or unwilling to fund - like care of the poor and the homeless. But on a local basis residents and businesses want to see action against the same poor and the homeless. And it seems that when it comes to South Westminster, localism trumps Big Society.

In truth the legislation as it currently stands is probably unworkable - and certainly would end up being enforced in a partial and selective manner. There are some exemptions proposed in the legislation: so for example sporting events would be exempt, which will be a relief to marathon runners. And while it will be an offence to give people who are starving food, it will remain acceptable to give out promotional nibbles to encourage people to eat in local premises. Heaven's forbid local businesses should be further inconvenienced! But in the event of a Police kettling operation, they wouldn't be able to give out water to people. And as an aside, the right to peaceful protest would be curtailed by this legislation as lieing down - as a form of protest for example - would be illegal under this legislation. 

But beyond these legal concerns and the attitudes of Jeremy Swain and The Westminster Cathedral there is a bigger issue here - and that is the ongoing and accelerated cleansing of the poor and homeless from the streets of the Capital. A process that has included the introduction of ASBOs, the hosing down of rough sleepers and sleeping spots by Council street cleaners, the deliberate under-counting strategies endorsed by the Rough Sleepers Unit and now culminating in a proposal to make such the act of sleeping rough an offence.

The idea that this will be restricted to one area of Westminster seems naive. Should this piece of legislation be successful, then a rapid extension across Westminster is inevitable. And then, in the run up to the Olympics, seeing am extension to other London Boroughs as the City is cleansed for the marketing jamboree of the Olympics. Westminster proposes, Boris disposes and streets cleared of "huddled masses" for a tourist-friendly Olympics.

Consultation on the proposed legislation closes on the 25th March 2011.