No ID - No Methadone? - Proposed changes to Drugs Regulations

The Home Office has launched a public consultation on proposals to make changes to the Misuse of Drugs Regulations. These proposed changes follow on from the Fourth Report of the Shipman Inquiry.

To read the Proposals in full, please go here

The low-key launch of the consultation at the end of July may mean that it escaped the attention of key agencies. We feel that the proposed changes may have some important ramifications for the Drug Treatment and social care field and would urge agencies to respond to the consultation.

The proposed changes are intended to improve the prescribing, audit trail, and safe handling of prescribed controlled drugs. They include proposed changes to the Misuse of Drugs Regulations 2001.

The proposals have been drawn up after consultation with the ACMD and a number of other agencies exclusively drawn from medical disciplines. Unfortunately, this list does not appear to include the National Treatment Agency, Drugscope, Homelesslink nor any other agency primarily concerned with the needs of drug users engaging with treatment providers.

We are concerned that this has meant that some of the proposals could negatively impact on access and adherence to treatment. We are also disappointed that the Home Office has not used this revision as an opportunity to clarify the legal situation relating to the storage of controlled drugs in non-medical settings.

Paragraph 15: Controlled Drug Prescriptions

Proposal:

Prescriptions for controlled drugs to carry a unique identification number so prescriber can be identified

All prescriptions for controlled drugs to carry a patient identifier number (NHS Number) to identify double scripting



Effectively, this proposal represents a return to a "register" of addicts. Within this proposal, all users prescribed controlled drugs will be recorded and identifiable within a central register.

A key concern must relate to homeless and transient patients who do not currently have, or do not know their NHS numbers. The proposals note a need to consider the "obligations on prescribers and dispensers faced with patients who are unable or unwilling to supply their NHS number."

We would go further than this and propose that given the risk of further excluding people who are dependent on drugs from treatment, those engaged in the treatment of drug dependency should be exempted from this requirement.
We would suggest that this exemption should be time-limited as follows:

"Prescribers treating people for dependency on controlled drugs will need to ensure reasonable efforts are taken to ascertain an NHS number. However, in order to ensure access and continuity of treatment, obtaining such a number need not happen prior to commencing treatment but should take place within the first three months of treatment."

Paragraph 22: Dispensing controlled drugs:

Proposal: requirement for dispenser to ask for the name, address and some form of personal identification of people collecting Schedule 2 controlled drugs.

This proposal is mediated by a proposal to ensure that Pharmacists still have discretion to dispense where a person has no form of identification.

We are concerned that this proposal needs more careful attention to ensure that people being treated for drug dependency, especially those who are homeless or transient, are not unfairly treated by this proposal. Many such patients will have no formal documentation to prove identity, and those who are homeless or in temporary accommodation may struggle to prove their address.

In order to facilitate dispensing to such patients, we would propose the following:

Patients attending agencies for drug treatment to be issued with an ID card which includes patient ID number and photograph, which will be an agreed form of identification at local pharmacists. This will be made available at no cost to people attending treatment. Such a system would be extended to patients receiving treatment from GPs within a shared-care scheme.

Paragraph 27: Controlled Drugs in the Community

We have contacted the Home Office on previous occasions requesting clarification of the regulations relating to the storage of prescribed controlled drugs in non-medical settings. It has been our ongoing concern that the storage of prescribed controlled drugs by hostels, day centres and other allied professionals is not robustly legal. We have brought these concerns to the attention of successive Home Secretaries and have been assured that the issue would be addressed when parliamentary time allowed.

We have documented our concerns relating to the current legal position in detail in the KFx guidance document "On Storage." We have appended this to our submission to the Home Office.

In order to enhance the safe handling of controlled drugs in the community we would like to make the following proposals:

" That hostels and day centres be given the authority under the Misuse of Drugs Regulations to store prescribed controlled drugs on behalf of Service Users, and return such drugs to the named patient.
" That while such services should be given this authority, they would not be obliged to store such prescribed drugs for service users or residents.
" Organisations who wish to store controlled drugs would be required to demonstrate that they can operate to agreed standards including:

Storage facilities

Record keeping

Staff references

Joint working with prescribers



The provision would be audited by the Pharmacy Inspectorate who would furnish a Certificate of Compliance, authorising the storage of such controlled drugs.

Conclusion:

Whilst it is essential that there are effective strategies in place to monitor the use of prescribed controlled drugs, it is essential that such measures do not have a disproportionately negative impact on patient care.

Where the patients in question are receiving their controlled drugs as part of a package of treatment for drug dependency, it is imperative that access and continuity of treatment is not reduced as a consequence of changes to the Misuse of Drugs Regulations.

We hope that this submission highlights these concerns and that they will receive serious consideration as part of the consultation process.


Kevin Flemen
KFx
September 2005

And here's your new Drugs Act

In the dying days of the Parliament, the Drugs Bill, which was being debated in the Lords, was rushed through the last stages of the 'democratic' process and received Royal Assent, passing on to the Statute Book.

The process was a travesty of democratic process. The Drugs Bill had been widely criticised for its inadequacies. It had been castigated on human rights grounds and the Joint Parliamentary Human Rights Committee was particularly scathing in their criticism. http://www.publications.parliament.uk/pa/jt200405/jtselect/jtrights/47/4702.htm

The Conservatives were broadly supportive of the legislation. Predictably the primary changes they wanted to see made were tougher sanctions and penalties, and so, given Conservative support and Labour backing, it seemed likely that the Bill would be passed.

As time ran short, the Bill could well have foundered before the dissolution of Parliament, especially if the Lords had done their job and given the bill the scrutiny it deserved.

However, with the sort of backroom deals that typify contemporary politics, the Bill was passed in the so-called 'wash-up' period. The Tories had been keen to see the Drugs Bill ammended to include moving cannabis from Class C back to B. This is something that Charles Clarke is privately keen to see, but publicly would be tantamount to a labour party policy U-turn. In order to stall such a U-turn whilst pacifying the Tories and securing the passage of the Drugs Bill, Clarke agreed to refer the reclassfication of cannabis back to the ACMD and seek their advice on the subject.

This face-saving formula placated the Tories, secured the passage of the Drugs Bill and, possibly, leaves the way forward for Clarke to reclassify cannabis if the ACMD makes such a recomendation.

Much of the Drugs Act 2005 cannot come in to force straight away, as it requires subsequent legislation, guidance or changes to regulations. The following sections will not be instantly available:

Mushrooms containing psilocin: these will all become Class A drugs, whether prepared or not. However, additional guidance or wording is required to ensure that landowners who merely have mushrooms growing on their land are not committing an offence. This clause will not come in to force until such a wording is agreed.

Initial assessments and follow-up assessments: this new power means that the police can require any arrestee who tests positive for Class A drugs to attend an initial assesment and, where required, a follow-up assessment. However, these new developments cannot take place until funding is released to pay for the assessors and these will need to be recruited.

It seems likely that this development will curtail, if not spell the end of arrest referal schemes as they are supplanted by these mandatory assessments.

Given their vocal opposition to the Drugs Bill, we assume that Turning Point will refuse to bid for any of the new contracts to undertake assessment and would not be so hypocritical as to condemn the Bill whilst actually receiving funds to deliver aspects of it.

Presumption of intent to supply: This section will mean that people found in possession of quantities of drugs exceeding the "proscribed amount" will automatically be considered to be intending to supply those drugs. These quantities have yet to be decided and need to be approved by parliament. This section cannot come in to force until then.

The only shiny jewel in all this sewage is that the amendment to Section 8 by Section 38 of the Police and Criminal Justice Act is repealed by the Drugs Act 2005. So a piece of legislation that Charles Clarke saw fit to pass to garner votes in the last election is repealed by a piece of legislation to garner votes in this one...plus ca change.

When Crackdown goes OTT

Amidst much fanfare and column inches, the Home Office launched Crackdown on 12th January 2005. The Home Office press release said

"Operation Crackdown is being co-ordinated by ACPO and the Home Office. It will involve 32 police forces in England and Wales, focusing on closing drug dens, disrupting local drug markets, seizing illegal firearms and bringing dealers to justice. A key part of the campaign will be working closely with communities."

 

The Home Office appeared to hope that such a high profile campaign, on the run up to a general election, would provide much needed media coverage and reinforce the impression of a Home Office tough on crime and tough on drugs.

However, we have been hearing worrying tales of excess, especially in the closure of so called "drug dens." The word from the Home Office has clearly been that they expect the Police to use the new powers provided by the Antisocial Behaviour Act to close premises. But in some areas, where crack houses are few and far between, the Police appear to have struggled to find proper drug dens. So increasingly any drug user is finding themselves at risk of a closure order - even if they are not "drug dens." So squats are being emptied using these powers and people who are drug dependent and living with their families are being warned that they may be summarily removed from their properties.

We have received independent information from Wiltshire and from Hackney of such misuse of these powers, and it seems likely that such occurrences are taking place else where.

Drugs and housing advisors concerned about misuse of the powers should advise concerned service users of the following:
the property in question must be associated with Class A drug use AND nuisance or disorder; there must be evidence of both. If the property is not associated with nuisance or disorder it should be possible to challenge an application for a Closure order.

 

The property MUST be the subject of a properly-issued Closure Notice. If a closure notice has not been served properly, a closure order cannot be issued. Increasingly the police will want to serve a closure notice on an individual; otherwise it will be posted to the house and affixed to a door.

 

The Closure Notice will specify the Date, Time and Place of the Court Hearing that will determine if a Closure Notice will be issued. You will have to act very quickly.

 

If the occupier or tenant wished to challenge a closure order they will need to attend court and should get legal representation as soon as possible. It is essential that this is done very rapidly as from the point of Closure Notice, a Closure Order will be sought and issued within 24 hours.

 

With legal representation, the occupier or tenant should attend court and apply for an adjournment; this should be allow for proper submissions to be prepared and submitted. The court can grant a period of adjournment for up to 14 days.

 

The occupier and legal team should return to court and provide grounds to challenge the application for a closure order. This could include:

• demonstration that the property is not associated with Class A drug use. This could be supported by evidence of drugs workers, housing support workers, evidence from drug treatment projects etc
• evidence that the property is not associated with disorder or nuisance: this could come from supporting evidence from other neighbours, evidence from Housing Support workers, diary to demonstrate that nuisance is caused by others, etc
• proposals that other approaches will resolve the nuisance or disorder: this include a willingness to attend treatment, agreement to exclude visitors who cause nuisance, or willingness to change behaviour that is causing nuisance.
• other submissions that support the contention that the issuing of a closure order is not an appropriate response.

If a Property is closed, the person will be homeless. It is ESSENTIAL at this point that they do NOT surrender their tenancy at this point as they may be considered intentionally homeless. They should continue to seek legal advice, and make a decision as to whether they wish to take further action.

 

They can apply to the court for the Closure Order to be discharged, but would have to demonstrate to the court's satisfaction that the nuisance or disorder would not recur.

 

Given sufficient legal back-up and a strong case, there may be scope to mount a legal challenge to a closure order, but this will require extensive legal support and resources.

 

If you are squatting remember, these powers were intended to close properties associated with Class A drug use and serious nuisance. Squatters who are using drugs recreationally and are not causing disorder or serious nuisance should NOT be on the receiving end of such closure orders. It is important that efforts are made to challenge misuse of such powers in the courts.

 

Remember: ACT QUICKLY: GET LEGAL ADVICE: GET AN ADJOURNMENT: PREPARE A CASE

The Decline and Fall of David Blunkett

We had been in the process of writing a piece about David Blunkett and the vendetta against perceived antisocial behaviour.

However, overtaken by events, his removal from power has come, not from pursuing a series of draconian and punitive measures against refugees, asylum seekers, economic migrants, people suspected of terrorism, drug users and young people.

Instead it came from the hubris of believing that, while the state had every right to stick its nose in to the private lives of its citizens, he was entitled to privacy while he conducted illicit trysts.

Mr Blunkett has overseen a Home Office that has eroded civil liberties to a greater extent than any other peace-time Government. Traditional rights - including property rights, right to free assembly, freedom of speech and freedom of movement have all been stripped away. Not because of someone's offending behaviour - but because of unproven allegations that behaviour could be considered "antisocial."

Other rights, including Habeas Corpus have been ignored and as his last act before resigning, he has introduced the prospect of ID cards on spurious , anti-terrorist grounds.

While we do not hold out massive hope that any successor will adopt a more even handed approach, we are not in the least saddened to see the back of Mr Blunkett, one of the few people to make Michael Howard look relatively liberal!

Spinning Wheel Blues

Inconsistent policies on drugs and gambling demonstrate Government confusion on both habits.

Amidst all the sound and fury regarding the Government's plans to reform gambling, few commentators have spotted the obvious comparison between Government's approach to gambling and to drugs.

Simon Jenkins, writing in the Evening Standard, was one of the few. He noted "If any law is in urgent need of reform, it is the thus ineffective 1971 Misuse of Drugs Act. It does far more harm to minors than do fruit machines. Yet Ms Jowell and her colleagues will touch it."

Looking at the arguments put forward by the Government in support of it's reforms of gambling, one would be hard put to fault exactly the same arguments if put forward for drugs reform.

In an article, again in the Standard, Tessa jowell defended her bill thus:
"if adults nake the rational informed decision to gamble, they should be allowed to do so. They should be encouraged to do it in places tha are crime free and properly regulated. Above all else, children should be protected from the temptation to gamble."

A key thrust of the Govenment's thinking is that a lack of control has created greater risk to young people. The arrival of high-prize gaming machines in venues used by young people exposes them, the argument goes, to temptation and risk. A licensed and regulated market would remove these machies from these arenas, and limit them to venues where only adults would access them.

If one substitutes "use drugs" for "gambling" in Jowell's argument, the argument is all but identical to the arguments put forward by drug policy reformers.

Fear has been expressed, both in terms of drugs and in terms of gambling that proposals to change the law will result in an increase in problem gambling and gambling addiction.

Here, Jowell offers a different analysis, and again one that is wholly appliable to the drugs field. She argues:
"to judge an entire industry by the people who can be addicted by its product is similar to closing down every pub in the country because of the lif story of an alcoholic. It is not possible to close down an industry and prohibit people from what they consider a pleasure because of the tragedy of a few."

Again, these are sentiments that most drug reformers would recognise and applaud.

After this, however, the Government's approach to gambling and the vision of the drugs reform lobby go in sharply different directions. While the current spin put on the gambling reform is one of "protection through regulation," the other is one of "profit through expansion." The licensing and development of larger casinos, the facillitation of local authority licensing and the projected profits for local and state profits are aspects which demand an increase in the number of gamblers and, by association the number of problem gamblers.

This is where the approach to gamblig and to drugs part company. Drug reform proposes control and safety through license and regulations. A key model is distribution through medical routes for some drugs and controlled and regulated markets for others, notably cannabis. Most drug reformers would abhor an approach which saw big corporations take over this market and actively recruit new users.

The Government is, on the one hand, right to think that regulation is safer than a absence of safeguards. This applies to drugs as much as gambling. But to then actively promote and expand such a market would be indefensible to both too.

The Met ain't so pretty either:

The new metropolitan Police campaign that uses the images of drug-dependent women to highlight the dangers of drug use is grotesque.

The images themselves are disturbing and distressing, but they are not new. They have been circulating on the internet, and the Nimby-wesbsite "Crack Cocaine in Camden" has had a link to the images for a couple of years.

Pictures of three women are used; Roseanne Holland, Melissa Collara and Penny Wood. Holland is believed to be dead, Collara was not contactable and Wood is in treatment.

So the Met are exploiting the images of three tragic women. Depersonalised and exposed to the shocked looks of public they disintegrate before our eyes. UK arrest pictures could not have been used as it would breach confideniality. But the Met have no such qualms about scooping images off the net and using them. They are exploitative, breach decency and ultimately they are ineffective.

The images are as much a condemnation of the US war on drugs, and the failure of the US penal and treatment system as they are of the drugs themselves. Collara was arrested 18 times in three years. Where were the interventions, the opportuities to engage with both harm reduction and with treatment. Holland was arrested at least five times in eight years.

Collara had (according to the Daily Mirror) been sexually abused and had lost her mother at an early age. She was engaged in drug use and prostitution. But despite repeated arrests, the help she so badly needed was clearly slow in coming. Ultimately it was not that the "system" got it right for her but one police officer who viewed her as a person needing help rather than a criminal.

The failure of the war on drugs is manifest. The failure of the criminal justice system that failed these women is written across each face. And the failure of a policy that makes needle exchange illegal and fails to offer adequate education past "just say no" is etched across these billboards.

In the good old days of drugs education, the police used to use the gore fest "Better off dead" to scare would-be users away with footage of autopsy - again of a dead female user. Thirty years later they are using the same approach - but with new images. But where do they go next? More shocking images? More gore? As any body with any media-awareness knows, this process is ultimately self-defeating. We become inured to horror, harder to shock. We cease to care or even notice and the images cannot touch us.

The effects of crack can be extremely damaging; but ill-considered advertising can damage us too. And this damage is so much less obvious

Drug Testing in Schools

An example of a drug strategy now just gesture-politics.

The widely-reported announcement that the Government was to endorse random drug-testing in schools came as a surprise to many.
The mystery of the DfES Guidance Document:
Certainly it seems to have come as a surprise to Drugscope, to the teaching unions and associations and to other Drug charities. It will also come as a surprise to the DfES who published their "Drugs - Guidance for Schools" this month.

This Guidance Document, for headteachers, Governors and LEAs covers all aspects of drugs education and prevention in school settings. The Guidance Document was put together by Drugscope, Alcohol Concern and the DfES, and is endorsed by Stephen Twigg, the Undersecretary of State.

The Guidance document makes little reference to sniffer dogs or drug testing. The report "Headteachers are within their rights to invite the police or private companies to bring sniffer dogs onto school premises or employ drug testing."

However, the report does not advocate such an approach, and does not go in to detail about how to implement such a strategy.

What the report does stress is the need to ensure that any enforcement measures such as sniffer dogs or drug testing are "consistent with the pastoral responsibility of the school to create a supportive environment," and that "A headteacher requesting the use of sniffer dogs [and/or drug testing] solely as a deterrent,where there are no reasonable grounds for suspicion and where prior consent has not been sought, will need to consider possible challenges by parents and pupils under the Human Rights Act."

The announcement made by Blair go far beyond the guidance reccomended by the Guidance document and put a greater weight on sniffer dogs and drug testing than have ever been discussed before.

Blair and the Cult of the Sparkly New Idea

So why should Tony Blair use an interview with the News of The World as an opportunity to announce that the Government is to put its weight behind random drug testing in school settings.

The actual comments made by the PM are not in themselves earthshattering. All he has actually said is 'If heads believe they have a problem in their school then they should be able to do random drug testing,' he told the News of the World. 'Guidance will be given to headteachers next month which is going to give them specifically the power to do random drug testing within their schools.'

But since his announcements, a range of ministers have spoken on the subject and elucidated on the subject and, it seems, added a range of meanings to the PMs comments.

So Ivan Lewis (Education Minister) spoke on Channel 4 news as a process of identifying people early so they could be refered for treatment and counselling. He went further on the Today programme on Monday, arguing that schools could use it as a part of the school policy and pupils or parents who refused to accede could be rejected from the school. He stated that the Government "expected schools to take all appropriate measures [to prevent drug abuse]" suggesting that the Government expected schools to introduce drug testing. But Lewis was clearly under-prepared and under briefed for this interview, saying that he thought most headteachers wanted this power, but unable to say what consultation had taken place, and what the outcome was. John Prescott spoke about testing being a deterrent. And Downing Street added commentary, saying that the aim would not be to see pupils expelled from school.

Who leads on drugs?
But the implication was the same: Blair had produced a "policy" from nowhere, in contradiction to what the DFES was saying and without reference to the drugs or education field. ANd on the back of Blair's statements, a range of other Government heads were wheeled out to speak on the subject. But not, crucially, Caroline Flint or Blunkett. So is this a strategy that has been approved by them or is it Blair's alone.

There are potentially a number of driving forces behind Blair's statement. One has to note that Blair's direction here mirrors (once again) that of George Bush. Just as Blair seems willing to follow Bush into a war on Iraw without a robust evidence base, so it seems that he is prepared to pursue Bush's campaign of schools drug testing, even though the worth of such an approach is not proven.

Similarly, Blair was visited by Sweden's PM may have influenced Blair's view of drug policy. The Swedish drugs policy is credited in some quarters as having reduced the extent of problematic drug use in Sweden and is held up by critics of liberal drug policy as a viable alternative.

But alongside the obvious influence of Bush and the possible influence of other European countries, we must look at influences much closer to home. Either actively or tacitly, we are in to the initial stages of an election campaign. And as predicted elsewhere on this website, drugs are going to form a core aspect of this campaign.

Blunkett and Blair seem to be lurching to outdo Michael Howard and Letwin. But without any loud, effective voices to challenge this drift, there is little scope for stopping it. With most major drugs charities now wholly or partly tied to Government funding, there are fewer and fewer with the independence and scope to get their voices heard.

And let us also not lose sight of how some of the research in to school drug testing was funded. The most recent study in Scotland was funded by Euromed - one of the leading manufactures of drug testing products. Not necesarily the most objective of sources. Yet this report is now being cited as grounds for the expansion of school drug testing.

A resounding 'NO' to random drug-testing in schools:
The proposals to endorse or encourage drug testing in schools is ill-thought, unworkable and counter productive.

School Drug Testing:

• Cannot take place without the consent of the young person in question in school settings: to do so otherwise is likely to be assault
• Is a poor indicator of substance use; most drugs have a very short window of detection
• Breaks down trusting therapeutic relationships between schools and pupils
• Cannot differentiate between use that has taken place in leisure time and that which has taken place in school time
• Is likely to result in more school exclusion and truancy to the most at-risk
• Will not deter those who use drugs
• Is unworkable in practice and
• Is contrary to all good policy and practice on the subject

Cannabis: Discussion deteriorates and Home Office produces its leaflets

Under increasing pressure from the media, drugs professionals, users and the medical profession, Blunkett came out of his bunker with all guns blazing. After he had put both feet in, many in Government may have wished that he had kept quiet and let the more-capable Caroline Flint try and deal with the flack.

On the Today programme, Blunkett said that the cannabis policy that he had implemented would be "transparent, non-variable and understandable." Given that the policy being rolled out is the exact opposite of this, it is hard to fathom if Blunkett is just utterly in denial or is simply unaware of the amount of confusion.

Given a policy that is being interpreted in a different way by individual forces, where ultimate decisions are left to an officer's discretion and has confused everyone, it is hard to see how Blunkett can think that the policy has achieved Blunkett's aims.

But, even more astonishingly, he has already concluded that his approach is right, saying that he is "not prepared to consider reversing it." So no matter what the evidence base, Blunkett has decided that this is the correct approach and he will not be changing it.

It may be indicative of the Home Secretaries increasing inability to grasp these points that, rather than continue to engage with the debate in a meaningful way, he instead launched an astonishing attack on Michael Howard, and asking him to confirm or deny if he had ever smoked cannabis, a question that Michael Howard refused to answer.

This undignified spat put Blunkett and Downing street on the back-foot. Downing Street dismissed it as 'political knockabout,' but others held this up as evidence that the Home Secretary is becoming increasingly gaffe-prone.

Certainly in a week when the Home Secretary was keen to see his Anti-Social Behaviour Act take pride of place in the media, he will not have been pleased to see it knocked into the inside pages while cannabis dominated all the papers.

In this flurry of media coverage, sniping and counter sniping, the Home Office produced its series of leaflets which, according to Caroline Flint, have been extensively piloted.

The leaflets are very poor: the one aimed at children makes no reference to school exclusion; it fails to make it clear that for young people on their second or third offence, they will be refered to the YOT and go to court. And the emphasis is primarily on the good jobs that cannabis could spoil or the holiday abroad. Certainly not the two things that are going to put off young people in Hackney from smoking!

The second leaflet, aimed at adults is, if anything worse. It oversimplifies, contains misleading legal points and forgets to mention things like allowing use on premises. Worse still, although FRANK is branded all over the leaflets, when you phone him he hasn't seen them, and doesn't know what they say.

The war on drugs: who calls the shots in the looming policy war: Blair, Blunkett or Johnson?

On Friday the 25th January the Independent, along with other papers, ran a news piece about some of the recommendations spilling out from the Forward Strategy Unit in Downing Street. One of the ideas to make the news was that a new offence of using drugs should be created and a conviction for use should act as a trigger either for enforced treatment or for imprisonment.

The news article was not new; rather it first ran in the Independent at the end of last year, under the banner "PMs drug report shifts focus to high harm users."

The ideas described in both articles have emerged from work coordinated by the Forward Strategy Unit; this Unit within 10 Downing Street is headed up by civil servant Geoff Mulgan, former head of DEMOS. Work is undertaken by a number of advisors, most famously John Birt.

The report prepared by the FSU concerning drugs has not been published, and is supposed to be a confidential document within Downing St. The 'Birt report on drugs' supposedly looks at a greater emphasis on enforced treatment, and looking at a regime that orders imprisonment or treatment for anyone testing positive for heroin. Other measures in the report are said to include increased monitoring of identified users through a register of addicts.

The measures proposed in the report are alarming and would result in many more people being unjustly targeted, criminalized or forced inappropriately in to prison. Yet the report is supposed to be the result of a year's research and presumably involved input from various 'experts' in the field.

Unfortunately, the report has not been published, so the researchers involved and the authorities consulted are, at present unknown. The research is, according to the Independent "too sensitive to publish," and Downing Street has described the research as a private piece of work.

The report, its contents and its status within Government throw up some intriguing questions.

Why, for example has this private report been cited, twice now, in the Independent. Given that the Indy ran it at the end of December, it suggests that it was intentionally leaked from Downing St or by someone within another department attempting to expose the proposals in the report.

The fact that the news story reappears again in the Indy this week is probably more to do with the Indy trying to tag an old story on to the current controversy surrounding cannabis. If it isn't it would perhaps suggest that parties unknown are leaking the story again, presumably also to fuel controversy around cannabis. Either way, the timing would seem to be either to distract from the Home Secretaries fumblings with cannabis, or to let the public know that he means to deal with other drugs robustly.

But more importantly, the issue of the report indicates deeper and more worrying concerns. Because all the indications are that three or four departments are now tugging in different directions when addressing drugs; instead of a joined-up strategy, different factions are fighting, presumably over both resources and profile.

The Home Office has been primus inter pares for a while now. While its status was somewhat reduced during the brief reign of the drugs czar, the mantle for drugs has been firmly taken back into the Home Office since Blunkett moved.

However, this position of pre-eminence is being gently eroded on several sides; the ODPM is taking a lead on some aspects, most notably efforts to move rough sleepers and other street populations into hostels and treatment. Given the associations between substance use and antisocial behaviour, the Antisocial Behaviour Unit, under Casey and Brady, is effectively directing a substantial swathe of drugs policy and money.

Similarly, the role of the Prime Minister's office (and the Forward Strategy Unit) suggests that Blair is interested in playing a more active role in directing drugs policy. The article in the Independent talks about Home Office sources expressing unhappiness about how policy is being shaped, and questioning the nature and reasons behind the PMs involvement.

The almost unheard voice in all this is that of Melanie Johnson. As the undersecretary in the Department of Health whose brief includes drugs, one would expect to hear more from her, nor her departmental boss John Reid.

Aside from a single written response regarding links between cannabis and schizphrenia, little can be found of her thoughts in Hansard. A better glimpse is provided in a newspaper report at the time when Blunkett was seeking to extend the Closure powers in the Antisocial Behaviour Act to cover class B and C drugs too. Johnson was quoted at the time as saying ""I have serious concerns about the possible impact that the extension of these powers to class B and C drugs may have, as suggested." Whilst hardly conclusive, it would suggest that she was sufficiently unhappy with the Home Secretaroes stance that she was prepared to disagree and do so publicly.

Unfortunately it is very clear at this stage that the Home Office, the ODPM and the Prime Ministers office are taking a lead and also perhaps wrangling for the upper hand somewhat. In the meantime, the DoH, who should be taking a strategic lead, are left languishing. And as it does so the health agenda is still further subsumed by the other three Departments.

This situation will only get worse as the General Election draws closer. The latest that this could be is June 2006. But if this an earlier date was preferred, then key policy areas like drugs will become a political battle ground. A contest for the drugs vote is not likely to offer many favours to harm reductionists or policy reformers. And if the ground is to be fought out between Blunkett and Michael Howard, we should be very worried indeed.

Media furore over cannabis legislation

With the reclassification of cannabis only a fortnight away, all sections of the media were running cannabis stories like they were going out of fashion. Indeed, the number of hacks that were walking the streets purchasing cannabis samples either for their own use or for testing must have seen them tripping over each other.

The coverage in the press has been generally critical of the Government's stance. The criticisms are varied according to the political leanings of the source, but primary concerns include:

• the confusion relating to how under 18s will be treated. The Evening Standard highlighted widespread confusion amongst young people and teachers who were receiving the erroneous impression that cannabis was now legal, and the reality that according to the ACPO guidance they should be arrested under all circumstances;
• the ongoing debate regarding the relationship between cannabis use and mental well-being. With ongoing research exploring how cannabis impacts on mental wellbeing, many papers concluded (without a robust evidence base) that reclassification would result in an increase in mental illness amongst young people;
• the fact that police nationally are not sure how the law should be implemented despite the ACPO guidance. The Metropolitan Police have produced their own guidance, described by the Independent as being 'subtly at variance' with the ACPO guidance. Sources within the Met were quoted in the Indy, saying:" Senior Met sources have flagged significant differences between the wording of the recommendations and those issued by the Met to its borough commanders. "The Met guidelines say there is a presumption against arrest. It is urging officers not to make arrests."

A number of high profile figures have started to criticise the way that the reclassification has been pursued. Ruth Runciman is quoted in the Standard as saying "We recommended that the position on cannabis should be that it is no longer an arrestable offence. What Mr. Blunkett has done is to take specific steps to maintain its arrestability. We still have some of the most punitive laws on cannabis in Europe. It is a very confusing situation."

With high levels of criticism of the strategy across the media, it was left to Caroline Flint MP to defend the strategy to the media. Blunkett remained strangely silent throughout. She is by and large in the right; she has inherited a muddle created by Mr. Blunkett and, barring a cabinet reshuffle post-Hutton, it is unlikely that Blunkett will accede to a change in direction now.

With the reclassificatio due on the 29th January, the Government insisted that publiciy material was being prepared by the Mentor Foundation and would be distributed in good time for the reclassification. The Mentor Foundation is avowedly an organisation that pursues a Prevention agenda; as part of the justification for this stance, the Mentor Foundation cites sources including the UN, stating "Drugs destroy lives and communities, undermine sustainable human development and generate crime. " No analysis is included to consider how international prohibition contributes to drug-related crime and harm.

Having looked at the content of the drug-specific information on the website, there is a great deal of inaccurate, value laden and sensationalist information which reinforces myths and misconceptions. Much of this is US-based and not relevant to the UK drug scene.

Quite why the Mentor Foundation should have been chosen to prepare literature for the reclassification is unclear. One of its trustees, the pro-hunting Tory Peer lord Mancroft, has come out against the use of criminal justice sanctions for cannabis use, saying "The use by successive governments of the criminal justice system in dealing with cannabis - "a health and social problem" - had produced "no results" and had led to "a massive increase in drug use." [BBC:18.10.2000]

To compound the above problems and confusion, the Observer [19.1.04] reports that, due to funding problems, a large number of Drugs Advisor posts are to be cut in April. These posts, who help schools to develop policy and practice in schools-based drugs education, support and responding to incidents, will come to an end as core funding is removed. While some LEAs will continue to fund the posts, others say they cannot afford to. WIth the piloting and role-out of Blueprint in the pipeline, this seems like a short-sited response.

In short, with the reclassification less than ten days away, we have an inconsistent and unworkable policy on cannabis which increases risk, increases confusion and utterly fails to increase the credibility of the drug laws. One person is responsible for this: Mr. Blunkett. The reclassification was a simple process and it is astonishing that he has been allowed to meddle with it with such disastrous results.

'Poverty' Chief takes up top job at Drugscope

Martin Barnes, currently Director of the Child Poverty Action Group, takes up the post of Chief Executive of Drugscope in the New Year. The move came following Roger Howard's move from Drugscope to Crime Concern.

Barnes has been Director of CPAG for 11 years. In this time, CPAG had expanded with a threefold increase in expenditure from the late 90's to the present. However, his departure from CPAG coincides with a period of internal disgareement at CPAG. The charity made the news as staff walked out on strike following management decisions to reduce terms and conditions of employment for new starters. While there has been no indication that the move to Drugscope was related to these internal issues at CPAG, it is to be hoped that Barnes' arrival at Drugscope will only be a boost to staff morale, rather than a portent of less good things.

CPAG has described itself as a "critical friend to Government" and traditionally CPAG has occupied a close position to Government in briefing on how economic strategy is liable to impact on poverty. It would be fair to describe CPAG as a strong campaigning body with good access to Government. They have however, had minimal contact with drugs.

It will be interesting to see if Barnes' arrival at Drugscope heralds a shift of focus. Over the past few years, Drugscope has embraced the Government's "drugs and crime" agenda; it is to be hoped that Martin Barnes will bring a shift instead to the "drugs and social exclusion" nexus instead. A focus that lifts people and communities out of poverty, and an agenda that looks at opportunity and involvement rather than punishment would be welcome.

The drugs field urgently needs strong,confident and informed voices to lobby and campaign for urgently needed reforms to policy and law. We hope that Martin Barnes can provide this voice and remains a critical friend of government.

http://society.guardian.co.uk/charitymanagement/story/0,8150,1043799,00.html
http://society.guardian.co.uk/charitymanagement/story/0,8150,1048094,00.html
http://www.cpag.org.uk/

Water, water everywhere and not a drop to fix:

Confusion has become apparent with the changes to the Paraphernalia Legislation initiated this summer. The changes to the legislation were discussed below.

At the time we highlighted these concerns and it has become obvious that these were well-founded.

A big concern was the lack of additional budget to fund these additional costs. The Government has effectively acknowledged the health benefits of revising the paraphernalia laws, but has not matched these with funds to purchase the resources. As a consequence, around the UK, exchanges are restricting what they give out because of the funding issue. These concerns were highlighted by Druglink and have been extensively discussed by UKHRA.

The second concern relates to the ongoing situation with water for injection/sterile water. The phrasing of the amendment, restricting water distribution to "water for injection" within the terms of the Medicine Act has resulted in a number of services feeling hampered in their distribution of water. This has been an especially big problem in areas where the local exchange is not linked to the NHS and so finds it more difficult to secure prescribed 'Water for Injection.'

Exchange Supplies have been working extensively to circumvent this problem, and are producing a guidance sheet to outline the current position.

Similarly, the arbitary stupidity of the decision to make citric lawful for distribution, but not ascorbic is just daft.

The other area of concern is a lack of clarity within the DLEU about what the law actually means. When asked to clarify what "utensils for the preparation" meant, the DLEU replied to us that they were not in a position to define this as it would be for a court to decide. They did however say that the terms was open and not resctricted to the examples cited.

However, others who have contacted the DLEU have received different answers, being told that some items were forbidden. Such lack of clarity in the DLEU, combined with the inadequate drafting of the legislation need to be addressed and further revision is now essential.

ACPO and Cannabis

Reclassification: all smoke and mirrors?

The proposal to reclassify cannabis from Class B to Class C comes a step closer with the publication of the ACPO guidance to police on how to process cannabis-related offences.

In reality, the proposals from ACPO are a mixed blessing. On the one hand, the number of people put before the courts (approximately 80,000 per year) for cannabis offences will undoubtedly be reduced. Less prosecutions, less criminal records, and less resultant long term consequences: these are welcome and long overdue developments.

On the other hand, there are serious and substantial flaws within the way the cannabis reclassification has been handled and these are reflected in the ACPO guidance. Unfortunately, ACPO has not seen fit to place the guidance on their website, and it has yet to appear on the Home Office Website. We are therefore relying on information from the media to understand what is in the guidance. A selection of links is included at the end of the article.

The draft legislation currently passing through Parliament makes possession of Class C drugs an arrestable offence. There is nothing in law to shape or restrict under what circumstances this power of arrest should be utilised. This has been left to the guidance prepared by ACPO.

In an ideal world, the Home Secretary would have had the courage to simply reclassify cannabis, and possession of it would have ceased to be arrestable offence. Instead, under pressure from senior police officers, Blunkett appears to have acquiesced to a compromise that sees cannabis reclassified but leaves power of arrest wholly at discretion of the police.

The guidance produced by ACPO does state that there should be a "presumption against arrest" for possession of cannabis, unless the possession is aggravated by one of a number of factors:

· Smoking cannabis in public:
· Repeat offenders: Where an officer is aware of a person repeatedly dealt with for possession of cannabis, he or she may arrest him or her.
· Local policing problem: Where a fear of public disorder is associated with cannabis use, the police may arrest rather than warn.
· Young people: Those aged 17 and under will be dealt with under the Crime and Disorder Act 1998, and not the guidelines - they will be arrested.
· Adults with cannabis inside or near schools or premises used by young people

However, these "aggravated" situations are solely guidance and the decision whether or not to arrest is solely at the discretion of the police officer.

The net outcome of the ACPO guidance is a regional lottery that means different police forces can choose to adhere to - or disregard the guidance as they see fit. Further, individual officers can choose to arrest or confiscate and caution at their discretion. Such an approach is wholly inconsistent. The risk is that certain groups in society - young people, especially from black and other ethnic groups - will be disproportionately arrested. Others will be happy recipients of a confiscation and a caution.

Such an approach leaves too much discretion in the hands of the police. Even though an individual may feel that they have been treated unfairly - that they should have simply received a warning, there is no legal recourse available to them. This is the problem when guidance is used in place of robust legal protection.

Juveniles remain especially disadvantaged by the proposed legislative changes, Thanks to confusing messages from the media and from Government, many young people already believe that cannabis has been reclassified and effectively depenalised,. Few are aware that post-reclassification, they will still be arrested and, unlike older users, will not simply receive an informal warning, Instead, depending on previous offending histories, they will end up before Youth Offending Teams or before the courts, and liable to receive criminal records.

As with other recent changes to drugs legislation the Government has taken a momentous step - in this case to reclassify cannabis. But as with changes to Section 8 and to paraphernalia legislation the Government has then wavered in their resolve and turned the changes into a poor, misguided compromise that will cause confusion and inconsistency.

Paraphernalia Legislation- Welcome changes marred by restrictive drafting:

The Government has amended the legislation relating to drugs paraphernalia. The changes increase the range of equipment that can be given out by drugs workers and allied professionals. The legislation ameliorates the situation created by Section 9a of the Misuse of Drugs Act 1971, which made it unlawful to distribute equipment other than hypodermic syringes and needles for the administration of controlled drugs unlawfully held.

The changes to the legislation are contained in Statutory Instrument Number 1653, and follow recommendations made by the Police Foundation review and the ACMD. It also follows extensive lobbying by harm reduction groups including The Exchange, UKHRA, Lifeline and others.

The changes and their ramifications are considered in detail in the revised KFx publication "Injecting Equipment And Sharps Bins - Legal and Practice Issues (September 2003.)" The key changes are that certain professionals can distribute certain equipment as detailed below:

Clearly, there is much to welcome here. The Government has recognized that the legislation impeded effective harm reduction work. Further, it recognizes that it is unacceptable that workers should be obliged to work on the wrong side of the law, even if prosecution is unlikely. The various groups and individuals who have lobbied, provided the evidence base and stuck their necks out to achieve this change deserve praise for facilitating this change.

However, as with many other recent changes or developments within the drugs field, the amendments to the paraphernalia legislation have been marred by an overweening desire to maintain 'control' on the part of Government. This tendency has been apparent through the proposals to amend Section 8(d) of the MDA, the reclassification of cannabis, and now the present example. In each case, rather than choose a simple revision or rescinding of the relevant legislation, the Government has chosen a response that on the one hand changes or relaxes the legislation but which simultaneously introduces new restrictions and ambiguities.

The revisions to the paraphernalia legislation are a case in point. Rather than removing the existing restrictions entirely, the amendment makes provision for a handful of additional items to be made lawful for distribution by a limited range of professionals.

The outcome of this is an inconsistent piece of legislation, which results in the following:

· It is lawful for doctors, vets, pharmacists and others undertaking "lawful" drugs treatment work to give out specified paraphernalia. However peer supply of this paraphernalia remains illegal. So on the one hand a drugs worker commits no offence by giving citric acid to an injector but the injector would commit an offence if they passed some of that citric on to a partner. To compound this confusion it is not illegal for a peer to distribute on needles and syringes to peers, but it is illegal for them to pass on other paraphernalia such as citric or utensils.
· The list of items that can be distributed is at some points inclusive and at other points exclusive. The legislation specifies that it is now lawful to distribute citric acid. However, it remains illegal to distribute other acidifiers such as ascorbic acid.
· Conversely, the list of 'utensils for preparation' designated in the legislation gives a few examples but is not an exhaustive list. It mentions 'spoons, bowl, etc,' but this does not exclude other equipment being distributed. However, by specifying utensils for 'preparation' this would appear to mean that the distribution of items for consumption (other than syringes and needles) remains illegal. This means that the distribution of foil, pipes etc remains illegal.
· The Government has not seen fit to amend the Medicines Act, and so water for injection remains a prescription only medicine. This impedes the ability of some agencies, especially those working outside the NHS, to secure satisfactory arrangements for its legitimate distribution.

The paraphernalia legislation, like much of the Misuse of Drugs Act 1971, has become a hindrance to harm reduction work whilst having a diminishing benefit in terms of law enforcement. Across the country, innumerable shops and market stall sell drug paraphernalia with virtual impunity. The only bodies that are substantially impeded by the legislation are those seeking to undertake harm reduction work.

In reality, the paraphernalia legislation has never been an effective piece of legislation and is routinely flouted. But rather than accept this and rescind the legislation, the Government has instead tinkered with it, as it has tried to tinker with Section 8 of the Act, and with cannabis reclassification.

The resultant legislation continues to restrict practice, and throws up new ambiguities. It is unclear exactly who it applies to. The Drugs Legislation Enforcement Unit within the Home Office is unclear itself as to who the legislation applies too. They intend that it should extent to all parties engaged in drugs work, even if not directly employed as drugs workers. So it is intended that the legislation should also apply to housing workers, police or others engaged in drug treatment initiatives. However, the DLEU also acknowledge that this is not explicit within the legislation and the exact interpretation of bodies authorized to distribute equipment under the legislation would need to be decided by a court. Similarly, the DLEU were not in a position to determine the scope of the term 'utensils,' and this too would be open for interpretation by a court..

In further worrying comments since the amendment was passed, it has become apparent through discussions on the UKHRA board, that serious concerns are being raised regarding the resources available to ensure adequate distribution of equipment. Some commentators have noted that distribution of equipment is hampered less by law than by fiscal concerns.

Unless the relaxation of the law is matched by additional ring-fenced funds to purchase equipment and ensure that it is distributed effectively alongside informed harm-reduction information, then the changes to the law will remain a cosmetic exercise.
While the changes to the paraphernalia legislation are to be welcomed, and represent a step on the incremental process of legislative change, this welcome is tempered by unhappiness that the changes remain restrictive, in terms both of the equipment and the groups covered. It enfranchises professionals while excluding users themselves. It allows for some equipment but forbids others. And neither it nor the accompanying guidance places any onus on services or those commissioning them to ensure that this extended provision is made available across the UK.

Ian Duncan Smith and Oliver Letwin on drugs

At the start of July, Letwin and IDS launched the Conservative's strategy on drugs, and there was substantial media coverage as a result. While the Tories are hopefully still unelectable, the strategies that they are outlining are the source of great concern. Not least because, if drugs become a political hot potato on the run-up to an election, it seems likely that the ever-flexible David Blunkett could find himself dragged off down an increasingly reactionary drug strategy dead-end.

The media reporting on the Tory strategy highlights the extent to which it has not been effectively thought out or priced. Unfortunately, rather more commentators commented on the latter aspects ("how will it be paid for?") than the former ("is it a viable way forward?")

Letwin and IDS have clearly been influenced by the Swedish model, and are seeking to copy this:
"... rehabilitation, as we have seen in Sweden and many other countries, where they have reduced addiction, cut the levels of crime. We are going to copy that."

Rather than just focussing on the issue of Class A drugs, the model used in Sweden is robus against all substances including cannabis. Possession or use of cannabis amongst young people is a trigger offence which means that young people are required to accept treatment.

Given that levels of cannabis use in the UK are variously estimated between 16% and 40%, this would mean creating capacity for some 3 million young cannabis users. At various points, Letwin and IDS have said that they want to model policy on both Swedish and Dutch models. These two models are mutually exclusive and demonstrate more about Letwin and IDS's fundamental lack of grasp as to how the systems work. The Netherlands adopt an approach that creates a clear seperation between cannabis and other drugs. No such seperation is made within the Swedish approach. Dutch treatment options are varied but do include high-dose methadone maintenance and experimental use of Diamorphine. Engagement and harm reduction through needle exchange and consumption rooms is also part of the provision, along with a high level of user and activist involvement.

The Swedish Government has vigorously opposed such developments and has been lobbied extensively by bodies such as HNN Sweden, who in turn were largely responsible for obstructing moves within the European Parliament and at the UN convention in Vienna to embrace such harm reduction principals.

Mr Letwin rejected the idea of prescribing hard drugs on the NHS to help drug users abandon their habit. "If you have maintained addicts you will have a permanent dependent population paid for by hard-working people. That is intolerable,"

This appears to suggest that Letwin rejects the international evidence that supports the prescribing of Class A drugs such as Diamorphine or Methadone either on a reduction or maintenance basis. It suggests that he is pursuing a forceful detoxification regime followed by a period of enforced rehabiliitation.

Finally, the proposals are substantially under-costed, as discussed in the media. But far more worrying than this is the huge shift in thinking that IDS and Letwin's approach would suggest. Many of the gains made over the past fifteen years would be eroded by such as a policy, and while not billed as such, this is still a war on drugs.

GHB becomes a Controlled Drug

The Home Office announced that GHB would become a controlled drug with effect from 1st July 2003. A number of other substances were also added to the list of Controlled drugs.

The ACMD had recomended that GHB be added to the list of controlled drugs and the Government had consulted on the proposals. The move came in part because of the suggested links between GHB and drug-assisted sexual assaults.

Class and Schedule:
GHB becomes a Class C, Schedule 4.i drug. This means that possession without prescription will be unlawful, and at present, the maximum penalty for possession will be two years and supply will be five years.

However, until the Criminal Justice Bill 2002 completes its passage through parliament, POSSESSION of GHB will NOT be an arrestable offence. Once this bill becomes statute, the penalty for the supply of GHB (and other class C drugs) will increase to 14 years and possession of class c drugs will become an arrestable offence.

Strange comparisons:
While the addition of GHB to the list of controlled drugs is welcome, it does highlight the inadequacies of the current classification system. Once cannabis is reclassified, it will also be a class C drug. By placing both GHB and cannabis in class C, this suggests some sort of comparabilty in risk/safety between the two substances. This is clearly erroneous, and educators will need to stress that there is no equivalence between the two substances.

Links:
The Government postings on the reclassification are at:
HOC 39 - Misuse of Drugs Act 1971 (Modification) Order 2003 (SI 2003 No.1243) - Misuse of Drugs Regulations 2003 (SI 2003 No. 1432) 303kb

Changes to the Misuse of Drugs Legislation - Control of GHB and Seven Other Substances (Correspondence)

Blunkett leaves UK drugs policy on disarray (again!).

A series of leaks and ad hoc policy decision, fuelled by sloppy reporting in the Sunday papers, have left the UK's drug policy in confusion once again. Having effectively killed off the prospects of extended diamorphine prescribing last week with their restrictive "guidance" document, the Government created further confusion over cannabis and premises legislation.

Cannabis
Since Blunkett first announced his intention to reclassify cannabis, the process has been mired in confusion and incompetence. The simplest move would have been to move cannabis to Class C, and make possession of it a non-arrestable offence but leaving supply an arrestable offence.

But rather than adopting this approach, the Home Secretary, either for personal reasons or under pressure from senior Police Officers, decided it was important that the power of arrest was retained, and so went through a series of half-thought through measures to achieve this.

Sine then, a variety of measures have been proposed: there was a proposal to create a three-strikes and your nicked approach to cannabis policing. Given that such an approach would have required a rather substantial data-base, such a plan seems to have been quietly dropped.

The second approach was to make cannabis possession an arrestable offence in certain limited settings, described as "aggravated possession." This included the notorious "blowing smoke in a police officers face" and other similar situations.

But the bottom line, as incorporated in to the Criminal Justice Act 2002 simply makes unlawful possession of Class C drugs an arrestable offence:

9 Power of arrest for possession of Class C drugs

In Schedule 1A to the Police and Criminal Evidence Act 1984 (c. 60) (specific offences which are arrestable offences), after paragraph 6 there is inserted—
“Misuse of Drugs Act 1971
6A An offence under section 5(2) of the Misuse of Drugs Act 1971 (c. 38) (having possession of a controlled drug) in respect of a Class C drug (within the meaning of that Act).”

No reference to aggravated possession, no reference just to cannabis. The Government proposal is to issue guidance, agreed with ACPO, on when and where people should be arrested but this will only be guidance. Ultimately, local forces and ultimately individual officers will have personal discretion as to when they choose to arrest.

Effectively, the reclassification of cannabis, in practice, simply means that the maximum penalties for possession have been reduced; it will remain an arrestable offence and the penalties for supply will remain the same as they were for Class B drugs - 14 years.

To make matters worse, unable to reach decision about how to implement the revised strategy, it is now being proposed that the reclassification of cannabis be delayed until autumn at the earliest. Young people, already labouring under the misaprehension that cannabis is either now legal or will be from July, are going to be further confused.

This mess is entirely of Blunkett's making. It stems from a premature announcement of the decision to reclassify, before the details had been worked out, followed by a craven retreat from the decision as he came under pressure from the police and the media.

Use on premises:
A series of leaks and reports in the papers caused a flurry of concern that the Home Office wanted to widen the proposed powers incorporated into the Anti-social Behaviour Bill 2003. The legislation proposes creating new powers to close premises where premises are associated with the use or supply of class A drugs and also with nuisance or serious disorder.

It was widely reported that the Home Secretary wanted to extend this power to cover Class B and C drugs too. This is something we were concerned would happen when the legislation was first proposed, and it was a relief to see no such amendment was made when the Bill was discussed at committee stage. Again, the driving force behind this seems to have been the Home Secretary, being advised and pressured by unknown sources.

Further confusion is being caused by the current state of play regarding the status of Section 8(d) of the MDA; it is not clear either to the field or to the Home Office, whether organisations still have an obligation to prevent the smoking of cannabis on premises that they manage.

Under changes to the sentencing for class C drugs offences, organisations who allow cannabis smoking post reclassification (or indeed supply of Valium!) will face a maximum of fourteen years in prison. But first clarification is needed as to whether or not 8(d) is still enforceable at all.

Time for Blunkett to get off drugs!
Given the importance of drugs policy and strategy, it is essential that drug strategy is taken out of Blunkett's inept hands. Since he has taken over primary control over drugs strategy, it has been wholly subsumed by his crime and anti-social behaviour agenda.

Rather than listening to his advisors and those from other departments, he has leant to much of an ear to the police and too little to those who understand the field. It is time for a change in this process and the brief for managing drugs should no longer be left with Mr. Blunkett.

New guidance on injectable heroin and injectable methadone treatment for opiate misusers

The NTA released the long-awaited guidance on the prescribing of injectable diamorphine and methadone on Friday 13th June 2003. Such an inauspicious publication date was matched with an equally inauspicious publication. While recognising that diamorphine and methadone prescribing has a limited role in substitute prescribing, the guidelines bind such restrictions around the prescribing of diamorphine as to make it more difficult, rather than less difficult to achieve than it is at present.

So, rather than extending the prescribing of diamorphine, the NTA has effectively done the reverse. Responses from the field have, to date, been muted. Discussions on the UKHRA boards have been vocal and critical of the guidance, asking how "how can the NTA have got it so wrong?"

Roger Howard, the soon-to-depart head of Drugscope, provided a quote of stunningly anodyne quality, even by his own standards. Presumably, in anticipation of a move to Crime Concern, he has no wish to upset Blunkett or AInsworth. Anyway, his comment on the guidelines was: "We welcome the NTA guidelines on heroin prescription and hope that they will lead to the situation found in other countries where, when other treatments have failed, there is an increase in users potentially being prescribed heroin."

How the report was developed:
The Guidance describes itself as a "majority consensus approach" which presumably means that there was some dissent from the expert groups, but this was the consensus of the majority, and the views and concerns of the minority have not gone on record.

Our understanding was that, in the final document, the views of the medical consultants, were given higher prominence and the report reflects their views rather than all the experts consulted.

The Eight "key principles."
The report outlines 8 key principles that underpin prescribing of injectables, as follows:
1. Drug treatment comprises a range of treatment modalities which should be woven together to form integrated packages of care for individual patients.

2. Substitute prescribing alone does not constitute drug treatment. Substitute prescribing requires
assessment and planned care, usually with other interventions such as psycho-social interventions. It should be seen as one element or pathway within wider packages of planned and integrated drug treatment.

3. Within the substitute prescribing modality, a range of prescribing options are required for heroin misusers requiring opioid maintenance. Some options may carry more inherent risks than others (e.g. injectable versus oral options). Patients who do not respond to oral maintenance drug treatment should be offered other options in a series of steps. This would normally include:
• oral methadone and buprenorphine maintenance, specifically optimised higher dose
oral methadone or buprenorphine maintenance treatment, then
• injectable methadone or injectable heroin maintenance treatment (perhaps in combination with oral preparations)

4. Injectable maintenance options should be offered in a local area that can offer optimised oral methadone maintenance treatment including adequate doses, supervised consumption and psycho-social interventions.
This is essential to ensure oral drug treatment options have been fully explored prior to a trial of injectable maintenance treatment and to ensure smooth transition back to oral treatment if required.

This is an interesting clause and appears to be an interesting piece of sleight of hand. On the one hand it places a level of obligation on providers to make options other than oral methadone available to people who do not respond to oral methadone. This would appear to suggest that local areas would be expected to make such resources available. However, subsequent clauses provide a number of limitations on this.

The requirement to provide "optimised higher dose oral methadone" is an interesting development. It suggests a tacit acknowledgement that methadone is still being prescribed at insufficiently high levels, and without necessary support in place. So before local agencies can explore any other options such as injectables, increases in levels of methadone and additional support will need to be explored.

Given that a number of regions still have ridiculously low caps on methadone, increasing this will require substantial movement from local prescribers.

5. Injectable and oral substitute prescribing must be supported by locally commissioned and provided mechanisms for supervised consumption. Injectable drugs may present more risk of overdose than oral preparations and have a greater value on illicit markets and hence may require greater levels of supervision.

6. Injectable maintenance treatment is likely to be long-term treatment with long-term resource implications. Clinicians should consider the move from oral to a trial of injectable preparations carefully, including long-term implications for the patient and drug treatment systems and involvement of services.

7. Specialist levels of clinical competence are required to prescribe injectable substitute drugs.
Heroin prescribing also requires a Home Office licence.

So despite Blunkett's assertion that an aim was to increase access to diamorphine prescribing, no changes to the archaic licensing system.

In the main body of the report, there is a proposal that all injectable opioids would require Home Office licence if being used for the treatment of addiction which could, in turn, have an impact on people currently prescribed injectable methadone.

8. The skills of the clinician should be matched with good local systems of clinical governance, supervised consumption and access to a range of other drug treatment modalities.

The detail and key areas of concern:

Supervision:
The requirements around supervised consumption are the most odious aspects of the guidance, and the aspect that will reduce stability and make the guidelines unworkable. Provision of supervised consumption - even for a short initial period, will dramatically increase the cost of the intervention. While diamorphine is already a more expensive option compared to methadone, the cost of twenty-plus supervised injections per week, at an average of 10+ worker hours per week, will cost in excess of £150/client/week in terms of supervision, before the cost of converting suitable premises are bourne in mind.

Certainly, supervised consumption on pharmacy sites would be difficult: it is hard to envisage many pharmacies would want to undertake this task, and the same is probably true for GP surgeries. Which means that such consumption will need to take place in drug projects.

The guidance proposes "there was great potential in providing injectable drug treatment from highly centralised injectable clinics" which is fine in large inner-city areas but means that, in rural areas, such provision is not feasible.

While the report notes that supervised consumption will require multiple daily attendances, but perceives this to be a welcome development:

The requirement for daily or multiple daily attendance was also discussed as requiring a significant change in current British provision (particularly out-of-office hours). Whilst such requirements may encourage the patient to progress towards improved outcomes, they are also very restrictive of liberty and represent a significant, but positive, change from previous practice in England. (emphasis added).

But, as policy development work for the Soho Rapid Access Clinic highlighted, this brings with it some complications around storage of CDs on site. Daily doses of drugs have to be delivered to the clinic and CD cabinets installed. Staff authorised under the MD regulations will need to be on site to dispense, and medically trained staff on site for emergencies. Three times a day. For maybe one or two clients who have to travel in three times a day.

Although this guidance says that local provision will need to be commissioned, there is no additional money to make such provision available. Again, the NTA will be able to blame the local providers for their failure to provide rather than looking at their own responsibility.

Eligibility Criteria:
The guidance provides strict limits as to eligibility, as follows:
Inclusion criteria for injectable opioid maintenance:
Clients should meet all of the following inclusion criteria in order to be eligible for injectable
opioid maintenance:
• The client should have a protracted history (> 3 years) of heroin dependence and regular daily injecting.

This was to be expected but also means that some clients for whom injectable methadone or heroin may be appropriate will be excluded. For example, amongst homeless drug users in central London, a high proportion had rapidly escalated habits over a short period of time, but had built up substantial injecting habits over less than three years.

• The client should be aged 18 or over.
• The client should be able to provide informed consent. This includes no active medical or psychiatric condition impairing the patient’s capacity to provide informed consent
• The client should be willing to comply with the conditions of injectable opiate treatment, including:

•  a treatment plan
• regular supervision and monitoring
• avoidance of persistent injecting in high risk areas (e.g. neck or groin veins)

This is a big concern and excludes long-term femoral injectors. Again, looking at Central London homeless populations, the extent of femoral injecting is as high as 80%. This group would be excluded from such treatment, even where it may be an effective intervention.

• continuation of injectable treatment being conditional upon positive healthy response to treatment (which includes other treatment elements in a package of planned, co-ordinated care)
• diversion of the prescribed injectable drugs and “double scripting” being grounds for discontinuation of injectable treatment.
• The client should first have received optimised oral maintenance treatment - an adequate period (normally at least six months and for some this could be significantly longer) of optimised conventional substitution maintenance treatment and associated package of care.
• There should be a persistence of poor treatment outcomes despite a current optimised oral maintenance treatment episode. Indicators of poor outcomes may include:
• continued frequent (daily or almost daily) injecting of illicit heroin or other opioids
• patients at continuing high risk of the transmission of HIV, HBV or HCV to themselves or others
• continuing injecting-related health problems (e.g. abscesses, cellulitis, systemic infections), poor general health, poor psychosocial functioning and drug-related criminality.

This is a catch 22 and a nasty one at that. In order to get on to a diamorphine prescription, a patient would have to engage with optimised oral methadone for at least six months. Failure to adhere to such a programme (e.g. use on top, missed appointments) is likely to result in being dropped from treatment. But if someone does adhere to the optimised methadone treatment, then it seems likely that the clinician will adjedge the methadone as being effective and, as such, there would be no need to switch to injectable diamorphine.

This is the drugs equivalent of the ducking stool; if you sink and drown, you weren't a witch; if you float you are and get burned.

If the inclusion criteria are met injectable opioid maintenance treatment may then legitimately be considered by the clinician, in consultation with the patient, key carers and the relevant multidisciplinary team.

Ommissions:
The guidance seems to be a work in progress. It restricts and hampers the work of prescribing injectables without exploring how to overcome these barriers. The document offers no guidance on how supervised consumption can be practically achieved and creates substantial new obligations before injectables can be considered.

There is a failure to explore potential other routes of administration, including heroin reefers or other strategies for administration, or proposals for weekend take-home doses.

The model of thrice-daily supervision is hugely unworkable, and the exclusion of the most ill, those with impaired liver function and habitual femoral injectors excludes those most at need.

Conclusion:
After a long period of waiting, there is no sign here of more treatment, better treatment or fairer treatment. This report sides heavily against those who wish to see diamorphine made available on prescription in a practical and accesible way.

This is a case of style not substance. The Government will claim credit for more flexible prescribing policy, and will blame practitioners for failing to deliver what they have, in fact, made impossible.

Links:
To view the complete guidance, follow this link:
http://www.nta.nhs.uk/guidance/prescribing/HeroinFullGuideFINAL.pdf
Press Release: http://www.nta.nhs.uk/news/020115.htm

TALK TO FRANK?

The Home Office unveiled its new "Talk To Frank" campaign in May. The linked campaign includes a telephone helpline service, a website and a new advertising campaign to promote the site. The launch and publicity campaign will cost £3m this year.
http://www.number-10.gov.uk/output/Page3766.asp

WHO is FRANK?
Talk to Frank is put together by a large number of agencies.

The PHONE SERVICE: The rebranded "Talk to Frank" service is provided by the Scottish-based Essentia Group. (http://www.essentiagroup.com/).

Essentia describe themselves thus:
Rewriting the rules of an entire industry, the Essentia Group is the UK's leading contact centre specialising in health and social welfare - a technology-based provider of governmental and commercial organisations’ information and advice services in the area of health and lifestyle management.

Essentia do operate a number of smoking and mental health services and have a track-record in substance use; presumably therefore, soem staff have a history of working with substances and new staff are receiving a level of training to achieve this level of competence.

THE ADVERTISING CAMPAIGN: The "Talk to Frank" campaign was designed by Mother working in conjunction with PHD. Mother are big players in Adland, and their roster includes such health-inducing products as Coca-Cola and environmentally sound companies as Unilever. Unfortunately they do not have a website but you can send them feedback on the FRANK campaign by clicking here: mother@mother.ltd.uk.

PR for the launch was handled by Fishburn Hedges, a London based PR company who also provided PR for Connexions.

The website and email interface was put together by EURO RSCG CIRCLE (aka Circle), a global digital marketing agency. Their website is at http://www.circle.com/contact/index.html

Reviewing FRANK
So is "Talk to Frank" any good. Reception from the mainstream drugs field was mixed. Roger Howard, was warmly receptive of the site and offered the following uncritical comments to the Guardian:

"Frank has been extensively trialed in the community where young people and their parents seem to be receptive to the campaign.

"Frank will hopefully provide better and more accurate information for young people and their parents to encourage them to talk to each other about this topic and we look forward to seeing the evaluation on the effectiveness of this in the future."

Much has been made by the Government and the media that the "Talk to Frank" campaign represented a step change away from "Just say no" approaches and a new, more honest and credible approach.

In reality however, the National Drugs Helpline had never promoted itself in this way; previous publicity campaigns for the Helpline had concentrated on the line as a source of factual information, such as the long-runnning ads about cocaine and ecstasy that were often on XFM in London.

Release welcomed the rebranding too, describing the new "Talk to Frank" approach as "more friendly" than the NDH.

There were a number of criticisisms of the NDH; the most important of these was the ridiculously short time window target for callers. Many callers were simply referred on to a local service, and call-handlers assiduously bundled potentially long callers - especially distressed parents - on to other services as quickly as possible. If "Frank" is really providing a better service, it will be interesting to see if there is a greater "depth" to the work, or it restricts itself to simple advice and referal on.

The Campaign:
The idea of "talk to Frank" was clearly intended to promote the idea of speaking to an informed friend: but the advertising company decided that the informed friend should be someone who sounds like he is white and male. Despite the fact that the campaign was trialled, this seems like a strage choice: why Frank? Why a male? How does this fit in with any sense of cultural diversity? Some organisations have disapproved of the way that the police have been portrayed in the adverts too.

Content: KFx has refered a number of errors on the Website to relevant bodies and is satisfied that they are being dealt with at the time of writing.

LINKS:
Talk To Frank http://www.talktofrank.com/
Guardian Web review: Frank has no cred: http://politics.guardian.co.uk/homeaffairs/story/0,11026,962418,00.html

Drug advice campaign is a wasted opportunity, say charities: Guardian: 23.5.03
http://society.guardian.co.uk/drugsandalcohol/story/0,8150,962322,00.html

The Home Office posts "official" position on Section 8(d)

The Home Office has written to people who responded to the consulation to Section 8(d) of the Misuse of Drugs ACt 1971, confirming the current Government position. The letter confirms that the Government does not intend to implement 8(d) at this time, prefering to explore alternative powers under the Anti-social Bhevaiour Bill.

The letter says that the postponement of the amended 8(d) will be for a period of 2 years to allow for evaluation, but that the potential to extend 8(d) "will remain on the statute book" pending evaluation.