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An evidence-based approach to drugs policy

On 18 July 2017 I spoke in a parliamentary debate about drugs policy. This followed publication of the government’s new Drug strategy 2017, which sets out a number of new actions to prevent the harm caused by drug misuse.

In my speech, I paid tribute to local organisations that provide services to people with drug problems, and the experts and specialists who have shared their knowledge with me over recent weeks. I praised some aspects of the government’s strategy, but also raised a number of concerns about the current approach. The strategy does not, for example, include an explicit aim of reducing premature deaths caused by drug use; it virtually ignores the most harmful drug – alcohol; there’s a lack of funding to support treatments for drug misuse; and it fails to review the legislative framework surrounding alcohol and other drugs to make it evidence-based and focused on harm reduction for all drug use. I called, for instance, for the regulated testing of the drugs themselves, as well as the provision of drug consumption rooms. I advocated that we should treat drug misuse as a health and social problem rather than a criminal problem. And I suggested that, if we treat alcohol and tobacco in a certain way, we should provide parity of protection, information and education in relation to other drugs.

I will feature in a new BBC documentary series on drugs to be broadcast in the autumn, first on BBC3 then on BBC1. Keep a look out for it!

It’s long, but you can read the full text of my speech here:

What a pleasure it is to follow my hon. Friend the Member for Bassetlaw (John Mann). I agree with him on doing one’s own research and reading the papers, but also on respecting professional expertise. Although I am afraid I come to slightly different conclusions on some aspects, there is a lot of agreement between us, particularly on locating the problem in the Department of Health.

I pay particular tribute to the hon. Members who have made their maiden speeches today. My hon. Friend the Member for Slough (Mr Dhesi), the hon. Member for Stoke-on-Trent South (Jack Brereton), and my hon. Friends the Members for Kingston upon Hull West and Hessle (Emma Hardy), for Wolverhampton South West ​(Eleanor Smith) and for Ipswich (Sandy Martin) all made wonderful, inspiring and rousing speeches. They set a very high bar for themselves, as well as their colleagues, over the coming years.

I thank the hon. Member for Reigate (Crispin Blunt) for his suggestion that there should be a royal commission on drugs that looks carefully, thoroughly and objectively at the evidence. My hon. Friend the Member for Manchester, Withington (Jeff Smith) provided very moving examples of how our legal structure is currently failing people. The right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Newport West (Paul Flynn) also gave inspiring and helpful speeches.

Over the past six months, following the advice of my hon. Friend the Member for Bassetlaw, I have had the great privilege of being exposed to a range of different experts, specialists, academics and interventions in my own constituency and beyond as I have been part of the process of making a BBC documentary on the use of drugs. I have been involved as an MP and as a citizen of a city with above-average rates of drug use and drug misuse, and with exceptionally forward-thinking, effective drug misuse services, including, but not only, GPs.

The makers of the documentary have followed me around—veritably stalked me at times. They assessed the impact of the abuse and misuse of alcohol and other drugs—I am going to keep using that phrase—on my constituents and facilitated meetings between me and people with specialist knowledge and skills. The results will be broadcast in three parts this autumn. I have not seen it. Other documentaries may well be available, but I urge hon. Members to see what they made.

As part of that process, I have met local organisations commissioning or providing services to people with drug problems. I particularly pay tribute to the Bristol Drugs Project and DHI—Developing Health and Independence—along with commissioners in Bristol City Council. They have been extremely generous and patient with their time to educate and inform me, and also in being willing to listen to questions and ideas with which they did not necessarily agree, and vice versa—that is, ideas that I did not initially agree with but have been able to see the point of.

I have met people in support groups and programmes who are in the process of desisting from alcohol and other drug misuse. I have visited Horfield prison, which is in my constituency. I have been briefed on the nature of drug use—particularly the use of spice—and its impact on the prison, the staff and the prisoners. I have met specialists including Sir David Nutt, the leading psychologist, pharmacologist and psychiatrist, who formerly chaired the Advisory Committee on the Misuse of Drugs, and Dr Ben Sessa, consultant child and adolescent and addiction psychiatrist at Imperial College, to discuss the research and evidence base for and against our current drugs policy.

I met a specialist drug safety tester from the Loop project, which provides free and confidential drug counselling and testing of substances—without, hon. Members may be pleased to hear, returning those substances. I was puzzled to hear that, but the testers cannot return substances to the people who have asked to have them tested, because that would be classed as drug dealing. I do not think that that is helpful, but it does at least provide people with information about the quality of what they might be about to take.​

I was told by the Loop project that, as a result of its work, not only are people better informed about what they might be taking—whether or not it has been cut with impurities, including concrete—but if they discover that a substance is unsafe to take, they hand in quantities of drugs voluntarily. It is a way of cleaning up the supply of very unsafe drugs, as well as giving people the information they need to make a well-informed choice about whether, when and how to consume drugs. I discussed with Loop the purpose and function of drug consumption rooms. I take on board what my hon. Friend the Member for Bassetlaw has said, because he has far more experience in this matter than I have, but I am interested to know more about the various pilots and the research that he mentioned.

I met homelessness organisations and homeless people who have compounding problems on top of drug and alcohol problems. I discussed with my campaign volunteers, staff and local residents their concerns about drug misuse, which are many and varied. I did various drug impact walks through my own constituency, looking around me, talking to people and identifying the problems that have both a visible and an invisible impact on local people.

I have analysed my own experience, as a long-term resident of the area, of how the use and misuse of drugs has affected the local area over the years, and how and why it has changed. I have, as a consequence, made many reports to the local drugs litter cleaning services. That is one of the consequences of the current regime that we would do well to address, and we should at least consider the use of drug consumption rooms because it would reduce nuisance to other people. I have also had to respond to extremely unpleasant side effects of alcohol and drug misuse on my own doorstep, both at home and in the entrance to my constituency office.

I have done a great deal of reading of the research on the impact of our current legal system and support services on the use and misuse of alcohol and other drugs. I thank everybody who has given me their time and attention during this process, which has been hugely educational, influenced my thinking and informed my beliefs. I particularly thank the BBC team, Bart, Ae, Poppy and Hugo, for making me part of such an interesting process.

To inform my response to the drug strategy, I contacted many of the people I have mentioned, and I analysed the findings of various papers by the Advisory Council on the Misuse of Drugs and other evidence against the scope and detail of the strategy. As a result of that review, although I applaud aspects of the strategy—I will mention them shortly—I have the following criticisms. The strategy does not include an explicit aim of reducing or, ideally, eliminating premature deaths caused by drug use. I would really like to see that front and centre. The strategy virtually, although not completely, ignores the most harmful drug. I say respectfully to the Minister that alcohol is a drug, and one that is entirely legal; I will come back to that shortly. The Government’s welcome acceptance of evidence-based treatments for drug misuse and mental health problems is a step forward, but it is undermined, as colleagues have said, by the lack of a funding strategy to support it. The strategy fails to take on key recommendations from the report published last year by the Advisory Council on the Misuse of Drugs on preventing opiate-related deaths.​

Finally, I must add my voice to those of others who have said that the strategy represents a wasted opportunity, when the Government could have reviewed the entire legislative framework surrounding alcohol and other drugs and made it consistent, evidence-based and focused on harm reduction for all drug use. I echo the suggestion made by the hon. Member for Reigate that a commission should do what I believe the Government could have done over the last two years.

The strategy opens with the ambition

“for fewer people to use drugs in the first place”,

and for those who do, to

“help them to stop and to live a life free from dependence.”

However, that ignores the fact that many people take drugs recreationally, free from dependence and free from the harm caused to other people that results from some drug use. They are at risk of causing some harm to themselves, and such harms tend to arise from the criminal justice framework that we wrap around them. We should have the ambitions to reduce harm and prevent deaths—I support the aim to reduce harm, and I want to increase recovery from dependence—but I also want to take us as a country towards a fully evidence-based, open-minded approach to both.

Most of the means of preventing death in the “Reducing Opioid-Related Deaths in the UK” report by the ACMD last year, which I mentioned earlier, have been ignored in the strategy. For instance, drug testing—I mean not testing of people to see if they have taken drugs, but of drugs to see what they have in them—as well as the provision of drug consumption rooms and a wider examination of forms of treatment have all been ignored either partially or wholly. The strategy ducks the fact that much of the use of alcohol and other drugs takes place with comparatively little or no harm identified by the user, and frequently with great pleasure, which therefore undermines some of the messages given in the strategy. If users do not themselves experience their drug taking in a way described by the strategy, they are likely to dismiss all of the good stuff in it. Harms arise from the unregulated nature of the market. The organisation Loop has shown me one of the huge life-saving benefits of being able to test drugs such as ecstasy in clubs and festivals. I want the full protection of regulation, education, testing and a licensing regime to be given to all my constituents, not just those whose drug of choice is the legally available one of alcohol.

I must say that there are some aspects of the strategy that I very much welcome, such as the emphasis on prevention and the use of compulsory personal, social and health and economic education, which is now part of the curriculum, to increase the awareness and understanding of young people. By the way, I say to the Government, “You’re welcome”. It took us a while to convince the Government that this needed to happen, but Opposition

Members are always pleased when the Government realise we have got something right. I am also very pleased that the drug strategy recognises the limitations of some educational approaches, such as the format of lectures by the police or reformed addicts. Such approaches tend not to have a good evidence base, and I am glad the Government have recognised that.

I also want to say that the two drugs that have arguably caused me the greatest personal harm are two legal drugs—alcohol and tobacco. I am sure everybody ​in the House knows about the link between tobacco consumption and lung cancer and many may also know about the link between alcohol consumption and liver cancer, but it was not until I was diagnosed with breast cancer that I learned about the causal links between alcohol consumption and other cancers. While I was being treated, I was contacted by a publican about the new NICE guidelines on alcohol consumption. He claimed that they were biased and in favour of teetotalism, and he was very angry about what he said was an unnecessary and unwelcome bias, given that the guidelines say that there is no “safe” level of alcohol consumption. I therefore read the guidelines and all the research review papers informing the guidelines—I was on sick leave, so I had time to do so—and I came to the carefully considered conclusion that the guidelines were both accurate and helpful.

It was helpful to me to know that there is no safe level of alcohol consumption, and reading the research papers helped to convince me that the abstemiousness, as far as I could possibly manage it, that I had fallen into during chemotherapy was something I wished to keep to for the sake of my own health after the treatment ended. This was all news to me: I did not know until I had breast cancer that alcohol was so closely linked to it. Since then, I have realised how many other people are not aware of the wide, many and varied risks associated with alcohol, which is a completely legal drug. Alcohol is available on these very premises, and no doubt somebody somewhere is in the process of consuming that legal drug right now. At the risk of sounding like Nana from “The Royle Family”, I have—with the exception of a very small glass of bubbly at weddings and perhaps a sweet sherry at Christmas—stuck to my non-consumption of alcohol, and I have to say that I feel all the better for it. That is a good example of how providing accurate information about a drug can inform someone’s decision making.

Alcohol is at the top end of the most harmful substances both to the user and to others—it is more harmful than heroin, in fact—but if I fall off the alcohol-free wagon by going into a shop or a pub and buying some alcohol, I at least know that it will not have been cut with something much more poisonous. I know that I am not risking my job by breaking the law and I know that I will be picked up afterwards if dropping off the wagon causes me problems. I believe that the regulatory, information and licensing systems for alcohol provide a great template for reforming the law on other drugs. I am not knocking anybody else’s right to choose to drink alcohol; I just want parity for my constituents who use other drugs.

I want to say quickly that I am not sure where the money will come from for everything, because money was conspicuously absent from the strategy. Other Members have drawn attention to that and perhaps others who are still to come will do too. That is a big omission. Whether it is in interventions purely in the health service, which my hon. Friend the Member for Bassetlaw referred to, or in drug treatment programmes, specialist programmes or mental health services, the cuts by this Government in local government, the health service and elsewhere have been felt across the board. There is no good way to carry out any of the very good proposals in the strategy ​without adequate funding. Mental health services and drug and alcohol services all need to be properly funded. As I am sure the Government are aware, there is a 2.5 return on investment. I hope that the Minister will address that point in her closing remarks.

Something that is very personal to me is the prevention of drug-related deaths, particularly those from heroin. People in my life have lost theirs to drug addiction, including addiction to heroin and alcohol. That is why I want to be clear that when I talk about reforming our laws, I am not saying that these drugs are good to take; I am just saying that if we are clear that alcohol is not good for us and yet it is legal, well-regulated and licensed, we at least ought to look at why we are failing people with a heroin addiction, people who use drugs recreationally and do not have an addiction problem, and the people around drug users. The hearts that are broken through heroin-related deaths go much wider than the people who use the drug.

The number of opioid-related deaths has gone up year on year since 2010. I thoroughly applaud the Minister for saying that she wants an evidence-based approach, but she appears to have ignored the conclusions and findings of the Advisory Council on the Misuse of Drugs that came out just last year. It reminded us that there were 2,479 drug-related deaths in 2015 alone, so keeping drugs illegal is clearly not preventing death.

Among the report’s findings was this:

“That the UK has high-quality systems for the recording of opioid-related deaths,”—

which is good—

“but that more could be done to improve national information, especially on toxicology and prescribing, as well as on the contribution of opioid use to levels of mortality from other causes.”

Data collection is partially addressed by the Minister in the strategy, but I would like further information, if possible.

The report also states that

“a probable cause of the recent increases in drug-related deaths…is the existence of a prematurely ageing cohort of people who have been using heroin since the 1980s and 1990s.”

It states that other contributory causes of those recent increases are

“multiple health risks…among an ageing cohort of heroin or opioid users, deepening of socio-economic deprivation since the financial crisis of 2008, and changes to drug treatment and commissioning practices.”

The paper goes on to make some very sensible suggestions, which I urge the Minister to remind herself of. I will remind her of some of them now. It states:

“There are a number of evidence-based approaches that can be used to reduce the risk of death among people who use opioids. The strongest evidence supports the provision of opioid substitution treatment (OST) of optimal quality, dosage and duration.”

I know that the Minister is aware of that. However, the report goes on to say:

“Other substance misuse treatment options could be further developed in order to reduce the risk of death including broader provision of naloxone,”—

for hon. Members who do not know, that is a substance that can be used to halt and then reverse the effects of overdoses, thus saving lives —

“heroin-assisted treatment for those for whom other forms of OST are not effective, medically-supervised drug consumption clinics, treatment for alcohol problems, and assertive outreach to engage heroin users who are not in treatment into OST (especially for those who are homeless and/or have mental health problems).”​

We are all harmed by a failure to address those issues. We are harmed when we are troubled by the homeless person on the street who is clearly suffering; by the relative or friend who goes without the treatment that they need; or by someone who dies needlessly of an overdose when it could have been prevented by safe use in a drug consumption clinic, accompanied by counselling to try to engage that person in drug cessation. I want us to notice that we are all harmed by that, not just those who are using drugs.

The strategy recognises the record high levels of deaths and drug misuse and it makes some recommendations, such as recommending that all local areas should have appropriate naloxone provision in place, but the Bristol Drugs Project, which has such a distribution system, tells me that it is unable to get to everyone who is at risk of heroin overdose. I would like it to have the funding it needs to reach more people and prevent more deaths. The Advisory Council on the Misuse of Drugs also recommended the drug consumption clinics that I have mentioned, and discussions with people in the sector and with other specialists lead me to believe that investing in drug consumption spaces, where drug users can have their drugs tested, receive counselling and, above all, consume drugs safely and with no associated harms to the rest of us, would be money well invested or at least worth exploring further. We would gain in the reduced cost to emergency services, local council cleaning services and the prevention of drug-related deaths.

I turn to the obvious contradictions in our laws on alcohol and other drugs. On criminalisation, the ACMD has mixed views, but the Government are unequivocal — they are opposed to reforming the Misuse of Drugs Act 1971. The strategy states:

“We have no intention of decriminalising drugs. Drugs are illegal because scientific and medical analysis has shown they are harmful to human health”—

I do not disagree. It continues:

“Drug misuse is also associated with much wider societal harms including family breakdown, poverty, crime and anti-social behaviour.”

Those I would qualify. As others have said, and I reiterate, that argument simply does not hold water. The research review carried out by Professor David Nutt for The Lancet shows that alcohol is by far the most dangerous drug in the UK for harms to others and harms to the user. It is far more harmful to other people than any other drug, including heroin, crack, methamphetamine, cocaine, cannabis and tobacco, but it is regulated, with licensing conditions and ways to protect users if their drug of choice is alcohol.

The hon. Member for Louth and Horncastle (Victoria Atkins) mentioned the awful people who deal in drugs and use violence. I agree: I want to protect my constituents from falling prey to that violence and abuse. She also mentions the harms that vulnerable people suffer when they are forced to traffic drugs. I agree, and I want to avoid those harms, but I respectfully disagree with her — it is the criminal nature of the drugs trade that causes those harms. That is my interpretation of the evidence, and I urge hon. Members to consider the suggestion by the hon. Member for Reigate of a royal commission to examine that further.

If we are to take an approach of making a substance illegal because scientific and medical analysis has shown it is harmful to human health, we need to make alcohol and tobacco illegal. Are the Government proposing that? ​No, they are not, and I do not want them to. I would simply invite them to consider that their entire rationale for maintaining the legal status quo is undermined by that. It would be far more effective to tackle the harms done to others and to the user to review the entire criminal law associated with alcohol and other drugs, and to consider reforming it to make it truly evidence based.

Before I conclude, I want to add some comments and caveats on the wider social rationale. Some people think—and some hon. Members have implied it today—that drug harms are the responsibility of the individual and, if people choose to use drugs, they should be left to take the consequences without the taxpayer having to pick up the tab. I know that the Minister does not agree with that approach and I am glad about that. To those people, I say that we are all picking up the tab anyway—in the huge costs of policing drug use, accidental overdose and so on. We are also picking up the tab when people in our own lives are harmed by drugs. It is no use saying that it is always someone else’s child, parent or sibling. Many sober people who have never taken any drugs are affected by a relative or friend’s drug use, whether cash is stolen from them to pay for drug use or in having to deal with the impact of overdoses or the health consequences of substances added to drugs.

The social and economic cost of drug supply in England and Wales is estimated to be £10.7 billion a year, just over half of which—£6 billion—is attributed to drug-related acquisitive crime. Would that we could reform that—and I think the Minister should take this opportunity to consider that there are ways of reforming it.

I want all Members to take a moment to be quite imaginative. I want them to imagine the nature of the shops that currently exist for people to buy drugs if they wish to. Those drug shops are already all around us, but they are dangerous, they are illegal, they are unregulated, they are untaxed and they are unlicensed, unless your drug of choice is alcohol.

Why do we not decide to do something different with that £10.7 billion a year? Why do we not decide that we will treat drug misuse as a health and social problem rather than a criminal problem, and direct the funds towards treatment and recovery for those who need it? Why do we not also recognise that the harms done by legal drugs are in excess of those done by illegal drugs, and decide to reduce or even end the harms caused by the illegal nature of some of those drugs? I want Members to focus their minds on the harms done by the drugs rather than by a legal situation which could be reformed.

Why do we not acknowledge that some people are consuming both harmful illegal drugs and legal drugs right now, but at least those consuming legal drugs will be doing so in the knowledge that the strength and purity of the substance that they are consuming is regulated, so they can make informed choices? Why do we not become really brave, and decide that if we are going to treat alcohol and tobacco in a certain way—and yes, rightly provide education and information to help people to make those informed choices, and treatment for those whose consumption has started to harm them or others—we should provide parity of protection, information and education in relation to other drugs?

Let me very clear about this. There is no safe level of consumption of any drug, be it legal or otherwise. The only way in which to be completely safe from the harms ​of consumption of any drug, including alcohol, is not to consume it at all. Having access to good-quality information gives people the opportunity to make evidence-informed decisions for themselves about whether and how to consume alcohol or other drugs. Relying on the law to inform decision-making is not working, It skews the decision entirely in favour of the most dangerous drug. I am sure that many people have no idea of the links between alcohol consumption and cancer, for example.

I am not suggesting that we should jump straight to full legalisation of all drugs. I am simply raising the importance of considering whether and how to revise the legal framework for all drugs. If we are to have an evidence-based system of response to the consumption of alcohol and other drugs, it must focus on harm reduction. It must treat the harms as social and health harms when they are social and health harms, and as criminal only when it is necessary to treat them as such.

We urgently need the royal commission referred to by the hon. Member for Reigate, and we need to be able to have a well-informed, honest and open debate about the regulation of alcohol and other drugs in order to reduce avoidable harm, increase informed decision-making, and end the deaths caused by alcohol and all other drugs.

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