Britain’s new strategy for tackling drugs misuse

The UK government is to be congratulated on the launch of its new drug strategy,¹ but probably not for the reasons it might expect. The greatest praise is due not so much for any specific policy proposal—these are rather predictable—but for the discipline and integrity the government has shown in preparing a national drug strategy that is more seriously committed to evidence than to rhetoric. With such a principle established the government is now well positioned to revise the strategy as new evidence becomes available and to advance drug policy in a manner similar to the advancement of evidenced based medicine. In this we hope that the government will establish the same requirements across all sectors—in prevention and enforcement as well as in treatment.

In 1997-8 the total government drug related expenditure was estimated at £1.4 billion ($2.2 billion), 62% of it spent on enforcement activity.¹ Yet the strategy document points out that much of this is reactive and not specific to drugs. The rest of the spending is split, with 13% on treatment, 12% on prevention, and 13% on international supply reduction. Thus, 75% is spent on enforcement and supply reduction and 25% on prevention and treatment. The minimum costs of the social problems generated by severely dependent drug misusers alone are about £3-4 billion annually.

Just under half of young people report ever having consumed an illegal drug; most of this is accounted for by cannabis, but a substantial minority have consumed amphetamine, ecstasy, or lysergic acid (LSD). Only a tiny minority of these go on to be dependent users. Nevertheless, the numbers seeking help for drug problems have continued to climb, prisons are now recognised to have a large population with a history of serious drug problems, and up to half of young homeless people may have a serious drug or alcohol problem. At last there is some recognition that poverty, inequality, and social exclusion contribute to serious drug problems. The criminal justice system is heavily burdened with people with serious problems: 60% of people arrested tested positive for illegal drugs, nearly 20% of them for opiates. At a conservative estimate, the general costs to the criminal justice system of drug related crime are at least £1 billion every year.

The results from the National Treatment Outcome study that followed 1100 new entrants into treatment reported that 664 addicts committed 70 000 offences over the three months before they entered treatment.² At one year’s follow up there were major reductions in drug use and criminality. The researchers estimate that, mainly through reduced criminality, £3 is saved for every £1 spent on treatment and that this saving occurs across a range of treatment modalities.² By comparison, other international studies have consistently reported that enforcement strategies have net costs—and that fact alone should make us challenge the overall distribution of resources between enforcement and efforts to treat and prevent.

When the idea of an anti-drugs coordinator, or drugs tsar, was mooted considerable concern was expressed that such a position indicated a drift towards a greater emphasis on rhetoric and a shift away from the more public health focus of the previous decade.³ That public health focus has successfully contained the spread of HIV among injecting drug users, resulting in the UK having one of the lowest rates of transmission among injecting drug users in the world. The new strategy places great emphasis on crime prevention, but to the credit of the coordinator and his deputy they have grasped the importance of treatment as a key part of the response and recognised the cost effectiveness of treatment by comparison to other approaches.

Nevertheless, the challenge remains to see what capacity this strategy will have to effect change. Rightly, the strategy emphasises drug prevention among the young, but the evidence for the effectiveness of such prevention activities is unfortunately weak. Good information that will reliably inform and guide strategy is lacking. The US strategy relied on national indicators of reported drug use among young people and, on these measures, reported success—while indicators of severe harm climbed unabated. A greater emphasis on and development of indicators of harm, such as rates of positivity among arrested people and levels of problems in the prison population and among other groups of socially excluded people, might help begin to address some of the serious inadequacies of policy to date. The prevention side of the policy remains weak, with no clear tools to tackle prevention. Indeed, the strategy document fails to come clean on the paucity of current options. A serious commitment to researching more effective prevention strategies is needed if progress is to be made over the next 10 years. A balanced policy needs to consider different control options for different drugs and needs to recognise that tobacco and alcohol are a serious part of the problem.

The proposal to build stronger partnerships across the different sectors and in particular between criminal justice, health services, and social services poses a challenge to all sectors. However, this is a timely challenge for the treatment and rehabilitation services to respond to and develop innovative working methods with new partners and with new resources to support such innovation. Building an informed and self critical but adaptable drug policy requires a long term strategy with appropriate investment in research and evalua-tion; we hope that this is the first step in an evolving and practical 10 year strategy.

News p 1411