The Independent Drugs Commission for Brighton and Hove has recommended, among other things, an investigation into setting up a “Consumption Room” in the city. This is a place where users can inject drugs safely.
Such a facility could help prevent HIV and hepatitis C infection and respond to overdoses.
Such moves are undoubtedly progressive and will improve the health of drug users.
But government cuts now being imposed by local authorities undermine more enlightened policies (including facilities like that proposed in Brighton) and tend to impose a low regard for drug users’ safety and their liberty.
Right now government funding targets heroin and crack users to bring them into (predominantly prescribing) treatment services. This has accompanied a decline in heroin and crack use, with estimated numbers down below 300,000 at the start of 2011 for the first time — a 33,000 drop from a peak in 2005/6.
What is the reality behind the figures?
Since the late 90s governments have emphasised the role of criminal justice services in bringing drug users into treatment, with the expansion of CARAT (Counseling, Assessment, Referral, Advice and Throughcare) workers in prisons and drug intervention programmes linked to local police and courts. More people are being seen by a drugs worker and referred into treatment.
However the continued availability of drugs in Britain in prisons, and the high risk of overdose of those using after leaving prison, remains a threat to recovery.
That leaves community treatment services, such as those prescribing methadone and subutex as substitute legal drugs to prevent withdrawals from heroin and other opiates.
Questions need to be asked about the long-term fate of those in treatment. For short periods substitute prescribing can be really useful. But thousands of people, mostly over 40, remain physically dependent on very high doses of prescribed methadone for many years, and not necessarily supported to move forward.
The argument goes that as they don’t need money to buy drugs, they commit less crime; but they are also at risk of overdose when drinking alcohol, or using other stimulant and depressant drugs on top of their script.
Counselling and group therapies need to be more readily available alongside prescribing treatment. Meanwhile little impact is being made on the supply of drugs including those such as ketamine and novel psychoactive substances (legal highs). And even with improved surveillance technology, tackling domestic production of skunk is a struggle as the amount of cannabis being grown in the UK has now reached 50% of that which is consumed here.
However, the prospect of a well integrated treatment system that encompasses the best of professional and peer-led support, such as SMART (Substance Abuse and Addiction) recovery groups, is undermined by an increasingly target-driven culture in which local services are expected to move individuals through a linear pathway of treatment that justifies the planning of the commissioners rather than meeting the needs of the drug user.
The latest initiative from this Government is Payment By Results (PBR), a funding settlement that is being piloted in several areas in England and Wales.
Under PBR services will only get a small part of the funding money they need to operate up-front, with the rest following if service users leave the service having met targets such as being drug free for a certain number of weeks.
But people don’t get better to order. And whilst it is reasonable to want quality services, if charities have to get bank loans to cover their costs — which they may never be able to repay —many services will not function.
Supporting service users in the way they need is being undermined by an impersonal funding regime and one that will lead to more disengagement from services and greater risks.
Portugal decriminalised the possession of illegal drugs in 2001. Professor Alex Stevens of the University of Kent says data suggests that between 2001 and 2007 the most problematic form of drug use fell and there were significant reductions in drug related deaths, HIV infections and prison population. The policy was also founded on expanding treatment options.
However, Portugal’s successes are being undermined by cuts in public spending. Elsewhere in Europe, a spike in the HIV rates following the withdrawal of drug services in Greece further underlines the importance of stable funding for services.
