Tuesday, January 23, 2007

Tony's drug policy map for Gordon

In an interesting development the Sunday Times reports on a 'confidential' memo written by David Bennett, the head of the No 10 policy directorate, in advance of a policy summit held at Chequers last Friday.

The memo, according to the Times, 'outlines the prime minister’s “emerging ideas” for his last months in office which he hopes will be so far advanced when his successor takes over that Brown will have to follow them.'

It apparently "brings together suggestions from policy groups set up by Blair in the wake of last autumn’s botched “coup” attempt by Brownites. Their job was to study ideas for Britain’s long-term future."

Internal Labour political shenanigans aside there was an interesting inclusion in the list of emerging ideas:

"Prescribing addictive drugs in a bid to help tackle drug-related crime."

Now obviously this isnt a new idea. The UK has been prescribing heroin for decades (even though it is limited to a couple of hundred recipients today) and also widely prescribes the synthetic opiate methadone as well as some various other drugs to long term addicts, including amphetamines. However, despite promises made by David Blunkett to expand prescribing (back when he was Home Secretary - to the Home Affairs Select Committee on drugs in 2002) and some promising pilot projects like the Swiss-style heroin prescribing drop in centre in London, the pace of change has been glacially slow.

The obstacle has been primarily a political one - both in Government and within the medical establishment. Politicians have been reluctant to be seen putting money into providing drugs to addicts - since whilst it makes all sorts of sense on any rational cost benefit analysis (using public health or criminal justice measures) it makes potentially terrible headlines in the Daily Mail and other papers who have it in for the Government (as being 'soft' of drugs and crime etc). That said, the idea has had personal and editorial endorsements from a range of unlikely individuals and publications, including many in the media who the Government are most afraid of. This Government PR problem has been compounded by politics in the medical establishment who are also notoriously reluctant to embrace substiutute prescribing, for different but equally lame reasons.

But then here it is on Tony's menu of legacy policy ideas. The idea actually was put to the Prime Minister, a second time, by 'blue skies adviser' John Birt's half of the Number 10 Strategy unit report back in 2003 but failed to have real traction (the report being supressed) and the alternative option of a massive increase in CJS administered coerced treatment apparently being more politically palatable. But now, third time lucky, Blair's advisors have once again alighted on the fact that prescribing to dependent users can potentially deliver excellent health and criminal justice outcomes (something UK drug policy has not seen alot of recently, or if we are being honest, ever).

The danger is that, as the Times suggests "the chancellor’s allies have indicated that Brown will make a decisive break from Blair’s legacy when he enters Downing Street by refusing to keep to the 10-year policy review" and that the drug prescribing idea will fall by the wayside with the rest of them, ironically for a different set of political reasons. The hope is that this innovation may survive the 'break' from Blair's legacy, given that it's impossible for Blair to be associated with any such progressive reforms of drug policy during his time as boss. Maybe Brown will be the pragmatist on drug policy that Blair has failed to be - he's from the Treasury after all and does, one hopes, understand the concept of cost/benefit analysis, as well as the need to appease the tabloids.

5 comments:

Bob said...

Given there isnt enough heroin to go round at the moment, the idea at present of wider prescribing is just not possible.

Its a good idea of course, perhaps we could get the heroin from Afghanistan, but that really would be a step too far for the Daily Mail.

Steve R said...

It wouldnt be terribly tricky to grow some more. Its a raw material crop like any other and over half of global opium production is already for the legal market (mostly in Tasmania and India). The issue is with the UN drug agencies that license legal opium cultivation.

Anonymous said...

As most of this years bumper opium crop has ben harvested under supervision of us and uk troops, and supply increases here, I find these policy 'debates,' disturbing, a policy is being enacted whilst government pretends it's something else, lies is too nice a word for this situation!

Allan Brown said...

Policies that are humane and sensible, whatever are you thinking.
Mind you I am more concerned what the political machine will, or will not, push out post 2008, and the most worrying part of Steve's post is the line about Gordon Brown "refusing to keep to the 10-year policy review". I hadn't seen this before and it begs the question which way will he go, take his eye of the ball entirely or keep with existing systems. There is already a lot of posturing and positioning coming from the Department of Health about a world after the NTA, and a lot of cash strapped PCT's, local councils and future Childrens Trusts are eager to pull down the ring fenced spending. I am less worried about the possibility that we will ignore innovation, and more concerned that the sharks are circling and once the NTA and the DAT's go (or a reduced to a talking shop entirely), there will be no drug strategy to speak of, no checks and balances, and only a punitive approach to drug treatment. I for one would rather improve the structures and utilise the expertise in shifting the agenda slowly, rather than return to the bad old days of paternalistic prescribing, riven with the ego and desire for self promotion of the prescribers.

Bob said...

Steve; But as we both know, heroin is banned for even medical use in the US, so getting the UN to do anything is impossible.

Anonymous; I dont really understand what you are suggesting, are you saying that US and UK troops are involved in the production of opium? They certainly seem unable to stop it, but I think thats just because there isnt anywhere near the number of troops needed in Afghanistan to provide law and order.

Allan Brown; Indeed, I think everyone is waiting to see what Gordon will do, he hasnt exactly given us much idea.