Sunday, February 24, 2008

Is three billion a year on enforcement good value for money?

According to the Governments own reviews they have been spending something in the region of 1 to 3 billion a year on drug enforcement (depending on how you measure it) - preventing the supply of drugs - with the express aim increasing the price of drugs as a way of deterring use. Increasing the price of drug may or may not deter use to the degree they suppose but that has been the plan. The particular target has been the two drugs identified by the Government as 'causing the most harm': heroin and cocaine. The big plan back in 1998 was to have reduced availability by 50%. By this week as fate would have it.

It would be easy to be fooled by the statistics put out by the Home Office that this endeavour has been broadly successful. More drugs are being seized we are told, usually in the form of how drugs are being 'prevented from reaching the streets'. We also learn that more drug gangs are being broken up, or 'smashed' as they like to say. Also, more criminal assets are being seized. Excellent. But what's all that got to do with reducing drug supply or availability? Measures that would actually give a real indication of heroin and cocaine availability have been studiously avoided by the Home Office and never seem to crop up in their publications, strategies, or consultation documents. Measures like drug prices, or surveys drug users - asking them highly technical questions like 'how available are heroin and cocaine?'. The Home Office deliberately uses 'availability' targets that are in no way measures of availability. (Call me cynical, but could it be they are trying to, whats the phrase I'm looking for...deceive us?)

Whilst we don't have much decent or consistent trend research in terms of drug user surveys (although we really should) we do have some pretty good drug price data, based on test purchases. This was most recently revealed, again, in a parliamentary answer last week, reproduced below:

Mr. Malins: To ask the Secretary of State for the Home Department what the street price of (a) heroin and (b) cocaine was in each of the last 10 years. [178111]

Mr. Coaker: The information requested is shown in the following table.

UK Average Drug Prices 1997-2007
As at December: Cocaine (per gram) Heroin (per gram)


































So heroin and cocaine prices have almost halved - having spent 20 billion of so on attempts to increase them. During the same period of time the UK has achieved the dubious position of number one in Europe for both heroin and cocaine use, the latter of which has doubled, the former plateauing at a historic highpoint since 2001. Oh, and we have a disaterous crack epidemic which we didn't have back in 97.


Miserable news indeed. Not that you will hear the Home Office talking about it next week; it is unlikely to feature high in their press releases for next week's big new strategy launch, which will be awash with the familiar propaganda about how great its all gone and some earnest talk about not resting on laurels and needing to do more.

Interestingly this price drop means that the country's growing population of problematic heroin and cocaine users (who are, thanks to the illegal market distribution networks, largely superimposed) don't now have to commit quite so much crime to buy their drugs. As a result drug related crime may have fallen slightly. We cant be sure about this since 'drug related crime' isn't actually measured, as a number of other parliamentary answers have made very clear (more discussion here). We will, however, hear a lot about this (unmeasured) fall in 'drug related crime' this week from the Home Office, credit for which will be give to the Government's new drug treatment programmes even though there is no evidence to suggest this is the real reason - the evidence of treatment outcomes is actually pretty terrible, with over 80% re-offending within two years. But the drop in crime is much more likely to be a fortunate side effect of the utter failure of that cheeky 20 billion or so in supply side spending to increase drug prices.

Cheaper drugs mean less crime committed by dependent users. Take this to its logical conclusion and you get; free drugs means no crime committed by dependent users (well, not to buy drugs anyway). Even though prices have been falling let us not forget that prices of heroin and cocaine are still inflated by over 3000% because of prohibition - turning low value processed agricultural products into criminal commodities literally worth more than their weight in gold. Still, given that 30,000 or so high harm causing dependent users are responsible for over half of all property crime, accruing something in the region of 16 billion a year in crime costs the idea of expanding the facility for controlled maintenance prescribing starts to become rather more appealing.

Spending 3 billion a year to create a further 16 billion in crime costs just doesn't seem like great value for money.

Maybe we should be having a serious debate about the policy alternatives instead of the sham policy consultation we were subjected to last year. Maybe if we invested that 3 billion in evidence based public health interventions: prevention and education, treatment, helping people rebuild their lives, addressing the social deprivation that underlies most problematic use and so on - then the number of problem users might actually start to fall, and if we took the illegal market out of the hands of gangsters and street dealers and brought it within the law then some of the terrible harms it creates might be reduced. How bad does it have to get before we have a serious debate on policy alternatives?

A good to start would have been for the Home Office to tell the truth about what's working and what isn't. But don't hold your breath during the new strategy launch this week. It will be a miserable stage-managed regurgitation of the old failed strategy with a bit of cosmetic window dressing. No debate, no new ideas, no change, no hope.


Peter O'Loughlin said...

The idea that 'free' drugs would mean no drug related crime is ludicrous for a number of reasons, not the least of which is that they would be rationed for so called 'safe use', thereby in many instances leaving the user with a shortfall which would provide ample opportunities for black market supplies, much in the same way as many prescription drugs are available now.

The attraction of mind altering substances available on our NHS would increase their availability, and as with all products with increased availability comes increased use, attracting new 'customers'.

On the other hand if one wants to increase the number of addicts in this country, it is an excellent idea. Of course at the same time since that would make them legal, alcoholics should be provided with free alcohol and inveterate nicotine addicts with tobacco, unless you think the latter two should be discriminated against because they do not choose to use illicit drugs?

We could also contemplate the possibility of proven effective abstinence focused treatment, in safe and secure drug free environments, where not only is the addiction treated but also the addict, with nurturing and caring treatment for the almost invertible co-occurring mental and physical conditions associated with addiction.

A bonus there would be that those with addiction and mental health problems currently incarcerated in overcrowded prisons unfit for human habitation, would receive proper treatment. It would also have the advantage of creating space in our jails, thus dispensing for the need to release dangerous criminals into the community as is happening at present. Given the cost of keeping mental ill addicted people in prisons, such treatment would to to a considerable extent be self funding.

As Addaction point out 50 percent of addicts becoming drug free would not only be a considerable return on investment, but also a positive contribution to society, whereas your suggestion serves only to continue the spread of disease and despair through our society.

Steve R said...

when heroin users are prescribed heroin their offending falls dramatically. Its a simple and incontrovertible fact - with lots of research to support it, the jrf 2003 review being a good start. Why does someone need to steal to buy heroin if they are on an adequate prescription? They don't. The other benefits of pescribing in terms of increased safety, reduced HIV and Hep transmission (and death), decreased social nuisance and street dealing, decreased prison population and enforcement spending (freeing up money for treatment etc), and increased contact with medical services (therefore increased treatment take up) are also well documented. You've picked the wrong fight regards heroin prescribing - it is a pro-treatment and recovery approach, and infinitely preferable to the illegal drug carnage we have today.

Mind altering substances are available NOW. Making them available on the NHS does not increase the appeal - it medicalises and deglamourises them, The experience in Holland and elsewhere shows that prescribing in no way increases use, any more than supervised injecting rooms.

The idea that we let people die as a form of deterrent is pretty repulsive to me. Its human sacrifice as drug education policy.

The decrease in user dealers actively recruiting new users is a also significant benefit of prescribing. The difference between illegal availability and prescription availability is one of control. We would control availability not the illicit market.

Alcohol is cheap enough, because it is legal, to not necessitate crime to support a habit. Its simple economics. Both heroin addict and alcoholic have drug problems but the heroin addict has a crime problem as well. Unsurprisingly it doesn't help. And yes, I would personally support nicotine replacement being available on prescription.

This debate has nothing to do with the availabilty of any form of treatment - which should be available to all in need regardless of a drugs legal status. If the doctor determines that maintenance prescribing is the most pragmatic way forward (with abstinence as a longer erm goal) then thats what I would support.

Once again - a prescription model makes it more likely for people to get into treatment and recovery than if they are left in hands of a dirty dangerous illegal underground drug scene. It also dramatically reduces the likelyhood of them ending up in prison - which you rightly point out is an inappropriate environment for addressing drug problems.

Matt said...

Peter when you talk about 'free drugs' are you referring to making them available on prescription?

If so how can drugs be both "rationed for so called 'safe use', thereby in many instances leaving the user with a shortfall" and also "increase there availability"?

chrisbx515 said...

I think Peter completely misses the point and has a weird vision that somehow my making drugs illegal and imposing moral judgements on the use of drugs that all humans will sit back and say ‘Hey yea drugs really bad’!!! As usual the prohibitionist views ignore the reality and any of the evidence. Still at least when they come in and post it makes a change from agreeing with each other! The debate is really over – or maybe Peter and his friends like the fact that there is a global industry worth billions being run with the greatest of global efficiency by organised crime?