Tory Social Justice Policy Group on Addictions: first thoughts

The Conservative's Social Justice Policy Group report on Addictions is finally published today (full report, exec summary) after a two year gestation. It forms part of the Group's Breakthrough Britain report that, under the guidance of former party leader Iain Duncan Smith, is attempting to update and recast Tory social policy more generally. Whilst it is unclear at this stage how much of the addictions report will make the Tory manifesto, party leader David Cameron has given a strong indication today that he is taking it very seriously. There is a real possibility that Cameron may be forming the next government so we should take it seriously too.

Consequently Transform have made an effort to engage with the development of the document. We made a written submission, gave a presentation to the working group and had meetings with the authors, as well as attending various public discussion events during the document's development. I had a chat with IDS, and he seemed like a reasonable chap.

So, anyway, here it is, all 428 pages of it which I have dutifully ploughed through today so you don't have to. It's all very confused and disappointingly the same as previous Tory policy, with some islands of sensible analysis swimming in an all too predictable sea of misunderstanding, incomprehension, and politically blinkered ideology. Harm reduction, as they define it, comes in for a particular kicking (weirdly, given that the Tories were responsible for introducing it in the UK), as does any treatment intervention that is not resolutely abstinence based from the outset. They are OBSESSED with cannabis classification without any sensible explanation why, and have totally failed to understand the broader critique of prohibition or the inevitable failure of a punitive / enforcement led approach to dealing with the public health and social problems associated with drugs. There's a lot in here which will warrant closer consideration and discussion in the blog, but for now here's some first thoughts and a couple of things to highlight.

A few bits of the report are downright strange. It includes three of the written submissions complete and apparently unedited. There are two on alcohol policy from the Institute for Alcohol Studies, and Alcohol Concern; all sensible stuff about better regulation of alcohol which has clearly informed some of the reports more sensible recommendations about alcohol pricing. But then there is the bizarre inclusion of a rambling, ranting submission from Mary Brett, a former headmistress from the evangelical prevention school of drug policy thinking. Brett's submission, which essentially marks a range of UK drug organisations (and publications) according to their adherence to her particular preoccupations with prevention, abstinence and cannabis (sounding familiar?) totals over 130 pages, yes, that's 130 PAGES, incredibly making up about a third of the bulk of the complete 428 page report.

Whilst I was unable to find a list of submissions that were made, there is one I do know of that didn't warrant inclusion: Ours. So for the record I will be putting it online. It was essentially a series of discussion points to try and make the groups think outside of the narrow confines of more mainstream Tory drug policy thinking (weighing in at a relatively lightweight 5 pages). This they have singly failed to do. They casually dismiss the law reform analysis thus:

"Concern for a stigmatised and untreated population of addicts in the 1970 and 80s – then considered a deviant fringe of society - also resulted in the emergence of a ‘street agency’ voluntary sector. Interlinked with addicts’ equal rights to receive health care alongside other members of the population grew another assertion: the right to use drugs and the right not to be criminalised. From this developed a lobby which today argues for acceptance of the reality of widespread ‘harmless use’ of drugs in the population. The logical corollary of this argument is that it is the prohibition of drugs that is the problem, not drug use itself. They argue that prohibition drives highly profitable and uncontrollable crime thereby exploiting and corrupting socially vulnerable communities, both criminalising individuals and infringing their human rights. (23) In the brave new world of legalised drugs the optimistic scenario projected is one in which ‘harmless’ drug use would go up, while ‘harmful’ drug use would go down – a projection which flies in the face of all that is known about rising parallel trends in alcohol use and harms."

Much of this quote appears as an either ignorant or a willfully confused misrepresentation of the reform position, as anyone who had read our literature would clearly understand. Worse, the reference (23) is given as 'Transform Drug Policy Foundation'. To my knowledge Transform have never used the phrase 'harmless use', in fact in our written submission, which didn't make the report, we say on the first page:

All drugs carry risk and cause harm. However, we need to make very clear distinctions between harms caused by drug use and misuse and harms created or exacerbated by policy - in this case, enforcement of prohibitionist legislation. The principle of policy implementation must be: First do no harm.

The Transform submission does, however, make a distinction between non-problematic or recreational use, and problematic use - suggesting, logically enough given that they are different, that different policy responses are required for each. The SJPG is apparently incapable of engaging with this (really quite low) level of policy sophistication. I understand that the 'harmless use' reference has been mis-attributed to Transform, having been confused with the RSA report (which to note, pointedly stopped shy of recommending legalisation and regulation). For the record we contacted Kathy Gyngell, who apologised for the mistake and offered to make a clarification at Thursday's press conference.

That said, the mostly excellent RSA report itself is also rather grotesquely misunderstood and misrepresented by Duncan Smith and the new report. On the 'harmless use' front, the RSA report actually says this:

The use of illegal drugs is by no means always harmful any more than alcohol use is always harmful. The evidence suggests that a majority of people who use drugs are able to use them without harming themselves or others. They are able, in that sense, to ‘manage’ their drug use. They are breaking the law in possessing illegal drugs, but they are not breaking the law in any other way. The effects that drugs have depend to a large extent on the individuals who use them, the drugs that they use, the ways in which they use them and the social context in which they use them. The harmless use of illegal drugs is thus possible, indeed common. Nevertheless, all illegal drugs, like all other psychoactive substances including alcohol and tobacco, carry risks. Some people die as a result of their misuse of drugs, many more are made ill, some of them very ill, and drug use can compound, as well as be caused by, problems of mental health. Drug use and crime are closely associated. The cumulative costs to society, including in purely monetary terms, are enormous.

I might not have used the term 'harmless use', but in context this RSA comment seems pretty reasonable to me, and is based, as they note, on evidence. The fact that drugs have risks doesn't mean that those risks are realised in every user every time a drug is used. Risk refers to a probability of something happening, and regards drugs and harm that probability is demonstrably not 100%. If you cant get to grip with this, as Duncan Smith seems incapable of doing with his outright condemnation of the RSA report as 'irresponsible', it suggests that you have approached the issue as an idealogue not a scientist, and that your mind was already made up.

A more systematic critique to follow......

Home Office splits...Home Office keeps drugs. Doh!

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In January there was talk of the Home Office splitting into a Ministry of justice and a Ministry of public protection, or something like that. The Transform blog speculated over the scuffle that would ensue over who didn't get to keep the poisoned chalice of doomed drugs enforcement. It was a jokey piece, partly because it all seemed like a Government bluff to make it look like the doing something to make the struggling department 'fit for purpose' after the various crises and series of high profile debacles. Turns out they were serious.

Cut along the dotted line. (© TDPF 2006)

Tony Blair announced in his speech on the matter that:

The Home Office will retain its other existing responsibilities, including for policing, anti-social behaviour, drugs, overall crime reduction, immigration, asylum and identity, in addition to its responsibilities for security and counter terrorism.

The Ministry of Justice will be responsible for policy on the overall criminal, civil, family and administrative justice system, including sentencing policy, as well as the courts, tribunals, legal aid and constitutional reform. It will help to bring together management of the criminal justice system, meaning that once a suspect has been charged their journey through the courts, and if necessary prison and probation, can be managed seamlessly.

I don't really get it, but anyway drugs will stay in the Home Office after all: I can hear the whoops of joy from here. One suspects it wont make the slightest bit of difference for drug policy, and gives the strong impression of being just another 'process' achievement as a proxy for those still-elusive 'policy outcome' achievements (see the SOCA blog for more discussion of this phenomenon). But it does at least demonstrate that there is some flexibility - especially in response to failure. Bear in mind that drugs has already moved once during the ten year strategy (from the Cabinet Office), so, with the drug strategy review about to get underway, and given the disastrous outcomes of the Home Office's time in charge, maybe there is a window of opportunity for a rethink.....

For the record: Transform have been suggesting for years that the drugs brief, being a health issue, be moved to a more appropriate department, like Health for example (as recently happened in Spain). The recent RSA drugs report also suggested that the drugs brief be taken away from the Home Office, although they suggested it move the Department of Communities and Local Government, rather than Health where alcohol and tobacco policy are overseen.
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RSA Drugs Report - so near and yet so far

The RSA published their long awaited drugs report last week to not a little fanfare. The report suggests that the current policy is based on ‘moral panic’, suggests that most drug use is relatively harmless, that tobacco and alcohol should be included in the drug policy making process and that prohibition cannot stop people using drugs – they are here to stay.

It will be seen as a watershed report in raising the level of debate on drugs and drug policy in the years to come. The Commissioners are to be congratulated for producing a groundbreaking report. You can read the press release , the exec summary, or the full volume here and judge for yourself.

In my op-ed for the Guardian online I argue that it is the politics of prohibition that makes it so difficult for politicians to engage with Reports like the RSA's.

And in the Mirror I ask whether we are adult enough to engage in a public debate on the efficacy of repealing prohibition and replacing it with legal regulation

The RSA analysis could easily be the basis for a Phd on the repeal of prohibition and its replacement with a far more effective system of legal regulation and control. But that is not quite where the RSA report takes us. I’ve identified a number of reasons why I think that the report fails to reach what should have been its natural conclusion.

A fundamental mistake: not nailing the problem

My experience of commenting on drug policy issues is that the failure to identify prohibition as the overriding problem leads to convoluted and internally inconsistent solutions. Unfortunately the Report fails to recognise that it is prohibition that is the radical and anomalous response to drugs and that regulation is the policy response that conforms far more closely to social and legislative norms.

Oddly, prohibition seems to be identified as not being ‘viable’ very early on in the report but the analysis is not developed. This is a quote from the report (p 29) that would lead us to believe that there is only place that the analysis could go:

“As readers of our report will quickly discover, all of our recommendations and suggestions are founded on two core beliefs. One is that drugs and other psychoactive substances are simply not going to go away. People have used them for thousands of years, widespread demand exists, supply is plentiful, and the illegal-drugs industry, not to mention the alcohol, tobacco and legal drugs industries, are among the best organized and most market-oriented in the world. Prohibition is no more a viable policy in Britain today than it proved to be in America during the 1920s and 1930s.With regard to illegal drugs, young people, in particular, are often told ‘Just say no’. That may sometimes be good advice. The only trouble is that there are, and always will be, large numbers of people who, for whatever reason, ignore that advice and choose to say yes. Drugs are a fact and, in our view, need to be accepted as a fact. We believe, as our choice of title suggests, that policy and the administration of policy should be based on a cool appraisal of the facts, not on fantasy and wishful thinking. In the words of Reinhold Niebuhr’s famous prayer:

God, give us the serenity to accept what cannot be changed;

Give us the courage to change what should be changed; and

Give us the wisdom to distinguish one from the other.”

But whilst no one claims it will be easy or happen overnight, history clearly shows that prohibitions can be changed. If drug prohibition is ‘no more a viable policy in Britain today than it proved to be in America during the 1920s and 1930s’ then the logical conclusion is surely that it should be repealed and replaced with something more viable. What it might be replaced with takes us to the next point.

A new Substance Misuse Act?

The failure to identify prohibition as the key problem leads to some confusion about what the legislative framework is for. The Report recommends that all drugs come under one new Misuse Act. Leaving aside the fact that the report suggests that most drugs are used rather than misused, what would be the point of putting all drugs into one piece of legislation if some are prohibited and some are legally regulated? It would end up being nothing more than a list.


Not dealing with supply side

In one of the their discussion documents (produced in the run up to the final report and available here) titled 'The supply of illegal drugs in the UK' , under the 'points to consider' section, the Commission notes:

"1. HM Revenue and Customs estimate that we spend 1 billion + per year trying to control the supply of drugs. Given the difficulties in the path of these efforts, can we really say that our enforcement policies are motivated by practical considerations, or are they moral ones? Are we pursuing a policy of supply reduction because we think it will work, or because we think drug dealing is wrong and should be punished?"

they then ask:

"Is legalisation of the drugs trade the only real way of controlling the supply of drugs? – (e.g. by creating a trade which could be regulated and taxed and could guarantee stable prices and safer drugs, which would not require a smuggling network that can be used for other illicit trades, which would not be surrounded by a gun culture, etc.)"

This question of supply seems to have been lost when it came to writing the final report. What is called for seems deliberately ambiguous, hinting at the obvious but terribly wary of being explicit about it:

"Drugs policy should, like our policy on alcohol and tobacco, seek to regulate use and prevent harm rather than to prohibit use altogether. Illegal drugs should be regulated alongside alcohol, tobacco, prescribed medicines and other legal drugs in a single regulatory framework."

Strangely the Commission opted for regulating use rather than supply. Perhaps it was a case of committee syndrome, where dissent forced a somewhat unsatisfactory and woolly compromise around the prohibition / regulation question? When asked at the launch event last week, Anthony King said the committee felt that it was for ministers and civil servants should be sorting out the specifics for each drug. Perhaps this is fair enough, yet it is at odds with the very specific recommendations in much of the rest of the report.

The committee received various reports from Transform, including our own (referenced by the RSA) aswell as reports from the Health Officers of British Colombia and the King County Bar Association - which provide very clear and detailed analysis of how legal regulation of different drugs would work - from a public health and legal standpoint respectively. This was a missed opportunity to introduce some clarity, nuance and sophistication into the debate about regulatory alternatives to prohibition - and the flirting around the issue without nailing it makes for frustrating reading when the much of the other analysis is so spot on.

Why no recommendation of cost-benefit analysis?

From the report (p 113):

"The most recent version of the strategy is the Updated Drug Strategy 2002. Its overall objective is ‘reducing the harm that drugs cause to society – communities, individuals and their families’. This objective is anchored in a philosophy of prohibition. The opening paragraph of the summary of the strategy states: ‘We have no intention of legalising any illicit drug. All controlled drugs are dangerous and nobody should take them.’ What is missing from all these accounts is a detailed analysis of the cost-effectiveness of the drug strategy itself. Basic calculations have been published of the ratios between the costs of drug interventions and their savings in terms of health and social costs. But Christine Godfrey, co-author of the key study of the economic and social costs of drug use mentioned above, has argued that a really robust and thorough-going cost-benefit analysis should be a priority for government.

Failure to complete this analysis makes it impossible for policy makers to consider alternatives to existing policy by comparing the costs of the current strategy with the estimated future costs of other options, whether these be decriminalization, legalization or zero-tolerance. We agree with Professor Godfrey.

It is dissapointing and inconsistent then that the report did not call for such a cost-benefit analysis (of current policy and alternatives) in its recommendations. Transform called for just such an audit in 2002.

The decision to keep the remit domestic rather than international

There is a significant problem in attempting to review and recommend change from a narrow domestic viewpoint. The UK is committed to international prohibition in the form of the three UN drug conventions to which we are signitories, and it is these that creates the vast globa lillegal drug markets and associated problems. The RSA report shows that the significant price hike in heroin and cocaine occurs between production and domestic wholesale. But calls only for enforcement to be focused on Mr Bigs. (p 13):

"The fight against the supply of illegal drugs should not stop, but it should be refocused so that it concentrates on organized criminal networks rather than on largely futile efforts to interdict supply."

Whilst no one is suggesting enforcement should ignore violent gangsters, unfortunately all the evidence shows that this is futile at interrupting drug supply too, on the basis that the trade is so lucrative that there is always a queue of gangsters waiting to make a killing by moving into the vacuum successful busts will occassionally create. Furthermore it is prohibition that creates the opportunity for gangsters in the first instance - just as it did with non-viable alcohol prohibition. Transform believes that it is impossible to truly understand domestic drug policy unless it is placed in its global context.

Weak analysis of drugs and crime link

The failure to ‘nail’ prohibition as the specific first cause of the link between drugs and crime appears to be a major fator in the Commission's avoidance of calling for its repeal. Although it cites the £16 billion annual crime costs committed by a few hundred thousand heroin and crack users fundraising to support a habit, it fails to identify prohibition as the culprit. The report does call for heroin prescribing (what is that if not legal regulation of a currently illegal drug?) for the usual familiar reasons including reduction in offending - but still fails to make the link explicit. Prohibition directly causes almost all 'drug-related crime' - they really needed to make the point much more clearly.

We are left with what is undoubtedly a thoughtful and throrough report, but also one that walks you to the door but isn't quite willing to suggest you walk through, that does all the hard work and then fails to quite see it through. It doesn't dare go the one step further than the similar reports from the Police Foundation (2000) or the Home Affairs Select Committee (2002), that would have marked it out as historic. Arguably, the HASC went further by at least recommending the Government 'initiate a debate' on 'legalisation and regulation' 'at 'UN level'.

Overall the thrust of the Report has created a significant window of opportunity to scrutinise the failings of current policy. It is now up to those with a vision of prohibition's replacement to use this opportunity to increase the momentum toward a more effective system based upon regulation and control of supply. Despite our criticisms, thanks must go to the RSA for opening up the debate once again.

Media comment on the report:


Alice Miles in the Times suggests that the Commission has been equivocal over its attitude to alcohol

Mark Lawson in the Guardian doesn’t quite get it

Telegraph leader

Guardian leader

Independent leader

Telegraph op-ed starts the build up to RSA drugs report

A decent op-ed in today's Telegraph by Philip Jonston kicks off the build up to Thursday's publication of the drug policy report form the RSA, (titled: Is drug policy working? and if not, why not?) and what promises to be a feisty week of drug policy debate with an emphasis firmly on progressive refrom. The RSA report has been two years in its gestation with Transform amongst the many groups and individuals submitting information and analysis. It has set itself up as an 'unofficial royal commission' and Jonston, who sat on the report's committee gives some strong hints about what it is likely to contain. His analysis covers familiar ground;

Drugs policy has failed. Do not take my word for it. That was, essentially, the conclusion of the Prime Minister's strategy unit in a report published last year after initially being suppressed. The aim of drugs policy over the past four decades has been to reduce demand and curb supply. It has done neither. Crime associated with drug-taking is as rife as ever. A new way needs to be found.

The RSA report that he details will no doubt take a similar line, stopping short of calling for legalisation and regulation of any currently illegal drugs (perhaps with the exception of cannabis, and probably calling for a debate or leaving the door open in the future) but clearly acknowledging the failure of prohibtion and calling for a move away from failed criminal justice measures, suggesting a variety of sensible public health led interventions as alternatives.

Hopefully the report will go further, and distinguish itself from either the Police Foundation report (1999) or the Home Affairs Select Committee report on drugs (2001), its immediate predecessors. These previous reports made much the same points about the need for reform and a public health approach and we can expect a certain amount of overlap with the RSA, with calls for more heroin prescribing, safe injecting rooms, an overhaul of the classification system and so on. Potentially, as Jonston hints:

most of us felt, without being excessively libertarian about it, that if people are harming neither themselves nor others, the state has no reason to intervene.

..the significnat new call, going beyond the previous 'unofficial royal commissions', will be for the non-prosecution of individuals for personal possession of drugs. This would be a major step forward (without which it will potentially just be rehashing the conclusions of its forbears), but we will have to wait and see....

Public approve a rational approach to drugs

According to a recent YouGov poll carried out by the Daily Telegraph and the Royal Society for the Encouragement of Arts, Manufactures and Commerce a majority of the public think that personal cannabis use should be decriminalized. The poll, discussed in an article by the Daily Telegraph on the 14th August 2006, also revealed that the majority of the public still believes that "hard" drugs such as cocaine and heroin should remain a serious criminal offence. The poll reveals that the public takes a pragmatic approach to drug use and would be amenable to policies which approach drugs according to the harm they cause. Sadly the poll shows that prohibition itself is not regarded as harmful but at least the public is beginning to realise that the legal status of a drug is not a useful indicator of its harmfulness.