Friday, July 13, 2007

More critiques of the Tory Social Justice Policy Group on Addiction report

I went to the launch event for the Tory Social Justice Policy Group on Addictions report (full report, exec summary) yesterday and discussed some of its contents with the working group and its authors. Interesting stuff indeed, and I have been diligently poring over the detail of the report. There is a lot to talk about; it covers an awful lot of ground at 428 pages and it is certainly a heavyweight document, literally, if not always intellectually. I hope to discuss some of its recurring themes over the coming weeks on the blog as I feel it will be a useful exercise to highlight many of the problems and confusions within contemporary drug policy thinking and debate.

In the mean time here are a three of the critical responses that emerged for yesterdays official launch:

Firstly from the International Harm Reduction Association:

Evidence, not ideology, must drive public policy on drug use

Commenting on the launch of the Conservative Party’s new drug policy proposals, the International Harm Reduction Association (IHRA) has called for UK drug and public health policy to be based upon evidence, not politics.

IHRA is the leading organisation in promoting evidence-based harm reduction policies and practices on a global basis for all psychoactive substances, including illicit drugs, tobacco and alcohol.

“Iain Duncan Smith say he wants a ‘clean break’ from harm reduction programmes such as needle exchanges,” said Prof Gerry Stimson, IHRA Executive Director. “These programmes were in fact introduced by the Conservative Government in 1987, and they have helped keep HIV infection among injecting drug users extremely low by international standards. The Tories also expanded our methadone programmes.”

“The Conservative’s new drug policy suggests there is insufficient research to support harm reduction interventions. In fact nothing could be further from the truth, as the controversial nature of these programmes means they are among the most rigorously monitored and evaluated of all drug programmes. The scientific research from around the world shows clearly that needle exchange and methadone save lives, and for this reason these interventions are supported by the World Health Organization and the United Nations, among many others.”

“Interestingly, the detailed research on harm reduction produced by the WHO and the UN is conspicuously absent from the new Tory policy, suggesting that the authors have cherry-picked their ‘evidence’ to fit pre-determined, ideologically driven outcomes,” said Prof Stimson.

“Of course we need more and better treatment programmes to rehabilitate people who use drugs. But let’s not fool ourselves, you can’t rehabilitate someone who has died from HIV/AIDS.”


Appended to the above press release is the document:

Misrepresentation of the Effectiveness of Harm Reduction: Evidence Ignored in Conservative Party Policy Recommendations

"We certainly know from our experience in the UK that clean needles can dramatically improve the position as far as drug users are concerned. To those who say that free needle exchange is too radical, too liberal a step, I reply that it was introduced here not by some way out administration of the left but by the government of Margaret Thatcher."

Lord Fowler
House of Lords
19th May 2004

World Health Organization Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users – Evidence for action technical papers (2004) online here

This is the most comprehensive report ever produced reviewing the evidence base for needle/syringe programmes (NSPs), and is based on a review of over 200 scientific studies:

“The studies reviewed in this report present a compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level.” (p. 30)

World Health Organization, United Nations Office on Drugs and Crime and UNAIDS position paper: Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention (2004)
online here (pdf)

“Substitution maintenance therapy is one of the most effective treatment options for opioid dependence. It can decrease the high cost of opioid dependence to individuals, their families and society at large by reducing heroin use, associated deaths, HIV risk behaviours and criminal activity. Substitution maintenance therapy is a critical component of community-based approaches in the management of opioid dependence and the prevention of HIV infection among injecting drug users (IDUs).” (p.2)

“Methadone maintenance treatment is also an extensively researched treatment modality. There is strong evidence, from research and monitoring of service delivery, that substitution maintenance therapy with methadone (methadone maintenance treatment) is effective in reducing illicit drug use, reducing mortality, reducing the risk of spread of HIV, improving physical and mental health, improving social functioning and reducing criminality.” (p. 14)

“Substitution maintenance treatment is an effective, safe and cost effective modality for the management of opioid dependence. Repeated rigorous evaluation has demonstrated that such treatment is a valuable and critical component of the effective management of opioid dependence and the prevention of HIV among IDUs.” (p. 32)

World Health Organization, UNAIDS, United Nations Office on Drugs and Crime Policy Brief: Provision of Sterile Injecting Equipment to Reduce HIV Transmission (2004)

online here (pdf)

“The provision of access to sterile injection equipment for injecting drug users and the encouragement of its use are essential components of HIV/AIDS prevention programmes, and should be seen as a part of overall comprehensive strategies to reduce the demand for illicit drugs.” (p. 1)

United Nations High-Level Committee on Programme Preventing the transmission of HIV among drug users: A position paper of the United Nations System (2001)
online here (pdf)

“Several reviews of the effectiveness of syringe and needle exchange programmes have shown reductions in needle risk behaviours and HIV transmission and no evidence of increase into injecting drug use or other public health dangers in the communities served. Furthermore, such programmes have shown to serve as points of contact between drug abusers and service providers, including drug abuse treatment programmes” (para 10)

Commonwealth Department of Health and Ageing (Government Of Australia) Return on Investment in Needle & Syringe Programs in Australia: Summary Report (2002) online here

"By the year 2000, approximately 25,000 HIV infections are estimated to have been prevented among injecting drug users since the introduction of NSPs in 1988, and by 2010 approximately 4,500 deaths are projected to have been prevented.” (p.i 10)

“By the year 2000, approximately 21,000 HCV infections are estimated to have been prevented among injecting drug users since the introduction of NSPs in 1988, (of which approximately 16,000 would have developed chronic HCV); while by 2010 approximately 650 fewer injecting drug users are projected to be living with cirrhosis and 90 HCV-related deaths would have been prevented.” (p. 10)

“Overall, total treatment costs avoided over the life of the cases of HIV and HCV avoided by NSPs are approximately $7,808 million.” (p. 13)

“The results demonstrate that NSPs are effective in reducing the incidence of both diseases [HIV and Hepatitis C] and that they represent an effective financial investment by government... The results demonstrate that, across all measures of effect used in the study, NSPs have yielded a significant public health benefit, and that continued investment will result in further financial savings to government and improvements in both the quantity and quality of life of injecting drug users accessing NSPs.” (p. 21)


Before moving on to the next commentary, it is worth pointing out that IHRA, the leading independent centre of expertise on harm reduction, in the world, were not approached for a submission to the working group. Given the reports repeated critique of the approach (as they define it - or in fact fail to define it) this seems like a stunning oversight. IHRA do, however, warrant a brief mention in the online version of the report. The mention comes within the rambling 130 page submission/rant from former headmistress Mary Brett that is included in toto, suggesting they are part of some global drug promoting / legalising conspiracy (which rather disappointingly Transform are not identified as being part of). Of IHRA, Brett says this:

"The IHRA (International Harm Reduction Alliance), of which the UKHRA is an offshoot and The Drug Policy Alliance are to a large extent funded by George Soros"

These 27 words have the dubious achievement of containing an impressive 3 factual errors: They are mistakenly called the International Harm Reduction 'Alliance' (it is 'Association' ), UKHRA is mistakenly described as an offshoot of IHRA (there is no formal link), and IHRA are mistakenly described as being funded 'to a large extent' by George Soros. They currently receive no funding from George Soros (although there are some Soros funded scholarships to attend the annual IHRA conference). In fact they are 'to a large extent' funded by the sinister 'Department for International Development'.

Right then, next:

, a press release from the UK Drug Policy Consortium, which, as well as making similar assertions to IHRA, is noteworthy because it is the UKDPC's first commentary on an external policy document (they have, up until now, been keen to state that they are collecting evidence rather than making recommendations, or offering commentry on other peoples)

Conservatives risk adopting flawed drug policy

Although the Social Justice Policy Group have spent much time and effort gathering opinions, anecdotes and case studies for their recent weighty report ‘Breakthrough Britain’, they have not taken sufficient account of the scientific evidence of ‘what works’ to tackle the UK’s drug problems.

This has led to some distorted analysis using selected and partial evidence, particularly in two key areas: methadone prescribing and drug treatment.

Despite a cursory acknowledgement that methadone prescribing can have a positive role, overall the report vilifies such programmes (dubbed ‘methadone madness’) and concludes they have “contributed to the growth of the problem rather than lessened it”. In doing so they ignore the robust body of evidence which demonstrates that harm reduction and treatment programmes including methadone prescribing have over many years contributed significantly to reducing deaths and other drug-related harms in the UK.(1)

In looking at drug treatment programmes the Group notes that one size does not fit all, but again contradicts itself by putting far too much reliance on abstinence, claiming: “abstinence is the most effective method of treatment and the only appropriate one for many addicts”. This sidelines some of the best available research. For example, NICE has comprehensively endorsed a range of treatment programmes including substitution drugs such as methadone and buprenorphine as well as residential rehabilitation.(2)

Roger Howard, chief executive, said:

“The UK Drug Policy Commission urges the Conservative Party to look carefully again at the scientific evidence before accepting the proposals outlined in the Social Justice Policy Group’s report. The Addiction’s Working Group which produced the proposals has been selective and partial in its analysis and interpretation of significant research findings across many areas of its work. Consequently, the Conservatives risk adopting flawed drug policy advice.”

(1) As noted in the independent report we commissioned: An Analysis of UK Drug Policy written by Professor Peter Reuter and Alex Stevens, April 2007. The full report and executive summary can be downloaded at the UKDPC website:

See also NICE technology appraisal (2007) Methadone and buprenorphine for the management of opioid dependence.

(2) In draft guidance published by NICE and currently being consulted on, they state: “Opiate misuse is often characterised as a long term, chronic relapsing condition with periods of remission and relapse, so although abstinence may be one of a range of long term goals of treatment, it is not always achieved.” [National Institute for Health and Clinical Excellence – Drug Misuse: Psychosocial management of drug misuse: Draft guidelines January 2007].

NICE has also undertaken rigorous studies of the available evidence, which endorse a variety of treatment approaches.

Thirdly, an excoriating piece from Johann Hari in the Independent titled the very worst policy to combat drugs in which Danny Kushlick, Transform's Director, is quoted: "The report's authors avoid the science and the evidence like the plague". Hari, as ever, takes no prisoners and tears the report apart.


Anonymous said...

Surely they must know this wouldnt work?

Anonymous said...

One of the fundemantal problematic issues is that the Tories and other allied groups still see treatment ie methadone in particular as being a cure all and not part of a raft of measures to assist with sustaining more viable life choices

Anonymous said...

In truth Steve, Hari only addressed on part of the policy, namely cannabis, which does not surprise me.

In doing so he quoted a couple of pieces of selected research, when as we both know there are many more which take an entirely different view.

Because there was no facility doe comment on his article, I emailed him raising a number of questions; to date I have not received an acknowledgement. I live in hope, rather than expectation>

Steve Rolles said...

Hi Peter

I agree up to a point. I didnt think it was his best effort on the issue (he has written eloquently about drug policy, and it is all archived on his website), because, as you say he focused too narrowly on cannabis, although to be fair, the SJPG report did rather obsess over cannabis, it bought into many of the misunderstandings and misrepresentations on potency and psychosis (chosing the evidence that matched their proeconcieved positions - a balance which needs some redress), and the call to reclassify was what got most of the headlines. I would have done it differently and I have: Ive written about these issues at length elsewhere in the blog regards the recent IOS retraction and the current potency panic (comments welcome as ever).

I would also have made the heroin point differently, but the broader point, that it is the illegal aspect that induces the choas and offending associated with heroin use I agree with. He also mentioned a quote from Transform which made it worthy of noting on the blog.

I would be interested to know what you think of the other critiques i mentioned in the blog, regards the narrowness of the reports consideration of evidence on substitution treatment and prescribing.

Im going to be writing more about the report in the coming days, so there will be plenty more to talk about no doubt.