Tuesday, 8 March 2011

It's time to talk sensibly about tackling drug misuse

It must be bash The Herald week.

I’ve mentioned the misleading headlines and questionable motivations of the Glasgow-based newspaper in the previous few posts. Listening to Callum Leslie interviewing Robin Harper MSP this morning on, I was intrigued that the discussion turned to the media depiction of Lib Dem policy as one of “giving out free heroin” – especially as it was Callum himself who introduced the motion at Conference.

Lest we forget, The Sunday Herald had proclaimed that "Lib Dems back move to give addicts NHS heroin". While slightly less hysterical than the Scottish Sunday Express (which incorrectly asserted that “Nick Clegg’s keynote conference speech was overshadowed yesterday after Scottish party members called for heroin to be made free on the NHS”), I really was quite surprised that a quality paper would indulge in such dangerous simplicities.

Robin Harper is an MSP I hugely respect, and his retirement from Holyrood will leave our parliament the poorer for it. Callum observed that the SNP, Labour and Conservative parties had all been quoted in the Express but that the Greens had been overlooked - so what did they make of it all? To which Robin replied that this kind of gross misrepresentation is typical of how the media have interpreted the Greens’ position on similar issues. No-one is calling for “free heroin”, just a strategy on substance abuse that actually works. Prison doesn’t work, especially as drugs are far more readily available in prisons than on the street. Robin pointed out that the best argument for a new strategy on drugs is the unpalatable truth that Scotland accounts for a large percentage of the Taleban’s heroin trade and therefore it is reasonable to assume that not only does the status quo fail to break the cycle of addiction, it actually allows money gained by criminal means to go directly to funding terrorism.

“So”, asked Callum, “we can deal with drugs and international terrorism at the same time?”

Yes, insisted Robin. The best thing would be for Afghanistan’s opium to be taken out of the Taleban’s hands and incentives provided to grow wheat. Depriving the Taleban of their funds (and, therefore, power) would be one objective; the other would be a tighter control of heroin. It is, after all, the lack of control that is the problem.

Of course, this isn’t what Callum Leslie’s considered motion was about. Having actually read it, I did not see anything particularly controversial about it. It was certainly not intended to overshadow Nick Clegg’s speech – and neither did it. So, let’s see: “conference believes that CSOs [Community Service Orders] and DTTOs [Drug Treatment and Testing Orders] are far more effective in dealing with the route causes of drug offences...conference believes that fines carry a risk that the offender may turn to further crime to pay the fine...conference calls on the Scottish Government to ask the new Scottish Sentencing Council to review sentencing in drug possession cases, with a view to ensuring the maximum effective use of DTTOs and CSOs.” There’s nothing in there about free heroin. Neither is there anything to even suggest that prison would no longer be an option. What Liberal Democrats actually want (and, it seems, the Greens too) is a system of sentencing that actually deal with the problem and is effective in ending the cycle of substance misuse.

It is true that an amendment called for “specialist diamorphine maintenance” but to construe that as tantamount to gifting heroin to those with addiction problems is disingenuous in the extreme. Besides, in his speech Callum made it very clear that such treatments would be used sparingly and would be “tightly controlled”. “This treatment would only be used for those addicts who have not responded to other treatments such as methadone treatment” he insisted.

I have an interest in this. In a former life (I know I have a few of them) I lived in a rehabilitation centre for people with addiction problems and later worked in adult mental health services with people affected by substance use. At 20 years old, I was offered some surprising and tough insights into the world of drug misuse. What was very clear to me was that prison didn’t work; apparently it was far easier to feed habits in Barlinnie than it was in our centre, something that some of our clients resented. I knew people who had been through the revolving door so many times, whose lives were rendered meaningless and futile by the justice system’s failure to actually facilitate solutions. What current arrangements do is create professional criminals. At the very best they are responsible for the creation of a (largely male) underclass, dependent on the state for financial sustenance and who lead disempowered lives.

Even the rehabilitation programme offered had severe limitations, dependent as it was on clients being sufficiently motivated to help themselves. When people lead hopeless lives, that kind of motivation is rare indeed. Very many of our clients went on to reoffend. The door kept on revolving. No-one seemed to care.

Methadone programmes, while having their uses, also have their limitations. Most obviously, methadone is more dangerous than prescription heroin and was itself responsible for 30 deaths in Scotland last year.

Another thing so often overlooked is the co-relation between substance abuse and mental ill-health. Admittedly this is something that the conference motion didn’t directly refer to, but it’s patently obvious to any mental health professional that prison is not the best environment for people who are mentally ill.

There are many reasons why CSOs and DTTOs should be utilised, in the words of the carefully phrased motion, to “maximum effect”. That does not mean these are the only solutions, or that there are easy answers to a complex problem. But they are certainly a very significant step in the right direction – and are currently permissible under law, so it’s not even a legal change that Callum Leslie was calling for but a change in the culture of sentencing.

Finally, I’ll come to what the other main political parties reportedly told the Express about their position on drug sentencing (although if they were misadvised that the Lib Dem position was one of giving away free heroin to addicts, I’m not surprised by their reactions). Annabel Goldie stated that ““I have never been convinced that state-funded heroin is the answer. There is already an over-reliance on another opiate, methadone, as a treatment...we need radically improving access to recovery programmes, which lead to abstinence.” No surprises there, but as I stated earlier, "recovery programmes" have their limitations and can only be a part of a wider solution. Labour’s Richard Baker MSP explained helpfully that “what society wants most is to get junkies off drugs, not keep them on” (it's hardly encouraging to know that an elected representative refers to those with addiction problems as "junkies" for the benefit of the press) while an anonymous spokesperson for the SNP added: “they should stick to proven methods to get users off drugs.”

And what are proven methods? Diamorphine maintenance treatment has a particularly strong evidence base. Clinical evidence also suggests that CSOs and DTTOs would be far more useful in reducing drug use (and its associated secondary effects) than the limited range of options generally used in Scotland. As Callum pointed out, it will also save money. Where’s the controversy in that?

We need to talk sensibly when it comes to tackling drug misuse. It's a great shame The Herald prefers sensational and misleading headlines to responsible discussion.


Ewan Hoyle said...

Excellent post Andrew. If you want to get involved with Lib Dems for Drug Policy Reform do get in touch.

Anonymous said...

well said geezer not that id be a lib dem or anything, but im a professional baghead, by professional, i mean i have a professional job, and have a heroin habit too!!!! and im sick of being labelled a dirty fucking junkie!!! yeah, id also say my heroin use has a lot to do with mental health issues too!! and methadone maintenence dont clear the blues like real h

Andrew said...

Thanks Ewan. I will get in touch!

Anonymous, many thanks for your post. You don't have to be a Lib Dem to see that treating drug users as less than human doesn't help anyone. I can't quite believe the "junkie" quote myself, it shows a prejudiced and intolerant attitude.

Methadone has its uses but also its limitations, and some people just don't respond to it.

Sorry to hear you have mental health issues. I hope you're getting the support you need. My own belief is that far more attention needs to be directed at improving mental health if drug use is to decrease. The historic emphasis on prison sentences really makes a bad situation worse.

Anonymous said...

yep, im gonna see if i can get more people to post comments up here and maybe get in touch.. i mean i know a fair few "functioning addicts" as they be called, and well, theres been a drought going on since novembe, and thyre not functionning so well anymore.. what can we do?

Andrew said...

This is a complicated problem and there are no easy answers


I think we all know what is NOT the answer.

A lot of people who have well-formed ideas on this issue sadly do not have very much experience of the reality.

I think the main thrust of the original conference motion was simply to have health professionals and sheriffs looking at a larger range of options. The "one cap fits all" approach really is not helpful, as people respond to different approaches in different ways. We need to look at what evidence there is, especially in how other countries deal with drug "offenders" and adjust our sentencing so that it actually deals with the problem rather than simply filling our prisons, which is a huge drain of the public purse.

There is a lot of evidence for the benefits of diamorphine maintenance therapy and it's by time this was seriously considered, although no-one was calling for it to be free - just for the law to allow for it to be provided to people that needed it. The complex funding issues weren't even discussed.

"There's been a drought since November...they're not functioning so well anymore". This is the kind of thing both politicians and the media are not familiar with. When supply is low users suffer; it also increases demand and prices go up, which in turn leads to associated problems of drug-related crime. It's this kind of situation it's in all our interests to avoid.

Maybe Robin Harper is right - drug supply needs to be more tightly controlled, and removed from organised crimials and terrorist organisations. But that's another issue....

Akhtar said...

Only in America,1298/

Andrew said...

Slightly off subject, but a profile of Robin Harper in The Scotsman: