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Scotland's Drug Problem
Scotland's Drug Problem
Report of a conference organised by the Royal Society of Edinburgh Tuesday 27 May 2003
ACKNOWLEDGEMENTS
The Royal Society of Edinburgh would like to thank the following people and organisations :
ORGANISING COMMITTEE
Professor John Beck, FRSE Programme Convenor, The Royal Society Edinburgh Professor Robert Kendall CBE FRSE Honorary Professor of Psychiatry, University of Edinburgh, Former Chief Medical Officer, The Scottish Office. Sadly Professor Kendall passed away in December 2002. The Royal Society of Edinburgh would like to express their deeply felt gratitude to Professor Kendall who was the main inspiration and driving force behind this event Professor Neil McKeganey Director, Centre for Drug Misuse Research, University of Glasgow
SPONSORS
CONTENTS
INTRODUCTION ................................................................................... 3 THE SCOTTISH SCENE ............................................................................ 5
Mr Hugh Henry MSP Deputy Minister for Justice, Scottish Executive Professor Neil McKeganey Director, Centre for Drug Misuse Research, Glasgow What kinds of drugs are being used? What kinds of people are using them? What damage is this causing? How widespread is the problem and is it growing?
IN THE ILLICIT
THE ROLE
OF THE
POLICE ....................................................................... 9
Mr Richard Brunstrom Chief Constable, North Wales Police The drug debate; time for change.
OF THE
MEDIA .................................... 11
It has become inescapably clear to us that the eradication of drug use is not achievable and not therefore either a realistic or sensible goal of public policy.
Report of the Independent Inquiry into the Misuse of Drugs Act, established by the Police Foundation and chaired by Viscountess Runciman 2000.
Modern society is engaged in what is often seen as being a war against illegal drugs. It is a war that has created many casualties. Drugs can destroy the lives of those who take them, they devastate communities where drug taking is rife, they create a wave of crime across the country and are a drain on public services and on the public purse. It is also a war that some believe can never be won. People who take this view believe that change is essential to help minimise the misery caused by
drug taking. But what sort of change is needed? Does the answer lie in greater liberalisation of illegal drugs? What evidence exists of effective interventions? What obstacles lie in the path of progress? The Royal Society of Edinburgh brought together a group of experts from the UK and overseas to examine how best to respond to the drug problem and to identify the best way forward. This report summarises the main presentations and the conclusions of the Conference.
The Deputy Minister for Justice at the Scottish Executive, Mr Hugh Henry MSP, opened the Conference by welcoming the delegates, particularly those from other parts of the UK and abroad. The Minister provided an overview of drugs policy in Scotland. He explained that it is designed to reduce the amount of drugs available on the streets through a range of enforcement activities, whilst also working to reduce the demand for them. However, he emphasised that a policy based solely on limiting the supply of drugs will not solve the problem. Demand is being tackled by educating and informing young people about the dangers of drugs (eg through the Know the Score campaign) to prevent them taking up the habit, helping communities affected by the impact of drugs, and providing treatment and rehabilitation for those already addicted. He identified the twenty two locallybased Drug Action Teams in Scotland as a key element in the policy. This is the way forward having a suite of national strategic objectives that incorporate local partnership delivery mechanisms. We have considerable scope to design and implement solutions in Scotland and, as an Executive, we continue to be open to new ideas. Mr Henry said that treatment works. For every 1 spent on treatment, over 3 is saved in other areas such as in the courts or the health service. Scotland has been improving the services it offers to drug users, supported, The Deputy Minister said, by record levels of investment by the Executive, but he accepted that, in many areas, waiting times for treatment and rehabilitation are still unacceptably long. He said he was interested in new developments elsewhere, such as the legal
prescription of heroin. Although the Executive has no current plans to introduce this in Scotland, we should not rule out a treatment which might improve the health and rehabilitation of a small minority of patients for whom all other approaches had failed, Mr Henry said. The Executive is keeping in touch with progress with the pilot schemes south of the border. Among the obstacles to progress are the strong opinions which are held about drugs policy by members of the public, the media, those engaged in the drugs field and by politicians. Instant solutions are often put forward that are unworkable. Media coverage can be sensationalist and unbalanced. Simple solutions will not work, said Mr Henry. A one-size-fits-all policy will just drive us to failure. We need to recognise that we work in a very difficult, complex environment. The problems which Scotland is facing are no different than in many other nations, and he hoped that the delegates would share experience and expertise, both within the UK and internationally. In a question session after his presentation, Mr Henry was asked about the attitude of the Scottish Executive to other developments such as safe injecting rooms. Mr Henry said that the Executive is willing to look at approaches which are backed by robust research and success, but there is currently a lack of evidence to support the benefits of injecting rooms. Figures on the extent of illegal drug use in Scotland were presented by Professor Neil McKeganey, Director of the Centre for Drug Misuse Research at the University of Glasgow. Recent research has established that there are around 56,000 heroin users in Scotland which, is considerably higher than the previous best estimate of 30,000. There
IN THE ILLICIT
DRUG MARKET
The choices facing policy makers were examined by Professor Alan Maynard of the University of York. He said they represented choices between different evils: in effect the continuation of current policies which have created a huge crime problem and much attendant misery, or a
move to greater liberalisation and regulation which may reduce crime but create a larger health problem. He questioned why so much public money, attention and effort is currently devoted to a drug problem which constitutes such a small health threat. The 500 drug-related deaths a year
Dr Peter Reuter, Professor of Public Policy and Criminology at the University of Maryland, examined the diversity of drug policies adopted by advanced western countries. There are liberal policies in the Netherlands and Australia, heroin maintenance in Switzerland and the decriminalisation of possession of drugs in Italy, Portugal and Spain, amongst other countries. On the other hand, the U.S and Sweden remain dedicated to tough use of criminal sanctions against drug use as well as against small-scale trafficking. However, there is no correlation between rates of drug use and national policies. There is also discontent with policies that are harsh, intrusive, expensive and inhumane, but great resistance in some countries,
particularly the United States, to experimentation. Countries are trying to learn from each other, but the lessons that are drawn from experience elsewhere are usually extremely crude. Dr Reuter used the experience in Switzerland with heroin prescription as an example. The Swiss responded to a growing heroin problem by creating a no crime zone in Zurich, where small amounts of any illicit drug could be bought and sold without fear of prosecution. This led eventually to a political decision to experiment with heroin prescription. The trial was deemed by Switzerland to be a success and heroin maintenance was introduced for addicts who meet certain criteria. They can self-inject up
THE ROLE
OF THE
POLICE
through. This is a cast iron, rock solid social security system for organised criminals. This cannot be a sensible policy, argued Chief Constable Brunstrom. The choice is between continuing with the international regime of proscription or regulating the supply and use of drugs. I think the evidence is increasingly strong that proscription will not and cannot work. I believe it is a sterile policy. We have got to take the criminality out of this and focus on the social causes, said Chief Constable Brunstrom. Tobacco is a more dangerous and addictive drug and we have managed to reduce tobacco dependency over time. We may be able to do the same with these illicit substances. He called for drug users to be treated as victims rather than criminals and for them to be given treatment rather than imprisonment. Heroin prescription is supported by the Association of Chief Police Officers and Chief Constable Brunstrom described it
Richard Brunstrom, the Chief Constable of North Wales Police, presented an argument for radical change that would take drugs out of the hands of criminals and reduce the appalling social consequences of current drug use. He said he wanted to see a policy based on principle, not on expediency, and called for better leadership from politicians. He described current legislation as illogical, unethical, counterproductive and untenable. It has managed to create an 8 billion a year trade in illegal drugs in the UK, with all this money going into the pockets of criminals. The global trade in drugs is estimated to be worth $400 billion, which is more than the total worldwide trade in petroleum. Almost half of all crime in the UK is drugsrelated and the cost to society has been put at 18.8 billion - 850 a year for every household in England and Wales. Although drug seizures have increased, 90% of drugs still get
disposable incomes who provide a ready market for drugs. These trends together with other factors such as geographical location of drug supply routes, explain more about drug use prevalence than any policy or intervention, added Mr Hartnoll. Last year up to 20 million people in Europe used an illegal drug, but 5% of these people accounted for 90% of the health costs. This sub-group of problem injectors is also likely to have been responsible for most of the drug related crime. Mr Hartnoll said it is a waste of time to develop policies to try to reduce prevalence. Where they can have an effect is in reducing the adverse consequences of drug use. That has been borne out by action taken in the UK in the 1980s, when drug users were supplied with clean needles in an attempt to prevent the spread of HIV. That policy has proved to be effective and the UK has the lowest rate of HIVinfected drug users in Europe, despite having some of the highest rates of drug use.
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MEDIA
The media has played a central role in demonising drugs and drug users, said Magnus Linklater, one of Scotlands leading journalists and a former editor of The Scotsman newspaper. The broadsheet papers and the middle market tabloids have made drugs the middle class scare story of our time, he said. The cumulative effect of this kind of coverage has made it harder to tackle the drugs problem at its roots. People who advocate treatment rather than punishment are seen by sections of the media as encouraging drug use and undermining society. It was not always like this. Mr Linklater reflected on his time at The Scotsman when the paper supported the liberal and pragmatic policy of supplying clean injecting equipment to drug users to stem the spread of HIV. However since then, more and more English-based newspapers have introduced Scottish editions, bringing with them a different set of political views and a much more critical stance
on many issues. The media is influential in shaping policy largely because politicians want to have the media on their side. Mr Linklater said that treatment at every level is the right approach and tackling the problem of drugs also means tackling deprivation. Success will not be achieved easily or quickly and that is a hard message for both politicians and the media to grasp. We in the media tend to deal in simplicities so, I think, do Ministers. There are grounds for optimism, however. Complex messages about drugs can be accepted by the public if they are clearly stated and if Ministers unite behind them. It requires qualities of clarity and leadership. The media does not like running behind public opinion and if politicians are clear about the policy they want to follow the media may become not the enemy of drug control but the protagonists of it.
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The conference expressed clear dissatisfaction with and frustration at the current position, which has left society paying a heavy price for its decision to declare certain substances to be illegal. It leaves too many drug users without help or support, creates havoc in our communities, drains resources and powers a crime wave that profits only the criminals who have caused it. There are powerful arguments in favour of considering some alternatives. But what alternatives? There appears to be no relationship between policy interventions and prevalence. There is a clear need for more evaluation to gather firm evidence about what works. What should be done in the meantime? Chief Constable Brunstrom believes Britain may be ready to have a mature debate on what it should do about drugs. Professor McKeganey, in his summing up of the days proceed-
ings, echoed that view. He also said there needs to be a greater willingness to experiment. The importance of treatment was emphasised throughout the conference, but Professor McKeganey said that has to mean more than methadone. It should include a trial in Scotland of heroin prescription and other initiatives such as the establishment of safe injecting rooms. He said recovery from drug addiction is not impossible. There is a way out of drug addiction. We must do all we can to help people find that way out. That may also be true for society at large. The conference was clear that there must be a better way than the one we have at the moment. The best choice for the future may be greater regulation. We need our politicians to be brave enough to examine the options. That can start with an open and honest debate.
This report reflects opinions expressed by participants in a specific event. It does not, however, necessarily represent the views of the RSE Council, nor the Societys Fellowship.
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Scotlands Drug Problem The Royal Society of Edinburgh ISBN 0902198 73 4 May 2003
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