Posted on: 14 September, 2023
A fortnight ago the Home Affairs Select Committee (HSAC) launched their long awaited report into drugs, recommending several evidence-led proposals which would reduce the harm drugs are causing across the UK, including amendments to Misuse of Drugs Act 1971 (MoDA) and Misuse of Drugs Regulations.
Recommendations include the implementation of an overdose prevention centre pilot in Glasgow, national standards for low level diversion schemes across all police forces, a national drug testing centre, centralised funding for diamorphine assisted treatment (naming the Foundations initiative, which is now closed but was led by Cranstoun’s Clinical Director Danny Ahmed), and voluntary naloxone carriage for police across England and Wales. The report also analyses and critiques the Government’s 10-year drug strategy, supporting the shift towards health based interventions, but notes that without significant expansion in the range of intervention, the strategy alone will not make the transformative impact required to turn the tide on the drugs crisis in the UK.
Other significant recommendations include the suggestion that drug classification must be reviewed by the Advisory Council for the Misuse of Drugs (ACMD) to better reflect the risk of harm, and that some psychedelic drugs should be reclassified as a matter of urgency in order to support clinical research into medical or therapeutic use.
The paper is extremely timely given the increased prevalence of nitazenes in the United Kingdom’s drug supply (read more on the emergence of nitazenes in the UK here). Treatment providers are witnessing alarming clusters of synthetic opioids that are often many times stronger than pure heroin which itself is typically much stronger than street heroin, and without a Whole System approach, the loss of life could be catastrophic. The recommendations put forward would help to mitigate the scale of the escalating potential public health emergency, if elements which do not require amendments to MoDA are implemented quickly.
The comprehensive set of recommendations would set the United Kingdom on a pathway towards evidence-based drugs policies, which would not only reduce harm and reduce suffering, but will likely save taxpayer money across policing, criminal justice and health. This thorough report, rooted in evidence, must not be overlooked by the Government and – given the Cross-Party members of the Home Affairs Select Committee – must yield consensus on areas of agreement across the political spectrum. The preservation of life must usurp political posturing.
The report calls for national standards across the United Kingdom to implement diversion schemes, which we believe would help alleviate issues related to the post-code lottery of policing, and may help to reduce disproportionality outcomes in some parts of the country. A conservative estimate highlights how around 4.25 hours of police time are saved by referral to a pre-arrest diversion scheme, and the rate for those re-presenting is less than 5% compared to a proven reoffending rate of over 1 in 5 for crime overall.
We encourage the government officials reviewing the report to consider the Whole System approach to criminal justice which Cranstoun advocates for. Our approach aims to provide an intervention at every stage of the criminal justice process, with additional emphasis on early intervention for young people to minimise future harms and risk. By offering multiple opportunities to engage with education or treatment, we can increase the number of people in treatment, thereby reducing the risk of harm and potential fatality.
The criminal justice process – in relation to drugs – provides a golden opportunity to educate people on the harms of drugs, create pathways into treatment, understand the realities of the drug market better through the appropriate use of drug test on arrest, and safeguard those who may be at risk of falling into county lines.
The utilisation of criminal justice as a prong to reach those who the treatment sector struggle to reach is crucial. Evidence from the Lancet – related to Scotland – highlights how people who are not in drug treatment are nearly 3.5 times more likely to die from drugs than those who are not. Alongside pre-arrest diversion, Cranstoun strongly advocated for the roll-out of Arrest Referral Schemes, such as the scheme we operate, CARS. This involves placing trained treatment professionals in custody cells to offer people arrested the chance to refer to treatment.
Any national framework for diversion schemes should include opportunities to divert at every stage of the criminal justice system, using pre-arrest where possible, post-arrest diversion where this is not possible and through the use of out of court resolutions. In addition, the criminal justice system should be utilised as a pathway towards education, support and treatment for those who need it. We urge policy makers to utilise every possible innovation to keep people out of the criminal justice system, with a focus on addressing the root cause of crime, as opposed to reactive action that can often exacerbate issues related to crime and reoffending.
Overdose Prevention Centres
The HASC report recommends the piloting of an overdose prevention centre in the city of Glasgow, which has long been expected, and as of this week was essentially green lit by the Lord Advocate, Scotland’s top prosecutor. The report does however suggest that the committee believes that the only pathway for implementation is through sign-off from the UK Government, and calls on the Government to create a legislative pathway to allow for a Glasgow pilot, which would help to build the evidence-base in the United Kingdom. The report recommends the pilot be joint funded by Holyrood and Westminster governments.
Since the release of the report, significant developments have occurred related to the Lord Advocate’s prosecution policy on a Glasgow OPC. Alongside a positive statement for those in favour of implementation, the UK Government’s Scotland Secretary confirmed that they would not stand in Holyrood’s way. In short, the pathway sought by HASC has been achieved, however no changes to devolutionary powers will be required.
Whilst unsanctioned, OPCs on these shores have been trialled already, and to great effect, as per a scheme by Cranstoun’s Campaigns Lead Peter Krykant, and subsequent evaluation by Queen’s University Belfast. We strongly support the move towards a pilot scheme in Glasgow, but believe that there is a strong global evidence base to safely deliver OPC pilots in a number of ‘hotspots’ for overdoses and public injecting at this point. Whilst a single pilot scheme would be an improvement to the current situation, there is more than one model which could be trialled simultaneously, and an evaluation could compare two models, ensuring that any potential longstanding scheme is rooted in best practice and supported by evidence.
Cranstoun has campaigned extensively for implementation in Dundee, which has a drug death rate that is among the highest in the UK, second only to Glasgow in Scotland, and is also one of the most deprived parts of the United Kingdom. The recent Scottish drug death figures for 2022 highlight how you are 16 times more likely to die from drugs if you live in the most deprived parts of Scotland, compared to the least deprived areas, which demonstrates the need for more than one OPC now. We received the backing of 28 Members of Scottish Parliament for an OPC in Dundee, and stand ready to deliver such a facility.
Cranstoun welcomes the mention of overdose prevention centres being not just sole facilities for injecting drugs, but also should provide wrap-around care. Cranstoun proposes a social-integrated model for overdose prevention centres which includes the ability to take on the spot blood tests to reduce the spread of BBVs, provide basic necessities, the ability to speak to a health professional, and potentially the integration of some drug checking facilities. For example, the increase in the prevalence of contaminates means that any available testing should be made available at such facilities, so the person intending on injecting can discard the product, or at least reduce the amount they were intending on taking.
Diamorphine Assisted Treatment (DAT)
The Committee recommends the centralised funding and implementation of DAT, referencing the excellent results from the evaluation of the scheme operated by Foundations’ and Cranstoun’s Clinical Director Danny Ahmed, in Teesside.
Diamorphine Assisted Treatment has existed for decades, more recently in Glasgow, Teesside and Switzerland, but also previously under the British Model up until the 1960s when the global war on drugs, and subsequent Misuse of Drugs Act 1971 came into place.
Cranstoun believes that centralised funding for such schemes – as highlighted by the report – are essential for their long-term success. Long term funding is key to successful operation, as people who use the services must have full trust in the longevity, to allow them to disassociate with the people who are selling drugs illegally. In short, if there is a fear the supply could be cut, then the person using the service will be less willing to give up their illicit supply link.
DAT is particularly pertinent due to the increased prevalence of synthetics opioids such as nitazenes – and it is logical to state that those who are addicted to opioids but on DAT, will be the most guarded from a fatal overdose. The evaluation from Foundations’ scheme highlights how street use of drugs decreased by 80% for those on the scheme. Furthermore, in line with the objectives of the 10 year drug strategy, DAT undermines the criminal gangs who run the drug market by cutting their connection with their market, negatively impacting them financially.
In critiquing the Dame Black 10 year government drug strategy, the report notes that whilst there is acknowledgement of the need to address stigma encountered by those using drugs, “there is no specific actions to support this ambition.” The report further noted there had been calls for a national awareness raising campaign in relation to stigma.
The HASC report rightly highlights the need to tackle stigma encountered by people who use drugs. Cranstoun endeavours to address stigma by always providing non-judgemental services, meeting people who use our services where they are at, and using appropriate and non-stigmatising language. We have staff with lived and living experience at all levels of the organisation, who have encountered stigma and understand the feelings of isolation and ostracisation that this can bring. We consider the feelings of people who use drugs when making all relevant operational decisions, and believe that more must be done to reduce the stigma encountered by people who enter into drug and alcohol treatment.
Getting help to reduce, halt or understand your reasons for using drugs, by seeking treatment should not be a stigmatising experience. Speaking honestly and openly about substance use should not be such an impossible situation, and evidence suggests that stigmatisation of this kind can lead people who use drugs into worsening mental health, and riskier behaviours when using drugs which increases harm.
The underpinning of stigmatisation is rooted in the illicit act of possessing substances. Without strides towards fundamentally changing our drug laws, stigma in some form will continue to be encountered by people who use drugs.
HASC also notes that the ten year strategy does not recommend the involvement of people who have lived experience of using drugs when designing services, and we support calls for their inclusion in decision making, in order to deliver best practice.
Over the HASC report provides a number of sensible evidence-based recommendations and the Government must listen to the expert advice. For too long policies related to illicit drugs have been dictated by ideology and this report must prove a turning point towards policies rooted in evidence.
The scale of the crisis related to drugs is unprecedented, and given the alarming rise of nitazenes, this could get drastically worse without immediate action. The findings of this thorough report, and the emergence of potent synthetic opioids contaminating the drug supply, demonstrates the urgent need for the implementation of a Whole System approach encompassing a range of harm reduction measures. We need to accept the realities of the drug crisis by meeting people where they’re at, providing the right intervention at the right time and implementing globally evidenced solutions.
The ability to provide a range of options to suit the needs of the person who is using our service is fundamental to delivering best practice drug treatment, and these harm reduction measures proposed will create new pathways into treatment, enabling providers to reach those who have the most complex needs, who are not yet in treatment but may benefit from it.
Recommendation including a national testing programme for drug testing, the implementation of overdose prevention centres in known hot spots across the United Kingdom, a fully funded integrated diamorphine assisted treatment programme, national standards for diversion schemes which include options to divert at every point of the criminal justice system and serious consideration for the repealment of the Misuse of Drugs Act 1971 and all consequent legislation are extremely welcomed.
We must not miss this opportunity to improve our outdated and failing drugs policies, which are costing thousands of preventable deaths each year, by implementing a Whole System, health-based approach to drug use. Without action, the consequences will be grave.