We need to talk about drug addiction, decriminalisation, legalisation and regulation

It’s time to look again at our policy on drugs,  a topic which we can ‘own,’  which will get us noticed In the media and, which will differentiate us from Labour and Conservatives.

I’m not talking about cannabis, recreational use has become almost mainstream, is  more or less ignored by the police and is certainly far, far less harmful than either tobacco and /or alcohol, -that is established medical fact.

The medicinal uses of cannabis are now being acknowledged and established, even if there is a long way to go on further research and getting the medical supply chain organised.

No, I want us to talk about the hard stuff; class A, like heroin and cocaine. This is the topic where a change in mind-set is needed,  an end to ‘the war on drugs’, and if that can be achieved the medical and societal gains will be huge.

Since the general election in 2019 we Liberal Democrats and to a lesser extent Labour have become more or less invisible; – not surprising in the face of a national and international health emergency of monumental proportions. But, as the total incompetence of the Johnson Tory government on almost every front becomes  more obvious with every  passing month, it’s high time for us to emerge from the shadows and start some proper debate on some fresh topics both in health and beyond, and  which might get us some useful media coverage as a bonus.

We made great progress on mental health in the coalition years, particularly on the concept of  parity of esteem, but have lost traction on this topic since as the associated stigma has reduced and it is now widely talked about, particularly by celebrities, who wear it almost as a badge of honour, although sadly mental health is still  seriously under-resourced for the rest of us who need to rely on NHS services. It has now been widely acknowledged as a massive problem, particularly in young people, by all political parties, and is no longer something which differentiates  us. That is a great success for us, but it means we need a new  health story.

We have a compelling story to tell on caring about caring and carers,  but this won’t cut it on its own, plus the white paper on social care when it finally arrives this autumn will contain much of what we believe in, and can agree with in principle, if not in detail. There will be endless wrangling over numbers and cost, but frankly almost anything has to be an improvement on the current dire state of affairs.

Drug addiction needs to be seen as a health issue not a criminal one and the recent 2 part  independent review of drug misuse by Dame Carol  Black clearly lays out an alternative way forward.

This review examined prevention, treatment and recovery  and lays out clearly and unequivocally the case for a change in direction from viewing this as a  criminal issue to one of public health by which addiction is treated as a chronic disease to be managed within the NHS, by daily medication and regular medical review,  no different from say diabetes, arthritis or hypertension.

The Black review is in two  parts; the first published in February 2020 focused on  the background to the illicit drug market and how it must be completely disrupted if progress is to be made. Particular emphasis is given to the advent of  ‘county lines’ and the criminalisation of mainly vulnerable teenagers and  young people who act as couriers and dealers for the organised criminal gangs which are behind the scenes ( and largely escape justice). This change in ‘business model’  has allowed the criminal gangs behind this industry to grow their market massively in the last decade or so, and to spread the use of drugs out from the metropolitan cities to the leafy suburbs and beyond to rural towns and villages.

The illicit drug market has a current value estimated to be close to £9 billion and the cost to the health service, criminal justice system and wider society is estimated at a  further £19 billion annually.

Somewhere in the region of 3 million people take drugs regularly,  and about 300-350,00 of them are on the hard stuff (class A substances) Annual drug-related death rate is just below 6,000 (4,500+ in England and Wales 1,300+ in Scotland, +northern Ireland) A significant proportion of these deaths being from inadvertent overdose of adulterated drugs of variable strength and quality as expected in an illicit marketplace.

The cannabis market accounts for approximately 2.5million of the 3 million regular users but has a market value of only £2 billion and makes some contribution to the £19billion societal costs but probably not  much.

The illicit drugs market is the main driving force behind the nation’s crime figures;  half of all homicides and half of all acquisitive crimes are related to drugs, astonishing but true.  One in 3 prisoners is in jail for drugs related offences, many serving relatively short sentences with no scope for rehabilitation and with high rates of recidivism.

The second part of the Black  review has just been published (August 2021 ) updates and confirms the previous findings, now exacerbated by the health and societal inequalities thrown into sharp focus by Covid and makes 32 recommendations for the way forward. It’s a long read, but worth the effort.

The case for a change of approach  to one of harm reduction by treating drug addiction as a public health issue rather than a criminal one is overwhelming, as outlined above. Additionally, it would provide an opportunity to  permanently undermine international drug-related  crime networks.

Coincidentally it also goes some way to filling the £30billion black hole in the NHS budget.

So what’s not to like?  The only question it seems to me is, are we Liberal Democrats brave enough to go for it?  I hope so.

* Catherine Royce is a medical doctor and was previously PPC for Uxbridge (2001) and Romsey (2017). She is on the Liberal Democrat Women executive and currently a member of the Federal Policy Committee.

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21 Comments

  • Jenny Barnes 1st Sep '21 - 4:40pm

    One reason for the criminalisation of drugs is so that the police can pretty much always arrest someone for something. If they “know” that someone is a villain, but can’t prove it, they can nearly always get them on a drugs charge. So from their pov it’s a success. One villain locked up. https://www.youtube.com/watch?v=teSPN8sVbFU

  • nigel hunter 1st Sep '21 - 4:46pm

    Yes,we should go for it.We are the party that starts revolutionary changes.At 1st laughed at derided , opposed. but at the forefront of change.

  • Jayne mansfield 1st Sep '21 - 4:49pm

    I totally agree that drug addiction is a health issue not a criminal one.

    However, I would argue that instead of standing downstream and trying to pull drowning victims out of the river, bravery is standing upstream and stopping them falling in, in the first place.

    To do this, one needs to deal with social issues, rather than focussing on the individual s who have been damaged by them.

    I wish there was a political party with a vision, a vision of a society where children are protected from the sort of stresses that lead to addictions. The increasing number of very young depressed children, some having their depression treated by antidepressants should be alarming, but the idea that there is a pill for every ill seems like the easy option given that politician are too cowardly to say it is the society in which they are being raised that is the problem.

    Is it any wonder that chemicals or alcohol, seem to some, an answer, a short respite that numbs pain?

    We need to dig deeper and challenge the causes not the symptoms.

  • John Marriott 1st Sep '21 - 6:31pm

    Decriminalisation? Oh yes! Legalisation? Oh no! Yes, Jayne Mansfield, it IS time to treat all addictions as a health issue. It’s also time to ditch the 1971 Misuse of Drugs Act.

  • Cannabis can cause mental illness. I have seen evidence of this. I don’t doubt the possible medical benefits of particular cannabis derivatives but I do doubt your cavalier dismissal of the illegal drug as being harmless,

    You talk about hard drugs and the failure of criminalisation and the war on drugs. You acknowledge that drug taking is a celebrity badge of honour. I totally agree.

    Let us be clear. The majority of hard drug users in this country are those who can afford to buy the stuff, feed the habit, conceal the problem and pay off the problems that they cause and conceal the lives that they ruin.

    These are the middle class, nice people who hold dinner parties and fuel the demand. The losers, foot soldiers, kids and low life who man the supply chains are the ones who experience the war, and that war is faught on many fronts with many opponents, least of all law and order.
    This false war on drugs has protected the user class for so long that they now believe their own propaganda. Yes, it is a medical problem for some. it is also a crime without punishment for many. To tackle drugs, first tackle hypocrisy.

  • Yes we should go for it however our policy on drugs is already far better than the Lab/Con approach but we seem afraid to talk about it possibly for fear of alienating voters with conservative minded views.

    The harm reduction approach is the best one (Portugal is an interesting case study) and will make the public safer from other forms of crime so let’s be bold and proudly tell the voters where we stand on this issue. It’s one reason I support the party.

  • . Dame Black’s work is indeed interesting, but, for workers in the field it reads like one more go on the roundabout, all been said and mostly done before and then the wheel turns.
    1 Yes drug dependency should be and largely is already viewed as a public health issue, treatment is available to those who want it and services across the country (mainly charities) are far more flexible, agile and innovative in delivering services than most statutory organisations, including the NHS can ever be.
    2 The fact is that most dependent drug users will (at some point ) commit crime to fund their drug use, the criminal justice system already has robust diversion from custody programmes in place for those people who are dependent users rather than professional dealers or traffickers. It amazes me how many politicians across all parties don’t seem to realise this!
    3 Decriminalisation / legalisation? Decriminalisation, yes and we have been moving that way since the Blair government. Legalisation; of what? Cannabis? heroin and crack? Ecstacy?, everything? How would that be legislated, who would be the provider? G.P . and pharmacy? or a gram of heroin from Tesco..In my experience most people who advocate legalisation have not fully thought through the ramifications.
    If one was to say, well it should all be through doctors and pharmacies then no doctor will ever, deliberately prescribe sufficient drugs to intoxicate and potentially endanger a patient so many wanting to get high would seek additional drugs. If you want people to buy their drugs from Tesco as we can with alcohol then all I shall say is welcome to hell!…if you had seen and heard what I’ve seen and heard….
    4 Simple possession should perhaps not be a criminal justice concern, however the crimes people commit to get their drugs, should attract the full force of the law, again if you had seen what I have seen…
    5 Yes we can and should always try and learn and implement the very best evidence based practice from other countries.
    6 No, Dame Black,drug treatment is not broken, in an emergency or on its knees, the staff are not demoralised and burnt out or universally looking to leave, in fact we get more candidates and volunteers than we can place.There is no problem with retention or recruitment. That said it has been bottom of the pile for too long, so hey, one more ride on the round about…. Why not?? …..hold on everybody!

  • I completely agree with Catherine. I worked as a Specialist GP in Addiction Services. Users were failed by the NHS and Criminal Justice. So is everyone else. the War on Drugs has failed. everyone knows this but as per comments above it’s not a vote winner. We need to make it one and change the narrative. Everyone seems to concur. Is there a working party? Motion at Conference. Happy to help. PS And what is funding the Taliban?? (no answer required)

  • Helen Dudden 2nd Sep '21 - 10:26am

    It is sad to watch the destruction of an addict. In Bath, being homeless, is soon replaced by the ways of the street.
    There is little treatment at present for any kind of mental health, or any kind of health treatment. I’m told by surgery only very urgent blood tests.
    Lack of descent housing, and the state of society is another reason other’s will follow.
    As a Party I believe we should be standing up for the many on the housing register just existing.
    This government’s attitude to those who voted for them is beyond words.

  • Nonconformistradical 2nd Sep '21 - 10:32am

    @Peter
    “Cannabis can cause mental illness.” All strengths of cannabis or are you referring to stronger stuff?

    “The majority of hard drug users in this country are those who can afford to buy the stuff, feed the habit, conceal the problem and pay off the problems that they cause and conceal the lives that they ruin.”
    Evidence please on use of hard drugs and any correlations with income and/or wealth.

  • Alison Willott 2nd Sep '21 - 11:22am

    Totally agree with Catherine. As a magistrate, one is well aware of the recurring imprisonment of drug offenders with their awful health problems. Prohibition funds a black market with all its consequences. Let’s follow Switzerland’s example (a country not known for its liberal views…) as set out in these two articles from a North Carolina journal:
    https://www.northcarolinahealthnews.org/2019/01/21/switzerland-couldnt-stop-drug-users-so-it-started-supporting-them/
    and
    https://www.northcarolinahealthnews.org/2019/01/28/switzerland-fights-heroin-with-heroin/
    Just note the following figures from the Swiss policy: house thefts down by 98%; drug overdoses down by 64%; drug prosecutions down by 75%; HIV infections down 84%. Of course we should be following their example.

  • @ John Marriott et al

    Yes it is right to distinguish between legalisation and decriminalisation.

    I think Cannabis should be legalised and harder drugs should be decriminalised and available at licensed centres.

    Unlicensed supply should still be a criminal offence.

  • David Chadwick 2nd Sep '21 - 12:58pm

    Good article. I agree. Being bold on this is a good way to increase our media coverage while increasing the pressure on the government to raise the revenue required to fund good public services.

  • Helen Dudden 2nd Sep '21 - 1:21pm

    CBD has no THC. It’s valuable in the treatment of children and seizures, also age related illness. It can be successful in the treatment of pain, and sickness during cancer treatment.

  • Lorenzo Cherin 2nd Sep '21 - 1:54pm

    Would you Catherine, explain your heading, and view properly regarding it.

    I am unclear what from this we are being asked to say yes to!

    Your description of criminals would mean they would not be criminals, so ate you saying we ought to have a legal trade in class a drugs, with the current and odious criminal masters becoming decent business people!

    Or do you want to decriminalise rather than legalise?

    To make class a drugs a legitimate business, is absurd and wrong.

  • Alison Willott, in ref to the HAT, heroin assisted treatment project in Switzland, described in the journal to which you refer, the option of prescribing injectable heroin ( or diamorphine ) for opiate dependence has been available in the U.K. the best part of a century. As with the Swiss project in order to be considered for this treatment it is generally the case that the individual must be over 18 yrs old, have been dependent upon opiates for at least 2 years and attempted 2 other types of treatment, usually methadone and buprenorphine,without success. The reason that diamorphine treatment is not common is that it is not / has not been viewed as the most effective treatment, the prescribing G.P. needs an additional licence, and sadly once word gets around that a certain G.P. will consider prescribing, they often get inundated with demands and or threats from would be patients. But the option exists and has done for a long time, there is also an option for injectable methadone. The U.K. actually has a very good drug treatment system.

  • Catherine Royce, I note you are an MD, so it is with some reflection that I challenge your somewhat casual statement that it is established medical fact that Cannabis use is less harmfully than toabacco, if I didn’t know better I’d swear I can sense a litery echo of ‘end of!’, surely not. You don’t say what form of use of Cannabis but for the sake of argument let’s say smoking, the most common form of use. Even a cursory search of the web reveals a range of recen I e. Published this year, opinion and articles on both side of the argument. I am not aware of any clear definitive and irrefutable evidence on either side of you are please post link.
    For one thing we would need long term studies with people smoking similar doses in similar ways for any truly valid comparison , again I am not aware that any such studies exist are you? I do find it quite sad that large numbers of people on both sides of the argument seem to have such vested interest in being right. Either way smoking tobacco or Cannabis could hardly be described as harmless, angels dancing etc.

  • Matt Wardman 3rd Sep '21 - 8:57am

    There are three things missing from this article imo.

    1 – The issue of establishing a legal supply chain to crowd out County Lines etc. How and what would it look like?
    2 – A link to the evidence it says it is based on. Where do I read this report?
    3 – Police are now beginning to notice larger numbers of drugged up drivers – iirc the numbers are now at something like 10% of drunk drivers, despite low levels of test equipment. What about this side of it?

    Thanks

  • Nonconformistradical 3rd Sep '21 - 9:06am

    “Police are now beginning to notice larger numbers of drugged up drivers – iirc the numbers are now at something like 10% of drunk drivers, despite low levels of test equipment.”
    So if more were being tested we might expect more ‘drugged-up drivers’ to be detected?

    Should drug-driving be subject to the same penalties as drink-driving? I believe there are no sentencing guidelines for drug-driving offences. After all, alcohol is just another drug – it just happens to be legal to consume it.

  • Matt Wardman 3rd Sep '21 - 7:40pm

    @Nonconformist

    OK. Found a recent reputable report from Feb this year.

    https://www.pacts.org.uk/news-and-publications/drug-driving-the-tip-of-an-iceberg-a-report-from-pacts/
    PACTS is the Parliamentary Advisory Council for Transport Safety (PACTS).

    There’s a report here:
    https://www.pacts.org.uk/wp-content/uploads/PACTS-Drug-Driving-The-tip-of-an-iceberg-3.0.pdf

    I agree with the OP that treating the issue as public health / medical is important, however I am not sure how firm the science is on appropriate blood levels for driving etc.

    I’m also keen that alternative supply chains be established rather than just decriminalisation, as part of the solution is surely to kill the illegal drugs’ trade.

    But do we know enough yet?

  • Peter Hirst 8th Sep '21 - 4:08pm

    The missing item from your otherwise exellent discourse is education, somthing this Party used to major on. Prevention is the key though treatment is also essential. A proper drugs and addiction education programme throughout the school curriculum will do wonders. We believe in freedom but it must be undermined by a knowledge of the risks and benefits if any of taking all drugs.

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