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Why our ‘drugs are bad’ approach has only made things worse:

This month, the Home Affairs Select Committee published its extensive report on drug policy and treatment in the UK. Both wide-ranging and spotlighting local initiatives, the review examined the shift towards a public health approach to tackling substance use while critiquing Britain’s largely toutdated drug legislation and heavy focus on criminalisation.

In this piece, we will explore some of the more controversial proposals for drug policy and treatment, which have demonstrated impact but, for political reasons, remain largely off the menu in the UK.

Let’s start with the obvious. Drugs can destroy lives. In 2021, there were 4,859 deaths related to drug poisoning, with a further 9,641 deaths recorded as alcohol-specific, an increase of 27% on pre-pandemic figures. This increase is primarily explained by opiates, street benzos (including bootleg Valium and Xanax) and polydrug use.

Addiction and abuse significantly contribute to homelessness, unemployment, criminal activity, domestic abuse, and physical and mental ill health. Drugs can accelerate the breakdown of relationships and, in some cases, whole communities. In her 2020 review of drugs, Dame Carol Black estimated the total cost to society to be more than £19 billion per year – more than double the value of the UK’s illegal drugs market.

And yet, the evidence is overwhelming that our approach to tackling this issue has failed. It’s 52 years since President Nixon declared his ‘War on Drugs’. It has cost over $1 trillion, cost hundreds of thousands of lives, and wasted millions more through mass incarceration, with people of colour disproportionately targeted in both the UK and the US.  Drug deaths are higher now than at any point in history, whilst across England and Wales, over 10,000 people are serving sentences for drug offences, making up 12% of the prison population.

However, some other approaches and models have demonstrated considerable impact, whilst advances in research are finally starting to shift mindsets at the highest levels.

The Portugal model – decriminalisation and drug consumption rooms:

In the 1990s, Portugal experienced an opioid epidemic so severe that Lisbon was dubbed the heroin capital of Europe, and one per cent of the entire population was addicted to heroin or crack.

Adopting a health-based approach, Portugal broke from the norm. In 2001, it de-criminalised possessing up to ten days’ worth of narcotics for personal use. Rather than face prosecution, users caught by police would meet with a 3-person ‘Dissuasion Panel’, typically including a psychologist, physician and social worker. Individuals assessed as addicted received some form of treatment intervention with enforcement suspended, and the case closed if the individual was not re-arrested within six months.  

For those unwilling to seek treatment, a harm-reduction approach was adopted, with designated safe consumption spaces and mobile units staffed by psychologists and nurses driving around Lisbon distributing clean needles and condoms and providing medication, health support and information.

These reforms have had a profound impact, with the number of heroin users falling by 75% and a 90% reduction in needle-related HIV diagnoses. Portugal now has the lowest drug-related death rate in Western Europe, one-tenth of the UK’s and one-fiftieth of the USA’s.

The Home Affairs Select Committee’s report lamented that more progressive pilots tackling opioid addiction in the UK, including the diamorphine-assisted treatment (DAT) project in Middlesbrough, have lost funding despite impressive results.

The report calls for piloting a safe consumption space in Glasgow, where fatal overdoses are highest. This is currently prohibited under Britain’s drug laws, but after the Home Office initially rejected this recommendation, it has now confirmed it will not try to block the initiative and allow Scotland a devolved decision; as a result, approval is expected by the end of the month.

The potential health benefits of psychedelic drugs:

Alongside the gradual shift to a public health approach is the growing body of evidence that some illegal substances offer health benefits and have a role to play in treating mental ill-health.

In the past few years, several studies, including clinical trials, have been published demonstrating the positive impact of psychedelic drugs, including psilocybin (the psychoactive ingredient in magic mushrooms) and MDMA.

A series of studies have demonstrated psilocybin’s positive impact on relieving major depressive symptoms in patients for one month and a year. In 2021, a Phase 3 clinical trial found that MDMA with counselling effectively treated patients with severe post-traumatic stress disorder.

Further research is required, but in the UK, the licensing requirements for researching Schedule 1 drugs (including psychedelics) are incredibly costly, severely limiting the number of organisations engaged in advancing the evidence base. The Select Committee report has pushed for research barriers to be reduced, but the government has so far been cagey on any commitments.

What next for UK drugs policy?

There’s little doubt that attitudes at the top are slowly shifting towards a more health-focused approach to tackling drugs; however, much like criminal justice, it remains a policy area where elected politicians’ fear of appearing ‘soft’ on the issue tends to override the evidence base of what is effective.

What is clear is that our outdated, values-based approach to drugs has failed. Not only has it created an unregulated market where the products are often unsafe and where violence is the main form of dispute resolution, but it has also stigmatised and criminalised users, pushing many vulnerable people further into the shadows and away from the support they need.

Substance use is a complicated and controversial topic, but isn’t it time for the UK to treat it like any other health issue and adopt an evidence-based approach? Historically a country that prides itself on being a global pioneer in medical research and innovation, this is an area where we should again take the lead in designing and delivering effective, person-centred and trauma-informed models of care. The more comprehensive health and social benefits will be immeasurable.

Adam Moll is Director of External Affairs at Social Interest Group
adam.moll@socialinterestgroup.org.uk