Ch 19. Drugs

… almost half all victims of violence say their assailant was ‘under the influence of alcohol’1 and surveys of wounded patients in A&E come up with similar responses.2

1The 2006/7 BCS put the figure at 46 per cent which has been broadly constant year on year (ed Sian Nicholas, Chris Kershaw and Alison Walker ‘Crime in England and Wales, 2006/7’, Home Office Statistical Bulletin, July 2007, see p. 65. [http://webarchive.nationalarchives.gov.uk/20110220105210/rds.homeoffice.gov.uk/rds/pdfs07/hosb1107.pdf]). Another study estimated 40 per cent – see Tracey Budd, ‘Alcohol-related assault: findings from the British Crime Survey’, Home Office Online Report 35/03. [http://library.npia.police.uk/docs/hordsolr/rdsolr3503.pdf] In addition the Office of National Statistics reports that between 8,000 and 9,000 people die each year in England and Wales as a direct result of alcohol ingestion.

2Back in the 1990s, when I was on a government inquiry into crime, the drinks industry went through a period of denial, asserting, ‘There is no evidence that alcohol is a major factor in crime and no general link between alcohol and crime has been found.’ (Low in Alcohol, commissioned by The Portman Group, 1995) Yet when I spent two weeks auditing a hospital emergency department (for a BBC series called The Truth About Crime) most victims of violence on Friday and Saturday nights had been drinking and every one reported their assailant had been drunk.

 

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As for tobacco, it has become what one reporter called the ‘new cash cow’ for criminal gangs from the Mafia to the Triads.1 Intercepts and intelligence show it is big business for counterfeiters as well as for smugglers big and small. The Revenue estimates cigarette frauds swindle taxpayers out of £2 billion a year.2

1Jonathan Sibun, Daily Telegraph, 29 August 2009. [http://www.telegraph.co.uk/finance/newsbysector/retailandconsumer/6110778/Revealed-2bn-cost-to-UK-from-cigarette-smuggling.html]

2 ‘Tackling Tobacco Smuggling – building on our success’, HM Revenue & Customs and UK Border Agency, April 2011.

 

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Government ministers know this but have often had an uneasy relationship with scientists over what is really a political issue dressed up as a scientific one, and culminating in the sacking of their top adviser in 2009.

In 2009 Professor David Nutt was sacked by Health Secretary Alan Millburn the day after publication of a paper in which he noted that alcohol and tobacco were more harmful than many illegal drugs including ecstasy and cannabis. Relations had been tense for some time prior to this. In essence ministers believed Prof Nutt had been inclined to stray from the scientific into what they regarded as the domain of politics. An alternative view was that, especially in drugs policy, politics strays into the domain of science, and in 2013 Prof Nutt was awarded the prestigious Maddox Science Prize for his persistent defiance of political orthodoxy.

 

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Self-report questionnaires suggest about 5 million people have tried class A drugs and half a million are current class A users.

Drug Misuse Declared: Findings from the 2011/12 Crime Survey for England & Wales (2nd edition), 2012. [http://www.homeoffice.gov.uk/publications/science-research-statistics/research-statistics/crime-research/drugs-misuse-dec-1112/extent-adults]

 

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In 2004 a ministerial strategy paper made the sensational claim that ‘280,000 problem drug users cause around half of all crime’.

Home Office website 2008, ‘Keeping Crime Down: Facts and Figures’, citing One Step Ahead: A 21st Century Strategy to Defeat Organised Crime, Home Office, March 2004, p. 2.
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… in this case no evidence was offered at all. Perhaps a ministerial adviser noted that 280,000 addicts were known to health authorities at the time and simply painted in their culpability for about 5 million crimes.

I cannot find any basis for the One Step Ahead assertion that half of these were caused by junkies. The nearest I can get is that figures released under a Drugs Intervention Programme showed that offenders identified through a drug test on arrest already had an average of 8.8 convictions. 280,000 x 8.8 = almost 2.5 million, or half the recorded crime rate at the time. But all that tells us is that some people on drugs commit a lot of crime, not that all do. In any case actual crime is at least double the recorded rate: according to the BCS there were about 5 million recorded crimes and 10 million BCS crimes when the briefing paper was prepared.

 

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Offenders who use drugs are twice as likely to be arrested as offenders who do not, which automatically doubles the perceived scale of the problem.

Alex Stevens, ‘Weighing up crime: the over estimation of drug-related crime’, Contemporary Drug Problems, 2008, Vol. 35, Nos 2/3, pp. 265–29.

 

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In any case, maybe habitual drug users are just the sort of people who for whom bad behaviour and getting high were both part of the same culture or personality malaise.

There is evidence that many junkies have multiple problems and complex offending patterns before they start on drugs. Angela Burr, ‘Chasing the dragon: heroin misuse, delinquency and crime in the context of south London culture’, British Journal of Criminology, 1987, Vol. 27 (4), pp. 333–57; or Mark Edmunds, Tiggey May, Ian Hearnden and Mike Hough, Arrest Referral: Emerging Lessons from Research, Drugs Prevention Initiative Paper 23, 1998, Home Office, London.

 

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Police and policy-makers reflexively see drugs as a motive rather than a symptom. (Revealingly, confidential crime documents compiled by the Prime Minister’s Strategy Unit in 2003 spoke of ‘crime linked to alcohol’, but of ‘drug-motivated crime’).

Strategy Unit Drugs Project, Phase 1 Report: Understanding the Issues, 13 June 2003, pp. 22–3, unpublished. My italics.

 

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But it has been known for a long time that spending on drugs often follows success at crime rather than crime just being a consequence of the need for drugs. As one investigator put it, ‘day to day, crime was a better explanation of drug use than drug use was of crime’.

Richard Hammersley, Alasdair Forsyth, V. Morrison and J. Davies, ‘The relationship between crime and opioid use’, British Journal of Addiction, 1989, Vol. 84, p. 1040.

 

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A systematic review found the odds of offending were one-and-a-half times higher than normal for cannabis users, with the odds of offending rising in line with what one might call the delinquency of the favoured drug rather than its addictiveness or price. If one thinks of a hierarchy of social acceptance of street drugs, with marijuana at the bottom and crack cocaine at the top, offending rates climbed with each rung up the ladder.

Trevor Bennett, Katy Holloway and David Farrington, ‘The statistical association between drug misuse and crime: A meta-analysis’, Aggression and Violent Behavior, Vol. 13, 2008, pp. 107–18.

 

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… the acid test (no pun intended) is this: according to simplistic theory, junkies should stop thieving when they have enough money for their fix – but generally they don’t. Even those seeking official help and given free drugs frequently don’t stop offending. I have been on police searches where a prolific burglar was found to have bags full of stolen property on one side of his bed and two large prescribed bottles of methadone on the other.

Nonetheless there is some evidence that prescribing heroin to addicts does reduce their involvement in crime, and to a lesser extent the same is true of heroin substitutes like methadone. See Nicole Egli, Miriam Pina, Pernille Skovbo Christensen, Marcelo Aebi and Martin Killias, ‘Effects of Drug Substitution Programs on Offending among Drug-Addicts’, Campbell Collaboration, 2009.

 

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As one group of researchers put it: ‘Stated simply, acquisitive crime provides people with enough surplus cash to develop a drug habit, and the drug habit locks them into acquisitive crime.’

Mark Edmunds, Tiggey May, Ian Hearnden, Michael Hough, Arrest Referral: emerging lessons from research, Home Office, London, 1998, p. 10. ISBN 1-84082-057-8.

 

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In one particularly intriguing study, psychologists from Glasgow tracked down over a hundred people who had regularly injected heroin – on average they each had one fix every four days for seven years – but none had had addiction treatment or been in custody. Almost all binge-drank at times and took other drugs as well and a third acknowledged their habit had caused problems with education or at work. Yet in only once case did heroin use cause the break-up of a relationship and only 15 per cent were unemployed.

David Shewan and Phil Dalgarno, ‘Evidence for controlled heroin use? Low levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland)’, British Journal of Health Psychology, 2005, Vol. 10, No. 1, pp. 33–48. [http://www.gcu.ac.uk/violence/downloads/heroin.pdf]

 

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Pathways in the brain, like tracks through the forest, become wider and deeper the longer they are used. After prolonged and heavy traffic, nature takes time to reclaim them. This is why simple ‘detox’ programmes rarely have long-term benefits.

Detox is mostly mumbo-jumbo based on a failure to understand how efficiently the body works to maintain homeostasis. But it is accepted so widely and with such gullibility that many companies cite ‘detox’ (without any evidence or consistent explanations of the process) to promote commercial products from foot patches to hair straighteners. See Debunking Detox, Voice of Young Science, London, 2009. [http://www.senseaboutscience.org.uk/index.php/site/project/14/]

 

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Each year in England and Wales, getting on for half a billion pounds is invested by the state to wean people off street drugs

Source: Ministry of Justice, 2008: £92 million spent in prisons in addition to £398 million on the National Treatment Agency.

 

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Some of this is science-based to some degree or other, most is good intention and a lot is pop psychology and pre-Enlightenment quackery.

[See for example http://www.drugrehab.net/.] See [http://www.neuronovo.com/rapid-recovery] for some classic mumbo jumbo including a promise of ‘RapidRecovery’ from ‘Intravenous and oral NeuroNutrients’ to rectify an ‘underlying acquirement of a dysregulated brain stress system and deficiencies or imbalances in brain chemicals’. Even with all this hocus-pocus technobabble, UK clinics are relatively constrained compared to some abroad. A typical American rehab clinic claims, vacuously, that ‘street drugs, prescription drugs, alcohol and other drugs can remain in the body for years’, and proposes that ‘an exact program of medically supervised exercise, dry sauna sweating and vitamins, rid (sic) fatty tissues of these residues’. Almost all clinics promise success. Narconon, for example, announces itself as ‘The World’s Most Successful Drug Rehab’ and claims that ‘an amazing 76 per cent of our graduates choose to remain drug-free and become productive members of society’. The cornerstone of Narconon’s approach is ‘our Sauna Based Detox Program’ supervised by a ‘professional Addictionologist’. [Source: US and UK Narconon advertisements, 2008–2013.]

 

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Some of the private clinics allege they can ‘consistently’ solve almost any substance dependency, including alcohol, heroin, methadone, benzodiazepines or cocaine. At least one is a front for scientology. There are promises of quick treatments (‘our programme for most addictive substances is just ten days long’), ‘non-judgemental’ processes and ‘complementary treatments’ including ‘auricular acupuncture’, hypnosis and herbal teas, and some resort to scaremongering.

An example of scaremongering is Admit Services which claims to be a referral agency for ‘Detox and Rehab clinics’ and who, for a long time on its website warned: ‘Alcohol and drug addiction is usually an ILLNESS that requires treatment in a specialist alcohol and drug rehab clinic. Very few people – less than 5 per cent – can drink less or become substance free on their own.’ In fact many if not most Britons are able to cut down or even eliminate smoking, drinking or drugs use on their own. Those who can’t are the exception. [http://www.admitservices.co.uk/ – last checked 2013]

 

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According to press hand-outs, Britain’s National Treatment Agency achieved a ‘watershed’ in drug treatment in 2007/8, supervising 200,000 people, half of whom ‘completed treatment successfully’. But at the most generous interpretation only 11,000 of the patients were judged as drug-free by the end of the process, and they may be the ones who would have given up drugs anyway.

Statistics from the National Drug Treatment Monitoring System, 1 April 2007–31 March 2008, Department of Health, September 2008.[http://www.nta.nhs.uk/areas/facts_and_figures/0708/docs/ndtms_annual_report_2007_08_011008.pdf] Despite the poverty of proof, the NTA’s CEO insisted that science, not politics, underpinned his empire: ‘We must convince the public that money spent on drug treatment is money well spent,’ he said. The Times, London, 3 October 2008. (Note: the National Treatment Agency, formed in 2011, was disbanded in 2013 and its responsibilities were assumed by Public Health England.)

 

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When a team of researchers trawled through 8,000 published research reports on drug-user interventions they found only twenty-four which made the grade for what medical scientists would regard as decent evidence. Accordingly, ‘very limited conclusions’ could be drawn.

Amanda Perry, Simon Coulton, Julie Glanville, Christine Godfrey, Judith Lunn, Cynthia McDougall and Zoe Neale, Interventions for drug-using offenders in the courts, secure establishments and the community. Cochrane Database of Systematic Reviews, 2006, Issue 3. Article No: CD005193. [doi: 10.1002/14651858.CD005193.pub2], pp. 37–8. [http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005193/pdf_fs.html]

 

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In 2012 the government’s annual drugs strategy review claimed: ‘For every £1 spent on young people’s treatment services, there is a return of up to almost £2 over a two-year period and up to £8 over the long term.’

Which sounds impressive until you read the original source of that arithmetic and note the ‘important caveats’, including ‘lack of robust evidence’, a ‘limited sample’, a ‘partial picture’, the fact that ‘long-term benefits are very difficult to assess’ and the hugely significant warning that researchers had been ‘unable to distinguish from the data the impact that treatment has on outcomes compared to the impact of other factors’.

‘Specialist drug and alcohol services for young people – a cost benefit analysis’, Research Report DFE-RR087, Frontier Economics for Dept for Education, February 2011. [https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR087.pdf]

 

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There are similar caveats galore from US studies, along with warnings about ‘publication bias’, meaning negative findings tend to get buried while positive outcomes are hyped.

Ojmarrh Mitchell, David Wilson and Doris MacKenzie, ‘The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior: A Systematic Review’, The Campbell Collaboration, November 2012.

 

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It is understandable that mandarins from the ministries of justice and education might find this a moral challenge, or that economists who advise civil servants are ignorant of bioethics norms and think fair comparisons would fail ‘obvious’ ethical objections: ‘Having established a treatment need, treatment providers have an obligation to treat these individuals, rather than monitor them as part of a control group.’

Ibid., p. 16.

 

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At present drugs are given grades rather like school marks in reverse. Scoring a C can put you on the naughty step while class A drugs are wicked and could get you a detention. The categories are allocated with agonising care

The Advisory Council on the Misuse of Drugs is a large consultative group of officials, expert clinicians and voluntary groups, established under the Misuse of Drugs Act 1971. Apart from classifying street drugs it produces sober and scientifically detailed accounts of their pharmacology, promotes research, reviews official responses to drug problems and flags up risks.

 

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We can be reasonably sure that education programmes can do harm as well as good – controlled experiments showed students came out better informed but no less likely to take drugs.

Sue Weaver and Forest Tennant, Effectiveness of Drug Education Programs for Secondary Schools, American Journal of Psychiatry, Vol. 130, 1973, pp. 812–14. [http://ajp.psychiatryonline.org/cgi/content/abstract/130/7/812]. And R. R. Clayton, A. M. Cattarello and B. M. Johnstone, ‘The Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year Follow-Up Results’, Preventative Medicine, Vol. 25, No. 3, 1996, pp. 307–318.

 

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We can be confident that haphazardly arresting drug-takers who come into our view will make no difference – as the cop who ran Chicago’s narcotic division put it, ‘There is as much cocaine in the Stock Exchange as there is in the black community. But those guys are harder to catch.’

Quoted in Policy Paper Urging New York State Leaders to Repeal the Rockefeller Drug Laws, The Correctional Association of New York, May 2008, p. 3.

 

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Yet we can also reasonably assume that interdiction cuts supplies, raises prices, displaces casual users from the market and obliges heavy-duty users to cut down, to seek help or to downgrade to less satisfying products. A drought of heroin in Melbourne in 2001 shifted users to replacement drugs but, even so, cut overdose admissions to hospital by 75 per cent.

Strategy Unit Drugs Project, Phase 1 Report: Understanding the Issues, 13 June 2003, p. 101, unpublished.

 

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Self-report questionnaires suggest that the number of drug users has been falling steadily and 2012 recorded the lowest level since measurement began in 1996.

Drug Misuse Declared: Findings from the 2011/12 Crime Survey for England and Wales (2nd Edition), Extent and trends in illicit drug use among adults aged 16 to 59, Home Office, London, 2012. [www.homeoffice.gov.uk/publications/science-research-statistics/research-statistics/crime-research/drugs-misuse-dec-1112/extent-adults]

 

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High prices can check demand. We know this from cigarettes but also from cocaine. (Economists Ilyana Kuziemko from Oxford and Steven Levitt from Chicago calculated that when cocaine prices rose by 10–15 per cent, consumption dropped by 20 per cent.)

Ilyana Kuziemko and Steven Levitt, ‘An empirical analysis of imprisoning drug offenders’, NBER Working Paper 8489, National Bureau of Economic Research, Cambridge MA, September 2001.

 

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… if individual liberty is a motive for liberalising drugs how does that square with the consistent finding that 80 per cent of heroin users say they would like to stop but can’t?

Source: National Treatment Agency survey, 2007.

 

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Ultimately there are only two coherent positions: prohibition or legitimisation. Logical consistency is not always congenial with cultural norms so we can mix and match the two.

New laws which rely on mass compliance need to go with the grain of public attitudes. Thus tough restrictions on tobacco only became practicable as smoking became increasingly unpopular – by 2006 the proportion of British adults who smoked had fallen to less than 25 per cent compared to over 45 per cent in the early 1970s.

 

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It may be time to try the Dutch approach we touched on in Chapter 17, removing from circulation offenders who have proved resistant to everything else.

… It might be more tranquil (and cheaper) for society, and better for the health and well-being of repeat-offender junkies, if we experimented with long-term secure but benevolent residential care. At the very least this is something that deserves more thought and experimentation.

The Dutch experience warns about the danger of diminishing returns. Poorly targeted initiatives will fail. In any case there are huge dangers in long-term detention if institutions, intended to be benign, are allowed to become complacent – or cruel. After new psychiatric drugs became available in the 1960s and ’70s many countries woke up to the fact that mental hospitals had become dumping grounds, locking up thousands of people who had no cause to be there. (There are also dangers in the opposite direction, as witnessed in many countries which adopted a policy of hospital closures. In the UK, especially after 1983, at least 30,000 beds were lost and inmates were discharged in large numbers, ostensibly for care in the community. It caused a huge problems and quite a few injuries and deaths. As the mental health campaigner Marjorie Wallace pointed out, people were, ‘carelessly decanted into seaside bedsits and back-street hostels, onto the streets or into prison, or returned to families who had been given no help’.)

 

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