My Lords, I rise to ask the Minister about the Government's response to the remarkable draft discussion paper issued on
What does the new document say? A quote from the Foreword, signed by none other than Antonio Maria Costa, the executive director of the UNODC, makes clear the radical shift of policy. Mr Costa himself has for years promoted criminalisation. The fact that he now feels it is right to challenge 50 years of UN dogma must be something of a turning point. Mr Costa now says:
"The aim of this draft discussion paper, 'From Coercion to Cohesion' is to promote a health-oriented approach to drug dependence".
The paper quotes the narcotic drug conventions in support of the health-oriented approach. One of the great strengths of the paper is that it argues the scientific case for treatment as an alternative to criminal justice sanctions, suggesting that the health approach,
"is in agreement with a large body of scientific evidence",
including epidemiological, clinical and neurobiological.
Many across the world have said these things, but not the UNODC. The paper argues that,
"there is increasing evidence that a health-oriented approach is also the most effective in reducing illicit drug use"
By the same token, imprisonment often worsens the problem in a variety of ways. In my view, no serious policy-maker can ignore this paper.
There are two explanations for the change of heart by the UNODC. First, the sheer cost and level of destruction caused by the war on drugs has become a significant world problem. Secondly, more and more countries have become disenchanted by the UN conventions as interpreted-until now-by the UNODC and they have taken unilateral action. I would add a third explanation-action by 30 Peers from this House. I shall say a little about each of these.
First, as to the cost, the criminals and gangsters involved in the drugs trade are benefiting to the tune of about £320 billion a year, and I know that a lot of people in this House are aware of that. The most severe consequences of course have been in Latin America and Afghanistan. In Mexico, for example, drug trafficking employs some half a million workers and has involved some 5,600 killings a year. The profits to Latin American traffickers have financed 25 years of civil war in Colombia and devastating social disruption in Mexico, Peru and Bolivia. These profits are aiding the Taliban in Afghanistan and, indeed, funding the killing of British soldiers. That is what we are talking about here. The US spends some $40 billion a year trying to eliminate the supply of drugs; it arrests 1.5 million of its citizens each year; it imprisons half a million of them. We in Britain spend £19 billion or so on the criminal justice system responding to drugs and drug-related crime, most of it a consequence of the criminalisation of drug use.
The second explanation for the 180-degree policy shift of the UNODC is the growing disenchantment with the UN conventions. For some years a number of countries have made it clear that they are not happy with the criminalising consequences of the UN conventions-notably Brazil, Mexico and Bolivia in South America, but also Italy, Spain, Portugal, the Czech Republic, the Baltic states, Switzerland and others in Europe, and, indeed, a number of states in Australia and the US. They have explored more civil or health-oriented approaches to drug addiction and have in many case removed criminal penalties for the possession of cannabis or, indeed, for the possession of all drugs. These initiatives have not led, as feared, to increased drug addiction. Rather, countries such as the US and UK, with tougher policies on drugs, have levels of narcotic drug use at least as high as those countries with more liberal policies.
On the role of the House, in 2009, 30 Members of this House signed a letter to the UN Secretary-General, Mr Ban Ki-moon, urging him to establish an inter-governmental panel charged with the task of examining all possible alternative policies for the control of the drugs trade, including an evaluation of the experience of countries that have experimented with alternative policies despite the UN conventions. In his reply, Mr Ban assured us that the commission on narcotic drugs had on its agenda a review of current policies. We responded saying that we were not aware of any resources devoted to any such review, and so the correspondence continued. It seems reasonable to suppose that interest in an area of failure by the top man in the UN may have been helpful in strengthening the arm of the forces of reform within the UNODC.
I was subsequently invited to the UN Commission in Vienna in March this year and met Mr Costa. Certainly he was well aware of the activities of 30 Members of this House. Since then, Mr Gilberto Gerra, a health policy chief at the UNODC, who was involved in my meeting with Mr Costa, has asked us to do what we can to achieve endorsement of the discussion document by as many Governments as possible across the world-a slightly daunting task, I have to say. I am hoping that our coalition Government will be the first formally to endorse From Coercion to Cohesion. There are strong reasons why they may want to do just that.
As I mentioned earlier, this country spends more than £19 billion on the criminal justice system due to the criminalisation of drugs. The Government want to cut all wasteful public expenditure. There is no more obvious public service area of waste than this-waste of resources on prisons, police officers, court officials, judges and the whole paraphernalia of the system. I should assure the Minister that, by endorsing the UNODC document, the Government would be committing themselves neither to any specific policies nor to any change in the treatment of drug traffickers. This is, not surprisingly, a purely pragmatic document where recommendations, if implemented in some form, would lead to major savings in public spending and to benefits for hundreds of thousands of individuals, for communities and for our whole society.
Let us take just one example of a good policy. The UK's randomised injecting opioid treatment trial programme showed that heroin-injecting addicts reduced their crimes by more than two-thirds as a result of the programme. Taking heroin-injecting addicts substantially out of the criminal justice system would provide enormous savings to the taxpayer, albeit that some of that money would need to be reinvested in health services. Yet even more savings would be achieved through cuts in the benefits bill as users engaged in therapeutic programmes to help them reduce their drug use, organise their lives and in time return to employment. They might remain intermittent drug users, but if drug use were decriminalised, they could become contributing members of society.
On the supply side, the heroin addicts involved in the RIOTT programme reduced their spending on street drugs by £250 per week, from £300 to £50. It is clear that if countries across the world adopted similar programmes, drug traffickers would lose the bulk of their opium sales. This approach would massively dent the billions of pounds currently earned by the gangsters, who rely on addiction and illegality.
This QSD does not pose an idle question. It represents a real plea for the Government's endorsement of the UNODC's most important paper in 50 years. Although many would have liked it to go further, I was delighted to see reference to a review of drugs policy on page 23 of the coalition Government's programme. They now have UNODC support for such a review. We have the biggest opportunity in 50 years to begin to resolve one of the world's most challenging and destructive problems. I await the Government's response with interest.
My Lords, it is my first and very pleasant duty to thank on behalf of the whole House the noble Baroness, Lady Meacher, not just for initiating this debate but for co-ordinating the letter to Ban Ki-Moon, working with the UNODC and going to Vienna, which I am quite sure, as she suggested, has had a considerable effect.
I do not think that this is a discussion paper; it is more a positioning paper, which reveals a radical and welcome change in the United Nation's stance. It is radical because, as we have heard, the United Nations has until now focused almost exclusively on the elimination of drug use and suppression of the drugs trade. Now, suddenly, we see that focus switch towards the only effective way to tackle the drug problem, which is to reduce the demand for drugs by providing appropriate help and healthcare to drug users and addicts. The change is welcome because a growing number of people in public and political life have pressed for a move away from gesture politics towards a more mature and pragmatic policy which will have a significant social and economic benefit.
What has brought this about? It is quite simply a change in the direction of American policy. For years, the United Nations was unable to move even if it had wanted to-which I do not think it did-because its most powerful member and paymaster, the USA, was determined to go on promoting its war on drugs and its "just say no" campaigns.
With the arrival of the Obama Administration, however, that has changed. The language has changed. It seems that-not overnight, but carefully and slowly-the Administration will wind down the war on drugs. It is this change in US policy that has taken the shackles off the United Nations and allowed it to move in this new and very welcome direction.
Crucially, the UNODC is accepting, indeed encouraging, member Governments to act in a way many do already, but, more importantly, in a way which it had previously argued was in breach of the conventions. This paper invites us to take a position started by the previous Government. In reality, very few people in the UK are sent to prison for possession of drugs alone. We remain in the position, however, where an enormous proportion of those currently in prison, probably over 50 per cent, are there for drug-related crimes. This paper invites us-and I am confident the new coalition will accept this-significantly to increase both the availability and the quality of treatment in the criminal justice system and the wider community, with the specific objective of getting people off drugs rather than maintaining them on drugs indefinitely, giving them appropriate support when they leave prison, and helping them to lead healthy and, I hope, happier lives as positive members of society.
Throughout this paper, the UNODC reiterates that drug dependence is a health and social problem, but health and social problems cannot be solved by using the criminal justice system. We therefore cannot say, "We will give you the help you need until the moment you need it most, when you relapse, whereupon we will withdraw that care unless and until you get yourself arrested". That is a pretty good summary of what happens in too many cases in the UK.
The paper also raises some interesting points about coercive treatment. I agree that this is an unattractive route and I hope the Minister will confirm that that is not within the Government's thinking.
I make two other points in passing. The first concerns the difference between users and those addicted to, or dependent on, drugs. Not everyone who drinks alcohol is an alcoholic. If you do not believe me, go and look in the Bishops' Bar this evening. Not everyone who uses drugs is an addict. Addicts and alcoholics are ill. They need treatment, even if they do not always want it. At some stage whether we like it or not, society is going to have to get used to the idea that large numbers of our fellow citizens have made informed decisions to use drugs in the same way that their fellow citizens use alcohol. The vast majority do not have health problems and do not commit crimes and, on balance, they behave better in public than many of their fellow citizens who drink. That is for another day, but that other day is coming.
Lastly, I draw attention to the comments in the paper about drug courts. They exist in the UK to a limited extent, and it would be very interesting to hear the Minister's views.
We are barely a month into this new Government and it would be unfair to expect a detailed response from my noble friend on the Front Bench today. Indeed, it is a pity we are not having this debate in a few months' time when we could reasonably expect a more detailed answer. If that is the case, perhaps I could ask my noble friend to come back to the House at a later date and make a fuller statement on the Government's policy. Even so, I hope he will say that the Government welcome this paper and that it is, indeed, the general direction in which the Government would like to move.
If the Obama Administration, the United Nations, the Public Accounts Committee and the Permanent Secretary to the Home Office in the report that was published by the Public Accounts Committee in April, find common ground on a policy issue of this complexity, you can reasonably conclude that a consensus is starting to form. It seems there might be a consensus forming in your Lordships' House this evening, and I very much hope that Her Majesty's Government will join, if not lead, that consensus.
My Lords, I thank my noble friend Lady Meacher for placing this debate on the agenda. I strongly support her position of decriminalising drugs, and that of the UN. I would also like to disclose my membership of the UK Drug Policy Commission, as a commissioner. However, everything I say here is entirely my view and does not express the view of the commission in any way.
I would like to begin with what would happen if we thought the unthinkable and decriminalised drugs at the point of production. Coming from Iran and being familiar with the Middle East, I can assure the House that decriminalisation of drugs in general, and poppies in particular, would have an enormous impact on the conflict in Afghanistan, and in particular on the support given by farmers to the Taliban. Although during the Taliban era poppy production was banned, it gradually began to seep back in and has taken huge momentum since the departure of the Taliban, for the simple reason that these people live on arid land with very little water. About the only two things worth growing are poppies and cotton. Any economist in his right mind would know that growing poppies might actually ensure survival when growing cotton is very unlikely to do so. In simple economic terms, there is not very much choice for these farmers.
What can be done is to recognise that poppies can be used for medicinal purposes and that they can be contracted to produce poppies for pharmaceutical reasons. That has been done in India and Turkey. In the 1970s, when I was a member of the Iranian Co-operative and Rural Affairs Ministry, it was done in Iran. We found that legalising poppy production helped pharmaceuticals and did not increase the numbers of addicts in the country. Recently there has been a similar agreement between pharmaceutical companies and farmers in Didcot, with Macfarlan Smith. Clearly, as my noble friend indicated, that has not resulted in a marked increase in addicts, but it has increased the number of happy farmers in this country. Legalising production of drugs would help us internationally. As for the national economy, it would be hard to do better than as presented in my noble friend's explanation with regard to cost-benefit analysis.
My personal experience of working with young people shows that, unavoidably, most dabble with drugs in their early years. I must admit that, although I do not drink, I certainly did smoke pot in the 1960s. It was great fun. I did not do anything to anybody when I was high; I danced a lot and listened to music. I lived to tell the tale, and I assure noble Lords that I am not a criminal. Criminalising drugs "otherises" a whole category of people, many of them young people with a bright future in front of them. The difficulty of being labelled as a criminal, even for those who do not actually go to prison-though many do-is that once you are regarded as an addict to heroin or crack you are no longer employable. A great deal of evidence suggests that only those who are well supported by their families and have a context of support, healthcare and pathways to employment survive their occasional experimentation and possible addiction. It is a great loss of opportunity for improvement. Prisons are universities for drug-dealing and those who come out of prison-and even those who go in-come out with absolutely no alternative but to join the black market. It is a costly alternative. Surely it would make sense to see drugs as a problem exactly like alcohol and others and to treat those people rather than criminalise them.
My Lords, the noble Baroness, Lady Meacher, deserves double congratulations, both for bringing this important United Nations report to our notice and to the Government's and, as she has described to us, for playing such a significant part in initiating the process that eventually led to its publication.
Its observations and recommendations are not revolutionary in themselves. Most of its points are already well known and understood by those, like myself, who have been involved in helping problem drug users. What is remarkable, as both the noble Baroness and the noble Lord, Lord Mancroft, have pointed out, is that this reasonable and humane paper has emanated from the UN Office on Drugs and Crime, a body that up to now has been on the draconian wing of the worldwide debate on drugs. This was thought to be largely due to the strong influence of the United States, with its tendency to use custodial sentences for drug users, thus having the highest prison population in the world. As well as the other reasons given by the noble Baroness, though, perhaps the change of heart has something to do, as the noble Lord, Lord Mancroft, mentioned, with the change of the American Administration.
"This paper outlines a model of referral from the criminal justice system to the treatment system that is more effective than compulsory treatment"-
I emphasise, more effective. What the paper advocates,
"results in less restriction of liberty, is less stigmatising and offers better prospects for the future of the individual and the society".
A useful feature of the paper is the list of references to the recent research on which its conclusions are based. I recommend that those in the Home Office and the Department of Health who are responsible for drugs policy pay careful attention to the papers that are cited.
The central message of the document is that drug abusers should be regarded as sick or sad people rather than bad people. This is not to say that they do not get involved in crime or become skilled liars in order to obtain the substances on which they are dependent. The document points out that treating drug users as criminals does not deter them from continuing their habit, and that treatment for drug abuse in a coercive setting is less effective than in a negotiated voluntary setting.
I look forward with interest to the contribution of my noble friend Lady Massey, under whose leadership the National Drug Treatment Agency has greatly increased the availability of treatment. I suspect that she is in sympathy with the approach of the UN document. The National Audit Office reports that numbers in effective treatment in the UK rose from 134,000 to 195,000 between 2004 and 2008. I hope that the noble Baroness can give us some figures on the effectiveness of this and on whether there is evidence that drug-related crime rates have fallen.
There has been increasing and welcome use of the drug rehabilitation requirement, the successor to drug testing and treatment orders, for drug users who have committed an offence. However, the NAO reports a lack of consistent research into its effects. Perhaps better results might be obtained if the social needs of drug offenders, particularly housing and employment, were given more attention. I am aware that the Government are aware of this, but implementation is erratic.
An innovation mentioned in the UN paper is the establishment of special drug courts in some countries. These can be staffed by personnel who are familiar with the special needs and characteristics of drug users, especially their tendency to relapse several times before finally giving up fully.
I commend this report to the Minister, and I hope that its contents will be scrutinised carefully and used to improve not only the lives of drug users but, as the noble Baroness, Lady Meacher, has said, society as a whole.
My Lords, I thank my noble friend for this debate on treating drug dependency through healthcare, not punishment. It will be interesting to hear the Government's response. We are discussing a huge worldwide problem. For some years, I chaired an organisation called Phoenix House, which has several drug rehabilitation houses in the UK; it also operates in Germany and the United States. It can be an alternative to prison, but it is a drop in a very large ocean. Drug abuse reminds me of King Canute, who could not stop the sea coming in. This debate makes me think: how can the worldwide tide of drugs be stemmed? How can the effect of drug abuse be lessened?
I have served on the parliamentary All-Party Group on Drugs Misuse for many years. Some years ago, a god-daughter of mine died of an overdose of drugs and alcohol. She was a graduate of Oxford University. Drug abuse covers all strands of society and causes much heartache and despair. A co-godmother asked me at the funeral, "Couldn't you have done something to stop this happening?". I am sure that many of us try to do our best, but being a Member of your Lordships' House cannot solve all these tragic situations.
For many years, I served as a member of a board of visitors, now called monitors, at a young offender institution. We used to get the odd case of drug abuse, but always alcohol problems. Now, the majority of the young inmates have taken drugs as well as alcohol. The situation is rocketing. Some people will say that you have to get a prison sentence to get treatment, as there are not enough centres for treatment in the community-and of those that there are, many are very expensive. On Sunday, I met a doctor who runs an A&E department in Middlesbrough and asked him how the situation relating to drug abuse is there. He said, "Rough", but also that as long as it is criminalised it will go on going up. Recently, there have been murders of prostitutes, all of whom were on drugs. Prostitution was the only way that they could afford their addiction.
"people continue to inject drugs and engage in other high-risk activities for the spread of HIV and hepatitis in prison, the prison environment is highly conducive to HIV spread",
and to TB. It continues:
"The lack of continuity of HIV treatment on entering and leaving prison increases the risk of developing drug resistant strains",
of the HIV virus and drug-resistant tuberculosis.
Which type of tuberculosis did the prisoner who died in Cardiff prison this April have? Also, what happened to the prisoner with extensively drug-resistant TB who was treated in St George's Hospital, Tooting, and referred there from Pentonville prison? He originated from Georgia. If these people do not continue taking their drugs, they are exceedingly dangerous to the community where they land up. The mobile X-ray unit that finds and treats hard-to-reach people who may have TB in London, many of whom take drugs, may lose its NHS funding this year. That would be an utter disaster. Many people are already doing vital work treating and helping people with complicated dual-health problems. They need support and funding, as this discussion paper suggests. Health promotion needs expanding. Can the health service and the third sector do it all? That is debatable.
My Lords, I, too, congratulate the noble Baroness, Lady Meacher, on introducing us to this important discussion paper. I declare an interest as having, over many years, represented and prosecuted in many drugs cases, involving the use and possession of drugs, drug-related crime and the importation of drugs.
The paper accords very closely with Liberal Democrat policy, as set out in the report of the commission under the chairmanship of my noble friend Lady Walmsley some years ago. It is a serious problem that costs the economy a huge amount, as the noble Baroness herself pointed out-some £19 billion a year. However, the punitive approach has not proved successful for drug addicts and alternatives must be found to the sanctions of the criminal justice system.
Drug dependency is brought about by a multitude of factors, as set out most clearly in the report. They include a history of social and personal disadvantage; temperament and personality traits; prenatal problems; poor education; adverse childhood experiences that lead to non-existent self-esteem; a lack of bonding within the family that creates social isolation; and, sometimes, psychiatric disorders. Drugs are seen by many such individuals as a panacea to relieve adverse conditions-a form of escapism. We are dealing, in most cases, with vulnerable and damaged individuals.
Heroin does not cause people to become violent, as alcohol does, but, as the noble Baroness, Lady Afshar, said, it does make people unemployable. It has that great impact on our society, accordingly, of carrying these people along. I remember one defendant being asked, when cross-examined severely by the prosecution for having administered drugs to his girlfriend, who had died, "How do you know she liked it?". He said, in a chilling way, "Everybody likes heroin". It was freely available to him, and more available, he told me, in prison than it was outside. That is one of the factors that we must grapple with.
I cannot follow the noble Lord, Lord Mancroft, in referring to people who take recreational drugs in a moderate way. Those who think that taking cocaine socially is clever should remember that their affluence is promoting the importation of drugs by very serious and dangerous criminals, who do not hesitate to use violence to protect their trade in the cities of this country. As for cannabis, I am afraid I missed the 1960s; I was bringing up a family at the time. However, I recall prosecuting three men for growing cannabis. In fact, what they were growing was agricultural hemp and they had to smoke 10 spliffs to get the effect of one. Nevertheless, they got three years' imprisonment for it and what that did for them I cannot imagine. Imprisonment exacerbates all the problems. It exposes the individual to older criminals, gangs, illicit drugs within the prison estate-which I referred to-and a worsening addiction which, on release, can be the root cause of further reoffending.
It has been demonstrated that more than half of the prison population in the United Kingdom uses drugs, whether it is heroin or crack. If they are there for just three months, or serving a short sentence of that sort, they cannot be dealt with in any constructive way. No treatment can be effective within that period. As the noble Baroness, Lady Masham, pointed out, prison presents additional health problems from HIV to TB to other factors due to overcrowding and prisoners being locked up for substantial periods. These worsen the psychological factors that led to the original drug dependency.
The noble Lord, Lord Rea, referred to drug courts, as mentioned in the report. We on these Benches have watched the pilot scheme under which drug courts have been rolled out in England, particularly the west London drug court. Its statistics are impressive. According to Judge Julian Philips, a stipendiary magistrate since 1989 who was appointed judge in the west London drug court in 2005, there has been a drop of 20 per cent in shoplifting in the area. He said that his methods have been extremely effective. Perhaps others can speak about that. A confirmed addict needs £100 for one day's worth of drugs. That means that he has to fence £400 or £500 worth of stolen goods to feed his addiction. An average addict will commit 127 crimes a year. Following the approach adopted in west London, some 60 per cent of addicts do not reoffend during the course of a court order, and 20 per cent remain drug free. That compares with an average over the country of 3 per cent, as reported by national treatment agencies.
A complete review is needed of how the resources are used. We should not waste money sending drug addicts to prison but use those resources in a positive and constructive way along the lines that this most helpful paper sets out.
My Lords, I, too, welcome the UNODC discussion paper, and congratulate the noble Baroness, Lady Meacher, on securing this very timely debate.
Large numbers of offenders of all ages commit drug or drink offences. I believe that something like 80 per cent of the prison population has a connection with drugs or drink. I do not think that drug dependency is treated in most prisons, so the rate of reoffending is inevitably high and those people are less likely ever to be able to reintegrate into the community. As we all know, drugs are widely available in prisons. I was very shocked to be told yesterday by a barrister who does a lot of prison visiting that prisoners who go in taking cannabis move to heroin because it is less obvious in the blood stream when testing is carried out. They come out of prison heroin addicts. That is a terrible indictment of an element of our prison system.
As regards the human suffering of those who take drugs and those who live with, or are connected with, those who take drugs, there is, of course, a huge effect on families. As the noble Lord, Lord Freud, said in the previous debate, 80 per cent of drug users are on benefits and are, presumably, unemployable. The point that I particularly wish to bring to the attention of the House-it has not yet been referred to-is the effect of drug use on children. They are affected in all sorts of ways. When parents are on drugs, they do not give their children love, care and attention. Children who truant, commit crimes and move into gangs come from dysfunctional families. A substantial group of dysfunctional families in this country are those in which one or both parents take drugs. Children as young as 10 to 12 are recruited as runners and by the time they are 18 are dealers on housing estates. By the time they are 18, they are dealers. That is a terrible aspect of life in some parts of the country.
I do not how many noble Lords know about cannabis farms. Do you know that private houses are rented out to gangs who turn them into cannabis farms? They create one by pulling out all the interior, taking the electricity and water for the spray and heating system, and using polythene. Fortunately, the smell is extremely strong and the police can detect it using infrared technology in helicopters. Thereby, many of the cannabis farms are found. The police discovered a number of cannabis farms in private houses near Heathrow that were being tended by Vietnamese children as young as eight or 10. They had of course been trafficked into this country and all they did was tend cannabis farms in private houses.
It is difficult to know the best way to deal with drug abuse and whether drugs should be decriminalised. One thing is absolutely certain, which encouraged those of us who signed the letter sent by the noble Baroness, Lady Meacher, to Kofi Annan-the present system around the world is not working. It is certainly not working in the United Kingdom. It is costly, time-consuming and is, overall, ineffective, as the noble Baroness told us. The successes in the discovery of loads of drugs only highlight the huge difficulty of keeping up with the inflow of drugs to this country and through this country to other countries. We all know that sentencing, however severe, does not seem to have any deterrent effect on drug abuse.
One possibility might indeed be to decriminalise, but one would have to be extremely brave as the Government of a country to do that in light of the 180 countries that deal with sentencing severely. One only has to go to Singapore and walk into the airport to be told that to carry drugs means death. We are a long way from making Singapore decriminalise drugs.
I was interested in what the noble Baroness, Lady Afshar, said about Afghanistan. For a long time I have wondered why this country, perhaps in concert with other countries, does not buy the entire Afghan production of opium. We know that there is a world shortage of morphine and I should not have thought that it would be difficult to sell at a profit. If we bought it, we would do down the Taliban at one stroke-certainly to a large degree.
The proposals of the UNODC are extremely interesting. There seem to be two ways in which one could go on this: either by keeping the criminal system, whereby offenders go through the courts but do not go to prison; or, preferably, by diverting entirely from the prison system. I cannot believe that setting up a large number of clinics in the United Kingdom could be anything like as costly as keeping the drug addicts in prison and releasing them to reoffend whereby, again and again, they are a charge on the state.
I should like the Government to try out further pilot projects that divert from prisons to alternative remedies. It would be crucial that clinics were free, freely available and properly set up to deal with drug offenders. I urge the Government to do something such as that and see by how far they could cut out the people in prisons.
My Lords, after not speaking for some time in this House, I find myself on my feet twice in the same afternoon. It is a privilege to take part in this debate. I add my congratulations to the noble Baroness, Lady Meacher, on initiating it. This is a different debate from the usual one we have on substance misuse. It draws our attention to the discussion paper, which is a step forward-but only if we do more than just read it. We have to act on it, of course.
I declare two interests-first, as chief executive of Turning Point, which is probably one of the largest providers of substance misuse services outside the NHS, and as a member of the Government's ACMD, the Advisory Council on the Misuse of Drugs.
Our current system is questionable; indeed, I think that it is broken. All the evidence points in the direction that substance misuse is best treated through health and social interventions. Substance misuse has roots in an individual's psychosocial state. For treatment to be effective, the whole of the person needs to be the starting point of intervention. My organisation is incredibly ambitious for our substance misusers. It is a mistake to assume that providers of treatment for substance misusers allow them to languish on methadone without any intention of moving them towards work. That is wrong, certainly in the case of Turning Point and many of my fellow providers of treatment services, both within and outside the NHS.
We know the numbers, but it is worth repeating them. There are 400,000 problematic heroin and crack users in the UK, while 1.5 million people will be significantly affected by a family member's drug use. I congratulate the noble and learned Baroness, Lady Butler-Sloss, on her remarks about children. About three years ago, Turning Point produced research showing that one in 11 children goes home to parents who are misusing alcohol. We must not forget the impact on children, as the problem is generational. We know that those children are more likely to fail in education and we know that failure to be educated thoroughly leads to low job attainment and a greater likelihood of ending up in the criminal justice system. The line that can be drawn between substance misuse, criminal justice, poverty and family breakdown is clear and well understood.
Recovery is dependent on the stability of the individual and is more likely if someone has a steady personal relationship, meaningful employment and stable housing. For me, the question has always been how to get people to the position of having the quality of life that makes recovery more likely.
The use of coercive techniques and prison to prevent substance misuse is questionable. When the noble Baroness, Lady Afshar, spoke about cannabis, we all laughed, but what she said was interesting. If you are caught with cannabis and happen to live in one of the 14 poorest boroughs, the chances of your ending up being able to give a speech in the House of Lords are severely limited, but if you are a member of the Royal Family or on the Front Bench of either party and you admit publicly that you have used cannabis, you will get off. It is an offence, but the impact is variable, depending on your status. That seems entirely unfair.
Leaving that to one side, I have yet to meet a substance misuser who has benefited from a spell in prison. Some might say it, but I have yet to meet anyone for whom prison as an intervention has been effective in removing their drug problem. Addiction is an irrational state. You can punish people until the cows come home, but you will not move them from their fundamentally irrational position. It does not work in that way.
Also, we are naive to think that prisons are drug free. They are not. As the noble Lord, Lord Thomas, said, prison imposes a stigma, but it also imposes a significant heroin problem. A number of clients whom I have known over the years have, immediately on moving out of prison, scored heroin and died, because their tolerance has been reduced by their spell in prison. They have been able to get hold of heroin in prison, but only in smaller amounts; when they come out of prison, they go back on to the dose that they were on before they went in and they die. In that respect, prison kills people.
The use of prison as a sanction for substance misuse is short-sighted and fails to acknowledge the nature of substance misuse. We should pay attention to the challenge not just of illegal drugs but of substance misuse generally. Many sufferers from substance misuse have dual diagnosis: they have mental health problems as well as substance misuse problems. It seems rather obvious that, if you decide to be in or are forced into a position where you are killing yourself through the misuse of any drug, you are probably challenged in terms of your mental health. The Royal College of Psychiatrists has suggested that approximately half of all clients in substance misuse services have some form of mental health condition, most commonly depression or a personality disorder. Prisons simply are not suitable places in which to manage personality or mental health disorders. Nevertheless, some people who misuse drugs will end up in prison because they commit heinous crimes. We must ensure that these people are given adequate support to address the root of their personal problems, and this means that health and social care interventions within prisons are a must.
My own organisation, Turning Point, was one of the first to pilot the drug courts programme in Wakefield. We campaigned for many years to get drug courts established because we saw the impact that they had on individuals and their ability to turn people away from substance misuse, and indeed the criminal justice system, towards work and a normal life.
The document that has been drawn to the attention of the House is not the only one that looks at drug treatment. My organisation has signed up to a drug treatment consensus, which has also been signed up to by many leading drug treatment providers. This consensus document encourages the coalition Government to remember that there is more to drug treatment than getting someone off drugs or stabilising them on methadone, which often ends up being the focus of the debate. Rather, we should consider the needs of the individual. Recovery from addiction is a journey on which there are different paths. However, when it comes to addressing their addiction, for some people it is better also to address what is influencing it in the first place. That is seen in the ambition of the signatories to the drug treatment consensus for those with substance misuse problems, although we acknowledge that methadone is a step on the journey towards recovery from heroin addiction.
Although it is an interesting issue, it is worth pointing out that I am not too concerned about having a debate on whether or not to legalise drugs. In a society with a system of legalised drug misuse, would we not have addicts? We would, and we would still be faced with the challenge of what to do with them. That is at the centre of this debate. However, let us move away from illegal substances and draw attention to the legal ones. Alcohol specialist treatment services are much needed.
Solutions to this problem do exist. Often they are denied not because of a lack of evidence-the evidence is there-but because of moral panic and a desire to play to the gallery. We have a once-in-a-lifetime opportunity to set aside moral relativity and to focus on the evidence and the interests of those who suffer from this terrible problem.
My Lords, I am most grateful to the noble Baroness, Lady Meacher, for introducing this debate with such thoughtfulness. The previous speeches have been so fascinating that I am only sorry that we cannot spend more time on this very complex topic.
I begin by declaring an interest as the chair of the National Treatment Agency for substance misuse. The NTA was set up in 2001 with the aim of doubling the numbers in treatment and reducing waiting times. I am glad to say that these targets were achieved early. However, we are alive to and will address the issues that remain. As an organisation, we work across the health, criminal justice, education and welfare ministries and systems. Drug use everywhere has to be tackled across systems and not by one system alone.
Any addiction is a public health concern, and I am very interested in the coalition Government's intention to improve public health through a new public health delivery system. Public health, of course, involves family and community issues, as well as housing, employment and education.
The UNODC paper takes a somewhat polarised view and approach, using terms such as treatment being an,
"alternative to criminal justice sanctions".
I would say that we need effective treatment systems but that we also need effective criminal justice systems where treatment is available. I have worked in countries where the situation is polarised and where prison, labour camps and compulsory treatment centres are the norm. That is not the case in the UK and I want to give some examples.
There has been a dramatic expansion of our drug treatment arrangements over the past nine years due to more money being put into the system. The money has been there largely to fight crime but it has also benefited health. The number of people in England completing treatment and being free from dependency has increased from 9,000 to 25,000 per year. Offenders are systematically referred into treatment, preventing millions of crimes each year and saving costs. England now engages more than 60 per cent of the most problematic drug users in society in treatment, compared with less than 20 per cent in the USA. There are some success stories.
There is an emphasis on two things in the UNODC paper: one is outcomes and the other is evidence-based approaches. Many countries have not had drug strategies. England has a drug strategy against which outcomes can be measured and evidence bases set out. We know that drug users commit crimes to fund their habit; we know they often have other health, social and educational problems, as many noble Lords have said; and we know that each user is different and that successful treatment will address those differences. Recent debates in the media might suggest that treatment for drug use involves a simple choice between an abstinence-only approach and one based on methadone prescribing or other substitute prescribing. Individual users often do not subscribe to ideologies; they use.
The starting point for the NTA is that the majority of addicts want to overcome their addiction and get off drugs. We need a treatment system that helps them to realise that ambition. It may take time. It may take many attempts and different approaches in order for recovery to take place. Users want to recover from addiction. For some, this will be with the help of substitute prescribing or residential rehabilitation and for others it will be detoxification or community services. The NTA has long supported psychological and pharmacological interventions provided by multi-professional teams, as recommended in the UNODC document. Does the Minister agree that that approach is more appropriate than secure accommodation for offenders and drug abstinence orders?
I want to speak briefly of two initiatives in which the NTA has been involved where improvements have been made. One has been the development of the treatment outcomes profile. This is an individual client monitoring tool to reflect progress in an individual's drug treatment. It has received international recognition and was praised in the Lancet last year. It is a simple tool which motivates self-analysis and a change in habits.
The other initiative is the integrated drug treatment system in prison. It was developed to bring together the fragmented delivery of drug treatment in prisons and to ensure that drug misusers could access a range of evidence-based services which are clinically appropriate to the individual. As has been said already, more than half of those in prison are heroin and crack users who will remain in custody for three months or less. They are not in the system long enough to undergo abstinence-only regimes. Good clinical practice is to continue the treatment that the prisoner had before arrest, or prepare them for the treatment that they will receive on release. Not to do so leaves that population vulnerable to suicide or overdose on leaving prison, which is not a healthy option. The Integrated Drug Treatment System means that many offenders are being released into the community having been successfully engaged in drug treatment and not needing to go back to a life of crime. I have visited many prisons involved in this scheme and professionals and users alike speak highly of the system. If noble Lords are interested, there is an NHS/NTA short report called Breaking the Link, which addresses the issue.
So it is not a case of either coercion or cohesion, as suggested by the title of the UNODC paper, From Coercion to Cohesion. It is a case of having a strategy and a policy which address individual health and social needs and which, in turn, have a positive impact on crime, on families and on communities.
My Lords, this document from UNODC is the dawn of a new era. It calls for drug dependence to be treated through healthcare not punishment. For 50 years the United Nations has underwritten the war on drugs and its conventions have inhibited member countries from adopting alternative strategies. Now our task is to challenge Her Majesty's Government to acknowledge this change and, as suggested by my noble friend Lady Meacher, to take a lead in setting up a conference of UN member countries to discuss how the new policy can best be implemented. Many member countries have already experimented with the substitution of a health-oriented approach in place of prohibition, and they should all be invited to share their experiences at the proposed conference.
The common sense and valid arguments in favour of decriminalisation and regulation are well known. Decriminalisation means that drugs will be treated in a similar way to alcohol, tobacco and prescription drugs. It would ensure quality control and reduce the role of the criminal gangs that now control the international market.
However, in current deficit circumstances, an especial benefit would be financial. We and other Governments are desperately looking for sources of finance to extract ourselves from the recession. It is estimated that the war on drugs costs this country about £18 billion per annum. According to the Prison Reform Trust in its prison briefing of May 2010, the prison system as a whole has been overcrowded in every year since 1994 and the overall average cost per prison place is £45,000. About 55 per cent of those received into custody are problematic drug users. We are also told that 49 per cent of adults are reconvicted within one year of being released and, for those serving sentences of less than 12 months, that increases to 61 per cent. It is difficult not to deduce from those figures that prisoners are well looked after in prison and can probably fulfil their drug needs more easily there than in the open market. Clearly, if drugs were to become a healthcare issue, there would be increased costs from the provision of rehabilitation and treatment centres, but there would be an immediate benefit from new taxation and savings from prison and legal costs. In our current circumstances, the financial arguments are very strong.
I congratulate the noble Baroness, Lady Meacher, on the success of her dealings with the UNODC and hope that our new coalition Government will respond positively.
My Lords, I add my voice to those of others in thanking the noble Baroness, Lady Meacher, for her untiring efforts to change UN drugs policy. The UN thinks that she can change the world, and I have to tell your Lordships that, after many years' experience, it is wholly right.
The past 10 years has seen some modest reduction in harms. I pay tribute to the work of the National Treatment Agency in getting so many more people into treatment and care, but there is no doubt that our current emphasis on the criminalisation policy, which we have pursued here and abroad with minimal accompanying strategies on prevention and care, has been unhelpful. At the moment, we spend less than 7 per cent of the drugs budget on healthcare and less than 0.5 per cent on research into effective prevention and treatment strategies. There are no formal figures on how much is spent on education. Those figures alone must make us pause and rethink in the way that the noble Baroness advocated today.
I return briefly to the differences between decriminalisation and legalisation, which are seriously different strategies. Around the world, we know now, especially from studies in the United States, in different states' policies, and in Australia, that eliminating criminal penalties for possession of small quantities of drugs has no effect on the prevalence of drug use. That is true for marijuana and it is probably true for hard drugs as well, although I have to say that only Spain and Italy among major industrialised countries have tried it, and they do not collect outcome statistics that are in any way meaningful, so there is a serious problem there.
I love the story of the American academic researcher MacCoun, who works at Berkeley in California. He asked his undergraduate students whether they would be in favour of California removing penalties for possession of small amounts of marijuana. About two-thirds said yes, and the rest were opposed. Almost none knew that it had occurred 25 years ago.
Decriminalisation is not the same as legalisation, which allows some form of regulated sales or distribution, and of which there is only one contemporary example: the well known Dutch model of de facto legalisation which began in 1976. There is no instance of legal commercial access to cocaine or heroin in a modern, industrialised nation. Switzerland has probably come nearer than most and has concentrated significantly on improving health and reducing criminality among participants in its heroin prescription programme but, again, more rigorous research is needed.
Nevertheless, we can blame prohibition for much of the crime and violence around the illicit drug markets, for a large fraction of drug overdoses and drug-related illnesses and for corruption and the violation of civil liberties. However, other harms are due to the drugs themselves and the influence they have on the user's health and behaviour. Legalisation would eliminate the harms caused by prohibition, but it would not eliminate the harms caused by drug use. Thus, there is a trade off. If average harm went down under legalisation without an increase in use, we would clearly be better off than we are today, but if legalisation produced a significantly large increase in total use, total drug harm would go up, even if each incident of use became somewhat safer. Total harm can rise, even if average harm goes down. It is true to say that at present there is no firm basis for projecting the relative magnitudes of these effects.
What we need to do is perhaps to have some decriminalisation, but to refocus on the prevention and treatment strategy. President Obama's adviser, Thomas McClellan, has given many talks in this country and has described very well the new prevention strategy focusing predominantly on school and adolescent education, the re-engagement of parents, constant police monitoring and the involvement of all community organisations that come across young people. They are all pushing a specific message. I should remind noble Lords that drug addiction and misuse start between the ages of 10 and 21. Practically no one becomes an addict after that point. It is therefore very clear where we can focus our prevention strategies.
Overcoming addiction is very difficult. We know that compulsory coercion in the criminal justice system and compulsory treatment do not work. However, there are good forms of coercion. People need to take an active part in the choices that they make. That is part of the NHS commitment to all patients. They need to make active choices, and there are good forms of negotiation and coercion that can get people happily into treatment as a voluntary act. We should use coercion in the good sense of negotiating with individuals and asking what we can do to help them in their lives to make it sensible for them to come in and stick with the treatment. It is a long, hard graft and covers all the other issues that the noble Lord, Lord Adebowale, so eloquently described, but it is well worth it for the good outcomes that we can achieve.
My Lords, I should add to the chorus of gratitude to the noble Baroness, Lady Meacher, for bringing forward this debate. It echoes the debate on
We owe a debt of gratitude to all colleagues who have taken part. I do not want to be the purveyor of buckets of cold water to throw over the enthusiasms of the noble Baroness, Lady Meacher, but 14 years in the UN system taught me that conferences and discussion papers come and go. This is not a policy statement; it is not a strategy; it is not even a position paper; it is a discussion paper. It is no less valuable a step forward for that, but it has to be seen as something that will not necessarily lead to any immediate change. In the UN system, those are two words that cannot occur in the same sentence. But I expect the coalition Government-I think that we will see this-to look more seriously at enhanced healthcare solutions and decriminalisation. Much of the evidence coming forward in this debate is telling us what is wrong with our present system-about which, the truth is, I think that we have had our doubts. Whatever our capacity over a period, the question is always how we should move forward and deal with it.
I was much impressed by the contributions of several noble Lords. The noble Lord, Lord Thomas of Gresford, told us that this was very much Lib Dem policy, to which I will come back in a minute. I should particularly like to relate to the contribution made by the noble and learned Baroness, Lady Butler-Sloss, who brought children, who are very important, into the discussion. The debate was also sobering-if not by cold water, but by at least a chill-in pointing out the difficulties that we would have with decriminalisation in terms of any United Nations or international areas.
The noble and learned Baroness also posed a question, which I think was also asked in the debate on
I was very grateful to my noble friend Lady Massey for setting out the improvements that have been made. They are not as much as any of us would wish in terms of solving the problem. The noble Baroness, Lady Murphy, also pointed to some of those difficulties.
I should like to ask the Minister a couple of questions. First, I am interested in the Lib Dem policy. When we discussed it on
"That is a perfectly respectable view. It is not one that I share, because we are an enormously long way from being able to do that".-[Hansard, 22/1/09; col. 1798.]
That was the view of what is the major party to the current coalition. Will the Minister confirm whether that is still the policy?
Secondly, in the discussion that will no doubt take place on this interesting and valuable report, will the Minister indicate what discussions will take place with our European colleagues? In many of these areas, influence at the international level is much better when done in concert with our European colleagues than when we do it on our own. That would help us to move forward.
Thirdly, no one can expect a very detailed response from the Government tonight on a report which came out in March followed by a general election taking place in May. I was interested very much in the suggestion that there might be a return to this discussion at a later date when the Government's policies are more clearly thought through and their solutions more to hand.
My Lords, I thank the noble Lord, Lord Brett, not for a bucket of cold water-rather, I think, for a lifeline for me in responding to this debate. I will certainly take back the point about discussions with European colleagues because it is a very sound suggestion. One of the problems that I now face is that I have 12 minutes. Noble Lords will have seen notes coming from the Box, and I have been taking notes myself that amount to more than 20 pages. I could probably cover a good hour in responding. However, I will make sure that we produce from these notes and the points raised a response that will go to all participants in this debate and to the Library of the House. Taking on board the point just made by the noble Lord, Lord Brett, and that made by the noble Lord, Lord Mancroft, earlier, yes, I will make an absolute commitment that we will have another debate on this issue when the Government have bedded down a little more and have more to say on this matter.
The speakers list to which I will now respond is a checklist of the depth and breadth of experience available to the House on this topic, and I pay tribute to the noble Baroness, Lady Meacher, for promoting the debate and to her and other noble Lords' success in influencing the UN to produce the report that has provided its basis. The noble Baroness said in opening the debate that no serious policy-maker can ignore this paper. I can assure her, as a fairly new serious policy-maker, that I do not ignore it and neither will I ignore what has been said in the debate. It is timely and relevant.
Drugs are a scourge in our society. The Centre for Social Justice has identified addiction as one of the main factors linked to social breakdown. Drugs destroy lives and undermine the potential of our youth. Drug addiction feeds crime. Between a third and a half of all acquisitive crime such as burglary is drug related, and drugs also drive street prostitution, as referred to by the noble Baroness, Lady Masham. This Government are convinced that tackling the problem of drugs is a priority.
The noble and learned Baroness, Lady Butler-Sloss, reminded me of that old American saying, "If it works, don't try and fix it", because the corollary of that logic is that if it does not work, try something else. Where are we today? Many speakers have referred to the grim statistics. There are at least 330,000 problem drug users-those who use heroin and crack cocaine in the UK. The cost of drugs to our society is enormous. It is around £15 billion overall, of which nearly £14 billion is attributed to drug-related crime. In response, we have been spending around £1.2 billion on various interventions by health services, by the police, in prisons and through our probation services. On average, we estimate that 55 per cent of prison entrants have a serious drug problem, but as has been referred to, many are given short sentences with little time to enter into any serious rehabilitation. We believe that a better balance has to be struck.
Many drug users who leave prison do so with no supervision. Links to the community are there, through healthcare and drug intervention programmes, but too often the join-up is missing. We need to build on approaches such as the integrated offender management programme and innovative work that is being done in the voluntary sector, such as mentoring. Offenders must not fall through the net when they leave prison.
The noble Lords, Lord Thomas of Gresford, Lord Rea and Lord Mancroft, all referred to the drug courts, which are also mentioned in the UN report. Drug courts that support community orders and challenge offenders' progress through them are starting to develop. Initial results from two courts have been positive, and a full evaluation of four further drug-court pilots are due this autumn. The drug interventions programme has also made real progress by getting those who come into contact with the criminal justice system into treatment early. An evaluation has shown that overall volumes of offending fell by 26 per cent among those studied from this group, and we know that people who enter this treatment through the criminal justice system do as well on it as those who enter voluntarily.
The paper from the United Nations Office on Drugs and Crime supports the rationale of engaging drug users in treatment rather than relying on punishment alone. Healthcare and support services play a vital role in addressing drug misuse and drug-related crime. Without them, we would stand no hope of getting offenders off drugs. However, we have to carry public opinion with us, including the public opinion at the other end of this building, and we must not lose sight of the impact that this offending has on victims and our wider communities. Offenders must be made to take responsibility for the harm they have caused. Sentencing and tough sanctions should reinforce the treatment that needs to be available in prisons and in the community.
What should be said loud and clear, however, is that treatment for drug misusers is an essential part of our approach and, as the noble Baroness, Lady Meacher, made clear, it is cost-effective. A Home Office study estimated that the benefit for all drug treatments stands at around £2.50 for every £1 spent. As I have said, there is now substantial investment in drug-strategy interventions, and a large proportion of that is allocated to drug treatment. However, I am clear that treatment should not become an end in itself, creating a culture of dependency on state-funded methadone maintenance programmes. I was reassured by what the noble Lord, Lord Adebowale, said on this point.
The current approach in this country reflects the broad approach endorsed by the paper. However, we must avoid reading into the paper opinions that it does not express. It is not a blank-cheque endorsement of decriminalising or legalising drug use. The Government's approach, with the purpose of rehabilitating offenders, will use sentencing and criminal justice services to move them into treatment with the clear goal of turning their lives around, possibly with the incentive of reduced or community-based sentencing if they co-operate. We believe that legalisation takes no account of the consequences of the significant increase in use that might follow and the Government have no intention of legalising the so-called recreational use of any currently controlled drugs. I associate myself with what the noble Lord, Lord Thomas, said about it being a hobby for the rich which finances organised crime.
Our priority is to ensure that investment in treatment provides the best results. That means we must improve the effectiveness and cost-effectiveness of the treatment framework in place, including making better use of the voluntary sector. I am very impressed by the range of initiatives within the voluntary sector. This is not an excuse for avoiding the Treasury axe because there is a synergy to be built between what the Government are trying to do and what the voluntary sector can do.
Our programme in government is to take a fresh look at rehabilitation to ensure that sentencing for drug use helps offenders come off drugs, and to explore alternative forms of secure, treatment-based accommodation for drug offenders. We want to develop community sentences so that more offenders finish them drugs-free. We want to make sure that prisons are places where offenders address their drug misuse, not where their problems get worse.
I heard what the noble Lord, Lord Thomas, and the noble and learned Baroness, Lady Butler-Sloss, said about prisons. My officials are sending me encouraging statistics to show how hard they are working to tackle the problem of drugs in prisons and I shall include these in my round-robin letter.
We want to work with voluntary and private organisations to tackle the root cause of reoffending. Again I associate myself with what the noble Lord, Lord Adebowale, said about these problems often beginning in social and family backgrounds. We want to reduce reoffending through improved management of offenders and to strengthen and empower communities and the voluntary sector to manage those offenders who cause suffering to their local areas.
If we are going to carry public opinion with us on these matters, we have to realise that as well as drugs misuse being a terrible problem for the drug taker and their family and children, it is a terrible problem for the absolutely innocent member of the community who may be burgled or mugged when they come across the need of the drug taker to feed their habit through crime. We have to take them along with us if we are going to get support for the kind of approach that has been so widely advocated around the House tonight. Our approach will not abandon punishment or the criminal justice system but afford priority to treatment and rehabilitation, offering better prospects for the individuals concerned, for communities and for society as a whole.
I know that this position will not meet every hope and aspiration expressed by noble Lords, but I hope that they will see that our direction of travel takes account of the views expressed in the UN discussion paper, as well as the work done in this country and abroad by think tanks and NGOs. I can assure noble Lords that what has been said today will be studied by me and my colleagues in all the government departments concerned. My final pledge is: I will return.