The battle for hearts and minds

As reported in The Guardian (27th April) the Afghan government and NATO have been embroiled in a row after the NATO-led International Security Assistance Force (ISAF) announced to local poppy growers over the radio that ISAF understood why farmers needed to grow opium and that ISAF would not be engaging in crop eradication.

On the face of it ISAF's ad campaign sounds ridiculous; the West have been pressurising President Karzai's government to clamp down on opium production while Afghan heroin supplies virtually the whole of the UK market. Surely ISAF should be in there with flame-throwers at the ready?

But while ISAF have stopped the announcements, it still refuses to become involved in crop eradication. NATO argues that the sight of western soldiers slashing through poppy fields could drive hundreds of farmers into the arms of the Taliban. Western soldiers say their main job is to provide security so the Afghan government can tackle opium growing. To win support from sceptical farmers, British officers are at pains to distance themselves from poppy eradication efforts. "It's all about the civilians. They have to understand that we are here to kill the Taliban, not to cut down their poppy," said Lieutenant Charlie Mayo, a British military spokesman. There have even been rumours that British forces have exchanged fire with personnel under American command trying to attack poppy fields.

The dilemma over Afghanistan's opium economy is emphasised in a new book published by Pluto,'Drugs in Afghanistan: opium, outlaws and scorpion tales' by Dave MacDonald who was a field officer for the UN Office of Drugs and Crime in Kabul. MacDonald demonstrates that opium growing in structurally embedded in Afghan culture - a relationship between people and plant which goes back centuries. As Dr Richard Jones points out in reviewing the book for the forthcoming issue of Druglink, only time and commitment can help resolve the opium issue not just cash - and certainly not Rambo-style military interventions.

The reality gap in drug policy

Media reporting of recent overviews of British drug policy has concluded that the drug strategy has failed. And looking at the headline figures, it would be hard for any member of the general public to think otherwise. Indeed, the media gleefully leap on reports such as these for its daily dose of doom and gloom. So despite the investment, we have not seen a decrease in users of heroin or crack, still only a small percentage of drugs bound for the UK are seized, cocaine use has increased, cannabis farms are sprouting up everywhere and drug education must have failed because young people still try drugs. And so on.

So what can we say about this? Well, no drug strategy ever created has succeeded in substantially reducing drug use among any sector of the population or reducing the amount of drugs in circulation however much money has been thrown at it. The results of measuring the success of a policy against such basic indicators are inevitable.

By the same token, government measures of its own success are often equally flawed – and based mainly on quantity rather than quality – numbers in treatment, numbers of hits on the FRANK website, amounts of cash invested. And there are some developments that the government cannot in all honesty take credit for, such the reduction (according to the British Crime Survey and Home Office seizure stats) in the use of LSD, amphetamine and ecstasy which is to do with fashion and the workings of the drug market.

Because the things that maybe make the most difference are those which are difficult or even impossible to measure; the respect shown to a potential service user that persuaded them to come for their next appointment; the probation officer that went the extra mile for a client; the signal moment when a young person could have gone down the wrong road, but for a teacher who had faith in their abilities; the number of users who didn't die because of harm reduction strategies.

Scary for policy makers, but which leads to the thought that while matching investment against outcomes is a highly fraught exercise – this should take nothing away from the efforts of dedicated workers right across the health, social care and criminal justice sectors who are trying to make a difference to those with drug problems, their families and carers and the wider community. They deserve continued investment to support their efforts and so do the people they serve. Let’s start thinking outside the tick box.

Building on progress?

Because people still use drugs, there is a mistaken and simplistic view that the drug strategy has failed. The Government never claimed it could stamp out drug use – and no amount of money ever could. Simply spending money is no guarantee of success, but a problem in the past has been chronic under investment and a marginalisation of drug treatment, drug prevention and other interventions.

The Government has recently announced cuts across the drugs strategy when some key commitments and outcomes have yet to be met. The Home Office website states: “The Drug Interventions Programme is a critical part of the Government’s strategy for tackling drugs.” DrugScope has recently learned that the Drug Intervention Programme (DIP) main grant for 07/08 (i.e., this financial year) is to be cut by around 11%. The target of 1,000 DIP referrals a week to treatment, by 2008, has yet to be achieved.

A Department of Health press release issued on 29th March 2007 reporting a fall in overall illegal drug use among 11-15 year olds, stated: “Despite these promising figures we are not complacent – just one young person smoking or misusing drugs or alcohol is one too many.” DrugScope highlighted earlier this month that the Young People Substance Misuse Grant for 07/08 has been cut by just over 10%. We have to date been contacted by over a dozen projects reporting cuts to services and staffing. The target to reduce Class A drug use among young people has yet to be achieved.

Still to be found on the National Offender Management Service (NOMS)website: “The Integrated Drug Treatment System (IDTS) is due to be in place in prisons nationally by end March 2008 and will introduce a wider range of treatment options…” The additional £28 million planned for the IDTS in 06/07 was cut by 60%. As yet, it is uncertain how much of the £40 million planned for 07/08 will be used. In January the Chief Inspector of Prisons said: "The recent announcement of reduced funding could have a substantial impact on the implementation of this hugely important initiative.”

Yes, these cuts need to be placed in context, not least against the large increases in the adult Pooled Treatment Budget, even if the increases for the last two years have been less than was announced in 2005. Given the pressures on Department of Health spending few were surprised that the increase of over 40% planned for 06/07 was reduced to around 30% - still a significant rise. The increase of 3.4% for 07/08 (against nearly 13% planned) brings the total to £388 million, compared to the £442 million expected at this stage in the spending cycle.

The reduction in planned spending for the Pooled Treatment Budget has an inevitable logic: the target to double the number entering treatment by 2008 was met nearly two years early (the announcements in 2005 were ‘indicative’). A tremendous achievement, but the treatment effectiveness strategy explicitly emphasises the importance of improving aftercare/wraparound services, such as housing, employment and training, as key to improving outcomes. How is that needed investment being funded?

Some DA(A)Ts have received less money this year, although the National Treatment Agency (NTA) points to differences in average spend per person in treatment and some DA(A)Ts are getting significantly more. The NTA also points to the fact that some DA(A)Ts were underspending by year-end, but the delay in announcing last year’s Pooled Treatment Budget allocations will not have helped commissioning and planning – judging effectiveness or need by underspend is, in the circumstances, a blunt measure.

The announcement of the cut in the Young People Grant for this year came late in the planning cycle (end of February 2007) and the planned cut in DIP even later (end of March 2007, final allocations still to be confirmed).

The Home Office has said, in a recent letter to stakeholders, that in developing the next drugs strategy: “We must also seek efficiencies and re-focus upon the strategies and interventions that have the greatest impact”, which is reasonable. But, before the Government has published its consultation document, the ground is already shifting.

Yes, effectiveness and 'efficiency' need to be addressed (which will be challenging), but the cut in the Young People Grant is hurting and the cut in DIP funding may come as news to many front-line services, not least this far into the new financial year. Given where we are, it does not feel very strategic.

Oh Big Brother, Where Art Thou?

It's 2018 and the end of the second ten-year drug strategy. During that time, the strategy had become so focused on dealing with Prolific and Priority Offenders who use drugs, that eventually one heroin user was charged with all the remaining acquisitive crime in the UK. He was sentenced to life imprisonment in one of the new rehabs located on an abandoned North Sea oil rig and subject to 24 hour surveillance by an 80-strong security team. Thus the final link between drugs and crime was broken and Number 10 breathed a sigh of relief. But how was this achieved?

Simple really. Compulsory CCTV in all homes and the mandatory inclusion of everybody's fingerprints, handprints, iris patterns, voice recognition and DNA samples on the central database known as GOTCHA (GOvernment Tracking of Citizen Harm Agency) supplemented by Tag on Arrest for all offences including putting the wrong rubbish in a recycling bin and making unkind remarks about speed cameras. All of which might be a law and order politician's wet dream: the Saturday Guardian (31st March) highlighted what is the waking nightmare of our prison system stuffed as it is with those suffering mental health and drug problems.

The Guardian interviewed Stephen Rimmer, the current Director of Strategy for the Met Police, in his capacity as a former prison governor. But he had a key role to play in the recent history of British drug policy overlooked in the article. As Head of the Central Drugs Coordinating Unit (CDCU) under the last Conservative Government, he was a key architect of what became Labour's ten year drug strategy.

The CDCU was a brave experiment in trying to make government drugs policy cross-departmental in recognition of the fact that dealing with drugs is not just about criminal justice. It was a point underscored this week by Sir Stephen Lander, Chairman of the Serious and Organised Crime Agency (SOCA), in defending SOCA on the anniversary of its formation, from mounting criticism of its performance especially in relation to stemming the flow of drugs into the UK. But in fairness to SOCA, while acknowledging the dedication of the officers at the sharp end, none of its predecessors have done any better. For many years the enforcement agencies have openly acknowledged the small percentage of drugs seized in comparison with what comes in while those at the very top of the distribution chain and their assets appear fireproof.

The CDCU morphed into the drug czar's office, but the whole edifice was swept away by Whitehall intrigues allowing the Home Office to seize back control of drugs policy - a portfolio it is destined to hang onto if the shake-up of the department is confirmed. Rather than sitting with the new Ministry of Justice whose brief includes the prevention of re-offending, drugs will be closely tied into 'external threat' issues such as security, terrorism and illegal immigration.

Those who worked with Stephen Rimmer at the CDCU acknowledge him as a thoughtful and compassionate man. It is unlikely that he would have wanted the policy he helped create serve only to further demonise those with drug problems. However looking at the extent to which law and order issues have come to dominate the policy discourse and the implications of the proposed reorganisation of the Home Office, it is hard to come to any other conclusion.