Evidence of high numbers of drug-related deaths in Scotland have contributed to calls for the urgent need to offer more harm reduction-based approaches.
Drug consumption rooms (DCRs) are at the heart of this debate in Scotland. In healthcare settings they provide a safe and clean location where medical staff supervise administration of drugs, but they are currently not approved by Westminster.
DCRs are one type of intervention that falls under a harm reduction approach, which prioritises reducing the risk of harm to people who use drugs while promoting their wellbeing, empowerment, and access to healthcare. Other harm reduction initiatives such as needle and syringe programmes are still commonly provided in the UK, but the UK’s drug strategy indicates that policymakers are increasingly focused on abstinence, treatment, and punishment, with scarce mention of harm reduction approaches.
A new drug strategy is imminent and while major reform to drug policy is politically challenging, harm reduction has been part of the UK’s approach for decades. It is not incompatible with the government’s objectives of increasing numbers in treatment and cessation, but clashes with anti-drug rhetoric in Westminster. While a new strategy will inevitably have a strong criminal justice focus, it must also include funding and opportunity to provide evidence-based harm reduction interventions.
(Not) following the science
Evidence overviews of DCRs suggest they successfully engage with people who inject drugs, and are associated with positive health outcomes including reductions in mortality and overdose. No one is suggesting they will alone solve drug-related deaths, but evidence does not suggest negative outcomes such as increased substance use and related criminal activity. In fact, there is some evidence that they may lead to reductions in drug-related litter and crime.
However, the government’s Advisory Council on the Misuse of Drugs evidence-based recommendations for introducing DCRs in 2016 were rejected. More recently the Prime Minister had this to say when discussing DCRs: “I am not in favour instinctively of encouraging people to take more drugs. What I am in favour of is helping problem addicts off drugs, helping people with problems off their dependency, but I’m also in favour of a tough approach”
There is a lot to unpick there, but the emphasis on instinct and toughness driving drug policy over evidence is a well-trodden path. Sir Kier Starmer has also opposed calls for DCRs and other policy changes. The continued reliance on gut feeling and moral ideologies about drugs and people who use them is a rejection of the role of science and evidence in policymaking, as politicians take what Professor Alex Stevens nicely describes as a ‘moral sidestep’ to justify their avoidance of evidence. It might go against the instincts of our political leaders and the ‘tough’ image they wish to project, but funding harm reduction services does not mean that people will suddenly start taking lots more drugs or lead to increased criminal activity.
The Government-commissioned Black Review highlighted that we have plentiful evidence to assess against current policies. It reported record numbers of drug-related deaths were up 80% since 2012; over three million adults were using drugs a year, including 220,000 using them daily; over one third of the prison population were serving time for drug-related offences; and an estimated societal cost of £20 billion a year, with an illicit drugs market worth £9 billion. As Dr Adam Holland stated in an article accompanying an excellent short film: “The current approach is not only ineffective in preventing drug-related harm but itself directly and indirectly causes incalculable harm to those who use drugs and to wider society”.
Those calling for drug policy reforms often use evidence around stigma, dignity, health, access to healthcare and information, and inequalities. Our political leaders tend to talk about preventing and reducing drug use, crime, and impacts on wider society. On any such outcome however, criminal justice-focused policies based on eliminating drugs and punishing those who use them are demonstrably ineffective.
The power of gut instinct and the moral sidestep to avoid evidence
Unfortunately, the evidence matters not in comparison to our political leaders’ gut instincts and need to look tough on drug use as they call for a drug-free world. Eliminating (illegal) drug use is not only an ideologically driven motion, but, as emphatically laid out this week by the Global Commission on Drug Policy, never going to happen. The Chair of the Commission called out the UK Home Office’s 'high horse of oppression and prohibition' at a time when harm reduction policies are desperately needed.
However, such policies appear greatly at odds with the government’s renewed desire to crackdown on drug use through punitive measures such as raiding student parties, naming and shaming 'middle class drug users', and expanding drug testing. The moral argument against illegal drugs is circular: using these drugs is illegal because it is immoral and therefore needs to be punished, and use is immoral because the drugs are illegal. Evidence tells us that such morals-based approaches focusing on abstinence and eliminating drug use while seeking 'the harshest possible legal sanctions and consequences' for those that choose to use illegal drugs are bound to fail.
The lack of evidence, but also of empathy and compassion for the health and wellbeing of some of the most vulnerable members of society, in policy is not restricted to drug policy and may not be surprising, but it remains frustrating and damaging. Optimism for change comes from the support for an alternative approach from high profile advocates including the Lord Advocate in Scotland, the Green Party, and from the public with a recent study suggesting that the majority of Scots support the introduction of DCRs.
As public opinion continues to become more supportive of less oppressive drug policy, we can hope this will help our politicians be brave enough to look to evidence for guidance on much needed harm reduction strategies.
All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.