Evidence submitted by Health Poverty Action (DRU0095)
Home Affairs Select Committee Inquiry UK Drug Policy
1. Health Poverty Action is an international NGO that acts in solidarity with health workers, activists and communities worldwide to improve health and challenge the causes of poverty. Since our very beginnings, we have taken a justice-oriented approach, developing strong community roots, creating comprehensive and integrated health systems, and addressing the social determinants of health. We work in partnership with people around the world who are pursuing change in their own communities. We view drug prohibition as one of the core drivers of poverty and poor health globally. We welcome the opportunity to submit evidence to this inquiry.
2. Health Poverty Action works closely with Transform Drug Policy and we endorse their proposal for UK drug policy and reform of the Misuse of Drugs Act. As an international organisation we focus our response on the following question:
Are there laws, policies or approaches adopted in other countries that have been effective in reducing: drug use,
○ drug related deaths, and/or
○ drug related offending?
● If so, could they reasonably be expected to work in the UK?
3. The so-called “war on drugs”: has failed. In 2018, almost 27 million people used drugs worldwide.[i] Every year, $100 billion is spent on the “war on drugs”, while the global drug market’s annual turnover is estimated at $500 billion.[ii] The majority of this is unregulated and untaxed. [iii] Countries and jurisdictions around the world are beginning to wake up to the harms and failures of prohibition and move towards alternatives. This shift, from a criminal justice approach to health-based policy making, is essential if we want to take drug policy into the 21st century. It is time for the UK to catch up and develop and promote appropriate, evidence-based, and sustainable alternatives both in the UK and globally.
4. Evidence from around the world - including previous DFID funded programmes[iv] - shows that harm reduction initiatives, in particular when accompanied by decriminalisation, significantly improve the health and welfare of people who use drugs.[v] The government must dismantle the barriers people who use drugs face in accessing the services they need by increasing access to harm reduction services such as Overdose Prevention Centres and drug testing while simultaneously decriminalising the possession of all drugs for personal use.
New York - Overdose Prevention Centres
5. Overdose Prevention Centres (OPC) save lives.[vi] They prevent fatal overdoses, reduce high-risk injecting practices, increase engagement with drug treatment services[vii] and reduce hospital visits for acute care services related to injection use. [viii]There are now almost 200 in operation across the world.[ix] A recent (March 2022) article in the Lancet stated that OPC’s ‘ offer a new setting to deliver widely accepted and evaluated treatments, with no evidence they increase crime or drug use. The safest response to prevent harm is to support, and not oppose their introduction’.[x]
6. In New York, Overdose Prevention Centres have been introduced to enable people to take illegal drugs in a safe and hygienic setting under the provision of trained staff. Through drug checking and provision of sterile supplies the services can check and inform people about any concerning substances in their drugs as well as prevent infections such as Hepatitis B, Hepatitis C, HIV and Cellulitis. They also provide an opportunity for sign posting to additional vital support and advice. In the three weeks since the first authorised sites opened in December 2021, two New York City sites prevented at least 63 overdoses and were accessed more than 2,000 times by 396 different participants.[xi] If this rate continues, by the end of 2022 this would equate to the prevention of over 2,000 overdoses, far exceeding the rate of 130 predicted by authorities.
Scotland - Mobile OPC, Peter Krykant Safe Drug Consumption Van
7. Scotland, in particular Glasgow, Dundee and Inverclyde have the highest rate of deaths associated with drug use recorded in Europe, and rising - with 4.5 times the number of deaths in 2021 than recorded in 2000.[xii]Advocate Peter Krykant established a mobile OPC in a disused ambulance, providing services in a range of locations in Scotland and Wales. His service provides a safe and sterile space for people who use drugs. Its mobility allows Peter and his team to visit specific locations, at certain times that work for clients. This provides accessibility for the hard to reach homeless populations most likely to be otherwise forced to inject in the street.[xiii]
USA - Engaging young people about harm reduction
8. A “ just say no’ approach, delivering fear based messaging to promote abstinence does not stop young people taking drugs.[xiv] Lack of information on content, dosage, and the risks of mixing with alcohol or other drugs leads to higher risk of overdose and death. A harm reduction approach could mitigate some of the harms that can come from drug use. Education about drug taking for teenagers and young adults allows them to make informed and safer decisions about drug use. This should be delivered in a school setting with harm reduction education taught in schools for Key stage 5 where young people can learn about harm reduction concepts and strategies that will empower them to make healthy choices for themselves and others. Teaching can be supported by leaflets, posters and apps that should be readily available in schools.
9. In the USA, the Drug Policy Alliance’s Safety First: Real Drug Education for Teens[xv] is a comprehensive tool for teachers that allows them to have honest conversations about drugs with their students, equipping them with the skills to navigate their risks.
The Netherlands - Anonymous and legal drug testing: ( Jellinek and GGD Amsterdam Drug Testing Service)
10. A number of European countries have implemented drug testing with the aim of providing information as well as targeted preventive messages to people who use drugs recreationally. There are currently 33 drug checking service locations in the Netherlands where people can anonymously hand in their drug sample for testing and make contact with prevention workers. Results of this testing can also enable wider public health information. For example, in the Netherlands and Belgium, identification of an unpredictable and highly toxic compound through drug checking services instigated a public awareness campaign on national media. No deaths reported from this drug. In contrast in the UK where there are no such services, four deaths occurred as a result of this substance.[xvi]
11. Drug testing should be available in booths and mobile units in cities across the UK. A review of the impact of drug checking services at three music festivals in England in 2017 found that they were able to engage with young people, identify substances of concern, and that dissemination of test results and communication about identified risks were shared by service users with their peers, thereby providing wider dissemination and impact. It concluded such interventions “can increase strategies and behaviours to reduce drug-related harm such as poisoning and overdose”.[xvii]
Cambodia - Health Poverty Action Harm Reduction Program, Phnom Penh
12. The Cambodian government’s hardline “war on drugs”, has led to numerous human rights violations, including arbitrary arrest, torture and incarceration in overcrowded prisons. Labelled an “unmitigated disaster” by Amnesty international, the country’s so-called “war or drugs” has allowed the authorities to target the poor and marginalised.[xviii]
13. Amidst this, Health Poverty Action runs a ground-breaking holistic health focused support centre in Phnom Penh providing safe space offering harm reduction services and psychological support in a designated area free from criminalization in agreement with the local police. The centre operates in a “safe zone” in which police refer people to the centre instead of the compulsory detox centre and will not arrest anyone for drug use within 1 km from the centre. Other services include dosage control, take - home naloxone distribution, bi-weekly coordination meetings between people who use drugs and law enforcement and comprehensive care and support for children of people who use drugs. The department of mental health has further teamed up with the centre to develop an additional service for mental health counselling for people who use drugs.
14. Despite the national hard line approach towards people who use drugs this is an example of multiple stakeholders including the drug control authority, NGOs, health experts, the department for mental health, and people who use drugs working together to sidestep prohibitionist policies to achieve health based lifesaving harm reduction services.
Records indicate that crime by people who use drugs has dropped 70% following the intervention. Whilst a relatively new intervention, further impacted by COVID 19 meaning comprehensive data is not available, the program has plans to expand, including to provide drug testing as it has been so well received in the community.
15. Whilst harm reduction is important, ultimately legal regulation of the drugs trade, done responsibly and from a public health perspective is the only way to address the terrible injustices that prohibition has normalised. Designed well, with social justice, human rights and public health at its heart, and including the voices of those most impacted and harmed by prohibition, legal regulation could be transformative – and strengthen our global duty towards the Sustainable Development Goals. However, it has to be the right kind of regulation, designed through a social justice lens, otherwise it risks replicating the harms of prohibition. Health Poverty Action has identified 15 key priorities to be included in legal regulation policy that will directly impact and strengthen sustainable development and global equity.[xix]
16. 18 US states have now legalised cannabis for adult, non-medical use and 48 states for medical use.[xx] Uruguay legalised cannabis in 2013. In Canada where cannabis became legal in 2018 the federal government has retained control of regulating production, and given individual provinces and territories the responsibility of regulating retail sales in their regions.[xxi] The Canadian reforms were introduced with three clear purposes: keep cannabis out of the hands of youth; keep profits out of the pockets of criminals; protect public health and safety by allowing adults access to legal cannabis[xxii]
17. Cannabis in Mexico became legal for private, recreational use in June 2021. During the last three years, civil society groups like Instituto Ria have been closely involved in the process of creating this legislation, providing the technical and political inputs needed to ensure the framework works for sustainable development and social justice.
18. In Europe, legally regulated markets are being rolled out in Luxembourg and Switzerland. In the Netherlands as well as an increase in harm reduction services, production is now legal for coffee shops. In 2022 we are likely to see the legal right to home grown cannabis, in Malta, Italy and Denmark. Germany[xxiii] is due to legally regulate cannabis this year with a very particular focus on, home growing, an amnesty on previous cannabis related convictions, public health, and decriminalisation. Furthermore civil society groups and NGOS are requesting special attention to take into account the trade routes and supply chain from the Global South, as well as avoiding corporate capture and market monopolisation.[xxiv] The German Coalition is due to publish research into exploring legal possibilities and obstacles, both for the medical and the non-medical market and traditional production countries. That study is due by the end of this year.
19. Despite fears that US reforms would increase recreational use, evidence remains inconclusive, with different studies finding increase, decrease, and no impact.[xxv] It has however brought in tax revenue to fund public services. Colorado – with a population only slightly larger than Scotland - raised over 424million USD from new cannabis taxes and licence fees in 2021 alone.[xxvi]
20. Cannabis reforms have paved the way for the regulation of other drugs. In November 2020, Oregon became the first U.S. state to decriminalise the consumption of all drugs and the first jurisdiction in the world to develop plans for regulating psilocybin, the psychoactive compound in “magic mushrooms”, in certified settings.[xxvii]
21. Recognising the devastating impacts of prohibition including poverty, environmental damage violence, corruption and deaths, in 2020 Columbia debated a bill[xxviii] to regulate coca leaf and its derivatives including cocaine. The bill is now awaiting its third debate out of the official four, which will happen before 20th June. It has provoked an important national debate and demonstrates the increasing interest in the regulation of drugs beyond cannabis.
22. Health Poverty Action advocates the regulation of all illicit drugs. While cannabis legislation is picking up speed internationally, lessons learnt from the development of these new legal frameworks can be applied to the regulation of other drugs.
Conclusion and recommendations
23. The UK should follow the lead of countries and jurisdiction from around the world moving towards an approach that prioritises social justice and public health. This includes immediate harm reduction measures, decriminalisation of drugs and the legal regulation of cannabis in the short term, while longer term looking to legally regulate all drugs.
24. Legal regulating drugs will allow the government to control the drugs markets and remove power and influence from organised crime. It will ensure benefits for public health, vulnerable communities and society as a whole. The objective should be to design legal regulation that prioritises public health, human rights, sustainable development, environmental protection and social equity. Legally regulating drugs with this aim will have a range of benefits including: controlling access to drugs for young people; reducing the harms caused by the criminal market and mass criminalisation; regulating drugs in the interests of public health; reducing wasted enforcement expenditure (e.g. police and prison costs related to drugs offences); exploring the potential benefits and regulation of medicinal cannabis, and collecting tax revenue that could be used to support the NHS, public health, and harm reduction programmes.
As a first step the UK should:
25. Move responsibility for drug policy to the departments with the expertise and mandate to prioritise health, harm reduction and a development approach - the Departments of Health and FCDO.
Align drug policy with the Sustainable Development Goals (SDGs)
In domestic policy:
26. Dismantle the barriers people who use drugs face in accessing the services they need by increasing access to harm reduction services, and simultaneously decriminalising the possession of all drugs for personal use.
27. Legalise and regulate cannabis. This will allow the government to control the cannabis trade - ensuring benefits for public health, vulnerable communities and society - and generate tax revenues to fund vital public services – including the NHS. Start the process of legally regulating cannabis by :
● Bringing together a panel affected communities, experts and decision makers to decide on how to legally regulate
● Setting up a Cannabis Regulatory Authority to implement the policy recommendations of the panel
Explore options to legally regulate all drugs in the longer term.
In foreign and development policy:
28. Drive innovation by funding and supporting countries seeking to establish legal regulation systems, funding innovative new programmes like Bolivia’s coca control programme[xxix], and support and funding participatory research with affected communities at national and local levels.
29. Give political support to countries who want reform: Nations in the Global South exploring innovative new drug policy paradigms often come under pressure or face the risk of sanctions from more powerful members of the international community. FCDO should champion any progressive initiatives to legally regulate the illicit drugs market, particularly in low- or middle- income countries most affected by the ‘war on drugs’ at the UN and other international fora.
[iv] International Drug Policy Consortium et al. 2017. ‘Still no harm reduction? A critical review of the UK Government’s new Drug Strategy’. IDPC: London.
[v] Cook, C and Phelan, M et al. 2016. ‘The Case for a Harm Reduction Decade: Progress, potential and paradigm shifts’. Harm Reduction International: London. Available at: https://www.hri.global/files/2016/03/10/Report_The_Case_ for_a_Harm_Reduction_Decade.pdf
[xvi]https://www.emcdda.europa.eu/system/files/attachments/6339/EuropeanResponsesGuide2017_BackgroundPaper-Drug-checking-harm-reduction_0.pdf P 13
[xvii] Measham, Fiona
and Turnbull, Gavin (2021) Intentions, actions and outcomes: A follow up survey on harm reduction practices after using an English festival drug checking service. The International journal on drug policy, 95. 103270 - ?.
[xxiii] https://hanfverband.de/nachrichten/blog/dhv-die-wichtigsten-forderungen-zur-legalisierung and https://www.tni.org/files/publication-downloads/cr_german_10062019.pdf
[xxiv] See https://www.tni.org/en/publication/a-sustainable-future-for-cannabis-farmers for further exploration of these issues.
[xxviii] Video of Senator Iván Marulanda Introducing the bill: https://www.youtube.com/watch?v=JDq20Mszu_g&ab_channel=AFPNewsAgency