RHD0017

Written evidence submitted by Transform Drug Policy Foundation

About Transform:

Transform Drug Policy Foundation is an independent, UK-based charity working nationally and internationally towards a just and effective system of legal regulation for all drugs. We educate the public and policymakers on effective drug policy; we develop and promote viable options for legal regulation; and we support governments, policymakers and practitioners in achieving positive change that contributes to safer and healthier societies.

Glossary

‘Decriminalisation’ refers to the removal of criminal penalties for certain activities related to drug use — usually possession of small amounts of drugs for personal use, but sometimes minor supply or cultivation offences. In some legal systems criminal penalties are replaced by civil sanctions (such as small fines), while in other systems no penalties are applied. It is sometimes confused with legalisation, which is a distinct concept allowing for legal supply of formerly prohibited drugs.

‘Legalisation’ is the process of ending or repealing the prohibition of a drug. The term refers to the process of legal reform, rather than the specific policies that may come after. Legalisation, therefore, means the step between prohibition and legal regulation.

‘Legal regulation’ is the establishment of formal controls over the production, supply and availability of drugs. This will generally include licensing regimes, systems of taxation, marketing regulations, health and safety requirements, quality control standards and so forth. Setting out practical models for the effective legal regulation of drugs is core to Transform’s work.

Summary:

There is no question that the additional money going into the treatment sector will save and improve many lives. However, the extent of those benefits to individuals and society as a whole will be unnecessarily limited if the issues outlined here are not addressed. If we do not maximise these benefits, there is a risk that after the next Spending Review the continued expansion in funding identified by the Black Review as needed will not be forthcoming.

At the core of the problem is that the 2021 Drug Strategy - and the UK Government itself - fails to acknowledge that drug-related enforcement is costly and there is little to no evidence that it is effective in significantly reducing drug use or supply. But there is clear evidence that it exacerbates associated health and social harms.

It is therefore no surprise that this and previous Governments have failed to achieve the core aims of enforcement-led drug control: deterring drug use and restricting drug availability. Instead, the scale of use and drugs markets has increased dramatically, along with associated harms.

It also means huge sums have and continue to be squandered, resources that evidence shows could be far more effectively spent if the UK moved to approaches based on a truly health led approach - including ending the criminalisation of people who use drugs, and exploring models of legal regulation and control of currently illegal substances.

While much more is needed, a good starting point and litmus test for future intent would be for the Government and agencies like OHID to immediately drop the ‘Tougher consequences’ language running through its drug strategy - it tells people they are there to be punished not helped, undermines public support for treatment, and the public health approach itself.

Given the 10 year timescale it covers, the drug strategy is also unambitious. With the global evidence, and widespread support for the decriminalisation of the possession of drugs for personal use from authoritative UK health bodies, and UN agencies, not to mention the Scottish Government, it is disappointing there is no commitment to at least research and explore this approach in the UK. Representatives of the Portuguese government drug agency SICAD were invited to present to the UK Government’s 2020 drug summit. It is a shame none of the Ministers attending the summit remained in the room to hear their presentation on their decriminalisation approach, including how it reduced social costs by 18%, and numbers of people going to prison for drug offences, as well as saving and improving lives.

Progress on disrupting drugs supply

Substantial police, customs and military resources have been deployed to interdict drug supply both domestically and internationally in attempts to reduce the availability of drugs. Drug seizures are routinely celebrated by police and politicians as ‘preventing drugs from reaching the streets’. Drug seizure trends are volatile and hard to interpret, but have instead tended to track, rather than impact on, the supply. Seizures of cannabis, heroin and cocaine all follow a similar trend, having increased significantly between 1990 and the early 2000s, and subsequently decreased. However, the quantity of cocaine seized has risen again since 2011.

In 2003, the UK Prime Minister’s Strategy Unit estimated that removing organised criminals from the drug trade would require consistent seizure rates of 60-80% because profits are so high.[1] Research in Scotland estimated heroin seizures amounted to around 1% of the supply 2000-06.[2] This is consistent with the findings of the UK Home Office's 2020 Independent Review of Drugs Phase I Report, authored by Dame Carol Black which concluded that seizures are an affordable and factored-in cost of business for established organised crime groups: “The profit from one successful shipment is sufficient to offset the losses of multiple shipments.” [3] Seizures amount to far less than tax rates paid by legitimate businesses on trades with vastly lower profit margins, or for heroin may amount to less than just legal product loss rates alone. UK supermarkets waste around 2% of food, and fresh fish retailers waste 5% of products.[4]

The Government’s evaluation of its 2010-16 Drug Strategy acknowledges these failures, stating: “Some enforcement activities can contribute to the disruption of drug markets ... but the effects tend to be short-lived. Activity solely to remove drugs from the market, for example, drug seizures, has little impact on availability” and “illicit drug markets are resilient and can quickly adapt to even significant drug and asset seizures.”[5]

Even ecstasy (MDMA) seizures - with the highest rate of 14% - will be having negligible impacts on supply. The UN Office on Drugs and Crime has claimed that cocaine seizures globally have been greater than 50% of production - but even this has evidently failed to prevent rising production, supply and use, with cocaine experiencing falling prices and rising potency (strength), and a reported one million people using cocaine in England and Wales.[6]

The inefficacy of enforcement to tackle drug supply is not an issue of financing or resource, but rather a failing of the entire approach. As the Independent Review of Drugs notes, more resources are unlikely to lead to greater results:

Government interventions to restrict supply have had limited success. The key institutions involved are Border Force, the National Crime Agency (NCA) and police forces. All have faced budgetary constraints in the past decade and competing priorities. Even if these organisations were sufficiently resourced it is not clear that they would be able to bring about a sustained reduction in drug supply, given the resilience and flexibility of illicit drug markets.[7] 

Further noting that:

…evidence suggests that enforcement activity can sometimes have unintended consequences, such as increasing levels of drug-related violence and the negative effects of involving individuals in the criminal justice system.[8]

£6.9 billion a year is spent across the criminal justice system in England alone on dealing with drug offences and drug-related crime fuelled by the illegal trade (a UK-wide figure is not available). £1.4 billion is spent annually enforcing drug laws in England, with £690 million spent on drug related police enforcement costs, and an additional £733 million across the criminal justice system (courts, prisons, probation etc). This spending is not subject to any routine evaluation of cost-effectiveness.[9]

Supply-side enforcement interventions are invariably most effective at targeting the ‘low hanging fruit’, fuelling a process that perversely privileges the most efficient, adaptable and ruthless criminal operators. In a high-profit market, flexible criminal entrepreneurs have always found ways to meet the growing demand, and supply disruptions have historically only ever been temporary, localised and marginal. Enforcement can sometimes disrupt and displace markets, but never eradicate them. The ‘County Lines’ phenomenon, for example, is an evolutionary response by organised crime groups to the successful disruption of previously dominant supply chains and networks. County lines exploitation only exists on such a scale today because of enforcement. The Review of Drugs states that “new supply networks often emerge after effective police campaigns to disrupt existing supply chains.”[10] A separate report from the Home Office has acknowledged that these disruptions often increase violence and the newer suppliers are often more ruthless than their predecessors.[11]

It is revealing that while the Home Office lauds the numbers of ‘county lines’ phone numbers police shut down, it does not say what proportion of these are replaced in a given area, or how rapidly that process takes to happen.

In fact, despite the centrality of ‘availability reduction’ in enforcement narratives and successive drug strategies, no formal availability measures have ever been established, collected or published. However, in contrast to the proclaimed success related to seizures, data showing falling prices and rising purity all point to a reality of rising availability.[12]

Drug price and potency data has been inconsistently gathered or made available in the UK. EU data, however, provides a clear picture of how the regional markets, within which the UK remains a key actor, have shifted over the past decade - with a strong trend towards rising potency (increasing risks) and stable or falling price, and therefore increasing affordability.

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●        MDMA content in ecstasy pills and the THC content in cannabis (THC is the main psychoactive compound) have more than doubled from 2007-2017 across Europe, while prices have remained relatively stable.

●        Between the mid 1970s and the 1990s, the UK price of cocaine fell by between two-thirds and three quarters[13]

●        Between 1990 and 2004 in the UK average cocaine purity in police seizures fluctuated around 50%. In 2009 purity fell to a low of 20% before increasing to the highest level on record in 2018 at 63%.[14]

Drug-related problems cannot be solved by enforcement against supply. Higher levels of enforcement, however, can increase risk behaviours, and localised market disruption can further increase health harms. Temporary enforcement-related price inflation can encourage high-risk injecting over safer forms of administration (e.g. snorting or smoking) to maximise ‘bangs for bucks’, or can result in displacement from one drug to another, potentially higher-risk, drugs.[15] The impacts are unpredictable, but as experience with novel psychoactive substances (NPS) demonstrates, can lead to the use of novel drugs about which little is known (a risk factor in itself), creating challenges for police, forensics, harm reduction, treatment and emergency services.[16]

Reducing long-term demand for drugs

The long-held goal of drug prohibitionists remains a ‘drug free society’. A key aim of the 2021 Drug Strategy, and indeed the Misuse of Drugs Act 1971, is to reduce levels of illegal drug use through enforcement, based on the assumption that targeting people who use drugs and illegal drug supply can effectively deter use and restrict availability. It is vital for any meaningful discussion on the effectiveness of UK drug policy to acknowledge that there is little to no evidence to support either assumption. Instead, use has increased, and pursuit of these goals has come at a huge cost, both in terms of state resources and the negative impact on the health and wellbeing of individuals and communities.

Some enforcement data:

●        More than 3 million criminal records have been generated for drugs offences over the Misuse of Drugs Act’s lifetime:[17]

○        1.9 million guilty sentences in court

○        1.3 million recorded police cautions for drugs offences (police cautions form part of a criminal record and are flagged in certain criminal record background checks)

●        Since 1986 people have been sentenced to 680,000 years in prison for offences under the Misuse of Drugs Act (the total figure for the last 50 years is assumed to be higher as sentencing data is only available post-1986, and only for some regions)[18] 

●        16% of the prison population in England and Wales has been sentenced for drug offences. If offending related to drug use is included, this proportion rises to 38%.[19] In Scotland and Northern Ireland 9.9% and 7.2% of the prison population respectively has been sentenced for drug offences.[20] [21]

●        Since 2010 more than 80 percent of all drug offences recorded by police have been minor possession offences[22]

●        ‘Possession of cannabis’ has consistently been the most commonly recorded drug offence, making up more than two-thirds of all drug offences in 2019/20[23]

●        The proportion of stops and searches targeting drug offences in England and Wales has doubled from one-third in 2000, to nearly two-thirds in 2020, with only 10% of these leading to arrest in 2020.[24]

●        Since 2000 more than 9.5 million stops and searches have been carried out for drugs by police forces across the UK. [25]

What has happened to use levels:

●        The number of people using heroin rose from under 10,000 in 1971 to 260,000 today in England alone. This represents a more than 25-fold increase.[26]

●        Since 1971 cannabis use has increased by more than 5-fold, with more than 2.5 million people in England and Wales using cannabis in 2019.[27]

●        By 2019 3 million people used drugs in England and Wales, including almost 1 million people who used cocaine.[28]

●        Annual MDMA (ecstasy) use rose from zero in the mid-1980s to half a million people in 2019.[29]

●        The annual prevalence of any illegal drug use in Scotland has risen from 9% in 1996 to 13.5% in 2019.[30] 

It is now clear there is no meaningful deterrent effect from arresting or otherwise punishing people who use drugs. As long ago as 2006, the UK’s Science and Technology Select Committee found “no solid evidence to support the existence of a deterrent effect, despite the fact that it appears to underpin the Government’s policy on classification.”[31] The UK Government responded that it “accepts that there is an absence of conclusive evidence.”[32]

No such evidence has emerged in the subsequent 17 years, despite the Home Office’s commitment to “consider ways in which the evidence base in the context of the deterrent effect can be strengthened.”[33] In fact, the UK Home Office’s 2014 report “Drugs: international comparators”, which sought to correct this absence of evidence, instead concluded that “Looking across different countries there is no apparent correlation between the toughness of a country’s approach and the prevalence of adult drug use.”[34]

The most recent UK drugs strategy evaluation noted: “there is, in general, a lack of robust evidence as to whether capture and punishment serves as a deterrent for drug use.”[35] The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and The World Health Organisation (WHO) have made similar conclusions.[36]

Fear of legal sanction also plays virtually no role in motivating people to stop using illegal drugs: the 2015 Global Drug Survey found that worries about getting caught by police were cited by only 3% of those who stopped taking cannabis and 2% of those who stopped using cocaine or MDMA.[37]

In the UK there were 7.5 stop and searches (most for drugs) for every 1,000 white people, compared with 52.6 for every 1,000 Black people in England and Wales in 2022.[38] Yet there is no suggestion even this 7-fold disparity in enforcement has significantly reduced drug use in impacted groups, with levels of use remaining similar in Black and white populations

Relatedly, the global evidence suggests that removing criminal penalties does not lead to increased use. The UK Government’s own Advisory Council on the Misuse of Drugs has noted that “peer-reviewed studies have not [emphasis added] found that removing criminal penalties for possession is associated with higher rates of drug use.”[39] Most recently, a study of cannabis use among over 100,000 teenagers in 38 countries found no direct association between policy liberalisation and levels of use.[40]

The evidence is clear - policies criminalising people who use drugs, and blanket prohibitions of widely used drugs are at best ineffective, but more often are actively harmful, particularly to the vulnerable and marginalised. Instead, examination of the structural drivers of drug-related health risks point towards a range of policy needs and different health-led solutions.

Use and harm are not the same thing - it is reducing harm that should be the focus of policy. Clearly, drug use can cause substantial harm to individuals, but it is by no means inevitable. There are different types of drugs and drug-using behaviours, motivated by different priorities, which have different outcomes. According to the UN around 90% of drug use is non-problematic, with most people’s drug use moderate and doing them little or no harm.[41]

So, reducing the number of people using non-problematically will do little or nothing to reduce levels of harm. Focusing policy on reducing harm to individuals and society rather than use per se will bring the most benefits (see image below for an example using alcohol). Given the reality of drug use, we argue that governments should take control of drug markets through legal regulation - as is the norm for most risky activities in society

Illegally produced drugs lack health and safety information, and are of unknown (and highly variable) potency and purity, creating a range of risks not associated with their counterparts in the legal market.[42] Risks of overdose are increased, particularly for people who inject drugs, when drugs are unexpectedly potent. There are infection and poisoning risks associated with the adulterants and bulking agents used by criminal suppliers to maximise profits.[43] A recent concern is the emergence of potent synthetic opioids including fentanyl  and fentanyl analogues (50-1000 times more potent than morphine), and nitazenes including isotonitazene (500 times more potent than morphine) in supplies of street heroin. There were 130 deaths related to fentanyl and analogues in 2017, and over 20 related to isotonitazene in 2021.[44] This year (2023) has seen a serious spike in nitazene related deaths, with these drugs being found as adulterants in a range of products being sold as heroin, Xanax, diazepam, and oxycodone among others across the UK.[45] The potential scale of this problem is shown in the US, with 66,035 reported synthetic opioid-related deaths (excluding methadone) in the 12-month period ending October 2021.[46]

In the medium- to long-term Government must now initiate a process to meaningfully explore options for legally regulated markets for currently illegal drugs. The reality of resilient and growing demand for drugs, and the generational failure of an enforcement-led response to illegal drugs markets, has to be the starting point for any rational drug policy debate going forward. We have a choice: either these markets are regulated by responsible government agencies acting in the public interest, or they will remain in the control of destructive Organised Crime Groups acting in the interests of their personal power and enrichment. Whatever we might wish for, the reality is that there is no third option in which these markets will magically disappear. 

The Home Affairs Select Committee has twice previously recommended that the Government initiate an international debate on this question. The legalisation and regulation of drugs remains a politically challenging debate - but its importance in the UK grows greater as the cracks in the global prohibitionist consensus widen. The legalisation of cannabis for non-medical use is at the forefront of this debate, now implemented (or in the process of being implemented) in various forms across the world, including 24 US States (with Bills for Federal legalisation currently in the Congress/Senate), Canada, Mexico, Uruguay, Luxembourg, Malta, Switzerland, The Netherlands, South Africa, Germany, and multiple Caribbean states. More than half a billion people will soon be living in legal non-medical cannabis use jurisdictions. These experiences are providing valuable lessons for countries set to follow, including the UK, already the world's largest producer of medical cannabis.

The legalisation and regulation of drugs other than cannabis is also now a reality, with a legal coca leaf market established in Bolivia, and a Bill proposing a legal coca and cocaine market being debated in the Colombian Senate. Transform has been closely involved with many of these developments and contributed to the growing body of work on public health-led regulation models for different drugs in different environments. 

Moving towards responsible legal regulation of key illegal drugs markets offers the prospect of reducing or eliminating the harms of prohibition and the global criminal trade it has fuelled. We can finally achieve the meaningful reductions in crime that the ‘war on drugs’ has so conspicuously failed to deliver; from street level dealing and gang violence, to international organised crime, cartel bloodshed, corruption, and exploitation, undermining security, state institutions, good governance and sustainable development across the globe. The peace dividend from enforcement and criminal justice savings, combined with potential tax revenues from legally regulated markets, can be redirected into health and social programs to support and enrich communities rather than undermining them. Drug use, where it continues, can involve safer products, used in safer ways in safer environments. Freed up resources and the removal of political and institutional obstacles can facilitate evidence-based prevention for youth, harm reduction services for people who use drugs, and treatment for those whose use becomes problematic.

While reduction in harmful drug use remains an important target for the Government, a drug free society is an unrealistic and unhelpful goal. Policy-makers across the world must, and increasingly do, accept that some level of drug use is a reality that requires pragmatic management and regulated markets, not more decades of denial and delusional aspirations for a ‘drug free world’.

In terms specifically of the new drug strategy, are we returning to an ideologically driven, failed abstinence based approach based on throughput of people and ‘completions’ targets that are counterproductive? The near complete absence of mention of Opioid Substitution Therapy in the strategy or communications around it is extremely concerning. OST is the internationally recognised gold-standard for treating people with heroin dependency issues - and an approach found to reduce drug deaths.

OST is also key to demand reduction. A recent briefing by Jody Clark for four Midlands Police and Crime Commissioners (available on request) suggests that in the West Midlands OST is reducing the market for heroin by almost a third preventing £119m going to organised crime. That means it is preventing 78 times more heroin being sold in communities than the average annual seizures made by the region’s police forces.

Furthermore, why is there no funding committed for expanding Heroin Assisted Treatment (HAT), as called for by the ACMD, Health and Social Care Committee, and in its most recent report by the Home Affairs Select Committee. If the UK really wants to deliver demand reduction for heroin, and market disruption, provision of prescribed injectable heroin for use in a supervised environment for people who use heroin and have tried other treatment options without success is crucial.[47] This is a long-established treatment model in the UK supported by the Government in theory but not in practice. Evidence from the UK and overseas shows HAT is highly cost effective, improves health outcomes and substantially reduces acquisitive crime and associated criminal justice costs. Swiss research also suggests the 10-15% of people eligible for HAT use 30-60% of all illegal heroin.[48] This is in line with the 4% of the UK population who drink the most providing 23% of alcohol industry revenue.[49] So engaging eligible people in HAT and so largely eliminating their use of illegal heroin, provides an opportunity to substantially reduce the scale of the illegal heroin market and corresponding revenue for OCGs. It remains available only in two UK locations due to resource obstacles. Leaving this cohort’s needs unaddressed rather than rolling HAT out as Switzerland has done, dooms any heroin demand reduction strategy to failure. It is worth noting that people on HAT also reduce their consumption of other illegal drugs.

The Government plans research into the best approaches to reduce demand through behaviour changing communications. But will they commit to accepting the outcomes if the research, again, says they will have, at best, only marginal effects? Proposals such as seizing passports are simply doubling down on the failed punitive approach that has led us to the situation we are in today.

Any barriers to accessing treatment and supporting recovery;

Certainty of Government funding.

We will address these points together as they are linked.

We must ensure treatment delivers the benefits it can if we are to convince the public to support adequate funding for it, particularly at a time when other services are being cut. But a key and overarching barrier to people accessing treatment, with all the benefits to them and society that entails, is the continuing criminalisation of people who use drugs.

Criminalisation of people who use drugs has a profoundly negative impact in terms of creating or exacerbating health harms. The UK Royal Society for Public Health and UK Faculty of Public Health have stated unambiguously that: “Criminalisation leads directly to long-term health and wellbeing harm, including greater exposure to drugs in prison, severing of family relationships, and barriers to education and employment…criminalisation fails to address underlying substance misuse issues and discourages those with an addiction from coming forward for treatment [added emphasis].”[50]

Multiple studies have shown the negative impact of stigma attached to drug use and criminalisation creates barriers to access and engagement with treatment, health, harm reduction, housing and other services.[51] In addition, trying to educate young people about drug risks while simultaneously seeking to arrest and punish them leads to alienation and stigma, undermining outreach to those in need.[52]

It is also through these mechanisms that criminalisation of people who use drugs creates political and practical obstacles for health professionals working to address drug-related health problems and reducing harms. They are obliged to work within a malfunctioning legal and policy framework that is often in direct conflict with fundamental medical ethics – particularly the commitment to “first, do no harm” to those in their care. However, there is a clear and well-evidenced link between problematic or high-risk drug using behaviours and a series of (often overlapping) environmental risk factors. These include social deprivation, inequality, parental neglect, emotional, physical or sexual abuse, histories of being in care, poverty, school exclusion, mental health problems, and changes in social/personal status such as unemployment, divorce or bereavement.[53] Criminalising people for their drug use is actually a barrier to addressing these root causes, which are also supposed to be being addressed through the drug strategy and JCDUs.

In short, the arbitrary criminalisation of people who use (some) drugs is unethical, harmful, and fundamentally incompatible with delivering an optimised and effective public health response to problematic or risky drug use in society. It is concerns like these that led to the Scottish Government recently backing decriminalisation of people who use drugs, and we would recommend the Committee reads the report they produced to support this position, and their call to explore legal regulation of drugs.[54]

ADDER

The ADDER programme which lies at the heart of the new UK Government Drug Strategy is intended to develop local partnerships of stakeholders to coordinate law enforcement activity, including expanded programmes to divert offenders away from the criminal justice system, with expanded treatment and service provision.[55] 

Transform contacted a range of stakeholders including police, PCC staff, local authorities, and treatment and health service providers familiar with ADDER or directly involved in several of the original pilot ADDER areas, to gain insights into the project on the ground. Given the ADDER model is being suggested as a template for delivery of aspects of the new drug strategy as a whole, these lessons have wider significance.

There is widespread agreement among all the local stakeholders Transform contacted that a public health approach to drugs is needed. The chosen areas received ADDER pilot status due to the acute situation they were in, particularly with regard to drug related deaths, and evident failures of past criminal justice led approaches.

In terms of the ADDER approach itself, there is unanimous agreement, including from police we spoke to, that ‘tough consequences’ language and framing is counterproductive, is undermining a public health approach, and so should be removed. Transform believes this is also true of the language and framing in the 2021 drug strategy.

Firstly, as one put it, it is; “Reinforcing the public’s image of the drug user as criminal” and deserving of punishment, which undermines public support for treatment and other interventions. In the long term this risks reducing support for funding.

Secondly, there is concern that threatening and stigmatising vulnerable people, many with mental health problems or who have suffered trauma and childhood abuse, risks damaging their belief they deserve support. It also risks alienating individuals, reducing the extent to which they engage - particularly if the intervention is presented as police enforcement rather than health-led. One area reported they already have direct experience of clients being afraid to engage, worried they were opening themselves up to being arrested, or ‘grassed up’ if they talked openly about their drug use. Undermining this treatment worker/client relationship that depends on trust is unhelpful and damaging.

Many have gone further and called for a more comprehensive move away from an enforcement-led approach. One treatment provider stated to us; “It is clear from the statistics, WHO recommendations, common sense even, that relying on enforcement of drug laws is a dangerous waste of resources, but obviously no political party is brave enough to admit that to the voters at this time, so a public health approach has to be hidden under a layer of “tougher consequences” language. There is no chance that increased police activity is going to make much difference to the buying and selling of substances.”

The drug strategy supports, and the name ADDER includes, drug offence ‘diversion’. It is crucial that all police areas, including ADDER pilot areas, develop effective diversion schemes - not just post-arrest diversion, but also street level pre-arrest models that divert people to treatment services.

Coercion is, at best, a short-term solution for a few but for most will not result in long term positive outcomes and runs a high risk of alienating people driving them away from treatment.

●        Diversion models, such as those used by West Mids Police, involve a community resolution, and voluntary attendance for a treatment service assessment - with an 86% attendance rate - followed by tailored support. Multiple drug offence diversion models already exist in the UK, across over a dozen forces.These reduce reoffending, delivering better health outcomes, without arrest, or further burdening people with unnecessary criminal records. Transform has developed resources exploring how they work, and guidance and principles to help police forces develop their own schemes.[56]

●        We support exploring  a national diversion scheme, as proposed by the Centre for Justice Innovation, which allows agencies other than the police to divert people caught with drugs. Such a scheme could allow a wide range of agencies to manage drug use from a public health perspective without recourse to the police. For example, allowing hostels or local authorities to divert people to support services, rather than evicting them from their housing; or allowing youth clubs, schools, colleges and universities to deliver drug education programmes and treatment referrals instead of punishing or excluding young people.

●        Coercive drug testing on arrest is unethical and often, individuals with drug dependence issues are already known to police, but in any case there are more effective ways to identify who needs support without alienating them. For example, the West Mids PCC/Police voluntary approach delivers referral using ‘departure lounges’ in their custody suites, where people are engaged with, asked about drug use, and offered support prior to leaving.

Additional funding, but why only for some?
The expansion of funding for treatment and related services has been positive and necessary, but underlines how a national roll out must be accompanied by the resources to fund additional interventions properly. Without this it risks being little more than a rebadging exercise. While the primary focus on people with the most severe challenges can help some of the most vulnerable, and the communities they live in, to some it is seen as;  “Letting down those drug users who are not attracting police attention, but managing lives and jobs and getting along quietly. These people should also have this level of support and funding available to them if they need it.”

Clearer guidance is needed on:

a.   Multi-agency working

There is widespread support for taking a multi-agency approach built on partnership work as the most cost effective way to deliver the desired outcomes. While new resources have helped make these partnerships happen, political buy in and goodwill is essential. However, there is concern that partnerships may sometimes only be local, not regional or national. Illegal drug markets are not restricted to one local authority, nor are the movements of some people who use drugs, or those of many stakeholders, including police forces.

b.   Trauma informed training for police

Trauma informed policing is crucial to the delivery of ADDER and to engaging vulnerable people in treatment services more broadly. There are police who understand what this means in practice, and have the compassion and expertise to implement it. But it cannot be developed “by an afternoon of looking at some powerpoints.” Clear guidance on training around trauma informed policing needs to be established.

c.   Information sharing

There needs to be clarity and training on data protection issues, including what information is shared under which circumstances between partners, and what it will be used for, in line with data protection laws. Failure to do so could lead to mistrust if people believe their information is being shared with police forces without good reason. This deters people from engaging or feeling able to speak honestly about their situation.

d.   Local decision-making

To be responsive and tailored to local needs, local areas need control over what is included and delivered under ADDER. During the pilot phase of ADDER it is understandable that central government wanted to micromanage what was included and how it was delivered, requiring sign off for all proposals via their ADDER Board. However, such an approach is neither desirable nor sustainable as ADDER is rolled out further. The current approach stifles innovation due to risk aversion of central government, or an unwillingness to sign off interventions that do not fit with wider political agendas. Furthermore, having to pass every proposed intervention through central government risks creating a bottleneck.

e.   For the first phase, ADDER areas were given just two weeks to develop partnerships, and plan proposals in order to secure funding. Even if all staff in all partner agencies were available, this was an unacceptably short period to develop a new cost-effective multi-agency approach to spend large sums of public money. Giving more time would have allowed agencies to develop better proposals. The next tranches of money, for both ADDER and Enhanced Funding under the new drug strategy, areas still only had 4 weeks to develop plans and proposals, some to spend millions of pounds. A step change improvement in proposal quality could have come simply from allowing 8 weeks instead.

f.     Longer term funding streams required

Increasing the duration of funding both for ADDER and the wider drug strategy is crucial to improving outcomes. Government regularly only allocates funding for one year at a time, limiting what interventions can be invested in and allowing only temporary employment contracts. This is a significant barrier to appointing high quality staff who are in short supply. Given the wider economic situation in particular, staff with permanent posts are going to think twice about switching to jobs with one year contracts.

g.   It is unclear whether harm reduction will be adequately funded. There is also a lack of support for proven measures, widely used in other countries, with a solid evidence base including Overdose Prevention Centres (Supervised Drug Consumption Rooms) and safer smoking equipment provision - both of which the government opposes. Yet evidence and experience shows all these measures can help get people into treatment by providing an engagement tool particularly for the people current treatment offers are not appealing to.

h.   In her review, Dame Carol Black said the current treatment system was broken and ‘not fit for purpose’. One concern that is not confined to the ADDER programme, but to the wider way new resources are being allocated, is that funding new bolt-on initiatives, while welcome, does not address core issues identified by Dame Carol. For example, while funding for new outreach workers may be welcome, if the lack of capacity in already overburdened services they refer people to hasn’t been addressed, it will simply mean already excessive caseloads rise further.

November 2023