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European-wide free market. What is
the space that enables you to have
something that’s marketed but
exerts real pressure on the producers
not to maximise their market? We
try to do it with tobacco, with
alcohol but, particularly now with
social media, I don’t know how you’d
prevent viral marketing and so on.
How do you stop bigger and bigger
entities operating in the market and
trying to get the number of people
using their product up, when at the
moment it’s falling?
To come back to Clegg and his
“failure on an industrial scale”, you
only need to adopt a radical policy
like decriminalisation if you think the
thing’s not working. If you think it is
working then you need to look at the
harms that come from prohibition and address them directly, rather than running
the risk of doing more dramatic things.
We lock up only small numbers of people for cannabis possession – 500 a year,
according to official figures – and they only go for two or three weeks, but it does
seem crazy that we’re locking people up at all for simple possession. But if the
consequence of getting rid of that is cannabis being marketed, then when use goes
up, harmful use goes up, as night follows day. The debate is really about what are
the negative consequences of prohibition, and how we can minimise them. You
can keep things illegal and not lock people up. You can keep things illegal and stop
the police using it as an excuse to give a hard time to young black men. You can
stop a conviction for cannabis blighting someone’s employment opportunities by
changing the Rehabilitation of Offenders Act. You can actually address the harms
that flow from prohibition without legalising.
But as you soon as you begin to legalise I think you’re running a real risk of
slipping away from something that’s a very inefficient market – that doesn’t
maximise its clientele – towards a market that’s seeking fresh users all the time.
And it won’t be the Richard Bransons and the Russell Brands who’ll be using, it will
be people who are in and out of our prisons and our psychiatric hospitals, it will
the most vulnerable people who are most likely to succumb. I also fear the market
may escalate very quickly, like we’re seeing with gambling.’
As it’s the tenth anniversary issue of DDN, what do you think have been
the most significant changes in the sector over the last ten years?
‘In 2004 the treatment system’s expansion was well in train, but I think the biggest
thing has been the re-focus away from expansion and getting people in, to trying
to improve the offer for people when they are in, and trying to strike that delicate
balance between holding on to people for as long as you need to and working with
them in order to maximise their opportunities to recover. Improving practice to do
that is a really big ask.
Eventually we were successful in getting the clinicians to recognise that they
weren’t being ambitious enough on behalf of many of their patients. That’s now
accepted, and the stuff that John Strang led on was very helpful in that – finding a
clinically appropriate space where we can actually protect people and give them a
platform for them to recover. The big question for me, and this is something the
ACMD have been looking at, is that we need some benchmark for what good looks
like. How many people can you actually expect to recover? There are no really solid
international comparators.
If you talk to the Americans, for example, they say, “well, no one’s really got to
the stage you’re at in England” – a system where the vast majority of people who
need to be in treatment are in treatment, a system that can get people in quickly
and hold on to them – so nobody else knows. Without some sense of what good
looks like, we’ll always be vulnerable to being told that it’s not working.
As a slight corrective to that, what I’m not sure of is the extent to which we
focus too much on the drug and not enough on the person. There’s a group of
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Paul Hayes
November 2014 |
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people in society who’ve been dealt a not very good hand – they’ve been born into
families with difficulties, born into cities and regions with very poor employment
prospects, they’ve been let down by the education system, they’ve got mental
health problems. If they’re the majority – which the evidence suggests they are –
of the population addicted to heroin and crack, then maybe the issue we should be
looking at isn’t how many people we can cure, as such, but how do we actually
manage a population that will continue to struggle with life, only one of whose
problems is actually focused on their drug and alcohol use?
So it might actually be that the number of people you can expect to recover
isn’t a product of the drug they’re using, but of the society they’re living in and the
economic and social disadvantages that they suffer within that society.’
Which is a much bigger issue to try to tackle.
‘And for the current government, particularly, a much more challenging prospect
than to say drug use is a cause of poverty. If you think drug use is a cause of
poverty then you don’t have to think in terms of redistributing wealth, and for a
party of the right that’s a nice comfortable place to be. But if you believe that
poverty causes drug use, then that does suggest that you need to do something
about redistributing wealth and maintaining investment in public services.’
So finally, what do you think the sector might look like ten years
from now?
‘This might sound peculiar, but I think the optimistic scenario would be that the
sector is still dominated by a diminishing cohort of heroin users who haven’t yet
recovered, and they haven’t been topped up by new cohorts either of heroin users
or users of some substance as yet unknown that’s arriving from some lab in India
or China that wreaks new havoc. If we’ve got a diminishing number of heroin users
left over from the epidemic of the ’80s and ’90s and a system that’s flexible
enough to continue to provide services to that cohort and respond to the probably
smaller numbers of people succumbing to dependency on other drugs as they
emerge, and that frees up money to provide better services for alcohol users, that
would be the golden scenario.
I see not reason at all, structurally, why we shouldn’t be able to do that. But the big
proviso, of course, is money. If there’s not enough money retained in the system to do
that then we come back to competing priorities in the NHS and local government.
Which, at the risk of sounding like a stuck record, is why you need the broader
perspective. If you’re not thinking crime, worklessness, child protection – if you’re just
thinking narrow health – then you’re not going to want to make the investment.
But I was very disappointed and shocked to see the recent big increase in drug-
related deaths, and we need to watch that like a hawk. It might be a blip, it might
be something about the recording, it might be a consequence of the end of the
heroin drought, but we need to be looking at that. And if that’s followed by an
increase in use, when those numbers come out, then I think all bets are off.’
DDN
‘If you think drug use is a cause
of poverty then you don’t have to
think in terms of redistributing
wealth, and for a party of the right
that’s a nice comfortable place to
be. If you believe that poverty
causes drug use, that suggests
you need to do something.’