Overhaul approach to illicit drug treatment, concludes independent review

Author: Caroline White

The approach to illicit drug treatment needs to be completely overhauled, not only in terms of how much money is spent on it, but also how services are delivered, concludes the first phase* of an independent review.

The review was commissioned by then home secretary Sajid Javid in February 2019, to look at how the illicit drug trade is fuelling violence. The first part is an analysis of the issues; the second part will set out recommendations for action.

In the foreword to the first part of the review, Dame Black points out: “Treatment services have been curtailed by local government funding cuts. The total cost to society of illegal drugs is around £20 billion per year, but only £600 million is spent on treatment and prevention.

“So the amount of un-met need is growing, some treatment services are disappearing, and the treatment workforce is declining in number and quality.”

She continues: “Ultimately, we need to transform our approach to treatment, investing in it but also innovating, so that treatment services are able to respond to today’s drugs market and future developments.”

Referring to the number of drug deaths in 2018, the highest on record, and the cycling in and out of prison of long-term drug users who rarely get clean or find meaningful work, Dame Black said that drug problems blight the most deprived communities.

“I have seen first-hand, in prisons, schools, youth clubs and charities, the effects of increasing supply, greater drug purity and easier availability, combined with the loss of many protective factors – a perfect storm, to abate only if the government takes action,” she writes.

Around three million people took drugs in England and Wales last year, with around 300,000 in England taking opiates and/or crack cocaine.

The demand for opiates and crack/cocaine, and deaths from misuse of these substances, is closely associated with poverty and deprivation, says the report.

The review estimates that the health harms, costs of crime and wider impacts on society amount to more than £19 billion, more than twice the value of the market itself.

There is an ageing population of heroin users with severe health needs, some of whom are using crack cocaine too, but there is also a new population of younger crack cocaine users that don’t use heroin.

The use of new psychoactive substances among the general population has fallen, but has increased in vulnerable people, such as rough sleepers and prisoners, with government initiatives to restrict supply having limited success, says the report.

More than a third of people in prison are there because of crimes relating to drug use, it points out. Drugs within prisons are widely available, with around 15% of prisoners testing positive to random drug tests.

Local authorities, which are responsible for drug treatment services in the community, have cut their budgets by 40% in some cases, says the report.

“Spending on treatment has reduced significantly because local government budgets have been squeezed and central government funding and oversight has fallen away,” it states.

A prolonged shortage of funding has resulted in a loss of skills, expertise and capacity from third sector providers, says the report, adding: “Even if more funding became available for treatment (which is vital), there would be a lot of work to do to build up capacity and expertise in this market.”

As well as dedicated funding, the reintroduction of incentives and levers, and locally held joint responsibility and accountability, would go a long way to regenerate and vitalise the system, it suggests.

Commenting on the analysis, Councillor Ian Hudspeth, who chairs the Local Government Association’s Community Wellbeing Board, said that councils were committed to ensuring drug users get the right treatment and support, as part of their public health remit

“While latest estimates suggest there are about 200,000 people receiving help for substance misuse, it is essential that we reach out to the estimated 100,000 who are not,” she said. 

But she added: “We have long argued that reductions to councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy which will only compound acute pressures for criminal justice and NHS services further down the line. 

“This is why we are urgently calling for the public health grant to be published as soon as possible, as well as for the upcoming Budget and Spending Review to be used to secure sustainable long-term funding for public health.”

*Review of drugs: phase one report. Home Office, February 2020.