Roger Howard: Reefer madness

Our punishment-obsessed approach to addiction is the real drugs problem, writes Roger Howard

No one would deny that the UK has a serious drugs problem: we have, perhaps, the most serious problem in the EU, with nearly 40 per cent of all European drug-related deaths and more than 250,000 problematic drug users. That drugs policy needs a serious rethink is obvious. The real issue is what needs to be done, and is legalisation the answer?

In the past week we have seen a series of proposals on how to solve the problem of hard drugs. There have been government measures to retain police powers to arrest cannabis users; doctors at the BMA conference demanding that drugs be legalised; psychiatrists warning that "pot" may make us mad; and the Tories proclaiming tolerance and treatment for young addicts

But if we are going to have a rational debate, we need to examine what's happening with drugs policy at the moment. That means looking at treatment. There are only about 50,000 problematic drug users getting treatment of one kind or another each year - by anyone's calculations a serious shortfall from the 250,000 that need help. Waiting lists are normal: in December 2001 the average maximum waiting times were 14 weeks for specialist prescribing, about nine weeks for residential rehabilitation, and more than seven weeks for counselling.

Despite the evidence that treatment works, Britain's drugs strategy seems preoccupied with crime and punitive approaches. Yet studies show that for every £1 spent on drug treatment, the taxpayer saves £3. And much of that is because this is the way to ensure less crime.

But there is a more complex story behind these figures. Although there is a clear association between illicit drug use and crime, a totally causal relationship has never been established. Surveys of offenders' health show that they are much more likely to smoke nicotine than the general population does, but no one would seriously argue that smoking causes crime, or that crime causes smoking. Rather, smoking and crime are likely to share some common causal roots, without themselves being causally related. The same is likely to be true of some links between drug use and crime. For example, economic deprivation, social exclusion, low educational attainment and limited employment prospects are risk factors not only for chaotic or dependent drug use, but also for heavy involvement in crime.

For a very small proportion of dependent drug users, it is likely that crime will be a source of money. Even this small group who do steal to buy drugs tend to be involved in crime before they developed problem drug use. The idea that drugs cause crime is therefore over-simplistic and can distort policy. It may also mean that, even if drug dependency is successfully addressed, there may be no drop in crime. Effective drug prevention may have nothing to do with policy. It is about improving youth opportunities, education, training and jobs as well as family dynamics and environmental considerations.

There are other serious drawbacks with a crime-driven approach. The main one is practical and simple: drug use is, in general, not a crime - only possession, supply and trafficking are. In practice most drug users (ie recreational users) will probably go through their lives without committing any crime other than simple drug possession. So a strategy based simply on a crime-led approach, rather than a public-health one, will miss huge swathes of the population.

What we are left with in terms of current policy is the criminal justice system picking up the pieces for past failures with our health system: the failure to foresee the need for more treatment provision and the need to bring down the disgracefully high corresponding rates of infectious diseases such as hepatitis C and reduce the numbers of drug-related deaths.

Why, therefore, is drug policy in the UK so preoccupied with the cost of crime, and is it right that the huge welter of crime enforcement and justice measures (customs, police, courts, prison, probation) expends vast amounts of money to keep up with the few addicts?

Drug dependency is an internationally recognised medical condition, and is seen as such by the World Health Organisation. In other EU countries we see different approaches to the problem. In Switzerland there are much higher rates of heroin prescription for addicts than in the UK; Portugal has diverted much of its efforts into getting addicts away from the criminal justice system and into treatment; Germany and Spain have provision for safe-injecting rooms to reduce the harm that injecting drug users can do to themselves and others; and the Netherlands follows one of the most developed harm-reduction policies in the world, backed by a much more marginal criminal justice emphasis.

The result? The Netherlands for one has some of the lowest drug-death rates per head in the EU and lower rates of hepatitis C infection among injecting drug users. Not only is problem drug use, especially heroin use, relatively low, but so are the health and social costs. In fact, a recent EU report analysing public spending found that, on average, our European partners are spending a third more on drug-related health services per problem drug user than the UK does.

What then, is the way forward here? Is it, as some were suggesting last week, the total legalisation, and therefore governmental control, of all drugs? Is legalisation really a serious option?

It has taken more than 30 years for a home secretary to have the courage to make the most minor, sensible amendment to the drug laws, with the proposed reclassification of cannabis, something that the Advisory Council on the Misuse of Drugs first recommended nearly 25 years ago. It will probably have no impact whatsoever on crime, as most cannabis users are recreational, but it should in theory reduce the numbers arrested, as long as the police stop arresting people simply for cannabis possession. But will the police then go on the hunt for cannabis growers, for which sentences have been drastically increased? In this case it has been a case of one step forward, two steps back.

Let's be completely honest. Legalisation of drugs is simply not something that is going to happen in the foreseeable future. It is untried and untested waters with potential ramifications that would be very difficult to correct. In the meantime, while time and effort is diverted into this theoretical debate, more than 200,000 drug dependent users are facing the future without access to the proven treatment they need.

Instead of arguing the pros and cons of legalisation, let's pay attention to what works and increase the scale and quality of treatment provision. We must move away from looking at drug treatment through the lens of crime reduction and punishment. Let's be bold and start seeing treatment and reintegration as a sound health investment in its own right. This is not merely a question of increased funding, however. More money for treatment must be underpinned by more resources for training the people who will work in the services.

Drug dependency is a chronic relapsing condition. Just as tackling the underlying causes of drug dependency makes us look at family, education and environment, so, too, treatment will only be successful in the longer term with training, jobs and housing so that people can rebuild their lives.

We are already witnessing a shift from a punishment-based approach towards one that is more reliant on treatment. This can be seen in the way the Government is introducing drug treatment and testing orders which offer alternatives to custodial sentences, under which users have to agree to follow a drug treatment programme. But we need to go much, much further. It is about time we shifted the drugs debate away from a preoccupation with crime to a new concern for health and individual and community well-being.

Drugs will not be banished or go away. Learning to live with them and reducing their harm must dominate our thinking - not how to punish those who use or fall foul of them.

Roger Howard is chief executive of the charity DrugScope and a member of the Advisory Council on the Misuse of Drugs