Thursday, July 14, 2016

Taking a New Line on Drugs

This report in the UK introduces common sense into the problem of drug abuse.  Best yet it includes all drugs and completely gives up the utterly failed prohibition approach.

I had posted as much several years ago but now the time has come to actually try this someplace somewhere.  It will be very welcome, but also not easy to  impliment although our experience in tobacco and alcohol is promising.  Harm reduction is an ongoing work in progress and we have actually seen much progress, often voluntary. 

Both are far less the problem they were only forty years ago, at least in Canada.  I expect the same to hold true for all such drugs and expect the market for the nastiest in particular to collapse.  There was always a significant social aspect to illegal sales and without that it is hard to see why new addicts would be recruited..


This report, ‘Taking a New Line on Drugs’, comes at a timely moment for drugs strategy both in the UK and across the world. The special session of the United Nations General Assembly on the world drug problem, which took place in New York in April 2016, represented a missed opportunity to move on from the ‘war on drugs’ and take a new approach, despite the pioneering policies focused on public health and harm reduction being pursued by a number of nations. In the UK, the Psychoactive Substances Act came into effect in May 2016, and we await a refreshed Government drugs strategy later in the year.

‘Taking a New Line on Drugs’ assesses the situation in the UK as regards rising health harm from
illegal drugs, with reference to their context within the wider ‘drugscape’ of legal drugs such as alcohol and tobacco, and sets out a new vision for a holistic public health-led approach to drugs policy at

a UK-wide level.

1. ‘Drugs’ are not just those substances that are currently illegal. They also include  socially-embedded legal substances, such as alcohol and tobacco, used by the majority of people in the UK. Drugs strategy must reflect this reality, and not create artificial and unhelpful divisions.

2. All drug use increases the risk of some form of related harm, be it to the individual, those around them, wider society, or all three. However, drug harm cannot be objectively measured on a single scale – it is multi-faceted, including physical, psychological and social harm, both to the user and to others. Every drug has a different harm profile across these categories, and so it is too simplistic to only say ‘drug A is more harmful than drug B’.

3. Illegal drug use in the UK rose through the 1960s to 1990s, but has fallen over the course of the past decade. However, this overall fall hides the increase in the use of Class A drugs – those deemed most harmful under the existing classification system – and the take up of new psychoactive substances, the rate of which remains uncertain. More importantly, drug harm is not declining in line with the fall in use, and there have been increases in many types of harm including the number of deaths. Levels of drug harm, not simply levels of drug use, should be taken into account when considering the success of drugs policy.

4. At both individual and population level, alcohol and tobacco cause far greater harm to health and wellbeing than many of their illegal counterparts. Tobacco kills the most people and alcohol is not far behind, with death rates from alcohol misuse on the rise. Alcohol and tobacco use alone costs society more than all Class A drugs combined, and our policy priorities should reflect this.

5. Only a quarter of the public believe the current UK drugs strategy is effective in protecting their health and wellbeing.

6. The current legal framework is confusing for the public, and does not correlate with evidence-based assessment of relative drug harm. This situation is likely to get worse with the recent introduction of the Psychoactive Substances Act.

7. Internationally, increasing numbers of countries, alongside the World Health Organisation, are recognising the failures of prohibition-centric drugs policies. Instead, they are moving towards a public health approach which focuses primarily on reducing the overall level of harm associated with drug use, rather than the level of drug use itself, accepting that a certain level of use will always remain inevitable among those who are unable or unwilling to stop. International pioneers such as the Netherlands, Canada and Portugal have seen encouraging results, with reduced levels of drug harm and without the increases in use feared from decriminalisation.

8. From a public health perspective, the purpose of a good drugs strategy should be to improve and protect the public’s health and wellbeing by preventing and reducing the harm linked to substance use, whilst also balancing any potential medicinal benefits.

RSPH is calling for the UK to consider exploring, trialling and testing such an approach, rather than one reliant on the criminal justice system. This could include:

a. Transferring lead responsibility for UK illegal drugs strategy to the Department of Health, and more closely aligning this with alcohol and tobacco strategies.

b. Preventing drug harm through universal Personal, Social, Health and Economic (PSHE) education in UK schools, with evidence-based drugs education as a mandatory, key component.

c. Creating evidence-based drug harm profiles to supplant the existing classification system in informing drug strategy, enforcement priorities, and public health messaging.

d. Decriminalising personal use and possession of all illegal drugs, and diverting those whose use is problematic into appropriate support and treatment services instead, recognising that criminalising users most often only opens up the risk of further harm to health and wellbeing. Dealers, suppliers and importers of illegal substances would still be actively pursued and prosecuted, while evidence relating to any potential benefits or harm from legal, regulated supply should be kept under review.

e. Tapping into the potential of the wider public health workforce to support individuals to reduce and recover from drug harm.

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