The scale of the illicit drug trade in the UK is immense. Last year, the first part of an independent review of the drugs trade found the market in the UK was estimated to be worth £9.4 billion a year – with the health, social and criminal damage from this industry costing society an estimated £19 billion annually.
The review was conducted by Dame Carol Black, a medical practitioner and researcher who was previously the government’s national director for health and work. Her first report revealed that around 3 million people used illicit drugs in England and Wales in 2020. These numbers are staggering, especially when considering that drug-related deaths have risen to record numbers in England and Wales for the past eight years.
The second part of the review, which has just been published, makes a number of recommendations for how the government can best tackle drug problems in the UK. Black makes a total of 32 recommendations, covering all aspects of drug policy, from preventing drug problems through to evaluating the effectiveness of treatments.
Some of the main recommendations include:
Setting up a “drugs unit” that would put leadership and accountability for drugs policy, prevention and treatment into one central government department.
Providing funding for “peer mentors” in job centres to encourage drug addicts access to employment support.
Creating a fund to research which measures work best at changing the behaviour of recreational drug users.
Providing money to local authorities for drug services to ensure resources are given to those who need them.
Given the scale of the drug trade in the UK and the number of people using illicit drugs, it’s obvious that investment and reform need to take place. But to ensure these changes do happen, one of the biggest recommendations Black makes is that we need to stop continuing to frame problem drug use as a criminal activity.
Instead, problem drug use needs to be approached in the same way as other chronic health problems, such as diabetes or cancer. Treating drug addiction like other health problems would mean patients would be provided with help from skilled health workers – such as nurses, social workers and psychiatrists – rather than workers and volunteers that are sometimes untrained.
But treatment for drug problems hasn’t been a priority for the UK government for years – with spending and budgets for services and treatments reduced severely. This hasn’t been helped by the fact that many still view drug addiction as a personal choice. But this isn’t necessarily true, as many different experiences – such as trauma – can lead to a person developing problems with drugs. This shows us that, in many cases, drug problems are intertwined with health and mental health problems.
Research shows that the stigma from framing drug use as a criminal issues – rather than a health issue – can put people off seeking treatment. In some cases, this delay can be fatal, as treatment is an effective way of reducing drug-related deaths. Timely treatment can also reduce the spread of infections such as HIV and hepatitis by providing sterile needles and syringes to those who are injecting drugs.
Viewing drug use as a criminal issue also means less funding is invested into research on viewing effective treatments for these problems. Traditionally, investment has gone into research investigating the link between drugs and crime. Investing in research that explores the health aspects of problem drug use could lead to positive outcomes, such as finding targeted interventions that can minimise harm.
Framing drug use as a criminal issue has also seen funding put into treatments that mainly seek to reduce criminal activity associated with drug dependency. As such, many treatment services have become unintentionally “opiate centric”, as they mainly provide support for those with problems due to heroin, which are associated with crime. This again has been driven by a policy and resource focus which seeks to reduce crime but doesn’t reflect the range of drug problems that people present with.
But with the use of other drugs increasing – including cocaine and cannabis – a growing number of people are presenting to services with problems other than heroin. By investing almost solely in providing support and treatment for those with opiate problems, people experiencing issues with other drugs may not receive the kind of help they need. Investing in research to develop evidence-based treatments for all drug problems is urgent.
Perhaps the most pressing need to move drug policy to health services is the record number of drug-related deaths. Improving the access to and quality of treatment not only helps keep more people in treatment, it also reduces the potential for relapse – ultimately reducing drug-related deaths. But so far, policymakers have ignored this advice on reducing avoidable deaths. Providing services to people outside of treatment – such as access to housing and employment – may also help people break the cycle of problem drug use.
It’s no coincidence that since cuts were imposed on treatment services a decade ago, drug-related deaths started to rise and reach a new record. If attitudes toward drug problems are changed, and greater investment put into developing more effective treatments that people struggling can access, more people may be able to recover successfully.
Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.