Pubdate: Thu, 07 Feb 2008
Source: Economist, The (UK)
Copyright: 2008 The Economist Newspaper Limited
Bookmark: (Cannabis - United Kingdom)
Bookmark: (Harm Reduction)
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Treatment)
Bookmark: (Supervised Injection Sites)


Hard to Swallow

It Is Difficult to Trust the Policies of a Government That Keeps Its 
Evidence Secret

LOVED ones of addicts often make the same complaint: the worst thing 
is the deception. By hiding their habit from the world, sufferers 
hurt their families; more to the point, secrecy sets back their 
chances of seeking treatment and recovering.

So it is with drugs policy. In July the Home Office released a 
suspiciously cheery analysis of its work, as part of the preparations 
for a big overhaul of its long-term drugs strategy that is due to be 
unveiled this month. The evidence was so glowing that the Statistics 
Commission, an official watchdog, complained that it read "more like 
a briefing document" than a balanced presentation. There were more 
hints of manipulation this week when the home secretary, Jacqui 
Smith, had to write to her drugs-advisory council to reassure its 
members that she would not ignore their views on cannabis, against 
which she seems determined to stiffen sanctions.

Now, new evidence has emerged of the gulf between the government's 
public pronouncements on drugs and its private findings. An internal 
report by the Treasury, seen by The Economist, gives a plain-spoken 
account of how the drugs strategy was working in 2001. Parts of the 
document, recently obtained by Transform, a drugs-policy think-tank, 
are encouraging, and some of its criticisms may have been met since 
then. But some still stick--and the government's reluctance to make 
it public sooner raises questions about its willingness to deal 
fairly with the facts now.

The report is kindest about treatment for drug-users, which gets five 
stars (the top mark) for effectiveness; three stars go to education 
programmes and the referral of arrested addicts. But on law 
enforcement, the most expensive plank of the anti-drugs strategy, 
things fall apart. Police-intelligence work scores two out of five, 
as does that of customs officers. At street level it gets worse: 
cracking down on drug-dealing and drug-related crime rates only one 
star, whereas action on "soft" drugs such as cannabis scores none at all.

The Home Office now says that it has upped its game, revamping the 
national serious-crime squad and referring more offenders for 
treatment. But it is still spouting some arguments that the 2001 
report privately debunked. On intercepted imports, for example, the 
Treasury noted that although seizures had increased, the ever-falling 
price of drugs in Britain suggested that "in large measure rising 
totals [of seized drugs] reflect rising volumes of drug imports." 
Despite this, the analysis the government gave the public last year 
presented increasing drug seizures as evidence of diminishing availability.

Much of the 35-page Treasury report criticised the lack of rigorous 
analysis as to what worked. Evaluations were "process rather than 
output focused". On the issue of tackling the supply of drugs, it 
found "little evidence on the cost effectiveness of 
[criminal-justice] activities", and "that little we have does not 
offer strong support."

This might have been of interest to the voters whose money was being 
spent on such untested schemes. Steve Rolles of Transform says the 
Home Office is still sitting on two reports from last year that it 
deems too sensitive for release.

Yet evidence has seldom been more in demand. Though the government is 
unlikely to shift its stance on prohibiting most drugs whatever the 
evidence, its policy on treatment for drug-users, so far a relative 
strength, may be up for change.

At a drop-in centre in Hounslow, an unglamorous suburb in west 
London, clients (as the addicts are respectfully known) are relaxing 
with candle-lit acupuncture. Downstairs they can pick up syringes (in 
different colours, to avoid accidental sharing) and other 
paraphernalia to smoke or shoot up more safely. A centre over the 
road prescribes and dispenses methadone, an oral substitute for heroin addicts.

"Harm-reduction" facilities such as these have become more common 
under Labour, which has more than doubled since 1998 the number of 
drug-takers who go to them. Partly because of this, British heroin 
addicts are less likely to be HIV-positive than those in many 
countries. Yet there are hints that such thinking is falling out of 
favour. After it emerged last year that as few as 3% of those in 
treatment actually shake their habit, the Conservatives vowed "to 
solve addiction, not manage it" through residential courses where 
addicts get off drugs altogether. (As such courses cost roughly ten 
times more than a year of methadone, however, it is unlikely that 
most would have access to them.) Mike Ashton of DrugScope, a charity, 
cautions that the relative success of residential programmes may be 
due to the fact that only the best candidates are chosen for them.

A different strategy is to go farther down the harm-reduction route. 
One service that the clients in Hounslow are denied is a safe place 
in which to take their drugs; the lavatories even have locks on them 
to prevent illicit use. Providing "shooting galleries" where 
drug-users can inject themselves has been tried in some countries, to 
mixed reviews so far. And prescribing heroin rather than methadone 
might attract more drug-takers to safe surroundings, though it is 
dearer to procure and supervise since it tends to be injected.

It is hard to make such choices because, despite the Treasury's 
warnings seven years ago, much evidence is still limited to processes 
rather than results. That is, as far as we know: after all, the Home 
Office is still sitting on some of it. Perhaps the government should 
come clean. As the Hounslow clients are told daily, denial is not a 
healthy option. 
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MAP posted-by: Richard Lake