CAROLYN Leckie makes some very valid points in a typically insightful and compassionate article (Drug abuse is a national tragedy we should all be ashamed of, The National, February 26). She is correct in arguing that making significant changes to national drug policy is seriously undermined by the lack of control of the drug laws.

The central piece of legislation is the Misuse of Drugs Act (MDA) 1971, a law which has been effectively unreviewed for more than 45 years. I can think of no other law on the statute book that has not been overhauled within a similar period. Added to that, the MDA was itself a hastily cobbled together compendium of a number of earlier drug laws, including the Dangerous Drugs Act 1926!

Clearly there is a strong argument for a root-and-branch review of the legislation, but for the past four decades politicians have shied away from it for fear of receiving the white feather in the war against drugs.

The law has a number of fundamental problems which would merit review. It assumes that you are either a drug user or a drug dealer when, in real life, the boundary between the two is far more blurred. It lays down what are quite frankly draconian penalties for drug possession. In most courts now you are unlikely to receive a custodial sentence for possession, but there is a postcode lottery in terms of the severity of sentence. Making drug possession a non-imprisonable offence would probably have little practical impact on prison numbers, but would send out a hugely significant message to drug users.

Where I think Carolyn’s analysis is somewhat limited is in her offered solution. As far as I can see, the only suggestion she makes is to offer heroin (and injection facilities – but that is a quite different issue). Well, this might be part of the solution (though it wasn’t that successful in the 1970s when it was the treatment of choice), but it’s a long way from being the whole story.

Back in the 1970s, a senior official at the then UK Department of Health remarked that: “The trouble with drug treatment – and with drug policy – is that we have a tendency to rush from one great idea to the next like a herd of Gadarene swine”. Not many in the audience appreciated being compared to pigs, but she had a point. We are obsessed with the notion of a silver bullet for addiction. So in the past 50 years we have gone from a recovery-oriented treatment response to a harm-reduction/minimisation response and latterly back to a recovery-oriented response (although, in many cases, this seems to have been little more than a re-badging exercise).

The apparent demise of harm reduction probably lay in our failure to recognise that the term included two distinct elements – reducing the harm drug users might do to themselves and reducing the harm they might do to the wider community – and the fact that these might conflict with each other.

Many have argued for legalisation of drugs. Certainly this was a possibility explored in Kevin Williamson’s book to which Carolyn refers. This too may have unforeseen consequences. A licit market in drugs would inevitably find itself in competition with the black market, which would be unlikely to simply fade away. We have an example from history of what that might mean. Until 1965, most heroin addicts (of which I was one) were able to source supplies through general practitioners. At that point the UK Government indicated that it would accept the recommendation of an interdepartmental committee to remove this right from general practitioners and vest it in a small number of licensed psychiatrists. From 1965 to 1968/9, when the government finally acted on this recommendation, many general practitioners pre-empted the change and stopped prescribing. The addicts affected quickly found a hitherto virtually unknown black market in heroin. Those who continued to receive prescriptions from their general practitioners quickly worked out that they could sell their prescriptions to “new recruits” and “weekenders” and buy far more black-market heroin. The result, inevitably, was a dramatic rise in the number of new heroin addicts and an equally dramatic increase in consumption by existing addicts. So we should, as they say, be very, very careful what we wish for!

For most of the past 100 years, the solution has been generally seen to be a health-based one and the medical profession has been the loudest voice in the room. As a result, medical replacement treatments have been the major response. The vast majority of drug users entering drug treatment will receive a long-term prescription for methadone. If we now add heroin to the mix for some of those users, I am not convinced that this will result in a seismic shift in the drug subculture. And of course, when one type of drug treatment is dominant, other treatments are inevitably squeezed. This may not be intentional but it is inevitable; like how the large out-of-town supermarkets don’t deliberately set out to close down your village store but they do it anyway, just by being there.

Endless government reports have trotted out the mantra of a wide range of responses to the drug problem, but there seems little evidence of that happening on the ground. Try going to your local drugs team and asking to be referred to residential rehabilitation and see how many hoops you have to jump through just to have your request considered!

So yes, we need to have control of the drug laws to ensure that they can support the kind of drug treatment, prevention and enforcement responses we think are required. But we also need to step away from the insistence on binary choices.

The correct response is not a choice between health and law enforcement, or between abstinence and harm reduction, or between legal and illegal, but a carefully planned strategy that recognises the role of the law in reducing supply and the role of medicine in treating addiction but also sees addiction and drug misuse as a social disorder which will require a range of responses from multiple actors. These include housing providers, employers, self-help and mutual aid groups, leisure activity providers and equal access to a range of treatment providers according to severity and need.

Rowdy Yates
President, European Federation of Therapeutic Communities