Uk drug policy failure

Pat Hudson never leaves her house without a syringe of Naloxone. She will not be needing it for herself, but she wants to be ready for any emergency on the street. Naloxone is injected into the muscle and blocks the effect of opioids: If somebody has taken an overdose of heroin, it can save their life. “It’s a bit late, of course,” she says: Hudson’s 32-year-old adopted son, Kevin Lane, died in 2017 after taking heroin.

Hudson, 72, and her husband, Tony Lane, 83, are both academics and live near the town of Carmarthen in the west of Wales in the United Kingdom. She is a professor emeritus of economic history and still teaches classes at Cardiff University. For a long time, she did not know much about heroin. It was only when Kevin was in his mid-20s that the drug started to play a big role in her life. She found Kevin in an orphanage in Liverpool in 1986. He was 16 months old and he was not doing well. “He repeatedly knocked his head against the wall and held up his arms to anybody because he wanted to be picked up,” says Hudson. The signs of neglect and abuse were obvious. But a few weeks after being adopted, Kevin began to smile. “He would probably look back and say he had a happy childhood.” As a teenager, he had many friends, he was lively and always up for mischief. But school was a struggle in Wales, where the family had moved. Kevin suffered from ADHD as well as dyslexia. “In the classroom, where everything had to be written down and read out aloud, he had trouble keeping up,” says Hudson. He became “unruly” – constantly being told off for lack of concentration and for challenging behaviour, and, finally, he was expelled at the age of 15. “The childhood trauma and the rejection by the school were key reasons why he began using drugs,” says his mother. First, it was cannabis, which he started using in his early teens. Smoking a joint calmed him down; Kevin found comfort and an escape from a society he did not feel he fully belonged to. From time to time, he was caught smoking it and ended up with a criminal record. There was a time when drug use in the UK was not considered a matter for the police and judges, but for the doctor. Until the late 1960s, the British authorities pursued a progressive drug policy that stood in stark contrast to the militarised, punitive approach across the Atlantic. The United States authorities had long considered drugs a moral vice, an evil that had to be eradicated with brute force. In the early 20th century they embarked on a moral crusade against drugs – starting with the Opium and Coca Leaves Trade Restriction Act in 1914, and intensifying ever since. Washington used its diplomatic weight to try to force the rest of the world to follow suit. But, at first, Britain declined. Heroin addiction in particular was treated with a decidedly liberal approach in the UK. It was called the British System: Addicts received their prescription from their general practitioner, then they went and got their dose from the pharmacy – Boots on London’s Oxford Street was one of the main suppliers. The users led mostly healthy lives, they did not need to resort to criminality, and their number remained vanishingly small: In 1964 there were only 328 heroin addicts known of in the UK, whereas in the US, it was hundreds of thousands. But, under constant pressure from Washington, the British system began to buckle. In the 1960s, successive laws were introduced to criminalise possession of various drugs, among them LSD and amphetamines, and the prescription of heroin for treatment was restricted. The decisive piece of legislation was the 1971 Misuse of Drugs Act, which created the offence of “intent to supply” and increased penalties for trafficking and supply. Kevin spent some time in young offender institutions in his teens and, finally, in an adult prison in Cardiff during his 20s. “He did time for relatively minor offences such as shoplifting, petty vandalism and, later, joy riding,” says Hudson. “He didn’t do it because he needed money for drugs, but because he craved excitement and distraction from his mental health problems. “He never did anything violent. Kevin was somebody who was struggling with life, and that sometimes expressed itself in antisocial behaviour.” But the authorities had neither the time nor the resources to see individuals in this way. “The criminalisation at an early age compounded the feeling of being rejected,” says Hudson. She believes Kevin began using heroin in prison. To begin with, he seemed to have his drug habit under control. He trained as a tree surgeon and got a job he enjoyed and was good at. But then a new contract came up to cut down trees along a power line. It was a dangerous task that required regular drug tests for the workers, so Kevin had to own up to his problem and lost the job. Soon after that, he decided to seek professional help at a drugs treatment centre. “We were so relieved,” says his mother. “We thought, ‘finally we’ve got the experts involved’.” But the availability of treatment centres was faltering. In the course of the Conservative government’s austerity programme following the global financial crisis of 2008-2009, there was less and less money for drug treatment services. “The 2010 Drug Strategy led to a removal of what was referred to as the ‘ring fence’ – which protected public money for drug treatment,” says David Best, professor of Criminology at the University of Derby, who has done a lot of work on drug policy. “As local authority budgets have been cut, this has had a huge effect on drug treatment, particularly on residential treatment.” In addition, the authorities increasingly opted for an abstinence model of treatment. Under this approach, drug users are encouraged to wean themselves off their habit. But this has its dangers, says Best: “People newly detoxed – or just out of prison – are at the highest risk of overdose mortality, and the risk of relapse in the first year, post-detox, is 50 to 70 percent.” The government’s own Advisory Council on the Misuse of Drugs highlighted this danger in a report in 2016: “Many people who become abstinent will not sustain [their abstinence] but will relapse to opioid use. This is a known risk for overdose and death, as users lose tolerance to opioids during periods of abstinence,” the authors write.

‘We allow these dangerous substances to be controlled by criminals. It’s absurd’

Indeed, Kevin had taken a relatively small amount of heroin when he suffered a heart attack on December 12, 2017, at 9:30 in the morning. He had locked himself in the toilet of the department store, Marks and Spencer, in the town centre of Carmarthen. For a long time, nobody noticed him. “By the time the staff had broken down the door and got to him, he had been without oxygen for too long, possibly as long as 50 minutes,” says Hudson. When he arrived at the hospital, he was already in a coma. The machine that kept him alive was turned off the next day. Kevin was one of 3,756 people in England and Wales who died from the effects of drugs in 2017. For many years, this death toll has been steadily increasing. The most recent figures are for 2019 when 4,393 drug-related deaths were recorded – a new record. Scotland, where 1,264 deaths were recorded in 2019, has the highest per-capita death rate in Europe. Apart from Sweden, there is no country in Europe where so many people die as a consequence of drug use. Why so many? Kevin’s mother sighs. There were many moments when his life could have taken a different turn. If he had not been abused as a toddler. If his school had known how to support children to learn practical, rather than academic, skills. If the treatment centres had had more resources for mental health support. But, for Hudson, there is one decisive fact: Kevin was doing something illegal. “If possession and consumption of cannabis or heroine hadn’t been banned, he wouldn’t have had a criminal record. And he wouldn’t have had to lock himself in a toilet, where nobody noticed him. There are so many cases of heroin users dying behind closed doors. A combination of drug prohibition and the stigma that accompanies it is killing our young people.” Since her son’s death, Hudson has done a lot of research into the UK’s drug policy. She has joined the campaigns, Transform Drug Policy Foundation and Anyone’s Child, which try to achieve liberalisation of the UK approach. Hudson supports decriminalisation of possession of all drugs for personal use, and the establishment of Drug Consumption Rooms (DCRs). In these facilities, users can consume in a safe, controlled and clean environment. “In this way, the authorities can ensure that safe doses are injected, that the quality is good, and that young people are given advice and help if their drug use has become problematic,” says Hudson. She also advocates the legal regulation of the supply of drugs through prescriptions, licensed premises where users can consume drugs safely and pharmacies that are licensed to distribute them, so that people know exactly what they are taking. “Instead, we allow these dangerous substances to be controlled by criminals. It’s absurd.”

‘The police never interrupt the supply of drugs. Never’

Years ago, Neil Woods was fighting the UK’s war on drugs on the front line. One of the most active undercover cops in the drug squad, he landed hundreds of drug dealers and gangsters in prison. He started in the early 1990s when Britain’s youth were dancing from one rave to the next, popping pills en masse. Following 20 years of criminalisation, selling drugs had become the most lucrative source of income for organised crime and the gangs resorted to increasingly violent methods to keep the money flowing. Woods used to hang out with drug users in parks and on street corners, making friends and getting to know the dealers. Step by step, over weeks and months, he tried to get in touch with the higher-up people in the gangs: The criminals organising the drug supply. It was a dangerous job. One time, a dealer held a Samurai sword to his throat and threatened to kill him if he turned out to be a police officer. Another time a gang member chased him in his car. Time and time again, he managed to put entire organised crime groups behind bars. For example, the Burger Bar Boys, based in Birmingham, who controlled a large part of the drugs and weapons trade in the West Midlands – and whose quaint name stands in sharp contrast to the brutality of their methods. The gang prompted national headlines in 2003, when it attempted a “retaliation” against a rival gang in Birmingham, opening fire with a sub-machine gun on partygoers. Two innocent teenagers were killed. Woods spent more than half a year collecting evidence against the leading members in Northampton, one of the towns into which the gang had expanded. When the bust came in 2004, 96 people were arrested. Six people involved with the heroin and crack cocaine trade in this town went to court in 2005 and, in the end, three of them went to prison for nine years, while the other three got 10 years. But, Woods believes it was all for nothing. “I spent seven months on this operation,” Woods says via Zoom from his home in Hereford, England. He retired from the police in 2007. “I lived in constant fear; more than once I nearly got myself killed. Huge resources were put into the operation, and six of the leading gang members were arrested. But then, a week later, the leading intelligence officer called me and said: ‘Great, we’ve interrupted the drug supply in Northampton for two whole hours.’ Two hours.” That is how long it took for other criminal organisations to step into the gap and take control of the drugs market in Northampton. This was no exception: It is how the system works, says Woods. “All the police do is to eliminate the rivals of other gangs. They never manage to interrupt the drug supply – never. Because there are always people eager to take the opportunity and make massive amounts of money.” When he started as an undercover policeman, Woods believed he was doing good. Criminals were arrested, drugs confiscated. But the longer he was on the job, the more he realised his dangerous work did not achieve anything at all. “The war on drugs is deeply dishonest. In the papers, we see pictures of drug busts – arrested dealers, piles of seized drugs. And we have learned to see this as a success. But it’s a complete illusion.” The only thing the police ever achieve is to make drug criminality even more brutal. “Police never reduce the size of the market, but they do change the shape of it,” says Woods. “And that change only moves in one direction: Towards more violence. Organised crime adapts all the time – gangsters become harder and more ruthless because most ruthless are the ones that rise to the top. That’s why we now have children being exploited as drug runners. This is a reaction to the success of the police.” The victims of the war on drugs are everywhere. The addicts who waste their money and their health; the small-time dealers from poor backgrounds who are lured with the prospect of quick money; bereaved parents like Pat Hudson – and policemen like Woods. He suffers from Post-Traumatic Stress Disorder (PTSD), combined with a condition known as “moral injury”: “I have a deep sense of guilt because of the suffering that I have caused,” says Woods. In his undercover years, he says, he made friends with users selling drugs on the side to finance their drug habit: People in desperate situations, who nonetheless ended up being arrested. “I have made friends for the sole purpose of manipulating people. I used my talents to get to know people and emotionally manipulate them. I have caused harm to some of the most vulnerable members of our society, to no benefit at all. I never made society safer, and I never reduced crime. And once you understand that, it’s hard to live with.”

The Liverpool model – it worked, and was promptly shut down

Like Hudson, Woods sees a change in the law as the only way out of this mess. He is a member of the Law Enforcement Action Partnership (LEAP), a campaign made up of current and former members of the police as well as figures from the army and the intelligence services. Their aim is to reform drug policy in order to take control away from organised crime. “We want to legalise and regulate every single drug. Each drug is different and has different regulatory requirements. Heroin is the most dangerous one and causes the most deaths – but it’s the easiest to regulate by far. We simply go back to the British System,” says Woods. Back in the 1980s, there were still remnants of this system in the UK. In Merseyside, where the economic policies of the Thatcher years had a devastating effect, the heroin crisis was deeper than in most parts of the country. In Warrington, the psychiatrist, John Marks, legally prescribed heroin. His success was stark. His patients did not have to get their supply on the black market – where drugs are often of dubious quality – but received clean heroin under hygienic conditions. They often had jobs and families. Also, in the area around Marks’s clinic, the crime rate was lower – and over the years the number of heroin addicts actually fell. The Liverpool model found imitators around the world, for example in Switzerland. Inspired by the British doctor’s approach, Zurich opened its first Heroin Assisted Treatment clinic in 1994. “The Swiss authorities took Marks’s work as an inspiration,” says Woods. “They studied British evidence and started prescribing heroin. But the British authorities themselves ignored the work of Marks.” Funding was withdrawn, and in 1995, his treatment centre was shut. For Woods, there is no doubt the high number of drug deaths in the UK is a direct consequence of prohibition. “It sounds a bit too simple, but it’s true: The tougher the laws in terms of criminalising drug consumption, the more people die,” he says. “Just look at the countries that have a more liberal drug policy: Portugal or Switzerland.” In Switzerland, the number of drug deaths each year has halved since the mid-1990s. In the UK, by contrast, the number of drug deaths has doubled in that time, even though the total number of users has remained largely stable. Academics and health experts have long considered the punitive approach a failure. The present drug death crisis is exacerbated by a number of other factors, says Laura Garius, Policy Lead at the drug reform charity, Release. “Many of the people who started using heroin in the 1980s and 1990s are, by now, experiencing significant health issues, compounded by the health inequalities endured by this marginalised group, caused by its lower socioeconomic status. There is also a lack of investment in harm reduction and treatment, including a lack of accessible opioid substitution therapy, which would inevitably save lives.” Over the past 10 years, government funding for drug treatment has shrunk dramatically. Of the 195 residential rehabilitation centres registered with the Care Quality Commission (a watchdog) in England in 2013, more than 50 had shut down by 2019. Funding cuts have been “felt both in terms of pressure to reduce the length of stay [in treatment centres] but also a lack of funding to allow people to access residential services through social services budgets – so fewer people got less treatment”, says criminologist David Best. The alarming rise in drug deaths has led to calls for a fundamentally new approach. In 2019, the cross-party House of Commons Scottish Affairs Committee, which had investigated the worsening drug problem in Scotland, recommended a radical change in drug policy: Concluding that, “the criminal justice approach to people with problem drug use has failed”, its report advocated the decriminalisation of drugs for personal use as well as the provision of consumption rooms. The UK government rejected its recommendations. Nevertheless, Hudson and Woods are by no means disheartened. In the past few years, they have seen attitudes in the country change. “We have supporters in all big parties, from the Tories to the Scottish National Party,” says Woods. Last year, he spoke at both the Labour and the Conservative Party annual conference. “A few years back, that would have been unthinkable. Drug policy reform has firmly arrived in the mainstream.” This can also be seen in concrete new initiatives. In Middlesbrough, a Heroin Assisted Treatment clinic opened its doors in 2019 – the first such scheme in decades. It is licensed by the Home Office, which has the power to do this under current legislation and is partly funded by the local Police authority. One year after the programme started, participants said they were much healthier and had a higher quality of life. According to the clinic, there was also a significant reduction in their reoffending rates.

‘These people are really broken’

The contrast to other cities is stark, however. Take Glasgow, for example. The Scottish metropolis has been hit particularly hard by the ongoing drugs crisis. In 2019 alone, more than 400 drug-related deaths were recorded there – making up nearly one-third of all Scotland’s drug casualties. Since many needles are handed from one user to the next, one-tenth of users are HIV positive – as many as back in the 1980s at the height of the AIDS crisis. Until last year, Peter Krykant worked for a charity that provides fast HIV tests for homeless drug users. He saw the crisis getting worse and worse, and he was shocked to see how little had changed since he himself was an addict living on the streets of Glasgow in the late 1990s. “People are injecting in exactly the same places as I did 20 years ago,” says Krykant, 44, via a Zoom call from his home in Falkirk. He decided to do something to help – something which is technically illegal. Through crowdfunding and with money from his own pocket, he bought a small van last summer. He went about turning it into a mobile Drug Consumption Room (DCR), equipping it with clean seats, fresh needles and disinfectant. “We are a low-tech service,” says Krykant. “We don’t have a doctor or a dentist which a proper DCR would have. All we offer is clean material and a sterile room so that people can consume the drugs that they bring themselves. Because otherwise, they would do it in alleyways or empty buildings.” On August 31 last year, he opened his mobile consumption room, and since then he has been setting up every Friday morning in the centre of Glasgow. The demand for his service has been overwhelming. “Some of these people are really broken,” he says. “Most suffer from childhood trauma; they were abused physically, sexually or mentally. Many live on the street or in temporary accommodation.” There is one customer who is confined to a wheelchair because of his drug habit and could not even get into the van. Initially, his chair only had three wheels, so Krykant raised money to buy him a new one. Another regular customer is a 23-year-old woman whose arms are marked by signs of self-harm – “some of the deepest scars I’ve seen”, says Krykant. She injects heroin into her groin and lives in a tent. Up until the week before, she always came accompanied by a friend, an alcoholic. Krykant gave him a syringe with Naxolone and showed him how to use it if his friend should take an overdose. “That gave her a bit of security. But last week she came alone. I’m very worried about that.” The drug epidemic became particularly bad after the Scottish government cut the annual budget for alcohol and drug treatment services in 2016 by about 15 million pounds ($21m), a reduction of more than 20 percent. “Two years later we saw the effects of these cuts,” says Krykant. “Our treatment centres are underfunded and understaffed. Sometimes users are only offered one half-hour session every week or even every two weeks.” It is far too little to have a lasting effect, he says. A 2019 report by the UK government’s Advisory Council on the Misuse of Drugs highlights the particular dangers for homeless drug users: “Homeless people, particularly rough sleepers, are often poor at attending drug services and need flexible approaches such as assertive outreach,” the Council wrote. “Services already struggling to cope with demand from housed clients may not have the resources to extent ‘special’ services to homeless people.” Krykant knows there is only so much he can do to help the estimated 500 drug addicts – most of them crack or heroin users – in central Glasgow. He sees his project as a way to raise awareness and push for political change. “We’re making a public statement. We say to the governments in Edinburgh and London: We don’t care that you’re not officially allowing this – we’re doing it anyway.” The aim, eventually, is to have an officially licensed facility. Last year, Krykant faced a charge under the Misuse of Drugs Act because he was allegedly obstructing police trying to search drug users within his van. But in January 2021, the Crown Office – Scotland’s prosecution service – informed him he would not be charged. While Krykant welcomed the decision, he wants the authorities to go further and give the police clear instruction not to intervene in the running of his service. The response Krykant has received for his efforts is huge. Dozens of interviews with Scottish, English and international press have propelled him into the spotlight. Politicians have started paying attention. Across the political spectrum, people have pledged their support and, in January, he even met Nicola Sturgeon, the first minister of Scotland. Krykant is an inspiration for drug reformers across the whole country, among them Hudson in Wales. “If it weren’t for the pandemic, I’d be setting up a mobile consumption room following Peter’s example,” she says. “The legal system is unlikely to arrest somebody like me for trying to save lives.”