A new drug strategy for the UKBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3643 (Published 03 August 2017) Cite this as: BMJ 2017;358:j3643
All rapid responses
We agree with Winstock A, Eastwood N and Stevens A about there being no real prospect of reducing harm, by the Government recently published 2017 Drug Strategy . We express great concern at the lack of focus on harm reduction - an evidence-based response that protects people and ultimately saves lives - at a time when drug-related deaths are the highest on record.
• Heroin and morphine deaths rose by 109 percent in the England and Wales between 2012 and 2016 , when the evidence is overwhelming that harm reduction initiatives can reduce them. Initiatives such as opioid substitution treatment (OST) and needle and syringe programmes are only mentioned fleetingly within the Strategy, and others such as drug consumption rooms and heroin assisted therapy (HAT) are completely absent.
• It is appalling that the Government acknowledges in the strategy that the rise in drug-related deaths is ‘dramatic and tragic’, but proposes no concrete action plan to reduce them. For example, the strategy comments on the importance of naloxone to prevent overdose deaths but proposes no national systematic approach to naloxone provision, nor any new funding for this vital intervention. It is shocking that whilst drug-related deaths have outstripped both road traffic fatalities and deaths from blood borne viruses , there is no coordinated response from central government.
• This erosion of services continues against a backdrop of funding for all drug services being continuously reduced. Public health spending has reduced by more than 5% since 2013 , and according to analysis a further £22 million in cuts are to made for drug treatment by the end of 2017/18 . Without funding drug services will not be able to function effectively.
• The Government has dismissed decriminalisation of drug possession offences as being simplistic. Yet the World Health Organisation and a multitude of United Nations agencies have called for the end of criminal sanctions for possession and use of drugs in recognition that criminalisation creates barriers to those needing treatment and increases health harms.
People who use drugs are often vulnerable and marginalised. This new Drug Strategy simply does not begin to support them and reduce drug-related deaths. We call on the Government to implement the recommendations of the Advisory Council on the Misuse of Drugs to tackle opiate related deaths, these include: optimal OST prescribing; easier access to naloxone; a national HAT programme; and that drug consumption rooms are implemented where there is need . The Government must also ensure a minimum level of care by requiring local authorities to provide drug treatment and harm reduction services by law.
A new drug strategy for the UK BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3643 (Published 03 August 2017)
Cite this as: BMJ 2017;358:j3643
HM Government ‘2017 Drug Strategy- July2017’. Accessed 10th August 2017. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
Office for National Statistics (ONS), 2017. Accessed 10th August 2017. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
Department for Transport, ‘Annual Road Fatalities’. Accessed 10th August 2017. Available at: https://www.gov.uk/government/publications/annual-road-fatalities
Public Health England ‘HIV in the UK’, 2017. Accessed 10th August 2017. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
Public Health England ‘HIV in the UK’, 2017. Accessed 10th August 2017. Available at:
The King’s Fund, ‘Big cuts planned to public health budgets’. Accessed 10th August 2017. Available at: https://www.kingsfund.org.uk/press/press-releases/big-cuts-planned-publi...
The King’s Fund, ‘Chickens coming home to roost: local government public health budgets for 2017/18’. Accessed 10th August 2017. Available at: https://www.kingsfund.org.uk/blog/2017/07/local-government-public-health...
Advisory Council on the Misuse of Drugs (ACMD), ‘Reducing Opioid-Related Deaths in the UK’ (December 2016). Accessed 10th August 2017. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
Competing interests: No competing interests
The Drug Strategy 2017(1) adopts a directed approach to tackle the threats of new types of drug misuse. Those new threats include psychoactive substances, image and performance-enhancing drugs, ‘chemsex’ drugs and misuse of prescribed medicines. The Government’s novel approach brings the police, health and local partners together to support those high priority groups at risk of misusing drugs(2). At the same time, there is little or no provision for resources(3) to implement this kind of partnership, nor sufficient funding for harm reduction, drug education, and mental health to help those at risk with these new types of drug misuse.
Britain developed one of the harshest drug regimes in the world after the introduction of the Psychoactive Substances Act(4), yet it still hosts one of Europe’s largest illicit drug markets(5). Drug-related deaths in the UK are nearly three times higher than the European average(6). This contradiction lends considerable weight to the thesis that criminalisation and enforcement response do not resolve the problem of drug use. Criminalisation simply transforms market and consumer habits, further as David Nutt argues “limiting availability of a relatively low-harm drug can lead to greater harm from alternatives”(7).
More than ever, then, we must recognise that demand for illicit drugs is not going away, criminalisation does not work as it never worked in the past. Prohibition of drug use actually increases “exposure to violence and fosters stigma, discrimination, and social exclusion”(8, 9). We are also aware that criminalisation increases the health risks of drug use, particularly injection drug use(10).
The report from the Office for National Statistics on drug poisoning in England and Wales in 2016(11) states that the number of deaths from drug misuse reached record levels, higher than in any year since 1993. More than half the deaths were linked to an opiate. This data points to the problems and paradoxes of the British society. Consumption of psychoactive substances is likely to occur to enhance pleasure and fun. Opioid utilisation is likely a form of self-medication adopted by people who have undergone stressful lives or traumatic experiences.
The Government’s drug strategy is at best, based on a misdiagnosis of the root of the problem. The document focuses on vulnerable groups but ignores socio-economic causes that generate exposure to harm and misuse among those specific groups. Drug consumption needs to be contextualised in a social unit, but also in psychological frame to identify the reasons why some groups are more vulnerable and use drugs to deal with difficulties as society antagonises them(12).
What the plan misses is an alternative way of thinking and acting on drug-related issues. What is necessary is reconsidering existing responses to the problems associated with people's drug risk through understanding the cultural differences of these consumption behaviours(13). Closer consideration of the cultures and social contexts of vulnerable groups can improve future debate on drug education and reflection on the effectiveness of harm minimisation strategies.
Research is thus needed on how social, economic and health policies, or a lack thereof, create conditions that increase vulnerability, risk and harm. What is clear is that the human appeal for intoxication, both in the pursuit of pleasure or to reduce sufferance, remains a constant in any societies at the cost of individual health.
The approach of the new drug strategy helps, at best, mask the causes of risk and vulnerability of the target groups. It also suggests that if anyone or anything should be targeted, it is the lack of a proper drug policy, not the users most at risk.
2. Commons Library debate pack - Drugs Policy http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CDP-2017...
3. A new drug strategy for the UK. https://doi.org/10.1136/bmj.j3643
4. Psychoactive Substances Act 2016 http://www.legislation.gov.uk/ukpga/2016/2/contents/enacted
5. European Drug Report 2017: Trends and Developments. http://www.emcdda.europa.eu/publications/edr/trends-developments/2017_en
6. Deaths related to drug poisoning in England and Wales: 2016 registrations
7. Stories about ‘legal high’ deaths are bound up in media hysteria
8. Collateral damage and the criminalisation of drug use
9. Effect of drug law enforcement on drug market violence: A systematic review
10. HIV and risk environment for injecting drug users: the past, present, and future
11. Deaths related to drug poisoning in England and Wales https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
12. Sociopharmacology of drug use: initial thoughts
13. Party drugs and party people: examining the ‘normalization’ of recreational drug use in Melbourne, Australia
Competing interests: No competing interests