Intended for healthcare professionals

Rapid response to:


A new drug strategy for the UK

BMJ 2017; 358 doi: (Published 03 August 2017) Cite this as: BMJ 2017;358:j3643

Rapid Response:

RE: A new drug strategy for the UK

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
3. A new drug strategy for the UK.
4. Psychoactive Substances Act 2016
5. European Drug Report 2017: Trends and Developments.
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
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

08 August 2017
Marco Scalvini
Houghton St, London WC2A 2AE, UK