Third Report - Drugs
- HC No.
- HC 198
- Published
- 31 Aug 2023
- Items
- 71
- Response
- Response document linked: First Special Report - Drugs: Government Res… Read government response ↗
Select Committee · Home Affairs Committee
Drugs
Status: Closed
Opened: 10 Feb 2022
Closed: 1 Feb 2024
38 recommendations
33 conclusions
1 report
Inquiry scope
The focus of the inquiry is on illegal drug use and its effects on society and the economy. The inquiry considers the UK’s legislative framework on drugs and UK drug policy. The framework refers to, for example: the Misuse of Drugs Act 1971; the Psychoactive Substances Act 2016; and, where relevant, any subordinate legislation made under these Acts. In particular, the inquiry considers the Misuse of Drugs Act 1971 and its efficacy today. It assesses what impact the Psychoactive Substances Act 2016 has had since it came into force. The inquiry also looks at the impact of drug use in the UK, and at approaches to drugs adopted elsewhere. Read the terms of reference to find out more about this inquiry . Warning - some of the written evidence published as part of this inquiry may contain material that some readers may find upsetting.Reports
Recommendations & Conclusions
Public health responses to drugs gain increasing support and alignment with conventions.
Conclusion · source text
There is increasing support for public health responses as a tool to respond to drugs, and the adoption of such responses are within the spirit of the Drug Control Conventions.
Home Office
Balance criminal justice response to drugs with increased public health initiatives.
Recommendation · source text
We recommend that the Government balances its criminal justice response to drugs with an increased public health response that seeks to prevent and treat drug use and tackle the root causes of drug use through, for example, a broad range of harm reduction approaches.
Home Office
Misuse of Drugs Act 1971 and Regulations 2001 require reform.
Conclusion · source text
We conclude the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001 require reform.
Home Office
Reform 1971 Act and 2001 Regulations, integrating public health with law enforcement.
Recommendation · source text
We recommend that the UK Government reform the 1971 Act and 2001 Regulations in a way that promotes a greater role for public health in our response to drugs, whilst maintaining our law enforcement to tackling the illicit production and supply of controlled drugs.
Home Office
A wider review of Schedule 1 controlled drugs is urgently required.
Conclusion · source text
We welcome the ACMD’s work reviewing the status of drugs controlled under Schedule 1 to the 2001 Regulations. However, we conclude a wider review is required.
Home Office
Commission the ACMD to review drug classification and scheduling systems, with regular updates.
Recommendation · source text
We recommend that the Home Office commission the ACMD to review whether the most commonly used controlled drugs in the UK are correctly classified under the 1971 Act and correctly scheduled under the 2001 Regulations based on the scientific evidence available. The Home Office must reform the classification system and the scheduling system based on the findings of that review. We recommend the ACMD conduct updated assessments every 10 years, or in circumstances where a review is required, to take into account the emerging scientific evidence on controlled drugs.
Home Office
Urgently move psychedelic drugs to Schedule 2 to facilitate medical research.
Recommendation · source text
We welcome the UK Government’s commitment to reducing barriers to researching psychedelic drugs under Schedule 1 to the 2001 Regulations. Pending the outcomes of the ACMD’s ongoing review of Schedule 1 controlled drugs, we recommend the UK Government urgently moves psychedelic drugs to Schedule 2 in order to facilitate research on the medical or therapeutic value of these drugs.
Home Office
Concerns about increased NPS potency and use among vulnerable populations persist.
Conclusion · source text
We recognise that the Psychoactive Substances Act 2016 was enacted to deal with the surge in new psychoactive substances (NPS) and the related health harms. We note that it was successful in removing the open sale of NPS but are concerned with the use of NPS among vulnerable populations, such as homeless people and people in prison, and with the increasing potency of NPS.
Home Office
Increasing benzodiazepine use and its link to drug deaths causes concern.
Conclusion · source text
We are concerned about the increasing prevalence of benzodiazepine use, and its implication in drug misuse deaths, across the UK. We await the outcome of the Home Office’s consultation on the creation of a new offence to better enable law enforcement to prove the illicit use of pill presses. (Paragraph 43) Drugs 73
Home Office
Provide urgent update on pill press consultation outcome to the Committee.
Conclusion · source text
The Combating Drugs Minister must write to us with an update on the outcome of the consultation before 18 December 2023.
Home Office
Alarm over synthetic opioid harms and potential shift from heroin dependency.
Conclusion · source text
We are alarmed by the health and social harms of synthetic opioids, such as fentanyl. We are concerned that a reduction in the global supply of heroin will have the effect of people with an opioid dependency turning to even more potent and harmful synthetic opioids, which have contributed to the ongoing opioid crisis in North America.
Home Office
Increase monitoring of synthetic drug trafficking and prioritise heroin dependency treatment.
Recommendation · source text
To mitigate this risk, we recommend the Government, in partnership with the devolved administrations, increase its monitoring of synthetic drugs being trafficked in, and around, the UK, and prioritise supporting people with a chronic heroin dependency into treatment and recovery.
Home Office
Prepare a strategy to mitigate increased supply of synthetic opioids across the UK.
Recommendation · source text
We recommend that the Government must prepare a strategy to mitigate the risk of an increase in the supply and availability of synthetic opioids in the UK before the end of this Parliament.
Home Office
Home Office selectively adopts ACMD advice on drug classification changes.
Conclusion · source text
The ACMD seeks to provide scientific, evidence-based recommendations to support the development of evidence-based drug policy. We note that the Home Office appears more likely to adopt advice to increase the classification of a controlled drug than it is to adopt advice to reduce the classification of a controlled drug. For example, we note that in the cases of cannabis, MDMA, khat and nitrous oxide, the ACMD recommended a lower classification, or no classification based on a review of the evidence. We acknowledge that scientific evidence should remain a key driver but not the main driver in the development drug policy in all cases, including when the scientific evidence supports reducing the level of control placed upon a drug.
Home Office
Home Office withholding of ACMD's 2016 report undermines transparency and established practice.
Conclusion · source text
We are disappointed that the Home Office has repeatedly refused to publish the ACMD’s 2016 report, including to this Committee on a confidential basis. No other ACMD report remains unpublished and withholding this one contravenes established practice and undermines the ACMD’s transparency.
Home Office
Publish the ACMD’s 2016 report or provide a confidential copy within one month.
Recommendation · source text
We, once again, request that the Home Office publish the ACMD’s 2016 report. At the very least, we request that the Home Office provide us with a confidential copy of the document within one month of receiving this report. Failing that, the Government must explain in its response to this Report why this ACMD paper, and no other, deserves to be withheld from public view. (Paragraph 55) The 10-Year Drugs Strategy
Home Office
Make DHSC and Home Office jointly responsible for drug policy with a cross-departmental minister.
Recommendation · source text
In line with the spirit of the partnership approach in the 10-Year Drugs Strategy, we recommend that the Government make the Department of Health and Social Care and the Home Office jointly responsible for drug policy. We recommend that the Combating Drugs portfolio be held by a minister that sits across both departments. There is already precedent of Home Office ministers sitting across other departments such as the Ministry of Justice. The Home Office and law enforcement authorities would continue to respond to the illicit production and supply of drugs. (Paragraph 65) 74 Drugs
Home Office
Government’s 10-Year Drugs Strategy is a welcome step with increased funding.
Conclusion · source text
We welcome the Government’s efforts to recognise and respond to the issues in Professor Dame Carol Black’s Independent Review of Drugs and we welcome the ambition of the 10-Year Drugs Strategy. In particular, we welcome the cross- departmental and partnership approach and the increase in funding for the drug treatment and recovery sector. We believe the strategy is an important step in the right direction.
Home Office
Ensure long-term funding for drug treatment services with three-year cycles and ringfenced grants.
Recommendation · source text
We are concerned about the long-term sustainability and security of funding for the drug treatment and recovery sector. (Paragraph 74) a) We welcome the Government’s latest funding announcement, which provides funding in England over a two year period. However, we question whether this is a sufficient length of time for service providers to utilise the funding to embed change.We recommend that the UK Government provide funding throughout the 10 year lifespan of the strategy in three year cycles. b) In relation to the public health grant in England, we recommend that the Government go further than placing a condition on local authorities to have regard to drug and alcohol treatment by requiring local authorities to ringfence funding allocated under the public health grant for these services. c) We recommend that the Government give service providers a minimum of three months’ notice of forthcoming funding allocations under the strategy and public health grant to enable them time to plan appropriately.
Home Office
10-Year Drugs Strategy needs to expand its range of harm reduction approaches.
Conclusion · source text
The 10-Year Drugs Strategy recognises some harm reduction approaches but could go further. Abstinence-based recovery may not be an effective form of treatment for everyone. A broader range of harm reduction treatments are therefore required to help as many people into recovery as possible.
Home Office
Update the 10-Year Drugs Strategy to increase available harm reduction approaches for treatment.
Recommendation · source text
We recommend that the Government update the strategy to increase the range of harm reduction approaches available to support a person’s treatment and recovery from drugs in line with the approaches outlined in this report.
Home Office
10-Year Drugs Strategy lacks detail on effectively tackling drug-related stigma.
Conclusion · source text
The strategy states a commitment to breaking down stigma but provides little detail on how this commitment would be actioned. Stigma is a key issue for people with lived experience of using drugs and for their loved ones. Tackling stigma in all its forms must be a priority in the Government’s entire response to drugs.
Home Office
Devise and publish a cross-departmental action plan and UK-wide campaign to tackle drug stigma.
Recommendation · source text
We recommend that the Combating Drugs Minister leads on devising a cross- departmental action plan to tackle stigma. In devising the action plan, the Government must engage with people with lived experience of drugs and stakeholders in the drug treatment and recovery sector to understand fully how stigma can affect people and how best to tackle it. The action plan must be published before the end of February 2024. We further recommend that the Government work with the devolved administrations to roll-out a coordinated, UK-wide campaign to tackle stigma.
Home Office
Specific groups face significant barriers accessing drug treatment and support.
Conclusion · source text
We were concerned to hear about the barriers people, such as women and black, Asian and minority ethnic people, can face when accessing treatment. No-one should be unable, or feel unable, to receive treatment and support. (Paragraph 100) Drugs 75
Home Office
Prioritise identifying and addressing local barriers to drug treatment and recovery.
Recommendation · source text
We recommend that Combating Drugs Partnerships prioritise identifying the likely barriers to treatment and recovery for people within their local area and take steps to address these barriers as part of fulfilling their commitments under the 10-Year Drugs Strategy.
Government response · verbatim
The Government accepts this recommendation, as it echoes the expectations of local delivery of the Drug Strategy as outlined in the guidance for local delivery partners and the Commissioning Quality Standard. Guidance for local partners delivering the Drug Strategy sets out the principles that should be adopted by Combating Drugs Partnerships (CDPs), including access and quality. This states that “everyone is able to access timely, appropriate support in a form that respects the full, interconnected nature of their needs, wishes and background”. There should also be flexibility within local partnerships to respond and tailor approaches according to need. The expectations of needs assessments to be conducted by CDPs were laid out clearly in the guidance and communicated and discussed through webinars and other meetings with local stakeholders. The guidance outlines that needs assessments, delivery plans and progress reviews should be seen as linked elements of a continuous process to analyse the situation, plan actions to improve it, take these actions, and reflect on what has been learnt – as part of a cycle to better understand the situation and how to improve it. The guidance states that this work should specifically include consideration of the accessibility of services and any disparities across demographics or geography. The Department of Health and Social Care’s Office for Health Improvement and Disparities (OHID) published the Commissioning Quality Standard: alcohol and drug services in 2022. The CQS purpose is to guide processes, partnerships, and systems for effective commissioning of alcohol and drug treatment services to help improve treatment access, outcomes, and quality. This guidance refers to specific barriers to treatment and recovery and enables local partners to assess their commissioning practices, including through a self-assessment tool. OHID has commissioned a National Institute for Health and Care Research call through the Policy Research Programme (call 30–02–08. Need for substance misuse treatment). The winning bid has the project title ‘Unmet Need for Substance Misuse Treatment among Opioid, Crack and Dependent Alcohol Users.’ The aim of this research is to explore the current circumstances and histories of out-of-treatment substance users, and the barriers to treatment engagement and how might these be addressed in future. It consists of two case studies, a literature review, interviews with professionals and drug users out of treatment. The project started in January 2022 and is expected to finish in 2024. 10 Stigma Research Stream | Centre for Social Research in Health - UNSW Sydney OHID released an unmet need toolkit on 23 August. It provides local areas with updated estimates of the prevalence of opiate and / or crack cocaine use as well as the estimated number of people with alcohol dependency. National Drug Treatment Monitoring System data is also included in the toolkit to report the levels of unmet need for the different prevalence substance groups as well as by age, sex and for people that are currently or previously injecting. This data shows for which cohorts treatment access is currently working well and for which it is not. Additionally, a range of guidance documents have been incorporated that offer advice, evidence, and examples of good practice in reducing unmet need and in improving referral pathways and the general attractiveness of drug and alcohol treatment for those that require it. We welcome the strategy’s recommendation that the membership of local Combating Drugs Partnerships should include people affected by drug-related harm because it gives people with lived experience a platform to help reduce barriers to treatment and recovery at a local level. However, we question whether this is reflected at a national level.
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Home Office
Inclusion of lived experience in national drug strategy implementation questioned.
Conclusion · source text
We welcome the strategy’s recommendation that the membership of local Combating Drugs Partnerships should include people affected by drug-related harm because it gives people with lived experience a platform to help reduce barriers to treatment and recovery at a local level. However, we question whether this is reflected at a national level.
Home Office
Explain recognition and inclusion of lived experience voices in national drug strategy implementation.
Recommendation · source text
We recommend that the Government explain how the voices of people with experience of drug-related harms are being recognised and included in national efforts to implement the strategy.
Government response · verbatim
Nationally, the Government recognises the need to include the experience of people affected by drugs in developing, delivering and improving work to combat illicit drugs and communities are at the centre of the outcomes to reduce drug-related harms, deaths, crime and use. Examples of where such contributions have made a real difference include the roll out of Project ADDER, the development of the Commissioning Quality Standard, Drug Strategy guidance for local delivery partners, local guidance capability frameworks for treatment roles, and new guidance on recovery support services. We will continue to do more as we move forward. For example, the commissioning quality standard has seen local partnerships seeking ways to improve involvement of people with experience and related recovery organisations. Dr Ed Day, as the National Recovery Champion, has led work with the College of Lived Experience Recovery Organisations to promote and improve recovery support service provision and support the sustainable growth of such initiatives. This has included engagement with lived experience recovery organisations, to help him to produce an information pack for commissioners and service providers to raise greater awareness and enthusiasm. Dr Day has also worked with the Government to carry out a survey of local authority commissioners to better understand current provision in England, as well as a review of the international evidence. Dr Day’s work has informed the co-development of new guidance to help alcohol and drug treatment and recovery partnerships to understand the evidence for, value of and ways to foster and support lived experience initiatives and recovery support services. The Ministry of Justice is also introducing a new temporary accommodation service providing up to 12 weeks of accommodation after release for prison leavers at risk of homelessness. The Department for Work and Pensions is developing wider employment support for people in treatment to help them find employment through peer mentors. They are able to use their own experience of addiction and recovery to help individuals disclose their dependency to Jobcentres and access the support they need to move closer to work. At the heart of Project ADDER is embedding learning to ensure their reflections and personal experiences are considered through the interventions that are delivered. The Home Office also works closely with The National Experts Citizens Group, a representative group whose members have relevant experience and join Project ADDER expert panel sessions. These are aimed at discussing ways in which we can improve the services we deliver through the programme. We welcome the strategy’s commitment to supporting families. It focuses on the important role of the family in preventing drug use, particularly in relation to young people. However, it does not recognise the role that families can play in the treatment and recovery of family members who have already developed a dependence on drugs. Our discussions with families also made it clear that the level of support available for families, particularly mental health support, could be improved.
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Home Office
Drug strategy overlooks family role in recovery; mental health support for families insufficient.
Conclusion · source text
We welcome the strategy’s commitment to supporting families. It focuses on the important role of the family in preventing drug use, particularly in relation to young people. However, it does not recognise the role that families can play in the treatment and recovery of family members who have already developed a dependence on drugs. Our discussions with families also made it clear that the level of support available for families, particularly mental health support, could be improved.
Home Office
Embed specialist practical and mental health support for families of drug users.
Recommendation · source text
We recommend that local authorities use the funding allocated under the 10-Year Drugs Strategy to embed specialist practical and mental health support within drug treatment and support services for the families and the loved ones of people who use, or used, drugs.
Government response · verbatim
The Government accepts this recommendation. In 2023–24 local authorities earmarked over £10 million from the SSMTR grant to improve integrating responses to physical and mental health for people receiving drug and alcohol treatment in the community. This includes increasing the ability to identify, assess and ensure effective intervention for physical and mental co-occurring conditions, expanding psychosocial responses to common mental health problems within the treatment and recovery system, and expanding Alcohol Care Teams in hospitals. OHID and NHS England are also developing a Joint Action Plan to improve access to mental health treatment for people using drugs and alcohol. This will also include looking at ways to improve links between services, including encouraging better referral pathways in each direction and more joint working practices. It will also consider training requirements for mental health staff to improve knowledge and skills around co-occurring conditions within mental health settings. In addition, we are increasing the psychological support available in services through our workforce transformation programme. This is supported by the Drug Strategy commitment of 800 more medical, mental health and other professionals working in the sector by 2024/25. 18 new Mental Health and Wellbeing Practitioners started in drug and alcohol services in 2022/23. This new role was developed to provide wellbeing-focused psychologically informed interventions and coordinate care plans for adults with severe mental health problems in community mental health services. The strategic plan for the drug and alcohol treatment and recovery workforce to be published later this year includes commitments to increase the number of psychologists in the sector. We welcome the Government’s ambition to reduce demand for drugs including recreational drugs. However, we have heard concerns that the three-tiered framework of escalating sanctions under the Swift, Certain, Tough: New Consequences for Drug Possession White Paper may have a negative impact in, for example, perpetuating stigma and in relation to young people.
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Home Office
Concerns raised about new drug possession sanctions' impact on stigma and young people.
Conclusion · source text
We welcome the Government’s ambition to reduce demand for drugs including recreational drugs. However, we have heard concerns that the three-tiered framework of escalating sanctions under the Swift, Certain, Tough: New Consequences for Drug Possession White Paper may have a negative impact in, for example, perpetuating stigma and in relation to young people.
Home Office
Explain identification of drug-dependent individuals, youth impact, and costs for new sanctions policy.
Conclusion · source text
Though we await the outcome of the consultation on this White Paper, we ask that the Home Office further explain: (Paragraph 113) a) How people with a drug dependency—to whom this policy will not apply—will be identified and directed into treatment. b) The extent to which the policy is likely to affect young people aged 16–24 years old—among whom recreational drug use tends to be higher—and what analysis it has done on how effective the policy is likely to be among this age group compared to police-led diversion schemes. c) To what extent the cost of implementing the policy would fall to the devolved administrations. 76 Drugs County lines
Home Office
Drug strategy requires further action to prevent exploitation of children by county lines.
Conclusion · source text
We welcome the 10-Year Drug Strategy’s commitment to rolling up county lines but increasing law enforcement efforts is only one part of the solution. We therefore welcome the strategy’s commitment to reducing demand for drugs and to re- building the drug treatment and recovery sector. We believe that these actions will play an important role in tackling county lines. However, we believe the Government could go further to prevent children and young people from becoming exploited by county lines.
Home Office
Vital to keep exploited children and young people out of criminal justice system.
Conclusion · source text
To tackle county lines, we believe it is vital that the children and young people exploited (or at risk of exploitation) by criminal gangs are kept out of the criminal justice system.
Home Office
Implement report recommendations on harm reduction, especially expanding drug diversion schemes for offenders.
Recommendation · source text
We recommend the Government build on the harm reduction measures within the strategy by implementing the recommendations on harm reduction outlined in this report, particularly our recommendations on expanding diversion schemes.
Government response · verbatim
The Drug Strategy already provides strong support for harm reduction approaches and expansion of measures to reduce drug use. We recognise that a system wide approach is required to deliver interventions that support those caught up in county lines exploitation. The County Lines Programme forces (Metropolitan Police Service, Merseyside Police, West Midlands Police, Greater Manchester Police) take a holistic approach to tackling county lines, to not only pursue line holders but also work with partners to raise awareness of county lines exploitation, prevent vulnerable individuals from becoming involved in county lines and help those that already are to safely exit their involvement. This approach also seeks to reduce the harms associated with county lines, such as modern slavery, serious violence and homicide. Furthermore, as part of the Government’s Drug Strategy, we will be rolling out the Out of Court Disposal Drug Pilots to a small number of police force areas in England and Wales. The project will seek to expand use of Out of Court Disposals for eligible drug possession offences, while exploring how effective drug awareness courses can be in changing offender behaviour and on reoffending. We recommend that the Government work with local partners to link up drug treatment services for children and young people with exploitation services to ensure that they receive holistic support.
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Home Office
Link children and young people's drug treatment services with exploitation services for holistic support.
Recommendation · source text
We recommend that the Government work with local partners to link up drug treatment services for children and young people with exploitation services to ensure that they receive holistic support.
Home Office
Adopt a statutory definition of Child Criminal Exploitation to ensure consistent application.
Recommendation · source text
We recommend that the Government consider adopting a statutory definition on Child Criminal Exploitation.
Home Office
Pilot inclusion of Prevention Officers within County Lines Taskforces to share good practice.
Recommendation · source text
We welcome the British Transport Police’s efforts to improve responses to child exploitation through the secondment of two Prevention Officers from the Children’s Society. We recommend that the Government work with other police forces with a dedicated County Lines Taskforce to pilot the inclusion of Prevention Officers within those teams, and the sharing of good practice. (Paragraph 128) Project ADDER
Home Office
Project ADDER's holistic, partnership approach demonstrates effective joint drug policy responsibility.
Conclusion · source text
We found that the holistic, partnership approach adopted by the Project ADDER pilot has been largely well received. We conclude that Project ADDER demonstrates how effective joint responsibility for drug policy between the Home Office and the Department of Health and Social Care can be.
Home Office
Provide interim assessment of Project ADDER by January 2024 and updated assessment post-2025 conclusion.
Recommendation · source text
As the Project ADDER pilot is set to continue until 2025, we recommend the Home Office provide us with an interim assessment of the pilot by January 2024. The Home Office must also provide us with an updated assessment of the pilot no more than three months after its conclusion in 2025.
Home Office
Extend Project ADDER nationally or preserve progress in pilot locations post-2025 conclusion.
Recommendation · source text
We recommend that Project ADDER be extended across all of England and Wales if the assessments indicate that the Project is effect in achieving all of its aims: reducing drug-related deaths, drug-related offending, drug use, and disrupting the supply and trafficking of drugs. If the Government does not extend Project ADDER beyond the pilot phase, we recommend that it must make clear how it will preserve the progress made in the existing 13 pilot locations beyond 2025. (Paragraph 141) Drugs 77 Health-led harm reduction
Home Office
Evidence base required for safe consumption facilities across the United Kingdom.
Conclusion · source text
An evidence base for a safe consumption facility in the UK is needed.
Home Office
Support piloting of safe consumption facilities in areas of demonstrated local need.
Recommendation · source text
We recommend that the Government support the piloting of safe consumption facilities in areas across the UK where there is deemed to be a need by local government and stakeholders.
Home Office
Support Glasgow safe consumption facility pilot, creating legislative pathway and ensuring joint funding.
Recommendation · source text
In particular, we recommend the Government support a pilot in Glasgow by creating a legislative pathway under the Misuse of Drugs Act 1971 that enables such a facility to operate legally. The pilot in Glasgow must be jointly funded by the Government and the Scottish Government. The Government must work with the Scottish Government and local partners to establish and operate the pilot. The pilot must be evaluated in order to establish a reliable evidence base on the utility of a safe consumption facility in the UK. We repeat the recommendation made by the Scottish Affairs Committee in 2019 that, if the UK Government is unwilling to support this, the power to establish a pilot be devolved to the Scottish Government.
Government response · verbatim
The Government does not accept the Committee’s recommendation and does not support the introduction of drug consumption rooms in England and Wales due to the risk of these facilities condoning illicit drug use and encouraging the continued criminal supply of drugs to users. Since the publication of the Committee’s report the Lord Advocate has responded to a request from the Scottish Government for a focussed statement of prosecution in relation to a pilot drug consumption room. The statement indicated that, subject to certain conditions, she would be willing to publish a prosecution policy that it would not be in the public interest to prosecute drug users for simple possession offences (under section 5(2) of the Misuse of Drugs Act 1971 committed within a pilot drug consumption room in Glasgow. The UK Government respects the independence of the Lord Advocate as Scotland’s prosecutorial authority and will not interfere with plans to introduce a drug consumption room in Glasgow, providing those powers are lawfully exercised. We recommend that the Home Office and Department of Health and Social Care jointly establish a national drug checking service in England to enable people to submit drug samples by post anonymously. We recommend the Home Office consult stakeholders on how best to implement the service. In particular, we recommend that it learn lessons from the Welsh Government and Welsh partners on the experience of WEDINOS. We believe that, ultimately, a UK-wide drug checking service would provide the most effective approach, and we therefore encourage the UK Government and devolved Governments to consider jointly establishing such a service.
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Home Office
Establish a national drug checking service in England for anonymous postal sample submission.
Recommendation · source text
We recommend that the Home Office and Department of Health and Social Care jointly establish a national drug checking service in England to enable people to submit drug samples by post anonymously. We recommend the Home Office consult stakeholders on how best to implement the service. In particular, we recommend that it learn lessons from the Welsh Government and Welsh partners on the experience of WEDINOS. We believe that, ultimately, a UK-wide drug checking service would provide the most effective approach, and we therefore encourage the UK Government and devolved Governments to consider jointly establishing such a service.
Home Office
Expand on-site drug checking services and establish a dedicated licensing scheme for temporary events.
Recommendation · source text
We recommend the expansion of on-site drug checking services at temporary events such as music festivals and within the night-time economy. We recommend that the Home Office establish a dedicated licensing scheme for drug checking at such events before the start of the summer 2024 festival season. The scheme must devolve the power to grant licences to local authorities.
Home Office
Ensure appropriate psychosocial support and flexible access to opioid substitution treatment for patients.
Recommendation · source text
We recommend that the Government work with local authorities and health partners to ensure that people receive appropriate psychosocial support in addition to their opioid substitution treatment and ensure that they can continue to access opioid substitution treatment at a pace that meets their needs.
Home Office
Long-acting buprenorphine shows encouraging results for opioid treatment in Wales.
Conclusion · source text
We welcome the 10-Year Drug Strategy’s recognition of the potential positive impact of long-acting buprenorphine. We think that the use of Buvidal in Wales has provided a very encouraging UK evidence base and proved that it is an effective form of opioid substitution treatment.
Home Office
Commit to establishing long-acting buprenorphine as first-line treatment for opioid dependence in England.
Recommendation · source text
We recommend that the Government go further than its commitment under the 10- Year Drugs Strategy to explore the rollout of long-acting buprenorphine and commit to establishing it as a first-line treatment option in England for people with an opioid dependence.
Government response · verbatim
The Government accepts this recommendation and is already supporting the further rollout of long-acting buprenorphine. 126 local authorities provide long-acting buprenorphine as a treatment option to their population. From the end of 2021–22 to the end of 2022–23 NDTMS recorded an increase of 200% in the proportion of opioid clients being treated with long-acting buprenorphine in England. The NICE recommended a balance between methadone and buprenorphine in their 200718 technology appraisal, meaning that both these two medicines are required to be available as options for maintenance therapy in the management of opioid dependence. It is the responsibility of a patient’s clinician to decide, with the patient, which drug is most appropriate for their treatment based on a number of factors. NICE reviewed their recommendation in 2016 and concluded there was no new evidence that affects their recommendations in the guidance. However, they have since agreed that OHID could, with their endorsement, develop updated guidance that helps clinicians and patients make decisions in the light of new products and new evidence. We recommend that the Government replicate Scotland’s medication- assisted treatment standards in England to ensure that a consistent, minimum standard of care is available to people accessing opioid substitution treatment. In doing so, the Government must first consult stakeholders in the medical and drug treatment and recovery sectors on adapting opioid substitution treatment standards in a manner appropriate to England.
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Home Office
Replicate Scotland’s medication-assisted treatment standards in England to ensure consistent minimum care.
Recommendation · source text
We recommend that the Government replicate Scotland’s medication-assisted treatment standards in England to ensure that a consistent, minimum standard of care is available to people accessing opioid substitution treatment. In doing so, the 78 Drugs Government must first consult stakeholders in the medical and drug treatment and recovery sectors on adapting opioid substitution treatment standards in a manner appropriate to England.
Home Office
Ensure sustainable supply of prescribed diamorphine for patients facing shortages.
Recommendation · source text
We are concerned by reported shortages of prescribed diamorphine, particularly because of the serious impact they may have on the health and lives of patients. As prescribed diamorphine is a viable form of treatment in England, the Government must work with suppliers to ensure that a sustainable supply is available to patients whom clinicians deem suitable for it.
Home Office
Middlesbrough DAT programme impressive but lacked crucial joint local funding.
Conclusion · source text
We support the use of DAT supported by wrap-around psychosocial support. The impressive Middlesbrough DAT programme that we witnessed held benefits for both the public health and criminal justice sectors. We are most disappointed that joint local funding from both the health and criminal justice sectors could not be secured for the programme. That said, we recognise the cost of the programme and the difficult decisions that need to be made by local stakeholders when allocating funds to services. Given the rate of opioid-related deaths in England, it is not further consideration that is required from central government, it is swift action.
Home Office
Provide centralised funding to support Diamorphine Assisted Treatment, urgently re-establishing Middlesbrough's programme.
Recommendation · source text
We repeat the ACMD’s 2016 recommendation that the Government provide centralised funding to support the provision of DAT for people with a chronic heroin dependency for whom other forms of OST have not been successful. The centralised funding should first be provided to Foundations Medical Practice in order to re-establish its DAT programme in Middlesbrough as a matter of urgency. The Government should then work with local authorities to identify other locations in England where a DAT programme supported by holistic and wrap-around care is needed.
Home Office
Change public health guidance for diamorphine provision to allow multi-dose vials.
Recommendation · source text
We recommend that public health guidance on the provision of diamorphine be changed to allow for the use of multi-dose vials instead of single-use ampoules to mitigate the additional cost and supply chain pressures associated with single-use ampoules.
Home Office
Ensure needle and syringe programmes reach wider populations to prevent blood-borne virus transmission.
Conclusion · source text
We are concerned by the effect the Covid-19 pandemic has had on the provision of needle and syringe programmes. The UK must continue its efforts in preventing the spread of blood-borne viruses by ensuring needle and syringe programmes reach as wide a population as possible.
Home Office
Increase provision of essential equipment and additional services for needle and syringe programmes.
Conclusion · source text
The Combating Drugs Minister must work with the Department of Health and Social Care, the devolved administrations, and health partners to ensure that the provision of equipment—particularly low dead space syringes and safe water—is increased to reduce the transmission of blood-borne viruses and other illnesses. The Combating Drugs Minister must work to ensure that needle and syringe programme providers have the capability and capacity to provide additional services to people presenting to the service, such as blood-borne virus testing.
Government response · verbatim
The Government partially accepts this recommendation. 20 Injectable opioid treatment: commissioning and developing a service - GOV.UK (www.gov.uk) Needle and syringe programmes are already embedded into, or work alongside, drug and alcohol services, commissioned by local authority public health to meet local need. Drug and alcohol services already support blood- borne virus prevention, and provide testing, vaccination, and treatment for these viruses. The SSMTR Grant menu of interventions includes an expansion of these services, including specifying the grant could be spent on low dead space syringes. Local authority SSMTR Grant plans included an additional £1.3 million being invested in needle and syringe programmes in 2023/24. The UK Health Security Agency, because of its interest in preventing blood- borne virus transmission and meeting agreed targets for hepatitis C elimination, has mapped needle and syringe programme sites in England and is now planning to pilot a new system for collecting needle and syringe programme data using automated data extractions from existing software systems. NICE published guidance in 2014 on needle and syringe programmes for people who inject drugs to reduce transmission of blood-borne diseases.21 One of its recommendations is that commissioners of needle and syringe programme should provide a range of services to meet local need. These services should provide health promotion advice and provide readily available hepatitis B and C testing and provision of, or referrals to, services for vaccinations, treatment and secondary care. The evidence on the lifesaving effects of naloxone in counteracting opioid related overdose is clear. We welcome the national naloxone programmes in the devolved nations but are concerned that no such programme exists in England. We also welcome the joint working between the Government and the devolved administrations to expand access to naloxone. However, progress is slow. The need to expand and embed naloxone within services and communities is crucial to saving as many lives from opioid-related overdose as possible.
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Home Office
National naloxone programme absent in England despite clear evidence of lifesaving effects.
Conclusion · source text
The evidence on the lifesaving effects of naloxone in counteracting opioid- related overdose is clear. We welcome the national naloxone programmes in the devolved nations but are concerned that no such programme exists in England. We also welcome the joint working between the Government and the devolved Drugs 79 administrations to expand access to naloxone. However, progress is slow. The need to expand and embed naloxone within services and communities is crucial to saving as many lives from opioid-related overdose as possible.
Home Office
Establish a national naloxone programme in England and rapidly expand provision to at-risk groups.
Recommendation · source text
We recommend that the Government establish a national naloxone programme in England to bring it in line with the devolved nations. We also recommend that the Government speed up its work on expanding the provision of naloxone following the UK-wide consultation in 2021. Expanding provision must include any service and person who may come into contact with people who are likely to suffer an opioid- related overdose. In particular, we think that community pharmacists and peer-to- peer programmes are well-positioned in their local areas to supply, distribute and administer this life saving treatment. It must also include enhanced distribution of naloxone to prison leavers.
Home Office
Non-universal naloxone provision by English police forces creates a dangerous postcode lottery.
Conclusion · source text
The efforts of UK police forces to roll out this life saving treatment is welcome. However, provision of naloxone across English forces is not universal, which risks creating a postcode lottery on the availability of this potentially life-saving treatment in England. Further, while we recognise the concerns of some officers to carrying naloxone, we conclude that the saving and preservation of life is too important, particularly when a person’s health is in a life-threatening condition due to overdose.
Home Office
Mandate all police forces to roll out voluntary naloxone provision, including funding and training.
Recommendation · source text
We recommend that the Home Office requires all 43 police forces in England and Wales to roll out the voluntary provision of naloxone by operational officers. Volunteer officers must be provided with adequate training in the carrying and administration of naloxone before they can carry it on duty. The Home Office must provide additional funding to all 43 forces to supply naloxone and to support the training of officers on the administration of naloxone. The Home Office must also work with policing and health partners to devise guidance on the carrying and administration of naloxone for operational police officers. All 43 police forces must record when its officers have administered naloxone, and the surrounding circumstances, in order to better understand the use of the treatment in emergency situations. (Paragraph 208) Criminal justice-led harm reduction
Home Office
Inconsistent police diversion schemes for low-level drug offences create an unfair postcode lottery.
Conclusion · source text
We support the use of diversion schemes for low-level offences. The use of such schemes by police forces in England and Wales is increasing and we welcome the efforts of those forces in rolling out these schemes. However, we are concerned that the use and substance of diversion schemes can vary across police forces. This can result in the criminal justice system responding differently to individuals for suspected drug-related offences. This postcode lottery is wholly unfair. It is time that a more coordinated, national approach is adopted.
Home Office
Mandate all police forces to establish standardised diversion schemes for low-level drug offences.
Recommendation · source text
We recommend that the Home Office place a duty on all 43 police forces in England and Wales to establish diversion schemes in their force area for young people and adults who have committed low-level offences. The duty must outline requirements for the diversion schemes in order to ensure a minimum standard that all diversion schemes must satisfy. In drafting the duty, the Home Office must consult with police 80 Drugs forces and relevant stakeholders on what the minimum standards should include. The Home Office must also publish guidance on the implementation and operation of diversion schemes.
Home Office
Mandate police forces to record diversion scheme use for national overview and best practice.
Recommendation · source text
We recommend that police forces record the use of diversion schemes in their force areas to develop a national picture and an understanding of best practice. The Home Office must regularly update the guidance to incorporate this evidence base.
Government response · verbatim
Most police forces in England and Wales already have a range of options at their disposal, for instance via Out of Court Disposal (OOCD) pathways. These routes offer approaches based on the operational judgement of forces. Where appropriate, forces have the option to use such pathways to deliver meaningful consequences, such as treatment or education. As committed to in the Drug Strategy, we will soon be rolling out pilots to expand the use of OOCDs within a small number of forces for drug possession offences, and to better understand efficacy of educational interventions for offenders. As part of the OOCD expansion pilots project, the Home Office also aims to establish a more detailed national picture of OOCDs, by examining their provision in all 43 territorial police forces in England and Wales. The pilot will also support work to develop immediate justice as a sanction police could place on drug users. The overall programme of work on OOCDs will provide valuable evidence base for future policy approaches, so that we can ensure the OOCD pathways provide best possible outcomes for communities and for offenders. We welcome the increasing adoption of trauma-informed approaches by UK police forces. As drug use—particularly problematic or chronic drug use, can often be a consequence of trauma—we conclude that trauma- informed policing should be extended to situations involving drug use. We believe that this aligns with the Government’s commitment to adopting a whole system response to drugs outlined in the 10-Year Drugs Strategy.
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Home Office
Extend trauma-informed policing approaches to all situations involving drug use.
Conclusion · source text
We welcome the increasing adoption of trauma-informed approaches by UK police forces. As drug use—particularly problematic or chronic drug use, can often be a consequence of trauma—we conclude that trauma-informed policing should be extended to situations involving drug use. We believe that this aligns with the Government’s commitment to adopting a whole system response to drugs outlined in the 10-Year Drugs Strategy.
Home Office
Establish trauma-informed policing training and guidance for all police forces in England and Wales.
Recommendation · source text
We recommend that trauma-informed training and practices be expanded to all 43 police forces in England and Wales. The Home Office must work with police forces and stakeholders to establish training and guidance on trauma-informed policing. The training and guidance should take into consideration the types of trauma associated with drugs and the ways to reduce stigma linked to drugs. (Paragraph 225) Cannabis
Home Office
Lack of NHS access to cannabis-based medicinal products for patients.
Conclusion · source text
We support cannabis-based products for medicinal use (CBPMs) where there is an evidence base that it can be an effective form of treatment for managing conditions or symptoms. We welcome the ACMD conducting a further assessment of CBPMs following on from its 2020 report. However, we are concerned that there is currently a lack of access on the NHS for patients with a genuine medical need. Access continues to be a problem despite the high-profile cases of Billy Caldwell and Alfie Dingley—two children with severe and rare forms of epilepsy who have received medical cannabis to treat their conditions.
Home Office
Widen NHS accessibility of unlicensed cannabis-based medicinal products before Parliament ends.
Recommendation · source text
Pending the outcome of the ACMD’s review, we recommend that the Government widens the accessibility of unlicensed CBPMs on the NHS before the end of this Parliament.
Government response · verbatim
The Government does not accept this recommendation. Whether to prescribe medicinal cannabis, or any other drug, is a clinical decision and not a matter for Government policy. Licensed cannabis-based medicines are routinely available and funded on the NHS. However, for unlicensed cannabis-based medicines, clinical guidelines from the NICE demonstrate a clear need for more evidence to support routine prescribing and funding decisions. Until that evidence base is built, clinicians will remain reticent to prescribe and no decision can be made by the NHS on routine funding. Clinicians can apply for NHS funding in exceptional clinical circumstances, these requests are assessed by an independent panel made up of doctors, nurses, public health experts, pharmacists, NHS England representatives and lay members. The Government remains committed to taking an evidence-based approach to unlicensed cannabis-based medicines. That is why we continue to encourage manufacturers of unlicensed products to conduct research – our medicines regulator and the National Institute for Health and Care Research can offer them scientific and research advice if they do. Furthermore, we are working with regulatory, research and NHS partners to establish clinical trials to test the safety and efficacy of these products. There is evidence of the potential therapeutic value of CBPMs to treat chronic pain.
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Home Office
Potential therapeutic value of cannabis-based medicinal products for chronic pain.
Conclusion · source text
There is evidence of the potential therapeutic value of CBPMs to treat chronic pain.
Home Office
Support randomised control trials into effectiveness of CBPMs for chronic pain treatment.
Recommendation · source text
We recommend that the Government supports researchers to conduct randomised control trials into the effectiveness of CBPMs to treat chronic pain. If the evidence base supports this, and it is deemed to be cost-effective, we recommend that the Government enables the use of CBPMs for this purpose and works with clinicians to ensure that it is a treatment option in appropriate cases.
Government response · verbatim
The Government accepts this recommendation. Any researcher wanting to conduct Randomised Control Trials on the effectiveness of medicinal cannabis on chronic pain can ask the medicines regulator and the NIHR for scientific and research advice. NIHR welcomes funding applications for research into any aspect of human health, including medicinal cannabis to treat chronic pain. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality. NICE recommend that unlicensed medicinal cannabis is not offered to manage chronic pain in adults and that cannabidiol (CBD) medicines only be offered as part of a clinical trial.24 NICE recognises the lack of evidence to support the use of these medicines and recommends that further research be carried out on the clinical and cost effectiveness of CBD as an add-on treatment for adults with fibromyalgia or persistent treatment-resistant neuropathic pain. We are concerned by the harms that cannabis for non-medical use may pose, particularly in relation to young people. We do not believe that cannabis should be legalised and regulated for non-medical use.
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Home Office
Concerns about harms of non-medical cannabis use, rejecting legalisation for youth safety.
Conclusion · source text
We are concerned by the harms that cannabis for non-medical use may pose, particularly in relation to young people. We do not believe that cannabis should be legalised and regulated for non-medical use. (Paragraph 243) Drugs 81 Northern Ireland
Home Office
Paramilitary drug crime and political stalemate hinder Northern Ireland's drug response.
Conclusion · source text
We are deeply concerned by the role paramilitary groups play in organised drug crime in Northern Ireland, and the impact that this has on local communities, children and young people. We are also deeply concerned by the effect the current political stalemate is having in Northern Ireland and the extent to which it restricts Northern Ireland’s response to drugs, among many other issues. However, we welcome the continued efforts of public services and stakeholders to respond to drugs, particularly efforts that adopt a multi-agency response.
Home Office
Further support Northern Ireland officials and communities responding to drugs during political stalemate.
Recommendation · source text
In the absence of an operational Northern Ireland Executive and Assembly, the Government must further support officials and communities in Northern Ireland to respond to drugs. This must include support to develop and sustain early intervention and prevention initiatives under the Tackling Paramilitarism, Criminality and Organised Crime Programme, which seeks to draw young people away from paramilitary groups. It must also include the extension of the harm reduction policies outlined in this report. (Paragraph 249) 82 Drugs
Home Office
Oral evidence sessions
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| Date | Session and witnesses | Source |
|---|---|---|
| 22 Feb 2023 |
Oral evidence session
Angela Constance · Scottish Government,
Caroline Hart · Home Office,
Marcus Starling · Home Office,
Rt Hon Chris Philp MP · Home Office
|
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| 29 Jun 2022 |
Oral evidence session
Charlie Doyle · British Transport Police,
Dr Jack Spicer · University of the West of England,
Dr Richard Lewis · National Police Chiefs’ Council and Chief Constable of Dyfed-Powys Police,
Junior Smart OBE · St Giles Trust,
Nicky Hill · Abianda,
Steve Rodhouse · National Crime Agency
|
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| 15 Jun 2022 |
Oral evidence session
Andy Dunbobbin · Police and Crime Commissioner for North Wales,
David Sidwick,
David Thorne · South Wales Police,
John Campbell QPM · Thames Valley Police,
Serena Kennedy · Merseyside Police,
Zoe Metcalfe
|
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| 25 May 2022 |
Oral evidence session
Councillor Joanne Harding · Local Government Association,
Maggie Boreham · Hackney Council,
Professor Dame Carol Black · Combating Drugs,
Professor Jim McManus · Hertfordshire County Council
|
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| 18 May 2022 |
Oral evidence session
Dr Emily Finch · Advisory Council on the Misuse of Drugs,
Dr Owen Bowden-Jones · Advisory Council on the Misuse of Drugs,
Professor David Nutt · Imperial College, London,
Professor Jo Neill · Manchester University,
Professor Ornella Corazza · Hertfordshire University,
Professor Roger Knaggs · Advisory Council on the Misuse of Drugs,
Professor Stuart Reece · University of Western Australia
|
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| 27 Apr 2022 |
Oral evidence session
Chloe Hartnell · Hodge Jones and Allen LLP,
Dr Karenza Moore · Newcastle University,
Dr Kojo Koram · Birkbeck College, University of London,
Martin Powell · Transform Drug Policy Foundation,
Niamh Eastwood · Release,
Rudi Fortson QC · 25 Bedford Row Chambers
|
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Who gave evidence
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| Witness | Organisation | Sessions |
|---|---|---|
| Andy Dunbobbin | Police and Crime Commissioner for North Wales | 1 |
| Angela Constance · Minister for Drugs Policy | Scottish Government | 1 |
| Caroline Hart · Deputy Director for Drugs Supply and County Lines | Home Office | 1 |
| Charlie Doyle · Assistant Chief Constable | British Transport Police | 1 |
| Chloe Hartnell · Partner | Hodge Jones and Allen LLP | 1 |
| Councillor Joanne Harding · Councillor | Local Government Association | 1 |
| David Sidwick | — | 1 |
| David Thorne · Assistant Chief Constable | South Wales Police | 1 |
| Dr Emily Finch · Co-chair of the Recovery Committee | Advisory Council on the Misuse of Drugs | 1 |
| Dr Jack Spicer · Lecturer in Criminology | University of the West of England | 1 |
| Dr Karenza Moore · Lecturer in Sociology of Crime | Newcastle University | 1 |
| Dr Kojo Koram · Lecturer, School of Law | Birkbeck College, University of London | 1 |
| Dr Owen Bowden-Jones · Chair | Advisory Council on the Misuse of Drugs | 1 |
| Dr Richard Lewis · Drugs lead | National Police Chiefs’ Council and Chief Constable of Dyfed-Powys Police | 1 |
| John Campbell QPM · Chief Constable | Thames Valley Police | 1 |
| Junior Smart OBE · SOS Project Founder | St Giles Trust | 1 |
| Maggie Boreham · City and Hackney Public Health Team | Hackney Council | 1 |
| Marcus Starling · Deputy Director of the Drug Misuse Unit, Crime Reduction Directorate | Home Office | 1 |
| Martin Powell · Head of Partnerships | Transform Drug Policy Foundation | 1 |
| Niamh Eastwood · Executive Director | Release | 1 |
| Nicky Hill · Head of Services | Abianda | 1 |
| Professor Dame Carol Black | Combating Drugs | 1 |
| Professor David Nutt · Professor of Neuropsychopharmacology | Imperial College, London | 1 |
| Professor Jim McManus · Executive Director, Public Health | Hertfordshire County Council | 1 |
| Professor Jo Neill · Professor of Psychopharmacology, Manchester Pharmacy School | Manchester University | 1 |
| Professor Ornella Corazza · Professor of Addiction Science | Hertfordshire University | 1 |
| Professor Roger Knaggs · Chair of the Technical Committee | Advisory Council on the Misuse of Drugs | 1 |
| Professor Stuart Reece · Associate Professor of Medicine | University of Western Australia | 1 |
| Rt Hon Chris Philp MP · Minister for Crime, Policing and Fire | Home Office | 1 |
| Rudi Fortson QC · Barrister | 25 Bedford Row Chambers | 1 |
| Serena Kennedy · Chief Constable | Merseyside Police | 1 |
| Steve Rodhouse · Director General (Threats) | National Crime Agency | 1 |
| Zoe Metcalfe | — | 1 |
Correspondence
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| Published | Direction | Letter |
|---|---|---|
| 23 Nov 2022 | To committee | Letter from Minister for Crime, Policing and Fire on the Middlesbrough DAT programme, dated 11 November 2022 |
| 2 Nov 2022 | To committee | Letter from Public Health, Middlesbrough Council on closure of the Middlesbrough Diamorphine-Assisted Treatment programme, dated 31 October 2022 |
| 27 Oct 2022 | From committee | Letter to Project ADDER on closure of Middlesbrough diamorphine assisted treatment programme, dated 27 October 2022 |
| 27 Oct 2022 | From committee | Letter to the Minister for Policing and Crime on closure of Middlesbrough Diamorphine-Assisted Treatment programme, dated 27 October 2022 |