Coalition should pause before taking an axe to drug treatment budget

Our guest writer is Matt Cavanagh, special adviser to the Labour Government between 2003 and 2010, in the Home Office, Ministry of Defence, Treasury and Downing Street

Labour’s drug policy has few defenders, the Right thinking it not tough enough, and the Left thinking it too tough, along with the public health community – and all three agreeing that “we are losing the war on drugs”. But while the Left and the public health community debate the merits of decriminalisation or legalisation, there is a real risk that the Right’s agenda – cutting the money spent on managing drug addicts’ habits, in favour of “abstinence-based” treatment – will go unchallenged.

Few of those working on either drug enforcement or treatment would pretend that we are “winning” the war on drugs. The appalling human and financial toll both of the organised drug trade and of the chaotic lives of individual addicts is all too clear.

But any evidence-based approach should also acknowledge, despite this undeniably bleak landscape, that some trends are at least not going in the wrong direction: overall rates of drug abuse are stable or falling, and numbers in drug treatment have risen. (See page 7; within that overall trend, heroin and crack cocaine use seem to have been falling for some time; powder cocaine use seems to have started to fall; heavy cannabis use, by contrast, seems to be rising.)

That should give anyone pause before taking an axe to the drug treatment budget. Given the fiscal situation, the coalition is right to look for savings from this billion-pound drug budget – indeed many inside the Labour Government felt that, while we had been right to expand this budget a decade ago, we should have found more savings in this area ourselves during our last year.

The coalition is also right to try to accelerate the move away from input targets (numbers in treatment) and towards outcome targets (the number and proportion of users going on to drug free lives) – here too Labour should accept that we were too slow in pushing the National Treatment Agency in this direction over recent years.

But again, any new approach should acknowledge that, while painfully slow, this move towards a focus on outcomes has already begun – and not only are overall rates of drug abuse falling, and more addicts in treatment,  but the proportion completing treatment is rising, and so too is the proportion going on to drug-free lives. (See page 8.)

So there are two reasons for caution before rushing into bold policy adjustments. In fact, for those of us who believe that radical solutions – including decriminalisation, or a pharmaceutical or medical breakthrough – are too risky or too underdeveloped, this is the way drug policy is likely to remain for the foreseeable future – slow, evolutionary rather than revolutionary, the stuff of clunky workshops on ‘joined-up working’ rather than headline-grabbing initiatives.

Of course we need to try to increase the number of addicts moving on to drug free lives – but we need to do this carefully, and we need to see it as a complement, not an alternative, to reducing the harm that addicts cause – and that will include “managing” those addicts who are unlikely to kick their habit any time soon.

Critics of “managing” addiction point to the suspicious increase in methadone prescription in prison, with some justification; but before that gives the whole approach a bad name, we should remember one of the quiet success stories of the last couple of years, which was an experiment to increase prescription of heroin for hard cases who had tried and failed other kinds of treatment – an experiment which significantly reduced crime, without reducing the numbers going on to drug free lives.

Above all the different agencies involved in drug treatment need to work together to combine a focus on addicts’ needs as patients, with a focus on reducing the harm they cause to others – and that means genuinely combining these aims, rather than the two respective bureaucratic empires squabbling about who “owns” the addicts and the budgets that come with them.

Family intervention projects have shown on a smaller scale how agencies can truly work together to tackle drug addiction, alongside many other problems. Michael Gove may have included FIPs (Key workers providing intensive support to families) on his list of banned words, but if he’d looked at the cost-benefit analysis, he would have realised that the real challenge he should be setting his officials is not to think of a better name, but to think about how to make them scaleable, and how to apply the lessons in other areas of social policy.

As it stands, the coalition’s apparent hostility to spending on “managing” addicts’ habits looks like a dangerous mixture of cost-cutting (with the Treasury realising that few will want to defend spending on drug addicts) and moralising (with Iain Duncan Smith and his Social Justice Policy Group leading an increasingly influential strand in Tory thinking that state spending on drugs for addicts is not merely wasteful or low-priority, but morally wrong).

Both are simplistic – to reiterate, other than the leap of faith of decriminalisation, or some new pharmaceutical or medical breakthrough, there are no easy answers in drug policy, and responsible politicians should not pretend otherwise.