Over the past ten years,
Britain has gone from being seen as a world leader in drug treatment
to an international disaster.
Official statistics for the last year
show drug deaths have reached record levels,
with many predicting that this year’s figures
will be even higher.
It's getting worse all the time,
so this is the worst figure on record.
This has been largely driven by one politician,
a former leader of the Conservative Party
who made it his mission to transform British drug treatment,
with catastrophic results.
For too long now, all the money has been spent
on maintaining people who’ve got heroin habits, et cetera,
on methadone and substitute programs.
He’s got blood on his hands.
Iain Duncan Smith, blood on his hands.
In 2020, there were 4,561 drug deaths across England and Wales.
This is the highest number since records began,
breaking the record high numbers from 2019,
which broke the record high numbers of 2018.
But it wasn't always like this.
Back in 2011, there were only 2,652 deaths.
The UK hasn’t faced an opioid crisis like the US,
nor has there been any wave of super deadly new drugs
coming onto the market.
In fact, this rocketing number of deaths
has coincided with some very specific choices by successive UK governments.
This is the story of how a faction of the British Conservative Party
managed to completely restructure drug treatment services in the UK
and how tens of thousands of people may have died as a result.
[THE WAR ON DRUGS SHOW]
[TORY DRUG CUTS]
In the early 2000s, British drug deaths were falling.
UK drug services were run through the National Health Service
and broadly based on the principles of harm reduction,
which basically means helping addicts regulate their lives
and improve their health
in order to enable them to stop using when they’re ready.
If you look as far back as
the prescribing of heroin in the treatment of addiction
that existed from the 1930s up until the 1960s,
I think the British treatment system
has been one that’s primarily been based on harm reduction principles.
When it comes to heroin addiction,
most harm reduction strategies involve
medication-assisted treatment,
where you give users other opioids, such as methadone,
so they can slowly taper off their use.
This is generally considered to be
the gold standard of opioid addiction treatment.
At an Edinburgh chemist’s shop,
two heroin addicts with the AIDS virus
are given that daily liquid dose of the heroin substitute methadone.
The dose is enough to kill an adult with no tolerance.
The reason why methadone
and buprenorphine is used as opioid substitute therapy
is it’s a longer-acting opioid,
so it’ll last for 24 hours.
So that provides a basis of stability for somebody to know, you know what?
For 24 hours, you’re going to be fine.
You’re not going to rattle.
You can then look at other aspects of your life
because you’re not going to have to worry about going out to score
to feel well.
As the 2000s progressed,
high-profile members of the Conservative Party
began to see drug treatment as a way to attack the Labour government.
This was driven by former Tory leader Iain Duncan Smith.
In 2007, a think tank he co-founded, the Centre for Social Justice,
released a report that accused the current system
of using medication-assisted treatment
to simply keep addicts “parked on methadone” for years
rather than driving them to stop using altogether.
That phrase, “parked on methadone”, was eventually taken up by the press
and became a sort of lazy soundbite to describe
the supposed failures of the drug treatment system.
Issues such as drug users being “parked on methadone”
began to take hold
and had a lot of currency as well.
The only problem with this “parked on methadone” attack
is that it completely misreads
the entire point of how drug services operate
and the challenges they face.
When I heard that terminology, “parked on methadone”,
it made me angry.
It was more stigma. It was not based on any evidence.
In 2010, everything changed.
The Conservative-led coalition came into power
and soon published its recovery roadmap,
completely restructuring how British drug treatment worked.
The key idea of the roadmap
was to move drug treatment away from harm reduction
and towards abstinence.
This was classic 1980s Just Say No-style drug policy,
where the only goal is for people to stop using any drugs at all,
even if that’s the methadone that’s keeping them off heroin,
and even if they themselves don’t feel ready.
It’s no good saying after six months or twelve months,
“Right, you’ve been in for six months now,
you’ve been in for 12 months,
now you need to start reducing,” you know?
That’s not what it’s about.
It’s about retaining someone in treatment
so they can deal with all the complex problems
that they’ve come in with.
Once again, Iain Duncan Smith was at the heart of this strategy.
And, as ever, the media reported it almost completely uncritically.
This is the key test
for what has been a failing policy of the government,
which is that the government doesn’t really rate abstinence.
And we think the big debate is abstinence versus maintenance.
The best thing you can do for a drug addict
is to work to get them off drugs and then keep them off drugs.
If they lose their script completely, they’re not going to not use.
They’re still going to need to use, right?
You’re forcing the person back into street drugs
and all of the problems that they came with in the first place.
But, of course, most of the time,
what actually happens when you force someone off a methadone prescription
before they’re ready
is not that they magically stop needing opioids
but that they go back to scoring heroin on the street.
And often, they die.
When somebody’s tolerance is down because they’ve come off their script
and they’re going back to a street drug,
that’s going to be a problem.
They're going to overdose.
Iain Duncan Smith weaponized prescription medication.
This is the place where you come and get your scripts and that
for when you’re trying to come off heroin
and stuff like that.
Obviously, I came here a couple of days ago
and they’d messed my script up,
so I had to wait two weeks to get the other script back,
so I’m having to smoke heroin in the meantime for two weeks.
Drug deaths started rising almost immediately,
and this wasn't a surprise.
The government’s own official
Advisory Council on the Misuse of Drugs [ACMD]
publicly warned that this policy would lead to
higher rates of relapse
as well as many other areas where the new policy
was completely ignoring evidence.
In response, Iain Duncan Smith accused ACMD of providing cover
for the vested interests of a supposed methadone industry,
a claim for which he provided about as much evidence
as your uncle ranting on Facebook
that Bill Gates is putting microchips in the vaccines.
But it wasn’t just a switch to a 1980s-style Just Say No regime
that created the perfect storm for British drug policy.
It was that this move was accompanied by
the wholesale privatization of the drug treatment sector.
We saw the introduction of Public Health England,
which took on responsibility for the NTA.
What was significant here
is that the ring fence that protected spending on drug treatment
was removed.
So in effect, spending on drug treatment
was set against spending on other services,
like the services for the elderly or children services, for example.
This is where we see UK drug treatment
being passed on to the corporatized charity sector.
Organizations like Addaction,
Crime Reduction Initiatives, and Turning Point
began taking over huge swathes of the treatment sector—
and turning over huge amounts of money in the process.
To take one example,
in 2001, the annual turnover of crime reduction initiatives
was 2.1 million pounds.
By 2015, it had rocketed to 80.8 million pounds
and by 2016 to 158 million pounds.
And this rocketing growth was achieved at a time
when overall investment in the charity sector was falling.
So the third sector are
charities that are bidding for government contracts.
They will undercut each other to get those contracts.
The more you undercut the contracts, it's a race to the bottom.
It hasn’t been a race to the top. It’s been a race to the bottom.
When I first started working in the sector,
I had a caseload of 30.
By the time I finished working in that sector,
people had, regularly, caseloads of 60, 70, 80.
But this wasn’t just a problem of underbidding and failing to deliver.
The way these contracts were structured
often involved massive perverse incentives for the private providers
to rush people off their treatment programs.
So in order to record a successful completion,
a service user needs to exit treatment
and not re-present within a six-month window.
So this created perverse incentives
for treatment providers to try and get as many drug users into detoxing,
out of treatment as possible.
Worse still,
because overdoses or the risk of fatal overdose
is higher on treatment exit and a period of abstinence,
even death can be seen as a success by those measures.
Drug-related deaths are a result of a failing policy,
of a failure in commissioning and a failure of treatment.
That’s what is.
The reason why this situation exists
is because of poor government decisions.
You know, he’s got blood on his hands.
Iain Duncan Smith, blood on his hands.
So where does that leave UK drug treatment now?
The government commissioned Dame Carol Black
to undertake a comprehensive review.
And in July of 2021,
she reported back that the entire sector was on its knees
and not fit for purpose.
We need, first of all, to have the money to improve the treatment,
the recovery, the workforce.
Once you’re addicted, you have very little choice.
We should try and get in as early as possible,
but we need to treat it as much as we can as a disease.
And what my report is trying to say,
please do it as a whole system reform.
Specifically, she criticized
the fragmentation of service commissioning
and stressed the need for a centralized department
to handle addiction issues,
which sounds a lot like the National Treatment Agency
that the Tories abolished eight years ago.
It should be remembered that a lot of drug workers do amazing work,
and there are signs that many working in the sector
recognize it needs urgent reform.
Yet, for some reason, with UK drug deaths at record highs,
the government is sticking with
the same old failed war on drugs tactics.
And despite the obvious, horrifying failure
of the Just Say No policies they promoted,
people like Iain Duncan Smith and the Centre for Social Justice
have never meaningfully been held to account.
We’d like to congratulate drugs for winning the war on drugs.