A long pause since my April catch-up, and very different weather in mid-November as I try to come to terms with all that has happened in my areas of interest since then. ‘The Book’ has continued to be a major focus. With a pause following the receipt of the chapters – and some last-minute amendments by several chapter authors – proof reading took over as the principal area of work and activity. The proof reading also gave some authors the opportunity to make some final corrections to their texts but also to include references to events which had taken place since the submission of their text to make chapters as up to date as possible. Disappointingly but not unsurprisingly, such events were about detail, not significant changes of direction in drug policy. The Book was finally published in early October and there will be a launch event in London on December 13.
In the context of the book and the opportunity its editing has given me to consider the impacts of current international drug policy, I wonder how much of the motivation behind the group of would-be migrants travelling from Central America towards the USA has been the violence and lawlessness in the countries of origin which has resulted from the US-led ‘war on drugs’ and the destruction of administrations, institutions, settlements and ways of life in Central American countries.
In the last week of August I was at the annual meeting of ISAJE- the International Society of Addiction Journal Editors – in Prague. Many thanks to London-based colleagues who gave generously of their time to discuss terminology, for me a follow-up to the Global Commission report form late 2017 which looked at the contribution of judgemental and negative terminology to the continued marginalisation and stigmatisation of people who use drugs. The ISAJE meeting considered terminology, a theme which it had already considered in the past; predatory publishing; support for researchers and writers working in countries where there are no local independent publications or journals covering drugs, drug policy and addiction; the risks of colluding with repressive approaches in the drugs field by publishing papers which are essentially national propaganda and not independent commentary or research; and the continuing possibilities for collaboration between journals and international agencies. There is some activity which provides assistance and training for writers whose first language is not English and who have little experience in writing, editing and publishing.
Amongst other things I learnt that journals which had existed in the Czech Republic, Poland and the Slovak Republic have ceased publication. Discussion on the possibility of reviving this tradition on a tri-nation basis suggested that the linguistics are increasingly a barrier, even between the Czech and Slovak Republics: where in the recent past speakers of one of the Slav languages would be able to read texts in other Slav languages, the distinctiveness of each language is developing to the extent that it is less and less likely that this continues to be the case. (I was reminded of the myth, perpetuated by TV series, that Danes, Norwegians and Swedes are easily able to understand each other’s language). And I was intrigued by one participant’s assertion that ‘no body reads books any more’ – an assertion at odds with the impressive number and variety of book shops in Prague. That apart, the meeting was marked by its positive, supportive, collaborative and collegial atmosphere. It was good to finally meet face-to-face colleagues with whom I have long had a cyber-relationship
Two weeks later I travelled east again for this year’s City Health International Conference, held in Odesa, Ukraine. I was interested to attend because of my involvement in Ukraine fifteen years ago in establishing a national HIV/AIDS strategy. At the time, this was marked for me by interest and concern about the topics and the range of spin-offs – treatment, including the use of buprenorphine in OST; school-based and other young people’s information and prevention programmes; TB; commercial sex work. I was disappointed that it wasn’t possible for me to spend any time in resultant agencies to see what had happened and how far the innovations have been incorporated into main-stream public health work. It was interesting to hear the up-dates from several Ukrainian cities and local authorities on their proposals to establish drug consumption rooms. I displayed a poster on the UK position on DCRs. The UK delegates were considering betting on which country would be the first to open a DCR, Ukraine or the UK. Conference proceedings generally indicated much activity and debate around the whole range of public health and equalities issues in Ukraine, with some attitudes and achievements which should shame UK government positions. In contrast with Russian policy and legislation, OST and other realistic responses to drug use and dependence, HIV/AIDs, TB and Hepatitis are well-established and in place nationally. This is just one example of the models of society which have led most Ukrainians to opt for a western social model, not a Russian one, whose results are well observed and understood in Ukraine.
I did overhear a loud complaint on the first morning of the conference by a US delegate about the time they had spent in queues at Heathrow and Kyiv airports waiting to go through immigration. Given the reception awaiting non-US citizens at US borders this struck me as at best ignorant, at worst an example of entitlement, arrogance and assumed privilege. The UK Brexit slogan of ‘taking back control of our borders’ came to mind. As did my long-held view that we are all ‘foreigners’ when we step outside our own countries.
Returning to London in October was something of a shock after a wonderfully relaxing holiday in Ukraine – Odesa, Lviv and the Carpathians – which left me feeling refreshed and unwound. The back-log of correspondence and tasks in London took me six weeks to deal with – poor time management? ‘The Book’ was published at the beginning of October and preparations for the London launch followed. Papers which had been submitted to Drugs and Alcohol Today in September needed to be processed, and the 2019 themed issue on ChemSex took off, with a flurry of editorial mails and papers seeming to arrive every day. The content which has been submitted looks to be comprehensive, informative, ground breaking and international.
I spent a couple of hours watching the recording of the Westminster Hall debate on UK drugs policy. I was struck by what was for the most part a well-informed set of speeches by participating MPs. Several made reference to the contribution which DCRs could make to reducing drug related deaths in the UK, and there were many invitations to the Home Office Minister to visit Glasgow to talk to locals about their advocacy for a safe injecting facility and to remove the blocs to establishing one which have been asserted by the Westminster government. Disappointingly but not surprisingly, the invitations were not acknowledged, let alone responded to. The familiar government line that there are ‘no plans’ to introduce DCRs in the UK and that the government has ‘no intention’ of doing so was repeated. The government ‘cannot condone’ the prospect of DCRs and it ‘would not be responsible to support the illegal market’ – which, the Minister claimed, DCRs did. The Minister misrepresented the position of the INCB on DCRs laid out earlier this year. So much for the UK drug strategy being ‘evidence based’. The Minister further misleadingly claimed that ‘Health Education is being made compulsory in schools’, a position first misrepresented in the 2017 Drugs Strategy; and claimed that the 2016 Psychoactive Substances Act had ‘choked off’ the supply of psychoactive drugs. The ‘evidence’ advanced to support this claim was the closure of hundreds of high-street head-shops. MPs present pointed out that the market had simply migrated on-line. In his summarising comments, Ronnie Cowan referred to his visit to DCRs in Barcelona. What struck him there was the respect and humane treatment shown to drug users. This implied that current UK policy is inhumane.
As one colleague has commented: why are they so bone-headed…? In a broader context of commentary on UK social policy and the impact of austerity, this attitude to drug consumption rooms and the indifference to the rising numbers of drug related deaths, Philip Alston, the UN rapporteur currently (November 2018) investigating poverty in the UK, has referred to the UK government’s attitudes and policy as being ‘mean-spirited and often callous’. Yes indeed.
I have been providing editorial advice and support to Axel Klein around tramadol on Africa. His report was presented to a WHO meeting in mid-September. The outcome seems to be that the proposal, led by the Egyptian government, to add tramadol to the list of substances scheduled under the international conventions has been withdrawn, in large part because of the analgesic use of tramadol in countries and regions with poorly resourced health systems and an inability to use opiates for pain relief.
The year so far (April 2018) has been focussed on my co-editing role of the ‘After UNGASS’ book I’m working on with Axel Klein. Just before Easter we submitted all the texts we had received from the authors, followed the next week by the Foreword which Michel Kazatchkine wrote for us. Currently (April 2018) we’re working with the publishers on publicity and marketing. Our title is now amended to “Collapse of the global order on drugs? From UNGASS 2016 to Review 2019” and we’re expecting publication in October.
Benefitting from the chapter content and the authors’ knowledge, especially regarding the situation in the USA around cannabis (marijuana) for both recreational and medicinal purposes, it’s interesting to see how one of the principal pragmatic challenges to the international conventions is the status of cannabis. So here at last is conclusive proof that cannabis is a gate-way substance – but not in the way the original proponents of the theory maintained.
One of the spin-offs was an invitation to the early-January launch of the latest report by the Global Commission on Drugs “The world drug perception problem: countering prejudice about people who use drugs”. The two events gave me an opportunity to meet for the first time some of the book’s authors; and to renew other links and conversations. Asma Jahangir from Pakistan was one of the Commissioners present, reminding the audience at Chatham House that she and fellow Commissioner Olesegun Obasanjo, former president of Nigeria, had both been imprisoned in their countries as a result of their political activities and advocacies. It was therefore saddening to read that Asma Jahangir died a month later from a cardiac arrest.
There was a debate on drug consumption rooms in January in the UK House of Commons. As with the July 2017 debate which followed the publication of the UK Drug Strategy 2017, the MPs speaking showed extensive knowledge of the topic and concern for the well-being of the UK’s drug using population. This knowledge and concern were not shared by the Home Office minister replying to the debate, Victoria Atkins, who resorted to a hard-line response to the suggestions made during the debate – and by the ACMD in December 2016 – that drug consumption rooms be part of the UK response to drug use generally; and to the startling increase in drug related deaths in recent years in particular: “We have no intention of introducing drug consumption rooms, nor do we have any intention of devolving the United Kingdom policy on drug classification and the way in which we deal with prohibited drugs to Scotland.” She additionally mis-represented the evidence from and the extent of the existence of drug consumption rooms in other jurisdictions, and ignored or dismissed the essential feature of DCRs: they save lives. And this in contradiction of the oft-asserted claim that government policies are based on evidence. (The 2017 UK Drug Strategy uses the term ‘evidence’ 22 times, ‘evidence based’ 15 times). This attitude of casual indifference to the lives of people who use drugs is at odds with the position taken by the UK government in preparation for the 2016 UNGASS, where its own position, in conjunction with the common position adopted by the EU, was one of support for human rights.
In March the ONS published statistics showing the continued impact of volatile substance abuse in the UK, with around 55 deaths per annum attributable to VSA, often in combination with other substances. While data-collection seems to be of a high quality, the response by ministers to this continuing phenomenon and to drug-related deaths more widely could be seen as callous, careless, clueless or incompetent. Or a mix of all of these factors?
September 2017: discovering the joys and frustrations of co-editing a book – a follow up to the themed issue of Drugs and Alcohol Today earlier this year on After UNGASS. Most of the proposed chapters have an author but some are still missing and negotiations continue.
Puzzling to see the succession of documents and responses – finally – emerging from the government AFTER the publication of the 2017 Drug Strategy. Why they couldn’t be incorporated in the strategy is something of a mystery, especially as the strategy under-played harm reduction, but government moved a long way to acceptance of the December 2016 ACMD report’s harm reduction recommendations, including consumption rooms, in its formal response to that report.
July 2017: Along with editor in chief Axel Klein I’m pleased with the content and reception of Issue 2 of Drugs and Alcohol Today “After UNGASS” and the article readings – via DAT and via ResearchGate – and responses which have resulted. One set of responses will be included in Issue 3, now with the printers, to be published in late August. Together with Dave Bewley-Taylor, we are now working on a proposal to publish a book based on the “After UNGASS” themes and content.
The UK government has now published the long-awaited and long-overdue 2017 Drug Strategy. The potential was considerable, especially with the experience, examples, and lessons of UNGASS 2016 available, and the thoughtful and realistic recommendations of the December 2016 ACMD report on reducing opioid related deaths. The result, however, is disappointing, and can be seen as a series of missed opportunities. There is a welcome recognition of some emerging developments in drug use and prevalence, substances and behaviours, and of good and innovative practice, especially in the treatment sector. But overall this is a narrative, not analytic or reflective, document which essentially consists of a ‘more of the same’ approach and does not begin to address the increasingly evident failures and false premises of the international approach and conventions. The existence of the December 2016 ACMD report is mentioned but no response to its content made – although two weeks on from the publication of the Strategy the formal response to the ACMD report seems to have been published. However, blink and you missed it: almost as soon as an announcement was made and the response posted on government web-sites, the document was taken down again. An opportunity to consider the ACMD recommendations in the Strategy was lost and at the moment (July 31) it’s still not clear if the response some of us saw is what will be finalised. The Strategy makes its obligatory references to collaboration and joined-up practice but this doesn’t seem to have been applied to government itself. Back to the drawing board…
Late April 2017: One effect of the calling of the UK parliamentary election will be yet another delay in publishing a revised national drugs strategy. And given the apparent emphasis the prime minister (who used to be the minister responsible for drugs policy when at the Home Office) has placed on Brexit as THE election theme, there seems little likelihood that drugs policies (and other social policies) will get much consideration during the election campaign. Similarly with the December 2016 ACMD report Reducing opioid related deaths in the UK. In answer to questions in parliament earlier this year the government undertook to respond by the end of March. This has not happened – the ACMD has not so far (April 26) received a formal response to this report.
Looking at newspaper cuttings recently I was re-reminded of the comment made by the German journalist Stefan Aust, formerly editor in chief of Der Spiegel. Interviewed by Die Zeit last year on the occasion of his seventieth birthday, Aust was asked if he’d ever smoked cannabis. He said that he had, on two or three occasions in New York in the 1970s, but that he hadn’t continued as ‘it wasn’t his thing’. He added that he could confirm the claim that smoking cannabis led people on to the use of more dangerous drugs: he has been a chain smoker ever since…
April 2017: I am sure I’m not the only one waiting to see if the government will respond to the December 2016 ACMD report on drug related deaths by the end of the month, as stated in answer to a parliamentary question earlier this year. The Home Office has tended to procrastinate in such matters, but the optimists might say that this is the opportunity for a major shift in government attitudes to its national strategy development. (A revised national drugs strategy has been complete since March 2016.) A pessimist would say that this is a pattern of decision making we know from the past, and that it’s possible that civil service resources have been swamped by Brexit. The Department of Health, contributors to drug issues and documents, ‘lost’ 500 civil servants at the end of January. The drugs and alcohol brief at DH has now been combined with sexual health.
Interesting to hear indications from government, specifically the Department for Education, that drug education and sex and relationships education, major components of Personal Social and Health Education, will now be required of schools. What is less clear is what training and resourcing will be available to teachers and schools; and whether this apparent requirement will apply to all schools – local authority, academies, free, faith… And in this context it’s also interesting to read that Mentor has been granted further government funding for its ADEPIS drug and alcohol education work…but that this funding has come from Public Health England, not the DfE.
I’m busy, along with Axel Klein, with the final stages of preparation for the publication of a themed issue of Drugs and Alcohol Today entitled ‘After UNGASS.’ The papers in are informative and illuminating, and most provide good pointers to future activity to build on the outcome document and prepare for continuing movement in what is still internationally a prohibition approach to illegal drugs.
January 2017: It’s been a while…and about time I look at this page again. But where to start?
The three topics which immediately come to mind are NPS, UNGASS and harm reduction. There’s not much new I can say about novel psychiatric substances or the Psychoactive Substances Act from last year – except that with the benefit of hind-sight and history, the then Home Secretary’s decisions to disregard professional advice, including that of the Advisory Council on the Misuse of Drugs, and make decisions which to many seem ill-advised and even delusionary seem now to characterise her practice as prime minister. Decisive actions are unhelpful when they are inadequately informed and, as the PSA seems to be indicating, ineffective in achieving their supposed aims. I recall that the eventual acceptance of the ACMD recommendation to allow drug treatment agencies to distribute foil to injecting heroin users took three years from delivery of the report to home secretary’s signature. And that last spring at an Addaction conference in London Andrew Selous MP, then Parliamentary Under-Secretary of State, Minister for Prisons, Probation and Rehabilitation at the Ministry of Justice, constantly referred to NPSs as ‘lethal highs’, not an encouraging sign of a government with an open-mind receptive to evidence. As Michael Gossop writes in the final sentence of his excellent book ‘Living with drugs’: ‘Drug taking is here to stay and one way or another we must all learn to live with drugs.’
Similarly tardy is the long delay in publication of what was initially promised to be a 2016 revision of the 2010 national drugs strategy for England and Wales. Although an agreed re-write was finalised and, it seems, approved in March 2016 it has yet to see the light of day. Indications are that, like the 2010 version, the revision does not include any reference to harm reduction, clearly a conscious omission which is reinforced by the approach of other government-near agencies. This omission is mirrored in the final documents which emerged from the Vienna and New York UNGASS deliberations and ‘agreements’ in 2016. While the UNGASS documents do represent some moves in the direction of a health and human rights approach, the prohibition ethos remains as the foundation stone of the international conventions – largely, it would seem, to keep the authoritarian and punitive Russian and Chinese governments on board to maintain the facade of international consensus. Here in the UK this can be seen reflected in the retention of the drugs brief by the Home Office – law and order – and not the Department of Health.
It is, though, encouraging to see that discussions about the establishing of drug consumption rooms in South Wales and the Glasgow area are at an advanced stage. Three cheers for devolved administrations, more so in the case of the Scottish parliament for the quality of the reports it commissions on social policy, including drugs, and the acceptance of policy recommendations which are far more evidence-based than those of Westminster governments, including a more nuanced and realistic stance on ‘recovery.’
Closer to home, I continue to enjoy (with the occasional exception of using publishing soft-ware) my co-editor role on Drugs and Alcohol Today, which is currently focussing on a themed issue entitled ‘After UNGASS.’ This has resulted in a series of exciting papers analysing, deconstructing and providing formative responses to the UNGASS process and documents last year.
June 2015: I read that the Norwegian criminologist Nils Christie died on May 27. Amongst other observations he has said: “the most dangerous use of drugs is the political.”
The publication of the Psychoactive Substances Bill will confirm for many that the government doesn’t seem to understand the complexities of substance use and users; drug markets; and the bankruptcy and ineffectiveness of prohibition and legal approaches. And as others, including Release and Transform, have pointed out, whatever happened, in Home Office eyes, to the Advisory Council on the Misuse of Drugs?
I am still involved in Home Office correspondence about the International Comparators report from last October. The latest Home Office letter I received (22 May) still rejects making consumption rooms available and legal in the UK; appears to be in denial about the increase in drug-related deaths last year; and fails to mention recognising the views and suggestions of users as distinct from service users – points raised in my letters.
It was disappointing and a shock to discover that DrugScope has gone into liquidation. Professionally, it will leave a huge gap. Procedurally, it seems to me that more might have been done in March to find alternatives to the liquidation. It’s difficult to know the full story. The only silver lining is the continuation of DrugScope Daily… but I’m reminded of the Ry Cooder line: behind every silver lining there’s a grey cloud….
I have just (January 2015) sent a letter to the Home Office to follow up their October 2014 report Drugs – International Comparators. The report as published gave much space to the drug consumption rooms in Copenhagen, an area of practice I am very familiar with following visits and conversations over the past three years. But there were some major omissions in the report’s coverage, especially around the significance of the mobile consumption room which operated from September 2011, and the role and involvement of BrugerForeningen, the Danish Drug Users Union, in helping to shape and inform Danish drugs policy and practice. I note from UK press coverage that former Home Office Minister Norman Baker, who visited Copenhagen a year ago as part of the preparations of the report, has expressed dissatisfaction with the report since its publication. My own reading would seem to confirm his concerns. I have also sent my letter to UK NGOs, informing the Home Office that I was doing so. Not likely to be a huge election issue, but you never know what goes on behind the scenes.
On the theme of suppressed or distorted reports, I’ve also become aware (January 2015) of the concerns being expressed, ten years down the line, by some researchers and commentators about the methodological and probity aspects of the Home Office Blueprint drugs education and research programme for schools. One comment on the concerns is: too big to fail?
Starting (December 2013) to pass on information and impressions from my late October visit to Copenhagen to see what developments there have been since my January 2012 visit. The initial impression is: what a mess the city is (still) in from the Metro construction – Londoners, think Victoria and Tottenham Court Road stations… And linked to this is the recognition that Copenhagen is something of a boom-town at the moment, with a creeping gentrification in the Vesterbro district, still a geographical focus for many socially excluded people, including injecting drug users, and the site of the agencies set up to work with them.
One such agency is Mændenes Hjem – the Men’s Home – which works with and for homeless men. Its core activity is working with homeless people, and in doing so Mændenes Hjem has expanded its activities as it has become aware of additional needs and service requirements. Most recently it has become the site of one of the (currently) two building-based drug consumption rooms in Copenhagen. When I visited at the end of October all spaces in the rooms were in use – one room for injecting users of heroin and cocaine, the second for those who smoke their heroin. In spite of the busy-ness, the atmosphere was calm and organised, with the users I observed generally following the expectations about clearing up, disposing of paraphernalia, and keeping their distance from other users. Staff checked users’ names – often aliases – and what they were using. In the injection room, there was an increasing use of cocaine. Local professionals commented on the low level of purity of the cocaine available in Copenhagen, an observation reflected by one user I spoke to at length, who commented that if she had known about the fall-off in quality she would have ben a cocaine user twenty years ago… The assessment was that, currently, the best quality cocaine in Denmark is that found in southern Jutland. It’s not clear if the cocaine available there comes from the east of Denmark and Copenhagen, or if it comes from Germany and the south – Hamburg is as close to southern Jutland as Copenhagen.
All of this activity and provision has been set up since June 2012, when the Danish parliament voted for a law permitting local authorities to establish drug consumption rooms. As a result, there are currently two DCRs in operation in Copenhagen, with a third in the process of being converted; one in the city of Odense on the island of Fyn; and one about to open in the Jutland city of Århus. The original vehicle-based consumption room (fixelance: a combination of fixerum and ambulance) continues to operate, now under the aegis of Copenhagn City Council. It was the, at the time illegal, introduction of fixelance which contributed to the change in Danish law.
October 2013: Aware of the retreat from PSHE apparent in the ‘new’ national curriculum, for both sex and relationships and drug alcohol and tobacco education. At the same time as senior ministers talk of the importance of PSHE and what they see as the desired outcomes – less drug use, less sex: these are simple people – the same voices are denying schools and the teaching profession the means to reach those ends, or more realistic and people-friendly ends, such as care, support, attention, looking after, harm reduction, knowing where to go when… Perhaps they don’t really mean it? – a claimed interest in reducing drug use is not supported by the decisions not to introduce minimum unit pricing for alcohol or plain-packaging for cigarettes. The Lancet has recently expressed concern about the government’s public health intentions – and this has, for me, been confirmed by today’s move of Anna Soubry from her post as public health minister. I heard her speaking at last year’s DrugScope Conference and was impressed – she seemed to know what she was talking about, and to have a commitment to her brief. Perhaps that’s why she was moved…?
I’m also preparing for a return visit to Copenhagen at the end of the month, to up-date on drugs policy and practice there. The cue has been an invitation to the twentieth birthday celebration of BrugerForening (the Danish Drug Users Union) but I’ll also be visiting the second drug consumption room (fixerum) there and talking to the people behind the street-paper ILLEGAL. It’s to be sold by drug users to help them to fund their use and to avoid crime and other methods. The paper openly tells its purchasers that any money made by the sellers is likely to be used to buy illegal drugs and has the City Council’s approval. Imagine Boris doing his shtick at a launch of a London version… No, me neither…
Still wondering (July 2013) – or am I just naive, and old enough to know better? Plain-packaging for cigarettes being shelved – that is, not acted on – until the results of practice in Australia are known – should take about thirty years for results to become apparent. Minimum unit pricing for alcohol also shelved. But it’s nothing to do with the presence in the Prime Minister’s office of a lobbyist for the alcohol and tobacco industries. As the sceptical response has it: yeah, right. More bad news for public health.
Disappointing too that the Home Secretary has rejected the advice of the ACMD on khat and has moved to ban it. It continues to puzzle me – and many others – why politicians continue to believe, or to claim to believe, that banning the use of a substance will stop it being used. And what is the ‘message’ that this decision is supposed to give? That there is little or no understanding of all the issues involved here? That the ‘message’ is more important than the impact? That senior politicians are unable to think creatively and with regard to evidence and advice? That the perceived views of other governments are more important than the well-being of the khat using population and community? The recent revelations that the Office for National Statistics is considering reducing or stopping collection and publication of data around drug use suggests that no one in government will attempt to record and monitor the impact of this ban, so we will never know how effective – or not – it is. Will it be acceptable to the Home Secretary if current khat users turn to alcohol…?
And yet: the Home Secretary has also just announced that she accepts the recommendations contained in the ACMD report on the use of foil in treatment programmes for heroin users, subject to conditionality. So some evidence does get heard and accepted – albeit with a three-year delay between report delivery and report acceptance. And there are hints that the Secretary of State for Education may just have got – and accepted – the message about nutrition and learning for school pupils.
Just wondering (May 2013) about the coincidence of the All-Party Parliamentary Group on drugs and the ACMD meetings this month both being on the same day. And interested in the subsequent press coverage of the ACMD meeting. I saw the ‘high lights’ of the proceedings as being: the failure of the Home Office to respond to or acknowledge Council’s report on the use of foil by heroin users, delivered in early 2010; the dis-investment in drug and alcohol services already evident following the transfer of responsibility and complete, but no longer ring-fenced, funding to local authorities as they take over public health responsibilities; the ‘disengagement’ of the Department for Education from cross-Departmental activity around drugs; and the number of ‘new’ drugs reported since the beginning of the year. Not hard to guess which topic the media focussed on, to the exclusion of any other.
Disappointed but not surprised to see that the government is back-tracking on its previous commitments to alcohol minimum unit pricing – this in spite of the compelling results of Tim Stockwell’s Canadian research – and the introduction of plain packaging for cigarettes and other tobacco products. Given the presence of alcohol and tobacco industry representatives on Department of Health working parties, it’s even less of a surprise – and perhaps a ‘surprise’ which was already ‘spoilt’ in 2010 when Andrew Lansley set up the ‘consultative’ bodies. It seems to me that this is a further example of commercial gain superseding public health interests – and in this respect it was significant that the public health minister, Anna Soubry, (who I am reliably informed often travels home after work by bus, continuing to discuss policy matters with colleagues while at the bus stop) appeared to be fighting a rear-guard action when the indications of a U-turn on these policies became apparent. I’m also interested in the argument that minimum unit pricing will affect the pockets and purses of ‘responsible’ alcohol users. By my calculations, using a 50 pence per unit minimum price, a 330 ml. bottle of lager (not super-strength) would cost a minimum of 82.5 pence; a bottle of wine £ 5.25; and a bottle of whisky £ 15.75. I assume (aha!) that the majority of ‘responsible’ drinkers choose quality drinks. I can’t see how that pricing would increase the costs of ‘responsible drinking’ – and it’s certainly more than pub prices. Yet another excuse, it seems to me. And I wonder when we’ll first hear public arguments along the lines of how much longer will the irresponsible use of illegal drugs be used as a brush to tar all users, including those who use responsibly…?
I’m also disappointed, but once again not surprised, to see the many claims by government and ministers that sexual behaviour and attitudes still need to be changed, with various references to domestic violence, objectification of women, trivialising of sex and sexual behaviour, ‘consent’ and, spectacularly, the current spate of revelations of on-going sexual abuse by public figures. In the face of this hand-wringing, Michael Gove’s Department for Education (education for what…?) maintains a steadfast refusal to countenance PSHE becoming a statutory teaching requirement in schools, and the proposed national curriculum science outline reduces the content which can be seen as contributing to sex and relationships education. There seems to be a failure (deliberate?) of those currently with the power – and responsibility – to do so to act on the need, and to undermine PSHE in general, sex and relationships education in particular. This is a characteristic of government, not parliament, where debate and consensus are reaching high levels of quality and informedness. In spite of this, the relevant minister and ministry refuse to act. This is a situation where some in government are requiring or expecting the ends while at the same time not providing or even obstructing the means. It would appear that staff at the Home Office and the Department of Health are increasingly frustrated by the lack of response of their DfE counterparts in such cross-departmental topics, aggravated by DfE failure to attend relevant cross-departmental meetings.
Still thinking through, and thinking on, my February trip to South Africa, both the country and the work I was doing there – presenting a workshop on monitoring and evaluation to the staff of a community development programme – The Thoughtful Path – in Munsieville Township, on the outskirts of Johannesburg. Professionally, it was an extremely positive experience, with plenty of involvement, questioning and discussion. And the learning and making extra sense of the in-puts was being acted on from Day Two (of three…) of the workshop. Personally, it was fascinating to have a glimpse of, to me, a new country and set of contexts. And what an opportunity – to visit a second country in transition, Russia being the first, and to be able to do so with local insights and a great sense of purpose.
February 2013: Pleased to see that the recommendations of the ACMD working group on khat include retaining its status as a substance not classified under the Misuse of Drugs Act…and interested to see if the Home Secretary accepts this recommendation. I attended one of the evidence gathering sessions of the working party and noted the range of views brought to the working party’s attention; and that these were often contradictory. It seems to me that the Council’s recommendations are sensible and pragmatic – and they make a welcome change from the succession of ‘ban it’ recommendations the Council has recently made with regard to new psychoactive substances and/or their precursors.
Increasingly puzzled and angered by the lack of progress in the Government’s and the Department of Education’s supposed consideration and review of PSHE. While many Ministers make statements and comments about the desirability of certain attitudes and aptitudes amongst young people – ‘what’ – there has been a consistent refusal to make the link with the ‘how’ – ways in which many of these attitudes and aptitudes can be supported and strengthened through work in schools. I and many colleagues have long wondered why this Government has not accepted or adopted the findings and recommendations of the 2009 Macdonald review of PSHE – and indeed whether they are even aware of its existence. The knowledge of PSHE and drug education demonstrated by a DfE spokesperson at a Mentor seminar late last year was depressingly poor, and their attitude casual and almost dismissive.
Absorbing the information and implications of the November 2 ClubDrug Clinic seminar at Chelsea and Westminster hospital; and yesterday’s DrugScope Conference ‘A question of balance.’ Both detailed the selection of new substances and changes in ‘drugs of choice’ now emerging, which confirm the shift away from sedative to stimulant drug use amongst some drug using populations. Official responses are mixed: the ACMD seems to be concentrating on identifying and then banning both new psychoactive substances and legal highs when they are deemed illegal, whereas bodies like ClubDrug Clinic are working on a cross-disciplinary and cross-sector (statutory and voluntary) response to the emergence of new using patterns – and populations – and their needs. This includes providing an amalgam of drug and sexual health service, background and in-put, which is relevant and appealing to a very specific population. The responsiveness of the NHS, London Friend and Antidote seems to me to be a model of good practice. At the DrugScope conference it was heartening to hear Roger Howard of the UK Drug Policy Commission making the link from the drugs field to the established findings of social epidemiologists and others, including Richard Wilkinson, Kate Pickett and Michael Marmot, of the strong – causal? – links between income inequality within a country and the ‘health’ of that country and population – size of the prison population, prevalence of mental health problems, rates of inter-personal – including domestic and sexual – violence, levels of problematic substance use. Good to see the drugs field starting to make the connection, which has implications for how ‘up-stream’ policy responses need to be, even if a little belated…
And congratulations to Denmark’s BrugerForening (Danish Drug Users Union) which celebrated its 19th. birthday on November 1. at an event attended by MPs and a Minister, amongst others, and whose BrugerVen (Users’ Friend) award for 2012 went to Fixelance, the NGO who pioneered the mobile consumption room in Copenhagen which has led to Danish law permitting (since June 2012) the establishment of consumption rooms in Denmark. See my DrugLink articles for more…
March 2012: Saddened and disappointed by an exchange with a lecturer at the Institute of Education. I had been at a book launch – Stephen Ball’s ‘Global Education Inc.’ – which described how much, globally, education (and other social policy) was in the hands of private (i.e profit-taking) organisations, dressed-up as ‘philanthropic’ or ‘social enterprise’ Foundations and Trusts. This is increasingly taking control of social policy away from governments and states and transforming them into clients and customers, ‘buying’ the policies and services being hawked by international organisations which, to me, seem to be a way of selling to national governments solutions to the social issues and needs which the same neo-liberal organisations have in large part been responsible for creating. Good business….one of the launch quotations was ‘doing good by doing well’ – i.e. providing solutions [to problems we have created or exacerbated] and making a profit from doing so. As if to demonstrate the power and prevalence of this thinking, I saw a former IoE lecturer after the launch, who told me that he was busy training schools who wanted to become centres of learning. When I expressed scepticism at the value of turning schools into teacher training institutions his response was that he was personally benefitting from it. Forget ethics and professionalism…
Digesting and reflecting on the interviews and discussions from my five days in Copenhagen at the end of February. Thanks to the introductions and recommendations of Michael Jourdan, I was able to set up five conversations and interviews with individuals and organisations active in the drugs policy field. The results were fascinating and informative, and all those I met were generous in their time and willingness to provide information and answer questions. The quotation I had found before my journey which provoked smiles and nods of assent – and of resignation – was that of the Norwegian criminologist Nils Christie: “The most dangerous use of drugs is the political.” Now I have to distil my experiences and conclusions into 1500 words for an article to be published in DrugLink, probably in May. Yes, the furnishings and decor are as cool as the TV dramas suggest (The Killing and Borgen) – next time you’re there have a look around Illums Bolighus… No, I didn’t see Sarah Lund, in character or in real life. (Michael Jourdan is the editor of the Danish journal Stof – it’s about what it looks like – we met in 1999 (and have kept in touch since) when I was stopping off in Copenhagen on my way to Moscow for Project HOPE work and attended sessions of the Young People’s sub-committee of Narkotika Råd – The Drugs Council – while it was still in existence. See DrugLink for more….!)
February 2012: Taken aback by the extent of changes to education and health provision which the Conservative-led coalition has been introducing. I’m above all shocked at the thinly-disguised attacks on the public sector, especially education and health, and the accompanying dismissal and criticism of services and professionals, and their principles, skills and expertise. We were here before in the 1980s…. More specifically, I’m trying – not alone – to make sense of the responsibilities which free schools and academies will have for promoting and supporting young people’s development – for implementing PSHE principles and programmes. And so far I am not encouraged or reassured.
The light relief for me will be a working trip to Denmark later this month to look at drugs policy, particularly around cannabis regulation and the provision of injecting rooms. These topics will be familiar to anyone who keeps up to date with postings on the Hungarian Civil Liberties Union’s web-site. The arguments for both seem clear and well established – what I hope to discover more about is the extent to which a political consensus has been established and how far the necessary legislation has progressed. Watch out for my article in a summer issue of DrugLink. And for sub-titled TV fans, remember the references by the fictional Copenhagen politician Troels Hartmann in ‘The Killing’ to ‘fixerums’ – injecting rooms, mis-translated in the sub-titles as ‘drug dens.’ A case of fiction being very close to fact in this instance.
Surprised that it has taken me so long to return to this page to up-date it… My first thoughts this week (January 2011) reflect new colleagues and interests following my visit to the National Institute for Drug Prevention in Budapest in November. News this week suggests that the Hungarian government is reconsidering its approval of the previously established national drugs strategy, developed in co-operation with the EMCDDA and other international bodies using an evidence-based, scientific approach. This, it seems, is not to the liking of the new (2010) government. For both professional and personal reasons, I hope that this does not result in a retreat by a national government from evidence based drugs policy making: there’s a worrying comparison to be drawn with governmental policy and attitudes in Russia. The strength and successes of evidence-based policies, including harm-reduction approaches, were well illustrated by Gerry Stimpson in November, when he gave the first Alison Chesney and Eddie Killoran Memorial Lecture at the London School of Hygiene and Tropical Medicine.
Along with many colleagues and organisations, I have been shocked by many of the public health and health promotion and education measures announced by the new UK government. Much of the progress and acceptance – and, crucially, funding – of PSHE and SRE which we were able to enjoy in the last years of the Labour governments has been called into question. Although the ‘official’ reason frequently given has been that there is no proof of the effectiveness and impact of those interventions and initiatives, it seems to me that it’s not possible to make such judgements without having seen through and evaluated the interventions. This, then, says to me that the decisions have been made for ideological or whimsical reasons and not on any evidence-based judgement or assessment. It’s especially strange given that so many of the interventions being questioned, closed down and un-funded have been those aimed at changing the situations from which Prime Minister Cameron made so much political capital in pre-election references to ‘broken Britain.’ Strange, then, that when in government existing work responding to some of the aspects of ‘broken Britain’ – for example, teenage pregnancy – are being closed down. There’s a worrying parallel here with my Hungarian reference of the closing down of advisory and specialist bodies and organisations, using the camouflage of bureaucracy, resource saving, accountability and vested interests.
My own recent work has illustrated some of these tendencies. At the end of 2009 I had some direct personal experience of management styles and psychologies, both negative and positive. It was disappointing to reflect on the negative example, and to realise that for some managers (and Ministers?) it’s the exercise of power that is the driver for their practice, not the quality or impact of the work for which they have a responsibility (why did you do that? because I can…) Like the closing down of advisory bodies by government, there’s still in some quarters a conscious ignoring of evidence, experience and history. I’ve recently become interested in the concept and practice of work force development, seeing it initially as an interesting and effective way of adding to work-force skills and knowledge and changing professional cultures. My role as a tutor on the PSHE Certificate course for teachers for four years gave me some insights here, as did last year’s involvement in the Liverpool John Moores University-led project to develop European Quality Standards for drug prevention. From these experiences, I’ve developed my view that work-force development needs to include those at the top of hierarchies – politicians and decision makers – as well as the practitioners who are those usually expected to take part in work force development and seen as being in need of it. Listening to an education Minister at Womankind Worldwide’s November conference Freedom to Achieve reinforced my view – and, increasingly, experience – that those making the policy and strategy decisions, and the resultant demands on practitioners, often do not fully understand the issues they are responsible for. The Minister’s commitment to work combating violence against women and girls was clear and encouraging, his understanding limited and populist, poorly informed and simplistic.
The two relevant UK white papers for my area of work and interests – Healthy Lives Healthy People and The Importance of Teaching – both refer to PSHE and SRE, but with differing emphases. The DH white paper has more content about PSHE than the DfE, which suggests some differences of opinion and emphasis between the two Departments. It’s noteworthy that the DfE white paper refers to consultations about SRE and gives a list of those to be included in any consultation – a list which omits young people. It’s also intriguing that there appears to be no acknowledgement of the results of the reviews of PSHE, SRE and drug education which took place in 2009. This could give the impression that the present set of Ministers do not know of these reviews (unlikely) or that they are choosing to dismiss and disregard them because they were commissioned and carried out by a different government. So here’s hoping that Chris Bryant MP’s Ten-Minute Bill does get though parliament to make good some of the trade-offs in March – April 2010 which lost the clauses which would have made the provision of PSHE and SRE a statutory requirement for school and entitlement for pupils. I have on my shelves a book about UK attitudes to sex and relationships education called The Ostrich Position, which describes the current situation well. It was published in 1986…
November 2009: Seeing once again the conflict between knowledge and ideology being displayed by the sacking of David Nutt as Chair of the ACMD – not the first time I have referred to the ACMD here; and the instant, knee-jerk rejection by Government of the Robin Alexander report on primary education. So much for evidence-based practice – or am I being naive in believing that it ever meant anything…?
Pleased, nevertheless, to see that the recommendations that PSHE become a statutory part of the school curriculum have now been endorsed and acted on by government – and noticing the back-lash from some organisations and voices which seem not to be aware of the real situations and needs of young people and want to deny them knowledge and opportunities to openly discuss sex and drugs. Duh. Perhaps deny and denial are the key words here…. So congratulations Ed Balls, you have got something right. As for the opposition voices: people like myself need to recognise that these views will always be present and that we need to be prepared to counter them, however tempting it is to wish that the debate might have moved on in the last twenty five years. My objection remains that such voices claim to speak for others and all when this is clearly not the case. I have been struck by recent meetings with parents in Tower Hamlets schools where individuals have expressed their opposition to sex and relationships education saying ‘we’ and have been challenged by others present, saying that the views being expressed are those of the individual concerned and do not represent everyone at the meeting.
I’m buzzing after my first (October) trip to Samara – at the evidence of good practice in schools and sexual health services, at the interest of professionals in developments in the UK, at the concern for scientific (i.e. evidence-based) programmes, at the willingness to listen and learn – in contrast to the suddenly changed climate in the London local authority I have been working with for some years – and the invitation to do some work with the social sciences department at the university. And at the high-level of skill and ability in translation and interpretation, which enabled some warm and in-depth interactive working during the seminar proceedings.
April 2009: Drawing breath after a busy nine months personally and professionally, and coming to terms with new hard and soft ware following a major IT failure in October 2008. Much has happened but some of it seems to be the same old same old…
The damage which can be caused by alcohol is being increasingly recognised and acknowledged, but the actions open to government, particularly around pricing, have been shied away from. Evidence based policy…?
The advice of the ACMD has again been dismissed by government, this time on the classification of ecstasy. The new characteristic of this dismissal was the public dressing-down by the Home Secretary of the ACMD Chair’s legitimate and statistically justified observation comparing the fatalities associated with ecstasy use and those associated with horse-riding. Evidence based policy…?
The ‘big’ news in the education and schools sector is the decision announced last October that sex and relationships education and drug education will become statutory requirements in schools’ teaching programmes – in September 2011.
I am maintaining my professional contacts with colleagues in Russia, and have begun preparing for a locally-funded project in Samara local authority to plan and implement a programme of sex and relationships education in schools there. This promises to be an exciting and rewarding challenge. My first visit is arranged for September 2009.
I am enjoying the widening of perspectives and need for work discipline and good time-management presented by peer reviewing of articles and book reviewing. The worth-while books are expensive for a private practitioner – long live libraries.
Especially in the light of the ‘credit crunch’ and what I see as the failure of the Anglo-Saxon economic model, I am frustrated by the apparent lack of recognition by the Gordon Brown’s of this world of the findings of the social epidemiologists, most recently in Wilkinson and Pickett’s book ‘The spirit level.’ Once again, it would seem, ideology is trumping evidence, and in a particularly damaging and careless way.
…interested to read the revived publicity being given to academies and what would appear to be misrepresentative and misinformed claims for their success by government – but no longer surprised to see evidence again being trumped by ideology and ‘conviction.’ This observation remains constant, in 2008 when first written and in 2009 when re-visited.
…experiencing a sense of schadenfreude on reading of the growth in inequality under New Labour, a process I hasten to add that did not start in 1997 but has been an inevitable result of the macro-economic policies pursued by successive governments for the past thirty years. So much for the Anglo-Saxon models – of economic and cultural and social policies.
…disappointed but not surprised that the Government has not accepted the ACMD’s recommendation that cannabis remains a Class C substance. And struck by the Home Secretary’s comments about the linkage between cannabis use and mental health – as if the ACMD had not taken this aspect of cannabis use into account in its evidence collection and decision making. So much for evidence based policy…
…interested to note that in his twenty-minute presentation at the Drugs and Alcohol Today event in London on May 1 Vernon Coaker referred to drug use and to substance use but did not specifically mention alcohol. In reply to a comment from the floor he claimed that his brief did not specify alcohol – a somewhat faux-naif response in the light of his Home Office responsibilities, which include, we were told when he was introduced, ‘drug and alcohol misuse.’ Once again: so much for evidence based policy…
…following the autumn and spring discussions on the reclassification (or not) of cannabis and the role of the ACMD with a mixture of interest, amusement, disbelief, puzzlement and disappointment – the latter at the lack of honesty and knowledge of some contributions. At least I’m getting value for money when I buy a newspaper (I’m very old-tech – newspaper, buying ….) or switch on the TV
…educationally, recognising from my experience, past and present, the numbers of reports and survey results which suggest that in the UK education is not, at present, a force for social change or advancement; and that educational achievement remains largely determined by an individual’s class (i.e. socio-economic) origins and family background
…aware of the growing ease with which alcohol can be obtained – also when most shops are shut. Home delivery services are becoming established, as they have been for some time in Spain. ‘Availability’ is the name of the game, it seems, for legal and illegal substances.
…relishing a holiday (August 2007) conversation with Danish colleagues in a car park in Torshavn, the capital of the Faeroes, about drug and alcohol use and the Danish Center for Rusmiddelforskning based at Aarhus university. The car park was that of a car rental company, none of whose cars were locked, the conversation passed the time waiting for the office to be opened on a Sunday…
…continuing to extend my understanding of the role of national income distribution as one cause of poor individual and social ‘health’ – with acknowledgements to Richard Wilkinson. This has been heightened by the August 2007 media stories about City bonuses and executive pay – disproportionately higher than in Germany, lower than in the US – and its ratio to average pay in those companies.
…pleased to see that the July government teenage pregnancy stats., which include 2005 figures, indicate that the reduction in conceptions amongst under 17s resident in Tower Hamlets, where, with local authority colleagues, I am working with schools and parents on the provision of sex and relationships education for 5 to 16 year olds, has continued. Were I a politician I would claim that the Teenage Pregnancy Strategy is working. As a reflective practitioner, I am more cautious – but definitely encouraged.
…enjoying the memories of a June break in Florence, where I realised that the UNICEF research centre which publishes the Innocenti reports is based in a former hospice for foundlings – hence the name.
…interested to read the Lancet article (June 15) reporting on the high incidence of alcohol-related deaths in Izhevsk, Russia, a city which I visited in December 2006 and where the public health statistical over-view reported ‘poisoning’ as a major cause of death.
…contributing to the end-of-Blair evaluation with a four-liner in the Guardian (May 14): ‘Mr Blair believes “this is the greatest nation on earth.” Did he read the UNICEF report “Child Poverty in Perspective” published earlier this year?’
…continuing discussions with colleagues on the future of drug education following the publication of UK government and NGO reports which have questioned the role and impact of drug education as a prevention tool
…working on a lower secondary school drug education project in S London, with the lesson piloting now completed. ‘Back to the drawing board’ for a final version of the lessons before materials are prepared and made available to schools and a training programme for staff introduced.
…revising an article comparing drug education and sex education – and seeking a publisher or editor
…with colleagues from the Healthy Schools Team, planning for the next PSHE CPD programme in Tower Hamlets, using our experience from the first three years