News

August 5 2024

At the end of July I drove a car donated through the ULEZ to Ukraine scheme to Lviv, western Ukraine. This was organised by Britsh-Ukrainian Aid. Friends contributed to a fund to cover the costs of the outward journey. This is my reporting-back letter to the donors and supporters:
Back at home I can catch up with some correspondence and good intentions. First of all, a big thank you to you all for your contributions and donations., and expressions of concern. My personal thanks were echoed on a bigger scale on Thursday July 25, when Ukraine’s ambassador to the UK thanked the drivers and organisers of the vehicles which were about to leave London for Ukraine. It was clear how important the event and commitment represented are, and the solidarity and support which all involved demonstrate(d). Amongst the vehicles in that convoy were two ambulances and a single-decker London bus, representing the involvement of the Greater London Authority through the donation of vehicles as part of the ULEZ scrappage scheme. Also a big BMW motorbike… Similar thanks and acknowledgements were made at a reception ceremony in Kyiv on July 30. I didn’t attend that ceremony – I left the car I had driven (a diesel engined Ford C-Max) in Lviv (get your atlases out!) on Monday July 29.
I returned to London at 1.10 a.m. on Friday August 2, taking my time to get back. The whole experience was both satisfying and sobering. We were about 25 vehicles in the ‘convoy’ – not all of us travelled together – and on the journey and in Lviv I noticed other vehicles from Germany, Austria, Poland and Lithuania doing similar trips- Lithuania is particularly vulnerable to potential future Russian military aggression.. In Ukraine I also noticed a Copenhagen bus which had been donated. I wondered if it was being used to ferry people from Ukraine to the border. Ah, the border… I had heard stories about the border crossing and was a little apprehensive about my experience. I crossed from Poland into Ukraine in two hours, which I understand was quite good going. It could have been shorter for me if there hadn’t been a confusion on the Polish side between the letter O and the number 0 in ‘my’ car’s registration. My return was less felicitous. I travelled from Lviv to Krakow by FlixBus and then on to London by plane. Train tickets require advance booking and are long sold out so I had to settle for the bus. The service I was on was scheduled to leave Lviv at 12.45 (it did) and arrive in Krakow at 20.00. We finally arrived at Krakow bus station at 02.09 on the Friday. The exit to the city was locked, as were the men’s toilets, not a brilliant combination. The taxi rank was empty. I walked across the forecourt and lo and behold a smart black Mercedes cab appeared out of nowhere and took me to my hotel. In the event, it took eight hours to cross the Ukraine-Poland border, a situation I had been warned was possible. The whole process was slow and thorough. Once at the check points, which took more than six hours of queuing, we all had to get off the bus with our luggage for an exit check at customs – there is a concern on both sides of the border to prevent weapons smuggling – and passport control. Fifty metres on and the same at the Polish side of the border – take your luggage, get off the bus, luggage goes through an air-port style scanner (as it did on the Ukraine side) – and have your passport checked and stamped again. Then wait for the bus itself to be checked and pull forward before we could get back on and drive off. Observation: the toilets on the Polish side are better than on the Ukrainian side. Border guards on both sides carried hand guns, some of the Ukrainian border guards carried long-barrelled weapons and deployed dogs. My bus had come from further south in Ukraine before it called at Lviv. The same driver took the bus to Krakow. He was at the wheel from at least 12.45 Thursday till 2.10 Friday and continued to Katowice. He wasn’t driving all the time but….
When I left London there was a mix up about ferries. I finally got to Dunkirk at 1.00 a.m. on Friday and drive thought the night – adrenalin. I had a couple of rest breaks lying across the back seat of the car. Driving in Belgium was helped by road signs which showed route E40, which I followed all the way to the Poland-Ukraine border. I stopped over night in Giessen, between Köln and Frankfurt in Germany, in a hotel in the city centre. I slept for two hours in the afternoon, had a shower then went to eat. The guy on reception spoke excellent English (he had been a sous chef at the Dorchester) although I also managed well with German, which we favoured in our conversations, and walked me to the street corner where he pointed out a restaurant specialising in local (Hessen) cooking. It was cantarelle session, reflected in the menu choices. A good ten hour sleep, then off again.
I made it to Poland on the Saturday, staying in a small town called Opole, a little east of Wroclaw. It was elusive ! but I was rescued by a group of English-speaking twenty-somethings at a petrol station who set me up with my hotel destination using Google Maps and GPS. This was a first for me (but not Sue) and it worked perfectly. Opole looked fascinating but I only had time for an hour walk around late in the evening to stretch my legs. One downside of the drive was passing places I would have liked to stop at, including one sign on the autobahn in Germany saying that this spot marks the former border between the Federal Republic and the German Democratic Republic, west and east Germany. The drive through the south eastern part of Germany, Saxony, took me through some attractive landscape and numerous towns of historical and architectural interest (or so the road-side signs said) – castles on hill tops, industrial and mining museums, Goethe’s town of Weimar, also of the 1920s Republic, former concentration camps…. For much of this stretch of the journey there was little other traffic and I was able to drive at 100 mph for sustained periods, which helped to cover the distance.
The autostrada (as they are called) in Poland were/are of excellent standard and quality – EU funding? – and the E40 indicators returned – they were often absent in Germany – and I was able to make good time to the border. The quality of the ‘food’ on offer at services in eastern German and Poland was poor. It was filler rather than food… One overall observation in all countries I drove through: there are HUGE numbers of big lorries on the European motorway system, and even more parked up. Once across the border into Ukraine I followed the M11 to Lviv – this is a road number and by no means a motorway, as I had first naively anticipated – and then a GPS route sent to me by British-Ukrainian Aid in London to the house of an organiser’s friend, who put me up for the night on Sunday. He took me to a, in his words, typical English pub (the Black Cat) the next morning for coffee – his is a non-coffer household, which some of you are aware could have been problematic for me! It was a nice enough bar/restaurant but would not really be recognisable as an English pub to most of us. Still with the car, I used GPS again (I’m a convert!) to visit a Rehab centre. When I was still editing at Drugs and Alcohol Today I helped publish a paper by a senior staffer at the Ukraine Alliance for Public Health. By chance, they were at a funders’ seminar in London at the beginning of July and I re-established contact. The leader of the Rehab centre in Lviv was also there and invited me to visit when/if I did the drive. So I did. The rehabilitation referred to is for those who have lost limbs or have other disabilities restricting their mobility and are fitted with prosthetics. This includes developments in the technology and design of prosthetics. One focus is enabling mobility so that individuals can travel around the city – which has included discussions with bus manufacturers – and be visible, not isolated and out of view. (One of my experiences when I was working with Project HOPE and they did a study tour to London were the comments that disabled people and people with e.g. visual impairments were publicly visible and not, as they were in Russia at the time, isolated from others). At the moment, it’s all veterans who attend the Lviv centre, which has a residential capability. I had a small reception committee and a lengthy guided tour. Much of the tour guidance was by a former helicopter pilot who had spinal injuries and brain contusion and was in a wheel chair. He received his injuries in 2014, a reminder of how long Russia’s assault on Ukraine has been going on – that’s when The Little Green men annexed Crimea and occupied pars of eastern Ukraine and the Donbass, home of heavy industry, coal and other minerals, including rare earths. Protecting the interests of Russian speakers in eastern Ukraine is an excuse and propaganda, the real basis for that intervention is economic. The centre leader followed up some discussions we had started in London in July, about interventions intended to help drug users to recognise their situations and, perhaps, begin to change their behaviours. It was good to be on familiar professional ground and feel able to contribute! Back in London I had my final consultation at St. Thomas’ with the orthopaedic consultant whose team treated my ruptured tendon last October. The team also do work on prosthetics and he has agreed to have his details sent to Lviv for possible cooperation and collaboration. Rehab currently has close professional links with services in Czechia, the Czech Republic.
The centre leader found me a hotel to stay in for the next three nights, on the central market square, and I then GPS’ed it to the parking lot where the donated vehicles were being assembled for driving further east, an option I declined. I had found the driving demanding, sometimes hypnotic and even hallucinogenic – when I was on the plane home someone walked down the centre aisle holding an illuminated mobile phone and I had a quick thought that I was being overtake, even though it was on the wrong side -and didn’t want to do more. I stayed in Lviv resting and relaxing and, so to speak sight seeing – Sue and I had been there in 2018 – until the epic bus journey on Thursday August 1. I failed to find any live jazz, but some of the places I stopped off at had jazz as background music. For the whole trip, coffee was consistently excellent.
Signs of war? I didn’t see any bomb or missile damage in the city centre but there have been attacks – missile strikes – on Lviv. On advice I had down-loaded an ‘Alert’ app onto my phone, which works phenomenally well. There was one air-raid alert during Monday night, followed by an all clear about twenty minutes later. There was a second air raid alert on Tuesday afternoon, when I was visiting an art gallery in the city centre. We were ushered out of the building and I stood the central boulevard, Svobody Avenue, watching all who were there, including youngsters playing in the fountains in front of the opera house, taking no notice at all. The all clear came, again, about twenty minutes later. This was the day when there had been an intense missile and drone attack on Kyiv. The quieter signs of war were the young men of fighting age who were in the city centre missing a limb, fitted with prosthetics. There are many trees in Lviv, sometimes singly, sometimes in groups, sometimes in rows, bearing the names of fallen fighters. In the city centre I also saw a couple of groups of soldiers getting ready to return to the front line, or so I assumed, in Land Rover-type vehicles in camouflage paint and with Ukrainian and red and black flags indicating, I think, army. One such group was outside the garrison church in the city centre. On my final day, outside the garrison church, I saw a group of soldiers in camouflage fatigues and holding single red flowers waiting for a funeral service.
I’m pleased and proud to have done the drive and delivered a useful vehicle – it was a large-ish saloon which ran beautifully, and will be of great use and value to local resources – that’s really the point. I wouldn’t do it again – I found the whole experience challenging and demanding, but I was driving solo. And as some have reminded me: I’m not 25 any more… And I’m pleased to be back home.
Thanks to you all again.
Slava Ukrainii!

May 2024

Watched the TV series shown on BBC TV Dope Sick directed by Barry Levinson and then read the book Empire of Pain researched and written by Patrick Radden Keefe. Both are about the Sackler family, Purdue Pharma, the opioid oxycontin and the US opioid deaths epidemic. Empire of Pain looks at the longer history of the Sackler family and Purdue, Dope Sick focuses on oxycontin. I watched and read with a growing sense of disbelief and anger, at the greed and mendacity of the Sacklers and the slowness of response by the US Food and Drug Administration and the Drug Enforcement Administration. The denial, wishful thinking, disinformation, misrepresentation and corruption, not to mention the death toll, described are shocking and left me incredulous. As did the attitudes and callousness of the Sacklers – whose name is still inscribed on the floor of the recent extension to Dulwich Picture Gallery. I was also reminded of UK attempts to instill a duty of candour into the workings practices and cultures of health staff here.

January 2023

The state of retirement is still for me one of limbo. No longer actively engaged in work or projects, I’m finding it difficult to do a ‘big bang’ retirement and cut off completely – the field is too interesting! I haven’t unsubscribed from bulletins and newsletters, still participate in webinars, try to keep up with developments. And the paper I write on the UK 2021 drug strategy has been re-submitted, rewritten, after an initial rejection on the grounds that the topic was ‘old’ and the content added little to what had already been said and written. The rewrite benefitted from some helpful feed-back from colleagues – but not the journal to which I initially submitted: don’t editors give formative comments and feedback any more?

The re-write also benefitted from autumn statements by ministers which appeared to cast doubt on the commitment of additional/enhanced treatment and recovery funding beyond the initial three-year period. The situation around levelling up funding does not bode well for social spending, neither by distribution nor amounts. But the hot-spots identified in the strategy do seem to be more objective than the skewed funding allocations for levelling up, which clearly favour parliamentary seats the government would like to retain at the next election. Other statements attributed to the home secretary indicate either an ignorance of, in this case, drug issues – cannabis described as a gateway drug – or a deliberate confrontation with evidence and expertise – ah yes, evidence, the key claim of the strategy…. I’m not sure which is worse, ignorance or confrontation, but neither seem to me to be fitting characteristics for responsible government, which should have the interests of all in the country at heart. Or am I missing something…?

December 2021 up-dates.

I will be stepping down from my role as co-editor of Drugs and Alcohol Today at the end of the year. My thanks to Axel Klein for the initial invitation to take up this post in 2014, and for the events and experiences which the role introduced me to. Thanks too to the authors and peer reviewers I have worked and communicated with for their expertise and commitment, all of which have been shared on a voluntary basis. I know full well that for many in academia, publication is an important career booster but many of these colleagues have, in my experience, gone beyond basic expectations and demonstrated great collegiality, thoughtfulness and generosity of time. This has been especially so with guest editors; I have enjoyed extended correspondence and exchanges with many of them which have added to my knowledge and awareness of the field. There have been many recent comments from colleagues about the part Axel and I have played in establishing DAT as an important journal and contributor to the knowledge and science of drug and alcohol issues, from both practitioner and policy making perspectives.

Contingent on this move is my resignation from the International Society of Addiction Journal Editors Board. I have been pleased to collaborate with other Board members in up-dating some parts of the ISAJE guidance. I leave ISAJE at a time when it is, I think, discussing the appropriateness of the terms ‘abuse’ and ‘addiction’, still much used in journal titles. Given the stance ISAJE has recently taken regarding the role of tobacco industry funding in publishing, I wonder how long it will take for similar interrogation of the motives and expectations of the US National Institute of Drug Abuse in its funding of journals, authors and university departments: NIDA seems to me to continue to act as a front for the prohibition agenda of the US government and to cause some self-censorship in academia.

The early December news from the UK is the publication of a ten-year dug strategy, From harm to hope. My initial reading of this document (hindered by the lack of page numbering, several blank ages, and a contents page which doesn’t tally with the contents) is that it is big on ambition, less so on detail: there is much what, little why or how. The announcement of additional funding for drug and alcohol treatment is be welcomed, as is the allocation of this additional funding to local authority public health budgets rather than the creation of new structures to serve a central government initiative. The strategy claims credit for accepting some of the recommendations of the review of UK drug policy and practice included in Dame Carol Back’s reports, including the expansion of treatment capacity, but does not acknowledge that the under-funding has been a direct result of government policy over the past eleven years. This has been paralleled in the under-funding of child protection services high-lighted by the death this year through abuse and neglect of a six-year old boy and the phenomenon of ‘gangs’ which may be seen as filling the void of social and peer activities which previously existed through comprehensive youth services and venues, SureStart centres and a host of other support and care provision, lost to us as a result of the austerity policies of Conservative-led governments since 2010.

From harm to hope promises ‘a new approach’, ‘new penalties for drug users’, a reversing of ‘the rising trend in drug use within a decade’, a reduction in ‘drug-related crime, death, harm and overall drug use’. There is no specific reference to heroin-assisted treatment or to drug consumption rooms; or to local initiatives from Police and Crime Commissioners. There is little new in either the content or the intentions of this strategy: the creation of multi-agency local partnerships was first proposed in the 1995 national drug strategy. There are references to harm reduction, a welcome contrast to the 2017 drug strategy. There are frequent references to research: these are considerably under-mined by the vagueness and irrelevance of other content and the failure to acknowledge previous practice. The footnotes to the Strategy are mainly to government publications, essentially data-collection, not analysis. There are no text or footnote references to the ACMD or (surprise!) the EMCDDA as sources of research and indicators of alternative policies and practice. Recommendations of the UK’s own ACMD, including on khat in 2013 and opioid-related deaths in 2016, were rejected and ignored at the time. The ACMD was, it seems, neither consulted nor involved in the Psychoactive Substances Bill in 2015/16. The conclusion to be drawn is that UK governments are not willing to listen to and act on research and evidence which they do not like or which does not fit preconceptions. The claims of ‘evidence based’ practice and policy are far from convincing.

International research partners and collaborators mentioned are FiveEyes, a military intelligence alliance of nations in the English-speaking world; the United Nations Office on Drugs and Crime, which still maintains a prohibition agenda; and the UN Commission on Narcotic Drugs, the governing body of UNODC. The 2019 CND meeting which I attended was notable for the high proportion of participants at the initial ‘high-level’ sessions wearing military and law-enforcement uniforms. This session of CND spread over seven working days, with inputs from governments, professional bodies and civil society organisations, providing a range of views, opinions and evidence on drug-related topics. None of this debate was incorporated into the final statement or communique of the session: this had already been announced at the opening session on the first day. The strategy’s references are a collection of misplaced links – I did wonder at times if the authors of the strategy knew anything about drug policy – and follow the orthodox prohibition, ‘war on drugs’, agenda and approach which has demonstrably failed. So it’s puzzling to see the prime minister claiming in the 2021 strategy that ‘the old way of doing things isn’t working’ (page 3) when the references to research are very much in line with ‘the old way of doing things’.

There appears to be a genuine belief in From harm to hope that it is possible to create a ‘drug free’ society in the UK, in spite of all the evidence and example globally and since the 1920s. that striving to achieve such an aim is expensive, damaging, futile and enormously wasteful of human lives. Flying in the face of such history could be seen as yet another attempt by a national government (it’s not just a UK phenomenon) to avoid examining causes and instead concentrating on symptoms, and of distracting government energy and resources and public attention from underlying societal needs and their causes which governments may feel unable to acknowledge and may, at bottom, have no idea how to respond to.

September 2021 up-dates.

From September 2020 I have been a Board Member of ISAJE, contributing to guidance on journal metrics and the 2021 Annual Meeting, an experience which has demonstrated the persistence of some stereotypical views on tobacco and the tobacco industry. In a wider context, this illustrates for me the continued false opposition of reform and regulation, harm reduction and prohibition. The delusion of prohibition persists in spite of the cumulative evidence of its lack of realism and, especially in the ultimate manifestation of prohibition in the War on Drugs, the high costs in human life resulting from the zealous pursuit of the impossible.

2019 – 2020: Collaborated with John Collins, then LSE, now Global Initiative Against Transnational Organized Crime, and Katherine Pettus, International Association for Hospice and Palliative Care, on book project “Opioids, Health and Harm: From Colonialism to Populism”. The book has been postponed but the chapters submitted have all been placed in appropriate journals. Thanks to all chapter authors for their patience and texts. You never know, a version of the book may yet appear…

In May 2019  I attended the three-day conference of the International Society for the Study of Drug Policy. An impossibly crowded agenda made it difficult to get to even the most attractive and relevant presentations, but there were some outstanding presentations and, as ever, the chance to meet colleagues old and new, and to meet virtual colleagues in real-life. Although the Society includes the term ‘policy’ in its name it was, for me striking that there was only one presentation which took the international conventions as its theme. Given the French setting and organisation, it was also striking that there were no presentations from the Maghreb or Levant, regions where I would have expected some representation because of the strong political, cultural and linguistic connections, past and present.

‘The book’ on international drug policy was launched in December 2018 in London to a small audience who, together with three of the chapter authors, provided an intense and detailed conversation around the contents and themes. It seems to be a slow but consistent seller. The two editors’ experiences at the March 2019 High Level Review and Commission on Narcotic Drugs meetings in Vienna did little to dispel our thinking behind the title: “Collapse of the global order on drugs”. Self-preservation and the maintenance of an established bureaucracy – and approach – rather than a ‘review’ were the order of the Vienna days.

My immediate thoughts at the time, sent to colleagues and follow attendees, are below:

“Blaine on the Conventions and Tramadol”: March 25. 2019

I found the whole CND experience intriguing, and not fully a positive reflection.

There are two topics which I picked up on which I thought might be of interest to some of you. Both are of particular current interest to me and I have had some involvement in conversations about them with some of you. It was interesting to see the number of police and military uniforms present; and the small numbers of women in official delegations (gender sensitivity?), a stark contrast to the make-up of NGO and CSO events.

I’m aware that I was a first-timer at the event and that you may well have reached these conclusions a while ago and be working on negotiations and responses. But I did get the impression from all of the proceedings that the banners and controllers are not currently engaged in argument and debate – there was much sloganising. It’s the ‘abuse’ which motivates the response to control and schedule.

But for what it’s worth…

The Conventions and Civil Society involvement.

At the Informal Dialogue with UNODC Executive Director session on Wednesday morning Yuri Fedotov said that the Conventions could be changed and amended by international agreement. Such agreement could only be via official and governmental representations, and one country alone can’t change the agreements. This was in reply to a question about smart approaches to cannabis. His answer also included the response that the situation where US States were legalising the recreational use of cannabis did not contravene the Conventions because this was not an action of the State. Jamie Bridge, who convened this session, may be able to say more on this.

A subsequent conversation I had with Palani Narayanan from the Global Fund after the INPUD side-event on March 21 clarified that civil society organisations can’t directly change the Conventions. What they can do is, firstly, to influence and change their own state’s policies and also push their states to argue for change at the international level through CND and INCB events. One tactic, in practice in some countries, is for CSOs to become part of national official delegations.

My thoughts as a UK citizen include that this is something we desperately need in the UK. To cite one example, I’m aware that the Danish Drugs Users Union (BrugerForeningen: BF) has been involved in the discussion and development of drug policy and practice in Denmark. BF has in the recent past been invited to and included in ministry (that’s ministerial and civil servant) discussions on national drug policy. I’m not sure if this practice continues since the change of government in 2015. Sounds like a great model to try to adopt in the UK, but I’m there seems to be little or no recognition of user voice in the UK, the emphasis being on service users’ views, which doesn’t extend to involvement and doesn’t constitute a comprehensive awareness of the range of views, voices and opinions of people who use drugs in the UK.

Tramadol.

I heard several calls for tramadol to be scheduled, usually on the basis of its ‘abuse’. Those making these calls usually accompanied them with references to the amount/extent of misuse; and the numbers and amounts of seizures. I have questions about the accuracy of these assertions and statistics: some seemed to come from nations which also commented on their difficulties in completing the ARQ. But what really struck me was the failure to distinguish between licit (to use the term of the Conventions) tramadol – i.e. a pharmaceutical product of assured purity and quality which is traded in a regulated and documented way – and what is called tramadol and which is used for recreational (illicit) purposes. I suspect that these are two very different substances, and that much ‘abused’ tramadol is not of the highest quality, may not be ‘tramadol’ at all and, in the seemingly few cases where it is pharmaceutical tramadol which has been diverted, falls into the category of medicrime.

Scheduling tramadol in an attempt to deal with the illicit use and trade in ‘tramadol’ would inhibit the availability of licit tramadol and the quality of response of health services to analgesic needs and the assured supply of an essential medicine. How this is expected to affect illicit tramadol, which comes from different sources and via different routes to pharmaceutical tramadol, I don’t understand. There are two different ‘products’ here and attempting to reduce the use of one by restricting the supply of the other does not seem to make sense. Rather, it would seem to be a gesture and an attempt to demonstrate action by states which are unable or unwilling to adequately regulate trade and production of substances within their own borders. The recourse to scheduling and the assumed reduction of flow will benefit policing and military responses but have little or no impact on the market for illicit tramadol (and other recreationally used substances) without reducing demand – because the origins of demand are not being looked at – and would have the probable side-effect of reducing the availability of pharmaceutical tramadol.

I draw a parallel with the refusal or inability in some quarters to understand and accept the distinction between CHT and CBD in cannabis-derived products.

In the events I got to, I noted the reluctance of some schedulers and controllers to consider the social origins of health causes of ‘drug abuse’, seeing it as an individual failure devoid of any wider social and economic factors.

As I started by saying, these may be reinforcing rather than supplementary thoughts and ideas – most of you have been working in these setting for longer than I have been involved in the international politics of drug policy.”

Back in the UK, it’s been depressing to see the same-old climate and attitudes being maintained by the Westminster government around drug policy. Ministers continue to oppose the establishing of life-saving drug consumption rooms, in particular in Glasgow, and to deny and refute evidence for their value and relevance. This tendency – to deny evidence in favour of ideology, and to do so with no apparent concern for those most affected – has been a consistent feature of the discussions about the proposed Glasgow DCR, with interesting linked discussions about the extent to which relevant powers and competences are devolved to the Scottish Parliament. In the meantime, Finland, Iceland, Ireland, Luxembourg and Ukraine have all opened DCRs., or amended national legislation so that they can legally operate. Taken together with the still patchy availability of naloxone, it’s difficult not to see current government practice and attitudes towards people who use drugs as being of callous disregard.

This stubbornness on the part of government is accompanied by a casual dismissal of argument and the identification of alternatives, and the misrepresentation of the position the International Narcotics Control Board has moved to in a 2018 commentary on implementation of the Conventions. Such dishonesty and arrogance have been further shown in the veto by the Home Office minister of the nomination of Release’s Niamh Eastwood for membership of the ACMD, seemingly because of Niamh’s dismissal of the arguments and probity of the minister concerned. Such is the current state of social policy making in the UK, where pique and self-esteem over-rule need and evidence.

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.

And previously…

…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