{"id":46718,"date":"2020-02-28T12:09:49","date_gmt":"2020-02-28T11:09:49","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46718"},"modified":"2020-03-06T12:26:00","modified_gmt":"2020-03-06T11:26:00","slug":"ian-hamilton-they-talk-we-die-continuing-paralysis-uk-drug-policy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/02\/28\/ian-hamilton-they-talk-we-die-continuing-paralysis-uk-drug-policy\/","title":{"rendered":"Ian Hamilton: &#8220;They talk, we die&#8221;\u2014the continuing paralysis of UK drug policy"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">The latest report into drug use in the UK is another reminder of why drug policy should be based on evidence rather than ideology, says Ian Hamilton<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/07\/IAN_HAMILTON_2018.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-42580\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/07\/IAN_HAMILTON_2018.png\" alt=\"\" width=\"183\" height=\"170\" \/><\/a>Compare, for a moment, the political reaction to the coronavirus outbreak we\u2019re witnessing with that of drug related deaths. The former sees considerable planning and every effort put into minimising the risk of contagion. The latter, also a pressing public health issue, receives minimal attention and no discernible effort from politicians, despite the record numbers of drug related deaths being documented, which rose to <\/span><a href=\"https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsrelatedtodrugpoisoninginenglandandwales\/2018registrations\"><span style=\"font-weight: 400\">4359 in England and Wales<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-scotland-48853004\"><span style=\"font-weight: 400\">1187 in Scotland<\/span><\/a><span style=\"font-weight: 400\"> in 2018.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The parliaments of Holyrood and Westminster agree that the issue is a priority, but that seems to be all they can agree on. Typifying the worst aspect of politics, the Scottish and UK governments have managed to turn their response to drug related deaths into undignified posturing. Rather than working together, they held <\/span><a href=\"https:\/\/www.theguardian.com\/politics\/2020\/feb\/25\/glasgow-drugs-summits-highlight-contrast-in-uk-and-scottish-approaches\"><span style=\"font-weight: 400\">separate summits<\/span><\/a><span style=\"font-weight: 400\"> on the subject in the same venue one day after the other. Exemplifying the friction between the two governments, the Scottish government has <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-scotland-scotland-politics-49063485\"><span style=\"font-weight: 400\">blamed<\/span><\/a><span style=\"font-weight: 400\"> the Home Office for obstructing its plan to introduce a drug consumption facility in Glasgow.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Dame Carol Black, who was appointed by the Home Office last year to review the UK\u2019s drug policy, has presented her <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/review-of-drugs-phase-one-report\"><span style=\"font-weight: 400\">findings<\/span><\/a><span style=\"font-weight: 400\"> at the second of these drug policy summits held in Glasgow. Unfortunately, before she had even got to her feet, a Home Office minister had already <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-scotland-51644786\"><span style=\"font-weight: 400\">rejected<\/span><\/a><span style=\"font-weight: 400\"> the idea of drug consumption rooms, describing them as a \u201cdistraction.\u201d Despite the UK government\u2019s reluctance to even pilot a drug consumption facility, there is <\/span><a href=\"https:\/\/www.bmj.com\/content\/366\/bmj.l4906\"><span style=\"font-weight: 400\">evidence<\/span><\/a><span style=\"font-weight: 400\"> to support their role in reducing drug related harm, including mortality.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">There is nothing novel in Dame Black\u2019s report, but that doesn\u2019t mean it doesn\u2019t have something important to say. The problem is that it\u2019s the latest in a line of other <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/reducing-opioid-related-deaths-in-the-uk\"><span style=\"font-weight: 400\">reports<\/span><\/a><span style=\"font-weight: 400\"> on drug related harms, which have been commissioned and received by the government in recent years. The consistent theme of these reports is that the government should adopt evidence based, rather than ideological based, policies. In spite of these calls, our drug policy continues to be in a state of paralysis.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The government is wedded to an ideology that frames drug use as both a criminal and health matter. Dame Black\u2019s report delivers a damning assessment of the government\u2019s attempt to disrupt the supply side of the drugs market, even suggesting that additional funding for enforcement agencies is unlikely to have an impact. Dame Black joins the chorus of organisations <\/span><a href=\"https:\/\/publications.parliament.uk\/pa\/cm201919\/cmselect\/cmhealth\/143\/14302.htm\"><span style=\"font-weight: 400\">calling<\/span><\/a><span style=\"font-weight: 400\"> for investment in specialist drug treatment, but wisely points out that this won\u2019t achieve immediate treatment capacity as it will take time to recruit and train the additional staff required.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">One of the casualties of cuts to addiction treatment budgets has been addiction psychiatry, a specialty that has all but <\/span><a href=\"https:\/\/www.bmj.com\/content\/357\/bmj.j2704\"><span style=\"font-weight: 400\">disappeared<\/span><\/a><span style=\"font-weight: 400\"> as providers compete with each other to provide \u201cbest value\u201d tenders for services. It is difficult to imagine that we would allow any other area of healthcare to languish in this way, a clear signal of the lack of value we place on people who develop problems with drugs.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Michael Marmot\u2019s <a href=\"https:\/\/www.bmj.com\/content\/368\/bmj.m747\">recent report into health equity<\/a> in England found clear <\/span><span style=\"font-weight: 400\">links<\/span><span style=\"font-weight: 400\"> between poverty and falling life expectancy. Mirroring this finding, Dame Black\u2019s report draws attention to the inequity of treatment provision for drug addiction and how this contributes to higher drug related mortality in our most deprived communities.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Given these links between poverty and mortality, it seems obvious that it\u2019s not drug markets that need disrupting, but the ongoing blight of inequality. The need for treatment could be reduced if more effort and resources were invested in prevention. There is an economic as well as altruistic case that can be made for this approach. Dame Black estimates that the cost to society of illegal drugs is \u00a320 billion per year, while \u00a3600 million is spent on treatment and prevention.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It really doesn\u2019t matter which way you look at the causes or consequences of drug related deaths, something needs to change if we are to reduce the rising number of fatalities. We have the evidence, but as one banner stated outside the summit: \u201cthey talk, we die.\u201d It is sobering to think that for every day we talk rather than act, 15 more people will die needlessly.<\/span><\/p>\n<p><em><strong>Ian <span class=\"il\">Hamilton<\/span><\/strong> is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. <\/em>Twitter: <a href=\"https:\/\/twitter.com\/ian_hamilton_\"><span class=\"css-901oao css-16my406 r-1qd0xha r-ad9z0x r-bcqeeo r-qvutc0\">@ian_hamilton_<\/span><\/a><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0I am affiliated with Alcohol Research UK.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The latest report into drug use in the UK is another reminder of why drug policy should be based on evidence rather than ideology, says Ian Hamilton [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/02\/28\/ian-hamilton-they-talk-we-die-continuing-paralysis-uk-drug-policy\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":46724,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-46718","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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