The needle and the damage done: why our drugs policy must change

In and out of prison, thieving and selling sex, Brian was a criminal from the age of 17. Only after he had wasted his twenties on eight prison terms and intermittent crime sprees did anyone bother to address the sickness at the root of it all: he was a drug addict.

Brian, from Manchester, turned to drugs after being sexually abused in his mid-teens. He stole to pay for amphetamines, crack, and heroin – but now, aged 34, he has not taken drugs for just over two years and is out of prison.

Brian was lucky enough to be put in and get through the tough regime of the "therapeutic community" at Channings Wood prison in Devon, sharing his inner feelings with 112 other drug addicts, facing the daily shouts of "Nonce!" as they walked to the treatment centre. He survived several breakdowns.

Brian's early story is typical. "Pretty well all the people we deal with are involved in both criminal behaviour and drug taking," says a spokeswoman for Addaction, Britain's largest drugs and alcohol charity.

Not all drug addicts commit crime – but the average problem user spends about £16,500 a year on drugs, of which £13,000 has been obtained illegally.

The response of successive governments has been to punish the crime rather than treat the condition. There is now, however, a growing clamour for that to change. Increasing numbers of experts and people working with drug abusers are suggesting it is time to try helping sick people rather than just locking them up.

Last week the Home Affairs Select Committee completed a full-scale public inquiry into drugs in Britain, which produced a report entitled "The Government's drugs policy: is it working?". Their answer to the question was a resounding "no".

MPs called for the downgrading of ecstasy to follow the reclassification of canna-bis and for greater emphasis to be placed on treating heroin, cocaine and crack addicts.

Tina Williams, the mother of a drug user, had told the committee there was a "shame and blame" culture surrounding addiction. The Association of Chief Police Officers pointed to a "disproportionate distribution of resources". The UK Harm Reduction Alliance said: "In no other sector of health and social care does service provision prioritise the needs of other members of society above the health and welfare or the needs of its clients."

Dr Claire Gerada, of the Royal College of General Practitioners – generally a supporter of the Government's drugs policy – said categorically: "It should be dealt with as a health issue."

She believes, along with other doctors, that funding for treatment is inadequate. Getting an appointment can take several months – far longer than many addicts are prepared to wait around.

There is debate, however, about how any extra funds should be spent. Britain may have the biggest drugs problem in Europe, but experts caution against the wholesale adoption of liberal models from other countries such as Spain and Portugal, where the possession of drugs is not a criminal offence and is punishable only by fines and treatment referrals.

Switzerland and the Netherlands run apparently successful programmes based on the prescription of pure heroin to addicts. The evidence points to significant reductions in illegal activities, improved health and many patients going on to methadone programmes or abstinence therapy. However, many GPs warn that pure heroin can kill, and while it may help cure some of the social ills of addiction it won't wean users off the drug.

There remain strong economic arguments for treating, rather than punishing, addicts. The overall cost of drugs misuse to society is estimated at between £10bn and £18bn a year in total, including £234m to the health service and £1.2bn to the criminal justice system. Experts claim that for every £1 put into treatment, £3 is saved on criminal justice.

Despite this, two-thirds of the money available to tackle drugs is being spent on prohibition and enforcement measures.

Drug use has increased significantly in recent years. About 45 per cent of 16- to 19-year-olds and 35 per cent of 20- to 24-year-olds are sometime drug users. During the six months ending September 2000 almost 300,000 people experienced drugs-related problems, according to the charity DrugScope.

The Government's commitment to treatment is clear – in principle. The national strategy formed in 1998, "Tackling Drugs to Build a Better Britain", proposed that the amount available should be increased by 7 per cent a year. That target has already been exceeded. The cash spent on treatment has gone up by 35 per cent in the last year to £400m.

Nevertheless, critics insist more must be done, that the emphasis must shift further so the misuse of drugs is seen as a health issue and policy is led by the Department of Health. In 1997 the new Labour administration was keen to agree with experts who said drugs were a cross-departmental issue, so it placed responsibility in the Cabinet Office. The problem? The Cabinet Office has no spending power and no clout in the hard-fought negotiations for Treasury cash.

A move to Health would not close off a voice for drugs funding but, symbolically, it might change the way drug addiction is seen by a public weary of paying the price for drug-induced crime.

The Government did appoint a drugs tsar, Keith Hellawell, but he was sacked in 2001 after criticism of his 10-year plan. A National Treatment Agency was then created, and a review of funding and treatment will be completed this summer.

For the moment the person in charge of drugs policy is Bob Ainsworth, a Home Office minister. He's a busy man, the "Minister of State for crime reduction, policing and community safety with responsibility for action against drugs including development of a coherent drugs and alcohol abuse strategy". (Oh, and Mr Ainsworth is also responsible for dealing with organised and international crime, European law enforcement and judicial co-operation.)

The usual promises are all there: more money on the way, reforms on the way. And yet the balanced "rights and responsibilities" rhetoric of New Labour never betrays which way the scales are tipping. Since their early, long-abandoned, forays into drugs policy in the first term, ministers have grasped the need for drugs to be looked at "in the round", to borrow another favourite phrase. Whether that means putting the emphasis of policy where drug users, doctors, teachers, MPs and police are all now pointing remains to be seen. The Home Office implies not. "We are not expecting radical changes to the strategy but a refining of the process."

Peter Martin, chief executive officer of Addaction, remains hopeful: "The National Treatment Agency has begun to co-ordinate strategy and research and to drive up standards," he says. "After a month in the post, the Home Secretary, David Blunkett, announced he would take evi- dence and make decisions on the direction in which drugs policy should go. This has not delayed new initiatives being piloted. Ultimately, decisions have to be taken on the basis of evidence presented, but where evidence is patchy, then innovation and risk have also played a part in policy and that has to be applauded."

Nevertheless, there is still a huge difference in the way life looks from the magistrates' bench, or from behind Mr Ainsworth's busy desk, and what those who are working with drug addicts are seeing on the streets.

"We think government policy needs to change," says a spokesman for DrugScope. "If it is just going to be based on enforcement it is never going to work. It's not just about stopping trafficking and policing the ports. We need a policy that is about preventing new users from getting involved; and one that treats existing users, to help them break the cycle that is destroying their own lives and having such an impact on the community around them."

Lisa is 33; 14 months ago, her seven-year-old son was taken into care.

After a decade in which life had been dominated by the pursuit of her next fix, she knew it was time to change. Her "nightmare" as a crack and heroin addict had to end. It was not Lisa's first warning: she'd twice been convicted of shoplifting to feed her habit; her son was born with withdrawal symptoms; and in 1993 her elder sister died of a drugs overdose. But bereavement simply plunged Lisa deeper into the only world she could cope with – dealing, drug-taking, spending hours in the bathroom or disappearing for weeks to drift between south London's crack houses. "Drugs became my security. I was comfortable with that." Lisa had a job for six months in 10 years. Her son often missed school or didn't get fed properly. "My drugs came first." Without them she was "paranoid"; with them she was dysfunctional. Her only friends were other users. Despite her brushes with the law, no one helped her. Lisa's own will got her through. Today she's going to her part-time cleaning job, which "means the world to me". And she's taking her son to school.

Tom Carnworth, a consultant psychiatrist in Co Durham, is a specialist in drug treatment.

The doctor knows he can help addicts if he

gets to them in time. But his work is frustrated

by a lack of direction and targeted funding. "There are a huge number of initiatives and money comes down for all sorts of bizarre things. If it was all channelled straight into drug services, and we could cut waiting times we would have a far better situation than we have got now." He is concerned at calls for doctors to prescribe heroin and is worried that doctors get only six hours' drugs training before qualifying. Dr Carnworth wants better training for doctors to help them deal with the addiction-related conditions – including tobacco and alcohol abuse – that account for an estimated 40 per cent of all health problems in the NHS. Education, too, is vital. But showing children videos of people dying from overdoses is "crazy", he says. Stigmatising addiction just won't work.

Peter Walker, who advises the National Association of Head Teachers, says no school can ever be totally clean.

"Show me a head teacher who says they haven't got a drug problem and I'll show you a liar." Infant schools, primary schools and secondary schools are all affected. But the problem, he insists, starts at home. "By far the most popular place for taking drugs, according to a study, is the user's own home or the home of friends. The next most popular is a disco, and one of the least popular places is school." More training for teachers and more investment in drugs education material such as videos and pamphlets are also needed. But Mr Walker, a head teacher himself, says the key is for schools to work in partnership with parents. Once drugs have found their way past the school gates, a compulsory drugs policy is needed. Users need help and have to be "forced" into treatment. Dealers must be kicked out. "I don't believe in giving them a second chance. I know that can push the problem on to the streets, but you remove the risk from inside the school."