Lying in a hospital bed, 24-year-old Stacey Rhymes cuddles a childhood toy before putting out an arm to her mother.

‘Hold my hand, Mum,’ she whispers, then slips into a coma. A few hours later, on a spring afternoon earlier this year, the girl with a whole life ahead of her was dead.

The once radiantly pretty Stacey had drunk herself to death on cut-price bottles of wine bought from corner shops, supermarkets and local pubs. She had started drinking at 17 and seven years later her body simply gave up under the constant assault from alcohol.

Her mother, Louise, says: ‘I now want the world to know exactly what happened to Stacey and why. It was a terrible way to go.   ‘Her stomach was like a balloon, as if she was nine months pregnant. Her long hair was falling out, her urine was coloured black and she could not eat. She was scared to look in the mirror because her eyes were canary yellow. The only way to stop the pain at the end was morphine.’

The story of Stacey Rhymes is a salutary one. She is one of the youngest people in modern Britain to die of alcohol abuse. And her mother, speaking for the first time, is determined that the loss of her daughter will not be in vain.

She has set up a Facebook website in memory of Stacey to highlight the dangers of alcohol – and particularly its increased availability following New Labour’s 24-hour drinking laws – which now kills more young women than cervical cancer, and more people, generally, than hard drugs.

A film clip about Stacey on YouTube, put there by her mother, has been watched by 16,000 people in a fortnight. It is now one of the most viewed in Britain by children and teenagers.

At the family’s terrace home, in Bramcote, on the outskirts of Nottingham, where Stacey grew up with her brother, Jay, now 19, sister Katie, 21, and stepfather, Terry, her mother says: ‘Alcohol is as treacherous as a Class A drug. Yet it’s available at all hours and at rock-bottom prices.

‘This morning, I saw a pack of four cans of lager at the supermarket for 92p. You can’t get four cans of children’s pop for that! Young children should be warned about alcohol in the way they are warned about drugs.  ‘I want them to be shown a photograph of Stacey’s face when she was dying. She was killed by alcohol – a drug that is as easy and cheap to buy as a packet of sweets.’

Since the relaxation of licensing laws in November 2005 – which allowed round-the-clock sales of drink in pubs, clubs, shops and supermarkets – the cost to the nation both socially and financially has been huge. Coupled with low prices for alcohol, there is now an orgy of drunkenness that rivals the gin epidemic of early Victorian times.

The facts are stark. The numbers dying from alcohol-related health problems is rising. In 1999, there were 4,000 deaths. Today, the figure has doubled, with the age of the victims going down, too. Hospitals admit for emergency treatment more than 9,000 drunken teenagers every year.

According to Alcohol Concern, 800,000 children below the age of 15 drink regularly in Britain. Nearly two-thirds of them will have had alcohol in the past month – with one in seven consuming enough to make them sick. One in three think, it is acceptable to get drunk once a week.

Campaigners say that one in ten eight-year-old boys (double the figure ten years ago) and a quarter of 11-year-old girls (ten per cent more than in 1995) have also experimented with alcohol.    Staff at the casualty department of Alder Hey Children’s Hospital in Liverpool will not be surprised by these statistics. A survey by the hospital – which admits only under-17s – showed that more than half the children treated after binge-drinking had bought their alcohol from a pub or a shop.

Nearly three-quarters of patients are girls, and the favourite tipple is vodka. Every week, seven or eight drunken youngsters are treated at the hospital – a quarter so ill that they have to be put on a ward or go into intensive care.

According to Pat McLaren, an Alder Hey spokeswoman: ‘They come in on a Friday and Saturday night in particular. Some are found unconscious on the street or even beaten up. We get them sober and contact their parents. We try to get them to change their ways.’

Alder Hey and Liverpool are not alone. Cases of liver cirrhosis in 20 to 30-year-olds – who often started drinking as children – have doubled in less than a decade.  Eight women in Britain die each day from liver disease – often at ages younger than men with the same condition because their bodies are more sensitive to alcohol poisoning.

As Professor Ian Gilmore, President of the Royal College of Physicians, warns: ‘The damage to society from alcohol is greater than from drugs.’   Dr Gray Smith-Laing, a gastroenterologist at Medway Maritime Hospital in Gillingham, Kent, says: ‘The young of all social backgrounds think it is cool to get completely legless, yet nothing could be more uncool. This is a classless and sexless phenomenon. We have not seen the peak yet.’

Young women such as Stacey Rhymes make up half his caseload. Some have irreversible liver damage from drinking. One woman of 26 he treated recently died of liver cirrhosis.  Dr Smith-Laing says: ‘We need a dramatic rise in the price of alcohol so it is no longer affordable for the young.’

It is against this frightening background that Stacey’s mother has bravely decided to speak out.

She reaches for a pile of treasured childhood photographs. They show Stacey on her first birthday; at eight in a white hat at a family wedding. There is one of her with bright, clear eyes and long thick hair smiling at the camera  – she is just 17, and it is a few months before she began to drink.

Louise, 43, says: ‘Stacey had a wonderful childhood and we were a close family. There wasn’t a lot of money, but we did old-fashioned things. We went to the park for picnics and walks around Nottingham.  ‘She had lots of friends and when she left school at 16, she got a job in a local pub as a waitress. She met a boy, and there was even talk of an engagement.’

But things were soon to change. ‘For no apparent reason, Stacey began to drink. She had arguments with the boyfriend about it. She lost the job she loved and her boyfriend, too. She was just drinking all the time. She became foul-mouthed. She stole money from us, her family, to buy the alcohol,’ says Louise. ‘Stacey would go out drinking at night then lie in bed all day. I couldn’t get her up, even though I tried before I left for work.

‘In the end, we found her a housing association flat in Nottingham, where she moved. We thought it would be a fresh start.’ Nothing could be further from the truth.

‘Stacey then got in with a bad crowd. Her friends were all drinkers, too. She would lie in bed with a bottle. A few times, she burned the bedclothes with her cigarettes. She got involved in a serious brawl, and was sent to prison for eight weeks.

‘We were horrified, but she came out looking far better. She had not been able to drink while inside. We took her back to her flat where there were eight weeks – £800-worth – of giro cheques from the benefits’ office. Stacey spent every penny on drink. She was evicted from her flat due to debts on the rent.’   Stacey wouldn’t move back home because her mother and stepfather, a self-employed builder, refused to allow her to drink. Revolted by what alcohol had done to their daughter, they are now teetotal.   Instead, Stacey found a place at a hostel in Derby, five miles from Nottingham. ‘That lasted five days before she was thrown out for drinking,’ recalls her mother.

By now, her life was out of control. For a time, Stacey lost contact with her family. She lived rough in Derby. In desperation, Louise tried to get her daughter sectioned under the mental health laws so she would be taken into hospital. ‘But the authorities said she was quite normal, just an alcoholic.’ she recalls today.   Stacey was now drinking five litres of wine a day and some cider, too. She no longer dressed fashionably, put on weight and didn’t eat properly. ‘Her stomach was huge and she was very ill,’ her mother says.

On March 28 this year, Stacey was admitted to Derby Hospital – to Ward 308 which deals with alcohol-induced liver problems. She had been to her GP because her face had gone yellow and she was having trouble walking because her limbs were swollen. The doctor told her to go to hospital immediately  –  it took her a week to do so.

Dr Jan Freeman, a consultant in whose care she was put, says: ‘Stacey was at the end of the road. She could have been saved only by a liver transplant. Like lots of young people, she never thought it would happen to her. Well, Stacey’s death shows it can happen to some.’    There is no doubt that Stacey was well looked after in the hospital but, during the next seven weeks, until her death on May 22, she managed to discharge herself three times and return to drinking.

Once, she walked out in her pyjamas, hailed a taxi then disappeared. Derby police put out appeals for the public to look for her. Her parents searched, too.    He mother recalls: ‘We got her back to the hospital on each occasion. The last time was on May 17. She had been staying with a drinking buddy. She rang up saying she was being sick and it was streaked with blood. Her skin was itching, a symptom of alcohol poisoning.

‘I knew that we would lose her, because of her colour. I thought she wouldn’t make it over the weekend. But three days later, she had picked up and told us she was scared of dying. I told her that if she stopped drinking, she would live.’    It was, of course, a white lie. The next day, the hospital rang Louise to say Stacey had a hole in her stomach, caused by acid from a ruptured peptic ulcer. There was nothing more the doctors could do.   Within 24 hours, the family were called to the hospital for the final time. Stacey died in her mother’s arms of abdominal bleeding and alcohol-related liver disease.

As confirmation of Stacey’s tragic story, Nick Sheron, a liver specialist at Southampton General Hospital and secretary of campaign group, Alcohol Health Alliance, says drink-induced liver disease – once the preserve of middle-aged men – is affecting all ages and both sexes.

He explains: ‘If they are alive, it is never too late to stop drinking. But, often the symptoms show up so late that half the patients die before they have a chance to change their ways.

‘In the Sixties and Seventies, wine used to be nine percent proof, now it is 13 percent. Beer was 3.2 percent, now a lager is five percent. The size of a wine glass is bigger, too  –  from 125ml to 175ml, and in some cases 250ml. That is a third of a bottle.’

Dr Sheron warns that alcohol is being used as a drug, instead of a part of a social event or accompaniment to a meal. ‘The young drink to get wasted as quickly as possible. They think if they can remember the night before it is not a good night out, and 24-hour licensing is one of the problems,’ he cautions.

With prices so low, Professor Mark Bellis, director of the Department of Public Health at John Moores University in Liverpool, adds: ‘A young person with £10-a-week to spend can get drunk three times a week.’   The scale of the crisis cannot be over-stated. Alcohol abuse, leading to either injury or disease, now costs the NHS £1billion annually with 40 per cent of casualty departments’ admissions being drink-related.

Significantly, the London Ambulance Service says that alcohol-related emergency calls have increased by 12 per cent since 24-hour drinking laws were introduced.   As spokeswoman Anna Lowman says: ‘One of the aims of the new laws was to eradicate the 11pm to 2am disorder flashpoint when the pubs and off-licences used to close. But this is still our busiest period. Fourteen per cent of all calls during these hours are linked to drinking.’

Yet this is not the only catastrophic side-effect. The Cabinet Office admits the real cost of drinking is £20billion a year if you include suicides, alcohol-fuelled crime, anti-social behaviour, depressive illness, family breakdown and domestic violence.

Only this month, the Local Government Association – representing councils – warned the 24-hour drinking plan to emulate a European style cafe-culture in Britain had failed miserably. It costs £100 million a year to oversee the late licensing system, provide staff to clean town centres of vomit or urine (often both) and help for the ‘walking wounded’ at the end of a night’s hard drinking.

At Stacey Rhymes’ funeral in Bramcote, held near the park where the family used to picnic, there were 150 mourners – some were her old school friends. As her mother says: ‘Stacey chose her way – and they theirs. They have got married, have children and careers. They are enjoying life. My daughter drank herself to death.   ‘She never had any problems getting her hands on another bottle. In many ways, she was a victim of our times.’

Source  Newspaper cutting  – sent to NDPA not identified.

New Medications May Offer Hope To Drinkers Battling Alcohol Dependence Individuals who experience the physical, mental and social symptoms associated with alcohol dependence are offered hope through the results of two recent studies by researchers at the Medical University of South Carolina (MUSC). In separate investigations, researchers found favorable results for a medication to help heavy drinkers who are trying to modify their consumption, as well as a medication to reduce alcohol withdrawal symptoms and prevent relapse. In a landmark study, MUSC researchers working with investigators at the University of Virginia Health System and elsewhere have found that topiramate, an effective therapeutic medication, not only decreases heavy drinking, but it also lowers all liver enzymes, plasma cholesterol, body mass index (BMI), and systolic and diastolic blood pressure all of which tend to increase with heavy drinking and pose such serious health risks as heart disease and cirrhosis. Notably, these combined effects suggest that topiramate may decrease the risk of heart disease in alcohol dependent individuals. “These findings add growing data indicating that heavy drinkers who modify their drinking with the help of medication and supportive counseling may see an improvement in health and well-being, as well as a potential reduction of risk for the development of heart and liver diseases. This shows that treatment of alcoholism has potential health benefits beyond the immediate behavioral and emotional improvement caused by a reduction in drinking” said Raymond Anton, M.D., distinguished university professor. By decreasing liver enzymes and cholesterol levels, topiramate also may reduce the risk of fatty liver disease, which leads to cirrhosis – a common consequence to end-stage liver disease leading to death in some alcoholics. Additionally, topiramate significantly contributed to a decline in obsessive thoughts and compulsions, components of alcohol craving, and also had a greater improvement in their “overall quality of life,” and specifically an improvement in general and leisure activities and household duties, as well as a reduction in sleep disturbances. The Food and Drug Administration has approved topiramate for seizures and migraine headaches, but it is not currently approved for treating alcohol dependence. Ortho-McNeil Neurologics, Inc., manufactures topiramate and provided study funding. Results from the nationwide 14-week trial involving 371 male and female diagnosed alcoholics was published in the June 9 issue of the Archives of Internal Medicine. Source:www.medicalnewstoday.com  July 2008

Revealed: Government helpline tells children ‘cannabis is safer than alcohol’

Children calling the Government’s drugs helpline are being told that cannabis is safer than alcohol and that ecstasy will not damage their health, an investigation by The Sunday Telegraph has found.

 Advisers manning the Frank anti-drug helpline are telling children cannabis is safer than alcohol

Advisers manning the “Frank” helpline are informing callers they believed to be children as young as 13 that alcohol is a “much more powerful drug than cannabis” and that using the illegal drug recreationally is not harmful because it “doesn’t get you that high”.

Callers are also being told that taking ecstasy will not lead to long-term damage and that if they are in doubt, to “just take half a pill and if you are handling that OK, you can take the other half.”   They are even being told that they would be able to smoke a cannabis joint, on top of ecstasy, with no ill-effects.

The advice, given to reporters who rang the helpline posing as young people, has alarmed anti-drugs campaigners who branded it “scandalous” and “irresponsible.”   Health experts have condemned the advice given to children as “frankly appalling”, “factually incorrect” and “worryingly cavalier”.

After being presented with the findings, the Government last night said it had launched an immediate investigation into the Frank service, which is funded by three separate departments, and said it would be taking action advisers involved.

Chris Grayling, the shadow Home Secretary, said: “The idea that the Government’s helpline should be saying to young people “go for it” and that cannabis should be class C when it has just been classified by the Government as class B, shows that the Home Office is all over the place in its approach to drugs.”

Professor Neil McKeganey, professor of drug misuse research, at Glasgow University, said: “Having read one of the transcripts, it is extraordinary that the Frank counsellor seems more concerned to place cannabis smoking in some kind of comfort zone of acceptable behaviour rather than address the risks of such drug use on the part of a 13-year-old child.”

Mary Brett, a spokesman for the Talking About Cannabis charity, said: “It is scandalous. These people are talking to kids, for goodness sake. Taking drugs can trigger all kinds of psychosis in people that have a genetic predisposition to it. Why are they not told that? Medical experts have said time and again that skunk, the newer type of cannabis that many young people are taking, is dangerous.

“These children are being told they can choose. But the risky bit of their brains develops before the inhibitory bit of their brain and they take risks.

“They have to be told ‘this is not for you’. When they hear fair, reasoned arguments against, they respond. It is obvious they are not hearing them from Frank.”

The helpline, established by the Government in 2003 with £3 million funding, was described in a Home Office drugs strategy recently as “the key channel by which Government communicates the dangers of drugs, including cannabis, to young people”.

But in calls to its helpline, manned 24 hours a day, seven days a week, reporters posing as teenagers were told by different advisers that drug taking was not harmful.    At no point in the conversations did the Frank team try to dissuade the callers from taking drugs.

The effects on the body were played down to the extent that one adviser, referring to ecstasy, said: “At the end of the day I know where you’re coming from – doing a pill and it felt great.”

Another counsellor said that cannabis, a class B drug, should be regarded as class C and that “cannabis doesn’t really get you that high. You know you are always in control”.   A third adviser stated: “nicotine is physically addictive. Cannabis isn’t. You can stop smoking it any time you want.”

Alcohol was presented as a much greater danger than illegal drugs, including heroin, more expensive and with many more negative effects.   One adviser told a caller: “The withdrawals of alcohol are worse than heroin for example; people can die when they become addicted to alcohol and stop suddenly.”

The reporters were also told that the police “would not do anything” if they found a young person with cannabis and that if they are caught with pills, they should say they were for their own use to avoid being prosecuted as a dealer.

In one call, where the reporter claimed to be the friend of a 13-year-old boy who had started smoking cannabis, the adviser said: “He won’t get addicted, no. Tell him you spoke to Frank and they told me it’s not as dangerous as alcohol. Tell him they said by using it recreationally, it’s not as bad as alcohol, because that’s the truth in terms of the power of the drug.”

He went on to say that if alcohol was illegal, it would be a class A drug, the most harmful category, whereas “cannabis should just be a class C drug”.   Another reporter, posing as a 15-year-old girl who had taken her first ecstasy tablet, asked if it would affect her health in any way.

The response was “Nah”. He told the caller that he could not say “go and take Es, you’re absolutely fine”, but that “in terms of taking a pill like that, it’s not going to affect your health”.   He went on to say “obviously you had a really good experience. It’s like most things, if you do it in moderation, you lessen your chances.

“A good idea is if you don’t know what it is you are taking, take a half a one and see how you go and if you are handling that OK, you can take the other half.” The adviser was also unsure what classification the Class A drug was.

During a discussion where the adviser talked about mixing drugs, the reporter asked if it was safe to have cannabis after taking an ecstasy pill.

The adviser said: “Again, I’m not condoning it but it wouldn’t spin you out like another pill or powder. If you’re asking me if you could have a spliff with it, would it have any major affects, generally speaking, no, although people are individuals so what works for one might not work for another, but generally speaking, no, you’d be able to have spliff with it.”

An estimated five million people in the UK are users of illegal or street drugs. Health experts are growing increasingly worried about the affects on young people’s mental health. There is also growing evidence that contrary to earlier assumptions, cannabis can be addictive.

Varieties of skunk, which contain much higher levels of tetrahydrocannabinol (THC), the active chemical, are more dangerous than the cannabis used in the 1960s and 1970s but are now widespread and often the choice of young people.

Dr Zerrin Atakan, consultant psychiatrist at the Institute of Psychiatry, said: “Any drug use while the brain is still developing may lead to structural or functional changes. One Australian study has shown that heavy cannabis users show clear structural abnormalities of the brain.

“Another recent study has also shown that cannabis use before 18 can lead to abnormalities in areas of the brain that control memory, attention, decision-making and language skills.

“Also, contrary to previously held beliefs, it is now considered that regular users can develop ‘tolerance’ to the drug, one of the main characteristics of addiction. Regular users require higher doses to become ‘stoned’. Some people find it very hard to give it up and become highly anxious if they do.”

According to the Home Office, drug use among all ages, including young people, has fallen in recent years. The Government, which downgraded cannabis to a grade C drug in 2004, has recently reclassified it to B.

A Government spokesman said: “It is completely unacceptable for a Frank adviser to be giving out wrong, misleading and inaccurate information. We are urgently looking into the matter and will identify the person or persons involved and take action.

“Frank is an important resource for young people who need help and advice about drugs. It is vital that Frank advisers give out correct and straight forward advice – we have therefore commissioned a review of the training advisers receive and will act upon it.”

Source: www.telegraph.co.uk  l8th April 2009

October 04, 2010

DODGY DOSSIER 3: NATIONAL TREATMENT AGENCY FIGURES

THE STATISTICS OF FAILURE IN THE NTA ANNUAL ACCOUNTS 2009/10, AND 2005 OUTCOMES RESEARCH

 by Deirdre Boyd

 If this country wishes to cut crime and get addicts into recovery, it is vital that our drugs policy is built on a solid foundation of fact not a quicksand of PR illusion which will bury us all. If failed so-called treatments and systems are promoted as successes, then truly successful treatments being considered by government might be discarded as unnecessary.

 That would be a tragedy for Britain. In an attempt to avert this, we must correct the errors published today by Robert Verkaik, home affairs editor of the Independent newspaper, who reiterated to the nation the NTA press release that “The long battle to break the link between drug addiction and criminal behaviour is being won. Nearly a half of all addicts who participated in drug courses in 2005 have been found to be free from addiction and no longer committing crime four years after leaving treatment. For those with cannabis or cocaine habits the success rates are as high as 69 per cent and 64 per cent respectively”. 

 Sorry but this is very far from the truth. It looks as if £848,960,000 has been spent in one year on people NOT leaving treatment satisfactorily.

 Deceptively, the NTA figures were placed beside the real success stories of addicts who now lead drug-free lives thanks to Rapt rehabilitation programmes, as though they were cause and effect. The reality under the NTA regime is that only about 2% of people seeking help get rehab (and a similar number get drug free).

 October is, of course, anniversary time: the NTA board meeting. This time last year, the National Treatment Agency for Substance Misuse used our hard-earned taxes to pay for positive PR in the Guardian, whose Terry Kirby wrote that it “has a seemingly perfect response” on spending resources (a Freedom of Information query from Addiction Today elicited that the NTA gave the Guardian £219,337 of our money in that 18-month period). Then Addiction Today number-crunched to put the record straight about lack of recovery-oriented treatment for addicts and thus dismal results. It was vital to identify what went wrong, as covering up the true figures denies tens of thousands – perhaps hundreds of thousands – of vulnerable people a chance to quit drugs and addiction for life.

 Since then, we have changed government and health secretary Andrew Lansley abolished the NTA. But it has two years to embed its practices and its staff into the Public Health Service. Can its directors live up to the trust placed in them by the prime minister over this transition period? Judge for yourself as we numbercrunch the NTA Annual Report 2009/10 and that press release.

 NTA ANNUAL REPORT 2009/10

 In its Annual Report 2009/10, the NTA chooses to quote for its figures a National Audit Office report, Tackling Problem Drug Use, which states that 213,000 people were in contact with the treatment system, 168,000 of these “in effective treatment” – and that only 28,000 “left treatment satisfactorily”. The first question is what happened to the other 140,000 people? The funding per person, according to the NTA report, was £3,000 – so that is £420,000,000 spent on people not leaving treatment satisfactorily. What happened to them?

 And the unexplained costs could be worse. The government-funded DTORS report estimated an average annual treatment cost not of £3,000 per patient but about £4,500 (Summary of Key Findings Research Report 23, section: Cost-effectiveness of drug treatment “With drug treatment costs of around £4,500 …”) but by Research Report 25 this figure had jumped to £6,064  (“The average cost of drug treatment over the whole DTORS sample was estimated to be £6,064…” So the NTA Annual Report 2009/10 could be indicating £848,960,000 spent on people not leaving treatment satisfactorily.

 Perhaps this is why Hansard, which prints all MPs’ speeches in the House of Commons, reported a comment in July by David Burrowes: “The annual report of the National Treatment Agency for Substance Misuse, which was presented to the House… is in stark contrast with the 30th report of the Public Accounts Committee in March, which concluded that £1.2billion is spent on tackling drug misuse without the government knowing the overall effect of that approach”.

 And what does “satisfactorily” mean? The previous annual report stated that “24,656 (41%) were discharged successfully, defined as those completing treatment free of their drug of dependency”. This last phrase is removed in the current version – perhaps because, last year, Addiction Today highlighted that it meant patients stopped using one drug but were using others. This is equivalent to saying that an alcoholic has completed treatment free of dependency on whiskey but is now dependent on vodka, brandy, high-strength lagers… Professionals refer to this as cross-addiction, where one drug is replaced with another and the addictive behaviours continue unchanged. The final figure came a maximum 8,980 people perhaps free from dependency: a similar number to those who managed to get into rehabs.

 “Changes in definitions mean that direct comparisons to previous years are not possible,” the NTA Annual Report states. So we must leave you to judge from last year’s for the moment. And ponder this…

 DODGY DOSSIER OF DISCHARGES

 As the NTA prepared for its 5 October board meeting this year, it issued a congratulatory press release not about these latest annual accounts but results from five years ago. “In an international first, the NTA tracked the post-treatment journey of thousands of drug users over a four year period and has discovered that almost half of those discharged in one year subsequently demonstrated sustained recovery from addiction,” said the press release. “Nearly half of those leaving treatment neither need further treatment nor were found to be involved in drug related offending”.

 “These findings are very exciting because they help us define more accurately what ‘success’ looks like for drug treatment,” trumpeted NTA CEO Paul Hayes, promoted from his career as a probation officer to this role and taking home a salary rivalling prime minister David Cameron (£135,000-£140,000 pa). NTA’s performance can also be credited to its executive director over these years, Rosanna O’Connor.

 The sad reality is that only “discharged” patients were included in the study. Again, we do not know what happened to the greater number not classified this way. Nor can we refer to the 41,475 (of 54,000) discharged people in the report as “participants” as the NTA has equated lack of proof of negative results as proof of positive results – see Professor Neil McKeganey’s expert opinion on this below.

 DISCHARGED OR DEAD?

Last year, when the NTA Annual Report referred to “individuals discharged”, a deeper look revealed that 905 were “discharged” from this earth completely, having died.

 More had “moved away”, had “treatment withdrawn” or are “not known”. 1,769 are said to have declined ‘treatment’ – perhaps due to the growing phenomenon of people refusing a lifetime on methadone, or a reflection of stories of a high-volume low-care organisation which gets vulnerable clients to sign DIR forms which they think give treatment but are refusal forms.

 *******

 Professor Neil McKeganey’s blog is copied below for clarity on this topic.

 NTA TREATMENT OUTCOME RESEARCH:
HARD EVIDENCE OR POLITICAL SPIN?
by Neil McKeganey,  Professor of Drug Misuse Research, University of Glasgow

 The National Treatment Agency has announced a near miracle in drug treatment. Followed up over a four-year period, the NTA has claimed that “Nearly half of those leaving treatment neither need further treatment nor were found to be involved in drug related offending”. When you recall that drug addiction is a “chronic, relapsing condition”, you might wonder how any treatment could be that good? Too good perhaps to be true?

 So what is the claim that addicts leaving treatment need no further treatment actually based on? Is it based on any sort of clinical or psychological assessment of the individual drug user to assess his or her level of continuing need? Have the researchers who have undertaken this work examined the living arrangements of the drug users concerned, have they looked at their contact with their children, at whether the individual drug user is in employment, at whether they are still using illegal drugs, at whether they are even using prescribed drugs? Do they know anything about the housing circumstances of the drug users involved?

 The answer to all those questions, sadly, is no.  The NTA has claimed near-miraculous success for drug treatment whilst knowing next to nothing about the lives of the people it is so eager to celebrate as treatment successes.

 hat the NTA has done is to undertake an analysis of client records to see whether drug users leaving treatment re-contact drug treatment over the next four years. If they  do not, then according to the NTA,  the individual must be well on the road to their sustained recovery. Here is another interpretation based on the same data: that a large proportion of individuals leaving treatment were so disappointed by their experience of treatment that they did not return. Another interpretation of the same data is that, having contacted drug treatment services with a drug problem and left those series with a drug problem, many drug users might have wondered at the point of recontacting services.

 Those interpretations would not be welcomed by those providing drug ‘treatment’ or those, like the NTA, responsible for improving the quality of drug treatment. There, I am afraid, is the rub. The assessment of the success or otherwise of treatment has to be based on a good deal more than an analysis of records undertaken by the very agency with a vested interest in the quality of the treatment being provided.

 So what about the claim that ‘treatment’ leads to a massive resolution in drug-related offending? That claim is based on the NTA looking to see whether individuals leaving treatment provided a positive drugs test to a criminal justice agency or contacted the Drug Interventions Programme over the next four years. One would not have thought it needed to be pointed out – but not being drug tested by the police and not contacting the Drug Intervention Programme is not the same thing as ceasing one’s involvement in drug-related offending. 

 The NTA has acknowledged that it cannot categorically assert that all individuals who do not return to treatment or contact the Drug Interventions Programme are leading entirely drug-free or crime-free lives. To do that, it says, would require each of the 40,000 clients in the study to be personally contacted and interviewed.

 In fact, what would be required is only to study a representative sample of treatment leavers. Despite its cautionary caveat, the NTA has done precisely what it should have  refrained from doing – claiming near-miraculous success for drug treatment on the slimmest-possible evidence base.

 The NTA has too much invested in a positive story of drug ‘treatment’ for it to be responsible for the evaluation of that treatment. What we need is for our drug treatment services to be subjected to rigorous and independent evaluation. Only then can we be assured that the claims we are reading in the press and elsewhere about the effectiveness of the treatment services provided are based on hard evidence rather than political spin. 

 Definition of treatment: click glossary.

 Comments

 If independent treatment agencies made such extravagant claims on such flimsy evidence they would ridiculed and in fact their medical staff could be reported to the GMC for misrepresentation.

 Posted by: Peter McCann | October 04, 2010 at 07:15 PM

  As a volunteer with a service user recovery involvement group, this report stinks. We are not allowed into the so-called rehabilitation group – because our job is to promote “best practice” involving the clients actively in the service. The slogan To empower is c**p. More fitting is control.

 Trying our hardest to fight for the rights of service users does not go down well with the services. When a service users tells me that they will except any s**te thrown at them, that tells it all.

 I will continue to be a pain in the butt because when I read these stupid reports it just strengthens my commitment, enthusiasm, motivation and passion.

 I sit round the tables of SUIP, SDRC, SDF and many more. The only reason they invite members of the group is because they have to tick the box.

 I have written to government, just to confirm what part they think service user involvement groups should play. They made it clear that it very important and will continue to support these groups. Well, they should pass this on to the highly-paid judgemental, non-empathy employers they have at present.

 As for the recovery stats, they should attend our group. We are the foot soldiers in the real world of recovery. The real story reads like a horror story. Wake up.

 Posted by: CONFUSED | October 07, 2010 at 12:24 AM

 I worked for one of the biggest providers of the type of ‘treatment’ cited in Dr McKeganey’s report. It has been my experience that this well known organisation is staffed almost through-out by unqualified and inexperienced staff. They operate like a fascist state within the organisation, disciplining individuals or threatening them with disciplinaries if they dare to dissent in any way. In other words if you dare to question the system they call ‘treatment’. It has been my observation over the time that I worked for them that they are very cosy and familiar with the NTA and seem to have extraodinary sway when it comes to commissioners and winning tenders.
The projects that they run are ineffective at best and actually dangerous for clients at worst. Their staff are so incompetent and lacking in self-awareness that there is no room for innovation or clinical excellence. Yet the U turn that has taken where CEOs and others at the top are now bleating on about being ‘recovery focused’! -What this actually means is that they are following the pound note – simple. They have little commitment, interest or knowledge around what is needed to treat addictive disorders and support individuals from a place of crisis and chaos into abstinent recovery.
It appalls me that this agency has any credibility as they have in my experience never shown any aptitude in assisting individuals into recovery. It therefore is only natural for me to question whether their overnight success and strong hold on voluntary sector tenders is closely linked to their relationship with the NTA.
I beleive that all these agencies should be subject to rigorous monitoring in order to assure ethical and clinical excellence.

 ted by: anonymous | October 07, 2010 at 08:25 PM

  I am a recovering addict doing some voluntary jobs and returning to college in January…. it appears what the real interest is . If the services were to keep in contact with their clients after rehab or detox or even self withdrawel , then one would know how the client is or is not doing well , in our after care lives theses things appear to go unnoticed. In my years as an addict for 29 yrs i, feel i have a little bit of experience also having taken on the link with recovering addicts , the after care structure needs to be totally adjusted to say the least. This will only be the time to try and find out about true recovery.

Source:  Addiction Today Oct. 4th 2010

Obama laughed and as someone said, it is no laughing matter. He laughed I think not at the question but at the sheer silliness people who want cannabis legalised, at the irrationality that lies behind the call. Much of the legalisation argument is founded on falsity. Cannabis particularly, low CBD cannabis, has all the harms of tobacco and much more. Tobacco and alcohol as legal drugs (in most countries) cause far more personal and social harm than all the illegal drugs put together. The trivialisation of cannabis harms has been going on for too long, the normalisation and legalisation of this substance would inevitably lead to MORE USE, more use means, without any doubt, MORE personal and social harm as night follows day. So legalisation would not reduce that harm it would on the hard evidence of the tobacco/alcohol model, increase it. The second string of the argument is that illegal drugs are a gift to organised crime and that legalisation would remove that gift. This is a naive or dishonest argument. Illegal sales can always undercut legal sales by price, legal sales would allow crime to produce something “stronger”, regulations around age of purchase would encourage crime to target those excluded by age. Legalisation would produce counterfeit (cheaper) product, the application of any tax at all would encourage crime-to avoid that tax. The end result of legalised cannabis would be more consumption, by more people, for more of their lives. All that amounts to more harm. Just as we have with tobacco and alcohol. If anyone doubts what I say I ask them to consider the personal and social harm from alcohol in those countries where use is culturally or religiously taboo and to compare with similar sized societies where use is allowed and normalised. So why did Obama laugh? I suggest he knows the truth of what I speak, he knows that the tide of scientific opinion continues to move against the safety and harms of cannabis. He knows that the UK has only recently because of that social and personal harm and at the request of our National Director of Mental Health, reclassified cannabis to a more serious drug, (where it historically was under our system). We have rejected the nonsense of the pothead and stoner lobby. So should the USA. You should get off your drugs and get back to work.

Source: David Raynes response to article about drug use in USA March 2009

ACHIEVING THE PRESIDENT’S GOALS FOR REDUCING

YOUTH DRUG USE

Results from the 2004 Monitoring the Future Study

This year’s results from the Monitoring the Future (MTF) study further consolidate the historic reductions observed in last year’s results. In 2003, current use of any illicit drug and marijuana current use each declined 11 percent—exceeding the President’s strategic goal of a 10 percent reduction in 2 years from the 2001 baseline. This year’s MTF results indicate that current use of any illicit drug has declined 17 percent since 2001, while current marijuana use has dropped 18 percent.

Highlights of findings from the 2004 MTF on youth use of illicit drugs, alcohol, and tobacco; changes in anti-drug attitudes; and the impact of anti-drug advertising include the following—all changes discussed here are statistically significant:

Changes Since 2001 in Substance Use Among Grades 8, 10, and 12 Combined

Use of any illicit drug in the past 30 days (current use) among students declined 17 percent, from 19.4 percent to 16.1 percent. Similar declines were seen for past year use (13%, from 31.8 % to 27.5 %) and lifetime use (11 %, from 41.0 % to 36.4 %).

As a result of these dramatic declines, approximately 600,000 fewer youth in 2004 are using illicit drugs than in 2001.

Marijuana use, the most commonly used illicit drug among youth and the drug of primary interest to the Media Campaign, also declined significantly. Current use declined 18 percent, from 16.6 percent to 13.6 percent; past year use declined 14 percent, from 27.5 percent to 23.7 percent; and lifetime use declined 11 percent, from 35.3 to 31.3 percent.

Declines in youth drug use were not limited to these two categories. The use among youth of many of the most commonly used classes of substances are in decline, including LSD, MDMA (ecstasy), amphetamines, methamphetamine, steroids, alcohol, and cigarettes.

The use among youth of the hallucinogens LSD and ecstasy among youth has plummeted.  Lifetime use of LSD fell 55 percent (from 6.6% to 3.0%) and past year and current use each dropped by nearly two-thirds (from 4.1% to 1.6% and 1.5% to 0.6%, respectively).

Lifetime use of ecstasy dropped 41 percent, from 7.4 percent to 4.4 percent.  Past year and current use were each cut by more than half (from 5.5% to 2.5% and 2.3% to 0.9%).

Use of amphetamines, traditionally the second most commonly used illicit drug among youth, also dropped over the past two years. Lifetime use declined 20 percent, from 13.9 percent to 11.2 percent. Past year use fell 21 percent (from 9.6% to 7.6%) while current use fell 24% percent (from 4.7% to 3.6%).

Lifetime, past year and current use of methamphetamine among youth declined by 25 percent each — from 5.8 percent to 4.5 percent, 3.4 percent to 2.6 percent, and 1.4 percent to 1.1 percent, respectively.

Lifetime and annual use of steroids dropped 28 percent and 23 percent, respectively (from 3.2% to 2.3% and from 1.9% to 1.5%).

The use of alcohol, the most commonly used substance among youth, also declined.

Lifetime, past year and current use each declined by 8 percent (from 65.7% to 60.5%, 58.4% to 54.0%, and 35.7% to 32.9%, respectively). However, there was little improvement in these measures between 2003 and 2004. Reports of having been drunk in the past two weeks declined between 10 and 12 percent in each of the three prevalence categories.

Cigarette smoking among youth continued to decline. Lifetime and current use each dropped 20 percent (from 49.1% to 39.5% and 20.3% to 16.1%, respectively). However, there was little improvement in these measures between 2003 and 2004.

MTF began collecting data on the non-medical use of Oxycontin in 2002. In 2004 there was a 24 percent increase in past year use of Oxycontin for all three grades combined compared to 2002, from 2.7 percent to 3.3 percent.

Changes From Last Year in Substance Use among Grades 8, 10, and 12

MTF collects data from three specific grades: 8th, 10th and 12th graders. There were no statistically significant changes between 2003 and 2004 found for any grade in lifetime, past year, and past month use of hallucinogens in general; hallucinogens other than LSD; cocaine in general; crack cocaine; amphetamines; tranquilizers; heroin and other narcotics; and being drunk. Additionally, there were no statistically significant changes for any grade in lifetime or past year use of Oxycontin, Vicodin, or Ritalin and past year and past month use of alcohol. The following statistically significant differences were found:

Among 8th graders:

Any illicit drug use in the past month declined 13 percent, from 9.7 percent to 8.4 percent.

Marijuana/hashish use in the past month declined 15 percent, from 7.5 percent to 6.4 percent.

Lifetime inhalant use increased 9 percent, from 15.8 percent to 17.3 percent.

Lifetime, past year, and past month use of methamphetamine declined 36 percent (from 3.9%to 2.5 percent), 40 percent (from 2.5%to 1.5%), and 50 percent (from 1.2% to 0.6), respectively.

Lifetime and past year use of steroids declined 24 percent and 21 percent, respectively (from 2.5% to 1.9% and from 1.4% to 1.1%).

Among 10th graders:

Lifetime use of MDMA (ecstasy) declined 20 percent, from 5.4 percent to 4.3 percent.

Past month use of powder cocaine increased 36 percent, from 1.1 percent to 1.5 percent.

Past year use of GHB declined 43 percent, from 1.4 percent to 0.8 percent and past year use of Ketamine declined 32 percent, from 1.9 percent to 1.3 percent.

Lifetime use of steroids dropped 20 percent, from 3.0 percent to 2.4 percent.

The only decline in 2004 of cigarette use occurred among 10th graders. Lifetime cigarette use declined 5 percent, from 43.0 percent to 40.7 percent, and smoking half a pack or more per day declined 20 percent, from 4.1 percent to 3.3 percent.

Among 12th graders:

Lifetime use of LSD declined 22 percent, from 5.9 percent to 4.6 percent.

There were no statistically significant changes found in each grade from last year in lifetime, past year, and past month use of hallucinogens in general; hallucinogens other than LSD; cocaine in general; crack cocaine; amphetamines; tranquilizers; heroin and other narcotics; lifetime, past year and past month use of alcohol; and being drunk.

Anti-Drug Attitudes

A key aim of the Media Campaign is to improve youth anti-drug attitudes and perceptions; these changes are thought to be precursors to positive behavior change. We have seen improvements among youth in the perception of the harmfulness of using drugs and disapproval of people who use them, particularly for marijuana.  Statistically significant changes include the following:

Among 8th graders, both the perception of the harmfulness of trying marijuana once or twice and smoking it regularly improved from the previous year, by 6 percent and 3 percent, respectively. Perceived harmfulness of smoking one or more packs of cigarettes a day also improved significantly from the previous year, by 8 percent. The levels of these measures in 2004 are the highest they have been since 1993.

Among 10th graders, perceived harmfulness of trying MDMA (ecstasy) once or twice increased by 4 percent, while perceived harmfulness of smoking one or more packs of cigarettes per day increased by 4 percent as well. While the increases from the previous year in all other measures of perceived harmfulness were not statistically significant, the 2004 levels are the highest they have been in recent years.

Among 12th graders, perceived harmfulness of taking heroin regularly declined by 3 percent, while perceived harmfulness of taking heroin occasionally without using a needle and taking one or two drinks nearly every day increased, by 4 percent and 14 percent, respectively. There were no other statistically significant changes in perceived harmfulness among 12th graders.

Among 8th graders, disapproval of people who try marijuana once or twice increased by 3 percent from the previous year, as did disapproval of people who smoke marijuana occasionally and those who take LSD regularly, increasing by 2 percent and 5 percent, respectively.

Among 10th graders, disapproval of people who smoke marijuana occasionally increased by 4 percent; those who smoke marijuana regularly increased by 3 percent, those who try inhalants regularly increased by 1 percent, and those who try MDMA once or twice increased by 3 percent.

As with perceptions of harm, the 2004 levels of disapproval are the highest they have been since 1993 (8th graders) and 1994 (10th graders).

Impact of Anti-Drug Advertising

Exposure to anti-drug advertising (of which, the Media Campaign is the major contributor) has had an impact on improving youth anti-drug attitudes and intentions. Among all three grades, such ads have made youth to a “great extent” or “very great extent” less favorable toward drugs and less likely to use them in the future over the course of the Media Campaign (i.e., since 1998). However, more than half of the increase in most of these outcomes among all three grades has occurred in the past three years. This is particularly striking among 10th graders, the primary target audience of the Media Campaign.

Source: ONDCP, USA, December 21, 2004.

A personal view by David Raynes

 

The background to and an account of the hearing, in London on 5^th February 2008, of evidence to the UK Advisory Council on the Misuse of Drugs. It met to take this evidence on re-classifying cannabis to Class B from C under the UK system.

There is surely hardly an observer of drug politics in the world who does not know that the UK, four years ago, surprisingly downgraded cannabis from B to C. under our A to C classification system of potential harm, (Also used to establish social sanctions against use & trafficking). With only a short debate in parliament, the issue was driven through by Home Secretary David Blunkett (now out of government) who had only weeks before, entered the UK Home Office as the responsible Minister.  The issue was noticed and claimed around the world as a victory for the drug legalisation lobby who clearly thought this was a step on the way to their nirvana of legal dope for all. Such an action would have been unthinkable for Blunkett’s predecessor Jack Straw (still in Government). Perhaps Prime Minister Blair took his eye off the domestic ball; bogged down over Iraq, he gave Blunkett his way while apparently we are now told, “having real doubts” himself. Thus are we governed.

The downgrading reverberated around and beyond the English speaking world; such is the power of the internet.  Some lobbyists lied about it, saying the UK had made cannabis legal. It had not, it had messed up, confusing the anti-use message and, strangely, had to put up the penalties for trafficking all Class C drugs because Blunkett had apparently not appreciated his proposed action held the danger of making Cannabis trafficking a minor crime compared to tobacco trafficking. Politically unsustainable. He swears now to this writer he had no external influences on him. Foreign readers may not know he is blind. Does his denial of external influence during his arrival briefing and subsequently before his announcement, sound credible?

Cannabis downgrading (and ultimately legalisation) had been heavily pushed in the UK, since the mid 90s, by a small but noisy, largely London based, media lobby. The downgrading and even legalisation issue was taken to the heart of an educated elite, perhaps fearful their kids might get arrested for pot smoking and not overly concerned about the wider social consequences of cannabis use, especially on the socially disadvantaged.

The statutory body that advises government on drugs, the Advisory Council on the Misuse of Drugs (ACMD) had also advanced the downgrading issue. A report from the “Police Foundation” (not much to do with the Police) led by Baroness Runciman also contributed to this new golden age of pro-pot haze and muddled thinking. A current Liberal Democrat candidate for Mayor of London, then a senior Policeman, made his own timely contribution by announcing the relaxing of the policing of cannabis the day before a pro-pot march. The scene was set. South London lapsed into a drugs no-mans land of dealers in all illegal substances. Great work! Really helpful to anxious parents. A real mess of confusing signals.

A couple of oddball Chief Constables added their pro-drugs bit and in all the UK parliamentary parties there were similar odd (but minority) contributors to the general nonsense. None of these people thinking through exactly how this idea would further damage Britain’s already bad drug using culture. Rank and file Police Officers, the key top scientists and many experienced drug workers, of course opposed the changes but were ignored. David Blunkett astonishingly refused to see six top scientists & doctors who strongly opposed his downgrading.

The UK continued to develop one of the biggest drug problems in Europe. We have difficulties with all drugs, legal or illegal. In a separate earlier action in 1999, focussing on “the drugs that cause most harm” (I always wonder who thought up that phrase), UK Customs had stopped targeting cannabis imports and the UK was flooded with the stuff, much of it Moroccan Cannabis Resin and according to users, of poor quality. The price after 2000 dropped as supplies increased, “Blunkett’s Blunder” in downgrading took effect three years later.  “Age of first use” dropped alarmingly as did “age of first regular use”. Reportedly, kids–often pre teen were/are using cannabis on the way to school, at school and on their way home. The effect of this is that these kids become un-teachable, discipline breaks down, they fail academically, some drop out of education, they are forever damaged. Many, too many, become mentally ill, some diagnosed psychotic, others below formal diagnosis as mentally ill, are nevertheless unable to really contribute to society and cause huge distress to their families. The unemployment or mentally disabled register looms for many, their jobs taken by educated hard-working Poles and others from Eastern Europe. The government becomes seriously worried. Alarm bells ring in the Department of Social Security and in the Department of Health, both now picking up the pieces of the very wrong Home Office policy. The downgrading policy is looking expensive and socially damaging.

Out on the streets, the imported poor quality cannabis resin was gradually replaced by home grown and Dutch “sinsemilla” or “skunk” cannabis, this getting progressively stronger but strength alone being only one of several contributing factors to damage.. Frequency of use and age of first use is also important, and, in the view of this writer, so is the different ratio of THC to CBD in this new fresh, home grown “super-weed”. The belief is that CBD moderates the effect of THC on the brain.

A new Home Secretary, (Blunkett having left government), took over and anxiously asked the ACMD for advice –yet again, on cannabis classification. The ACMD resorted to “return-to-sender” for this enquiry after a half-hearted review where, according to inside information, there was no vote merely a decision by the Chairman, Sir Michael Rawlins and a round the table “chat”. Dissent in the ACMD, is not encouraged our spies tell us; the ACMD members, all of them, have only negligible knowledge of the drugs market. The self-selection of new members keeps out those who oppose liberalisation so plainly, the internal debate is and can only be, very one-sided.  Perhaps the Home Office should ensure more balance?

No change then, the cannabis problem for teenagers and pre-teens gets worse. In 2007 the spin doctors and even Ministers take comfort in figures from the British Crime Survey which shows a slight reduction in cannabis use at ages 16 to 24. No one other than this writer mentions this is simply because cannabis for older young people is becoming unfashionable and gets replaced by cocaine, crack-cocaine and (particularly) gross & physically damaging alcohol consumption. Government has allowed 24 hour alcohol licensing despite widespread public concern.  Cocaine use in the UK has also zoomed up. The infection spreads to Ireland, that society develops a similar drug habit.

The regular discovery of organised Cannabis Farms, a new phenomenon in the UK (although known elsewhere, for example in Canada) and an entire new industry in the UK since “Blunkett’s Blunder”, goes unexplained, Cannabis use is down we are emphatically told. When this writer challenges this and points to the farms, one joker (A Professor and a pro-pot lobbyist) suggests the UK is a substantial exporter of cannabis. A statement that defies belief, there is no evidence of such a thing, not substantial anyway. Things are spiralling out of control. Britain is a nation of sick young people; drugs of all sorts are cheaper than ever, youth is more affluent than ever. Prime Minister Tony Blair, architect of “Blair’s Britain” and now being blamed for “Blair’s Feral Youth” is forced from office in the autumn of 2007, largely over Iraq and his handling of the Middle East but his party and most other people are basically just sick of him. This writer tells the media that the cannabis market has widened and deepened, the totality of use is higher. If it is not, where is the output of the cannabis farms going?

A new broom and a largely new group of Government Ministers take over in autumn 2007. Gordon Brown as new Prime Minister is a dour Scot, son of a church Minister he sets a different social tone to Blair and just maybe, has more integrity and social conscience. Consideration is suddenly being given to abandoning plans for giant casinos; 24 hour drinking is being reviewed, so is cannabis policy. Brown appoints a new Home Secretary, Jacquie Smith, first woman in that position. She is a self confessed experimenter with pot at University but all credit to her, she and Brown, together, take a different tone on drugs issues. She is after all a mum and mums (good for them) are driving a new national wave of sustained protest about kids being mentally damaged by pot. Brown signals he is minded to re grade cannabis to where it was, back to Class B, ending the confusion and sending clear messages about the harms. Smith refers the issue once again, back to the ACMD. The implication, clear beyond any doubt, is that Brown and Smith want, and will have, cannabis re-graded even if the ACMD do not support it. On the fringes of the ACMD there are dark mutterings about resignations if their views are ignored. Some observers may think that would be a good thing.

So we arrive at 5^th February 2008. The ACMD is forced; reluctantly it seems, to hold some of its hearings in public (Why not all in public you might ask-Parliament is after all in public). It arranges a one day hearing in the City of London. Public access is limited because numbers are limited and prior application and approval are needed.  Questions to witnesses by members of the public are strictly forbidden though there is a short public comment/question session at the end.

Chairman Sir Michael Rawlins runs a tight ship, ACMD members call him “Sir”, he calls them by their first names. Very few ACMD members ask questions. Of those that do the most active seem to do it to show how clever they are, not, particularly, to illuminate the real issues. We get no indication or feel for what most members think at all. There is a pre-occupation with the penalties for drugs use & possession, not the science and social science of harm-potential and the actuality in the country. Arguably the very things that should most concern this committee. Astonishing.

Early witnesses from the Forensic Science Service and GW Pharmaceuticals confirm that herbal cannabis seizures (home grown) in the UK, are gradually getting much stronger in THC and that this new form of the drug contains hardly any CBD, leaving the effects of strong THC unconstrained. Resin we are told, long the staple of the UK market, is declining in market share and historically had almost equal amounts of THC & CBD. More work is needed on the issue of CBD but it is plain that by selection, a much higher THC-containing product is gradually taking over the market. It will continue to do so. Other academic witnesses on the potential mental health effects tell us that CBD may be “anti-psychotic”. The absence of CBD may therefore be aggravating the mental damage from the stronger THC. The new selected cannabis may be two or three times stronger, certainly not the 10 or 20 times of the tabloid press and even some over zealous commentators on my side of the debate. Cannabis is not homogeneous and techniques are available in the market to sieve it and extract a higher THC product. The mental health ill effects are more marked in young men; by 2010 cannabis use will be implicated in 25% of schizophrenia cases. Professor Robin Murray has spoken of 1500 cases a year, very expensive to treat and of course this is only the clinically diagnosed.

The most telling early witnesses are from “SANE” & “Rethink”, both mental health charities. Marjorie Wallace from SANE talks of the “confusion about legality & safety” and that cannabis is implicated in 80% of 1^st episode psychosis. She says, “Only re-classification can counter the mixed messages”. There is then, an immediate and astonishing outburst from Chairman Sir Michael, angry, venomous, red-faced. (This is a really serious scientific approach, observe and learn I think to myself?) He barks out, “Are you really wanting people to go to prison for five years for possession”? 

Any minor confidence one might have had in a dispassionate scientific appraisal, led by Sir Michael at least, surely evaporated. His remarks are nonsense of course and misleading of the ignorant. Sentencing guidelines and historical fact show that imprisonment for just personal use possession, of any illegal drug, hardly occurs in the UK. Why bother with the facts when you are Chairman of such an important meeting, advising government, confident, despite the evidence, that you know best? Does the Home Office know he is behaving like this?

The position of “Rethink” is truly hard to fathom. They accept all the harms of cannabis, indeed they tell us about them, yes they are getting worse but to them, re-classifying so that the public can understand this better, is astonishingly not important. To this observer they seem to have been “got at” by someone, so perverse is their position. Is their funding being threatened if they take a more robust view?  Their position is surely odd especially seen in the light of the remarks by Wallace. This observer smells something very wrong indeed. They are in the same business as SANE, or ought to be. Just what is going on?

Professor Louis Appleby, National Director of Mental Health for the Department of Health gives an impressive presentation, he is clear about the mental harm, we hear of patient suicides and homicides, figures trip out, “68% had taken cannabis”, we (as a society) are “guilty of complacency” (about cannabis), “causal factor”, “benefits from re-classification”. “health perspectives” and much more. Professor Appleby is hugely convincing. He is in no doubt at all that re-classification is needed. One is encouraged that here, at last, we have a public servant being so clear about what is needed and why.

Another presentation about the physical harms is convincing that in cannabis there are all the harms of tobacco and more. Talk of head & throat cancers, early emphysema etc. A second presentation about cannabis & driving illuminates the fact that cannabis is now by far the most common drug found in those arrested under the Road Traffic Act. Cannabis influenced drivers exhibit “poor road tracking” & “divided attention”.

Debra Bell of the “Talking about Cannabis” mum’s pressure group then speaks, together with another mum, an anonymous Barrister, whose own family life, like Debra’s has been severely and permanently damaged by teenage cannabis use. Promising young people damaged mentally and permanently, we are told. Educational under-achievement, wasted years. We are told of the thousands of hits on Debra’s website, the families feeling “let down” by government and the ACMD, the widespread feeling that cannabis use has become acceptable and that parents and teachers were undermined by Blunkett’s downgrading.  Debra tells of the phone calls, parents at their wits-end, desperate and helpless in the face of kids who say cannabis is not so bad, “the government downgraded, it must be OK”. Some kids who even think it is legal. These mums must really worry Prime Minister Brown. These are articulate and educated people, they are not going to give up. They are also voters. These are the people we need to take the campaign against cannabis use forward. They bring a new focus to the battle.

M/s Cindy Burnett. Representing the Magistrates Association & Youth Courts. She is very convincing, she and colleagues are “worried about the message”, “downgrading sent the wrong message”, “caused confusion”. “unnecessary”, “poor effect on health”, “increased addiction”, “ youthful “addiction to cannabis”, “downgrading had a bad effect”, “shoplifting driven by drug addiction” (cannabis), “wrong in principle”, “badly handled”, “downward spiral”, need for Youth courts to be supportive. All strong stuff. The ACMD listen in silence, are they taking it in? Who knows?

A few government apparatchiks from the Home Office talk about their wonderful publicity campaign, they show some clips, fancy indeed but have they worked? How could these adverts turn back the bad effect of downgrading? Like swimming against a strong current. Such stuff keeps people in work but will probably have little effect.

The next speaker is Professor Simon Lenton from the National Drug Research Institute of Australia, his presence confuses, just why is he, particularly him here? I notice he pops up later in the programme again on behalf of The Beckley Foundation, (run by our disgraced ex Deputy Drugs Czar Mike Trace who resigned from the UN when exposed as linked with the George Soros inspired legalisation campaign and “Open Society”). I wonder who has paid Lenton’s fare, was it George? He can afford it. I certainly hope it was not UK public money.

Again, I ponder just why his presence is allowed by Sir Michael.

Lenton is badly briefed about the UK debate and absolutely confused; he addresses us on “The impact of the legislative options for Cannabis”. He seems to think that the lobby against cannabis and for re-classification in the UK is from people who want to “lock users up”; he is more concerned about the social sanctions than about the adverse effects. He does not appear to understand that those who want cannabis upgraded, re-graded to where it historically was, are quite prepared to examine different social sanctions, we know, everyone knows, the UK cannot arrest its way out of our drug problem.  Does he not know the pressure is about putting cannabis back where it belongs? To send a signal about the real harms. To start to change the damaging culture created around use, by the downgrading.

Is Lenton a closet legaliser cloaked in fine words, hiding his real intentions? I “Google” Lenton when I get home and check my files. Yes I thought I had heard of him from Australian friends. As I suspected, keywords, legalisation, Lindesmith, International Harm reduction, support for changes to the UN Drug Conventions etc, need I go on? That and the link with Trace tell me enough.

Does Sir Michael Rawlins understand this chap is a covert pro pot lobbyist? Does the Home Office know the witnesses have been rigged like this?

Steve Rolles from Transform, the UK’s main drug legalisation lobby group (for legalising of all drugs) speaks to us. I know him well and away from this subject can enjoy his company. He is a bright guy. His thunder has been stolen by Lenton he complains! Yes Steve we are having views like yours laid on pretty thick are we not? Is this deliberate? Is Sir Michael rigging all this stuff, does he understand it? If not him just who is rigging it? Legalisation is not up for discussion any more so just why does Transform get a slot (Debra Bell nearly did not!). Steve though admits “Cannabis is more harmful than we thought”. Well more harmful than you thought Steve, my view has been consistent since I met my first pot-heads in the 60s. My allies have always said Blunkett got it wrong, indeed the World Health Organisation indicated the mental harms of pot in its 1997 report.   Rolles advises the ACMD to concentrate on a “Scientific Harm Assessment”. Yes, I can live with that; as long as they take in all harm not just harm to the individual. Yes and they should remember that defining the social penalties for use or trafficking are not what they (the ACMD) are about, leave that to others. Rawlins passion about that penalty issue nags at me.

Do the ACMD silent members (maybe most of them) know they are being manipulated? Again, does the Home Secretary know about this? This loading the witnesses with legalisers when that is not on any agenda is surely verging on the corrupt. No wonder they want to keep out those of a different view. I reflect that it is apparent there are at least two other days of private hearings, just who are this group listening to then?  Would a “Freedom of Information” request flush it out? Can Jacquie Smith just ask? Will she? Perhaps, I muse, she will if she gets a copy of my note.

The penultimate speaker is Simon Byrne Assistant Chief Constable Merseyside Police. He is the Association of Chief Police Officers lead on cannabis. He is a reassuring and sensible figure, ACPO have changed their view, they are seeing the problems with youngsters on the ground, and, picking up the pieces. He is also not interested in locking youngsters up; he wants early intervention, guidance to youngsters and strong signals sent out that use is potentially very damaging. Byrne tells us there have been 2000 cannabis farms found in England & Wales in the last few years since downgrading, that this is a huge new criminal industry since “Blunketts Blunder” (though he does not call it that). Illegal immigrants, often Vietnamese are involved; it is taking up lots of police time. UK based readers may remember downgrading was partly sold as saving police time.  Byrne speaks of confused public views on cannabis; he and his colleagues are now strongly for re-classification to B. Re-classification would reinforce the perceptions of harm. Is anyone listening?

Next witness is Lenton again, this time on behalf of Beckley Foundation.  “Is cannabis use a contributory cause of psychosis”? He is reading a presentation prepared by Wayne Hall & Robin Room.  Yes it is a cause, and more, 1 in 10 users become dependent. Really? Age of first use is important. Well we agree. We just do not agree on a part of the solution, telling the public the truth by classifying the cannabis in the right place.

There is a brief open forum, I manage to chide Lenton for his ignorance about the reasons behind the desire for re classification, I speak about parents and supporting them, telling the truth about cannabis, there is applause from some of the public.  An ACMD member says they are not forgetting the individual sad cases they have heard about (from the mums), he looks at me, he is, I think, defensive, a man with a conscience. I remind the ACMD that Robin Murray’s 1500 schizophrenia cases a year are the tip of an iceberg, there are a quarter of a million people under 35 unable to work and claiming sickness benefits through mental illness, often associated with drug use.  There are thousands of others not in the statistics because their illness is not clinically diagnosed; the prisons are full of those who are said to be mentally ill.

A few other speakers, first a mum, then a legalise cannabis advocate, and more, it comes to an end. It is over. Lenton follows me and speaks to me outside. He is uneasy and edgy.  We debate changing the UN conventions, he wants it, I do not. The best kept international conventions of all I say. Their strength is in the fact that everyone keeps to them. I know but he appears not to, that the UK Government has explicitly said it wishes no change in the conventions. He wants “more freedom for States to do their own thing”. What are those things I say, what can states not do that you want them to do? We in the UK have prescribed heroin for years to a minority of users, the British system. He struggles to answer. He wants the Dutch to be able to deal with and control, (legitimise he means), their cannabis growers. Why I ask? Do neighbours want that? Does he not understand that one European country can not do that independently of the rest? Do the Dutch, most of them, even want that? (We know from an opinion poll that 70% do not want it). I remind him that Dutch drug policy has made the Netherlands, which is a first world country and economy, have a third-world drugs manufacturing, warehousing and distribution problem. Astonishing levels of drugs based criminality feeding ATS (amphetamine type substances) to the whole world, including Australia. . He has no other ideas when challenged. He is plainly not used to being properly challenged. Why is someone with his views here, in this meeting, priming people who are going to advise our government? Who invited him?

As I travel home, I reflect, we have heard very strong messages about the harms of cannabis, is the ACMD about to change its position? I very much doubt it. They seem to be set in their ways, closed off to the harms, controlled tightly by Rawlins, most of them not taking part in the debate. I remember the question “do users mix cannabis with tobacco”. Quite extraordinary, he is in another world.

We have though, I think, seen the cannabis legalisation argument holed below the waterline; they will keep trying but that legalisation debate is surely over in the UK. If it is really over here perhaps it will be over everywhere else. What happens in the UK is of enormous influence because of the English language and the Internet.

Will UK Prime Minister Gordon Brown and Home Secretary Jacquie Smith re classify cannabis even if the ACMD is not with them? Yes probably. They will have the support of most MPs; the Conservative parliamentary opposition is supporting it. Even some important Liberal Democrats including the then leader (our third party) who have historically been weak and wrong on drug policy have been seen at Debra Bell’s meetings, that is really good. They are also getting the cannabis harm message.  Drug Policy is best when all parties are in broad agreement. Britain’s drug policy failure can I think, be tracked back to the breaking of that unanimity in the mid 90s.

Prime Minister Brown has “made his views clear” on cannabis, he said that this week at “Prime Ministers Questions” in the House of Commons. Brown has widely been accused by his opponents of dither and “government by review”, of putting off decisions. On this I think, based on the evidence, he means business.

David Raynes.

Member. International Task force on Strategic Drug Policy

http://www.itfsdp.org/members.php

Executive Councillor National Drug Prevention Alliance UK

February 2008

The NDPA have encouraged many individual users to get into treatment for their addiction. In some cases they have had to ‘fight’ for funding to get into residential rehab – with a further fight to stay for secondary treatment, i.e. 24 weeks instead of 12. The best chance for long term drug dependent users is a minimum of 6 months residential rehab. We can guarantee that no users in a residential rehab would ever be rewarded with drugs.

Heroin and cocaine addicts on the government’s treatment programme are being given drugs as a reward for clean urine samples, the BBC has learned. The National Treatment Agency (NTA), which runs the £500m-a-year scheme, admits the practice is “unethical”. Its own survey of almost 200 clinics in England found users were being offered extra methadone, a heroin substitute, or anti-depressants for good behaviour. Health Minister Dawn Primarolo has asked for a report into the survey. She said the survey had raised “very serious issues”. She said, “It is unacceptable, unethical, it should not happen that prescription drugs and doses are used, or suggested that they should be used, as either incentives or withheld as sanctions as part of a treatment programme.”

Best principles

A third of clinics in the survey said users who produced a drug-free urine sample may be offered increased doses of heroin substitute as a reward – known as “contingency management”. A quarter admits that clients can choose the type of substitute drugs they want. The survey also found clinicians offering anti-depressants, cash vouchers or access to detox as a reward. The NTA said offering drugs for anything other than clinical need was wrong and it wanted certain practices “squeezed out of the system”.

The agency’s chief executive Paul Hayes told the BBC, “One of the things that’s important before we start rewarding people through things like contingency management is to make sure that we’re doing it according to the best principles for drug treatment.”

“There are a range of practices associated with drug misuse in this country that are not what we would want them to be.”  He said the NTA was set up to not only expand the provision of drug treatment, but also to improve its quality.

Very different

He added, “It is entirely appropriate to prescribe other drugs alongside prescription drugs that are to deal with withdrawal. Not as a reward, which is why we wouldn’t advocate it.”

“What we would say is the dose people get ought to be determined by the individual’s needs, not by whether or not they’re co-operating with the regime. That’s why the contingency management programme that we’re thinking of introducing, based on American research, is going to be very different to the ad hoc rewards that operate in not very well managed services in this country at the moment.”

Martin Barnes, chief executive of drug information charity DrugScope, said it was “appalling” to offer drugs as a reward. “It is a complete distortion of the principles of ‘contingency management’,” he said. “The practice is unethical, contrary to official guidance and creates potentially serious risks for the drug user.”

Matthew Taylor, of the Royal Society of Arts, a think tank looking at how best to get addicts off drugs, said an overhaul of current policies was needed.

General problem

“I think the reality is that our drug strategy just isn’t working,” he told BBC One’s Breakfast.

“Only a very small proportion of those people who are put through drug detoxification successfully complete the programme, and even when people do successfully complete the programme they revert to drug use very quickly.”

“So we need a different approach, and the fact that some people feel that they need to incentivise drug users with other drugs in order to keep them off illegal drugs is, I think, part of that general problem.”

Dr Michael Ross, former clinical director of Bradford’s drug dependency service, said drug addicts needed to be self-motivated to achieve results. “The idea of bribing the patient to achieve a result which wasn’t actually something they felt important is quite abhorrent.” he said.

The drugs treatment project is the centrepiece of government strategy. Only about 6% of users on the programme leave free of drugs each year. However, there is evidence that giving addicts access to services can reduce crime and improve health even if they continue to take drugs.

Source: Daily Dose. Oct. 18^th, 2007