Controversies in Drugs Policy and Practice Controversies in Drugs Policy and Practice Neil McKeganey ©NeilMcKeganey2011 Allrightsreserved.Noreproduction,copyortransmissionofthis publicationmaybemadewithoutwrittenpermission. Noportionofthispublicationmaybereproduced,copiedortransmitted savewithwrittenpermissionorinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988,orunderthetermsofanylicence permittinglimitedcopyingissuedbytheCopyrightLicensingAgency, SaffronHouse,6-10KirbyStreet,LondonEC1N8TS. Anypersonwhodoesanyunauthorizedactinrelationtothispublication maybeliabletocriminalprosecutionandcivilclaimsfordamages. Theauthorhasassertedhisrighttobeidentified astheauthorofthisworkinaccordancewiththeCopyright, DesignsandPatentsAct1988. Firstpublished2011by PALGRAVEMACMILLAN PalgraveMacmillanintheUKisanimprintofMacmillanPublishersLimited, registeredinEngland,companynumber785998,ofHoundmills,Basingstoke, HampshireRG216XS. 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AcatalogrecordforthisbookisavailablefromtheLibraryofCongress. 10 9 8 7 6 5 4 3 2 1 20 19 18 17 16 15 14 13 12 11 For Elsie and For Elise Contents Acknowledgements x Introduction xii 1 TheRapidlyChangingWorldofIllegalDrugs 1 Introduction 1 IllegalDrugs:AGlobalBusiness 2 TacklingDrugProduction 3 TheRapidlyChangingWorldofIllegalDrugs 4 TheNormalizationofIllegalDrugUseandthe GrowthoftheLegalHighs 8 ADrugTippingPoint? 10 Conclusions 14 2 What’sWrongWithHarmReduction? 16 Introduction 16 TheHistoryofHarmReduction:FromPublicHealthto DrugLawReform 17 TheEffectivenessofHarmReductionInterventions 29 AreHarmReductionInterventionsAbletoReduce OverallLevelsofHarm? 38 TheHarmReductionParadox 42 Conclusion 44 3 DrugTreatment:SoWhat’sAlltheFussAbout? 46 Introduction 46 TheRoleoftheMediaandtheLossofConfidencein DrugsTreatment 47 TheRoleofResearchinReassessingtheGoals ofTreatment 49 vii viii Contents TheContributionoftheThinkTanks 50 ThePoliticalSeaChangeinDrugAbuseTreatment 54 DrugAbuseTreatmentServicesandDrugUser Abstinence:AGoaltooFaroranAchievable Aspiration? 55 SoWhat’sWrongWithDrugAbuseTreatment? 61 Conclusion:ADrugTreatmentRevolution 68 ARadicalAlternative 71 4 DrugEnforcement:AWorldofMythandReality 74 Introduction 74 TheMysteryofDrugArrestandDrugSeizureStatistics 76 DrugsSeizure 76 ExplainingtheModestyinDrugsSeizures 79 ThePenaltiesforDrugSupply 80 HowIllegalisDrugPossession? 81 TheImpactofDrugsonPrisons 82 StoppingDrugsfromEnteringPrisons 84 Surveillance–WhereAretheLimits? 89 Conclusions 90 5 CannabisandtheClassificationMystery(orHowtoMake aHashoftheWorld’sFavouriteIllegalDrug) 92 Introduction 92 TheCannabisClassificationMystery 94 TheClassificationofIndividualDrugs 96 WhatDoWeKnowabouttheHarmsofCannabis? 100 PoliticiansandtheirExperts 104 ARadicalSuggestion:DoAwaywithDrugClassification 106 Conclusions 107 6 MeetingtheNeedsoftheChildrenofDrugAddicted Parents 109 Introduction 109 TheScaleoftheProblem 112 TheImpactofParentalDrugUse:TheVoicesofYoung PeopleandDrug-UsingParents 113 TheImpactofParentalDrugUseonChildren:The ResultsfromQuantitativeResearch 118 HowEffectiveareServicesatRepairingtheDamageto ChildrenfromParentalDrugDependence? 122 TheResponseofServices 126 Contents ix ARadicalAlternativeforMeetingtheNeedsof ChildreninDrug-DependentFamilies 127 TheProblemofScale 129 Conclusion 130 7 DrugLegalization:SolutionorSocialProblem? 132 Introduction 132 TheArgumentsForLegalization 133 HeroinPrescribing 139 TheInternationalDimension 141 DoDrugPoliciesMakeaDifferencetoDrug Consumption? 144 Conclusions 145 8 ThePoliticsofDrugsResearch:AJourneyintotheCold 147 Introduction 147 Methadone–theQuickRoadtoControversy 149 WhatDoDrugUsersWantfromTreatment:Abstinence orHarmReduction? 150 CalledtoAccount 152 ForecastingtheUKDrugProblem 155 AnUnwelcomeVoice 158 ButDoesAnyofthisMatter? 158 AreYouIntheTentorOutsideoftheTent? 160 Conclusions 162 9 Conclusion:SoWhat’sMoralityGottoDowithIt? 164 Introduction 164 Bibliography 170 AuthorIndex 189 SubjectIndex 192 Acknowledgements It is one of the great privileges of being an academic that you have the opportunity of talking at length with so many individuals whose dif- fering views and experiences help shape your own thinking and make the process of learning so enjoyable. In my case I have benefited from conversations with colleagues over many years. In particular, I would like to acknowledge my debt to Charlie Lloyd, Jim McIntosh, Michael Bloor, Robert Du-Pont, Joy Barlow, Griffith Edwards, Kathy Gyngell, Deirdre Boyd, Joanne Neale, Danny Kushlick, David Hunter, David Raynes, Mary Brett, Steve Rolles, Gerald Barlow, Lochy McLean, Rev John Mathews, Alisdair Young, Norman Stone, Theodore Dalyrmple, JoeWinston,UdayMukerji,GordonHay,JoeMcGallagly,PhilHanlon, David Clark, John Mullen, Joan McFadden, Roger Howard, John Strang, Archie Fulton and many others. That list contains people who would agree with much of what I have written, some who would agree withlittleofwhatIhavewrittenandafewwhowouldagreewithnoth- ing I have written. But debate does not need to find agreement to be helpfulinfurtheringone’sownthinking. Professor Marina Barnard (iwaly) has somehow always found the time to read what I have written and to provide a response that bal- ances criticism and encouragement. So much of what I have written startedoutasadiscussionwithMarinathatInolongerknowwhereher ideas end and mine begin. I am grateful to the University of Glasgow forthesupport ithasprovidedtothe CentreforDrugMisuse Research over many years and to Vice Principal Peter Holmes for the support he provided to me when I needed it most. I would like to acknowledge my debt to Evelyn Crombie with whom I have worked for 20 years x Acknowledgements xi and who has managed to create an office of normality and structure around me despite my inclination towards chaos. Finally, I would like to acknowledge my debt to my three children Rebecca, Gabriel and Daniella for reminding me that there are more important things in life thanwork.