Posts Tagged ‘Drug Consumption Rooms’

Introduction:

To answer the above question, I am first going to briefly examine what is meant by the terms substance use problem, Criminal Justice Intervention, Public Health Intervention and Harm Reduction. I am going to examine what is meant by contemporary society by the phrase substance use problem, how this concept then defines and drives what are the current thoughts around Criminal Justice Interventions, and public health interventions, and then I will examine what is meant by Harm reduction and how this may or may not compliment public health and criminal justice interventions.

What are Substance Use problems?

The common  contemporary concept of substance use being a social evil, is relatively new, and if you examine social history, and read commentators such as ( Anderson & Berridge 2000),(Barclay et al  2000 ) & (Gossop 2007)  you can see from their research and resultant books, that substance use has been a integral part of society from early times. In many historical pieces, many academics discuss how substances such as cocaine, opium , and alcohol were all used in various commercially available products without any recourse prior to 1820(Anderson & Berridge 2000).

With the advent of the pharmacology act of 1820, the rise of professionalism amongst the new scientific professions such as medicine and pharmacology, the adoption of a new “Medical Model “of viewing substance use issues, or addiction and the rise of temperance, due to the public and social drive against drunkenness and all of its resultant evils, the common concept of what a substance use problem were, gradually began to perfuse into societies psyche. Over the various decades, more prohibitive laws have been passed, each time the laws becoming more prohibitive, until after world war two, the modern landscape of prohibitive legislation was finally developed and ratified by several global position statements by the United Nations. First the 1961 Declaration on narcotics,(UNODC 1961) which ratified the concept of all member nations being drug free, and basing their drug policies on evidence,  and the 1971 convention on Psychotropic  Substances, which called for psychotropic substances to be placed into Schedule one or two dependant on Harm, and banning all use except for medical and research practice. (UN 1971) These two documents also reinforced the concept of the “drugs war”, which had began with the branching out of the enforcement authorities into enforcing social and racial stereotypes based on cultural use of alien substances by ethnic and disenfranchised groups(ref)  which  with the repeal of the Volstead act, which  was the catalyst for the prohibition years from 1920-1932, enabled  the law enforcement apparatus originally set up to enforce prohibition enact a new role as guardians of society  against the insidious march of deviant and immoral drug use as alcohol became a legal substance once more. This new role brought with it the need for a more robust legislative and social framework to control these “immoral substances” and as such a new paradigm acceptable to the public to allow the enforcement and development of new legislation.

This was achieved by not only classifying the sale and use of these substances as illegal acts out with medical and scientific use, but was also fuelled by the development of the scientific model of addiction as a “disease of the will”, an idea first vocalised as early as the 1600’s by men like Trotter, Rush, Levine, & Huss, who all initially discussed alcohol, but the ideas of this “disease model” were quickly applied to all substances. With the advent of the 12 step model, which was “scientifically” endorsed via research and study by E.M Jellinek .published in 1960?

The decision of the United Nations both in 1961, and later in 1971, to endorse these concepts within their individual conventions, introduced this concept of drug use as a form of criminal behaviour perpetrated by criminals to supply clients with substances to ensnare them in a disease process, which then drove them to more crime to facilitate their ever increasing craving for their substance of choice.

Therefore substance use problems can be seen as criminal behaviour caused by the use of illegal substances which by their very nature have medically related problems, such as mental health issues, and physical health issues which are in the long run detrimental to the drug user’s health and social wellbeing.

Criminal justice Interventions:

Within the substance misuse arena, the term Criminal Justice Intervention refers to any of the interventions delivered due to a service user breaking the relevant part of the legislation.  The whole idea of drug interdiction and the reduction of supply all of which are parts of the criminal justice system, as noted above, come from the moral model of addiction, which is based on the belief that the use of drugs and alcohol is morally wrong, and that by preventing use you prevent substance mis use. The most effective example of this was as discussed the Volstead act which ushered in the era of prohibition within the US, strongly supported by the temperance movement, this however is also held up as an example of how the criminal justice approach can cause a rise in criminality, and offers an environment for organised crime to flourish. (Buchanan & Young 2000)

Within the UK we have also had our criminal justice system influenced by this movement, one of the many legislative bills which can be traced to these movements, especially here in Scotland was the 1913 Temperance Act (Scotland) which was an attempt to control licensing, this is sometimes over looked by all of the prohibitions passed with the defence of the realm act, which was intended to control substances, specifically alcohol, and the access troops had to it.

 

The main legislation in respect to this in the United Kingdom is the misuse of drugs act 1971, which has tariffs attached to various acts involved in drug use, and has also a classification system based on how harmful the drug is, and each drug is categorised as A, B or C dependant on perceived harm. (http://www.legislation.gov.uk/ukpga/1971/38/contents)

This legislation also gives courts and enforcement agencies the power to hand out custodial sentences, the tariff for which depending on the class of drug, and the part of the legislation the offence is committed under.
In Scotland at this point in time, there are several  criminal justice interventions utilised which can also be linked to Public Health Interventions which are prison based  opiate replacement therapies, Drug Treatment and Testing orders. There are also others, e.g. Probation and community service orders, which may also have public health elements within them.

Within this essay, we are going to focus on two of these interventions, prison based opiate replacement programmes, and drug treatment and testing orders, due to the way they can be linked to public health through the blood borne virus and sexual health framework.

Public Health Intervention

Public health interventions are interventions which look at the health of the general population initially, then specific groups deemed to be vulnerable or at risk specifically within that general population.

As with Criminal Justice Interventions, as outlined above, Public Health Interventions have their  core concepts based within a model of addiction. The model of addiction that public health takes its main concepts and schemas from is the medical model, as briefly discussed previously. This model suggests that addiction is the result of a disease process, and as a result the various issues that are associated to this disease concept such as the cravings, and associated medical problems such as liver damage, blood borne virus and the social issues such as crime and some degree poverty can be abated by people “just saying no” or by facilitating people who use drugs into treatment. The public health model also looks at abstinence, as does the moral model, as the ideal, and to this end most interventions are geared towards a drug free life(Scottish Government 2008,).

Public health interventions rely more on policy than legislation, to guide and facilitate their delivery, and examples of this for substance use  directly related to our two interventions would be the Road to Recovery (Scottish Government 2008) the sexual health & blood borne virus framework (Scottish Government 2011) , both of which discuss in detail substance use/misuse and the governments expectations of what services should offer.

Public Health interventions, especially around blood borne viruses and their prevention, tend to be delivered alongside harm reduction techniques, which are the polar opposite to the models discussed as the focus tends to be on the reduction of harm with abstinence being of secondary concern, this often causes tension between drug services and public health services, as drug services are being seen to condone drug use (Lloyd & Hunt 2007). On the other hand drug services tend to look at harm reduction as one of the many tools on a continuum towards abstinence, but another difference is that drug services are also pragmatic and realise that the concept of abstinence is not suitable for everyone, and with most harm reduction services the role is completed with some clients by just ensuring someone turns up at the clinic is using the correct injecting technique and knows how to react in an overdose situation.

Harm Reduction Approach:

As outlined above, Harm reduction approaches focus on reducing harm, this approach is more centered on thebehaviour change model as described by Prochaska & DiClemente in 1980, but also uses elements from Bandura’s theories around learned behavior, and also to some extent Skinner’s work around operant conditioning. (Ghodse 1995, Rasool 2009)

Harm reductionists believe in facilitating change, by providing choice, and by influencing factors such as mentorship and peer concepts, and this can be seen actively at work in the various peer support models used throughout the current drug services. This idea is at odds with the interventions based on the more traditional viewpoints as outlined previously. These concepts focus on facilitating the service user to enter into treatment and then whilst in treatment, maintain their sobriety, with the ultimate aim to be to facilitate and maintain abstinence. The tension arises with the way that this is done, and how the problems are perceived.

As previously stated, Harm reduction is about choice, with the emphasis being put on personal responsibility, the other two models are about removing choice, the disease model could be said to absolve personal responsibility due to the concrete belief that addiction is a disease, therefore any “addict” or “alcoholic” is at the behest of a disease process which causes the sufferer to have cravings, and ensures that once they use their substance of choice they continue to use until they are intoxicated or causing physical/psychological harm to themselves. Within the Criminal Justice Model, again choice is removed from the service user, as they are either incarcerated, in which case they are removed from their supply, or through DTTO’ given a tariff that also involves forced treatment options on the pain of imprisonment when and if they do not comply(Rasool 2009) there is also the issues around the harm reduction agency facilitating an illegal act by facilitating the use of illegal substances, this argument can be seen in the various papers surrounding the setting up and running of “drug consumption rooms” and introducing needle exchange in a prison environment.

Do the two models compliment a harm reduction approach ?:

On initial examination the two models would seem to be at odds to a harm reduction approach, but to answer this question, we need to examine in more depth areas where all three of these concepts intersect, and the easiest topic to do this with is the current delivery of Blood Borne Virus Services within an addiction related context.

Blood Borne Viruses especially Hepatitis C and HIV have been an issue within the drug taking communities and the prisons that are more often than not a main fixture within their existence since the 1980’s.

The topic has been and continues to be an area of  research within academia, and in her book “ Aids in the UK : The making of policy 1981-1994: Virginia Berridge discusses how the issues around this encouraged the prisons within the UK to adopt  Opiate Replacement Therapy as a main tool to fight infection and reduce high risk behavior within the prison system in the 1980’s and 90’s, and the text from this era also indicates that injecting practice, and other high risk behavior was prevalent, which increased the risk of cross infection within the prison estate, with some of the respondents admitting in open questionnaires that they had indulged in risk behaviours whilst incarcerated. (Berridge 1996, WHO,1998).

This research and further discussions with the prison authorities led to Opiate Replacement Therapy being chosen as the main intervention to reduce these risk behaviours.

As with Prisons, and those incarcerated, HCV has also been an issue within the community with the incidence of HCV on the increase, especially within the drug using population. This issue has been deemed a priority by the Scottish Government who have produced two strategies to develop services Hepatitis C Action Plan (Scottish government 2006) which then developed into the Sexual Health and Blood Borne Virus Framework (Scottish Government 2011), which looked at all of the actions needed to deliver containment of what is a growing public health problem (Scottish Government 2006, 2011), inclusive of a section that was specific about Prevention,. In this section, it specifically looked at expectations around provision of services, and the expectation that services should complement each other.

The main thrust of these documents was to decrease risk behaviour in the community and increase access to preventative strategies including needle exchange and related therapies such as Opiate replacement therapy.

To achieve this various strategies were developed, which included the re-orientation of needle exchange to incorporate easier access to sterile equipment, more accessible testing processes, education about the issue and one of the few interventions that has spanned across all three areas without much disagreement has been that of using peers to deliver health, and harm reduction related messages, as well as Opiate replacement therapy.

Recent research has now highlighted that the combination of targeted prevention messages, and information on testing, has reduced transmission rates, and Peer education initiatives (Dolan et al 2004, Allman et al, 2006, Fisher et al, 2013, Moro et al 2013, Lianping et al 2013Weeks et al 2006), has been successful in delivering the relevant messages to target populations and reduced risk behaviour. Opiate Replacement Therapy has also been highlighted as an intervention, with roots in Harm reduction philosophy that has had a major impact on clients in both Public Health, and Criminal Justice environments, as it allows the service users to reduce risk by changing behavior around that risk, e.g.  sharing non-sterile equipment, by eliminating the risk taking.

Recent research suggests that ORT has been so successful in preventing onwards transmission of BBV within the prison environment that in the reports conclusion it suggests that there may be no need for needle exchange programs within Scottish prisons, it also suggests that this result is also due to other harm reduction strategies. (Taylor et al 2013). This trend of ORT and other Harm reduction strategies reducing ongoing transmission through high risk behaviours has also been witnessed in the general community, the NESI study & others indicated that a similar trend in the community of injecting drug users, suggested that ORT was one of the main contributors along with other strategies. (NESI 2012, Turner et al 2011).

Summary:

The question that was to be considered was Do criminal justice and/or public health interventions compliment a harm reduction approach to substance use and problems, and in order to do this we had to examine how and why we as a society view substance use the way we do, how this ultimately affected how we saw the problem , and as a result how this was developed into the conceptual ideas of the moral model and medical model to describe why people with substance use issues behaved in a certain way. We then examined how historically these concepts or models influenced the development of not only two distinct models, the disease model, and the moral model, but also how these models began to influence not only social concepts of addiction/ substance use, but also informed political and policy development in the western world. We then looked at how these historical ideals through globalisation led to the world acceptance of these concepts, and how this acceptance through the United nations conventions and declarations led to not only a prohibitive form on control through the development of legislation like our own Misuse of drugs Act 1971, but also how this “war on drugs” also led to, supported and normalised the continued medicalisation of drug use issues which has led to abstinence based policy statements like the road to recovery(Scottish Government 2008).

The next step of our exploration of the question examined how these two models viewed the harm reduction approach, and this concept and what it means in relation to the prohibitive and moral stance point of the medical and moral models, we also looked at how their is inherent tension between the traditional models and harm reduction due to the focus of harm reduction being on and this was explored looking at the issue of blood borne viruses, and how certain harm reduction approaches have been identified and utilised to control the spread of this condition, within the paradigms of the two traditional models, and their related interventions. We also briefly examined the research that has suggested that these identified harm reduction approaches, namely Opiate replacement therapy, and targeted prevention education utilising peer educators, has been seen to be as effective inside the criminal justice intervention that is incarceration, and also within public health where they are targeting substance use sub populations to facilitate total abstinence.

Conclusion:

Therefore when considering the question Do criminal justice and/or public health interventions compliment a harm reduction approach to substance use and problems, we have to suggest that in some cases these two  forms of intervention can complement the harm reduction approach, as outlined above, however we also have to concede that the two approaches that advocate criminal justice interventions and public health interventions i.e. the medical model and moral model, although fundamentally trying to do the same thing as harm reduction approaches, that is to protect the population from harm, are fundamentally different in outlook and design. We also have to concede that the two abstinence based models also in their own ways remove responsibility from people who use drug, and therefore by default remove ownership and responsibility for actions and behaviours as well. This again is a major difference that can only add to the tensions previously discussed, and this is evident when you examine the current debates around the introduction of drug consumption rooms in the community,( Lloyd & Godfrey 2010,Lloyd & Hunt 2007, Patel, 2007, McKeagney 2006, Rhodes et al 2006) or needle exchange programs within the prison (Taylor et al 2013). Therefore in conclusion it can be strongly suggested that some harm reduction approaches are complimented by Criminal Justice and Public Health Interventions, with the caveat that these harm reduction approaches can be effectively said to be within the letter of the law, i.e. are not encouraging the illicit injecting of illegal substances, or are not condoning use of illegal substances.

This discourse is well represented in research literature, (Lloyd & Godfrey 2010, Lloyd & Hunt 2007, Patel, 2007, McKeagney 2006, Rhodes et al 2006) and most famously was commented on by the Joseph rowntree trust in their 2006   paper “The Report of the Independent Working Group on Drug Consumption Rooms”

References

Anderson S. and Berridge V. (2000): Opium in 20th Century Britain: Pharmacist’s regulation & the people, Addiction Vol.95 (1)

Barclay et al, Royal College of Surgeons ( 2000) Drugs, Dilemmas and Choices, London Gaskell

 

Berridge V (1996) Aids in the UK: The Making of policy 1981-1994: Oxford University Press

 

Bloor M and Wood F. (1998) Addictions and Problem Drug Use: Issues in Behaviour, Policy and Practice,  London, Jessica Kingsley Publishers.

 

Buchanan J and Young L ( 2000): The War on Drugs-A war on drug users?. Drugs :education, prevention & policy Vol.7 No4

Department of Health(England) and The Devolved Administrations(2007):Drug Misuse and dependence: UK Guidelines on Clinical Management London: The Department of Health (England),the Scottish Government, Welsh Assembly Government, and Northern Ireland Executive.

Ghodse H.  (1995): Drugs and Addictive Behaviour : A guide to treatment  2nd  Edition London Blackwell Science Ltd

Gossop  M. (2007): Living with Drugs 6th EditionAldershot, : Ashgate Publishing Ltd.

Hunt N. And Stevens A. (2004): Who’s Harm? Harm Reduction and the Shift to Coercion in UK Drug Policy, Social Policy & Society Vol 3 . (4) pp333-342

Independent Working Group (2006) : Drug Consumption Rooms, summary report of the Independent Working Group, Joseph Rowntree Foundation

Jellinek, E. M. (1960). The disease concept of alcoholism. New Brunswick, NJ: Hillhouse Press

King R.S and Mauer M. (2006): The war on marijuana: The transformation of the war on drugs in the 1990’s: Harm Reduction Journal Vol 3 (6)

Lloyd C, Godfrey C (2010): Commentary on Pinkerton(2010): Drug consumption rooms-time to accept their worth: Addiction, 105 p1437-1438

Lloyd c, Hunt N, (2007)  : Drug consumption rooms: An overdue extension to harm reduction policy in the UK?: International Journal of Drug Policy  18  p 5-9

McKeganey N, (2006): Safe Injecting rooms and evidence based drug policy: Drugs: education, prevention, and  policy   Vol.13,No1, P1-3

Patel K, (2007): Research note: Drug Consumption Rooms and Needle and Syringe  Exchange programs: Journal of Drugs Issues 37: 737

Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M, Holloway G, (2006): Public Injecting and the need for “safer environment interventions” in reduction of drug-related harm: Addiction 101, 1384-1393

Runciman R,  Lloyd C, Hunt N, Fortson R, Green K, Hayman A, McKeganey N, Stimson G, Strang J, Wright N, (2006): The Report of the Independent Working Group on Drug Consumption Rooms: Joseph Rowntree Foundation

Rassool G.H., (2009): Alcohol & Drug Misuse: A handbook for Students and Health

Professionals,  Abingdon: Routledge

Scottish Government (2008) The Road to Recovery: A new Approach to tackling Scotland’s Drug Problem, The Scottish Government Edinburgh

Stimson G, Des Jarlais D.C, Ball A (editors) (1998): Drug Injecting and HIV Infection: World Health Organisation UCL Press London.

Turner, K et al. (2011) The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction, 106, 1978-88

University West of Scotland et al. (2012) Needle Exchange Surveillance Initiative (NESI): prevalence of HCV and injecting risk behaviours among people who inject drugs attending injecting equipment provision services in Scotland, 2008/2009 & 2010.

United Nations : Convention on Psychotropic Substances1971, United Nations New York.

United Nations Office on Drugs and Crime (UNODC) (1961): Single Convention on Narcotic Drugs 1961(amended in 1972), United Nations New York

http://www.legislation.gov.uk/ukpga/1971/38/contents  Accessed on  8th May 2014 @ 20.13

Question: Is Drug Policy Evidence Based ?

Introduction:

Drug Policies are a common feature of public health programmes world wide, and the question I have chosen to discuss in my essay is “Is Drug Policy Evidence Based”.
Every nation in the world will have some kind of drug policy, designed to protect their population from the harm that can be associated by the use of drugs either illicit or licit. This world wide  movement can be traced back to the emergence of the concept of capitalism in the 16th Century , just as western nations were taking their first tentative steps at colonisation and imperial expansion.
King James 1 with his “counterblast against Tobacco” could be cited as being the first attempt in Britain at controlling a substance with a policy of taxation (Barclay et al 2000), although within the Muslim world, alcohol had been controlled for centuries due to religious ideologies.
If we look at Britain specifically, there then followed a raft of substance control legislation , from the Gin Acts 1729  and 1736 (Barclay et al 2000), through the Pharmacy Act 1868 , Defence of The Realm Act 1914,and the Dangerous Drugs Act 1920 (Barclay et al 2000 and Rasool 2009) up to the recent Misuse of Drugs Act in 1971. All designed to control how the population used substances, and introduced to prevent substance related problems.  Globally, a Prohibitive Policy Structure has been followed since the inception of the United Nations Single Convention on Narcotic Drugs in 1961 which effectively declared a “war on drugs”, encouraging all member states to adopt a prohibitive stance within their local drug policies. This stance was further compounded by the Convention on Psychotropic Substances in 1971 and an amendment to the original 1961 convention in 1972.

We then need to ask, were these policies and legislation research based, and the evidence scientifically scrutinised, or were the legislation, and the policies that followed a way of forwarding another agenda.

Prohibition Vs  Decriminalisation/Legalisation:

Various nations have their own interpetation of the UN policy, and more locally, the UK uses the Misuse of Drugs Act 1971 as it’s main stay in the attempts to prohibit the use of controlled and illicit substances, (Barclay et al 2000), in effect criminalising the use of drugs which are used and accessed outside state control in line with the original 1961 UNDOC convention which looked to “limiting such drugs to medical and scientific use” (UNODC 1961)
In order to examine the question “Is Drug Policy Evidence Based ? “ we have to examine and contrast the two opposite stances, and as no country world wide has yet legalised the use of psychoactive substances we have to look at countries like Portugal who decriminalised all drugs in 2001 and Holland who has a more liberal attitude to drug use  and compare these policies with the UK who has a more prohibitive policy in place. To compare theses policies, we have to focus on a specific area, and examine the research followed, and how this research is transferred into policy.

Drug Consumption Rooms

Policies whether liberal, or prohibitive effect the population that they are used to protect and guide. Prohibitive policies are no different.

It could be said that whilst a prohibitive drugs policy designed to reduce consumption by preventing supply by using legal and social sanctions, it can at the same time isolate and marginalise sections of the population it intends to protect and all policies can have unintended outcomes as well as the intended ones.

In 2004, an Independent Working Group was established by the Joseph Rowntree Foundation, to look into, and gather evidence for the use of Drug Consumption Rooms, and their effects on the Drug Related Deaths due to overdose. The working group investigated, and visited sites throughout Europe, Australia and Canada, and looked at the current research, and published their findings, which were passed to the UK government, who rejected the findings “ for a number of reasons including lack of evidence , legal concerns, likely media and public hostility”. (IWG 2006)
The findings that were reported to the government at the time, included evidence that the introduction of these rooms would reduce the number of deaths, increase access to services, and lead to a decrease in blood borne virus cross infection.
Which were all issues which linked in to the “increasing emphasis within the Government drug policy on reducing harm” (IWG 2006 )

This seem s to be an interesting stance, when initially at the outset of the HIV epidemic in the early eighties, the UK government was among the first to encourage the use of Harm Reduction to combat the spread of HIV/Aids, and pioneered the introduction of Needle Exchanges, which has been instrumental in preventing an epidemic of HIV in the UK, but the same governmental apparatus seems to be resistant to the next “rational and overdue extension to the harm reduction policy.” (IWG 2006)

The more liberalised policies of some countries may be seen as allowing the move towards DCR’s , but as the IWG pointed out, the issues raised by the government for not adopting this policy were dealt with within the report, and the process used to gather information to formulate the findings. (IWG 2006)

As touched on previously, the historical context for drug control has always been that of prohibition, with the emphasis slowly shifting from a “voluntary “concept of control, prior to 1862, to a more coercive framework. This has been evident from the dawn of “New Labour” , who began to change terminology, to the point where “drug policy discourse of the New Labour Government largely focused on  drugs as an engine of crime” ( Hunt & Stevens 2004), this policy shift could maybe explain why the above issues have mainly fallen on deaf ears as it were.

The moral dimension of UK Policy

In a paper by Trevor Bennet and Kate Holloway, the two authors of the paper undertook a study looking at the above question,” Is drug policy evidenced based “but principally concentrating on current british policy & strategy and they studied case studies drawn from the four main strands of the current drug strategy to evaluate whether the strategy had its roots firmly in scientifically researched information. Out of the four main strands, almost all of three out of the four, had been grounded in , and could be linked to research around the subject, although on some of the flagship policy areas, there were some disparities on the way the research was used.  In the reclassification of cannabis, the government had basically based the decision on good strong reliable evidence, where it fell down was on how it had reported the findings of the evidence. (Bennet & Holloway 2010)
It was also apparent in some of the other case studies that some of the policy decisions were made prior to the publishing of the evidence “cited in the policy”. (Bennett & Holloway 2010)

Looking at this document, and taking into account the four main streams of strategy that the authors talk about, which are 1.  Protecting Communities through enforcement, 2. Preventing Harm to children, young people and families, 3. Delivering new approaches to drug treatment, and 4. Implementing public information campaigns, only one of the objectives nearly met all of the criteria, and this was the case study looking at cannabis re classification, and interestingly the other top scoring objective was objective 3 which looked at Dedicated Drug Courts. Interestingly enough both objective case studies were related to the coercive approach, of utilising criminal justice services to enforce policy, namely the enforcement of the re-classification of cannabis by the Misuse of drugs Act 1971, and the enforced treatment of repeating offenders with drug related criminal activities. This again hinting at a more hard-line doctrine within the government and policy producing apparatus. Therefore it could be argued that the government did not base the decision not to use Drug Consumption Rooms purely on the evidence in front of them but on an ideological stance as prescribed by previous governments.

Decriminalisation:

As we have seen , the UK at present prefers to use a prohibitive policy  stance when looking to protect our population from the harms of drugs, and as discussed, the majority of countries within Europe also subscribe to a prohibitive policy of drug control, there are however two exceptions to this , namely Portugal and the Netherlands. 
Both countries have embraced decriminalisation, The Netherlands in a limited form (mainly cannabis), and Portugal, almost exclusively.

The Netherlands & Cannabis.
The Netherlands has had  a unique policy, for many years. This is mainly due to the  way that the Dutch have distinguished between “Hard Drugs” & “Soft Drugs” , and the policy relationship built upon these definitions.
In the late 1970’s, the Dutch government formed a commission to inform, and advise on drug policy, called the Baan Committee, then published a report in 1976, which suggested that the definition of hard drugs and Soft drugs should be specific, this report was used to develop amendments to the Dutch opium act of 1919. The new amendment split the drugs available into schedule 1 and schedule2 drugs, based on the level of harm to health.  Schedule 1 covering substances such as heroin and cocaine, and “Hemp products such as Hashish and marijuana or “Soft Drugs” on Schedule 2 (Bloor et al 1998). This change in legislation, also increased the ease with which enforcement agencies could track and prosecute large scale importers, and with the addition of recognising the “expediency principle”  in effect decriminalised cannabis at street level, for recreational users as prosecutors would only pursue prosecutions that were in the public interest,(Bloor et al 1998) e.g. large scale traffickers not small time recreational users.
This model throughout the world at present is now held up as a possible alternative to total prohibition.

The UK and Cannabis

Interestingly, a similar approach was taken by the UK in 2004 when the then government re-classified cannabis to a class C drug on recommendations from the ACMD which led to the substance being reduced to category C within the Misuse of Drugs Act 1971. This was after the police commissioner in Brixton, had announced that his officers would no longer be arresting people for possession for personal use in 2001, and after the then Home Secretary David Blunkett had backed the “decriminalization” of  amounts for personal use This was when it was noted that 75% of drug arrests for possession were for possession of Marijuana. (King & Mauer 2006). Blunkett also went on to comment in further discourse “ this policy will permit Britain to concentrate efforts on the drugs that cause the most harm” (King & Mauer 2006).
As with most democratic states, the person in charge usually changes, as was the case when the prime minister at the time  moved on, and the Deputy Prime Minister, Gordon Brown took over the reins of power, this led to a renewed debate around the classification of this substance in 2007 based on its perceived dangers, and links to psychosis. A committee was established in December 2007 to examine all the evidence around the areas in discussion at the time, e.g. “ The Gateway Theory, Links to poor mental health, and potency to name a few.
“The outcome of the report was that the committee found “no compelling new evidence which would require the ACMD to alter its recommendation in 2006 to keep cannabis classified as Class C.” (UKDPC 2008), however Gordon Brown did follow through with the reclassification of the drug, in a very public way, against the advice within the report, with some of the media suggesting he was taking a “moral stance” against the drug.

Conclusion:

The question “Is Drug Policy Evidence Based?” may initially seem an innocuous, and simple question, but when you look deeper, it becomes evident that there is more at play when developing a drug policy than just discussing conceptual ideas around societies needs and the resulting protection of that society from spectres and monsters in the form of society destroying illicit substances.
When you examine in a micro way two or three initially straight forward seeming policy decisions, you see that political idealology also plays a big part in policy making as does the personal attitudes of the politicians.
Within this essay I have discussed several examples of policy decisions, made with the assumption of the general public, on good scientifically presented evidence, but under scrutiny, you see that in some cases, specifically with the example of the Drug Consumption rooms, and with the declassification then the reclassification of Cannabis, you can see a certain pattern of disinformation, arising when the information goes against the overall prohibitive stance taken by the government.
The United Nations Convention of 1961 was a prohibitive statement, but built within the convention is article 38, which allows the ratifying governments to “take all practicable measures for the prevention of abuse of drugs and for the early identification, treatment, education, after-care, rehabilitation  and social reintegration of the persons involved”, underlining the crucial  role of health and social interventions.”( UNODC 1961) This policy also enshrines the concept of policies designed around scientific research to enable the signatories to have fit for purpose  policies to protect their populations, and it could be suggested that in recent years, due to the influences of historical and artificially heightened public opinion around illicit drugs, and the use of combatitive language with regards to the policy of the “war on Drugs”, that in some way, this over arching concept of a policy fit for purpose has been lost in the quagmire of political and in some cases personal moral crusades against drug use and the population that uses the substances.
This is evident in the examples of policy decision cited in this essay, firstly drug consumption rooms, and the lack of enthusiasm for the UK government to accept and push forward in the words of the reporting commission “ a rational and overdue extension to the harm reduction policy.” (IWG 2006), again this is interesting due to the ground breaking policies in HIV harm reduction piloted by the UK in the eighties and then Cannabis re-classification debate of 2004-07 and the blatant disregard for the report by the UKDPC which backed up the classification of cannabis remaining at Class C when the Prime Minister of the time upgraded the classification , not only for what would appear to be personal moral reasons, but to reinforce a policy stance inherited by him from his predecessor. These facts in conjunction with many other instances which have not been discussed here, like the use of minimal pricing on alcohol, and the large cost of enforcing interdiction for small return, all suggest policy does not follow evidence based research, therefore drug policy could be deemed not to be principally based on evidence gathered by research, unless it fits in with already preconceived policy ideas e.g.  The coercive treatment approach as previously discussed within this easy.

References

Anderson S. and Berridge V. (2000): Opium in 20th Century Britain: Pharmacist’s regulation & the people, Addiction Vol.95 (1)

Barclay et al, Royal College of Surgeons ( 2000) Drugs, Dilemmas and Choices, London Gaskell

Bennet T. and Holloway K. (2010): Is UK Drug Policy evidence based ?, International Journal on Drug Policy  Vol. 21 pp 411-417

Hunt N. And Stevens A. (2004): Whose Harm? Harm Reduction and the Shift to Coercion in UK Drug Policy, Social Policy & Society Vol 3 . (4) pp333-342

Independant Working Group (2004) : Drug Consumption Rooms , summary report of the Independant Working Group , Joseph Rowntree Foundation

King R.S and Mauer M. (2006): The war on marijuana: The transformation of the war on drugs in the 1990’s: Harm Reduction Journal Vol 3 (6)

Rassool G.H., (2009): Alcohol & Drug Misuse: A handbook for Students and Health
Professionals,  Abingdon: Routledge

Bloor M and Wood F. (1998) Addictions and Problem Drug Use: Issues in Behaviour, Policy and Practice,  London, Jessica Kingsley Publishers.

United Nations Office on Drugs and Crime (UNODC) (1961): Single Convention on Narcotic Drugs 1961(amended in 1972), United Nations New York

Bibliography

Buchanan J and Young L ( 2000): The War on Drugs-A war on drug users?. Drugs :education, prevention & policy Vol.7 No4

Des Jarlais D.C (1995) :Editorial: Harm Reduction-A Framework for Incorporating Science into Drug Policy, American Journal of Public Health Vol 85. No 1