§ 7.28 p.m.
§ Lord St. Just rose to ask Her Majesty's Government what steps they are taking to deal with the great increase of hard drug-taking by the young in major cities.
§ The noble Lord said: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. My Lords, hard drug addiction is not a pleasant subject to introduce, but it is a very serious subject, due to the great increase of hard drug-taking in our major cities. This is borne out by the latest figures from the Home Office and also by people who work in the overall field connected with drug abuse. The number of addicts notified to the Home Office at 31st December 1981 was about 3,800. The large increase of about one-third over the 2,846 known at the end of 1980 was much greater than any of the increases during the last 10 years. In another place on 26th February, they had an Adjournment Debate connected with drug-taking, and it was then stated that as far as known 20,000 hard drug addicts must be added to the number, as well as and including barbiturate addicts.
§ Having opened with that, I would like to go back and say a few words about drugs in general before I return to the question of hard drugs. It seems to me that it is one of the things in this age in which we live that the young do take an interest in and I am afraid some of them fall for it, for every type of different drug. We know that it even goes to the sniffing of glue, and it has been stated in the past that they have brewed up bootpolish and got some kind of kick out of that.
§ I think that one of the problems which must be faced is the different point of view that is taken by the Government as a whole from the line that is taken by psychiatrists. Psychiatrists are, after all, the people who basically have to cure drug addiction. The other day I spent some hours talking to a consultant psychiatrist who had run a drug addiction unit. His line on the whole matter was that those drugs that one swallowed fell in one category and those that one injected oneself with came under a totally different heading. The main legislation that we have to go by is the Bill that was passed by Parliament on the misuse of drugs. That legislation plainly categorises under what headings various drugs come.895
§ Returning to the question of hard drugs, one of the groups of people who we are obviously out to try to deal with is the pushers. We know that the pushing of drugs is a most difficult problem for the Customs and Excise or the police to deal with. I feel that the penalties connected with pushers should be increased, In my view, they are the most despicable type of human being—if we can call them such—that exists in this world. They make a great profit out of their beastly trade and all the small pushers, even if they are fined or sent to prison for a short time, will have their fines paid by the large pushers and will come out of prison and continue in exactly the same way as they were doing before they were sent to prison.
§ We must not be too pessimistic about hard drug addiction, because there is no doubt that some people are cured. One of the difficulties about the whole problem is that we must take these people out of the environment in which they have been living and that, in a sense, is more difficult than the situation we were dealing with under the Mental Health (Amendment) Bill the other day. If there is to be a cure, one thing that is essential is that the person is taken away from the group of people with whom he has been mixing and taking drugs. I was talking to a Roman Catholic priest the other day and he said, "If only these people had been given some useful work right out of their environment". From a negative point of view one of the difficulties, especially as regards a heroin addict, is that he may go to a drug addiction unit and he may get cured, but probably within a very short time he will be back again on heroin and then the whole cycle starts once again. Apparently—I did not know this—a great many heroin addicts find it an amusing game to go, I believe to the South Kensington area in London (I cannot talk about the other big cities) to try to discover how they can beat down the pushers, mug them or whatever, in order to get hold of the drug, and then off they go again.
§ I think that one of the most serious aspects is the number of people who may complete one cure in a drug addiction unit, and after that they might come back again, but then they disappear—they are on the road to be a totally lost cause. They disappear into some small garret in London and we all know from what we have read and seen on the media the ghastly and frightful end that comes to a great many young people.
§ I think that the customs are doing a fine job. I only hope that the Government will not decrease any further the strength of the Customs and Excise who are starting to have some definite affect on the channels. The channels come from Pakistan and Turkey. The Golden Triangle may be out, but as one saw on the media the other night, they have had a bumper harvest and it is bound to find its way through one of the channels back again to this country.
§ The only other matter I wish to raise concerns something which is rather like an Alice in Wonderland idea. It is known as "the black box" by the psychiatrists who use it. It is a machine invented by a Scottish lady doctor, Dr. Meg Patterson. She worked on it for many years and it is based on acupuncture. I know the feeling of some Members of your Lordships' House on the question of acupuncture. But the fact 896 is that this machine which is called "the new electric stimulator", really works. It has the effect of cutting down the withdrawal period, which is the ghastly period which these people have to go through. They are on the machine for 10 days and generally they come completely off it. In fact, nobody really knows a great deal about it, but one could ask the same question about electric shock treatment. What exactly does it do?—the medical profession do not know. But the fact is that it has worked. People have to continue wearing the machine day and night for some 10 days and then they can be taken completely off it. They are not given any other drugs and if they have the will, the push and the power they can be cured. I should like to ask my noble friend Lord Cullen of Ashbourne whether it is a possibility that these machines could be generally hired and tried out at one or two of the addiction centres throughout the country?
§ In conclusion, I should like to thank all noble Lords who will take part in this debate, especially the right reverent Prelate, who, like all other noble Lords, has waited a long time to speak. Therefore, as I have no right of reply, I take this opportunity to thank noble Lords who will take part in this debate very much indeed.
§ 7.40 p.m.
§ The Earl of Denbigh
My Lords, we, on these Benches, are extremely grateful to the noble Lord, Lord St. Just, for initiating this short debate this evening. I should like to thank him for such a timely debate, because, with the recent release of the Home Office figures—which show a 40 per cent. increase of new notifications over previous years—it is time that we showed some concern for this increasing problem.
I speak as chairman of the Standing Conference on Drug Abuse, which is the representative body of all the non-statutory agencies working in the drug-related field. The question of Home Office notifications is one that was last raised in a debate which I initiated in October 1979. As many of your Lordships may or may not know, the Home Office figures show only the people who are taking opiate-type drugs. There are many other people—particularly abusers of barbiturates and amphetamines—who are not referred to at all in these statistics, and there is no accurate way of figuring out exactly how many there are. However, I think that a figure of 25,000 is a fairly modest estimate of the number of people with drug-abuse problems in the country; in fact, it may well be nearer 50,000 than 25,000. There has been a particular attempt to try to reduce the prescriptions of barbiturates through normal medical channels, but still large quantities of them are found on the streets. There is even evidence to show that illegal manufacture of barbiturates is on the increase.
Like the noble Lord, Lord St. Just, I should like to praise the efforts of the customs and the police who have been seizing ever-increasing quantities of hard drugs, particularly heroin. I believe that last year the figure was 191 lbs. I think it is true to say that in the last three years the price of heroin on the street has remained stable; in fact, at one point it even dropped. In times of inflation—to use a well known political phrase—in real terms this actually means that heroin is considerably cheaper now than it was three years ago. 897 We also have reason to believe that heroin is infinitely more readily available throughout the country, not just in London, as it was mainly in the 1960s. There is a particular increase in Scotland; I think that Glasgow has shown a dramatic increase in the number of addicts being registered there. As regards the availability of barbiturates, we must remember that most of these pills originally come from a legitimate source in this country. They are not being imported; this is a home-produced problem and one that must be looked at very carefully.
As the noble Lord mentioned, many addicts are pushers. Obviously, for many addicts the only way in which they can finance their own addiction is by dealing in the drugs. I think that one must define fairly clearly someone who is attempting to make a vast fortune out of the improper use of drugs, and someone who is in the unfortunate position of being a drug addict but having to find some way of financing his habit. indeed, if there had been a shortage and a reduction in the amount of heroin around, I am sure that we would have seen the price go up, and that has not been the case.
City Roads, which is a short-stay, multi-drug abuse detoxification centre in London, was originally set up mainly to deal with people with barbiturate and amphetamine problems. Earlier on there was virtually no instance of anyone going there with a heroin problem. Now many people who go there use heroin as part of their cocktail of drugs. This is mainly because it is relatively cheap and also available.
I should like to give one more example to show how the figures do not relate to what is going on. Another London agency, the Hungerford Centre, carried out a survey between September 1979 and December 1980. it had 430 contacts; 51 per cent. of them were regularly using opiates; 31 per cent, were using barbiturates and amphetamines, and only 13 per cent. of these people were in treatment, receiving prescriptions and believed to be notified to the Home Office. That is a small example, but I think it shows that the size of the problem is much greater than that which is reflected in the Home Office figures.
Considerable concern is also being expressed over the widespread use of hard drugs on a national scale. In fact, there are few facilities outside London and the Home Counties, and these were mainly set up in the 1960s, when we were talking about a much smaller problem than we are today. As those facilities can no longer handle the situation that now exists, we must start planning for the future.
As I have said, SCODA represents the non-statutory agencies which with the drug treatment centres, are doing an extremely valuable job. Another example is the rehabilitation houses' survey during 1980, which showed that eight houses with 103 beds had 998 inquiries. They followed up 539 applications, and 67 per cent. were assessed as suitable referrals. Unfortunately, only 37 per cent. of those people could be admitted, and 28 per cent. of those people were self-referrals. I am particularly concerned about this because here we have an addict who, for whatever reason—it may or may not be intended prosecution for a drug offence—actually wants to stop being an addict and, unfortunately, through lack of space or lack of per capita funding from local authorities, 898 is unable to obtain admission to a rehabilitation home. I think that we must look at creating more space for rehabilitation, particularly for people who want to get off of their own accord and who obviously do not have the unlimited funds which are available to certain sections of the private sector to receive treatment.
Funding of services in the drug field is obviously an extremely difficult problem. It is a known fact that they are not a particularly popular client group in accident and emergency units of hospitals, in the courts, or on the streets of whatever town they are in. As has been suggested, it is difficult to obtain funding from charities, because, again, it is not a popular sector of the community. In many instances local government is increasingly reluctant to provide funding for people seeking treatment. I believe that it is the duty of Her Majesty's Government to finance a network of services throughout the country, or to make a requirement that local authorities should provide the same facilities.
At the moment the situation is that many agencies are having great difficulty in obtaining funds at local level. City Roads, which I have already mentioned, has just had a reprieve for six months by virtue of a further grant from the Department of Health and Social Security. I might add that it is funded by the London Boroughs Association, two regional health authorities, the Home Office and the DHSS. An independent study, which has just been undertaken for the DHSS, shows that, subject to one or two minor things, it has been doing an extremely good job, and this extra funding has been given so that it can try to raise the money at a local level.
I do not think that it is really fair to expect a relatively small unit to have to spend an enormous amount of time dealing with about five or six different organisations in order to try to get the funding that it requires to continue in business. That is a particular operation which requires 24-hour, round-the-clock nursing for their clients. It is a hand-to-mouth existence which is unfair to them, and it is also unfair to their drug addicts who go there. I was told the other day from somebody working in a drug dependency unit that they also have expended an enormous amount of time trying to justify their existence and their financing. The facilities available for drug addicts were fairly inadequate several years ago, and for them to have to justify their existence now is really rather pointless.
This is a common problem in both the statutory and non-statutory field. It is very demoralising for the workers who work long, unsocial hours in that particular field. Their future is not assured, and I might remind Her Majesty's Government that rehabilitation is still considerably cheaper than prison, and a more attractive alternative. I would urge the Government to consider the possibility of central funding for drug services, and hope that something concrete can come out of this short debate, because I am sure that by the time we come round to the next one the figures will he showing an even greater increase.
§ 7.52 p.m.
The Lord Bishop of Southwell
My Lords, I am sure that all of us taking part in this dedate feel that it is tragic that we should have to debate this issue at all, not only because drug addiction destroys those who 899 become addicts but because it is essentially a problem amongst the young. It is said that there are no old addicts. They have either been cured or they are dead.
I am personally very grateful to the noble Lord, Lord St. Just, for raising this issue tonight. The statistics which have recently been produced, inadequate as they are bound to be, are still horrifying. The peak age for drug addiction seems to be around the age of 29, and it is people between the ages of 16 and 40 who are mainly involved. But the increase in the numbers of those becoming addicted is so dramatic that it is a cause for real heart-searching on the part of us all.
It has been said that the present crisis could have been predicted, and indeed that it was predicted, but it is no use wasting time on time wasted. We need to address ourselves to the present situation. The first point that I wish to make is that all drug-taking of whatever kind is dangerous, and young people can all too easily graduate from one drug to another until their case is hopeless.
My particular responsibilities lie in the East Midlands and I have been trying to discover what the situation is there so that your Lordships can get a picture of what happens in the provinces. Drug addiction is certainly not a purely local London problem any more. The major cities of the country have a greater problem than we do in Nottingham. Nevertheless, it is well for us to hear what is happening in the provinces.
One of the startling things is that although we do not have so much addiction to hard drugs there is a real problem at the younger end of the age range. There has been a quite dramatic rise in the number of young people glue sniffing; an activity which is legal, quite uncontrollable, but the consequences of which for the future are at present totally unknown to us. Who knows whether the next step for one of these youngsters who is at school—because it is between the ages of 15 and 17 that this is particularly taking place in our part of the world—may not be soft drugs, and then hard drugs?
At this age it is almost a sort of recreational drug-taking; something done for kicks under the influence of their peers. But, as with all crime, it leads to other crimes of petty theft and then to something worse. In Nottinghamshire 80 per cent. of police time in the drug squad is taken up with the question of cannabis abuse. As I said, other major cities are facing worse problems than we are, but the warning lights are on for us, and we need to act now if we are to prevent a worse future.
It is not that the police have been backward in making some significant seizures of cannabis resin in our part of the world: up to about £½ million-worth. In talking to the police I am impressed that they feel that they are not being hindered by the law from doing their work. In the field of drugs they believe that the law is clear, that the penalties are ample, and that the police powers of search and arrest are adequate. So it is not legislation that is required.
The problem we are debating today is, I fear, at heart a commercial one, and even a political one. Too much money is being made in the traffic of drugs, and Governments have not been beyond using this trade to influence policy and secure advantage. I 900 speak of course of Governments outside this country. We are up against a big problem. The point I am trying to make, however, is that there is something that we can do to help the future; namely, to work at the problems facing young people before they add drug-taking to their unlawful activities and ruin their lives.
It requires some financial help to those who are able to work at the problem among the young people themselves. Recently the Government have been farsighted enough to put some modest resources into a scheme pioneered in Nottingham whereby field workers get involved with teenagers who are either truanting from school or are unemployed. This is a voluntary scheme in which young men and women of great dedication and social conscience are seeking to provide for disillusioned and bored young people the motivation to do something constructive, so that they are helped to avoid getting into trouble and starting that long slide from intermediate treatment to borstal, and eventually to prison.
Nottingham Youth Action, as it is called, is an imaginative scheme which has the support of both the city and the county of Nottingham, and I mention it because it has in fact only got off the ground because central Government saw that there was here a serious attempt to deal with a serious problem and were prepared to support it financially. Again I quote this because the same needs to be done for drug-addiction. The problems are allied.
Financial stringency is a healthy incentive to look at the way in which we spend our money and make sure that we are getting our priorities right. I submit that, if the Government say that this is merely a local problem, as I believe they do say at times, then they must be failing in their responsibilities. Some help, even of a temporary nature, is essential to get worth-while schemes off the ground locally. I was interested to hear what the noble Earl, Lord Denbigh, said just now about the unpopularity of local funding. It is all the more urgent then that the Government give a lead.
The problem that we are debating can only be solved by strong policing of criminals, by adequate support of Government funds, and by one other thing which I should like to mention; we need to engender in the media helpful reporting of this problem. There is evidence that at times the press have not been wise in the way in which the problem has been presented: we need to help people see that it is pathetic rather than sensational to be a drug addict.
I am told that drug addition in Harlem, on the other side of the Atlantic, is not the problem it might be in the black community because that community has its own pressures against the taking of hard drugs. I was interested in talking to the police in Nottingham to discover that the same is true there. We have a fair number of people of Caribbean origin and they do not graduate from soft to hard drugs because of the pressures exerted within their own community. We could learn a lesson from them. Support in peer groups for common-sense reasons to enable young people to avoid getting into the drug habit is a way of dealing with the problem, and we need to support young people working among young people.
I should be failing in my duty to the East Midlands if I were not to speak about the work that is being done 901 in the therapeutic field. The East Midlands is served by the Trent Regional Health Authority. Our area has a population of about four and a half million people. Statistics reveal that the opiate-dependent population is as high as one in 2,000. Recent research, as yet uncompleted, could put the figure as high as one in 1,500. What resources do we have in the East Midlands with which to tackle the problem? There is an addiction unit in Nottingham at the Mapperley Hospital. Like most addiction units, its main responsibility is for opiate addicts. Patients are seen as out-patients, although the unit has access to in-patient beds. It is staffed by a consultant psychiatrist, social worker and other support staff, and it serves patients who, in the majority, live in the Nottingham area. In Sheffield, in the same region, the Royal Hallamshire Hospital provides an out-patient service, although it does not have the staffing support available to the Nottinghamshire unit. The Doncaster Royal Infirmary provides a similar service to that provided in Sheffield.
That is the total statutory provision for the Trent Regional Hospital Board. You may say we are lucky. If you are a drug addict in Truro, you have to travel to Bournemouth, I believe, to get any help. In addition to that statutory work, there is in Leicester a voluntary organisation called INFO which funds one social worker dealing with drug addicts, but all appeals for financial help in what is an increasingly big job have gone unheeded. There is also in Nottinghamshire, only about three miles from where I live, work by the New Life Foundation, a charismatic organisation led by a Baptist minister which has done devoted residential work in what was a large retreat house for the Kilham Fathers. I know how desperately hard that organisation has found it to raise support for the work it is doing, with the result that in some cases they are charging fees to patients.
That seems to me to be paltry provision for such a great conurbation of cities as Sheffield, Nottingham, Leicester and the four and a half million people who live around us. I believe that throughout the country there has been no very real increase of support services for drug dependents since the early 1970s, even though the problem has escalated alarmingly. My plea therefore is that the Government should really take the problem on board, see it as a problem which needs priority funding and so give local authorities the chance, first, to support those who are already doing some work, for they have the valuable experience they have gained and dedication to the job, and, secondly, to enable new work to be started which can give a much wider geographical spread to the efforts now being made. This is an important debate, despite the lateness of the hour and the short list of speakers. I hope with all my heart that the Government will be able to take the problem much more into their own hands and that the debate will evoke a very real response from the Government.
§ 8.5 p.m.
§ The Marquess of Tweeddale
My Lords, I wish to thank the noble Lord, Lord St. Just, for the opportunity to speak on this subject. The Government should address themselves not only to the problem of hard drugs but to the so-called problem of soft drugs. We have heard from several speakers that there is 902 supposed to be a link between soft and hard drugs, but in my view that is a great over-simplification. Certainly the majority of hard drug users started with cannabis or something of that sort, but, then, one might as well say that every meths drinker there has ever been started with milk. There does not seem to me to be anything inevitable about the progression from one to the other, and indeed the right reverend Prelate gave an example of that in the black community in Nottingham. The progression might be rather more inevitable if the milkman, to continue my metaphor, brought meths or lager along with the milk.
I feel that the connection between cannabis and hard drugs is largely one of supply, the same pushers, if it is possible to talk about the supplier of cannabis as a pusher, supplying both. I would, therefore, argue for the separation of the supply of those; in other words, for the legalisation of cannabis and the amendment of the Misuse of Drugs Act to allow for that. The open sale of cannabis would abolish the exposure of cannabis users to the temptation to go on to something harder and lethal. As the Government must be aware, there are a great many users of cannabis. The law is being abused throughout the country, not just by Rastafarians, hippies and other wierdos or freaks.
The average cannabis smoker is no more a freak than the average drinker, yet the law treats him entirely differently. I cannot see why that should be so, for there is hardly any evidence that cannabis in itself harms the health or society or that it is addictive; it may be habit-forming, but that is different. If we compare cannabis with the widely tolerated—in fact, virtually obligatory—alcohol, the list of hazards to health resulting from drink are endless, starting with sclerosis and heart disease and ending with a hang-over, something which most of us have experienced at some time. The social effects of drink are colossal—driving, crime, domestic strife and so on. How does cannabis compare? So far as I have been able to make out, from experience and what I have read about it, cannabis may induce one to be idle, silly and sexy but very rarely, if ever, nasty.
I conclude, therefore, that if one views the matter from a sufficiently detached viewpoint, one could make a far better case for the prohibition of drink than of cannabis. Goodness forbid that should be so, as would be one of the first to suffer. But I feel one could make quite a good case for saying that an enlightened Government would encourage cannabis rather than prohibit it, which is what the present Tory Government do and what Governments in the past have done. I therefore ask the Government to consider amending the Misuse of Drugs Act.
§ 8.9 p.m.
§ Baroness Jeger
My Lords, we are grateful to the noble Lord, Lord St. Just, for bringing this subject before the House. I would remind noble Lords that the Question tabled by Lord St. Just was:To ask Her Majesty's Government what steps they are taking to deal with the great increase of hard drug taking by the young in major cities".I hope the Minister will tell us of some constructive proposals and suggestions.
I was very interested in what the noble Earl, Lord Denbigh, said about the difficulty of voluntary organisations 903 working in this field. It seems to me that in all the cuts that have been made by the Government in funding for the health service and social work in the localities great pressure is being placed on voluntary organisations to step into what is really an unattractive field of work. This is very unfair, and I know of several voluntary organisations that are in great difficulty as a result of the recession, of having to pay VAT, and of being faced with other problems which arise from the current economic position. I believe that it is the duty of Government to take a fuller responsibility for these less attractive, yet vital, services in the community.
To be honest, the ordinary members of the public would rather give some money to Oxfam, blind babies, or lifeboats—all of which are excellent in themselves—than they would to running a centre for drug addicts, perhaps next door to themselves. This is one of the least popular efforts that can be made, and the Government must try to accept that they are placing an unfair burden on voluntary organisations in this field.
In this short debate we are trying to deal with a problem which goes deep into the history of human fallibility and one which has proved intractable throughout the ages and in many countries. I have talked to a police officer in Hong Kong, where the favoured treatment was what they called "cold turkey" where a person was shut up in a cell and left with a glass of water to sweat it out. That imposed terrible strains on the human body. I was in America last year, when I talked to psychiatrists who were undertaking long, expensive treatments of Vietnam war veterans who, under the terrible stress of the war, had found some comfort and release in the taking of drugs. I discovered that nowhere from Hong Kong to New York had anyone found a total answer to the problem.
I have to ask the Minister whether in this country the Government are doing all that they can, through the Health Education Council, for example, to try to deal with preventive measures. For instance, I wonder whether we are doing as much as we could to inform parents and teachers more fully about the hazards involved. Last week I was talking to a young teacher, who said that in the whole of her teacher training the question of possible drug-taking among pupils was never raised. No information was given on spotting the symptoms among older teenagers—and we know from statistics that the 15- to 18-year age group can be involved. If a teacher has no knowledge with which to spot that a child is behaving in a difficult way, and so cannot relate that to the possibility that the child is taking drugs, there is a breakdown in the system.
I wish very briefly to refer to a report from Glasgow, and to quote what the Minister said in another place on 3rd December 1981, as reported at col. 5 of the Official Report.
The Minister said:There has been a dramatic increase in the number of new heroin addicts seen at the two drug clinics in Glasgow in the first six months of 1981".But it seems to me that by the end of that debate the other place had not gone on to produce a programme which would deal with the question which had been investigated and set out in a very serious report relating to Glasgow, which is something of a new location for 904 this kind of problem. Many years ago it was not such a problem in Glasgow, but suddenly there has been an epidemic of drug taking in Scotland. I am not sure that we are doing enough to tackle the problem—and I am not at all making this a party point, since goodness knows! in my living memory at least no Government have been able to find the answer.
I should like to return to the theme of prevention and of Government help. Dr. John Strang, who is the Director of the Manchester Drug Dependency Unit at Prestwich Hospital, was quoted in the Observer of 28th February 1982, as saying that he has 60 out-patients a week, and a waiting list of 100. Now here is the breakdown. A young man or a young woman, having got to the point of facing up to his or her addiction, has the courage—I am sure that it does take courage—to march to a hospital and say, "Please help me. I want to get off these drugs." The doctor has to say, "You will be No. 101 on my waiting list". I say in all sincerity that, if that happens, the young man or woman is not likely to go back again. Often a young man or a young woman goes along to seek help in a moment of crisis, and to be turned away is entirely destructive.
I want to ask the Minister, why is there a waiting list of 100 at the Manchester Drug Dependency Unit? And if there is a waiting list of 100 there, how long are the waiting lists all over the country? Why are the resources of these essential places being restricted? This is the politics of the situation. The only political point that I want to make in the debate is the question of making resources available, of finding the priorities. The fact that people who seek help should be turned away from hospitals is totally deplorable. To me it is as inhuman as turning away someone who has been badly hurt in a car crash. One would not say to a person who had been half killed in a motor accident, "Go away; we have a waiting list of 100. You will have to wait". But drug addicts are often in a position that is just as serious. So I very much hope that the Government will tell us that they are taking positive steps to increase the amount of help that is available, and that they will make the extra help available quickly. I repeat that the person who is turned away will be very unlikely to go back.
I want to ask the Minister a particular question, of which I have given him notice. I have been very interested in the history of legislation on this matter, and I found myself wondering whether we should give more thought to returning to the pre-1968 decision about heroin, when there was a tolerance for prescription by GPs for registered addicts. I must confess that I am in two minds about this question, because I have seen both sides of it. On the one hand, if a person who was dependent on heroin could go to his registered family doctor and reveal his position, he could then get a monitored prescription. This meant that he was under medical care—and we all know the medical side-effects of drug abuse of malnutrition, of liver damage and so on.
At that time it seemed to some of us that thus being under medical care was a good thing. On the other hand, I know that there was a great deal of abuse. I regret to say that there was abuse by some doctors by way of over-prescribing; there was abuse by patients I who sold part of their heroin to friends or to other 905 pushers; and there was abuse by patients who came and made temporary residence arrangements in different areas covered by several doctors, and so were able to accumulate drug supplies.
On the other hand, at least that gave us some statistics. At least we were able to find out something about the number of people coming for help. I submit that the Home Office figures for addicts are a complete nonsense, because there is now no reason why an addict should come forward and register. At least before 1968, by registering, he stood to get some heroin from his general practitioner. But now he does not. So why should he (or, I regret to say, she) bother to register? This makes me query all the figures we are getting from the Home Office.
I should also like to ask the Minister whether the number of break-ins at pharmacists have increased since these new rules were brought into force. Has addiction been reduced? So far as I can obtain figures, there have been more break-ins at pharmacists and people stealing hard drugs, and addiction has not been reduced. So I am not sure whether we should not enter into some meaningful new discussions with the medical profession about whether we should have another look at the situation and consider (I do not go any further than that) looking again at these new rules.
Then I have to ask the Minister about the work of the Customs and Excise department. One reads in the press—and I will not go further than this—that there is to be a reduction in the number of civil servants. I am wondering whether the reduction applies to the customs service; whether we are to have fewer searchers, fewer customs men and women on duty trying to keep heroin and other dangerous drugs out of the country. It seems to me that it would be quite unfair for the Government to say kind things about their concern if at the same time they are cutting down the number of customs officers who might be helping.
I think we all appreciate the part that the police are playing in various parts of the country, but I should like to ask again—I am sorry I am asking the Minister so many questions, but I think that this is a very important debate—what discussions they are having with the Governments of those foreign countries which are the providers of some of these drugs. It seems to me absurd for us to be trying to get our customs service and our police service to deal with these drugs if at the same time their production in overseas countries is increasing. I should have thought that it ought to have been a priority for the Government to try to discuss with Governments in Pakistan, Iran, Turkey and South-East Asia how we can stop this poppy-growing epidemic.
That is an easy question to ask but it is a hard one to answer. To my mind it is very much involved with the standard of living and with alternative employment in these countries. It is no use telling a peasant in Pakistan to stop growing poppies if you do not tell him how to earn a living otherwise. This is where I feel it really is an international problem which is much concerned with overseas aid and development, so that it ought not to be necessary for anybody anywhere to grow poppies to produce hard drugs to destroy another human being in another part of the world.
I was very glad that the noble Lord, Lord St. Just, referred to the pushers, because they are the real criminals; and I am not sure whether or not the Government 906 are thinking about increasing the penalties for these destructive people in our midst. As I say, it is a very complex question. I think that there may be some connection with the present mood of despair and failure, and that it has something to do with unemployment, with boredom and with the lack of facilities in many of our big cities. In fact, when the police in London issued a report the other day which gave the colour of certain criminals arrested for assault and battery, I would have been more interested if they had broken the figures down into the unemployed and the employed.
I should very much like to know how this pattern fits into the number of people, especially young people, who have been charged with the possession of dangerous drugs. How many of them are unemployed, and how many are employed? I think that is much more important than the colour of their skin; and I think that if we are going to put this problem into the social framework that it deserves, we ought to be asking questions of that sort. Of course, the pity is that if this continues to be an epidemic among unemployed young working-class people, they quickly become unemployable and they quickly become involved, not only with related health diseases but with crime and with blackmail.
The report from the university in Glasgow to which I referred earlier, the Ditton Report, has found that addicts are increasingly coming from working-class families. There is a quite different epidemic today from the rather trendy university experimenters of the 1960s. Therefore, we are faced with a very serious social problem. I do not think we know enough about it. We certainly have not yet found the answers. All I would ask the Government tonight, as we look at these complex social and personal problems, is what they are doing about it. Because that is the Question before us tonight, asked by the noble Lord, Lord St. Just: what steps are they taking to deal with the increase in hard drug-taking? I look forward to hearing some hopeful and positive reply.
§ 8.29 p.m.
§ Lord Cullen of Ashbourne
My Lords, may I congratulate my noble friend Lord St. Just on raising this important and difficult issue. It is a fact that there has, over the last few years, been a substantial rise in the extent of drug misuse in this country. We do not have precise figures of the number of individuals who misuse hard drugs, but the indicators of a growing problem, in terms of quantities seized and reported addiction, clearly exist. The number of addicts notified to the Home Office by medical practitioners has doubled in the last five years, from 1,700 in 1977 to 3,400 in 1981. Although the majority of notified addicts are currently in their late twenties, there has been a significant growth in new notifications among the younger age group. There are, however, many who misuse drugs who never attempt to seek treatment. Estimates for the total number of hard drug misusers range from 5,000 to 40,000, and the true figure probably lies somewhere between these two estimates. My noble friend is very right, therefore, to bring this situation to your Lordships' attention this evening; and I am grateful for the opportunity to reply to the many points that have been raised. It would be wrong of me 907 to suggest that there is any easy or quick response to this problem. It is one which must be tackled in a number of ways and over a considerable period of time. I will try to explain briefly the various forms of response that are being planned or made.
The increased availability of hard drugs, particularly heroin, on the black market is undoubtedly a major factor in the increase in drug misuse; and part of our efforts are directed at stemming the movement of drugs into this country. Drug trafficking is very much an international problem which requires close co-operation between the authorities of the countries involved—which might be termed the producer countries, the transit countries and the consumer countries. This co-operation takes place at a number of levels. First, the United Kingdom takes an active part in the work of the United Nations Commission on Narcotic Drugs; that body last year agreed a five-year programme of action, which was endorsed by the General Assembly, aimed at achieving united action in the fight against drug abuse.
Assistance is also given to individual countries in practical ways through advice and training, particularly for law enforcement officers; and the United Kingdom makes an annual contribution to the United Nations Fund for Drug Abuse Control, which, in addition to enabling law enforcement capacity in key countries to be improved, finances major projects in developing countries aimed both at reducing the illicit production of narcotic drugs and at countering the effects of drug abuse.
In Europe, the United Kingdom participates in the work of the Council of Europe Co-operation Group against drug abuse and illicit trafficking in drugs (known as the Pompidou Group). This body is now developing a programme of activities particularly suited to the needs of European countries.
Co-operation between national law enforcement agencies is also of great importance in the fight against drug trafficking. I am pleased to be able to report to your Lordships that the liaison developed between our own customs and police officers and their counterparts in other countries is now closer than it has ever been. These close links make a valuable contribution in detecting drug traffickers, and the customs officers and the police deserve much credit for this. I should also mention the Central Drugs Intelligence Unit, located in New Scotland Yard; this is staffed jointly by police officers from a number of forces and by customs officers, and has an important national and international role to play in this task.
The noble Baroness, Lady Jeger, asked about the reduction in the number of customs officers, and my noble friend Lord St. Just said that he hoped that there would be no further reduction. It is true that there has been some reduction in the overall numbers of customs officers deployed, but these have been predominantly in areas where results were meagre, and in support staff. The emphasis has been on concentrating available resources in those areas which have proved the most successful and in developing expertise and initiative. In particular, the Investigation Division, which is staffed by selected personnel who are highly trained investigators, has been substantially increased.
908 Turning to the work of our own law enforcement agencies, I am sure your Lordship would wish me to join in paying tribute to the valuable work done by HM Customs. They have had notable successes in the past few years, and in 1981—as has been mentioned by several noble Lords—there has been a total of 326 seizures of hard drugs which I understand are worth at street level about £20 million. They have seized 90 kg of heroin, 6 kg of morphine, nearly 10 kg of opium and 13½ kg of cocaine. The task of these men is difficult and sometimes distasteful, and it can be dangerous work.
I have already mentioned the important role of the police in preventing and detecting illicit traffic in drugs. About a year ago, the Association of Chief Police Officers held their first National Police Drug Conference; a second conference is to be held later this week. These conferences provide an opportunity for chief officers to review their priorities and practice. They indicate the seriousness with which our police service now views this problem and the determination with which it is responding.
The police are increasingly concentrating their efforts on those who traffic in hard drugs. Many noble Lords have referred to the terrible pushers who make money out of this. The police have had some notable successes over the past year or so. My noble friend Lord St. Just and the noble Baroness asked whether the penalities for pushers should be increased. The maximum penalty under the Misuse of Drugs Act is 14 years and/or an unlimited fine. This indicates the seriousness with which Parliament has viewed this offence, and the courts have on occasions-imposed the maximum penalty. That is a high penalty.
Turning to the subject of treatment, I should have liked to give your Lordships a clear picture of the facilities available for treatment; but I find that these vary widely from area to area. The right reverend Prelate gave us examples of this. Within the hospital service most drug misusers are treated as out-patients. The consultant psychiatrist responsible may run a full-time drug dependency service for a 100 or more out-patients; he may be a general psychiatrist with a special responsibility in his contract for drug misusers providing a limited number of sessions; or he may be a general psychiatrist who sees drug misusers within a general psychiatric clinic. The staff support may vary from none at all to a team which may include other medical staff, nurses, social workers, clinical psychologists and clerical support. In some areas, psychiatric nurses work with drug misusers in the community. Precise information is not available centrally about "hospital-based treatment facilities"; but interpreting those words to cover everything I have described, there are about 50 such facilities in England and Wales, 18 of them in London, which provide some specialist service for opiate addicts.
Relatively few hospitals have designated in-patient beds, but these range from a whole ward to one or two beds. We know of about 100 designated beds for drug misusers in England and Wales, mostly in London. Most consultants, however, depend on the availability of general psychiatric or medical beds when in-patient treatment is needed—for example, 909 when a patient is willing to undergo complete withdrawal from drugs or is in an acute intoxicated state.
Help is made available to patients in many ways. First, from some general medical practitioners, as the recent notifications of addicts show, and some work within the hospital service. My noble friend Lord St. Just questioned whether there were enough psychiatrists trained and working in the drug misuse field. I would say that the question of the professional training of staff of all descriptions is a matter in the first instance for the appropriate professional training bodies, including the universities and the Royal Colleges. As I have already said, the services are patchy. The staffing of clinics for drug misusers, both medical and nursing staff, and their in-service training, are matters for individual health authorities—and in the case of social workers, individual local authorities—to determine in the light of local needs and available resources. It is likely that health and local authorities and those responsible for professional training will wish to review the situation in the light not only of the statistics indicating an increase in the numbers of drug misusers but of the recommendations expected from the comprehensive report of the treatment and rehabilitation working group of the Advisory Council on the Misuse of Drugs. Those reports are expected during the course of this year.
Help is also available from local authorities, though I doubt that many, apart from members of the London Boroughs Association and metropolitan authorities, would claim that they play a major part in helping misusers as such. They may, however, become involved in helping with associated family problems, with children or adolescents in trouble, or in co-operating with housing departments on accommodation for vulnerable young people. Help is also available from voluntary organisations. There are over 200 places provided in rehabilitation houses in England and some local authorities, notably the London Boroughs Association, contribute to the financial support of rehabilitation houses and other voluntary agencies providing support and counselling for drug misusers. The Department of Health and Social Security and some health authorities also contribute in cash and kind to some voluntary organisations. Two national organisations whose valuable work is recognised by the Department of Health and Social Security in the form of grant aid are the Institute for the Study of Drug Dependence and SCODA, the Standing Conference on Drug Abuse. The noble Earl, Lord Denbigh, is the chairman of SCODA and his speech today was immensely interesting and has greatly helped us to understand the problem of drug misuse and the part played by dedicated voluntary organisations in helping drug misusers. I am sure that his speech will be read with great interest by my right honourable friend the Secretary of State. People who have already begun to misuse drugs can be helped, and the evidence suggests that the earlier help is sought the better the outcome. The drug misuser may need a wide range of help over time for a chronic, relapsing and sometimes fatal condition. His or her problems are complex and daunting. It is no easy task for the health, social and voluntary workers in this field to provide a network of effective support of the right kind and at the right time.
910 Your Lordships may ask: Is this demanding work worthwhile? So much depends upon the motivation of the client and on his willingness to be helped and to help himself. The answer most surely must be, Yes. It is encouraging that in areas where treatment and rehabilitation facilities are available over a period to drug misusers this increases significantly the number enabled to live a more normal, socially acceptable and ultimately drug-free life. We need to know more about what factors make misusers of drugs more likely to seek help, and we can hope that as knowledge is gained and experience of providing effective responses is disseminated successes will become more widespread for the benefit of the drug misusers, their families and our society.
The Secretary of State for Social Services is far from complacent as to whether the present services are adequate to respond to the needs of drug treatment and rehabilitation. The problem has been changing. Not only is there the increase in opiate abuse shown in the recent notification figures, but a recent trend is multiple drug misuse, including opiates as well as other drugs which are not subject to the same control. In consequence, professionals working within the established hospital-based facilities are reviewing their roles. I repeat once more that services are patchy. Resources for statutory and voluntary services are constrained and the question must be asked: could they be better deployed to provide the range of help that is needed?
This is, however, a very difficult area. The advisory council, a statutory body set up under the Misuse of Drugs Act to advise the Government on all aspects on drug misuse hopes to produce reports on prevention, treatment and rehabilitation by about the end of this year. Meanwhile, the Department of Health and Social Security pump-primes innovation by statutory and voluntary agencies and provides research, for example, to determine how information on the nature and extent of drug misuse problems can be obtained in particular localities with a view to helping health and local authorities to make reliable assessments of the appropriate responses required from their services. Also the department, jointly with the Medical Research Council, funds the Addiction Research Unit whose work, it is hoped, may give new insights into dealing with this difficult problem.
I shall now attempt to answer some of the questions I have not yet turned to. My noble friend Lord St. Just referred to the black box and said that it definitely worked. He also said that he did not quite know how or why it worked, and I do not think that anybody else knows that yet, either. The question of whether the black box itself and the treatment works or whether it is some psychological operation is not yet decided, but it is entirely up to local health authorities to have the black boxes if they wish to have them. The choice of methods of treatment is for the medical profession and the funding of medical equipment and in-service training is for the decision of the health authorities.
The noble Marquess, Lord Tweeddale, raised the subject of cannabis. This subject has been raised many times before, so I think I must pay attention to that. The House will be aware that the Advisory Council on the Misuse of Drugs asked a group of eminent experts to assess the evidence of the effects of cannabis 911 use. The group's report, a copy of which is available in the Library of the House, states after very careful assessment that there is insufficient evidence to reach any incontestable conclusion and that more research is needed, especially with regard to long-term effects. As long as there is substantial uncertainty about the harm caused by cannabis the Government share the view expressed by the advisory council that a cautious approach to any change in the present law is necessary. Noble Lords will be aware of the danger that reducing the current penalties might be misinterpreted in certain quarters as an acknowledgement that the health risks involved in using cannabis have been exaggerated. That could lead to an increase in its use, and surely none of us would want to encourage that. The Government could not responsibly support a change in the law relating to cannabis as long as the dangers of using that drug are not adequately known. We do not intend to introduce or support legislation to alter the existing law concerning cannabis.
The right reverend Prelate, in his extremely interesting speech about the Midlands, referred to glue-sniffers. I will only say to him that we in the department have no evidence to suggest that those who abuse solvents or glue in their youth, later graduate to the abuse of hard drugs. I know that it is early days, so I hope that evidence of that kind will not come to us in the future.
The noble Earl, Lord Denbigh, referred to the financial problems of voluntary organisations which are doing valuable work in this field, and the right reverend Prelate mentioned the problems of funding local schemes for young people at risk. If the advisory council makes recommendations on changes in the arrangements for funding voluntary organisations or statutory treatment in rehabilitation services, these will receive consideration by health Ministers. But there would need to be compelling reasons for departing from the policy that provision of services is a matter for local decision and local initiatives by the health and local authorities.
The noble Baroness, Lady Jeger, asked about waiting lists. While I am aware of some difficulties, precise information cannot be obtained without disproportionate cost. The scale of services provided by a particular hospital is a matter for the district health authority to decide in the light of their assessment of local needs. But if the noble Baroness has other cases in mind, apart from the one in Manchester to which she referred, I shall be very glad if she will let me know. I am grateful for the information which she gave us about Glasgow.
The noble Baroness also asked about the registration of addicts. A person who is addicted to heroin may still receive heroin from a doctor in a drug treatment centre, and a general practitioner can still prescribe drugs, other than heroin or cocaine, to addicts. The major abuse problem in the 1960s was caused by doctors who were over-prescribing drugs to addicts. The present arrangements were introduced to combat this, following the recommendation of an interdepartmental committee chaired by the late Lord Brain.
The noble Baroness also referred to prevention measures. Experience has shown that the scaretactics 912 which were popular some years ago do not succeed in preventing people from experimenting with drugs. Evidence suggests that, as in other areas, a person can be well aware of the dangers of drug misuse and yet not be deterred from experimenting. Experts in this field argue now that a more positive approach is needed, which attempts to promote a healthy attitude to living in general and which does not concentrate specifically on drugs. A number of bodies have adopted this approach, particularly as regards health education in schools.
If I have not answered all the questions—and it is getting very late—I will certainly write to noble Lords. I have tried as quickly as I could to give an indication of the range of responses that are being made to what is undoubtedly, and regrettably, an increasing problem. I repeat that it would be wrong to suggest that there is any quick or easy answer, but that must not be an excuse for complacency. We need to respond in a cool and discriminating way, and to develop the expertise and the range of services that are already available. This will require a close and continuing partnership between the many agencies involved at local, national and international levels. The reports which are awaited from the Advisory Council on the Misuse of Drugs will, I am sure, make an major contribution to the development of policies and strategies for prevention, treatment and rehabilitation of drug misusers, and will assist in ensuring that available resources are used to the best advantage.