Addiction is not a moral issue - on Rennie, the Record and Labour

On Thursday afternoon, the Scottish Parliament debated the Scottish Government's Drugs Strategy, which has been in place since 2008. In general it was a pretty intelligent debate as you can see from the Official Report. The Government even accepted amendments from the Liberal Democrats and Conservatives, which passed. They would not, however, accept a Labour amendment after the opposition party has been supporting the Daily Record's campaign against methadone prescription. Because pharmacists who dispense methadone have extra costs in so doing, they get extra payments to help them with that. It's a maximum of £2.49 a prescription, so for Labour's Jenny Marra to describe the pharmacists as "methadone millionaires" is a bit much. 

Labour and the Record seem to have gone for full scale demonisation, not only of addicts, but also the health professionals on the front line who dispense their medication or who make judgements about care. Labour's attitude seemed to be more about trashing methadone than recognising it as part of the tool kit for treating people with addiction. It can stabilise lives, and to suggest that the heroin substitute was solely responsible for half the drugs deaths is wrong.

I was pretty unimpressed with Jenny Marra's rhetoric on this, and so, to be honest, was the Parliament. Very few speakers, even Labour ones, agreed with her line. Not, of course, that you would have guessed from the  Daily Record's coverage the next day which failed to point out that Liberal Democrats, SNP and Tories all spoke against Labour. When you can't even get the Tories to agree with your ill-judged and prejudiced stance, then surely you know you are on a hiding to nothing.

The paper edition of the paper (which I actually went out and bought), had a special section on Willie. It accused him being out of touch for, get this, suggesting that health professionals and not politicians should be making the decisions on appropriate treatment for people. If I go to see my MSP Angela Constance, I don't expect her to give me medical advice, or to tell me what my doctor should be doing for me.And nor would she ever do so.

I guess you can't really expect a sensationalist tabloid to understand the nature of addiction - although it would be good if they tried. You expect a bit more, though, from the people who make the laws that could potentially affect the treatment people are offered. I've become increasingly worried at the way Labour are treating addiction as a moral issue in the same way as the Tories, and, yes, sometimes Labour too, treat poverty and joblessness as some sort of personal failing. Don't swallow Labour's sanctimony on welfare - one of their first acts in Government way back in 1997 was to remove certain benefits from lone parents.

When I was at Liberal Democrat Conference in Brighton, I attended a fringe meeting on civil liberties at which one of the speakers talked about how people with addictions were often handed ASBOs and, then, when the inevitable breach happened, they were carted off to prison rather than given the help that they needed. I tweeted this and Labour MP for Glasgow South Tom Harris started on about how decent people needed to be protected from adults. We then had quite a long conversation on Twitter, some of which has been blogged by Zoe over at Complicity.

I found the distinction between decent people and addicts deeply offensive. I've had people close to me who have really struggled with addictions. If they could have stopped, they would have. Their lives degenerated into a fair bit of chaos but that didn't make them somehow not decent people. The struggle, torment and suffering they went through was immense, over many years. And there was a time when they actually were free for several years before, suddenly, just losing it again. It was horrible for us and horrible for them.

But, no, Tom took pride in how he'd had an addict evicted because they were making a constituent's life hell. He didn't seem to realise that the addict was his constituent too and was quite happy to see them made homeless rather than given help to recover. I just found that lack of compassion astounding, and very worrying.

Contrast with Willie Rennie's people-centred contribution to the debate:

There are about 60,000 drug users in Scotland. I met one of them, whom I will call Mary, when I visited Turning Point Scotland’s facility in Glasgow. She had a young son and her ambition was to be able to take her young son to school in the morning after giving him breakfast. That was her lofty ambition—something that for us would be quite normal. If we have kids, we do such things every day, but for her it was an amazing ambition, because she did not see in what circumstances she could achieve it. Her son was getting looked after by her brother on an almost permanent basis.

I said that about Mary because we talk about big numbers and big programmes, but at the end of the day people like Mary are normal people who deserve a chance like anyone else. Some of the ways in which we talk about them and whether they do or do not contribute to society demonise them but, for me, they deserve a chance. They would love to go back and have another chance, and we should respect them for the tremendously difficult challenges that they go through. They go in and out of drug use; sometimes they are in remission and sometimes they relapse and go back into serious drug use. Such is the chaotic life that those people lead.

Mary was on methadone, along with 24,000 other people. However, for me the central methadone issue is about health professionals choosing the right way to proceed. It is not for politicians to decide which treatments can and cannot be used; it is about giving the health professionals the tools. They have the evidence and the know-how and are the best people to make decisions to help people out of their circumstances. Recovery means different things for different people. Sometimes it is about being able to stay alive; for other people it is about getting back into work. For Mary, it is about being able to take her son to school in the morning. That is why it is regrettable to see some of the stuff that has been happening in the Daily Record, supported by some in the Labour Party. Demonising pharmacists just for doing their job is deeply regrettable.

Often, we focus only on the medical aspects of drug use, but much of the issue is to do with a person’s whole life experience. Perhaps they have mental health problems, housing problems or debt. Perhaps they have a chaotic family life and have been divorced. Perhaps they have had experiences in the military that have led them into drug use or alcohol use. We must sort out those issues as well if we expect people to recover long term. However, we must also recognise that sometimes people will have a chaotic lifestyle for some time. The simplistic view is that somehow we can get people into recovery automatically, if only we change one little thing, but that is just not going to happen.

I have been to some projects, including the Lothian and Edinburgh abstinence programme—LEAP—in Edinburgh. I saw its abstinence regime. It is not right for everybody, but it is right for some people. They brought the whole family in to share the experience and ensure that people were able to recover on a long-term basis.
It is a shame on this country that we have such a high proportion of drug users when we have such wealth. Poverty—the pockets of poverty that we have in many communities—is the root of much of the situation. Again, we must deal with that if we are to expect any longer-term benefits.

On methadone, the HIV rate among drug users in Russia, where they do not have the same kind of programmes as we have in Scotland, is about one in three. In Scotland it is less than one in 20. I do not know what more evidence we need than that simple statistic. In addition, lots of scientific studies show that hepatitis C is reduced by about 80 per cent as a result of needle-exchange and methadone programmes. Elish Angiolini’s report on Cornton Vale shows that when a lot of the women sent to the prison were taken off the methadone programme, the self-harm rates shot up. That is no coincidence, because significant benefit can be got from methadone.

Annabel Goldie is right when she says that the treatment is not necessarily right for everyone and is not perfect, and I accept that. However, we should not say that methadone is the reason why so many people are dying, because it is not. Other drugs were involved in 60 per cent of the cases in which someone’s death was connected to methadone, and alcohol was involved in 40 per cent. 

 Further, in many of those cases, the methadone was illicit, rather than being part of a programme. To simply say that all of those people are dying because of methadone is wrong. Methadone is part of the solution, not part of the problem. We need to be careful about demonising the programme and the pharmacists, because we might undermine the good work that is under way.

Almost every subsequent speaker expressed some sort of agreement with Willie. Maybe there's hope for this Parliament yet.

Later on, in his closing remarks, Willie talked about how hard it was to persuade people that addicts were people who needed help and compassion, not condemnation:

There is a big divide between drug users and the communities in which they live. I put up a Facebook posting about drug use the other day, and the response showed that a lot of people believe that drug users should be cut off. We need to recognise that there is a huge divide. People do not understand why drug users receive support, and we have a big job to do to convince people about the merits of providing support.

The approach by some members of the Labour Party is quite disgraceful in fuelling the lack of understanding. Politicians are supposed to show leadership, not pander to people's ill-informed prejudices, whether they're on human rights, immigration or addiction. Having a wide range of treatment options and not imposing the sort of one-size-fits-all approach that Labour is instinctively so keen on, is going to get more people better. That will benefit everyone, including their communities.

Making policy based on rational evidence is always a better option than subjective moral judgement. Labour would do well to learn that.

No, Scottish Liberal Democrats aren't for handing out heroin like sweeties - the truth behind the lurid headlines

RTFQ

That was my mantra before sitting an exam. Read the Flippin' Question*. Making sure you understand what you're being asked is fundamental. Otherwise, you can go off on one, write pages and then realise that you are not really giving the examiner what they want. Take it from one who knows.

RTFQ has a twin, RTFM, applicable to journalists in particular. It stands for Read the Flippin' Motion* before you write a headline which completely misrepresents what the Scottish Liberal Democrat (or any other but I only really care about ours) Conference has voted for.

"Lib Dems back move to give addicts NHS heroin" screamed the Sunday Herald. The Express was even worse. "Lib Dems want heroin given out free on the NHS" Really? To everybody? In schools? At sweetie counters? Whether they like it or not? Whatever, you might be forgiven for thinking, if you'd read those headlines, that you could just go along to your local pharmacy and pick up some controlled drugs along with your Rennies and your support stockings.

That's not the case, though. Let me tell you exactly what the motion passed on Saturday says:

"Conference further calls for increased investment in schemes like the Persistent Offenders Project and for specialised diamorphine maintenance clinics to be made available as an extra option facilitating intervention in the lives of the most vulnerable and most disruptive heroin users."

So, not really very many people at all, and only as an extra tool as a last resort.

This part was an amendment Glasgow South local party had tabled to a motion from the awesome Liberal Youth Scotland, who were calling for greater use of community service and drug treatment orders as opposed to fines for drug possession. This is the whole of their motion:

Conference notes that in 2008-09, across Scotland, 2296 people received a fine for
possession of drugs, compared to 78 who received a Community Service Order
(CSO) and 62 who received a Drug Treatment and Testing Order (DTTO).

Conference also notes that the Central, Fife, Northern and Grampian police force
areas only handed down one DTTO each in this year for drug possession

Conference believes that CSOs and DTTOs are far more effective in dealing with the
root causes of drug offences.

Conference also believes that fines carry a significant risk that the offender may turn
to further crime in order to pay the fine.

Conference therefore calls on the Scottish Government to ask the new Scottish
Sentencing Council to review sentencing in drug possession cases, with a view to
ensuring the maximum effective use of DTTOs and CSOs.

Conference also calls on any such review to take account of the risk of further crime
from handing out fines for drug possession.

Callum Leslie proposed the motion on behalf of Liberal Youth Scotland and explained why he thought it and the amendment were so important in tackling crime. I'm going to reproduce his speech in full (with his permission) so that you can see the whole of his argument.

Conference, Scotland has a drug problem. There's no point beating about the bush. We have a problem, and what we are doing at the moment isn't working. A quarter of adults admit taking one or more illicit drug in their lifetime, and the number of people taking drugs is not falling, despite our best efforts.
 We need to look again at the way we do things. We need to think different. It's no longer good enough to make strong statements, and be seen as being “tough on crime”, we need to put in place the practical solutions that can start to really address this problem. The case for community service almost does not need to be made. It is a long held Liberal Democrat belief that meaningful community payback is in many cases the most effective treatment. Why is it then that just 78 people received a Community Service Order for drug possession in 2008/09?
 Conference it seems utterly outrageous to me that 2296 fines were handed down for drug possession in the period. The Scottish Government's own report into evidence based drug sentencing recommended that we needed to “Improve our understanding of the benefits and costs of long-term prescribing and how to generate recovery communities within maintenance treatment services,” and this huge amount of fines does nothing to achieve this aim.
 The impact of a fine is, in general, minimal, and will not have any effect on re-offending. That is in fact almost a best case scenario. At worst, these fines will lead to further acquisitive crime from the offender to pay them, and potentially lead minor offenders only picked up for drug possession at first to a life of much more serious crime. Now, I know what some might say – fines don't cost anything, CSOs and DTTOs cost too much. I would say this, fines may not cost anything for the Government to collect on the face of it, but by not addressing the real problem and using those methods which reform and rehabilitate the offender, we are leaving ourselves open to having to spend much more money later on sending these people to prison – these methods do save money in the long run. It could be said that DTTOs are too expensive and their effectiveness has been called into question, however I believe that the amendment to this motion will strengthen DTTOs and give  sheriffs greater flexibility to hand down treatment programmes which will be most likely to reduce drug use and offending.
 Having said all of this, while I may firmly believe that alternatives to fines and prison are the most effective to deal with offenders, that is not what the motion is calling for. All the motion calls for is for the new sentencing board to look at these figures, and investigate whether or not we have the balance right.
 Conference this is not a debate about legalisation, or decriminalisation. I'm not opening that can or worms – we've all been there before and is a debate for another day. Liberal Youth Scotland simply have a deep concern over the way in which we are dealing with this relatively low level of drug crime, and are not addressing the real problems behind them. I would also like to speak briefly to the amendment, which Liberal Youth Scotland is happy to support. The amendment in the name of Glasgow South local party may sound controversial, but actually I believe it is anything but – it would reduce drug use in those with the most serious addictions, save the public purse money through alternative treatments instead of prison, and will reduce acquisitive crime associated with chaotic drug use. Diamorphine maintenance treatment would of course have to be tightly controlled, and would not be used lightly. This treatment would only be used for those addicts who have not responded to other treatments such as methadone treatment – many of those who are prescribed methadone treatment do not respond to it, and the methadone does not stop them going out and acquiring street heroin – and committing further acquisitive crime to do it. Ewan will speak to this in a moment but diamorphine treatment has by far the strongest evidence base, and can no longer be dismissed out of hand.Conference, we have a big opportunity here. Evidence-based drug policy is the way forward in how we deal with Scotland's relationship with drugs, and the new Scottish sentencing board must look at all of the available options, not just those available to sheriffs at the moment. I am confident that not only will increased use of alternative punishments, and particularly diamorphine treatment, reduce drug use in Scotland, it will save money, save us from the acquisitive crime associated with drug use, and save lives. Conference, I urge you to support the motion and the amendment. Thank you.

I am really pleased that Alex Cole-Hamilton, despite being the candidate for the target seat of Edinburgh Central, spoke out on a controversial subject. He said:

 “There is a great cost to society, and the public purse, if offenders are just abandoned to a cycle of crime and prison.

“DTTOs and CSOs are measures that would save public money by keeping drug abusers out of jail.

“Drug offenders should not be treated the same as murderers. We should work to treat the problem of drug abuse, not lock addicts away and condemn them to a life of crime.

“This is a problem that affects drug users, families and the wider community. It needs a holistic solution.” 

Most moving of all was the contribution made by 14 year old Alexandra White, who told very movingly and with understanding and clarity of how she'd lost a friend whose mother was a drug user and was in and out of prison. She did it all without notes, so I can't copy it. However, if you look here, at around 15 minutes in, you can see her and I'm sure you'll agree that she deserved the prize she received for best speech of the conference.

I hope I've managed to show you that the truth behind the lurid headlines is something much more sensible and evidence based.


* some words may have been changed to make this suitable for a family audience, and to spare me having to pay fines for swearing to my daughter

Expert calls for licensed sale of Cannabis

One of the country's most senior experts on Cannabis has called for the drug to be made available on a licensed basis - both for the seller and the purchaser.

Professor Roger Pertwee, is the professor of Neuropharmacology at Aberdeen University so there's not much about the effects of the drug on the human body that he doesn't know.

While he acknowledges that there are issues with Cannabis, he argues that the current approach of decriminalisation does more harm than good and has suggested a way forward. Today's Independent quotes him as saying:

"You'd need to have a minimum age of 21, and I would suggest you might even have to have a licence," said Prof Pertwee, from the University of Aberdeen, who pioneered early research on the effects of cannabis in the 1960s and 1970s.

"You have a car licence and a dog licence; why not a cannabis licence?"

The idea would mean only those not suffering from a serious mental illness or at risk of psychosis would be legally allowed to buy the drug.

He was clear that:

"We're allowed to drink alcohol and smoke cigarettes. Cannabis, if it's handled properly, I think is no more dangerous than that."

I think there might be some merit in what he's saying. If there was a proper licensing regime, the Police could concentrate their efforts on the people who operated outside that system. I wondered if there would be an illiberal element to restricting eligibility for licences - but we have that principle anyway in the way we deal with shotgun and driving licences. 

What is clear is that the current policy isn't working. By insisting that all drugs should remain illegal, the potential for someone using a less harmful drug to be lured by an unscrupulous dealer into a much more dependent relationship on substances which will rule and ruin their lives is clear.

I think we really need to have a proper, open debate about drugs and the best way to minimise the harm that they cause. We should make policy on the basis of evidence and not on the basis of prejudice or fear. It's quite strange that it's perfectly legitimate, even acceptable to say you have a hangover, or you got absolutely hammered on booze at the weekend. However, if someone came into work and said they'd been stoned on Saturday night, they'd likely be sacked on the spot, even though both activities for most people have the same amount of risk.

It's time to cast aside the blinkers and take a cold, hard look at the evidence.

Mephedrone kills kids - it should be banned, right?

It's always horrible to read of young people suddenly dying for any reason. As the mother of a girl who no doubt will at some point in the next decade go out clubbing with her friends, I read with horror accounts of how perfectly fit and well young people have gone out, taken some substance and died. I can only imagine what their parents are going through and feel so much for them.

The substance under the spotlight at the moment is Mephedrone, something I'd never heard of until yesterday. A "legal high", you don't have to look very far on Google before you find out how to buy some. It's apparently all the rage in the clubs.

The substance was implicated in the deaths of two young men from Scunthorpe as reported in the Guardian as well as that of a 14 year old girl last November.

So, obviously, it should be banned, shouldn't it as the Government advisers are likely to imminently suggest?

Well, maybe not.

Firstly, it's not absolutely certain that the Mephedrone actually caused the deaths. The young men over the weekend had apparently combined it with alcohol and methadone. We know that combining any drugs is something that should only be done with care and we also know that methadone on its own can be lethal. In the case of Gabrielle Price, the 14 year old who died last November, the cause of her death was determined to be Bronchial Pneumonia.

Secondly, is it a good idea to go round banning stuff as a panic reaction without any sound scientific basis? I've dealt with 3 potentially lethal substances already this morning - gas, water and electricity, but I've done it by being careful and minimising their risk. Should we maybe be saying to young people "Look, we don't know about this stuff, we do know that mixing it with any other substance could be dangerous, so if you're going to take it, please be aware of that." After all, banning it isn't exactly going to dry up the supply overnight. Banning it isn't going to make our young people safe or any less likely to be able to get hold of the stuff.

Thirdly, I am far from convinced that banning drugs is actually effective. Does it not just lead to really nasty drug dealer types using violence and intimidation to prey on their victims? If these characters were out of the supply chain, wouldn't that make it a lot easier for people to seek help, rather than be trapped in an appalling spiral of debt, addiction and crime?

Fourthly, why are so many people seeking solace in artificial substances to make them feel good? What is it that's wrong with the quality of the relationships around them and how can that be fixed? How can we make our kids naturally happy so that they don't feel the need for anything else? Should we not be doing more to encourage the feelings of energy and happiness you get from sport? Actually the range of things that need to be done to increase everyone's feeling of wellbeing is so vast - but just cos the mountain's huge doesn't mean we shouldn't try to climb it.

Enough of my rantings, however. Let's give the last word to someone who actually knows about drugs, a lot. Professor David Nutt was the cause of the worst hashtag in Twitter history (#nuttsack) when he was dismissed from his post as a Government adviser for disagreeing with Government policy and saying that Ecstasy and LSD were less harmful than alcohol. As someone who's seen the effects of long term alcohol abuse on family members, I can relate to that. Anyway, Professor Nutt is a man who knows what he's talking about and he doesn't think we should be rushing to ban Mephedrone.

If you want to know more about Professor Nutt, Mark Thomson, of the awesome Mark Reckons blog, interviewed him a couple of month ago.