§ 6.5 p.m.
§ Lord Pitt of Hampstead rose to call attention to the increase in the amount of drug addiction and the need for improved treatment for drug addicts by the National Health Service; and to move for papers.
§ The noble Lord said: My Lords, this debate is timely as there is at present a great deal of concern at the increase in drug addition and what should be done about it. The number of new drug addicts notified to the Home Office has increased five-fold in the past 10 years. The amount of drugs seized has also increased 10 times and there is a large amount of heroin readily available on the street. The Customs officers are doing a magnificent job against fearful odds, and I think we should pay tribute to them. The recently announced drive by the Home Secretary against drug trafficking is also to be applauded. My intention tonight, however, is to invite your Lordships to look at the victims of this traffic—the drug addicts—and to consider whether enough is being done to help them. I will try to suggest ways in which I think they can be better helped.
§ At present, specialist hospital treatment centres are supposed to provide the services required for the treatment of drug addiction. This is supplemented by the work of non-statutory voluntary organisations, which provide drug-free residential rehabilitation and a number of day-care counselling and advisory services. A few of them employ full-time staff. The rest are manned by volunteers. Last year, the Advisory Council on the Misuse of Drugs reported to the Secretary of State with recommendations for improving the services. The Secretary of State, in response to that report, promised a grant of £6 million over three years to be spent on improving those services. I am afraid that it is my view that the recommendations of the advisory council will not meet the problem and that the £6 million over three years will prove to be grossly inadequate.
§ The bulk of the new addicts are addicted to heroin. Moreover, the number notified represents only a small proportion of the actual number of addicts. This is borne out by many surveys and most of those who are active in this field, and is confirmed by my own observations, in that many of the addicts who I notify 1188 are not previously known to the Home Office, even though they admit to me that they have been taking drugs for several years. Their veins are often thrombosed, and they sometimes have a history of septicaémia and sometimes hepatitis. The majority of drug addicts seem to avoid the clinics and seek treatment elsewhere.
§ Some of the explanation for this lies in the fact that there are not enough clinics. They are often inadequately staffed, unable to cope with the influx and have long waiting lists. Most drug addicts go through a phase of wanting to give up their drug-taking. At that stage they tend to seek help. If they are told to wait for weeks they merely return to the street or wherever else they were getting their drugs. Within four weeks they are probably once more integrated into their group and will not seek help again unless forced to so so. It is therefore essential that when a drug addict seeks help it is given immediately. Treatment centres should be like the VD clinics and addicts should be able to get treatment immediately.
§ Moreover, the treatment centres concern themselves mainly with patients addicted to opiates; thus the amphetamine addicts and those addicted to barbiturates tend not to be accepted. It is for this reason that I suggest that the approach of the advisory council will not work. It will perpetuate the present system. What is required is an acceptance that drug addiction is an illness like any other and should be treated like other illnesses—on the National Health Service.
§ That means that the general practitioners should be the persons responsible for treating the drug addicts on their lists. GPs have no training in treating drug addicts. Therefore, the first essential is a training programme aimed at equipping GPs to do this job. They should have access to laboratory facilities to assess the drug-taking, and should have full support and advice from the specialist services which are hospital-based, and from the social and other services, both statutory and non-statutory, which are available in this field. The treatment centres should exist and be adequately staffed. They should serve as the specialist service to which the GP can refer for help and advice and to which he can refer patients who are better fitted for treatment at such a centre than by him.
§ GPs should be paid an extra fee for doing this work. This should be conditional on their receiving adequate training and also meeting regularly with their colleagues and the other workers in the field in order to pool their expertise. There should be regular meetings at district level of all those engaged in this work so that the situation in the area can be surveyed and the many forms of treatment discussed and compared, and perhaps some agreed treatment may emerge. Doctors should be free to undertake or not to undertake the work as they wish. It should not be part of their conditions of service.
§ I think that my suggestions could enable us to have a reasonable number of GPs working in this field; but GPs should be discouraged from undertaking to treat too many addicts. There should be a number above which they should not be allowed to go. The treatment of drug addicts is very demanding and time-consuming. Drug addicts are selfish, self-centred, difficult to control and very persuasive. An addict will need to be seen at least two or three times a week, and 1189 perhaps every day. They need time spent on them. A rapport with them needs to be established. They need to be motivated to stabilise their lives and abandon the drug. This requires time, patience and a great deal of understanding. If they are not to take over the whole practice, the doctor should take on only a very limited number of drug addicts.
§ What I have said so far refers to out-patient treatment, but in many instances what will be required will be immediate admission to hospital for detoxification and other treatment. Of course, this will have to be followed by counselling, psychotherapy, occupational therapy and other forms of treatment to keep the patient interested and active, and, of course, followed by job-hunting and retraining. These are all the things that would have been done if they were being treated as out-patients. There is therefore a need for more beds to be available for treating drug addicts. I think that this can be at regional level. This must, however, be part of the support and specialist facilities that should be available to the GP. In this way I think that we can provide a comprehensive drug addiction treatment service.
§ But education is also of the utmost importance if we are to be successful in preventing drug dependence as well as treating those affected by it. Training the educators will be as important as training the practitioners. There is therefore need for a full programme of education in this field. This will need as much attention as the programme of treatment which I have outlined.
§ Funding will have to be central and a lot more than £6 million over three years will be required. However, in assessing this expenditure it is worthwhile remembering the cost to the state and the community of dealing with drug addicts in other ways. Many drug addicts commit crime in order to finance their drug-taking. The cost of dealing with them through the machinery of the law can be quite high, and the social consequences of their actions can also be very damaging. The objective of my approach is to stabilise them and to motivate them to return to the community and make their contribution to its wellbeing. An investment to bring that about will certainly be worthwhile.
§ I am glad that this debate on drug addiction is following a debate on homelessness, as the two problems are frequently intertwined. There was a period when the area around my surgery was "squatted" and a large number of drug addicts registered with me as National Health Service patients. Moreover, it is often necessary to secure a change of environment for a drug addict in order to get him to change his habits. I heard the Minister say earlier that the Government do not intend to review the homeless persons Act again very soon, but I personally believe that the Act should be amended to include drug addicts among those to be given priority for rehousing under the Act. In the case of these people a certificate from their doctor indicating the necessity for such action should be a prerequisite to their being considered for rehousing. I believe that that would be an additional weapon in the armoury of those dealing with people who are affected in this way, because many drug addicts live in communities which are either squats or bed-and-breakfast hotels peopled by 1190 other addicts. So if we want to get them away from such groups, we must provide them with a home somewhere else.
§ My suggested programme is community-based rather than hospital-based, but it involves careful control of those who are treating drug addicts. However, I am convinced that a positive approach involving inducements and help to those willing to undertake the work is more likely to be successful than a negative approach bolstered by prohibitions. I hope that the Government will take this proposal on board.
§ However, I must point out that no amount of treatment will suffice to deal with the problem unless the preventative services are also effective. Thus, the activities of the Customs officers, police, and other agents of prevention should be co-ordinated. I gather that Hong Kong has been very successful in dealing with the problem, and I hope that the Government will consider the Hong Kong approach and the success that there has been there. I hope, too, that the Government will give the most serious consideration to the programme that I have outlined. I believe that it is a programme which could enable us to combat drug addiction with a fair degree of success. My Lords, I beg to move for Papers.
§ 6.24 p.m.
The Lord Bishop of Portsmouth
My Lords, I am grateful to the noble Lord, Lord Pitt, for introducing this debate and for the opportunity to make a contribution from these Benches on this desperately important subject. Behind what I have to say are some notable pieces of work for drug addicts and their families being undertaken in the county of Hampshire. I can speak in particular about the work of Dr. Philip Fleming, the consultant in charge of the excellent drug clinic in Portsmouth—though it might be even better if it were based more evidently in the community rather than in the somewhat isolated setting of a psychiatric hospital. I can speak, too, of the work of Mr. John East, a senior social work adviser for addiction within the county—a post which, I believe, is still unique in England—and of the work of Mr. Brian Hadden in directing the very interesting Alpha House project, where some three dozen addicts can be accommodated and where they are helped by means that are entirely non-medical and, in particular, through a training in relationships.
Those in charge of these pieces of work are unanimous in their conviction that drug addiction is on the increase to a horrific extent in this part of the country, as it clearly is elsewhere. The evidence lies not only in the number of referrals to various treatment centres and in convictions following police prosecutions, but also in what skilled workers are able to observe in the field; for example, at the recent pop festivals at Glastonbury and Stonehenge, where new trends in the drug scene were noted, as was the fact that at these festivals hard drugs were openly on sale.
Nor is there any doubt, surely, of the need for improved treatment by the National Health Service. As the noble Lord, Lord Pitt, reminded us, some clinics are no longer coping. The waiting time extends into weeks, which is a hopeless situation. In any case the provision of specialist clinics is distinctly patchy. To take an instance from my own diocese, I would 1191 point out that there is no clinic to which an addict on the Isle of Wight could be referred, though here it must be said that the Isle of Wight Health Authority favours the use exclusively of psychological treatment and has at present no practitioners licensed to prescribe controlled drugs. That, I suppose, illustrates the debate going on within the Health Service, in which I do not feel competent to take sides but wish only to express the layman's hunch that both physical and psychological treatment needs to be available.
But whatever means are favoured in any particular place, the treatment given by the NHS needs to be improved, and one step which would certainly encourage the dedicated people now working in the field would be a statement that the grant of £6 million announced by the Government in December 1982 as being available for work in the area will be renewed and, it is to be hoped, increased. Projects which are going well deserve an assurance of continuing funding, and additional finance is urgently needed, not least for research, to support other promising projects in both the Health Service and the voluntary sector. I believe that this particularly needs to be said when, as we all know, what we are discussing is not a popular cause, and drug addicts, who are often arch manipulators, are not always the most attractive of people. Proper support of this kind would surely be cheaper than keeping people in prison.
If I may say so, I hope, too, that as a token of the seriousness with which they view the whole problem it may be considered desirous for the Government to repeat the assurance give to us in this House on their behalf nearly two years ago; namely, that they do not plan to introduce or support legislation to alter the existing law concerning cannabis.
But improved treatment offered by the Health Service is not only a matter of additional funding, important though this is. It is also a matter of communication and of co-ordination of existing resources and facilities. Last week I heard from a consultant surgeon whose own expertise is in a different branch of medicine but who, one might have supposed, would know his way around the Health Service. Nevertheless, his experience, when help was urgently needed at a time of crisis by a member of his own family, was of general ignorance as to where immediate medical and social help could be found—help of the kind that is so marvellously available in the case, let us say, of' a road accident.
There is a need for improved treatment within the Health Service. But this is not a matter, surely, for the Health Service alone. To put it crudely, the problem of drug abuse is fundamentally a people problem. No matter how much we learn about substances and patterns of usage, in the end it is the person who uses and abuses: the evil and avaricious person involved in organised crime; the thoughtless person canvassing the advantages of this or that tranquilliser and writing up in a newspaper some pop star's experiments with drugs as if he was a hero, or failing to teach the children in his class the facts of life; the weak person unable to say, "No".
A multi-disciplinary approach is needed in which preventive work, including sound moral teaching, will be no less important than remedial, and which will 1192 have a place also for job-hunting and retraining towards the end of the course. In all these areas, I trust that the church will be ready to play its part, as I believe that it does already through its members in many of the kinds of ventures to which I have referred. This is a sombre topic to be discussing on the first occasion that I have had the privilage of addressing this House. There cannnot be many aspects of our social welfare more in need of urgent attention at the present time, or where there is greater need of a positive lead from both church and state.
§ 6.32 p.m.
§ Lord Mancroft
My Lords, the noble Lord, Lord Pitt, has introduced the debate on this sombre subject in a most valuable and authoritative speech. We thank him for it. We assumed, naturally, that there would be a contribution from the Bishops' Benches on such an important social question and we have not been disappointed. Only at the last moment did the right reverend Prelate let us into the secret that this was his maiden speech. I am sure that your Lordships will join me in congratulating him very much on his most helpful contribution. I wish that I could go on in the conventional manner and say that we hope to hear from him frequently in the future. Alas, in vain. I understand that he leaves us in only two or three months' time to become chief of staff to the Archbishop of Canterbury. In the unlikely event of my ever having to wait upon the Archbishop of Canterbury, I hope that at least I shall have a friend, or perhaps just an acquaintance at court. I know that I shall have a most persuasive one if ever I should need him.
This is a dual problem, cause and effect. I cannot help but cast my mind back 30 years, almost to the day, when, as Under-Secretary of State at the Home Department, I tried to persuade your Lordships to agree to the banning of heroin. All the Government's professional and legal advisers had said that this was the correct thing to do—but not Dr. Dowthwaite of Guy's hospital. He maintained firmly that there was no alternative to heroin in cases of terminal cancer and grave damage to the lungs. He lobbied most effectively. He lobbied your Lordships' House and your Lordships agreed and would have none of it. That is why heroin has never been banned.
Whether this has any relation to the fact that there are 200,000 drug addicts in this country, I would not know. As the noble Lord, Lord Pitt, says, there are so many unregistered addicts we do not know about. The drug is too easy to come by. That is the long and the short of it.
If I concentrate my few remarks on the effects of drug addiction it does not mean that I am not most appreciative of what the Government have done in the matter of prevention. They have been very sincere and hard working. I join in congratulating the Government servants—the police and Interpol, customs officers, coastguards and all the others who have had such marked success in their attempts to bring those responsible to book. I am also grateful to the courts for taking the matter much more seriously than they did previously. Only today, three serious cases were reported in which servants of the Crown had done their best and had had great success.
1193 I should therefore like to know from the noble Baroness who is to reply whether any further action is contemplated by the Government in prevention. Money is available, although admittedly not a lot. We are lucky to have had the amount that has been devoted to prevention. However, we should like to know whether the Government have more plans in mind. I should also like to know whether the Government have any further suggestions for treatment.
I wish to make a few suggestions. I commend to the House the proposals carried out in America at the Hazelden clinic in the state of Minnesota. It is called the Minnesota method. The system has been in practice there for nearly 40 years with remarkable success. The noble Lord, Lord Pitt, if he does not already know, will be glad to hear that it is available on what is the equivalent in America of the National Health Service. It is a remarkable record of success.
I do not declare an interest in the standard parliamentary way, but I think that I am in duty bound to declare a personal interest for the sake of the record. I have only time to mention a few features of the Minnesota method. First, drug addiction is regarded as an illness and only secondarily as a moral issue. They regard it as an entity in itself and not simply the result of emotional and material deprivation. They say that we should concentrate on the illness itself. They regard it as tractable and recoverable. They never use the word curable. That is a fatally dangerous thing to do. They say, as already mentioned in the debate, that treatment is much more effective and cheaper than jail. But treatment must also involve families. Drug addiction is not, alas, a personal illness or personal interest. It has hideously wide repecussions. It involves families, friendships, livelihoods and lives. It can wreck the lot.
I wish, therefore, to ask Her Majesty's Government whether they will be good enough, if they have not already done so, to examine the Minnesota method and its offshoots in this country in Plymouth and a hospital at Weston-super-Mare. It would not cost a great deal. The Government might even send a team to Minnesota to study the work at first hand. They would also, I hope, see fit to study the work of Narcotics Anonymous, which does a great deal of good work, where families meet—I speak from personal experience—and exchange lessons and experiences.
What other practical help can be given? I take up the point made by the noble Lord, Lord Pitt, on the training of general practitioners and specialists. What happens far too often is that a drug addict goes to his well-intentioned, friendly and helpful GP who takes the case seriously. He does not regard this, as so many people do, as a self-inflicted wound. That is a terrible thing. It is not a self-inflicted wound.. He says, "No, I understand the nature of your disease. I shall try and help you. I shall not send you to a psychiatric ward. That is the easy way out". Freud, many years ago, disconnected this terrible drug addiction from psychiatric wards entirely. The GP will go on to say, "I will not pretend I can cure you. I will not take your money, or the state's money, under false pretences. I do not know enough. I will send you to a specialist". Are there enough specialists who know enough? The 1194 noble Lord, Lord Pitt, thinks not. I agree with him. The next question, therefore, that I wish to put to the noble Baroness is the problem of training GPs and specialists in dealing with this dreadful addiction.
The noble Lord, Lord Pitt, talked about the community relationship. I agree entirely. The noble Lord will have seen today in the newspapers mention of a scheme at Exmouth which combines the work of church, state, local government, press and doctors to mount a counter-attack against drug addiction. The whole of Exmouth is combined in this work. We want more of it. We want more encouragement given to this type of scheme. I ask Her Majesty's Government to look into the matter to see if they can encourage this attitude in any way. I hope very much that they will, as the right reverend Prelate the Bishop of Portsmouth suggested, stamp on any suggestion like, "Have a sniff of this, old boy" or, "Take a pull on this cigarette, old chap. It won't do you any harm". My Lords, it will do harm. It leads straightaway down:The primrose way to the everlasting bonfire".This is a gloomy and horrible subject, but I think that I now see a little light at the end of the tunnel. However, it is still a very long tunnel and a very dark one.
§ 6.41 p.m.
§ Lord Soper
My Lords, let me first add my congratulations and best wishes to my prelatorial friend on his maiden speech, which, if he will allow me to say so, was as cogent and as relevant as I would have expected.
My noble friend the mover of this Motion has limited the parameters of the discussion to one form of addiction. If I presume to widen the argument somewhat, I do so on two grounds: first, it is permissible within the frame of the Motion on the Order Paper; and, secondly—as I hope to say before I sit down—I believe that, to see this particular problem of addiction to hard and soft drugs in its true light and with any sense of competence as to the way in which it can be treated, it must be seen against a much wider background.
It was an Anglican clergyman in the 19th century—none other than Charles Kingsley—who first intimated that religion could be the opium of the people, which would of course make me a pusher. It was Karl Marx who borrowed that tag (without acknowledging the borrowing) and said that religion was inseparable from such an opiate. Whatever may be the particular truth that lies within that attack upon religion, it cannot be denied that the element of addiction is not separable from some forms of religious exercise, and, indeed, it is a form of addiction which bears upon the problem more central to your Lordships' debate tonight of the addiction to drugs such as heroin, morphine and so on.
Obviously tea-drinking is an addiction, but a more or less harmless one, although I think no one in your Lordships' House should underrate the cathartic effects of a Methodist tea meeting. At the same time there can be no doubt that the two monster addictions are in the framework and general realm either of alcohol or of the drugs to which reference has already been made this evening, or both. I believe that, had 1195 alcohol appeared upon the public scene with the comparative suddenness with which these other drugs have come, it would have been immediately regarded as a far greater evil, demanding far more drastic curbing and discipline than has yet been accorded to it, very largely on the basis that familiarity has bred contempt for its worst and most dangerous aspects.
I would therefore couple what I have to say with the ways in which I believe this problem, so eloquently set forth by my noble friend Lord Pitt, can be seen against a wider backcloth. I would not be fair to myself unless I were to make reference to the fact that, in the whole question of alcohol, we have a parallel problem to that which now afflicts us with regard to the drugs to which reference has been made. The advertising of many of these drugs is abominable. The interest in making a profit out of what may be a curse to one's fellow man is highly reprehensible. I take as an example the outlet, in the case of alcohol, of the beer can. It was generally regarded in other times that the infrequent or (shall we say?) spasmodic intake of alcohol was on the whole desirable. The beer can makes it a permanent and continuous process.
But above all I would share with my noble friend, who has already adverted to this, the view that there is a need for education in this field—education which is sadly lacking and which is the more imperative because there can be no doubt that the problem has increased in its severity not only as regards alcohol but as regards the drugs to which reference is now being made. No one who has had any experience in this matter—and I have had a long one, if not a very deep one—can doubt that the problem has become more acute, more dangerous and more widespread. The number of youngsters who are more or less intoxicated after lunch at school is no inconsiderable comment. A number of those who play about with drugs in the first case do so on the comfortable assumption that they can drop them whenever they so desire, but that is an assumption to which my postbag gives an absolute and uncompromising, no.
I want to suggest that, within the framework of education, we may indeed be able to do something about the increasing problem of how to interpret the 1848 Act, which prescribes, as the one imperative lesson in school, religious education. I believe that if we can transfer the emphasis, particularly for youngsters, away from the more metaphysical concepts of the Christian faith and towards a sense of responsibility of living in a community and the moral principles that belong to an intelligent and worthwhile society, we may do a very great deal to prepare youngsters—and I am particularly concerned with youngsters at the moment—for the tests that they will have to undertake and the temptations which will assail them.
But pre-eminently—and my time is almost gone—I want to draw attention to that over-arching problem of addiction to drugs of one kind or another. Religion has been described as what a man does with his loneliness—he either cossets it by drugs or he invests it in the community in which he lives. Today I saw only a few yards from your Lordships' House a youngster wearing headphones and with a beer can in his hand: an example—I hope I am not mistaken, and I would 1196 apologise to him if I were—of the kind of masturbatory Träumerei with which Aldous Huxley described the behaviour patterns of people to whom he had objections morally. It is an ugly phrase but, my word!, it is very true.
It is the sense that we belong to a privatised society in which community takes second place to individual effort and individual desire which I believe to be one of the underlying and, indeed, over-arching problems with which we have to confront ourselves if we are to remedy this addiction in the first instance, which is not so much to a particular drug as to a form and a pattern of life which I believe to be anaemic at its best and selfish at its worst. It is not necessarily the fault of those who fall victim to this particular addictive process; it is much more due to the lack of the opportunity and the suggestiveness of a society in which they could invest their loneliness and not merely spend their time cosseting it.
This, of course, is part of a religious programme so far as I am concerned, and I make no apology for it. Education must be related, if it is to be effective, to principles which ultimately can be acceptable and permanent. The permanent and progressive kind of education that belongs to this field as regards the kind of remedies that my noble friend demands, and so rightly, is one in which we provide the incentive in the society in which we live for community rather than privatisation and encourage people to find the fulfilment of their lives not in cosseting their particular, personal and private emotions and feelings but in contributing to a society in which the more they forget themselves the more likely are they to fulfil themselves.
§ 6.50 p.m.
§ Lord Hunter of Newington
My Lords, I too am grateful to the noble Lord, Lord Pitt, for suggesting this debate. He and I had a sound medical education in the same school, and I congratulate him on the way he has introduced it. Fifty years ago when he and I were medical students, teaching in therapeutics and drug therapy was, to say the least of it, meagre. At that time the doctor was a sympathetic attendant at the bedside of the sick. A bottle of medicine was the usual prescription.
In fact, there were ony half-a-dozen drugs that were of proved value and capable of altering the course of illness, and the outstanding branch of therapeutics was surgery. Surgery was often carried out in a determined effort to treat the patient and to relieve suffering. The intelligent layman had no illusions about the doctor's limited powers, and yet his authority with the sick and their relatives had never been higher. At that time there were a modest number of heroin and cocaine addicts, often resulting from medical treatment. Marijuana was not fashionable. Some became dependent on chloral hydrate and other hypnotic substances, and on alcohol, which has been referred to.
It is perhaps desirable to describe the various changes that have taken place as a background to the present situation. I believe it is necessary to understand this to understand the problem. Until we do, it cannot be dealt with. Treatment centres for drug and alcohol addiction are often ineffective, anyway.
1197 Insulin, used in the treatment of diabetes, was discovered in 1922 by Banting and Best, and this directed medical research attention to the possibilities of preparing the normal secretions of the body for therapeutic purposes. The next advance was the introduction of sulphonamide drugs in the treatment of infections, and this stimulated the search for chemical substances to act against infectious disease. Penicillin then became available in 1942, and the optimism and drive of the researchers was redoubled. New pain relieving drugs, new hypnotics, drugs effective in heart disease, kidney disease, and many others began to be available.
Then in 1948 the introduction of the National Health Service meant that any drug, no matter how expensive, could be prescribed by a doctor under that service. The problem that arose, and is relevant background to this debate, is well illustrated by a report by Sir Douglas Black and a Royal College of Physicians' committee about the administration of drugs to the elderly. Elderly people, as some of us know, often suffer from a number of complaints: not sleeping; rheumatism; a bronchial infection, and so on. Consequently the busy doctor might prescribe three or four or more remedies. The problem that arises is compounded by the fact that almost every potent drug has side effects, some interfering with the body's handling of other drugs and producing further toxic effects. Age has an effect.
The consequence of all this is that drug treatment itself can cause illness. The situation is further compounded by the bathroom cupboard: the hoarding of previous drugs prescribed by the doctor, and often taken by patients on their own initiative. So one consequence of the chemical and medical revolution occurring in the context of free drugs for all has resulted in this new problem.
Properly conducted clinical trials often do not pick up toxic effects, or drug interaction effects, and the use of new drugs, even under the best possible conditions, is still an experiment. I was chairman of the Clinical Trials Committee when the Committee on the Safety of Drugs was set up in 1963. We got the fullest co-operation from the pharmaceutical industry in the steps taken to safeguard the patients, and I believe that the Medicines Commission, as it became, is as good a safeguard as that anywhere in the world.
You might say, what has all this to do with drug addiction? Well, the drug taking habit has become widespread, and generous prescribing by doctors makes it possible for people to have access to hypnotics and pain relieving drugs quite legally, and deliberate self-poisoning is made easier. As Sir Douglas Black's report says:The whole business needs tightening up".But this does not give rise to the marijuana, heroin and cocaine addiction and glue-sniffing. Or does it? Or does it create a fertile background?
There are other factors at work. Communication is much better than it was 50 years ago—communication by sea and air transport, for example, but also communication by the media. There is the combination of publicity about dangerous drug taking and the argument that in a free society everybody should be free to do their own thing and make their own decisions.
1198 The problem has become more acute in recent years by arguments used in the case of marijuana. Why should anyone not be allowed to take it? It seems so reasonable, because marijuana rarely produces antisocial behaviour. It has much more subtle ways of rendering people apathetic and pathetic. In a recent case, given much publicity in the media, the person was also carrying LSD, a hallucinogenic drug of terrible power. Many people who become psychologically dependent on one drug are candidates for the next. This can also result, of course, from the too liberal prescribing by doctors creating opportunity.
I believe that there is no argument for the legalisation of cannabis, though it has to be recognised that it is hardly controlled at the present time. The wide use of cannabis is related to its ease of access through the ports. The arguments against legalisation are on health grounds. There are some possible links with cancer; there are links with eventual psychoses; it produces a state of lethargy and inertia; and, as I have mentioned, an escalation to other drugs such as LSD and heroin.
I have briefly tried to sketch the background to drug taking in the community. It is obvious that more must be done to control it. Every effort must be made to ensure that dangerous drugs are not left lying about. How relevant is this background to the increase in hard narcotic addicts? That means, of course, heroin and probably deconal.
The problem is that drug addiction is increasing by about 30 per cent. annually. There is obviously an increase of the importation of heroin, and this is the result of the limited ability of Customs and Excise officers and other agencies to control it at ports of entry. This in turn is related to the insufficient number of officers and personnel to discover contraband. But at the other end of the scale—and this also has been referred to—there is the provision of treatment facilities.
The ability to treat patients is not keeping pace with the size of the problem. There are 28 treatment centres in this country, but relatively few have whole-time doctors and others in the health service dealing with this problem. In the West Midlands, with a population of 5.2 million, the medical staff of the regional unit comprise a total of one whole-time equivalent consultant. This, in practice, is divided among three consultants each taking sessions. They now tend to give more time to this than to what they were originally contracted to do, that is to look after other mentally ill patients.
The West Midlands addiction unit was one of the first in the country. It began 15 years ago when the problem we are discussing was relatively small. It has not developed substantially since. Surely in a large industrial complex there should be one consultant with sessional commitments to deal with drug addiction within each district health authority. Will the Minister please tell us if any district health authorities have doctors appointed for this purpose? The problem is so serious that it cannot be continued as a sideline to psychiatric practice.
As has already been mentioned, in 1983 the Government made a grant of £6 million to improve 1199 the services. This does not begin to match the problem. Moreover, the medical advisory system in the health service does not give high priority to this, for some reason which I cannot understand. Local authorities and local health authorities give it a low priority when it comes to budgeting. If the Government do not have an up-to-date asessment of this problem, then I feel that it is urgent that a full investigation is carried out.
§ 7.2 p.m.
§ Lord Rodney
My Lords, may I start by extending my congratulations to the right reverend Prelate on the occasion of his maiden speech, which we heard with much interest. I am sorry to hear that probably we shall not be hearing from him again. I should also like to express my appreciation to the noble Lord, Lord Pitt of Hampstead, for giving us the opportunity to debate this subject. As I was sitting here listening to his speech, I found myself agreeing with almost everything he said. If some of the things I say reiterate that, I think the corroboration and agreement will do no harm.
In my opinion there are three aspects to the problem, which are: what causes young people to get involved in the drug scene in the first place; how best to treat them once they are involved and, thirdly, how to encourage them and help them to disentangle themselves once they are involved.
The main factors contributing to young people's involvement with drugs are: deprivation during their childhood; the availability of the drugs themselves, which is all too prevalent at the moment; and the peer pressure groups they come into contact with as a result of which, either through boredom or bravado, they drift into the drug scene.
It is evident that if we could stop people becoming involved in the first place the problem would go away. But that is easier said than done. The pressures of everyday life and the social structures regrettably lead to increased deprivation of children. Certainly the Customs and Excise and the police have their successes in intercepting the importation and distribution of drugs, but where there is a market there will always be a ready supply, and again the peer pressure groups will always find naive followers ready to follow down the road to drug taking.
So, although we should never give up the fight to stop people getting entangled in the first place, it is regrettably a fact that there will always be new entrants into the drug scene and, sad to say, they are on the increase at present.
However, there is one aspect that could be given more attention. That is the area of education and information—this is something that most noble Lords have already mentioned: education for those closely associated with potential drug users and information for the general public. Drug takers are often considered as social outcasts and ostracised from society, which has the effect of driving them in on themselves and to associating only with other drug users. There is a considerable lack of knowledge among the general public about drug users, and what there is derives for the most part from the more sensational elements of the popular press. The impression is that they are all drop-outs. Certainly 1200 some of them conform to that image, but many try to live a reasonable life, holding down jobs and having families of their own, but they have found it hard to cope with the pressures of life and thus had recourse to drugs.
Regrettably, for the most part, drug takers are treated as pariahs. On conviction the usual solution is to lock them up. It might be more sensible, at least for first offenders, and cheaper in the long run, to send them to rehabilitation centres rather than to prison where they may be subjected to the influence of hardened criminals.
I believe that an information programme to bring out into the open the true facts about drug users, dispelling the myths which have grown up around the whole problem and presenting the situation in its true colours, would be one action that could be undertaken at a reasonable price and which would go a long way towards bridging the gap between the drug user and the general public.
As I have said, unfortunately there will always be drug users, and certainly their problems are self-inflicted. But so are many others. As a responsible, caring society we have to help these unfortunates wherever and whenever possible. At the present time there are only some 25 effective statutory clinics in the United Kingdom—there seems to be some divergence of opinion on the exact statistics, but there are not many—14 of which are in London. All the hospitals where detoxification can take place have long waiting lists. The 12 rehabilitation centres, none of which, incidentally, is statutory, can accommodate only about 150 patients at any one time.
It is true that there was a population of only about 10,000 registered addicts in 1983, but it must be remembered that by no means all drug takers are addicted. Among those who are, many, for one reason or another, do not register.
Here I diverge from the noble Lord, Lord Mancroft, but the conservative estimate that I have is some 40,000 to 50,000 against his 200,000 drug users. If his figure is right, the situation is even worse than we think. I have a figure of 40,000 to 50,000 drug users at present in this country. What can be done here? Certainly more funds and facilities are needed urgently, but the existing facilities could be put to better use in a number of ways. First, if all the different agencies, clinics and centres could be co-ordinated under one authority, this would lead to greater efficiency in the use of the present limited resources. Perhaps it could be organised along the lines of the probation service. I understand that funding used to take place under the auspices of the Department of Health and Social Services, but now each clinic is attached to a hospital and funded partially out of its central funds and partially from other sources, which again leads to a lack of co-ordination.
Another possible way the existing limited resources could be put to better use relates to the involvement of the GP. This again was mentioned by the noble Lord, Lord Pitt. The tendency at the moment is for doctors to refer their drug-using patients to a clinic and leave it up to them. This puts an enormous strain on the limited number of clinics that exist and, in many cases, instead of concentrating their expertise on drug users 1201 who need special attention or who are prepared to try to come off and need counselling, a high proportion of their time is taken up in dealing with cases which are reasonably stabilised and could be dealt with quite satisfactorily by the GPs, if they were better informed and had received some instruction from the experts in the clinics. Incidentally, the experts are willing to give this instruction since, in the long run, this would leave them freer to concentrate on those areas of work where they can be more effective.
I mentioned at the beginning of my speech the third element of this problem, which is how best to help and encourage drug users to disentangle themselves when they have come to realise that it is just not worth all the hassle. One social worker said to me that by the age of 30 most of them are either bored by the whole scene or they are dead. Once a drug user has decided definitely to come off it is quite possible to do so. They do not always succeed the first time, but if they persevere they will succeed. This is the time they need all the help and encouragement they can get from friends, relations and the specialist organisations.
We must remember that even when they are free, they are not yet free of the psychological reason which started them off in the first place. In such cases, the availability of rehabilitation facilities is paramount. Yet these seem to have been almost completely ignored. Certainly, there are such organisations as the parole release scheme which tries to break the gap between a user's release from prison and his re-entry into normal life by introducing him to the relevant helping services. This does not really cater for those drug users, many of whom may not have had a prison sentence and who need psychological rehabilitation.
My Lords, to sum up, it seems to me that those areas which can be improved without a mammoth injection of additional funds are these: by increasing and improving the distribution of factual information to the public at large and to the young people who are at risk of becoming drug users; by ensuring that GPs are better informed on this subject and thus can play a fuller part in the handling of those of their patients who have a drug problem. Finally, that the whole drug agency system in its broadest sense should be handled by one co-ordinating authority, so that the funding may be handled rationally and existing facilities used to their optimum advantage.
§ 7.11 p.m.
§ Lord Rea
My Lords, I, too, should like to thank my noble friend Lord Pitt for bringing this subject forward for debate. It concerns me professionally, just as it does him, since I, too, work in an inner city practice. Also I am pleased to discover that I agree with practically everything that he said and my approach will be very similar. First, I think that I should like to try to describe what it is that makes drug taking so attractive to a certain section of the population, and why it is such a problem for them to break the habit. I shall be referring mainly to heroin addiction—which is the most worrying problem, as noble Lords have said—but many of my remarks could be applied to other drugs, some also to the problem of drinking and some can even apply to that most addictive of habits, the inhalation of tobacco.
1202 The drugs that we are talking about relieve pain; not only physical pain but also emotional pain. Experienced doctors know that the dividing line between the two is hard to draw. All pain, in fact, can be regarded as an unpleasant emotional experience. Opiates not only relieve pain but replace it with a feeling of wellbeing amounting to elation, a transitory but very real sensation of peace and happiness which obliterates awareness of internal and external discomfort. Most of all our lives are fairly dull and routine but, if we are lucky, relatively free from pain. Feelings of happiness come in bursts, as do episodes of misery. But, for some, the daily reality feels painful most of the time; and if this group discovers a means of escaping, even in short bursts, from their pain they are very unwilling to give it up to return to a situation which feels emotionally uncomfortable or painful.
Drug takers have additional gains, apart from the "buzz" or "high" that they get each time they inhale or inject drugs. Because drugs are expensive and illegal, drug users have to be pretty ingenious to get them. A meaning to life appears—that is to procure drugs—and this becomes a central driving force in their lives. An illicit, rather desperate, but exciting camaraderie develops between users, a "we against them (the Establishment)" situation. Three birds are thus killed with one stone: the emotional pain, the rejection and hopelessness and the feeling of isolation. The penalties, apart from the possibility of ending up in prison for criminal activities, include abcesses, cellulitis, septicaemia from injection sites, hepatitis B, poor response to infection (with, for example, resultant pneumonia), malnutrition and physical neglect which also predispose to disease.
Drug addicts often live in squalid surroundings—"squats", as the noble Lord, Lord Pitt, described them—because of their diminished awareness of discomfort and also lack of money because every penny that they have got is spent on their habit. It is not surprising that in one series followed for ten years, 16 per cent. of long-term users died. One group of users in my practice were able to name 47 of their circle who had died over a period of some years. There is no doubt that the more easily available "seed" at present—that is the illicit heroin, poppyseed, if you like, mainly from South West Asia—has fallen upon fertile soil at the moment in Britain. There is a ready clientele of disillusioned young people who feel rejected by society. These are to be found now in almost every country with the present economic climate.
Government policies have not helped in Britain, to say the least. TOPS is not enough to satisfy hundreds of thousands of school-leavers who do not find jobs. They feel disillusioned, hurt and unwanted. No wonder the age group of drug users has dropped dramatically in the last five years. Those who get stuck on drugs often have personal feelings of inadequacy, but lack of a job may be one of the most critical factors tipping the balance to drug dependence.
To turn to some of the measures needed to cope with the problem: many have been described but I should like to add a few points. First, there are the organic medical needs which I have described. Every GP needs to be alerted to them. Drug users are more vulnerable to physical illness than the general 1203 population. But the difficult question of whether or how to supply the controlled drugs which users want on prescription in certain circumstances remains controversial and unanswered. Official drug clinics now mainly do this as part of a "contract" agreed with the user while steady withdrawal of the drug is taking place by reducing the dose prescribed gradually over a period of six to eight weeks. Some doctors, mainly in private practice, supply drugs on a maintenance basis. I disagree with this, even though the drugs given are "clean" and pure, since if the doctor concedes that some addicts are hopeless and will never be cured, the word gets around. There is (if you like) a knock-on effect and further addicts are attracted. But the doctor's chances of working constructively with them are progressively reduced.
If general practitioners are to be involved—and I think there is a strong case for making use of general practitioners, at least initially, to cope with the present crisis—they should receive, as many noble Lords have said, special training and be part of a team with full support. This team should include specially experienced social workers, should include liaison with the probation service and the nearest official drug clinics or rehabilitation units in the district or region; and they should work only on withdrawal contracts with patients.
My Lords, I hope that I have said enough to demonstrate that we are dealing with a problem with at least as great a social component as a medical component. The social needs of addicts are nearly always prodigious, although there are a few who just manage (as the noble Lord has said) to keep their jobs, homes and families together. Housing, employment, financial, legal and family problems will all often be present together and will be severe. Addicts must be offered help to solve them if they are to have any hope of staying off drugs once they have come round to choosing to be withdrawn. But what chance is there of extra social workers being allocated to work with general practitioners, or the voluntary or statutory helping agencies, with the current Government policies which will severely restrict the ability of local authorities to employ more social workers?
Special funds will need to be found in addition to the £6 million—that is, £2 million per annum. As has been said, facilities for withdrawal are woefully inadequate throughout the country and especially in many of the areas where the habit is increasing. There are, for instance, no clinics and no withdrawal facilities between Glasgow and Manchester in the North West. The social worker who runs the information centre in the West End called "Piccadilly Advice"—who is the daughter of a very active Member of your Lordships' House—tells me that she receives telephone calls from all over the country asking for help for addicts. They are seeking assistance in withdrawing. A recent case came from Swansea, where there is a severe drug problem but no facilities at all. Incidentally, this information centre is funded largely by the Greater London Council. Its future is thus uncertain.
There is an urgent need for rapid expansion of facilities in all the new areas which the epidemic has reached. There is a need for central Government 1204 support for a variety of different approaches because none can yet claim high success rates. Above all, there is a great need for the collection of more information both at local and central level.
The Advisory Council on the Misuse of Drugs produced a very valuable report in 1982, called Treatment and Rehabilitation. It is well known to the Department of Health and Social Security, as they commissioned it. The authors proposed a number of realistic recommendations as to how the present situation should be approached. In particular, they say that every region should establish a multi-disciplinary drug problem team to monitor the extent of the problem, to assess and support the existing services and to initiate new services where they are required. There are also a number of other specific recommendations for action, and one important suggestion is that every type of approach should be evaluated. Research is essential, but should initially be concerned with establishing which type of care is most effective.
Last year, as has been discussed, the DHSS invited local initiatives for new projects to be funded by the extra grant of £2 million per annum. I gather that so many suggestions came in that the fund was greatly over-subscribed. I hope that the noble Baroness who is to reply will say what is to happen to the proposals which came in perhaps too late to be allocated funds, and how many of them there were. I very much hope that all deserving projects will eventually be funded. In addition, I think that the proposals of the advisory council which I have mentioned should be instituted as a matter of urgency, quite apart from the additional £6 million, which after all represents only a rather derisory £50 per annum per addict.
My Lords, in the interests of the noble Baroness who is to wind up, I will stop at this stage. I have a number of other matters that I intended to mention but they have been covered already by other speakers.
§ 7.23 p.m.
§ Baroness Masham of Ilton
My Lords, I add my thanks to the noble Lord, Lord Pitt of Hampstead, for calling attention to this frightening and tragic situation. Some people are now saying that the narcotics habit in Britain has reached epidemic proportions. It is certainly not only a problem of the inner cities; it can be anywhere in the country. I feel uneasy that we are having only a short debate today. I think it should have been a major debate with two senior Government Ministers, one from the Home Office and one from the DHSS. This is no trivial matter, and I hope that this debate, short though it may be, will help to stir the Government into a state of urgency.
Britain has proved itself rather successful in fighting wars, but, then, the people rally to the sound of, "Land of Hope and Glory". With so much heroin on the streets, for those who try it and are hooked there is no hope and there is no glory. I pray that the Government will realise that they must do much more, and quickly, if we are to win the war against the pushers and the drugs.
All our young people are at risk. It is no good saying it will never happen to them. Young people like to experiment. They insist that there is nothing wrong 1205 with cannabis. Some of your Lordships have tried to get it legalised, but cannabis can lead people on to other things. All over Britain, in most towns, it is becoming fashionable, if you are under 25, to smoke, "snort" or inject yourself for kicks—so says the Guardian newspaper.
Young people know far more about drugs and modern life than do their parents. I feel it is most necessary that the Advisory Council on the Misuse of Drugs, or the Standing Conference on Drug Abuse, should with the Government's backing stage a concerted educational programme throughout the country on the dangers of trying drugs and of addiction, the signs to look for and what parents should do if they suspect involvement by their children. If parents suspect that heroin is being used and they go to their doctor, many doctors do nothing as they do not want to lose the confidence of the young person. Also, parents do not want to involve their own children with the police. So the parents are in a Catch-22 situation.
So little is talked about prevention, and even the title of this debate suggests that by the time a person is found to be on drugs they are addicted. Surely we should be warning everyone that they are at risk from the Devil, who, with his potions, tempts at parties, at bars and on street corners—and he may even be a friend. Television, popular magazines, Radio 1 and other channels, and public places such as lavatories and post offices, should all give warnings. The last people children listen to are so often their parents.
The other week I was on the interview panel for one of the categories of the Winston Churchill Fellowships. One of the applicants was a probation officer from Northern Ireland. He wanted to visit the National Standing Committee on Drugs of Dependence in Australia to learn about their educational programme. Northern Ireland has become most vulnerable because of the explosion of drug trafficking in Southern Ireland, and it has become at risk because of the land borders. I am told that Northern Ireland is not organised to combat or deal with this evil invasion.
May I ask the Minister: do our Government send people to learn from the National Institute on Drug Abuse in America? This body co-ordinates and makes reports on all the agencies concerned with drug abuse in America. They seem to have more experience than we have, and perhaps some of our National Health Service workers could benefit greatly by learning from them what is the most effective and long-lasting of the treatments.
The Customs and the police are seriously overstretched. What about the National Health Service? We hear that the junior doctors are writing to the Prime Minister about the risks to patient care. This ever-increasing drug addiction need for treatment is yet another agony for an over-stretched service which does so much for so many, but which is being drained of energy with so many vital priorities. Hepatitis is an added danger which the drug addict often brings with him or her to a hospital or clinic.
The DHSS report in 1982 of the Advisory Council on the Misuse of Drugs, entitled Treatment and Rehabilitation, has 45 recommendations. May I ask the noble Baroness, Lady Trumpington, how many of those have been implemented and by which health 1206 regions and districts? Perhaps she would write to me if she cannot give the information today. The noble Lord, Lord Rea, has already mentioned the report, and I should like to refer to some of the recommendations because I am myself a member of a health region and I have found that they do not know about these recommendations. If I may give some examples—5. Each regional health authority should ensure that the extent of problem drug taking in its region is monitored, assess the extent of the services provided and develop a policy for meeting local needs.6. Each regional health authority should establish a multidisciplinary regional drug problem team.8. Apart from providing a specialist service, the regional drug problem teams should have a peripatetic role within the region, giving support and advice to, and liaising with, specialist and non-specialist agencies, and encouraging the development of new services.11. In the long term each health district should establish a team similar to, but broader in composition than, the regional drug problem teams.13. Relevant statistical data held by central government should be made available to drug advisory committees and regional drug problem teams while preserving confidentiality.24. As a matter of urgency the ability to prescribe dipipanone, and therefore diconal, to addicts should be restricted to doctors licensed by the Secretary of State.34. The health departments should consider ways in which the need for multi-disciplinary expertise and training might be met, including the possible establishment of a national training facility.43. There should be increased funding direct from central government, possibly by way of pump-priming grants, normally for a minimum period of five years.There are many other recommendations. It would be well worth your Lordships' while reading them.
I do not think that the statutory bodies can cope alone. The Government should encourage more helpers to protect the weak, the foolish and the curious who try to gamble with life. There should be easily available advice centres for all who need them, which would be advertised in the telephone hooks and would be confidential, unlike the citizens' advice bureaux, which have to take a name and monitor it. My Lords,Eternal vigilance is the price of freedom.
§ 7.31 p.m.
§ Baroness Sharples
My Lords, I also am extremely grateful to the noble Lord, Lord Pitt, for initiating this evening's debate. We have been very fortunate to hear from, among other noble Lords, three renowned doctors with a wealth of experience in the field of drug addiction. How can we prevent the young from sliding to disaster, which is the end of so many when they get involved with drugs? A number of noble Lords have spoken about this, but should not the education of youngsters to make them aware of the danger start when they are much younger than is the case at the moment—perhaps, when they are about nine or ten?
Also, is it not imperative, as other noble Lords have said, that co-operation is sought between parents, schools, churches, doctors, police and customs officers, and that this should be done all over the country? I believe that children understand when the picture is painted simply. The statistics speak for themselves and the misery and pain of the victims and their families are often publicised.
What appals me more than anything is the wealth which the unscrupulous can amass from drug trafficking. The figures that I have seen defy belief and 1207 organised crime is now involved on an increasing scale. As your Lordships are very well aware, there are ready-made networks to distribute these drugs all the way down the chain, resulting in enormous profits for many people. Surely, with the co-operation of other countries which also are affected by this growing horror, the assets of these criminals could be seized when sentence is passed. We would obviously need co-operation from other countries, because in many cases money from these villains goes outside this country.
Sadly, as others have said, it is perhaps inevitable that to finance their craving for drugs—I believe that it costs £14,000 a year for each individual to satisfy his needs—addicts will steal. The crime figures published today by the Metropolitan Police are encouraging, as other noble Lords have said, but will these figures be maintained? If, as many people suggest, the number of drug addicts is increasing and perhaps accelerating, I only pray that our confidence will be maintained. As many noble Lords have said, the police and customs officers do a wonderful job and the courts now pass sentences on "pushers" which we would expect.
We must not become the main reception country for drugs, with re-exporting rife. This is a very real danger. As my noble friend Lady Masham said, it is not only in London and the big cities where the drug problem exists. Drugs officers throughout the country have their worries and, in the part of the country where I live, LSD is their main problem. Wealth accumulated out of the misery and degradation of these young addicts is the most revolting aspect of a very unhappy period in our history; but we must hope. There are new treatments for these addicts and perhaps we should seek more advice from America. I hope that my noble friend will have something to tell us about these new treatments.
§ 7.36 p.m.
§ Lord Ennals
My Lords, may I first congratulate my noble friend Lord Pitt on enabling the House to consider today this crucially important issue. May I, as a very new Member of your Lordships' House, say how moved I am by the quality of the contributions, the degree of expertise that has been presented to us from all sides of the House, and, at the same time, the degree of human understanding in the approach to the problems that we are facing. I was personally glad that my noble friend Lord Soper referred to alcohol as being an addiction, and that the noble Lord, Lord Rea, referred to cigarette smoking. I think that if we started afresh but knew all the social consequences that flowed from alcohol and cigarette smoking, we might find that circumstances would be different.
I was also glad that the noble Lord, Lord Hunter, referred to the problem of drugs for the elderly. One might add that roughly 4 million people today are taking tablets prescribed by their doctors, mainly tranquillisers, which in some cases have withdrawal effects that are no less serious and no less difficult to face than those of heroin addicts. I should very much like to congratulate and thank the right reverend Prelate the Bishop of Portsmouth and to say, too, that I hope he will get a few more speeches in before he goes to the important post that he is taking up.
1208 I must come on to the main subject of the debate and I suppose that I should declare an interest as I am a member of the board of Phoenix House. That is a rehabilitation centre for drug addicts, and I was delighted to hear that the noble Baroness, Lady Trumpington, visited the Lewisham centre last week. I am certain that that has added to her own knowledge of the problems that we are facing.
It has not been a new problem for me. In the late '60s, as a Minister in the Home Office, we were extremely worried because there were 2,000 or 3,000 known addicts. We are now seeing a dramatic increase of roughly 40 per cent. a year. The Home Office admit to 40,000 or 50,000 registered addicts, but most researchers and voluntary organisations involved in the field believe that the figure is nearer 100,000. I have not heard a figure as high as 200,000, which was mentioned by the noble Lord, Lord Rodney, but it could be. It was the noble Lord, Lord Rodney, who expressed doubt about the figure that had been given earlier. But there has been a massive growth.
We have to recognise, the House has to recognise and the country has to recognise, that we are facing a massive human tragedy, a growth of frightening proportions. We are talking about drugs which not only degrade but, as has been said by noble Lords on both sides of the House, kill. We cannot, we dare not, face this growth with any sort of complacency. We cannot do so if we know not just of the hardship faced by those who have become addicted, but of the tragedy for the families of those who have become addicted. Nevertheless, we have not made much progress. As Paul Brown wrote in the Guardian on 3rd January 1984 as part of a series of very well researched articles which were referred to by the noble Baroness, Lady Masham:The National Health Service, which is supposed to deal with the addicts who finally seek treatment"—I would emphasise that many of them never bring themselves to receive treatment—is still using a structure set up in the 1960s to deal with the so-called explosion of drugs in that decade.Since then the problem has become more than 10 times as serious. Yet the resources devoted to it are roughly the same.".I recognise, as has already been mentioned, that the Secretary of State announced in December 1982 an injection of£6 billion—no, £6 million over a three-year period. I wish that it had been £6 billion, because £6 million is a drop in the ocean compared with the size of the problem we face and the inadequacy of the existing facilities, which have been referred to by so many noble Lords. I am thinking of the speeches made by the right reverend Prelate the Bishop of Portsmouth, the noble Lord, Lord Pitt, the noble Lord, Lord Hunter of Newington, the noble Lord, Lord Rodney, and the noble Lord, Lord Rea. All of them referred to the inadequacy of the existing treatment facilities. I hope that the noble Baroness will be able to give us some good news, because £6 million does not go very far. It is not even inflation proofed and we are almost halfway through the period for which that sum was allocated. I believe, therefore, that it is a totally inadequate response to a problem which has now grown to epidemic proportions. I cannot use less strong words. Not only in the Government but in the 1209 country at large there is still an extraordinary degree of complacency about the problem, against which we have to do battle in one way or another.
Why has there been this dramatic growth in drug addiction? We know that there has been a flood of drugs into the country from Pakistan and Iran which has inevitably made them cheaper. It is now easier to get hold of drugs than it has been for many years, but we cannot escape from the fact that usually social problems face those who embark upon the dangerous and sometimes suicidal course of taking drugs. They may be facing the problem of homelessness, which we debated earlier today, family breakdown, children going into care, or unemployment. These problems can seriously affect people's ability to cope with life and increase their willingness to find something which will relieve them of what they believe to be a life without dignity.
I mentioned unemployment. Nobody can say that there is a direct link, but I have looked at the regions in which there has been the biggest increase in heroin addiction. At one time heroin addiction was just a London problem. Certainly in my Home Office days it was largely a London problem. However, between 1978 and 1982 there has been a 480 per cent. increase in addiction in the Midlands, a 437 per cent. increase in addiction in Scotland, a 386 per cent. increase in addiction in North-West England, a 148 per cent. increase in addiction in Wales and a 135 per cent. increase in addiction in the North-East. All of them are areas of high unemployment and deprivation. Therefore, the pattern of drug abuse is a sign of the malaise in our national life, for which all of us must bear a degree of responsibility but for which the Government must hear a heavy responsibility, not just for the causes but for the consequences.
As has been stated by a number of speakers, the outline of a national policy to deal with drug abuse was contained in the report of the Advisory Council on the Misuse of Drugs which was made to the Home Secretary about 18 months ago. The noble Baroness, Lady Masham of Ilton, referred to some of the recommendations. Many recommendations were made. However, although the Secretary of State announced very quickly the provision of £6 million, there has been no coherent statement since then about how the Government plan to deal with the problem. Several departments have an interest in the control of drug misuse and the provision of services, yet the interdepartmental committee which existed to provide a formal mechanism for the discussion of cross-departmental issues no longer exists. In his Statement on 1st December 1982 the Secretary of State said:The Government recognise the challenge posed by the growth of drug misuse to which the council has drawn attention and are determined to respond. The field has not received the attention that either the advisory committee or the nature of the problem itself demands".I hope that the noble Baroness will be able to tell us when the Government are to make a valid statement of their policy. They put the advisory council's document out for consultation and asked organisations to reply by March of last year. Even though the organisations sought to reply by March of last year, nearly a year has passed without an authoritative statement from the Government. If it is 1210 not possible for that statement to be made tonight, I hope that the Secretary of State will decide to make it in another place.
I do not intend to go through the report. It would be absurd to do so at the end of such a well-informed debate. A recommendation has been made about the specialist drug dependency treatment centres which exist on a regional basis. However, there are not nearly enough of them. It is recommended that liaison bodies should be set up to co-ordinate action between the various professions and interests, on the grounds that a broad network of services is required to combat the drugs problem. I am sure that is right. This is not just a problem for psychiatrists. It is a problem for general practitioners, social workers, parents and community workers. It is a problem for a team of people who have to face up to some of the causes as well as the consequences of drug addiction.
A further recommendation was that structured hostel provision should be made available and that other services such as day care should be developed by non-statutory organisations. But the problem is money. One recognises that the Government have to face the problem of finance, but I believe that the consequences of not putting more money now into treatment and rehabilitation facilities will cost the Government and the country much more than the additional funds which ought now to be provided. It will cost the Government more in terms of National Health Service treatment. It will also cost them more in terms of crime. There is no doubt that those who have no money, because they have lost their jobs or because they have never had a job, and who are unable to get the stuff they need will steal and become pushers. The majority of pushers are in fact pushers because they want to get money to buy the drug which sustains them. Therefore, we face a very serious problem.
I am not talking about throwing masses of money at the problem. I am, however, saying that the Government are not facing up to the size of the problem. And so much of the problem falls on the voluntary organisations. I am not going to run them down; I believe in the closest co-operation between the Government and the voluntary organisations. However, I know that Phoenix House and the other bodies with which I am associated, which offer two-thirds of all their resident beds to addicts—that is, 260 out of the 360 rehabilitation beds in the United Kingdom—need additional assistance. Some of us have been involved in this difficult task. One speaker said that this is not a popular subject—that people do not leap up, wanting to give large sums of money to help to deal with this problem. It is, in fact, a difficult subject.
I want to put in a word for general practitioners, particularly since I have a couple of them seated behind me. The Association of Independent Doctors in Addiction—AIDA—insist that GPs should be coping with 95 per cent. of addicts and urge that some of the £6 million should go on rudimentary training for GPs in the problems of addiction. That matter was referred to by my noble friends Lord Pitt of Hampstead and Lord Rea, and by the noble Lord, Lord Rodney; all of them agree that the training of GPs in the handling of this problem is a crucial issue.
1211 I wish to make two final points and will then sit down in order that the noble Baroness will have the maximum time with which to deal with the important points that have been raised. First, I believe there is a need for a massive education campaign. It is a campaign that needs to be run through the press and through the schools. We need to involve families also in an intensive way, as was said by my noble friend Lord Soper and the noble Lords, Lord Mancroft and Lord Rodney. Families themselves are hardly aware of the behaviour of their children, of what their children are up to, and of the dangers which their children face when they become involved in drug addiction.
My last point has been previously touched upon. As I said, the non-statutory sector has had the main task of rehabilitation—and, after all, treatment is largely a matter of rehabilitation—in complementing the medical treatment service, such as it is. Most of the money for the voluntary drug centres has come from local authorities. The GLC and other metropolitan authorities have been crucial in terms of funding those hostels. Many of them would be gravely at risk if the recommendations in Streamlining the Cities were to be implemented. That is a fact we cannot ignore if we are to confront the problem which faces us today.
I will end with a quotation from the Guardian of 5th January. I congratulate the Guardian on the way in which they have concentrated the nation's attention, as I hope this debate will do in a small way. The Guardian stated:…there is no political will to tackle the problem because middle-class parents, whose sharp elbows wield political power, don't realise that their own children are in this danger. There is almost total ignorance among such parents of the prevailing drug-oriented ethos at their children's schools, an ingrained belief that such things couldn't happen to nice children".That is the belief of too many people, and that is why the Government need to initiate, with the support of local authorities and parents, a massive campaign if we are to tackle what has become a problem of epidemic proportions in our nation.
§ 7.35 p.m.
§ Baroness Trumpington
My Lords, may I congratulate not only the noble Lord, Lord Pitt of Hampstead, on raising this most important and difficult issue, but also the right reverend Prelate the Bishop of Portsmouth on his most compassionate speech. The noble Lord, Lord Pitt of Hampstead, has quite naturally spoken from a medical viewpoint on a matter which has caused great concern over the past few years because of the substantial rise in the extent of drug misuse in this country. But it is inevitable that Home Office involvement must also be taken into account. Obviously—and noble Lords have said this—prevention is better than cure. It is for that reason that I emphasise the following facts and figures, some of which the noble Lord, Lord Pitt of Hampstead, mentioned at the start of his speech.
Between 1980 and 1982 the quantities of heroin seized by police and Customs increased no less than five-fold; and the quantities of cocaine increased by a similar amount in 1983 alone. Street prices for these drugs have remained static, and in some instances have actually dropped. This tends to confirm the 1212 anecdotal evidence that drugs are readily available on the streets. Equally, the number of addicts who seek treatment from doctors for their addiction is increasing at a rate of between 25 and 40 per cent. a year. Over 4,000 such addicts were notified to the Home Office in 1982, as compared with around 1,600 in 1972. I wonder what the figures were when the noble Lord, Lord Ennals, held office. The figures for 1983, when available, are likely to show a further substantial increase. As noble Lords have said, this takes no account of unregistered drug addicts.
I agree entirely with my noble friend Lady Sharpies that the indications are that more determined and more expert thieves are being attracted by the large profits that can be made from illicit drug sales. Premises on which drugs are stored present attractive targets because, in contrast to most other stolen goods, the street value of drugs on the black market is much greater than their normal commercial value.
The Government's response to the drug problem calls for action on the part of a number of departments, and in a recent speech the Home Secretary sought to bring together the various strands of Government policy. We are stepping up our efforts to stem the flow of drugs from aboard by increasing the amount of aid we make available to United Nations for drug abuse control in producer countries, particularly Pakistan, and by posting law enforcement liaison officers to Pakistan and the Netherlands. Customs activities in the country are being more selectively targeted. Since 1979, the number of officers specialising in drugs investigations has increased substantially, and the number concentrating on the detection of heroin trafficking has doubled. The Association of Chief Police Officers have given assurances of the very high priority they will continue to give to measures directed against drug traffickers. I am sure that those concerned—police officers, Customs officers, et cetera—will welcome the kind words of my noble friend Lord Mancroft; I share his feelings of gratitude.
We are also strengthening the control of drugs produced and prescribed in this country, and are actively considering further changes. Controls on barbiturates under the Misuse of Drugs Act 1971 are to be introduced later this year. The noble Baroness, Lady Masham of Ilton, and the noble Lord, Lord Hunter of Newington, will be interested to learn that dipipanone, which has recently proved very popular with addicts, will, from 1st April, be added to heroin and cocaine as drugs for which doctors require a special licence to prescribe to addicts.
The Home Secretary also announced that he intends to make full use of his powers under the Misuse of Drugs Act to take action against doctors who are prescribing controlled drugs in an irresponsible manner. The arrangements for the security of controlled drugs at all stages from manufacture to dispensing are being examined in the light of a report of the Advisory Council on the Misuse of Drugs published last November. Comments from interested bodies on that report are expected by the end of this month.
We must take firm action against criminals who profit from the misery of drug addiction and we must find more effective ways of dissuading people, particulary the young, from experimenting with drugs. We 1213 will be giving urgent consideration to the prevention report recently completed by the Advisory Council on the Misuse of Drugs as soon as we receive it—which we expect to be within the next two to three weeks. I am sure that the report will make a useful contribution to the development of policy and practice in this most difficult area, but clearly I cannot comment in detail until we have received the report and had a chance to study it. Prevention is, as I have said, of prime importance, but we must face the fact that a number of individuals will experiment with dangerous drugs and consequently become addicted.
Moving on, then, to the subject of the treatment facilities available within the NHS, it cannot be denied that provision varies widely from area to area. Currently there are 14 treatment centres, the majority of them in London. The reason for that is that, historically, London was the first major problem area. Outside the metropolitan area, therefore, drug misusers are mainly referred to general psychiatric services. Precise information is not available centrally about hospital facilities, but the DHSS is aware of approximately 100 psychiatric hospitals where some provision for treatment of drug misusers is available.
In most drug treatment units, and within general psychiatric services, there are no specific in-patient facilities, and the provision of staff, such as nurses, social workers and psychologists, is often very limited. Full multi-disciplinary drug treatment teams are very much in the minority. Outside London, the service is generally provided by a single-handed general psychiatrist providing an out-patient service. Drug screening facilities are limited and patchy; and social work support, where it is available, is rarely full time.
My Lords, it is no pleasure for me to state these unpalatable facts, but I would add that Government health Ministers are fully conscious of the situation and are taking steps to improve the state of affairs. As the noble Lord, Lord Rodney, said, drug misusers attract little public sympathy compared with other groups and have often had low priority in the allocation of resources, something they themselves are well aware of. But it is increasingly being acknowledged that there must be an adequate response to the needs of these people if a permanent change is to be made in their behaviour.
Before I move on to what the Government are doing, I must acknowledge the valuable contribution made to drug misuers by those outside the National Health Service.
Currently there are over 200 places provided in rehabilitation houses in England, though it must be said that most of them are in London and the South East. Financial help for these residential establishments, and for three London street agencies which provide equally valuable help for drug misusers but on a non-residential basis, has come from the London Boroughs Association and the Greater London Council and some health authorities. Some voluntary counselling and advice services are becoming available outside London. The Home Office provides grants to residential hostels which accept ex-offenders. Some national organisations in this field are grant-aided by Government.
As the right reverend Prelate said, people need to be helped, and I would say that people who have already 1214 begun to use drugs can be helped. The evidence suggests that the earlier help is sought the more promising the outcome. Parents apprehensive of their children's behaviour, as the noble Baroness, Lady Masham, pointed out, would be well advised to approach the wide range of statutory and voluntary agencies which exist for advice in confidence. Incidentally, I am certainly not a trivial Minister.
I listened, as usual, with the greatest respect, to the noble Lord, Lord Soper, who raised the question of education. My reply to him must be that it is for schools themselves to decide whether, and if so how, to include education about alcohol and drugs in their curricula. I hope that current attention being given to healthy lifestyles will go some way to meet his point. Educational material is available to schools from the Health Education Council and TACADE, the Teachers' Advisory Council on Alcohol and Drug Education.
Your Lordships will be aware that a little over a year ago the Government published a report on treatment and rehabilitation by the Advisory Council on the Misuse of Drugs. Immediately upon receipt of the report in 1982 the Government accepted the council's recommendation that responsibility for provision and development of services for drug misusers should remain at local level. My right honourable friend the Secretary of State for Social Services in an initial response to the report, announced in another place that consultations with statutory professional and voluntary organisations would be undertaken, and this exercise has since been completed. As part of that consultation he convened in January 1983 a conference of representatives of the medical profession to enable them to consider recommendations of particular relevance to doctors. He also made available the £6 million, which has been mentioned, over three years, to encourage health and local authorities and voluntary bodies to develop schemes for helping people with drug-related problems.
The response to this central funding initiative has been most encouraging. The guidelines giving detailed information about the initiatives which were issued to those wishing to hid for grants made clear that the department will aim to ensure that there is a reasonable geographical spread of projects and a reasonably equitable distribution of funds between different organisations and different types of projects. The noble Lord, Lord Hunter of Newington, and the right reverend Prelate the Bishop of Portsmouth, and I am sure other noble Lords, will agree that these guidelines will ensure that at least some of the imbalance between the level of services in the South East and those elsewhere in the country will be rectified.
§ Baroness Trumpington
We have very little time. If the noble Lord does not mind, I would rather answer questions which have been put to me. In answer to the noble Lord, Lord Pitt, and the noble Lord, Lord Mancroft, the Government are aware of debate among doctors about prescribing practices and indeed some public anxiety and sympathy, and more consideration needs to be given to the role of general practitioners in 1215 the treatment of drug misusers. Following the medical conference the Secretary of State has convened a small working group of medical practitioners under the chairmanship of Dr. Phillip Connell, consultant psychiatrist at the Bethlem and Maudsley hospital and chairman of the advisory council, to prepare guidelines on good clinical practice in the treatment of drug misuse and to consider the report's recommendation for the extension of licensing restrictions to include all the opioid drugs. This report, which will be dealing with most complex issues, is expected to be received in about six months' time. For your Lordships' information, I have arranged for copies of the terms of reference and membership of the medical working group to be placed in the Library.
My Lords, I shall now attempt, somewhat at random, to answer some of the questions which I have not yet covered. The noble Lord, Lord Pitt, and the right reverend Prelate, indeed most noble Lords, including Lord Mancroft, Lord Rea and Lord Ennals, queried whether the £6 million is enough. Everybody wants more money, but Government policy for the health and personal social services generally is that prime responsibility for the provision and development of services should remain at local level. It is for each health authority and local authority jointly to plan services to meet local needs in this field, as in others, in the light of their priorities and the resources available. My right honourable friend the Secretary of State for Social Services hopes very shortly to announce decisions and actions following his consideration of the comments of health and local authorities, professional and voluntary bodies on the report of the Advisory Council on Treatment and Rehabilitation.
In answer to the noble Lord, Lord Rea, on what is to happen to projects which exceed the £6 million allocated, consideration is still being given to a number of projects within the total of the £6 million available. It is hoped that projects which do not receive a grant from within this sum will receive consideration and local support when health and local authorities are planning services.
In reply to the noble Baroness, Lady Masham, with regard to awareness of ACMD's recommendation, copies of the ACMD treatment and rehabilitation report, including the list of their recommendations, were sent to all health and local authorities and professional and voluntary bodies concerned, as part of the Secretary of State's consultation exercise. Concerning her question about whether the recommendations had been followed up, I will have to write to the noble Baroness.
The noble Baroness, Lady Masham, and my noble friend Lady Sharpies asked whether the Government send people to the National Institute for the Study of Drug Dependence in Australia. I would reply that experts from the DHSS and professions in the United Kingdom take suitable opportunities to exchange information about treatment with delegates from other countries at international conferences.
With regard to Lord Mancroft's remarks, which were very interesting, about the Hazelden Clinic in Minnesota, further information on the statistics and research on which the Hazelden success rates are based 1216 has been sought from America for study by the DHSS. As to his other point about Narcotics Anonymous, self-help movements are generally to be welcomed. By their very nature the impetus to create local groups must come from individuals themselves. I am told that there are so far only about eight Narcotics Anonymous groups in the United Kingdom, mainly based in the South East. Our policy is to encourage the development of a wide range of services to which the individual can be referred, according to his or her needs.
The noble Lord, Lord Pitt, mentioned the Hong Kong way. This programme of method, maintenance and detoxification, allied to a major rehabilitation programme which is work based, has been well documented. That experience is available to doctors and others in the United Kingdom. As regards cannabis, the Government remain true to their original intentions. On the need for more research, a matter raised by the right reverend Prelate, the DHSS has funded the relevant research and, in addition, I can announce that it is to fund research projects to start in 1984–85 which will throw more light on the way services are organised and on reasons why addicts relapse.
My noble friend Lord Mancroft referred to the Exmouth doctors' initiative announced today. Decisions by doctors on ways of exercising care and discretion when prescribing for addicts are to be welcomed. Suitable alternative provision is a matter for local links between family doctors and the health authorities. The noble Lord, Lord Hunter of Newington, referred to district health authorities specifically appointing consultants with a responsibility for drug addiction. I can tell him that within some districts general psychiatrists have been appointed with the contractual responsibility to provide services to drug users. The majority of full-time specialists work in regional drug treatment units. It is the responsibility of health authorities to relate services to local needs and the Secretary of State has indicated that he is improving the accountability of the NHS.
My noble friend Lord Rodney referred to drug misuse being funded by one national co-ordinating agency. The Advisory Council on the Misuse of Drugs looked at this but concluded that the co-ordination and, therefore, the decisions about resources should be at local level. The noble Lord, Lord Ennals, attacked the Government for their complacency in the face of growth, although DHSS research does not support the noble Lord's assertion. The Government are not in the least complacent. We are looking to regional health authorities to review the scale of the problem in their areas and also to other bodies so that we can make plans to respond.
It was good of the noble Lord, Lord Ennals, to refer to my recent visit to Phoenix House. That same day I also visited St. Clement's day centre in Tower Hamlets. I should like to pay tribute to the band of very special people who work in those and other excellent establishments. Both visits added greatly to my slim store of knowledge on the subject we have been debating today. Had this not been a short debate I should have liked to speak at greater length on what I learned. I so agree with the noble Lord, Lord Rea, when he spoke about pain.
1217 Noble Lords who have spoken this evening have lived with this sad subject for a much longer time than I have. I have tried to answer some of your Lordships' questions and to reassure your Lordships, and other interested parties, that the Government are far from complacent. They are taking a number of positive and practical steps to prevent drug addiction at its source and to improve the service that is available to drug misusers. Naturally, I will write to any noble Lords who may feel that I have not replied to their questions.
§ 8.15 p.m.
§ Lord Pitt of Hampstead
My Lords, I am lucky in terms of time but I shall not inflict another speech on your Lordships. I merely thank all noble Lords who have taken part and supported me in this Motion. I want to congratulate the right reverend Prelate on his maiden speech and say how sorry I am to hear that we shall not be hearing him as often as we would like. Like the noble Lord, Lord Ennals, I hope we shall hear a few more speeches from him before he takes up his new appointment.
I was very interested in what was said by the noble Lord, Lord Mancroft. Of course, we can ban heroin. In fact, I think that we should not only ban heroin but also try to destroy its production, which I think we can also do. But I do not know whether that will solve the problem because addicts will find other things to which they become addicted. The Government are now going to make diconal more difficult to obtain. I do not think that will make much difference. Addicts will then be chasing palfium, DF. 118, or one of the other opiates. Therefore, although I agree that international action should be taken against heroin to get rid of it, because that can be done and there is no need for it, I should not like anyone to think that once that is done we shall have saved ourselves from the headaches that we now have. I suspect we will get headaches from other sources.
I am grateful to my two colleagues, my noble friend Lord Rea and the noble Lord, Lord Hunter of Newington, who told your Lordships that he was a fellow student of mine in Edinburgh. Of course, he became a distinguished vice-chancellor while I continued to be a humble GP. I was very glad to have his support here this afternoon and also the support of fellow GP, my noble friend Lord Rea.
I was interested in the historical analysis given by the noble Lord,Lord Hunter, because it is quite relevant to what I was saying just now about the destruction of heroin and that drugs will be created to which people will then become addicted. That is why I come back to the point at which I started. Although I am grateful to the Minister for the fullness of her reply, I am unhappy that she has not been able to take on board the difference between what I am suggesting and what the advisory council suggested. The advisory council is still basing its recommendations on the existing facilities but, I agree, broadened and adding more local antennae. But it is still based on the hospitals. I suggest that the Government should give serious consideration to having a community-based service, and that it should be centrally funded. Those were the two elements of my proposal and I do not think the Minister dealt with them. However, I hope that she will get her colleagues and her officers to study what I 1218 have said because it is my view that that is a better approach than the one we have followed heretofore.
I was very grateful that my noble friends Lord Soper and Lord Ennals took part in the debate because they form part of the non-statutory agencies which are very active in this field. We are very grateful to them for what they do. I was grateful to the noble Lord, Lord Rodney, for his support. I agree with much of what he said, just as he agreed with much of what I said. It is interesting to remember that all drug addicts are not drop-outs. In fact, there are many who are performing normal duties all over the place. Some of them are making decisions which are of great importance to us all and one would not know it. Therefore, the idea that drug addicts are merely people who have dropped out is a fallacy.
It is also a fallacy if the middle classes think that their children are not drug addicts. A lot of drug addicts are the children of middle-class parents. We need to look at this problem with the seriousness that it deserves. I again repeat that I hope that the Government will take on board the things that have been said.
I welcome the support of the noble Baroness, Lady Masham of Ilton. I like to see her at war, and I am always pleased when she is at war on my side. I thank her very much for her support. I think that we have had an interesting and useful debate. I repeat again that I hope that the Government will give serious consideration to the type of approach that I have suggested. With those words, I beg leave to withdraw the Motion for Papers.
§ Motion for Papers, by leave, withdrawn.