Therefore, it can be conceded that drug use can contribute to the levels of crime. It should be recognised also that all substance abusers who use illicit drugs are committing a crime in the form of possession, and, inevitably, that crime will have to be committed. Sentences for possession can range from three months to 7 years (The Oxfordshire Council on Alcohol and Drug Use, 2003), depending on the class of the substance.
There are a number of offences directly linked with substance abuse, aside from possession. In December 2002, the Government launched the This was aimed at tackling not only drug use, but also drug related crime. These crime include the following-
- Drug use in pubs and clubs
- Prostitution
- Drug Driving
- Theft
- Assaults
Other issues raised were-
- Drugs in work settings
- Begging
- Housing and Homelessness
- Discarding of drug-related paraphernalia
- Properties associated with drug use and nuisance
The Schaffer library of drugs (2002) argues that there are three types of drug related crime-
- Drug induced- the crime caused by people while under the influence of drugs
- Purchase motivated- crime caused by people to pay for their habits.
- Black Market crime- crime caused by organized criminal suppliers of drugs.
At this point, the lengths that are being taken to help the service user in order to prevent crime can be explored. Hackney County Council (2000) have created a ‘Drug Action team’, for the implementation of ‘a comprehensive strategy and action plan.’ Similar schemes have been created throughout the country in order to tackle increasing drug use and drug related crime. Substance misuse action groups have been created, with the word ‘action’ in the title of significance. The effectiveness of a Drug Arrest Referral Scheme has been tested, where those arrested by the police who want help with a drug problem are referred to professional help to overcome their addiction. Fairly recently (2000), the Government introduced, under the Crime and Disorder Act, The Drug Treatment and Testing Orders- a new order, managed in partnership, to reduce drug related crime by providing treatment for drug users. The National Audit Office (2001) say of the order-
‘Drug Treatment and Testing Order is one of a number of initiatives seeking to break the link between drug use and crime.’
Drug Treatment and Testing Orders were piloted in three areas in England from October 1998. In May 2000, the Home Secretary made the Order available to all courts in England and Wales from October 2000. By December 2003, 18,414 Orders had been made. In 2003-04, the Home Office allocated £57.3 million
to probation areas and treatment services in support of the Order in England and Wales. Immediately, the cost of a treatment and testing order can be seen
This table, taken from ‘The Drug Treatment and Testing Order: early lessons’, by The NAO, 2003, underlines the aims of the Treatment and Testing order, and the conclusions.
The NAO (2003) state that-
‘Around 28 per cent of Drug Treatment and Testing Orders terminated in the latest full year, 2003, were completed in full or terminated early for good progress.’
However there are a number of criticisms to be made of the treatment and testing order. Firstly, the cost; as stated earlier in this essay, the annual bill for funding this initiative is £57.3 million. It may be argued that this funding goes on to reduce crime committed, and the cost of substance abuse in general. However, as the table shows, the scheme has not been altogether successful, with targets having failed to be met. It is demonstrated that any funding given would need to be allocated over a period of time, in order to gradually increase results to the standard first sought. Also, the NAO (2003) state that-
‘…data from one of the areas we visited, and experience reported to us in the other areas visited, suggests that a high proportion of offenders do not remain on their Order for long.’
This is typical of any order; not everyone is going to attend. However, given the targets of the order, and the standards first set out, it can be accepted that a higher percentage would attend and complete the order. Research into the effectiveness of treatment more generally suggests that some miss-users will continue to misuse drugs (NAO, 2003.) After 12 months on the Order, nearly 70 per cent were testing positive for opiates. One may here compare the funding given to the results, and question the effectiveness of the Drug treatment and testing order. In order to assist drug users in coming off the substance abused/used, one must first attempt to understand why the drug is being used. The Drug Service User’s Charter of Rights and Responsibilities (1997) offer the following possibilities, which are divided into two groups.
Group A - Occasional or Recreational Use
- Curiosity - often the reason for initial drug use.
- Experimentation - young people may experiment with drugs and their effects to fill in gaps in their knowledge .
- Adventure, risk taking - some people may be attracted by the risk they see as inherent in drug use.
- Improve performance & body image - this may include the use of stimulants such as
cocaine and amphetamines, and performance enhancers such as anabolic steroids.
- To enhance experience - this will include the use of ecstasy by younger clubbers, and mescaline by older writers (e.g. Huxley).
Group B - Chaotic, Dependent or Risky Use
- To kill pain, including emotional pain - Some people will use drugs (generally opiates) as a means of escape from a reality they feel they cannot deal with in any other way (e.g. if they are suffering physical or psychological abuse).
- To find/maintain a sense of identity - Some users may welcome the sense of identity that membership of a drug-using fraternity bestows.
- To avoid withdrawal - Once dependent on drugs, users will wish to avoid the extremely unpleasant physical and psychological effects of withdrawing from their dependence.
A criticism of this model is that it over-simplifies the true range and pattern of drug use. It is an idea accepted that there is rarely one given reason for drug use. Social theory and normalisation can be attributed to the growing social phenomenon of drug use. It is clear that not only do drugs vary in terms of their type, dangers and effects, but also drug users vary in terms of their range and experience of drug use and associated problems. It is also becoming increasingly accepted that for many ‘recreational’ or ‘weekend’ drug users, the problems experienced are generally fairly minor. The bulk of drug problems are experienced by those comparatively smaller numbers who have become dependent and/or chaotic users, and by their friends and families and the communities in which they live. They often require specialized help in overcoming their addiction, and it is a valid argument that training should be given by those practicing medicine.
Evaluation of two pilot shared care schemes in the North of England (Hawkes & Cyster, 1998, Cyster, Hawkes & Williams 1999) revealed a number of fears about working with drug users initially held by GPs and other members of the Primary Health Care Team. They are named and described by the Drug Service User’s Charter of Rights and Responsibilities (1997). They include-
There was concern that the scheme would so raise the profile of their Practice with local drug users that they would be flooded with new (and difficult) patients.
Initially, there was concern about the possibility of drug using patients posing an unacceptable risk to the security of both Practice staff and other patients. It was found, however ‘…that drug users were no more demanding or abusive than some of their other patient groups, especially if managed in the correct manner.’ (‘Drug Service User’s Charter of Rights and Responsibilities, 1997). The most frequent complaint concerned drug users’ poor time keeping and the ‘knock-on effect’ this had on other patient appointments. It is therefore unethical to approach a drug user with the frame of mind that they may pose staff, or the other patients, some form of danger. It may be wise, however, to err on the side of caution.
Concern was expressed over the perceived reliability of drug using patients. In fact, analysis of audit data from one of the pilots showed that of a total of 882 appointments made during the research period, 76 (9%) were not kept and were recorded as a ‘Did not attend’, compared with 6% of the average patient- a fairly insignificant number.
- ‘Lack of Time with Clients’
Some surgeries expressed concern over the cost of GP time. Several respondents commented that the presence of GP Liaison Workers saved GP time, both by providing an efficient back-up service and by introducing an element of discipline and structure, resulting in a more efficient process.
- ‘Communication with Specialists’
Some Practices reported difficulties communicating with the specialist agency, the GP Liaison Workers generally providing a useful and effective link between the two shared care providers.
Interview data suggested that most GPs thought that supervised consumption of methadone should be introduced. These GPs were concerned about the spread of methadone onto the street and also that their patients might not be following their treatment plan. These, it can be argued, are valid cause for concerns, given the value of such substances. (McKegany et al 1988)
This description of methadone is given by ‘Ceredigion Contact’, an independent drug agency-
‘…methadone is mainly used today as a substitute for heroin in an attempt to relieve some of the problems associated with heroin addiction.’
Methadone mimics many of the effects of opiates such as heroin. Methadone programmes are intended to reduce the risks associated with heroin addicts who use illicit sources for their drugs. It is presumed that these risks- such as heroin overdose, HIV or hepatitis infection from shared syringes and risks associated with the need for criminal activity to fund illicit drug use- are reduced if addicts receive a daily supply of methadone as a substitute for illicit heroin. It is also presumed that, given a regular supply of a prescribed drug, addicts will be able to lead a more stable life as they will no longer suffer from repeated heroin withdrawal.
There are a number of issues regarding the supply of methadone to drug users. ‘Pharmacy-In-Practice’ (MJ Daly et al, 1997) describes the ethical dilemmas faced by doctors in a position to supply methadone. For example, there is always the possibility that the recipient is selling the methadone to fund a habit. There are other implications; valid questions can be posed regarding the ethics in supplying a substance abuser with drugs. It might be argued that this is doing little to wean the drug user off using drugs.
Having discussed possible treatments for drug use, preventative measures will now be discussed. A focusing on the dangers of drugs targeted at young people, particularly those aged 14 to 17 years, was by the Health Promotion Agency. Recent research shows that over one in four school children have been offered drugs and for most of these young people they were first offered drugs at 14 years of age. It was decided that the research conducted highlighted ‘the need for an ongoing programme of public information to make young people aware of the dangers of drugs’ (HPA, 2002). The campaign includes a series of television advertisements that were pre-tested with young people in the target age group to ensure they not only appealed but were credible too. To support the television advertising almost 100,000 copies of the information booklet, ‘Your body, your life, your choice’, have been distributed to post-primary schools for all fourth, fifth and sixth form pupils.
Rob Phipps, Senior Health Promotion Manager for the HPA says of this movement- “It is important that young people have accurate information about drugs and that they get this information at the right time, in other words, sooner rather than later. While the booklet covers a wide range of drugs, the television advertising focuses on three - Ecstasy, LSD and Speed. All drugs are dangerous but these ones are especially risky and research shows they are particularly popular drugs with the 14-17 year age group.”
In April 1998 the UK Government launched a 10-year anti-drugs strategy, 'Tackling Drugs to Build a Better Britain'. Four main strategies are listed:
- Young People – ‘to help young people resist drug misuse’, and to ‘halve the numbers of young people using Class A drugs by 2008.’
- Communities – ‘to protect communities from drug-related anti-social and criminal behaviour’, and to ‘halve the levels of re-offending by drug misusing offenders by 2008.’
- Treatment – ‘to enable people with drug problems to overcome them’, and to double the number of drug misusers in treatment by 2008.
- Availability– ‘to stifle the availability of illegal drugs on the streets’, and to ‘reduce access to drugs among 5 to 16 year olds.’
One thing is apparent; there is a need for prevention. The government is attempting to do this by means of education. The United Kingdom anti-drugs co-ordinator’s annual report (2001/2002) boasts that ‘….£152 million over three years has been identified for spending on education, prevention and treatment services for young people, to increase drug service provision for young people.’ However, the Department for Education and Employment’s (DfEE) article, ‘Protecting Young People (1998)’, states that ‘it is important drug education is based on evidence about what works and what clearly does not work.’ ‘Shock tactic’ approaches, often used by schools and local education authorities, are often ineffective, and, according to the DfEE, ‘are often counterproductive’. It is also claimed that ‘…the impact of drug education on drug using behaviour is limited. Drug education is unlikely to prevent young people from ever experimenting with drugs.’ Though perhaps seeming overly critical of drugs education, the report does concede that drug education can be beneficial when implemented in the correct manner- ‘…Drug education can contribute towards decreased harm and increased safety for young people, their families and communities.’ Therefore, it can be offered as the better opinion that drug education does little in terms of prevention. However, there is scope for preventing the misuse of drugs, to the point where they can become dangerous to the uneducated user.
Bibliography
www.healthpromotionagency.org.uk – February 2002-http://www.healthpromotionagency.org.uk/work/Publicrelations/PressReleases/dangerdrugs.htm
McNamara, D.P.A, Joseph D, Criminalization of Drug Use, Psychiatric Times September 2000 Vol. XVII Issue 9
Hough, M. (1996) Drugs Misuse and the Criminal Justice System: A Review of the Literature, Drugs Prevention Initiative Paper 15, London: Home Office.
www.drugpolicy.org -http://www.drugpolicy.org/global/drugpolicyby/westerneurop/england/
The Drug Treatment and Testing Order: early lessons, REPORT BY THE COMPTROLLER AND AUDITOR GENERAL
HC 366 Session 2003-2004: 26 March 2004
SCODA, 1997 - Drug service user's charter of rights and responsibilities - www.drugscope.org.uk -http://www.drugscope.org.uk/goodpractice/ki_pubs_template.asp?sid=3&id=12&pubid=57&title=Users
www.archive.official-documents.co.uk – Presented to Parliament by
the President of the Council by Command of Her Majesty, April 1998
http://www.archive.official-documents.co.uk/document/cm39/3945/3945.htm
