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Drug Treatment Disinvestment Undermines UK Attempts to Show International Leadership

The UK Government's message to the UN is right - robust investment and light-touch enforcement is the path forward - but those words will ring hollow if we fail to heed them at home.

This week, as the Government calls for investment in treatment services at the United Nations General Assembly Special Session (UNGASS) on drugs, new figures show cuts of 24% are expected at home.

The UNGASS has been widely touted in the media and by campaigners as heralding the beginning of the end for prohibition and the "war on drugs". In reality, a less radical proposal is most probably on the table - a welcome middle path between the calls for decriminalisation led by Latin America and the hard-line punitive stance of Russia and much of the developing world.

Government officials met recently in Vienna to prepare the ground for the politicians to take centre stage in New York. The direction of travel they have agreed for the UN closely follows the path taken in Western Europe over the past 30 years: a focus on treatment allied to light-touch enforcement.

Although campaigners for reform routinely talk about the "failed war on drugs", at a domestic level we should acknowledge that the model adopted in Western Europe has been remarkably successful

While the focus tends to fall on eye-catching initiatives like the decriminalisation of possession in Portugal, most informed commentators attribute the progress made to the widespread availability of well-funded treatment, an emphasis on non-custodial penalties, and changing youth fashions. Portugal is not alone as a success story: massive investment in treatment and harm reduction services, alongside moderate enforcement, has resulted in declining levels of drug use and associated harm across Western Europe.

The UK is seen by its EU partners as one of the leading advocates of this approach. Between 2001 and 2008 investment in drug treatment in England increased three-fold. To its credit the Coalition Government maintained this level of investment from 2010 despite the huge pressure on public finances.

This investment yielded significant reductions in heroin and crack use and improved treatment quality. Heroin use among the under-25s halved, the number of people treated each year increased from 80,000 to 230,000, waiting times were reduced from nine weeks to five days and early dropout from treatment programmes fell from 50% to 15%. Add to this the very low levels of HIV prevalence, decreasing overall numbers of injecting drug users and a dramatic reduction in drug-related crime, and you have a picture of a system heading in the right direction.

The UK government is taking a simple and positive message to UNGASS: investing in treatment will do more to reduce drug-related harm than investment in enforcement and prison.

Unfortunately, the power of that argument is being undermined on a daily basis back at home as a consequence of Andrew Lansley's NHS reforms. As part of that package, commissioning drug treatment became a local responsibility in 2013, and previously ring-fenced budgets for drug treatment were placed in the overall public health pot given to local authorities. At the time it was anticipated that integrating drug services with other local authority responsibilities would improve efficiency and outcomes. In the event, many areas of the country have seen disinvestment from drug treatment towards other services amid competing public health priorities.

While the official figures have yet to show it, two independent surveys now indicate the extent of expected disinvestment. Figures reported in February by the Association of Directors of Public Health show 70% of all local authorities are planning to reduce spending on drug treatment this year, on top of 45% having made reductions last year. In addition, Collective Voice - a project overseen by the largest third sector substance misuse service providers in the UK - has identified a 24% year-on-year reduction of drug treatment spending in a random sample of just over 10% of local authorities.

While drug treatment providers have become skilled at managing reducing budgets, continuing to deliver first class services through innovation and improved efficiency, year-on-year cuts at this level are sapping the system's capacity to innovate and much-needed responsiveness to emerging threats such as New Psychoactive Substances.

Reductions in the availability of treatment are a backwards step for treatment providers and the people who use their services, but they're equally unwelcome to central government. The Home Secretary recently identified access to treatment as a core part of her Modern Crime Prevention strategy. The Ministry of Justice is becoming alarmed about the lack of availability of treatment to support community sentences, potentially forcing courts to make more use of hard-pressed prison spaces. Moreover, it is a flagship policy for the Department of Work and Pensions and No 10 to route drug misusers into employment via treatment. However, the culture of localism, swingeing local authority cuts and the low priority traditionally given to drugs by public health professionals leaves the government with few levers to achieve these goals.

A potential solution could be delivered by the refresh of the Government's 2010 drug strategy, which is due to be published shortly. The drug treatment sector requires a clear commitment to well-resourced services if it is to continue to generate the benefits it currently yields to people and communities. If the new drug strategy can firmly grip this issue we will have a system capable of maintaining the tremendous progress made over the past 15 years.

The UK Government's message to the UN is right - robust investment and light-touch enforcement is the path forward - but those words will ring hollow if we fail to heed them at home.

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