Drug-related deaths in England, Wales and Scotland have hit record levels. In England and Wales, 4359 deaths from drug poisoning were recorded in 2018; this was the highest figure since records began in 1993 (Office for National Statistics (ONS), 2019). Around 2917 (two-thirds) of the deaths reported were as a result of drug misuse, a trend that has continued over the past decade (ONS, 2019). In the past year, the number of drug-related deaths increased in Scotland by 27%, to a record high of 1187, putting Scotland on a par with the USA in per capita terms (National Records of Scotland, 2019).
The illegal drugs market exploits vulnerable people, particularly the young, with around 27 000 young people in England now identifying as gang members (Children's Commissioner for England, 2019). Many young people are lured into drug dealing, often with fatal consequences. The supply and distribution of drugs has become increasingly violent.
On behalf of the government, Dame Carol Black was requested to undertake an independent review of drugs in 2019 in two phases: to analyse the problems and then recommend policy solutions. Phase one work has been completed. This rigorous analysis has the potential to help us understand the complex and overlapping markets for illegal drugs, as well as the ways in which drugs are fuelling serious violence. When there is an understanding of the market and the drivers that are behind illegal drugs, there is the possibility that the market can be disrupted.
Illegal drug use impacts on individuals, families, communities and nations. The UK has the highest number of rough sleepers dying on the streets from drug poisoning since records began. There is a high correlation with illegal drug use and poverty and these problems impact significantly on our most deprived communities. Long-term drug users are being put in and out of our prisons in a recurring manner, at great expense. They rarely achieve recovery or find meaningful work and many of their children are taken into care (Black, 2020).
The annual total cost to society of illegal drugs is approximately £20 billion; however, only £600 million is spent on treatment and prevention (Black, 2020). Underfunded drug treatment services have either been discontinued or have been severely curtailed, along with a decline in the treatment workforce as a result of local government funding cuts.
Cuts in funding have had a detrimental effect that has resulted in a loss of skills and expertise, along with a reduction in service provision. When appropriate funding is made available (and this is an essential requirement) much work will be needed to build up capacity and expertise, including outreach services that target new users, the provision of inpatient detoxification for those with complex and multiple problems, heroin-assisted treatment and residential rehabilitation and trauma therapy.
A multi-agency, holistic approach to treatment is needed, not just one that looks after short-term physical health but one that also provides sustained mental health support. This is a psychosocial approach and services need to be able to deliver both. Treatment services also need to be dynamic and able to respond to the current drugs market and any future developments. Innovative and effective strategies can only be effective if those people who have a personal, lived experience of addiction and recovery are invited to contribute to finding solutions. Failing to do this will mean that any attempts to curb the flow of illegal substances into the country will be futile.
The findings that have been detailed in Black's review cannot be allowed to gather dust. It must be acknowledged and acted on with a concerted effort undertaken by all key players to do something about it, to save lives, reduce HIV infections and crime.