Visiting the Town Hit Hardest By the UK's Drug Crisis
There are loads of things wrong with this country that aren't being discussed enough in this election. Until the 8th of June we'll be talking about all of them. Today: drug policy.
There's an election next week, so shake off that three-day Bank Holiday comedown and pay attention. Hopefully you registered to vote, and now you need to decide who gets your vote. But in which direction are you supposed to exercise your democratic right?
Fear not: I'm here to direct you on where the main parties stand on an issue that really matters. No, not Brexit, nor whether tap water will taste sweeter when once it's being provided by the state. Something else entirely: drugs – or, more specifically, drug policy.
If you're a drug user, you'll likely have some inherent interest in the topic. If you're not, why should you care?
Well first, let's rack up all the frankly terrifying developments in the UK drug scene over the last few years. Drug-related deaths are at their highest ever recorded, surpassing road traffic accidents for the first time ever. Annual deaths from heroin and morphine alone have more than doubled since 2012. Fentanyl has arrived, bringing with it the potential for deaths to skyrocket. Hospitalisations due to drug-related mental health issues have doubled in the last decade, with the prevalence of high THC, low CBD street cannabis being blamed for the rise. Ecstasy-related deaths are the highest they've been for ten years. Cocaine-related hospitalisations are increasing. Prescription drug dependence is affecting more people than ever, including a sudden and dramatic rise in tramadol deaths. Harms from benzodiazepine use are increasing alarmingly as counterfeit pills flood the illegal market. Spice, while never exactly the most pleasant of drugs, has evolved into ever-more potent and damaging forms since the enactment of the Psychoactive Substance Act almost exactly a year ago, now sitting alongside heroin and crack as a drug of last resort. Its deeply troubling and unpredictable effects have contributed to the meltdown of our prison system, while it's also wreaking havoc among homeless communities. Tackling this crisis has even become a central election issue in Manchester.
Despite all this, the government remains strong and stable in its determination to completely ignore the impending drug-related crises. This is the second election in three years where – with the noble exception of Tim Farron's Lib Dems hoping to emulate the success of Justin Trudeau and legally regulate cannabis – all aspects of drug policy have again remained firmly out of the political discourse.
Nowhere are the government failings more evident than in Middlesbrough, which sits bang in the middle of the area with the highest rate of drug-related hospital admissions, deaths and drug seizures in the country last year. Only last weekend, neighbouring Stockton-on-Tees witnessed a spate of 14 overdoses within 24 hours. So to get to grips with the magnitude of the problem I travelled up to Boro to meet the people directly affected.
On the edge of the city centre, the rows of Victorian terraces are gradually being torn down. Where they haven't been, the back alleys that snake between them are now closed off with high, heavy duty metal gates topped with spikes. It's not hard to see why: these alleys provide perfect sheltered spots to inject, and used needles and empty blister packs of prescription meds are not hard to find wherever a gate has been left ajar. In other alleys, children play alongside the drug litter.
Danny Ahmed is one of the clinical partners at the Fulcrum Medical Practice here. He looks after the strategic development of the clinical drug service in Middlesbrough, a central prong of the city's drug treatment strategy, Middlesbrough Recovering Together, and also has a caseload of clients for clinical opiate substitution. He's acutely aware of the situation, "We've seen a significant increase in the number of drug-related deaths," he says. "It's a national crisis."
Danny suggests there are a number of factors at play, from rising heroin strength to the increasing age of people who use heroin. Deteriorating health, he says, plays a big factor. "These are people who, in their twenties, were using drugs, but a 20-year-old's body is more able to cope with the harms that take place. People in their forties, they're more susceptible to overdose, just because the body can't manage it as well. A heroin-using lifestyle is a bit like driving your car around in first gear – you can do it, and you can do it for a good while, but your car will scream and moan, and eventually it's going to blow up. You can't do it forever."
Added to this, Danny says, polydrug use is rising, with many heroin users supplementing their high with a mix of benzos, gabapentinoids, the sleeping pill zopiclone and other pharmaceuticals, all too often washed down with alcohol. This creates a toxic mix and heightens the burden on their already fragile bodies.
Greg*, 42, is from just outside Middlesbrough and has been using heroin since his marriage broke up around 20 years ago, injecting for the majority of the last 15 years. He hasn't noticed the strength of heroin increase significantly over the last few years, but has seen the drug scene change dramatically. "In the last two years, that's all I've seen: people die," he says. "I must've lost – well, I couldn't count it on my two hands and my two feet. It's a lot more... a lot more than before."
The heroin-using population, however, didn't just suddenly become old overnight, and there are other factors at play.
"There's a recovery agenda in drug treatment these days," Danny explains. "The public health team will be being marked on the number of successful completions – the number of people they get out of treatment – but we work with the patients on what they feel is the right dose [of substitute opiate medication] for them. So some people are on maintenance, and some people are working towards coming off their medication."
A successful completion is counted as someone who completes treatment successfully, i.e. when they're no longer in contact with drug services. Unfortunately, when someone isn't in contact with services they're more at risk from overdose or other health problems – something less likely to happen to those remaining in treatment and on a methadone or buprenorphine script.
Danny is clear on the value of harm reduction: "It reduces harm – there's a really strong evidence base for it – but I also want people to have the potential opportunity to make changes to their life if and when they're ready to do that," he says. "We came into Middlesbrough at a time when the harm minimisation agenda was very much in focus, and I think we've kept that at our essence really, because we're very clear about the clinical guidelines for drug and alcohol treatment. So, for us, we kept our treatment the same. However, there needs to be an acknowledgement that there is a pressure on services nationally to get people out the door."
It is this pressure that could be leading services to push service users to abstinence faster than they are comfortable with, especially when services are required to compete for contracts with cash-strapped local authorities keen to see figures. "There is a drive towards successful completions, because that's the bean that needs to be counted most."
Danny doesn't blame recovery himself, but acknowledges that others have expressed their frustration. "There is some argument that the recovery agenda could be contributing to some of the deaths that we're having," he says.
The facts are hard to hide from, though. Previously drug-related death rates were gradually falling, then the Coalition government instated in the ideologically driven change to recovery, based on the premise that abstinence should be the end goal of drug treatment. It was suspected that this focus had been lost in the drug treatment community with the espousal of harm reduction and opioid maintenance, which too often failed to give people the opportunity for positive life change. Coupled with the continued defunding of services, however, the new target-driven system has led to one conclusion: recovery kills.
Danny takes a more nuanced view, but notes that recently the focus on recovery may have come to the detriment of harm reduction. "I think there's got to be a real balance in the agenda – so for me it shouldn't be an either-or between harm reduction and recovery," he says. "I think it's about having a harmonious relationship, and for those people who need to be on opiate substitute medication and stay in treatment for as long as they need, because of the protective factors [being in treatment provides]. We know that you are less likely to die if you stay in treatment, so that's always got to be remembered."
WATCH: 'The Hard Lives of Britain's Spice Addicts'
While heroin has long been on the drug menu in Middlesbrough, the emergence of Spice has become an added worry, especially for the most vulnerable. Greg first smoked it a couple of years ago, but he remembers how it changed once the Psychoactive Substances Act came in: "I heard about it, and it was in the shops and they were selling it, and then all of a sudden it wasn't in the shops. Basically, when it was in the shops I don't think it was as strong, and then when they made it illegal someone offered me some at a very cheap price for an ounce, and I took it. I only managed to smoke about a quarter of it, and next minute I was in hospital.
"I was in hospital for about five days, and I was hallucinating so bad, I was falling down, I thought I were dying. I was hallucinating to the point where I had to ask people, 'Did this go about?' I found myself in my next-door neighbour's front porch, cowering from my flat, thinking there was gangsters from Liverpool in the flat wanting to kill me. I ran out my flat and knocked on his door at six in the morning and hid in his porch. And there was nobody in the flat."
Greg is keen to stress that more should be done about Spice now it has reached such strengths. "It could bring everyone to their knees," he says, adding that compared to heroin "it's another level".
"I did a four-month prison sentence when this Spice stuff was about, and it's just unreal what people will do for it," he says. "They'll let people knock them out for a joint of it and film it on their phones."
Karen Thompson and Elle Laporte Butchart are part of the managerial team at DISC in Middlesbrough, which assists people with housing in the city. Up to 90 percent of their clients have concurrent substance misuse issues, and Elle says the rise of Spice has been clear to see. "Our clients that have been into prison that are then coming out, they've seen the impacts of Spice, and they'll say things like, 'I'm not touching that.' They're actually quite scared of it. One young lad that we were supporting, he actually ended up in a coma for a number of weeks through smoking Spice, thinking it was cannabis. That had a massive impact on his mental health – drug-induced psychosis."
Karen says the continual defunding of services has compounded problems. "I've noticed a massive difference from when I started, the amount of funding that was available, the ease with which people could navigate the benefits system with a little bit of help, compared to how it is now, where's it's just an absolute nightmare. The reduction in funding, the reduction in services – it's had a massive impact on people's lives. Social care, mental health teams have seen a massive reduction, so they've turned to services like ours to fill that gap."
In fact, it's worsening mental health in particular that Elle points to as driving the increase in drug problems. "Mental health is huge – that's the main one we feel with our service users," she says.
Danny has seen the same, and says decreased funding elsewhere, particularly in mental health services, is exacerbating problems. "They've had some squeezes in their services, so we find that our patients can fall within a gap, where they're not deemed appropriate for secondary care in mental health, so they don't have a severe and enduring mental health problem, however they're too complex because of their drug use problems for talking therapies. There isn't anything in the middle to support that."
Suzy's sister, Meg*, first started displaying mental health problems when she was 13, first attempted suicide when she was 14, started smoking both crack and heroin at 15 and first overdosed on heroin when she was 16. Now 26, Meg has suffered severe mental health problems continually, alongside her ongoing heroin use. Suzy has watched Meg fall between the ever-increasing gap in services. "In their eyes, given limited resources, she's the least prioritised person, when actually the person who really can't live their own life without a shit-ton of support is someone who should be prioritised," she says.
Suzy points out that funding cuts have made matters much worse. "Even just looking at the wait times for Meg to see a psychiatrist, you're looking at three or four weeks for an urgent referral. Going back, say, five years ago in London, she'd see a psychiatrist within four days."
In overlooking the effects of the defunding of drug treatment and other services, and the pushing of the recovery agenda at the expense of harm reduction, the Conservative Party has presided over a snowballing drug death and mental health crisis that is entirely of their own making. They declined to comment when I reached out to them, but their manifesto gives little sign that, under a Tory-led government, the situation would improve for those accessing drug services.
A manifesto commitment to ensure closer working between mental health and drug treatment services, and to employ 10,000 more mental health workers, is betrayed by the fact that no indication has been given that funding cuts to drug services areas will cease. Presented as a step forward for integrating crime prevention and drug services, the Tories have promised to place Police and Crime Commissioners on health and wellbeing boards, but because much of the PCC's role has been to enact billions of pounds of funding cuts to police services while shielding government from direct responsibility, this is another ominous sign.
Labour have big plans to revitalise the NHS, but a focus at the national level rather than the budgets of Local Authorities responsible for drug services means this area would miss out on the new resources. Their manifesto makes some welcome statements on righting historic public health injustices, but remains completely silent on the issue of drug services. Considering the issue is an open goal for criticising Tory heartlessness and mismanagement, it's an embarrassing oversight for Labour not to address it. Asked repeatedly for comment on the rise in drug deaths and defunding of services by the Conservatives, Labour failed to respond to VICE. Sadly, for the many thousands of people who rely on these services, it appears Corbyn has bigger fish to fry.
It is only the Lib Dems who have addressed the issue of refunding services currently under the scope of Local Authorities, promising to return public health budgets to the size they were prior to Tory cuts. Farron's party has also pledged to repeal the Psychoactive Substances Act, although with Spice now a Class B substance it's unclear what useful effects this would have, other than heralding the return of your friendly neighbourhood balloon seller.
The Lib Dems have been most explicit about helping people who use drugs, with other commitments to move drug policy under the responsibility of the Department of Health and decriminalise drug possession – a move that has been shown to improve engagement with support services. Ex-MP Julian Huppert, the Lib Dems' candidate for Cambridgeshire and advocate of evidence-based drug policy, tells me a change in approach is desperately needed: "Local authorities with public health functions should implement interventions that are based on evidence and will save lives and reduce harms to physical and mental health. This means treatment and support, rather than punishment."
Besides refunding, Danny Ahmed would love to see any new evidence-based approaches adopted, from fentanyl testing services through to drug consumption rooms, and sees Middlesbrough as a perfect location for such initiatives. With Glasgow pressing ahead with plans to open a drug consumption room and talk of police providing heroin assisted treatment in Durham, progress may still be possible, regardless of who ends up in No. 10 next week.
That said, Karen Thompson is worried about the prospect of another Theresa May-led government. "I'm frightened," she says. "I'm frightened for the clients that we support, for colleagues, for services in Middlesbrough. Workers are up to full capacity. People are at point of burn out because their caseloads are so high."
Of course, the problem with the issue of drug-related deaths is that it's not a vote winner. The people affected don't generally vote – none of the service users I spoke to were even registered – and most people who vote don't want to see their taxes spent keeping chronic heroin users alive, especially when they are feeling the pinch themselves. The Lib Dems are the only party proposing a full set of policies aimed at reducing drug harms, but Tiny Tim's hopes for the party's return to even double figures of MPs is currently looking optimistic. With neither of the main parties focused on addressing the crisis, the inexorable rise in deaths rates is only set to continue. While deaths of thousands of non-voters may not hurt their vote share, it should lie heavy on their conscience.
*Names have been changed