Living Healthier and Longer: The Role of Drugs

Overview

The UK, once a world leader in health-orientated drug policies, is now a world leader in drug-related deaths. In 2021, there were a record 3,060 deaths related to illicit drug use in England and Wales;[1] 1,330 in Scotland[2] (the highest rate in Europe); and in 2020, a record 218 in Northern Ireland[3]. This is a public health crisis.

FPH work and policy position

FPH recently coordinated two open letters advocating for overdose prevention centres (OPCs) to be introduced in the UK. The first letter called for pilot sites to be opened;[4] the second, to amend the Misuse of Drugs Regulations 2001[5], to create the legal framework to do so. In OPCs, people can use their own drugs under the supervision of professionals who intervene in the case of an overdose, allowing for wrap-around support and referral to wider health and social services. There is promising evidence OPCs reduce drug-related deaths where they are introduced, alongside a range of other benefits.

FPH will shortly publish an analysis piece detailing our concerns with the 2021 UK Drugs Strategy.[6] Its proposed punitive measures are unevidenced, harmful, and likely to increase socioeconomic inequalities. Furthermore, the strategy over-emphasises abstinence-based treatment and cessation of opioid substitution therapy, which has been shown to protect from drug-related mortality, amongst other benefits.

Criminalising people who use drugs is expensive; does not reduce drug use; and negatively impacts people who use drugs, exacerbating issues such as socioeconomic deprivation and childhood trauma. In Taking a New Line on Drugs,[7] the Royal Society of Public Health and FPH argued for an approach that provides people who use drugs with support rather than punishment. The UN Common Position on Drugs,[8] endorsed by the heads of agencies, and the 2019 Health and Social Care Committee on Drug Policy[9] have advocated to decriminalise the possession of drugs for personal use.

Current and proposed policies in the UK

Many elements of the UKs response to drugs are inconsistent with the UN Common Position on Drugs, which call for countries to adopt public health approaches to drug use, which put ‘people, health and human rights at the centre’.

The UK should urgently adopt a public health approach to drugs by: 

• Addressing the factors that may predispose to harmful patterns of drug use, including socioeconomic deprivation, trauma, and poor mental health;
• increasing the provision of harm reduction interventions for people using drugs, such as needle and syringe programmes and OPCs;
• Treating drug use primarily as a risk factor for poor health outcomes, as opposed to an immoral or criminal act; 
• Appropriately using evidence, with robust evaluation of promising interventions.

FPH policy recommendations

1. Greater emphasis on harm reduction: Support local areas to commission a range of harm reduction interventions, including OPCs and drug checking services. Remove legislative barriers to innovative interventions and amend the Misuse of Drugs Regulations 2001 to make OPCs easier to open.
2. Treatment retention over treatment completion: Drug treatment completion should not be incentivised, given retention in treatment is protective against drug-related mortality.
3. Support, not punishment: Revise the ethos of proposed out-of-court diversion schemes and review the Misuse of Drugs Act 1971 to ensure that people who have issues related to drug use are offered support rather than punishment.