Drugs trade causing unprecedented harm with policing often fuelling violence, landmark review finds

Government urged to radically overhaul and re-fund ‘disappearing’ treatment services

Related video: Boris Johnson announces nationwide lockdown to tackle coronavirus (Getty)

The drugs trade has “never caused greater harm to society” than it does today, a landmark review has found, with police efforts not only failing to stem supply but often fuelling increased violence in a market which now involves an “unprecedented” number of children.

Government cuts to services and a failure to contain the growing flow of higher purity drugs has allowed a “perfect storm” to develop, which can only be tackled by urgent government intervention, Dame Carol Black’s independent review indicated.

But reacting to the review commissioned by her predecessor, home secretary Priti Patel announced an additional £5m for law enforcement to tackle county lines, failing to provide any additional funding for “disappearing” drug treatment services.

While the illicit drugs market now costs the UK some £19bn a year – more than double its profits – only £600m is spent on treatment and prevention.

“The amount of un-met need is growing, some treatment services are disappearing, and the treatment workforce is declining in number and quality,” Dame Carol wrote.

“Ultimately, we need to transform our approach to treatment, investing in it but also innovating so that treatment services are able to respond to today’s drugs market and future developments.”

Dame Carol unveiled the findings of her year-long review at a Glasgow drugs summit, held as part of efforts to tackle record levels of drug-related deaths in the UK.

“The findings, which we will discuss today, are troubling and paint a stark picture of how illegal drugs are devastating lives and communities, and fuelling serious violence,” said police and crime minister Kit Malthouse, who was chairing the summit.

Dame Carol said the “most alarming” development she noted was the prevalence of children supplying drugs, “especially at the most violent end of the market”.

Some 27,000 young people are now involved in the county lines trade – which sees gangs from cities move into smaller towns and often violently usurp usurp local dealers, while using children or vulnerable people to sell their product.

The report framed the rise “against a backdrop of increasing numbers of children in care and children in need, falling local government budgets, cuts to young people’s services and increasing child poverty”.

While children from seemingly stable families with no previous contact with police or social services are involved in county lines, childhood poverty, trauma and exclusion from school are key factors.

There is clear evidence that young people – disproportionately young black men – involved in county lines are “much more likely than other young people to have been affected by adverse experiences such as neglect, substance misuse problems in the family, domestic violence, poor mental health, and exclusion from school”, the report said.

Highlighting the lack of prospects perceived by many young people in modern Britain, the report noted that not all young people are groomed or coerced – some see “going country” to sell drugs in often rural neighbourhoods as their best opportunity to earn money and status.

“This overlap between victim, offender and conscious choice presents challenges in the current response, where there can be a binary approach in categorising individuals either as victims or perpetrators,” it reports those in frontline services as saying.

Meanwhile, drug use among children aged 11 to 15 has also risen 40 per cent since 2014 after a long downward trend, despite a “sustained and significant” drop in the number of children accessing specialist treatment.

Those who do manage to receive treatment often struggle with mental health and self-harm, with some having suffered imprisonment and sexual exploitation, the report noted.

Meanwhile, teenagers recruited as dealers are now increasingly embroiled in the volatile heroin and crack cocaine trade, which has been overtaken by county lines groups. Dame Carol suggests these two drugs account for 86 per cent of the drugs trade’s £19bn cost to society.

She also warned county lines is “a highly adaptable business model, constantly evolving to avoid detection”. Recent evolutions include recruiting local children to act as dealers rather than sending urban recruits, and renting properties instead of the more high-profile practice of “cuckooing” a vulnerable drug user’s property.

Echoing what many veteran law enforcement figures have warned for years, the report also cautioned that policing “crackdowns” have little impact on the overall drug supply, instead often having “the unintended consequence of increasing violence, for example by creating a gap in the market for dealers to compete over, or increasing distrust in the drugs market”.

The report lamented that tackling drugs has fallen down the priority list for nearly all police forces over the past decade, partly due to funding cuts.

But, delivering an apparent coup de grace to the government’s longstanding and hugely costly “war on drugs”, it acknowledged that even if all relevant agencies were sufficiently resourced, “it is not clear that they would be able to bring about a sustained reduction in drug supply”.

It suggested that the National Crime Agency – the leading source of intelligence on organised crime groups – should intensify its efforts to intercept groups’ cash as it is sent across borders to be laundered, noting that denying these profit-focused groups their money and assets could be more effective at shrinking the drugs market than the threat of prison.​

The report repeatedly urged the government to reinvest in drug treatment services, which are increasingly provided by a handful of third sector organisations, and delivered a damning indictment of past Tory governments’ changes to the way treatment is run and funded.

Most of the national indicators of performance for treatment – rates of people successfully completing treatment, deaths in treatment, and estimates of un-met need – are going in the wrong direction, the review said.

At the start of the past decade, the government passed the responsibility for funding treatment services to local authorities, and severely reduced central funding. It also placed a renewed focus on abstinence, with service providers who championed efforts to stop people using drugs outright being effectively financially rewarded by local commissioners.

The Independent has spoken to service users and experts who warn this often came at the expense of evidence-based efforts to reduce drug-related harms, such as methadone, and may have pushed many back into street drug use.

The proportion of opiate users – who account for the vast majority of drug-related deaths – in treatment has dropped steadily since the government’s new measures, with less than 140,000 of England’s estimated 261,000 opiate users thought to be enrolled in treatment.

Funding has dropped by 14 per cent on average since 2014, and by as much as 40 per cent in some local authorities, the report found, resulting in a loss of expertise and capacity to treat service users.

“Drug treatment providers have been squeezed, staff are paid relatively badly and there has been high turnover in the sector and a depletion of skills, with the number of medics, psychologists, nurses and social workers in the field falling significantly,” the review said.

“The unregulated role of drug and alcohol or recovery worker, which is inconsistently and poorly defined, makes up the vast majority of the workforce.”

The review found that because treatment is commissioned separately from other healthcare and is outside of the NHS, “it is much harder to control the quality of care and clinical safety”, adding: ”Providers compete for commissions on price and, increasingly, a small number of third sector providers have dominated the market, offering basic services with no incentives to enhance quality.”

Despite warning that incorporating integrated help, such as housing and employment support to those in treatment was “equally important”, it also noted that some services, like outreach programmes targeting new users, have “disappeared” completely, while interventions like residential rehab and in-patient detoxification for those with multiple needs have been reduced.

“All of this means that, even if more funding became available (which is vital), there would be a lot of work to do to build up capacity and expertise in the market,” the review cautioned.

The NHS Substance Misuse Providers Alliance and Royal College of Psychiatrists welcomed the review’s calls for a reverse in funding cuts and implored the government to take action.

In a joint statement, they said treatment providers had been “put in impossible positions over funding, and lent their weight to the review’s calls for a more holistic approach to treatment.

“On the frontline this means practitioners working closely with colleagues in physical and mental health, criminal justice and homelessness services,” the statement said.

“At a structural level it means closer partnership between NHS and local authority public health commissioned services with improved routes into primary care and universal services.”

Health minister Jo Churchill agreed it was important a “holistic approach” is taken to drug addiction treatment, which also offers support for the mental health of people suffering with addiction.

“Dame Carol’s review is an essential step towards tackling drug addiction and we will build on her work to ensure victims of the illegal drug industry can access the right services,” she said.

“We are already taking tough action to combat county lines and violent crime and to disrupt and prosecute the organised gangs that bring so much misery,” said Mr Malthouse. “But clearly we all need to do more. Following this valuable review and summit we will take further action at pace, bringing together partners from across government and beyond to address the challenges head on, based on the very best evidence and expertise.”

Alongside further tough talk on combatting crime, Priti Patel said the health secretary Matt Hancock would commission a further review – to be led by Dame Carol – into prevention, treatment and recovery.

“It will build on Dame Carol’s work to ensure vulnerable people with substance misuse problems get the support they need to recover and turn their lives around,” Ms Patel said in a statement.

“It will look at treatment in the community and in prison, and how treatment services work with wider services that enable a person with a drug dependency to achieve and sustain recovery, including mental health, housing, employment, and the criminal justice system.

Unveiling her findings in Glasgow, Dame Carol said: “This review will have done its work if today people can acknowledge what it says and then decide to do something about it, rather than it just being another review with a set of figures that will just go on and we will do it again in three years’ time.”

Additional reporting by PA