Policy paper

Government response to the independent review of drugs by Dame Carol Black

Published 27 July 2021

Foreword

Secretary of State for Health and Social Care, Secretary of State for the Home Department and Sponsor Minister for Combating Drug Misuse

Drugs destroy lives, ruin families and tear apart communities. They are a major driver of crime, and the harms from drug misuse cost society £19.3 billion per year.

The need to address this issue has never been more urgent. Drug misuse is rising, and drug-related deaths have increased by 80% since 2012.

We have a moral duty to do everything we can to tackle the impact of drug misuse – whether it’s coming down hard on those who supply drugs, making sure children are no longer pressured to misuse drugs or get drawn into supplying them, or reforming the treatment and recovery system to help people overcome drug misuse.

The government commissioned Dame Carol Black to look at this vital issue.

Part 1 of the review provided the most in-depth and comprehensive picture of the issue of drug misuse that we’ve ever seen. This second part provides a series of concrete recommendations for government on what more we can do to improve prevention, treatment and recovery.

We’d all like to put on record our gratitude to Dame Carol, for her insightful report. We’re thrilled that she will keep lending her expertise, acting as an independent government advisor to review our progress in this work. She’ll be supported by the government’s recovery champion, Dr Ed Day and the new Office for Health Promotion.

Even before this review was published, we’ve been working to tackle drugs misuse. In January, we invested £148 million for the next year to cut crime and protect people from the harm caused by illegal drugs, including investing in the largest increase in drug treatment funding for 15 years.

We’ve also been stepping up enforcement, to thwart the supply of drugs and tackle the criminal gangs who cause so much misery. In less than 2 years, our county lines work has:

• closed down more than 1,100 lines
• led to over 6,300 arrests
• safeguarded over 1,900 vulnerable people

There is, of course, more to do and part 2 of this review will help us shape our work.

Drugs affect all parts of our society. So we will work across the whole of government as we respond. We’ve already appointed the first sponsor minister for combating drug misuse in a quarter of a century. We’ve also set up a new joint combating drugs unit.

This is our initial response. We will respond to Dame Carol’s review in full by the end of this year and set out our long-term strategy.

As we recover from this pandemic, let this be the moment when we tackle this scourge on society and help more people to live healthier, more productive lives.

Sajid Javid, Secretary of State for Health and Social Care
Priti Patel, Secretary of State for the Home Department
Kit Malthouse, Sponsor Minister for Combating Drug Misuse

1. The challenge of illegal drug misuse

Drug misuse causes extensive misery and harm to individuals, families and communities.

Part 1 of Dame Carol Black’s independent review exposed the scale of the national challenge. The harms from drug misuse cost society £19.3 billion per year, 86% of which is attributable to the health and crime-related costs of the heroin and crack cocaine markets.

Part 2 has described the current situation of the treatment and recovery system as urgently needing repair, highlighting that these challenges are likely to have worsened as a result of the pandemic.

Drugs are a global problem and international drug markets are currently strong with availability and purity high across a range of drugs. This is causing considerable harm around the world.

Countries involved in production and supply are facing particularly high levels of drug-related violence. Some countries are experiencing their highest levels of drug-related deaths over recent years, as can be seen with the North America opioid crisis.

The UK is among the countries in Europe most affected by drugs. Drug misuse deaths in England and Wales are at the worst levels experienced and drugs remain the most significant driver of crime. ^{[footnote 1][footnote 2][footnote 3]}

Despite this backdrop, since 2013 to 2014, the capacity and quality of the treatment system has been in decline. More than half of people with the most harmful opiate and crack cocaine addictions are not engaged in treatment.^{[footnote 4][footnote 5]}

Over 3 million adults reported using drugs in England and Wales in the past year. One in three 15-year-olds reported taking drugs in 2018. Although most of these individuals will use drugs infrequently, around 220,000 adults use drugs daily.

There can also be significant harm caused by so-called ‘recreational’ drug use. This includes overdosing and harm to mental health. These often impact negatively on relationships and work.

It is extremely concerning that overall drug misuse is rising, with this illegal activity risking becoming an unwritten norm for some in society.

This rising demand, including from infrequent users, fuels a dangerous and lucrative market. Heroin purity levels – which generally rise with increased supply – are at a 10-year high. An estimated 1,716 organised crime groups are involved in supplying illicit drugs in the UK, including within the prison estate.

The county lines model of supply also represents a significant threat. The number reported has quadrupled since 2017. There have been improvements in awareness and recording of intelligence on county lines over this period which may account for this increase.

However, data also indicates that the number of potentially active lines reported in any given month has reduced from between 800 to 1,100 to approximately 600. This is likely due to enhanced operational activity since October 2019.

This increase has driven unacceptable violence on our streets and in our communities, and is why our recent work to close down these lines is so important. In 2020, referrals of children suspected to be victims of county lines increased by 31%.

The recruitment of children and young people into county lines – and the subsequent child criminal exploitation – affect some of the most vulnerable young people in society. We should be doing our utmost to protect them.

The position is stark. Illegal drug misuse is a scourge on our society. Building on existing programmes, innovative and tougher approaches, and Dame Carol’s recommendations, the whole of government must step up efforts to tackle the problem.

2. Initial response to the recommendations in part 2 of Dame Carol Black’s review

Combating illegal drug misuse is a priority for this government. The 32 recommendations in part 2 of Dame Carol’s review set out whole system approach to tackling drug misuse.

As a result, we are developing a long-term strategy which will present our whole-of-government response to drive down drug supply and demand. This includes support for people through treatment and recovery, and an even tougher response to criminal supply chains and the demand that fuels these illegal markets.

We will publish this long-term strategy by the end of the year. This section of the initial response focuses on recommendations we can commit to now, ahead of this fuller response.

Central government leadership reform

On 1 July 2021, we launched a new joint combating drugs unit. Led by a senior civil servant, this is driving and supporting all work to combat drug misuse across government, reporting to the sponsor minister for the programme, Kit Malthouse, and the Prime Minister-chaired crime and justice task force.

A combating drugs delivery board oversees the joined-up delivery of all programmes aimed at driving down drug misuse. This includes Dame Carol Black and Dr Ed Day, the government’s recovery champion and representation from:

• No.10
• Home Office
• Ministry of Justice (MoJ)
• Department for Health and Social Care (DHSC)
• Department for Work and Pensions (DWP)
• Ministry of Housing, Communities and Local Government (MHCLG)
• Department for Education
• HM Treasury

A national outcomes framework is in draft with the purpose of setting out a clear set of measurable goals for the combating drugs programme across government.

We commit to an annual report to Parliament. The first report will be due in 2022, a year after publication of the new drug strategy. This will be able to report upon progress against the national outcomes framework.

We have appointed Dame Carol as ongoing independent advisor on drugs to work with us on developing and delivering our strategy, including reviewing our progress on those recommendations taken forward.

Funding for drug treatment and wider recovery support which supports the whole system approach

In January 2021, we announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs. £80 million of this new money is being invested into treatment and recovery services, delivering the largest increase in drug treatment funding in 15 years.

This funding will enable the delivery of more interventions to reduce the number of drug-related deaths and will reduce reoffending by bringing another 5,000 offenders into treatment. We know that offenders who have engaged in treatment go on to commit 33% fewer crimes. The funding also delivered £40 million of dedicated investment in tackling drugs supply and county lines, allowing us to expand and build upon the successful results of our county lines programme

The Ministry of Housing, Communities and Local Government, working with Public Health England, are delivering £52 million of funding in 2021 to 2022 through our rough sleeping, drug and alcohol treatment grant, building on £23 million in 2020 to 2021. Around half of people experiencing rough sleeping have a drug support need.

This funding provides specialist support and treatment for people who sleep rough or who are at risk of sleeping rough and is expected to contribute towards the government’s ambition and nationwide efforts to end rough sleeping by the end of this Parliament.

Over the next 2 years, we are expanding our innovative pathfinder programme – Project ADDER (addiction, disruption, diversion, enforcement and recovery). This additional £31 million of investment takes the total investment to over £59 million.

An additional 8 local authorities hardest hit by drug harms will benefit from intensive and coordinated programmes based on the local needs and context. These are Bristol, Liverpool City, Knowsley, Wirral, Tower Hamlets, Hackney, Newcastle and Wakefield.

In Blackpool, Middlesbrough, Swansea Bay, Greater Norwich and Hastings, Project ADDER is already delivering early successes in tackling drugs harms through excellent partnerships across health, enforcement, employment, housing and criminal justice agencies.

In May 2021 the Department for Work and Pensions (DWP) announced £6.1 million of funding to extend the individual placement and support programme across England, a unique pilot scheme to get those with drug and alcohol dependence back into work.

Her Majesty’s Prison and Probation Service has secured an additional £700,000 for 10 health and justice partnership coordinator roles within probation. These roles will work closely with health and substance misuse partners at a local level in order to improve continuity of care from custody to the community.

The Ministry of Justice (MoJ) is funding £1.3 million in delivering telemedicine in 86 prisons to enable prisoners to make contact with treatment providers in the community, putting in place arrangements for them to continue the treatment they need to help them stay away from crime after their release.

Strengthening local accountability

The Office for Health Promotion (OHP) will lead on monitoring local performance and holding the system to account, working with the Local Government Association to provide support to local authorities. The OHP will report on this work to the new joint combating drugs unit.

A local outcomes framework and a commissioning quality standard to support any future enhancement of the treatment and recovery system will be drafted in consultation with the local system to increase transparency, commissioning standards, joint working and accountability for treatment and recovery outcomes.

In line with the principles set out in the integrated care system (ISC) design framework, we expect ICS partnerships to work together across NHS and public health to jointly plan for the provision of mental health and substance misuse services, in line with the needs of their local population.

Supporting the workforce

The Department of Health and Social Care (DHSC) will work with Health Education England to develop training requirements and set occupational standards for staff, as well as devising an urgent comprehensive strategy on the future need of the workforce.

Addressing illicit drug use and attitudes to drugs in society

The government will develop its approach to challenging drug misuse and changing attitudes towards the use of illicit drugs. Drugs are illegal for a reason: they are harmful, affecting both physical and mental health, relationships and career prospects, and wider society. Individuals who use illegal substances need to know they are not only risking their health, but funding dangerous criminals who rely on fear, exploitation and violence.

The Home Office will support an expansion of police activity to tackle those individuals who break the law and ensure they face meaningful consequences. As part of this we will support an increase in the use of drug testing on arrest in a number of police forces across England and Wales, so those involved in crime, including misusing drugs, are identified and dealt with appropriately.

We will encourage drug testing on arrest for a wider range of offences where cocaine or opiates (the drugs which can currently be tested for) are suspected to have contributed to the unlawful behaviour. We are working closely with the National Police Chiefs Council and police forces to develop this work and understand how best to target cohorts of people who may take drugs less frequently and think they are less likely to be caught.

The Home Office, working with policing partners, MoJ and DHSC, will hold a roundtable later this year, bringing together policing, drug intervention experts and treatment providers to explore and gain insight on effective and innovative approaches to reduce the demand for the use of any illegal drugs, no matter when, how or by whom they are used. 

This will include consideration of how to ensure there are clear and meaningful consequences for all those who misuse drugs, such as fines, community service, referral to drug treatment and drug awareness courses, where relevant.

As part of this we will learn from, strengthen and develop the meaningful consequences being developed by some forces, including those such as Thames Valley and Durham, to most effectively deal with those who use illegal drugs and those who might be tempted to do so.

The government will develop plans for a summit with key partners including employers, educators, law enforcement and health organisations. We are clear, and we believe there is a strong consensus among the public on this, that there is a wealth of medical and scientific evidence for the physical and mental health harms of drugs and the damage they cause to society. This will draw out insights to tackle illicit drug use and support users to stop taking drugs and further support the sensible decisions of the majority of people to not take drugs. The summit will build on new and existing approaches, expertise and evidence.

3. A long-term ambition to combat drug misuse

It is clear from Dame Carol’s review that a new strategic approach is needed to clearly set out our response to the reviews and how this government will address this.

This government is determined to go further and be more innovative to address the complex relationships between drugs, crime, poor health outcomes and deprivation in our communities. To achieve this, it will be important that we have a clear, coherent plan for the coming years and the decade ahead.

This is why we are committing to publish a new drug strategy, later this year. Informed by the latest evidence, including from Dame Carol’s review, the government’s drug recovery champion and the independent advisory council on the misuse of drugs, the strategy will take a genuinely cross-government approach to tackle the supply of drugs and demand simultaneously.

This includes agitating and disrupting the supply chain at every stage, doing all we can to support those dependent on drugs to turn their lives around, breaking the cycle of crime and reoffending, and coming down hard on illicit drug use in wider society, which fuels criminal markets and damages communities.

The strategy will build on the £148 million funding package we announced in January in support of a system-wide approach, with a focus on 3 priorities:

1. Tough enforcement to break the business models of criminal supply chains, and professional enablers of the drugs market, who profit from and actively promote the suffering of others, causing violence and misery across the country. We’ve already begun to dismantle and fundamentally break the county lines model. With targeted enforcement we can go even further to attack other suppliers and those who import illegal drugs. This will protect more vulnerable people who are being exploited by these criminal gangs.

2. Developing a high-quality drug treatment and recovery system, fit for an advanced democracy that is determined to turn the tide on drug related deaths and reduce drug harms. Our ambition will be to offer a route to a healthy, productive life for everyone who falls into a harmful cycle of drug dependency.

3. Addressing so-called ‘recreational’ drug use by too many in our society who, knowingly or otherwise, support a dangerous and exploitative market and whose behaviour is both criminal and anti-social. This means being smart and developing tougher and more meaningful consequences to help reduce demand and shift behaviour and attitudes in those sections of society where drug use is currently seen as acceptable.

Strong national leadership at ministerial and official level will drive the collective ownership and accountability needed to develop and deliver the strategy across government.

The joint combating drugs unit will support government departments in driving forward a range of coordinated activities across enforcement, criminal justice, health, education, employment and housing to support our 3 strategic priorities.

Alongside national action, local partners have a critical role to play. By creating the right conditions for local leaders to also develop multi-agency partnerships, we can deliver results in driving down drug supply and demand.

The strategy will set out how we plan to build on the project ADDER pathfinders and work with local areas to test and promote a system-wide approach to drugs.

That is why we are committing to continue to engage widely on the approach and interventions within the strategy across a wide range of sectors and the whole system of combating drug misuse. This will build upon the engagement undertaken by Dame Carol and her team.

Building on our existing close working, we are also commencing a strong UK-wide sharing programme which encourages working closely with UK government counterparts in the devolved administrations on this union-wide challenge.

Through this strategy, we are determined to go further than previous governments to address the challenges posed in Dame Carol’s review head on.

1. Homicide in England and Wales: year ending March 2020. ONS, 2021 ↩

2. Understanding organised crime: estimating the scale and the social and economic costs. Home Office, 2014 ↩

3. Deaths related to drug poisoning in England and Wales: 2019 registrations. ONS, 2020 ↩

4. Substance misuse treatment for adults: statistics 2016 to 2017. PHE, 2017 ↩

5. Estimates of opiate and crack cocaine use prevalence: 2016 to 2017. PHE, 2017 ↩