Dame Carol Black’s New Review Backs Diversion Schemes, Funding, and Comprehensive Harm Reduction

by Isabella Ross

Commissioned by Health and Social Care Secretary Sajid Javid in his previous position as Home Secretary, Dame Carol Black’s highly anticipated ‘Review of drugs: phase two’ was released today.

The first part of the report, published in February 2020, was a watershed moment for the UK government’s understanding of drug supply, the impact of the drug trade on young people, and the futile, and indeed damaging effects of enforcement activity.

The second phase turns its attention away from criminality and toward prevention, treatment, and recovery, declaring its current state in the UK “not fit for purpose, and urgently need[ing] reform”. Her recommendations were centred around four key areas:

The first, “radical reform of leadership, funding and commissioning” called for government accountability, backing the coordinated action of several departments, including the Home Office, Department of Health and Social Care, Ministry of Justice, Department for Work and Pensions, and Ministry of Housing, Communities and Local Government among others. She recommended the creation of a central Drugs Unit to coordinate and develop the governments’ objectives and targets.

This recommendation was immediately actioned by the government, with the creation of the Joint Combating Drugs Unit announced this morning to “help end illegal drug-related illness and deaths”

Dame Black also called for “an additional £552 million” in funding from the Department of Health and Social Care on top of current expenditure to be put toward “provid[ing] a full range of high-quality drug treatment and recovery services”. She emphasised the cost benefit of this investment, stating that “each £1 spent on treatment will save £4 from reduced demands on health, prison, law enforcement and emergency services”.

The report’s second set of recommendations centre around the “rebuilding of services”, calling for more qualified drug treatment staff, funding for specialist substance misuse services for young people, access of people who use drugs to employment, and expanded recovery support. In this section, Dame Black impactfully backed diversion schemes like those in Durham, the West Midlands, and Avon and Somerset. She also recommended local authorities offer “evidence-based harm reduction” like needle and syringe programmes, the provision of naloxone, and “pharmacological and psychosocial treatments”. 

Dame Black placed specific focus on the role of the Ministry of Justice in addressing key issues of substance misuse in prisons, including greater transparency, continued care upon release, and probation that centres treatment. She also emphasised the need for the NHS to engage with the “wider health needs of drug users with medical co-morbidities”, calling on the DHSC and NHSE to develop an action plan to address this.

Dame Black’s third set of recommendations addressed prevention and early intervention, specifically encouraging services to mitigate the risk factors that draw young people into drug use, reducing recreational drug use, and provide an assessment of the support available to teachers in delivering the new Relationship, Health, and Sex Education curriculum.

The report’s final recommendation calls for “more research into what works to combat substance misuse, across supply, prevention, treatment and recovery”, and the government to “promote greater innovation in research […] by offering incentives or rewards” to relevant companies or organisations who create beneficial developments in the addiction field. 

Dame Carol Black’s review is comprehensive but not exhaustive; It positively engages the government to provide realistic and achievable recommendations that do not require the change of significant pieces of legislation like the Misuse of Drugs Act 1971 (MoDA), and offers solutions founded in evidence often shunned in the current state of the UK’s drug policy.

Little nuance in the types of and reasons for drug use is provided, offering an overly simplistic depiction of all drug use as problematic. Its section on recreational drug use pins the onus of the dangers of recreational drug use onto consumers, a reductive perspective that inhibits policy reform and the expansion of services like drug checking. While recommendations and comments on legislation were out of the scope of both phases, it is clear that the report’s analysis suffers from this limitation given the undeniable contribution of the MoDA to the issues discussed in both reviews. 

Despite these restrictions, however, Dame Carol Black and her team have made crucial and powerful recommendations for change that will likely encourage government-led action more effectively than ambitious calls for wide-sweeping policy reform. 

Initial promising signs position the second phase of the report as more influential than the first, including the creation of the Joint Combating Drugs Unit and Health Secretary Sajid Javid today thanking Dame Carol for the review and committing to “publish[ing] an initial response shortly on the urgent action we can take to turn the tide on drug-related deaths and get more people access to higher quality services”. 

The review is an incredibly exciting and at some points heartbreaking addition to the powerful existing body of literature on prevention, treatment, and recovery. It should now be clear to the government what needs to be done at a minimum to address the harms that inadequate policy and funding have inflicted on people who use drugs. The recommendations are neither onerous nor challenging to execute, and do little to obstruct the government’s preferred narrative first propagated in the Misuse of Drugs Act 1971. Phase Two of the review therefore appears well-positioned to make meaningful change. 

Issy Ross is a Content Writer at Volteface, Tweets @isabellakross

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