Deaths of despair: how Britain became Europe’s drugs capital

If progress is ever made in the ‘war on drugs’, it will be thanks to people like Lorna Hughes. She runs a community centre in the Bell Foundry council estate in Loughborough. It was set up by residents appalled at how their neighbourhood had sunk into an underworld of drugs and crime. They wanted someone there keeping an eye out and helping those who needed it. One of the disused flats, a burnt-out drugs den, was converted into an office and the Marios Tinenti Centre was born.

I went to visit a few weeks ago and Lorna talked me through her job. If she sees anyone doing drugs, she calls the police. If thugs are menacing people on the estate, she helps the residents lodge antisocial behaviour orders. If an addict wants help, she liaises with charities. If anyone feels in danger, she’s there with a cup of tea and advice. She represents order, security and sympathy in a place badly in need of all three.

There are estates like the Bell Foundry all over Britain, riddled with drugs and crime, but few of them offer this kind of support. The need has never been greater. Drugs killed 5,900 people in Britain last year, the most ever recorded. Addiction is estimated to be behind half of all murders and thefts and a third of all prison sentences. Heroin and cocaine are being served in huge quantities by a sophisticated drugs industry whose ‘county lines’ distribution network employs some 27,000 children and makes an estimated £800 million annual profit.

This makes Britain’s drug dealers among the most successful in the world, relatively untouched by the half-hearted attempts by politicians to dislodge them. In a recent survey, half of drugs users said they could get cocaine delivered in 30 minutes — half the time it currently takes an ambulance to arrive. The story of Britain’s drug-control policy has been one of institutional failure, punctuated by politicians declaring that enough really is enough.

This week, it was Boris Johnson’s turn. He went into full war-on-drugs mode, posing in police uniform for the cameras and vowing to thwack the bad guys. His headline proposal — to crack down on middle-class drugs users — seemed strangely unaligned with the real issue, which is the power that drug dealers wield over the most deprived housing estates. He did say that ‘you’ve got to come down hard on the gangsters who are making hell of people’s lives’ and ‘we want every-body to be able to grow up in safer streets’. Every Prime Minister in living memory has said something similar, however, and the problem keeps getting worse.

It’s easy to lose sight of just how much worse. In the 25 years since Britain’s drugs problem was made famous by the film Trainspotting, the number of people killed each week by drug abuse has risen fivefold in Scotland alone. (Devolution was not, as those of us who supported it had hoped, a tool to apply more attention and better solutions to the worst urban poverty in the first world.) The problems have been left to fester and intensify to an extent unknown in any other developed country.

Britain has meanwhile started to exhibit a form of social decay identified by Angus Deaton, who recently won the Nobel prize for economics, as ‘deaths of despair’. He pointed out that deaths from heart disease, cancer and diabetes have fallen in recent decades, but a certain category of deaths was rising: those involving liver disease, alcohol dependency and drug abuse. Science has helped us to get better at defeating the old killers, but social decay is seeing far more people drink or drug themselves to death.

Professor Deaton has started to look at Britain, which conforms to his thesis all too well. Drink-related deaths surged 19 per cent last year and, like drug deaths, stand at an all-time high. So the issue is not drugs in particular but addiction in general. Things that are legal, like super-strength lager and cider, are destroying lives as surely as heroin and cocaine.

Over the last decade, cocaine use has quadrupled. In 2010, when David Cameron came to power, 144 people died from cocaine-related complications; last year, it was 777. Drugs policy has been a major Tory failure — something with which the party has struggled to come to terms.

Poverty fell over the last decade as Cameron’s welfare reforms helped record numbers into work. But drug abuse didn’t fall with overall poverty, because its dynamics are different: it’s a bigger, harder and more expensive problem to solve. The policy focus inherited from Labour was the so-called ‘maintenance’ of heroin addicts: that is to say, administering methadone. ‘It was the easy option: to stick them full of drugs so they’re sedated and don’t commit crime,’ says one of those who set the policy. ‘We kept that going. It suited the Home Office and the NHS, who didn’t believe in rehabilitation.’

As health secretary, Jeremy Hunt pushed for money to be set aside for rehabilitation, which he said was cheaper than the cost of managing addicts — in terms of welfare, prison, A&E and crime. He briefly got his way when a pot of cash was set aside after the 2015 general election, but that was quickly raided. The real calamity was the 2012 Health Act, which transferred more public health work from the NHS (whose budget was protected) to councils (whose budgets were cut by a third). Drugs support was badly weakened. Scotland, for all of its devolved powers to do things differently, did even worse.

Meanwhile, the nature of drug use changed: we saw students on benzodiazepines, ‘legal highs’, and a surge in the use of ketamine. The dark web offered new ways to buy and sell drugs and the market, in general, has changed far faster than the authorities’ ability to understand or keep up. Dame Carol Black’s report into drugs in Britain, published last year, was unsparing about how bad things have become. More rough sleepers are now dying on British streets from drug abuse than at any time since records began. ‘Long-term drug users are cycling in and out of our prisons at great expense,’ she wrote, ‘but very rarely achieving recovery or finding meaningful work. Many of their children are taken into care.’

This underlines Hunt’s original point: that the cost of failure dwarfs the cost of treating the problem. Some £600 million a year is being spent on treatment and prevention but the cost of drug-related harm to society stands at £20 billion a year. The Tories have learned the hard way what happens when you strip out support. It was accidental — the implications of the 2012 Health Act were only realised long after the damage was done. (‘It’s a sore point for us Cameron-era Conservatives,’ says one of the architects of the policy. ‘We didn’t think it through.’)

There is no real alternative, now, to repairing the damage of the last decade. And this is precisely what the government’s new ten-year plan proposes to do. Drug addiction, it says, is to be treated as a chronic health condition and ‘people who need it provided with long-term support’. That means the kind of support that Lorna Hughes provides — or points people towards — in her office in Loughborough. This moves on from seeing drug addiction as an isolated problem and starts to treat it as a symptom of a troubled life: a symptom that it will take more than methadone to cure.

It’s a big shift in thinking and even seems to come with extra cash. Some £780 million has been pledged for rehabilitation, and while it’s still unclear how much comes from pre-existing budgets and is a statistical sleight of hand, it’s still a massive lift. It means a big rise — of 33 per cent — in treatment places for rough sleepers. ‘From the moment that an offender comes into contact with the criminal justice system,’ the plan says, ‘we will be focused on their rehabilitation and recovery from drug misuse.’ That would represent a break from how things have been. The government’s stated aim is not only to reverse the rise in drugs deaths within four years, but to force drug use to its lowest level in 30 years.

It sounds ambitious, but some of the figures suggest serious intent. The decay in local government health services would start to be repaired with £270 million for rebuilding the council drug services. The ten-year plan accepts that treatment is needed for whole families, not just for the addict, and there is a planned 50 per cent rise in substance-misuse interventions for young people. This reflects the fast-changing nature of British childhood: a third of 15-year-olds say they have tried illegal drugs.

It all adds up to a thoughtful and plausible drugs strategy — which makes it all the more baffling that the Prime Minister decided to sell it by talking about middle--class drugs users this week, pulling on a police hat and brandishing his Crimestoppers credentials. Polls show the Tories losing support from those who fear they are weak on law and order, so perhaps the focus on supporting addicts was thought too off-brand. So we have ended up with what looks like a comprehensive and humane policy, disguised as a headline-grabbing crackdown.

Some of the plan seems like overreach, such as the ‘zero tolerance’ of drugs in prisons, with testing targets to be set and the results published in league tables. Previously, random tests show one in six prisoners using drugs on any given day. In many places this is a deliberate policy: governors turn a blind eye because inmates are less trouble when sedated with drugs. Ian Acheson, a former prison governor, had a point this week when he observed that rehabilitation will be tricky to achieve while drugs are easier to find than soap in many British prisons.

There is also a political danger. An emphasis on drugs may come back to bite the government, given that the House of Commons could emerge as an example of how deeply engrained the drugs culture has become. There are reports of cannabis smoke wafting around the parliamentary estate and traces of cocaine being found in the loo near the PM’s private offices. Kit Malthouse, the policing minister, has said it would not be surprising if some parliamentary pass holders were taking drugs. Lindsay Hoyle, the Speaker, has previously spoken about a ‘drugs problem’ that needs to be confronted.

This was supposed to be ‘crime week’ for Johnson’s government. It started with stories about parliament’s cocaine snorters, then a video emerged of his former spokeswoman joking about No. 10 breaking the law with parties in lockdown. A government increasingly defined by its mishaps will struggle to get across its better ideas, especially if it appears embarrassed by them. Still, this was the week when a decade of Tory denialism on drug and alcohol addiction was replaced with a realistic way out. That need not be a source of shame.