In his white paper on levelling up Michael Gove covered Jericho to the Roman Empire to Renaissance Italy. He also talked about drugs.
That was a relief, because drugs are far more relevant to contemporary regional equality than meditations on ancient history. It is in our most deprived areas that the consequences of drug use are felt most painfully.
The Levelling Up Secretary’s white paper talked about the need to combat drug use: breaking supply chains, closing “county lines” distribution networks and preventing drug-related violence. It also pledged investment in treatment and recovery programmes, helping to help break the cycle of problem drug use. While some of these policies were welcome, the whole package falls short of what is needed to properly address our drugs-deprivation cycle. And levelling up won’t happen until the cycle is interrupted.
The UK does have a drug problem. There is substantial evidence which shows that drug use in this country is high relative to peers. One analysis, for example, has shown that the UK has the highest rates of drug use in Europe, including the highest rate of heroin, cocaine and ecstasy use. It is also estimated to have the highest rate of problem drug use for opioids.
Why are we faring so poorly? Part of the explanation lies in the UK’s high levels of regional deprivation and socioeconomic inequality. The UK is one of the most unequal nations in Europe, and drug misuse is strongly correlated with deprivation.
The North East of England has the highest drug death rate in England and Wales, more than three times that of London. The North East also has the worst, or among the worst, disposable income per capita, unemployment rate, child poverty rate and life expectancy and health inequalities of all UK regions. Blackpool – the most deprived local authority in England – is also the local authority with the highest drug misuse death rate in England and Wales.
Scotland, which has the unwanted title of “drug death capital of the world”, further illustrates the point. In 2020 its drug death rate was 3.7 times that for the UK as a whole, and higher than any other European country. People living in the most deprived parts of Scotland have been found to be 18 times more likely to die a drug-related death than those living in the least deprived areas.
Better drug policies can help to support levelling up, but if we are to address long standing regional inequalities, improve well-being and ultimately save lives, what is needed is something more ambitious than what the government has offered so far. Tweaks within the current legislative framework could include the expansion of drug policies such as safe drug consumption spaces, allowing users to take drugs under medical supervision; the targeted distribution of Naloxone, a medicine that rapidly reverses opioid overdoses; and the expansion of diversion schemes, whereby people caught with drugs are diverted towards treatment and education, rather than criminal punishment.
The more radical approach would be to completely overhaul UK drugs policy, parting from our current prohibition regime. Under the Misuse of Drugs Act, drugs are forbidden and individuals that transgress those laws are punished. A positive example of what can be achieved by reform is provided by Portugal, where decriminalisation – the removal of criminal sanctions against drug possession and use, usually to achieve public health or criminal justice objectives – has been successful in significantly reducing hard drug use, drug-related HIV infections and drug deaths.
In Portugal it has been reported that overdose deaths decreased by over 80 per cent after decriminalisation. A similar approach – one that favours prevention and education; providing access to evidence-based, voluntary treatment programmes; adopting harm reduction practices; and investing in the social reintegration of people with drug dependence – could achieve positive impacts in the UK. In the North East an 80 per cent reduction would result in around 200 fewer drug deaths a year. In Scotland more than 1,000 lives could be saved.
The government is right to have recognised addressing drug harm as an important element of its levelling up project, but it needs to go further. The boldest way forward would be to completely overhaul UK drugs policy, root and branch, creating a liberalised public health framework that prioritises support and treatment. Even within the current paradigm, there are effective policies the government could adopt to make a difference. Either way, a full and frank reassessment of our drugs policies is long overdue – and levelling up can’t happen without it.