198. Many witnesses have stressed to us the importance
of preventive work with young people designed to discourage them
from starting to take drugs. In fact this forms an important strand
of the National Strategy, under the Young People target. The Home
Office have told us how they are approaching this issue with a
plethora of initiatives including the Personal, Social and Health
Education curriculum, the National Healthy School Standard,
the National Drugs Helpline, the new cross-departmental Children
and Young People's Unit, Positive Futures, Connexions,
Health Action Zones projects, Youth Offending Teams, and Young
People's Substance Misuse Plans.
199. However, the Home Office has not presented
us with any evidence of the effectiveness of this work. The Health
Development Agency told us in evidence that:
"Most initiatives and innovations in the
drug education and prevention field are not evidence-based and
have not been subject to evidence-based evaluation. Initial findings
from [our] review show that there are very few systematic reviews
of drug education and prevention activity".
200. Mr Mike Trace told the Committee:
"It was suggested in the strategy that a
concerted programme of education in schools, backed up by more
intensive programmes targeted at socially excluded children and
adolescents, would achieve these targets [relating to reducing
young people's drug use]. The evidence base for this hope was
thin at the time and looks thinner now. While good drug education
in schools, and investments in programmes for marginalised kids
may be a good thing in their own right, they are unlikely to have
an impact on the overall prevalence of young drug use, and will
certainly not get anywhere near the target of a 50 per cent reduction".
201. We are also concerned about the quality
of drugs education material, and the possibility of ambiguous
messages contained within it. We accept Mr Ainsworth's recognition
that "preaching at young people is not going to work".
However, we believe that all drugs education material should
be based on the premise that any drug use can be harmful and should
202. Our attention was drawn to two leaflets.
The first was produced by DrugScope and entitled What and why?:
Cannabis. This document explains in some detail what cannabis
is, how it is taken, and some of the effects which may be expected.
While the leaflet explains that cannabis may have unpleasant effects
upon the user, it also lists some perceived pleasurable effects:
"cannabis alters perception. The sensation
is usually a pleasant one of general relaxation, a sense of being
on the same wavelength as others who are 'stoned', and heightened
sensitivity to colour and sound. Also common are the urge to eat
('the munchies') and fits of giggles as ordinary things become
203. The leaflet goes on to state that "Cannabis
is usually smoked by people who are part of a social group that
sees cannabis use as acceptable (or even normal) and who want
to relax and enjoy the company of others". DrugScope told
us that this leaflet is not aimed at children but at parents and
204. When we asked for further clarification
of their philosophy, we were told that DrugScope "as an organisation
prides itself on providing balanced, accurate drug information
to professionals and the public". They went on:
"whether we like it or not, drugs are part
of most young people's lives. It is from this premise that DrugScope
believes young people should be given balanced, accurate information
about drugs...A 'just say no approach' or shock tactics do not
connect with young people's reality; they are not credible with
young people who may think the message, in their experience, does
not reflect the whole truth. The approach may also make young
people seek information elsewhere, from friends, for example,
which may not be accurate".
205. The second leaflet given to us was produced
by Lifeline and entitled How to survive your parents discovering
you're a drug user. This leaflet includes a comic strip and
some advice which includes:
"Don't get caught in the first place. Don't
be blatant or obvious and remember: parents search bedrooms and
coat pockets...If you do get caught, don't expect your parents
206. In response to our request for further information,
Lifeline told us:
"Education and prevention are often confused,
an assumption is made that drug education prevents people from
taking drugs. There is no evidence that will stand up to serious
scrutiny that supports this from anywhere in the world...In the
mid 1980s when faced with the threat of AIDS amongst injecting
drug users, Lifeline looked at the available evidence and spoke
to drug users. Our conclusion was that we did not know how to
stop people taking drugs...we therefore decided to look at what
was possible. We believed that preventing HIV among injecting
drug users was both a more serious threat and preventable...we
are trying to reduce the harm from drugs by telling the truth;
the lies and exaggerations of primary prevention campaigns just
make our job harder".
207. We acknowledge the need to provide realistic
drugs education, but we believe that examples such as the Lifeline
leaflet cross the line between providing accurate information
and encouraging young people to experiment with illegal drugs.
We believe that publicly funded organisations involved in educating
impressionable young people about drugs should take care not to
stray across this line.
208. The parents of one recent young casualty
of a heroin overdose, Rachel Whitear, made the difficult decision
to release police photographs of their daughter's body in the
hope of preventing others from using drugs. We applaud them for
courageously allowing their daughter's photograph to be. We
do not share the view that confronting young people with shocking
images of the harm caused by some drug use is counter productive.
209. The initial memorandum from the Home Office
to the Committee stated that:
"Earlier this year  the Government
commissioned a long-term study on the impact of drug, alcohol
and tobacco education in schools. This will be a joint project
between the Department for Education and Skills, the Department
of Health and the Home Office. The study will look at which types
of educational input and other factors, such as socio-economic
and cultural have most impact on influencing behaviour. The project
will start in the autumn."
210. The study will conclude in 2007. We welcome
the commissioning of this research, but until 2007, the Home Office
must find other evidence on which to base policy. While we believe
that drugs education and prevention work are desirable, we would
be disappointed to see money being spent without evidence of effective
outcomes from policy.
211. We acknowledge the importance of educating
all young people about the harmful effects of all drugs, legal
and illegal. Nonetheless, we recommend that the Government conducts
rigorous analysis of its drugs education and prevention work and
only spends money on what works, focussing in particular on long
term and problem drug use and the consequent harm.
212. The point has also been made to the Committee
that the young people most vulnerable to drug abuse are those
excluded from school. It is therefore extremely important to aim
drugs education programmes not only at those attending school,
but, perhaps more importantly, at those who do not attend. The
1998/9 Youth Lifestyles Survey demonstrated that half of all truants
and excluded children had used an illegal drug, as compared with
13% of school attenders. While only a tiny proportion of school
attenders used Class A drugs regularly, 7% of excludees did so.
Mr Ainsworth told the Committee that:
"the degree to which we focus on those groups
and the degree to which we are going outside the young people's
area and the degree to which we link up with Neighbourhood Renewal
and Social Exclusion Programmesbecause that is where the
main impact of drug misuse is being inflicted on communitiesare
issues that we are trying to pick up in the stocktaking review".
213. We recommend that drugs prevention and
education programmes are targeted towards particularly vulnerable
groups of young people, such as truants, those excluded from school
and children in care.
214. The National Strategy contains a strong
commitment to treatment for drug users. However, drug users not
only require treatment for their drug problem; they also require
general medical services, in common with the rest of the population.
215. We were surprised and disappointed by the
minimal response to our request for evidence from the British
Medical Association on this issue. We have heard disturbing evidence
that a large, albeit decreasing, proportion of GPs appears to
be unwilling to treat drug users, with the effect that many users
are without access to general medical services. Dr Claire Gerada
of the Royal College of General Practitioners, told us that according
to estimates made in the 1980s,
"around 5-10% of general practitioners were
actively involved in the care of drug users. Of these doctors
that were involved they tended to have large numbers of patients
with some estimates showing that 5% of general practitioners looked
after 50% of all the drug using patients receiving treatment in
a primary care setting".
216. Dr Gerada went on to tell us that a more
recent, unpublished study suggested that GP involvement has risen
"50 per cent of a random sample of English
GPs had seen a drug user in the last month and 25 per cent of
the total...had prescribed methadone to a drug user...also the
numbers of [drug-using] patients each GP is seeing...has doubled
217. Dr Gerada pinpointed the minimal training
of GPs in this area as the reason for any residual reluctance
to treat drug users. She told the Committee that, in an average
five year undergraduate training course, a medical student is
given around thirty minutes training in drug misuse problems.
She said that: "every single doctor wherever they practise,
maybe in the Outer Hebrides, will see a drug user and yet there
is virtually no training in it".
This lack of understanding "breeds prejudice, it breeds fear".
We were encouraged to hear, however, that the number of GPs interested
in training was high.
218. We conclude that General Practitioners
are, for the most part, inadequately trained to deal with drug
misuse. We recommend that training in substance misuse is embedded
in the undergraduate medical curriculum and postgraduate General
Practice curriculum, as a problem which will arise with increasing
frequency over the careers of all prospective doctors training
today. We recommend that the Department of Health funds more training
courses in substance misuse for existing General Practitioners.
219. We would also expect the British Medical
Association and the Royal College of General Practice to take
a rather greater interest in this area than is evident so far.
In particular we would expect these organisations to use their
considerable influence to ensure that treatment of drug misuse
is included in the medical curricula. We would also expect the
professional bodies to encourage more of their members to take
an interest in treating drug abusers so that a handful of dedicated
General Practitioners are not left to shoulder the burden alone.
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