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Abstract
Based on documentary analyses and interviews with twenty key informants in 2012, this paper analyses the shift in British drugs policy towards “recovery” from the perspectives of major stakeholders. The processes involved in reopening the debate surrounding the role of substitution treatment and its re-emergence on to the policy agenda are examined. Drawing on Kingdon's work on agenda-setting, the ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a “recovery” focus as the organizing concept for British drugs policy are explored. Study limitations are noted.
THE AUTHORS
Betsy Thom, PhD, is Professor of Health Policy and Head of the Drug and Alcohol Research Centre at Middlesex University, UK. She is an Editor-in-Chief of Drugs: Education Prevention and Policy and has published on issues of alcohol and drug policy and practice. Current research includes the study of stakeholder groups in Europe, partnership approaches to implementing alcohol policy at local level, and workplace interventions/models of response to alcohol and drug problems.
Karen Duke, PhD, is Principal Lecturer in Criminology at Middlesex University, UK. She has published widely on the development of drugs policy in prisons, the interfaces between drugs and criminal justice policy, and the relationship between research, politics, and policy making. She is an Editor-in-Chief of Drugs: Education Prevention and Policy and the author of Drugs, Prisons and Policy Making (2003, Palgrave Macmillan).
Rachel Herring, PhD, is a Senior Research Fellow at the Drug and Alcohol Research Centre at Middlesex University, UK, with a particular interest in social and policy aspects of alcohol use. Current research includes developing responses for “frequent flyers” (people with highest rates of alcohol-related hospital admission/attendance) and the study of stakeholder groups in Europe. She is an Editor-in-Chief of Drugs: Education Prevention and Policy.
Anthony Thickett, PhD, is a Lecturer and Qualitative Researcher at Middlesex University, UK. His main current research interests include: drug and alcohol use, social exclusion, and visual/participatory research methods.
Notes
1 In 2001, the National Treatment Agency for Substance Misuse (NTA) was set up as a special health authority within the National Health Service to improve the availability, capacity, and effectiveness of treatment for drug misuse in England.
2 Acknowledgements: The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013), under Grant Agreement no. 266813–Addictions and Lifestyles in Contemporary Europe–-Reframing Addictions Project (ALICE RAP). Participant organizations in ALICE RAP can be seen at http://www.alicerap.eu/about-alice-rap/partners.html. The research has been conducted in Work Package 2 which is focused on stakeholder analysis.
3 The Departmental Committee on Morphine and Heroin Addiction (known as the Rolleston Committee) was appointed by the Ministry of Health to investigate morphine and heroin use. The Committee was chaired by Sir Humphrey Rolleston and the membership consisted entirely of medical men (see Mold, Citation2008, pp. 18–21).
4 As CitationMold (2008: 20) has outlined, there are no figures on the prevalence of opiate addiction at the time of the Rolleston report. Data on the number of addicts notified to the Home Office was collected from 1934 onward. However, the numbers were most likely to be in the hundreds. In 1935, there were 700 addicts who were mostly middle aged, middle class, and had become addicted as a result of medical treatment. There were also a significant number of addicts who were medical professionals.
5 The Brain Committee was convened twice. In 1958, the first Brain Committee commenced a policy review of the Rolleston arrangements and initially found that these were still appropriate. As a result of reports by the Home Office Drugs Inspectorate, the Committee was reconvened in 1964 to consider issues around the prescribing habits of doctors.
6 In the first half of the 1980s, official statistics point to a heroin epidemic with a peak in 1985 and a subsequent leveling off in the latter half of the 1980s (Power, Citation1994). Between the years 1980 to 1986, the number of new addicts notified to the Home Office increased dramatically from 1,600 in 1980 to 6,409 in 1985 (Home Office, Citation1987).
7 It is interesting to note that while the numbers of methadone maintenance prescriptions were rising, many were at suboptimal doses. Services tended to prescribe methadone maintenance doses below the clinical guidelines of between 60 mg and 120 mg. The daily mean methadone maintenance dose was 57.6 mg but ranged from 6.5 mg through to 127 mg. On average, services prescribed daily maintenance doses of less than 30 mg to 15.5% of clients, while 48% of prescriptions were for 31–60 mg of methadone, 27.9% for doses of 61–90 mg, 6.6% for doses of 91–120 mg, and only 1.9% for doses greater than 121 mg (NTA, Citation2007).
8 Drugscope is a UK charity based in London supporting professionals working in drug and alcohol treatment, drug education, and prevention and criminal justice. They are also the primary source of independent information on drugs and drug-related issues. See website: http://www.drugscope.org.uk/
9 The Royal Society for the Arts is charity based in London, which is “committed to finding innovative practical solutions to today's social challenges.” It undertakes research, puts on various events, and is supported by a 27,000-strong Fellowship. It has completed a number of projects around drugs policy issues. In March 2007, the RSA set up a Commission on Illegal Drugs, Communities and Public Policy which produced a number of influential reports. The RSA is currently running the Whole Person Recovery Project in West Sussex that aims to increase personalization and service user involvement in drug treatment. See website: http://www.thersa.org/
10 The Centre for Social Justice (CSJ) is an independent think tank. It was set up in 2004 by the former Conservative Party Leader, Iain Duncan Smith. They have produced a number of reports dealing with addiction issues. See website: http://www.centreforsocialjustice.org.uk/
11 The United Kingdom Drug Policy Commission (UKDPC) is a charity that operated between 2007 and 2012 as an independent body that provided analysis of the evidence concerning drug policy and practice. See website: http://www.ukdpc.org.uk/
12 The Department for Trade and Industry defines a social enterprise in the following terms: “a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners” (DTI, Citation2002).
13 It is reasonable to consider that a range of stakeholder background characteristics (e.g., age, gender, ethnicity, religiosity, education, professional discipline, socio-economic status, current position, political ideology, etc.) might be relevant in understanding their interests, objectives, and goals regarding opioid substitution treatment. However, in order to protect the anonymity of the stakeholders in this specialized area of drug policy, this type of data was not collected.
14 Druglink is a bi-monthly magazine for all those UK professionals interested in drugs and drug-related issues. It is produced by Drugscope, the national UK charity, which supports professionals working in the drugs and alcohol fields. It includes the latest news, feature articles, interviews, factsheets, reviews, and listings. See website: http://www.drugscope.org.uk/publications/AboutDruglink
15 There is limited devolution of powers to Northern Ireland, Scotland, and Wales, and each of these countries has its own strategy around drugs and alcohol ("New Strategic Direction for Alcohol and Drugs" in Northern Ireland 2006–2011; “The Road to Recovery: A New Approach to Tackling Scotland's Drug problem” (2008); “Working Together to Reduce Harm: The Substance Misuse Strategy for Wales” 2008–2018). All these strategies are coordinated within the overall UK strategy.
16 CitationBest and Laudet (2010: 2) define recovery capital as “the sum of resources necessary to initiate and sustain recovery from substance misuse.” Recovery capital can be broken down into four types: social, physical, human, and cultural (see Cloud and Granfield, Citation2008).