You
are in Research The
Scottish Office Central Research Unit PERCEPTIONS
OF DRUG CONTROL PROBLEMS AND POLICIES: A COMPARISON OF SCOTLAND AND HOLLAND IN
THE 1980'sby
Sally Haw, BSc,
Jason Ditton, BA PhD 1995
ACKNOWLEDGEMENTS Each
author made a separate study tour of The Netherlands. Jason
Ditton is particularly grateful for all the help generously provided by: Professor
H Bianchi, Dr E Buning, Dr P Cohen, Dr P van Dalen, Dr J van Dijk, Dr E L Englesman,
Dr J Horn, Mr R Kerssemakers, Dr D Korf, Dr J Naeye, Professor M Punch, Mr J Walburg,
Dr J van Wijngaarden, and Chief Inspector L Zaal. Sally
Haw, in turn, is particularly grateful for all the help generously provided by:
Dr M Blom, Dr E Buning, Dr E L Engelsman, Dr L M Erkelens, Dr B Eyromd, Chief
Inspector Heyden, Dr S Mustard, Dr P Sandwjick Dr J van Sinderen, and Dr H J van
Vliet. LIST OF
FIGURES AND TABLES Table
1 NETHERLANDS: Summary of the Opium Act, 1976: Maximum Penalties Table
2 SCOTLAND: Maximum Penalties under the Misuse of Drugs Act (From 1986 Onwards)
Table 3 SCOTLAND:
Controlled Drugs by Schedule and Class, Misuse of Drugs Act (From 1986 Onwards)
Table 4 SCOTLAND:Availability
and Potential Offences Under Misuse of Drugs Regulations (1986 Onwards) EXECUTIVE
SUMMARY The mainstay
of international drug control policy at an operational level has been the reduction
of drug production and drug trafficking. Demand reduction, as a theme, has appeared
more recently. The Netherlands has a world-wide reputation for its liberal control
regime, while Scotland has recently followed a different path. This review attempts
to assess the differences in policy in the period up to 1988, and the extent to
which they relate to the presence of different problems. The
Netherlands has a population 3 times the size of Scotland's. Until the early 1970s
heroin use in The Netherlands (as in Scotland) was confined to a small group of
users, but by the end of the 1970s, there were probably about 17,500 opiate addicts
in The Netherlands. Only some 40% were injectors, and the size of the opiate using
population has not changed during the 1980s. The
Dutch approach to drug control is based on the idea that "risk should be
the point of departure for drug policy". Cannabis products (excluding cannabis
oil) are distinguished from those which pose an "unacceptable" risk.
Those convicted of trafficking in unacceptably risky drugs are punished as severely
as they would be anywhere else. Chronic users of drugs posing unacceptable risks
may find the law used to coerce them into suitable treatment. Cannabis use and
small scale dealing in cannabis are both effectively decriminalised. Since the
incursion of HIV into injector sub-populations, treatment policy has changed locus,
with harm-reduction the dominant theme. The Dutch have an unearned reputation
for a laissez-faire approach and for a drug problem which is chaotic and out of
control. The reality is pragmatic social control which combines intensive surveillance
and early identification of emergent problems. The
rapid increase in opiate use that was experienced by most western European countries
came later to Scotland than to The Netherlands. However, by the end of the 1980s,
the prevalence of both opiate and injecting drug use in Scotland was considerably
greater than in The Netherlands. UK drugs legislation is complex: drugs are classified
into 3 levels of harmfulness and 5 levels of availability. An additional distinction
is made between possession and supply. Rates of trial, conviction and severity
of disposal have all seen marked punitive shifts during the 1980s. It is also
noticeable that many of the cases which led to prosecutions for 'supply offences'
in Scotland during the mid-1980s would have been dismissed as 'possession for
personal use' in The Netherlands. Yet
it is shown, in conclusion, that Germany and America both have a more draconian
approach to these problems than does Scotland. Scottish and Dutch drug control
policies are by no means at either end of the spectrum, and, indeed, have much
in common. In particular, the role of harm reduction strategies, and the utility
of the criminal justice system in levering users into treatment. 1.
INTRODUCTION The
control of the production and supply of illicit drugs has been of international
concern since the beginning of the twentieth century. In the first half of the
century a series of international agreements and treaties were signed mainly to
control the opium trade. Then, in an attempt to consolidate and unify the international
response, the United Nations drew up the Single Convention on Narcotic Drugs which
was signed by 65 countries in 1961. In addition to opiates and cocaine, this treaty
also covered cannabis. The Convention of Psychotropic Drugs of 1971 then extended
international controls to other drugs such as LSD, amphetamine, barbiturates and
benzodiazepines. Until
the early 1970s, the assumption behind most international policy was that drug
misuse could be contained and reduced simply by using law enforcement measures
to limit the supply of illicit drugs. However as Hartnoll points out, the Convention
of Psychotropic Drugs included an article on reducing "demand" which
required signatories to develop programmes for the treatment and rehabilitation
of problem drug takers and to promote prevention of drug use through education.
The requirement for "demand reduction" was subsequently included in
the Single Convention which was amended in 1972 (1). Nevertheless, the main objectives
of international policy at an operational level is the reduction of both the large
scale production of and trafficking in illicit drugs. In
sharp contrast, domestic drug policies which have developed in Europe and North
America since the 1970s have had the dual aim of reducing both "supply"
and "demand". These policies are based primarily upon an interaction
between law enforcement and programmes of treatment and rehabilitation, and, to
a lesser extent, educational measures aimed at prevention. This interaction of
the 3 strands of domestic policy gives considerable scope for national variation
depending upon the cultural and structural base of the individual countries concerned.
The Netherlands
- particularly Amsterdam - has gained a reputation as "Europe's 'drug gateway"'
(Times, 14 February 1985) and as "the drugs capital of Europe" (Times,
25 May 1985). Scotland, conversely, has followed an extreme version of the apparently
opposite "get tough" policy since 1980. The
aim of this report is to provide an account of the development of domestic drug
control policies in Scotland and The Netherlands, up until 1988, and then to discuss
these in the context of policies that have developed in Germany and the US. 2.
DOMESTIC DRUG CONTROL POLICIES IN THE NETHERLANDS 2.1
The Netherlands The
Netherlands is a small country with a population of 14.7 million, many of whom
live in the Ranstad, an area in the West of the country which includes the cities
of Amsterdam, Rotterdam, The Hague and Utrecht. Since the 17th century, The Netherlands
has been a trading nation and shipping, commerce and transit trade remain the
central economic activities of the country. Following the world-wide recession
which began in the early 1970s unemployment has remained comparatively high at
about 15% of the workforce. Political
upheaval in the Dutch colonies followed by independence, resulted in an influx
of ethnic minorities, first of South Moluccans, followed in the 1970s and 1980s
by a much larger influx of Surinamese. Current estimates suggest there are 35,000
South Moluccans and 180,000 Surinamese. Dutch policy in the 1970s and 1980s has
been to assimilate and integrate the ethnic minority groups, nevertheless unemployment
amongst young South Moluccans and Surinamese, aged 18-24 years, was estimated
to be 2 to 3 times higher than unemployment rates of white Dutch (2). 2.2
The Growth of Drug Taking Until
the early 1960s the use of illicit drugs was limited to small groups of individuals.
In the early part of the century, opium use was tolerated amongst elderly Chinese
(mainly of Hong Kong origin). There was also a small number of therapeutic addicts,
and professionals who had become addicted to opium or its derivatives because
of easy access. During
the 1960s the recreational use of cannabis became popular amongst young people
and by the end of the decade there were an estimated 10,000 to 15,000 regular
users. At the same time, opium use had also spread to middle-class youth. Initially
this group were small in number and on the fringes of the drug sub-culture but
by the early 1970s, there were an estimated 200 opium addicts of Dutch origin
At this time
the use of heroin was confined to a small group in Amsterdam and Rotterdam. But
in 1973, the arrest of many of the Chinese opium dealers coincided with an influx
of heroin first from Hong Kong and then from South East Asia (Thailand, Laos and
Burma) and many opium users changed to heroin (3). With widespread availability,
the number of heroin "addicts" rose rapidly and by 1977 the population
was estimated to be 5,000 (4). During the 1970s heroin use also began to move
down the socio-economic scale into 2 new groups - the ethnic minorities and other
young unemployed people. During
the 1980s the Dutch hard drug using population was estimated to be between 15,000
and 20,000 addicts (5). Approximately 50% lived in the cities of the Ranstad area
(5) with Amsterdam having the largest single addict population (about 3,200),
followed by Rotterdam with an estimated 2,500. The total population was thought
to be made up of approximately one-third indigenous Dutch, one-third Surinamese
and one-third "foreigners", 50% of whom were of German origin (6). There
is some evidence to support the idea that in The Netherlands, IVDU population
growth stabilised and in some cities may even have fallen. The number of deaths
(an indicator of prevalence) amongst Dutch addicts, for example, remained constant
for a number of years and the average age of drug users increased steadily. However,
while this may have been true nationally, there was also evidence of increasing
drug use amongst socially disadvantaged groups, particularly the ethnic minorities.
Wijngaart, for example, estimated that as many as 2% of the Surinamese and South
Mollucans may be dependent upon heroin (4). Increases were also reported amongst
Turkish "guestworkers" and some sections of young unemployed. Injecting
rates varied considerably between sub-groups. Amongst the Surinamese there was
practically no drug injecting, instead most inhaled the fumes of heated heroin
(commonly called "chasing the dragon"). However, amongst the indigenous
Dutch, injecting rates were estimated to be about 40%, and for "foreigners",
estimates of injecting rates rose to 70%. It
appears that by the late 1980s The Netherlands had a mean estimate of 17,500 indigenous
drug users. If it is assumed that only about 40% were injectors, then The Netherlands
had some 7,000 IVDUs. In
addition to heroin, a range of other drugs including cocaine, benzodiazepines
and amphetamines were available on the black market and these were frequently
used either in combination or instead of heroin. Unlike
in the US, cocaine use in The Netherlands at this time had stabilised and "crack"
was described as a rarity (1). However, if "crack" does become more
widely available in Europe, as some predict it will (8), there are a number of
features of the ethnic minority sub-groups which may make them more susceptible.
First an increase in heroin use, second similarity in methods of administration
of "crack" and heroin, and finally social marginalisation caused by
high rates of unemployment amongst young South Moluccans and Surinamese. 3.
DUTCH DRUG CONTROL POLICY The
Netherland's drug control policy has evolved over the last 20 years. Following
a period of confusion prior to enactment of the new Opium Act, a more cohesive,
integrated and explicit policy emerged after 1976. Two factors have been particularly
influential in development of current policy. First the 1972 report of the Narcotics
Working Party which shaped both the new legislation and the development of services
for drug users; and second, the national co-ordination of all ministries involved
in the drugs issue. 3.1
Dutch Drug Laws The
Opium Act of 1919 still provides the legal framework for drug control policy.
It prohibited the import, export and transit of cocaine, opium and cannabis. In
1953 the Act was amended. Maximum penalties were increased from one year to 4
years, and for the first time the possession of cannabis was made an offence.
In 1961 The Netherlands signed the Single Convention, and amendments to the Opium
Act in 1964 incorporated the requirements of the Single Convention. In
1968 a working party was set up to consider ways of responding to the developing
drug problem. Initially the working part was instructed to publicise the dangers
of drugs but in 1970 following the appointment of a new Chairman, who favoured
legal reform, the direction of the group changed (9). The working party reported
in 1972. The
recommendations were based upon the premise that "risk should be the point
of departure for drug policy"(6), and hence drugs legislation should distinguish
those drugs which pose "unacceptable" risks. The main recommendations
on judicial policy fell into 3 categories and were as follows: On
the question of trafficking in drugs which pose an unacceptable risk, the working
party made the following observations: "There
is no difference of opinion about the great dangers of using substances like amphetamine,
opium, morphine, heroin and LSD ... (and) ... it is true to say of the dealer
that he endangers the health of his customers ... That his conduct is deserving
of punishment is therefore not under discussion, any more than the view that such
conduct must be regarded as a felony."(l0). However,
the user of drugs which pose an unacceptable risk was regarded in a different
light: "The
chronic user of drugs, insofar as he has become dependent upon them, is usually
a patient. Punishing him is not the right approach. Against this is the fact in
the present situation pressure on the patient to seek aid and also to behave in
conformity with a programme of aid can be exerted in many cases only via the criminal
law."(l0) The
working party concluded, therefore: "It
will be necessary for the time being to maintain the felonious nature of chronic
use of these substances as a means of compelling the user to seek aid. "(10)
However they
did go on to say: "The
decriminalisation of chronic use, which the working party considers desirable
in principle cannot begin until an aid and service system has been keyed to these
principles." (10) With
regard to trafficking in and use of cannabis products the working party made the
following observations: "In
the existing legislation on cannabis the fact is overlooked that the risk to the
individual of using cannabis may not be put on a par with the risk of using substances
that have a strong pharmacological effect." (10) The
following was offered as a possible solution: "The
use of cannabis products, including possession for personal use and dealing on
a small scale could be reduced to a misdemeanour, while large scale trafficking
remains a felony subject to a term of imprisonment not exceeding one year."(l0)
However, it was
envisaged that prosecution for possession of cannabis products for personal use
and small scale dealing would be avoided "by reaching an agreement with the
public prosecution". This solution would effectively decriminalise possession
of cannabis and small scale dealing while keeping Dutch drugs legislation within
the Single Convention agreement. The
working party also considered whether a licensing system for the sale of cannabis
products was feasible. While this was considered to have many advantages, the
idea was rejected by the working party because The Netherlands would no longer
comply with the Single Convention. Withdrawal from this agreement would have 2
unacceptable consequences. First, The Netherlands would probably be unable to
obtain opium for the preparation of morphine from countries who still adhered
to the Single Convention and second, with the loss of co-operation of other signatories,
traffic in more dangerous drugs could no longer be combated as effectively. In
1976, 4 years after the working party had reported, a new Opium Act was enacted.
It will be recalled that under the old Opium Act of 1919 (amended in 1953), the
consumption of, or dealing in, all narcotic drugs was prohibited and the maximum
penalty for contraventions was 4 years imprisonment. The new legislation which
incorporated the main recommendations from the Narcotics Working Party represented
a radical departure (see Table 1). 
3.2 Prosecution
Policy The Opium
Act of 1976 provides the legislative framework for the drug control policy, but
application is dependent upon police, prosecution and judicial policy which in
turn are determined to a great extent by guidelines from the Ministry of Justice.
In 1980, guidelines were published which set the criteria for distinguishing between
drug trafficking and buying and selling for personal use. The guidelines indicated
that quantities of up to 30 grammes in the case of cannabis products, and up to
one-half gramme in the case of heroin and cocaine, should be classified as buying
or selling for personal use. The
guidelines also indicated that although cannabis for personal use was classified
as a misdemeanour principally to comply with the Single Convention, a policy of
non-prosecution of users or small scale dealers should be adopted. In Dutch law,
the non-prosecution of offences is possible if using the "expediency principle"
prosecution is judged not to be in the public interest. Application of this principle
together with the Ministry's prioritisation of police operational policy to drug
trafficking in "hard" drugs has effectively decriminalised cannabis
use. Ministry
of Justice guidelines also indicate that imprisonment for users of "hard"
drugs such as heroin is not appropriate, and instead contact with the legal system
should be used as a lever into treatment (11). Although
guidelines indicate police resources should be aimed at drug trafficking there
is still some variation in police operational policy in different areas. In Amsterdam
and other large cities like Rotterdam for example, the ''unofficial'' sale of
cannabis by "house dealers" in coffee shops and youth centres is tolerated
providing certain conventions are observed - no sales to customers under 16 years
of age, no advertising and no large scale dealing takes place. In smaller towns,
like Utrecht or Harlem, cannabis sales are less overt. Back in Amsterdam, possession
of up to 2 to 5 grammes even of heroin or cocaine is often ignored. While
drugs legislation and implementation has largely decriminalised any drug use,
drug users do still come into contact with the criminal justice system. In recent
years there has been a rise in cases of theft particularly in Amsterdam (12).
Much of this increase has been attributed to drug users from more deprived socio-economic
groups who steal in order to get money to buy drugs. However, in The Netherlands,
drug addition is not seen as a mitigating factor when property offences have been
committed because of the wide range of services available - including the legitimate
supply of methadone as a substitute for opiates. 3.3
Drug Treatment Policy Drug
treatment policy in The Netherlands developed gradually over a period of 15 years.
During the 1970s the primary aim of treatment was abstinence, and acceptance into
treatment was dependent on the drug users' willingness to become drug free. However,
towards the end of the 1970s, there was a growing realisation that such strict
criteria for access to drug treatment facilities excluded those who were unwilling
or unable to abstain. The result was a growing population of drug users who had
no contact with any kind of treatment agency at all. This, together with the advent
of HIV, caused a major shift in thinking and during the 1980s a new philosophy
emerged. The
primary aim of treatment in the 1980s was "to improve addicts' physical and
social well being, and to help them function in society in a more stable way"
in order to reduce the harm of drug taking both for individual drug takers and
the community as a whole. The key concept was "perceived accessibility of
facilities". The
development of services at this time was based on the premise that on the road
to "recovery or cure" drug users pass through 4 main stages - low threshold
contact, harm reduction, therapy and resocialisation. At different stages different
kinds of services are required. The result was a differentiated range of services
from "street corner" workers, "outreach" workers and low threshold
prescribing of methadone, through to residential drug dependency units, detoxification
centres and drug-free therapeutic community centres. However, the emphasis in
service development was undoubtedly on low threshold contact and harm reduction.
Abstinence became a secondary aim (14). 3.4
Legitimate Availability of Drugs Prescribing
of substitute drugs, like methadone, to addicts was based on the premise that
the provision of a legitimate substitute will reduce or eliminate reliance on
a black market. In The Netherlands, with the exception of a small experiment in
1983 with heroin, only oral methadone has been made available. Methadone was an
attractive drug for this purpose because it is long acting and, therefore, dispensing
could easily be controlled and was initially thought to block the effects of other
drugs. The prescribing
of methadone in The Netherlands first began in the late 1960s and early 1970s.
By 1978 methadone was available to addicts in most of the large cities. However
a report from the Federation of Alcohol and Drug Dependent Organisation (FZA)(4)
indicated that there were no uniform criteria for the selection of clients, little
agreement about dose levels and prescribing schedules, and a range of different
organisations involved. According to Buisman (1983)(4) this situation continued
into the early 1980s. By late 1981, it was estimated that 5,000 individuals or
one in 3 of the addict population were receiving methadone (1,300 in detoxification
programmes, 1,600 on a maintenance programme, and the remainder through family
doctors or general hospital). By the late 1980s, in Amsterdam, it was estimated
that approximately half of the addict population were prescribed methadone from
some source. In
Amsterdam and some of the larger cities, low threshold methadone programmes were
established which made minimum demands on the drug-user. The original aim of eliminating
reliance on black market opiate provision was never realised, but it was thought
that they made an important contribution to harm reduction, particularly amongst
chronic addicts. In Amsterdam, methadone was dispensed through the now famous
converted buses which toured the city following a regular route and timetable.
The conditions for participation were a medical examination, regular contact with
a doctor, registration on the central methadone register, and the consumption
of an oral dose on the bus. Unlike higher threshold methadone programmes, there
were no waiting lists, no counselling and no urine testing once enrolled, drug
users had simply to turn up at the right time and place and methadone was dispensed,
usually on a maintenance schedule. When
the low threshold methadone programme was first established it was envisaged that
it would have a stabilising effect on behaviour. It was also believed that after
an initial period drug users would move on to the higher threshold out-patient
methadone clinics which make greater demands on patients and require drug users
to give up illicit drug use, participate in regular urine testing, attend counselling
and eventually take up drug-free treatment. While a proportion of drug takers
have made this move, the city of Amsterdam in particular was faced with an aging
group of drug takers who failed to make the transition into these higher threshold
treatment facilities. Ways of encouraging this transition are currently being
considered. In spite of these kinds of problems, the treatment policy has achieved
one of its principal aims. For example, in Amsterdam it is estimated that 70%
of drug takers have some contact with treatment agencies, with over half receiving
methadone from the Municipal Health Service (14). In
addition to the low and high threshold methadone programmes, about half of the
400 family doctors also prescribe methadone in Amsterdam. Interestingly, the role
of the family doctor in relation to prescribing has changed. In 1976, the Dutch
Health Council argued against family doctor involvement in prescribing because
of the potential for manipulation by addict patients. However, in the major cities
their role has been reassessed because they are thought to have a closer relationship
with patients and have a better knowledge of primary health care requirements.
There are also sufficient family doctors to avoid the congregation of addicts
which specialist centres have inadvertently encouraged, and dispensing methadone
to "drug tourists" can be avoided, as only patients registered with
a family doctor can be prescribed methadone. 3.5
The Interface between Criminal Justice and Treatment Agencies Over
time views about the efficacy of drug treatment as a method of reducing the demand
for drugs has changed. During the 1970s, it was envisaged that treatment would
lead to abstinence and reduction in demand, however, during the 1980s it became
clear that this had not happened. Drug treatment became less central in the strategy
with education playing an increasingly important role. The role of law enforcement
in demand reduction reamined peripheral. However, in spite of police and prosecution
policy which had largely decriminalised drug use, the number of drug users sent
to prison, either for more serious Opium Act offences or property offences, such
as theft, increased. Towards the end of the 1980s, almost half of the inmates
in Dutch prisons were thought to have a drug problem twice as many as in 1979
(15). Most drug
users entering prison at this time were receiving methadone prior to their detention,
and the majority were initially prescribed methadone in prison (on a reduction
schedule). However, a drug-free detention programme had also been established
about 10 years previously. This programme was set up initially in remand houses
and aimed to: 1.
prevent drug use and trafficking in prison 2.
support drug users through drug withdrawal 3.
prepare drug users for moving into after-care facilities. Since
that time, an increasing number of drug-free wings have been established in prisons.
Drug-free wings offer inmates special help with a drug problem, and for highly
motivated prisoners there is the opportunity to attend clinics outside prison
before their sentence is completed. Entry to a drug-free wing is dependent upon
agreement to participate in voluntary urine testing 3 times a week. In December
1988, a mandatory urine testing scheme (on a less frequent basis) was also introduced
across the whole prison selvice. In addition to reducing differences between drug-free
wings and the rest of the prison system, this is also part of a strategy aimed
at reducing the amount of illicit drug use in prisons, and links with a scheme
to notify the public prosecutor whenever drugs are found in prison. But
how appropriate are prisons for the treatment of drug users? A report from the
Dutch Govemment's Scientific Advisory Council concluded that effective treatment
could take place in prisons, yet recommended that special prisons be established
specifically for this group of offenders. However, over and above practical problems
such as the identification of offenders with a drug problem (and what to do with
short stay prisoners), this recommendation runs directly counter to Dutch Government
drug policy which aims to assimilate drug users rather than isolate or segregate
them. And so,
in response to the growing population of drug users in prison, health and justice
Ministers recently recommended that drug users who commit drug-related property
offences should, wherever possible, be offered treatment as an altemative to imprisonment.
Failure to comply with treatment requirements would result in reinstatement of
the original prison sentence. 4.
DOMESTIC DRUG CONTROL POLICIES IN SCOTLAND Drug
control policy in Scotland is essentially the same as for the rest of the UK.
However, because of differences in legal structure the application of policy appears
to be qualitatively different. 4.1
Scotland Scotland
is a small country with a population of approximately 5 million. The country is
divided into 8 regional areas, but the majority of the population lives in the
central belt which includes the 2 major cities, Glasgow and Edinburgh. Scotland
once had a substantial industrial and manufacturing base but the world-wide recession
in the early 1970s caused large scale closures in the ship building, engineering,
mining and steel industry which resulted in high levels of unemployment, particularly
in Glasgow and Dundee. New jobs were created in light industry and in the financial,
service and tourist sectors during the 1980s, but the national unemployment rate
still remained high at 7%. 4.2
History of Drug Taking in Scotland The
use of illicit drugs first became common in Scotland during the early 1960s. Cannabis
products were used most often but other drugs like LSD and amphetamine were also
available. Many Scottish studies at this time focused on the student population
with whom drugs were most commonly associated (17), but in Glasgow cannabis and
LSD were also used by small groups in outlying local authority housing schemes.
Opiate use first
began in the late 1960s, probably amongst a very small number of Scottish drug
users who had London connections. Over the next decade the number of heroin users
rose but was contained within a group many of whom were prescribed substitute
opiates (methadone or morphine) and were therefore well known to existing treatment
agencies (18). As far as can be determined there was no evidence of a substantial
black market until 1980, when there was a large influx of Iranian heroin. This
was quickly replaced by heroin from Pakistan and Afghanistan. The number of drug
injectors rose rapidly and, by 1983, Glasgow was estimated to have a drug injecting
population of 5,000 (19). In the following year, Edinburgh was estimated to have
a minimum opiate using population of 1,500 and probably considerably greater (20).
There are no reliable estimates of prevalence of opiate use for Scotland as a
whole, but projections based on population density and an urban to rural spread
give an estimated population of about 13,000 in 1988, and 17,000 in 1989 (21)
During the 1980s,
injecting rates amongst Scottish drug takers were estimated to be between 70%
and 80% and, although many may have preferred heroin, a wide range of other drugs
were taken depending on availability. After 1985, there was a shift from the use
of black market heroin to pharmaceutical opiates, such as Temgesic (Buprenorphine)
and Dihydrocedeine. The use of Temazepam, a Benzodiazepine, also became very common
(23). 4.3 Scottish
Drug Legislation The
development of UK drugs legislation followed a similar pattern to most other European
and North American countries and the Dangerous Drugs Act of 1965 reflected the
requirement of the Single Convention agreement. Under this Act, cannabis and heroin
were seen as equivalent with maximum penalties for offences set at 10 years. Amendments
to the Act in 1967 extended police powers of search and arrest. The
current legislation concerned with the control of the use and supply of drugs
is the Misuse of Drugs Act. This was passed by Parliament in 1971, and its main
provisions came into operation in 1973. This Act replaced all the provisions of
the Dangerous Drugs Act, and contained two important changes in the interpretation
of drug offences. First, there was a shift from what had been loosely defined
as "dangerous drugs" to "controlled drugs" which were now
classified as Class A, Class B or Class C. And second, a clear distinction was
made between possession of a controlled drug and supply offences (24). Except
for additions to the list of controlled drugs and alterations to the penalties
attached to offences, the Misuse of Drugs Act remained unchanged for 12 years.
But in 1986, the maximum sentence for trafficking in Class A drugs was increased
from 14 years to life imprisonment. Table
2 outlines the penalties currently attached to each class of drug. 
In the same year,
the schedules which specify exemptions to the Act, and indicate whal counts as
an offence, were extensively reorganised in order to allow the inclusion of the
Benzodiazepines (minor tranquillisers) as Class C drugs. This reorganisation of
the schedules has made the Misuse of Drugs Act an extremely complex instrument.
The main difficulty is that the class of drug which determines the penalty is
now independent of the schedule which indicates when an offence has been committed
with a particular drug. For anyone wishing to understand the implications of changes
in the schedules, the classification of drugs within the regulations which now
define what counts as an offence - the Schedules differ from the classifications
of drugs within the Act used to specify maximum penalties that is the Class. Table
3 provides a summary of how the 2 classification systems relate to each other.
Table 4 outlines
the availability of controlled drugs and the offences which can be committed under
the new regulations. The drugs specified in Schedule 1, including cannabis and
LSD, are the most strictly controlled by law. None of the drugs in this category
are authorised for medical use. However, they may be supplied, possessed or administered
under license, but only in special circumstances, for example research (25). 
The drugs specified
in Schedules 2 and 3 include the majority of controlled drugs which are available
for medical use. Under the regulations, it is a criminal offence both to possess
them without a prescription or to supply them to other without proper authority.
On the other hand, Schedule 4 drugs such as the Benzodiazepines, may be possessed
without a prescription providing they remain in their medicinal form, but if prepared
for injection a criminal offence is committed. It is also an offence to supply
or possess these drugs with intent to supply. In
addition to the changes in the Misuse of Drugs Act, other new legislation was
introduced which radically extended powers to confiscate the proceeds of drug
trafficking. The English Act, the Drug Trafficking Offences Act, became law in
1986, while the equivalent Scottish legislation was contained in the Criminal
Justice (Scotland) Act 1987 which came into force at the beginning of 1988. The
main thrust of the legislation was to extend powers to enquire into personal financial
affairs, to seize bank accounts and to permit confiscation of proceeds from drug
trafficking. Moreover,
after an accused has been found guilty of trafficking, the onus is now on the
individual rather than on the prosecution to prove that assets are from legitimate
sources and not derived from the proceeds of drug trafficking (26, 27). By contrast,
housebreakers, for example, even if proven guilty of one charge of housebreaking,
do not thereafter have to demonstrate that their residual assets are not the product
of other housebreaking. 4.4
Prosecuting and Sentencing Policy The
ethos which underpins the Scottish system of criminal justice is one of autonomy
and independence. Furthermore, the policies of the three agencies, the police,
the public prosecutor (Procurator Fiscal Service) and the judiciary, are not influenced
directly by Government directives or guidelines. However, a study of the sentencing
of drug offenders in Scottish courts conducted in 1988, concluded that during
the 1980s there was a shift in policy which resulted in an increasingly punitive
response to both drug users and drug traffickers (28). This
study found that concurrent with an increase in heroin use between 1980 and 1986
came a sharp increase in the number of drug prosecutions. While the great majority
of offenders were prosecuted for possession of cannabis products (usually small
quantities of cannabis resin), there was also a sharp increase in the number of
prosecutions for offences involving opiate drugs and/or drug trafficking. Before
1980, many of these were referred to the High Court. In 1980 less than 1% of High
Court criminal prosecutions involved drug offences but by 1986 the proportion
had reached 27%. Mean sentence lengths for convicted drug offenders rose dramatically
from 321 days in 1981 to a peak of 1,132 days in 1984 and then fell gradually
in the following years to 712 in 1987. To
some extent both the increasing drug workload in the High Court and the increase
in mean sentences for convicted drug offenders reflected an increase in the seriousness
of offences committed. However, Scottish judges who were interviewed in connection
with the study indicated that many of those convicted of trafficking offences
at this time were drug users who sold drugs to finance their habits. In
spite of this, severe exemplary sentences were imposed and a prison sentence of
4 years might be expected by a drug user who was supplying small quantities of
opiate drugs. Similarly, for the supply of 500 grammes of cannabis resin a 4 year
sentence might also be expected. In
addition to severe sentences passed on offenders convicted of drug dealing, what
has characterised the Scottish response has been an increasingly literal interpretation
of the 'supply offences' contained within the Misuse of Drugs regulations. And
so, the "intent to supply it to another" in Section 5 (3) of the 1971
Act was often inferred (by judges and juries) from quantity alone, in the absence
of financial records, scales and means of packaging. As a consequence, a drug
user in possession of more than one or two days supply, put himself in danger
of being held to have the intent. At the same time, drug users were convicted
under Section 4(3)(a) of the Act (to supply a controlled drug) when the evidence
indicated that they had only shared drugs with a friend. Finally, "to be
concerned in the supplying" of a controlled drug (Section 4(3)(b)) might
be inferred, if directions were given to another indicating where drugs might
be purchased. These interpretations of the Misuse of Drugs Act Regulations brought
many drug users within the operational definitions of 'drug dealing' employed
by the police and the Crown. 4.5
Drug Treatment Policy Specialist
drug dependency units or treatment centres were first set up in Scotland during
the late 1960s. They were often linked to alcohol units and were run by psychiatrists
who provided both out-patient services and some in-patient detoxification. As
in English drug dependency units, substitute opiates were usually prescribed to
patients attending Scottish clinics. This practice of prescribing drug substitutes
to addicts was known as the British System of Containment and, until the mid-1970s
when drug use in England began to increase rapidly, was generally regarded as
highly successful in limiting the spread of drug use (29). Indeed,
this was the case in Scotland during the 1970s when drug use was largely contained.
Heroin use was confined to small numbers in urban centres, and the majority of
users were known to drug treatment agencies. Nevertheless amongst Scottish clinicians
there was some unease about the prescribing of substitute drugs and, during this
period, there was a gradual shift in prescribing policy. This included changes
away from: prescribing
diamorphine (heroin) to prescribing methadone (a synthetic opiate) prescribing
injectable to prescribing oral drugs maintenance
prescribing schedules to reducing schedules. Although
there was regional variation in prescribing policy, Scottish clinicians were gradually
moving from the idea of containment through prescribing achieving abstinence by
drug-free counselling. And by the early 1980s, when Scotland experienced its first
sharp increase in heroin use amongst the young unemployed, legitimate substitute
drugs were often impossible to obtain. In
response to the growing number of heroin users in Scotland, central government
funding was made available to establish a range of services in Scotland's major
cities- Glasgow, Edinburgh and Dundee. Many of the projects funded were community-based
services which offered support and counselling for drug users. This represented
a significant shift away from the medico-centric response of the late 1960s and
1970s (30). By
the end of the 1980s, a network of services had been established in Scotland,
ranging from drop-in centres to day programmes and residential rehabilitation
centres. There was also a growth in volunteer, self help and parent support groups.
The aims of these services were wide-ranging but during the 1980s the emphasis
of most drug treatment was towards abstinence with prescribing playing only a
tiny part. For example, in 1988, Scotland was estimated to have a drug injecting
population of about 13,000 (21), however at the end of that year only 187 drug
users were recorded as receiving noiifiable drugs as part of treatrnent (32).
In 1986, the
discovery of HIV amongst a large number of drug injectors first in Edinburgh (38)
and then in Dundee (34) led to a significant shift in treatment policy. As in
The Netherlands the majority of drug treatment agencies regarded HIV as a greater
danger than drug use, and as drug injectors would not necessarily achieve 'drug
abstinence' overnight, the primary focus of much of their work shifted from abstinence
to harm reduction. Needle exchange schemes were established which aimed to reduce
needle sharing and the risk of HIV transmission by making new injecting equipment
more available to injecting drug users. In addition, the non-prescribing policy
was gradually reversed in some cities. 4.6
The Link between Treatment and Punishment The
presence of a large number of drug users in Scottish prisons has caused considerable
concern because of the possible spread of HIV infection (31). Reports of illicit
drug use in prison has resulted in calls for prescribing substitute drugs and
the distribution of clean injecting equipment there. The latter proposal has been
rejected. However, a pilot drug reduction programme has been established at Saughton
Prison in Edinburgh together with an agreement in principle to establish similar
schemes in other prisons. In
the Government Green Paper, Punishment, Custody and the Community, the link between
opiate use and a wide range of offending behaviour was also noted and it was suggested
that: 'Although
more co-ordinated and intensified effort is being put into the care of drug misusers
who go to prison, the chances of dealing effectively with a drug problem are much
greater if the offender can remain in the community and can undertake to co-operate
in a sensibly planned programme to help him or her come off drugs' (36). And
in the White Paper, Crime, Justice and Protecting the Community that followed,
the value of supervision of drug taking offenders in the community was noted.
In particular, it was reported that: 'The
Government will take the opportunity to clarify other powers of the courts on
probation orders. It will be made clear that probation orders may include a condition
of treatment designed to reduce an offender's dependence on drugs or alcohol'
(37). The recommendations
contained in the Green and White papers were only directly relevant to England
and Wales. However, in Scotland, some judges did already hold the view that contact
with the criminal justice system could be used as a lever into treatment, with
attendance at a drug treatment service added as a condition of a probation order
or deferred sentence. However, this was by no means a well established practice,
and was dependent upon the knowledge of individual judges and the policies and
practices of drug treatment agencies involved. Furthermore
the interpretation of the Misuse of Drugs Act brings the majority of drug users
well within the operational definition of drug dealing which was punished severely
in the courts. 5.
CONCLUSION: INTERNATIONAL DRUG CONTROL POLICIES COMPARED 5.1
Summary of Dutch Drug Control Policy The
domestic drug control policy which was established in The Netherlands during the
1980s has been described as both pragmatic and tolerant. Pragmatic because realistic
goals were set for both law enforcement and treatment agencies. Tolerant because
policies sought to assimilate and normalise the deviant group rather than reject
and isolate it. The principal features of Dutch domestic drug control policy at
this time were: 1.
differentiation in the drugs legislation between cannabis products and drugs which
pose "unacceptable" risks, which resulted in the decriminalisation of
cannabis products. This, in principle, separates cannabis from the "hard"
drug scene. 2.
differentiation and prioritisation of law enforcement policy, which focused law
enforcement resources on drug traffickers rather than drug users, and resulted
in an operational policy of non-detection and non-prosecution of "hard"
drug use. 3.
the use of the threat of penal sanctions as a lever into drug treatment for some
groups of offenders. 4.
the provision of an extensive and highly developed network of treatment services,
ranging from low threshold methadone programmes to drug-free treatment centres.
5. prioritisation
of treatment aims into: contact, harm reduction and stabilisation of drug use,
rather than abstinence. Although
generally accepted in Holland, the Dutch drug control policies have received considerable
criticism from politicians abroad, particularly those from America and Germany.
In response to this criticism, the Dutch have established a programme to promote
their approach. This resulted in a coherent, well argued and well documented policy
which is gaining increasing acceptance at a European level. Much
of the criticism stems from a basic misinterpretation of policy, and a misunderstanding
of the mechanisms of social control. "Pragmatic" has been misinterpreted
as "liberal", and "tolerant" as "Laissez-faire"
with the result that the Dutch situation has been perceived as chaotic and out
of control. However,
an alternative view fits more closely the relevant facts. This asserts that far
from being out of control, a structure of social control through intensive surveillance
and early identification of changing patterns of use permitting rapid intervention
when necessary. This is publicly recognised in The Netherlands (16) 5.2
Summary of Scottish Drug Control Policy During
the 1980s, Scottish drug control policy shifted from one of containment through
prescribing to criminalisation. As opiate use increased in the early 1980s, the
availability of legitimate sources of opiates decreased. Concurrent with this
came an increase in the penalties attached to all drug offences and a shift in
prosecution policy which brought many drug users well within the operational definition
of drug dealing which was then dealt with severely in court. The principal features
of Scottish drug control policy at this time were: As
can be seen the aims of the treatment and criminal justice agencies in Scotland
were therefore in conflict, and this resulted in considerable variability in outcome
for drug users who come into contact with the criminal justice system. Drug users
convicted of offences involving dishonesty, for example, were often treated quite
leniently by the courts. The majority of those convicted of drug offences were
likely to be treated severely. There
was some recognition of the potential for using contact with the criminal justice
system as a lever into treatment but it did not develop into policy. Such an approach
can only be successful if: 5.3
Summary of American and German Drug Control Policies By
the end of the 1980s Scottish and Dutch drug control policies were by no means
at either end of the spectrum, and, indeed, shared some features. In particular,
both recognised the role that harm reduction strategies can play, and that the
criminal justice system can function as a useful lever easing users into treatment.
In the US, however,
the idea of using the criminal justice system to lever individuals into treatment
was taken a stage further with their concept of "civil commitment".
There, any medical practitioner or judge has the power to commit a "drug
addict" to compulsory treatment, whether or not the individual so wishes
(38, 39). However, while such treatment may reduce criminality and levels of drug
taking (40), compulsory treatment is impractical without an adequate number of
treatment "slots", and agreed criteria for measuring improvement or
cure. Ultimately, it is also undesirable on grounds of the infringement of human
rights which is an inevitable accompaniment of any compulsory treatment programme.
In the US, compulsory
treatment was also supported by the rhetoric of the "war on drugs",
which, amongst other aims, intended to reduce the demand for drugs by marginalising
the drug user. Interestingly, the Bennett Report which was published in 1989 contained
proposals which, if enforced at State level, would even marginalise casual and
occasional drug users. Following the "zero tolerance" policy, anyone
caught using or buying even small quantities of illicit drugs would be subject
to the following penalties: suspension
of driver's licence for 1-5 years suspension
of state benefits (student loans, grants, contracts) for 1-5 years criminalisation
of attempts to buy and sell drugs (without any evidence of consummation of sale
or purchase). The
Bennett Report further recommended that all state and municipal employers should
be required to take punitive action against any employee found to be a drug user.
Action might include suspension, termination or enrollment in drug treatment programmes.
In addition, States were encouraged to review their legislation to facilitate
the eviction of convicted drug users and dealers from public housing. These proposals,
if introduced, when combined with aggressive policing could marginalise users.
Whether, in the long term, this will reduce demand, or, as seems more likely,
foster the creation of a parallel underclass, whose members are permanently denied
the benefits of membership of mainstream society, remains to be seen. West
German drug control policy was similar to that in the US, in the sense that it
adopted a highly repressive and punitive police response to both drug use and
drug dealing. However, the West German attitude to treatment is more similar to
that of Scotland, with the development of a range of treatment options with a
social rather than medical orientation. This is in part because the prescription
of methadone is illegal. However, in response to growing alarm over high levels
of HIV infection amongst drug users there was a shift in thinking. HIV positive
drug users began to be prescribed methadone towards the end of the 1980s. Many
Germans also believe that decriminalisation and substitute prescribing will have
a more central role in the future. In 1988, German policy was in a state of flux
and this, combined with unification with East Germany, makes predictions about
the possible direction of German policy impossible to make. 5.4
Towards a Consensus Consensus
over international drug control policies is matched by variation at the domestic
level, which has its roots in national cultural and structural differences. Yet,
there is a growing recognition that at least some European harmony needs to be
fashioned at the level of domestic drug control policy. The
Dutch have a coherent criminal justice and treatment response to drug taking,
which works very well despite adverse international publicity. Given the negative
publicity of The Netherlands as "Europe's 'drug capital"', in 1989 there
was no evidence to support the inference that the Dutch somehow had a larger drug
'problem' than other countries. Indeed, if we draw together available estimates
of drug use in Scotland and The Netherlands such evidence as exists suggests that
Scotland had a higher prevalence of drug use. Scotland's
drug problem began 10 years later than that of the Dutch (The Netherlands witnessed
marked rises in prevalence from the early 1970s), and is expected to stabilise
during the l990s. Nevertheless, available evidence indicates that the prevalence
of drug use in Scotland will stabilise at a much higher rate that that reached
in The Netherlands. This is likely in spite of a highly punitive criminal justice
response to drug taking in Scotland during the 1980s. The
development of a European drug policy for the 21st century should not ignore the
components of the Dutch model which have been a success. Perceptions
of Drug Control Problems and Policies: A
Comparison of Scotland and Holland 
Sources: The
Netherlands data is described in § 2.2, and the Scottish data in § 4.2. Neither
is particularly or necessarily reliable, and is merely the best available. The
Scottish data used here is very conservative when compared with IVDU per 100,000
rates which might be deduced from other studies. For example , Ditton and Speirits
estimated that Glasgow had perhaps 1,000 IVDUs in 1981 (18); Haw that Glasgow
had 5,000 IVDUs in 1983 (19) and, most recently, Frischer that Glasgow had 9,424
IVDUs in 1989. These imply a rate of IVDUs per 100,000 Glasgow population of 86
in 1981, 432 in 1983 and 816 in 1989. The rates used in the following figure are
derived from the analogical epidemiological projection model referred to in Ditton
& Taylor, (21). This model conservatively estimates a rate of IVDUs per 100,000
for Glasgow for the same years as: 36 (1981), 136 (1983) and 616 (1989). BIBLIOGRAPHY |
