The Scottish Government

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Chapter 1: Setting the Scene

Introduction

As part of the Scottish Executive's Drug Misuse Research Programme ¹ the Effective Interventions Unit ( EIU) worked with the Scottish Drug Enforcement Agency ( SDEA) to develop specific proposals that culminated in an initial research focus on low-level drug markets. As part of this the EIU² reviewed the international evidence on the effectiveness of interventions to reduce the impact of low-level drug markets. This highlighted the need for a detailed picture of experiences in Scotland, and a common approach to reduce drug-related harms.

To provide a picture of experiences in Scotland three case-study areas were chosen. The areas were selected based on a number of factors. Firstly, the willingness of local bodies to engage in such a process, and secondly the perceived impact of illicit drugs on the neighbourhood and community, combined with social, economic and demographic characteristics. The areas finally selected were deemed to be those that would provide the most detailed picture of interventions against low-level markets and drug-related harms. All three were considered locally to have issues pertaining to the buying and selling of heroin (and associated drugs), whilst being socio-economically diverse. To safeguard their identity, the names of all three areas have been changed.

The buying and selling of heroin within a community can create significant drug-related harms. These may be direct harms resulting from drug use, affecting users, families, neighbourhoods and communities, or unintended harms resulting from the implementation of interventions against low-level markets. By focussing upon the buying and selling of a drug where a reduction in the number of users is likely to have a major impact on related harms within a neighbourhood and community, the effectiveness of interventions could be understood.

The objectives of the report are to provide data on:

• The extent, breadth and culture of local drug markets in the case-study areas.
• The impact of drug dealing on the local communities.
• The nature and impact of policing, and other interventions on low-level drug dealing.

Police enforcement, or supply reduction interventions were a particular interest of the research, as they are the main focus of UK drugs policy ³. The approach taken acknowledged that by looking to reduce the number of heroin users, policing approaches may reduce harms, and indeed the importance of including demand and harm reduction interventions within police strategies. The research aimed therefore to examine and interpret the data from interviews with respondents to assess its contribution to developing policy that is both realistic about the ways of reducing the prevalence (scope and scale) of drug use, and also committed to reducing drug-related harms.

Definitions

Low-level drug markets

"Low-level drug distribution networks are the crucial means by which drugs become available within a neighbourhood - these networks operate both by sustaining existing drug-using subcultures, and also by recruiting new users ⁴".

Low-level drug markets are the settings where the greatest volumes of drug transactions occur and subsequently where drug-related harms within communities are more likely to be felt. They are also of a diverse and often fluid and hard to predict nature. In spite of this, a distinction between 'open' and 'closed' forms is widely recognised internationally.

Put simply: open markets are where dealers will sell to anyone who approaches them, whilst closed markets are the opposite, where dealers will sell only to people known to them. This distinction can be further sub-divided to include 'residential' and 'street' markets. The terms open and closed can be considered to imply the entry requirements to a market, whilst residential and street - the situation in which such markets take place. A residential market may, for example, be closed or open. Street markets are commonly associated with open dealing, but could be of the closed form based on prior arrangements between known individuals.

Market 'structure'

The nature of a market concerned with the buying and selling of heroin may be complicated by individuals acting as both users and low-level dealers. One study in England has certainly provided evidence on this ⁵, using treatment outcome data, whilst anecdotal evidence collected from police officers for another report suggested that the majority of known low-level dealers are dependent users ⁶.

A classification of the activities of individuals within the buying and selling of heroin is important to assess market development and maintenance, particularly with regard to supply reduction interventions. What is, for example, the effect of removing a number of individuals dealing? By proposing a sliding distinction based on the preference of activity with regard to the use and dealing of heroin, an idea of low-level dealing can be gained, with a measure of the intended and possible unintended effects of police enforcement.

With any classification there is a difficulty concerning how the distinctions are set between categories. This is no different for illicit drug markets. If an individual is both a user and a dealer of heroin it may be difficult to assess which is the primary activity. It is impossible to base this on the amounts sold or used by an individual, as there are difficulties in measuring any identified variance. The following classification is drawn from a combination of previous and current research in the field.

'User'

A 'user' is a person dependent on heroin who finances their use through means (licit and/or illicit) other than dealing.

'User/dealer'

This is an individual who is heroin dependent supplementing other sources of income by occasional involvement in dealing. It is likely to be low-level in nature and for limited, unpredictable time-periods. User/dealers are generally independent and not working for another individual. Funds for dealing may be derived from numerous illicit and licit means.

'Dealer/user'

Within a low-level market there will be heroin dependents/recreational users who are first and foremost 'dealers'. Their access to quantities of heroin means that they can maintain their use, whilst looking to acquire a profit. Within a given area, a 'dealer/user' may supply numerous 'user/dealers' and/or other 'dealer/users'.

'Dealer'

A 'dealer' is solely concerned with making profit by transferring quantities of heroin. It is unlikely that they would have anything other than an indirect involvement (through the supply chain) in low-level markets. They are unlikely to use the drugs they deal, except recreationally in some cases.

Background and context

Existing policy

The international evidence base highlights supply reduction, demand reduction and harm reduction as the three broad goals of interventions in low-level drug markets. These approaches are not mutually exclusive and should by no means be seen as distinct. Supply reduction, for example may reduce drug-related harms by limiting the number of users, or the prevalence of markets.

Despite an increasing emphasis being placed on demand reduction, supply reduction interventions are still the primary focus of UK drug policy ⁷. It is difficult to find in 'Western' democratic societies examples of policing having a sustained impact on supply, and thus on drug-related harms ⁸. It has been reasonably argued that policing does not actually reduce the prevalence of low-level drug markets, but its presence does contain the expansion of them ⁹.

Following this line of thought with regard to supply-side interventions would imply that within a given community a level of drug use will remain, together with the consequent drug-related harms. Accordingly, these interventions should be measured in terms of how they reduce drug-related harms at the level of the local communities, such as the incidence of associated crime.

The potential of policing activities to create unintentional harms, such as increasing the risk of harm to drug users through the substitution of different and more dangerous drugs, or unsafe injecting practices must also be considered. Intensive enforcement may in addition lead to market displacement into neighbouring areas. Ultimately policing must be subject to the following:

"The net outcome of supply-side interventions should be assessed not only on prevalence and containment levels but on whether the anticipated harm from illegal drugs would have been significantly higher than the harm resulting from the intervention itself ¹⁰".

Reducing drug-related harms

Supply-side interventions are no longer seen, either within international evidence or within current innovative examples in England, as effective towards reducing drug-related harms and thus improving individuals' quality of life ¹¹. An approach linking intervention in supply with demand reduction to reduce drug-related harms is seen as the way forward. This acts to co-ordinate, target and link supply-side interventions with those of treatment provision, ensuring any disruptive effect the police have on a market is capitalised on and sustained by providing treatment and support to those drug users affected by it ¹².

A particular example of the failings of linking demand reduction initiatives with supply reduction is provided by the Australian Heroin Drought. Due to a number of circumstances, including police activity, weather conditions, falling harvest yield and the marketing decisions of traffickers, a drought occurred ¹³. During this time there was a rise in the availability of methamphetamine, whilst the availability of heroin decreased, with an associated price increase.

The failure to provide adequate demand-side reduction initiatives to capitalise on this by persuading users into treatment was seen to have 'led' users onto using methamphetamine, and contributed to a rise in property crime and an increase in unsafe injecting practices for heroin users ¹⁴. The demand for heroin was not seen to change with price, and thus the reduction in supply, with its associated price increase led to further drug-related harms.

Drugs and crime

A particular area of concern for policy makers in England has been drug-related crime, by which we mean activities that exclude violations of drug-laws, but include those that are committed by people who are using drugs, or in the course of buying and selling ¹⁵. This can be seen as a major factor guiding the response of linking police enforcement interventions, with those of treatment and support for drug users. Such an approach raises the potential of reducing drug-related harm both to drug users and to the wider community by capitalising on any decrease in the availability of drugs.

There is a body of thought that drug policy proposals should not offend the fundamental cultural or political values of a society by meeting a 'political standard' ¹⁶. The Drug Intervention Programme ( DIP) in England arguably meets this credential, showing local communities that bear the brunt of drug-related crime that they are not invisible. It also provides a targeted and co-ordinated response to reducing drug-related harms that affect individuals' and communities' quality of life.

Drug-related crime, and the links between drugs and crime is a complex issue. Some commentators argue that there is an 'economic compulsive' link between the two, whereby crimes are committed by users to fund their drug use ¹⁷. This would lend weight to supply-side interventions to reduce use and the need for criminal acts to fund it. However, it could also increase drug-related crime if amongst dependent drug users the demand does not change with price.

The 'economic compulsive' link has been challenged concerning its argument for a simple linear relationship between the use of drugs and the onset of crime ¹⁸. There may instead be non-causal connections between the two. Criminal activity may predate drug use, whilst criminal acts may amplify drug use by providing increased income. A number of commentators have argued that drugs are not causally linked to crime, but underlying social factors, such as socio-economic deprivation produce both problematic drug use and crime ¹⁹.

Initiatives aimed at reducing drug-related crime should not be discouraged. There is likely to be diversity amongst dependent drug users on whether the use of drugs causes 'economic-compulsive' crime, or on the presence of non-causal connections, or underlying social factors - where measures to reduce crime generally may prove to be more effective.

An example of a particular initiative concerning drug-related crime is the Tower Project in Blackpool, which aims to lead persistent offenders into treatment. It is based on the premise that many persistent offenders frequently use drugs, and drug dependence may intensify offending. An independent evaluation ²⁰ of the scheme showed it can act as a 'crackdown consolidation' approach to sustain earlier falls in crime. However, the evaluators found it was difficult to attribute the significant fall in local recorded crime since its introduction solely to the project's activities, or to those of the police more widely.

The 'economic compulsive' link has shown a ratio of between 9.5:1 and 18:1 (depending on the assumptions used) of benefit to cost for treatment provision, with the vast majority of benefits coming in the form of reduced crime ²¹.

Treatment may reduce the incidence of drug use and associated crime, but it does not necessarily reduce the lucrative nature of drug markets. The Derbyshire Drug Market Project aimed to produce a shortage of heroin by arresting all known heroin dealers, to maximise the potential for treatment. However, market replacements were so easily found that no significant reduction in the availability of heroin was reported for treatment provision to capitalise upon ²². This may be particularly apparent if current and potential dealers downplay the risks of dealing - namely police enforcement - and overestimate the rewards ²³. In this regard, supply and demand-side interventions may not prevent people getting into drug use and crime in the first place ²⁴.

Summary

The aim of this report is to understand within the existing policy paradigm what works and what does not in terms of interventions in low-level drug markets aimed at both reducing direct drug-related harms, and limiting any level of unintended harms associated with action taken.

It is important to assess the nature of heroin markets, and particularly in regard to supply-side interventions to understand the actions of market participants in buying and selling, and how markets develop and are maintained.

Equally important is an understanding of the effect of a heroin market on the wider community within which it is located, and how community members view enforcement and other responses to this market.

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