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UK, remember your settings and improve government services. We also use cookies set by other sites to help us deliver content from their services. You have accepted additional cookies. You can change your cookie settings at any time. You have rejected additional cookies. This publication is licensed under the terms of the Open Government Licence v3. To view this licence, visit nationalarchives. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. My independent review of drugs, commissioned in February by Sajid Javid then Home Secretary , was to be in two phases, an up-to-date analysis of the problems and then recommended policy solutions. This publication summarises the work from phase one, which included many months of rigorous and groundbreaking analysis to understand the complex and overlapping markets for illegal drugs. I took a market approach because the supply of drugs is driven by profit, and violence is often the result of competition for market share. Only by understanding the market and the drivers behind it can Government hope to disrupt it. For example, the growth in the county lines appears to be largely caused by market saturation in the big cities. It has exploited vulnerable people, especially the young. Some 27, young people now identify as gang members, many drawn into drug dealing, often with deadly consequences as the supply and distribution of drugs have become increasingly violent. There is a very tragic human story behind this market analysis. Drug deaths in were the highest on record. Since heroin-related deaths have more than doubled, while deaths involving cocaine have increased five-fold. We have the highest number of rough sleepers dying on our streets from drug poisoning since records began. Long-term drug users are cycling in and out of our prisons, at great expense but very rarely achieving recovery or finding meaningful work. Many of their children are taken into care. Problem drug use is highly correlated with poverty, and these problems blight our most deprived communities. I have seen first-hand, in prisons, schools, youth clubs and charities, the effects of increasing supply, greater drug purity and easier availability, combined with the loss of many protective factors — a perfect storm, to abate only if the Government takes action. Treatment services have been curtailed by local government funding cuts. So the amount of un-met need is growing, some treatment services are disappearing, and the treatment workforce is declining in number and quality. Previous Governments have de-prioritised these problems - from drugs entering the country right through to helping drug users access appropriate treatment and achieve recovery. I hope that the first phase of this review, with its thorough analysis of the market and assessment of areas for further policy investigation, will provide a firm platform for decisive action by the new Government. Many Government officials, organisations and individuals gave us of their time and expertise, and my challenge group held up a very necessary mirror to the work. My especially grateful thanks go to those men and women, living on our streets in our prisons or in shelters, who shared their stories, dreams and hopes. I very much hope that, moving forward from this review, we shall not fail them. Drug deaths have reached an all-time high and the market has become much more violent. The drugs market consists of a number of distinct but overlapping product markets. Most drugs consumed in the UK are produced abroad. The supply of drugs has been shaped mostly by international forces, the activities of Organised Crime Groups and advances in technology. There is an ageing population of heroin users with severe health needs, some of whom are using crack cocaine too, but there is also a new population of younger crack cocaine users that do not use heroin. The heroin and crack cocaine retail market has been overtaken by the county lines model, which is driving increased violence in the drugs market and the exploitation of young people and vulnerable drug users. The demand for powder cocaine is closely linked to that for other recreational drugs, such as ecstasy and amphetamines. Increased use of powder cocaine has been driven by those under The demand for these drugs is strongly linked to the night-time economy and alcohol. The use of new psychoactive substances among the general population has fallen but has increased in vulnerable populations such as those sleeping rough and those in prison. Government interventions to restrict supply have had limited success. All have faced budgetary constraints in the past decade and competing priorities. Even if these organisations were sufficiently resourced it is not clear that they would be able to bring about a sustained reduction in drug supply, given the resilience and flexibility of illicit drug markets. There has been a renewed focus in recent years by the NCA and police forces on drugs in response to the serious violence caused by the county lines model. More than a third of people in prison are there due to crimes relating to drug use mostly acquisitive crime. These prisoners tend to serve very short sentences, have limited time in prison treatment and poor hand-offs back into the community. They are very likely to re-offend. The problems are greatest in male local and category C prisons. New psychoactive substances have become increasingly problematic in prisons. Drug use in prisons is closely linked to the amount of purposeful activity available to prisoners. Treatment in the community is the responsibility of Local Authorities. Spending on treatment has reduced significantly because Local Government budgets have been squeezed and central Government funding and oversight has fallen away. A prolonged shortage of funding has resulted in a loss of skills, expertise and capacity from this sector. Treatment providers often have to prioritise the severe needs of the long-term heroin using population, meaning that services for other drug users have had less investment. Even if more funding became available for treatment which is vital , there would be a lot of work to do to build up capacity and expertise in this market. In addition to dedicated funding, the re-introduction of incentives and levers, and locally held joint responsibility and accountability, would go a long way to regenerate and vitalise the system. Recovery is about more than just treatment. Other factors are equally important, particularly housing and employment. Central Government has funded some excellent pilots to address the complex housing and employment needs of long-term drug users but these are time-limited and small-scale. Young people and children have been pulled into drugs supply on an alarming scale, especially at the most violent end of the market. There are strong associations between young people being drawn into county lines and increases in child poverty, the numbers of children in care and school exclusions. Social media has played a facilitating role. There is a considerable increase in children using drugs, after a long period of a downward trend. Those seeking treatment have a number of complex needs, including mental health needs, that can only be met through a combination of specialist treatment and wider social and health care. The illegal drugs market has long existed but has never caused greater harm to society than now. Drug deaths in were the highest on record 2, The increases have been primarily driven by deaths involving heroin, which have more than doubled since , alongside a five-fold increase in deaths involving cocaine or crack cocaine. We have seen the highest number of rough sleepers dying on our streets from drug poisoning since records began. Many of these deaths also involve alcohol. The high incidence of drug deaths is likely to be contributing to the slowdown in life expectancy in the UK after decades of growth. Huge geographical and socioeconomic inequalities lie beneath these trends, with entrenched drug use and premature deaths occurring disproportionately in deprived areas and in the north of the country. Drugs appear to be a major driver of the national increases in serious violence over recent years. An unprecedented number of very young people have been drawn into the drugs trade. To understand how we got here, we need to analyse the market and assess how it has been shaped by international and domestic forces. There are, of course, several markets at play, many of which interact. We also need to understand where and how Government has intervened and to what effect. These two markets are quite distinct in terms of production and importation but start to overlap significantly in the retail stage of the market, with a growing overlap in the customer base. The heroin market is long established, with a relatively stable number of longterm users approximately , The heroin market expanded rapidly in the s and 90s but the numbers of new users has declined substantially over time. The ageing of the heroin population and their length of drug use is a big factor in the record number of drug-related deaths. Increasingly, long-term heroin users are also using crack cocaine due to rising production and purity of cocaine and much more aggressive marketing of both substances together. There is also a growing market segment of younger crack users that do not use heroin. The estimated number of crack users is approximately ,, with a large proportion of this population also using heroin. Heroin and crack use are strongly linked to deprivation and this drives the geographical distribution of entrenched drug use and premature deaths, described above. Because source production for both products is limited to certain geographical areas, local factors such as political developments and changes in weather conditions can have big impacts on price and volumes produced. Worldwide production of cocaine boomed from , while heroin production boomed three years later. The rise in cocaine production has led to increased competition amongst UK suppliers, increases in street-level purity and increased use of cocaine and crack cocaine. The powder cocaine market in the UK is dominated by Albanian Organised Crime Groups, with their supply network stretching all the way from the source country to individual towns and cities. Powder cocaine is converted to crack much further down the supply chain — near street-level distribution, using basic equipment. Turkish and British Organised Crime Groups dominate the wholesale supply across the country, with some involvement by Albanian groups. At street level, heroin and crack tend to be dealt together. In other areas, many heroin and crack markets have been overtaken by county lines groups. There is also a risk that fentanyl, which has been found in the UK contaminating heroin supply, could become a mainstream drug given its low manufacturing cost, high potency and ease of distribution through the post. County lines is a relatively recent distribution model whereby a group supplying drugs from an urban hub establishes a network with a county location, for example rural or coastal towns which have fewer law enforcement resources than metropolitan areas. Customers in the county location make drug orders via a branded mobile phone line, often controlled from the urban hub. The county lines model of distribution appears to have evolved as a result of market saturation and declining heroin and crack use in big cities. London, Birmingham, Manchester and Liverpool supply the largest number of lines. The areas receiving the largest number of lines are coastal and market towns, such as those in the South East and East of England. The county lines model now stretches all over the country and has largely displaced local dealers, although there is evidence that this model co-exists alongside local dealers in parts of the country. A distinct feature of the county lines model is the use and exploitation of young people often aged and mostly male. Not all young people are groomed or coerced — some see it as their best opportunity to earn money and status. Adult victims of exploitation by county lines are predominantly people with drug addiction and mental health issues. Victims of exploitation are recruited face-to-face but also online. It is a highly adaptable business model, constantly evolving to avoid detection. It is a very violent business model, both for victims and between groups. The rise in the county lines business model seems to be a major factor in increased drug-related violence in the UK, alongside the related factors of the growth in the crack cocaine market and the increasing role of young people in drug supply. Potential future saturation of county lines markets raises the threat of violence still further. As with crack cocaine, the boom in global production in cocaine has resulted in increased levels of purity and increased availability of powder cocaine. The number of powder cocaine users has increased sharply over the past five years. Use has increased across a wide range of demographic groups, but much of the increase in the number of users has been driven by white males aged under Geographically, relative increases in use have been greatest in the South West of England and the East Midlands, with London seeing the largest decrease. The importation and wholesaling of powder cocaine is largely dominated by Albanian Organised Crime Groups, as outlined above. When it comes to retail supply the powder cocaine market diverges from that of heroin and crack, with dealers tending to be older, white and often delivering to venues within the night-time economy. Many powder cocaine users will have accessed the drug through a friend, rather than directly from a dealer. At the retail level, the powder cocaine market is associated with less violence than the markets for heroin and crack, although the supply chain internationally is extremely violent. There is evidence that individuals from county lines are also starting to deal powder cocaine, albeit as a side-line, with anecdotal reports of county lines groups setting up in universities. The increase in powder cocaine use is a growing health concern, with cocaine-related deaths at an all-time high and making up 1 in 7 of all deaths from drug poisoning although some are likely to be crack cocaine deaths — it is not possible for coroners to differentiate. Although most powder cocaine users are occasional users, there is a risk that the increase in prevalence amongst young people will lead to more problematic use in future. Powder cocaine use is a risk factor in crack cocaine use. The involvement of county lines groups increases the risk of both powder and crack cocaine markets growing further. The cannabis market is the single biggest product market in terms of the number of consumers — with over 2. However, with a huge number of users and intermediaries, it is not the most profitable. Cannabis use is widespread across the population, but the majority of users are aged under Higher levels of use are associated with lower incomes and more deprived areas. Cannabis poses a large number of health risks, including psychological and respiratory disorders, particularly given recent increases in potency. The cannabis market is very hard to monitor — there are low barriers to entry and it can be grown and produced almost anywhere. There is no robust data on production but it is thought that for herbal cannabis, domestic cultivation exceeds importation. Resin cannabis tends to be imported. There is a considerable amount of small-scale private production but also a large number of Organised Crime Groups involved in the growth, importation and distribution of cannabis in the UK. Vietnamese groups are known to be involved in human trafficking, where Vietnamese nationals are forced to work on cannabis farms in the UK. There is evidence that young people with heavy cannabis use have been pulled into county lines operations to pay off debts. There are estimates of the numbers of users in England and Wales — , users of ecstasy, , users of amphetamines and , users of New Psychoactive Substances NPS in the last year , with many people using two or more of these substances concurrently. Most users of ecstasy and amphetamines are under There has been little change in the prevalence of use and profile of users over time. NPS use among the general population declined in response to the Psychoactive Substances Act but remains high in rough sleeping and prison populations, particularly for potent synthetic cannabinoids. Synthetic cannabinoids have become a growing problem in prisons, with growing levels of violence, disorder and health issues. They have also contributed to the increased health problems and deaths of rough sleepers. Synthetic drugs, in principle, can be produced anywhere. In practice, ecstasy and amphetamines are produced largely in Belgium and the Netherlands, although amphetamines are also produced in the UK. Synthetic cannabinoids and other NPS are primarily manufactured in China and, to a lesser extent, India. Organised Crime Groups are involved in the importation of synthetic drugs into the country. The dark web has also become an important source of retail supply, especially for NPS outside of synthetic cannabinoids. The retail supply of ecstasy and amphetamines is often based around the night-time economy and is linked to the sale of powder cocaine. Synthetic cannabinoids were sold legally prior to the Psychoactive Substances Act but are now sold by street dealers alongside other substances such as heroin and crack. As identified above, there is a serious risk that potent fentanyls will become an established market in the UK, following the US. This was followed by the Psychoactive Substances Act , which introduced a blanket ban on the production, supply, possession with intent to supply and import and export of psychoactive substances. There are three key enforcement agencies that deal with different stages of the supply chain and with associated violence and exploitation. Each has an important role to play, although changes in the supply of drugs over time have been driven largely by international forces. For example, the purity and price of heroin and cocaine have been determined far more by political and climatic conditions in production countries than by the actions of domestic agencies. The evidence suggests that enforcement activity can sometimes have unintended consequences, such as increasing levels of drug-related violence and the negative effects of involving individuals in the criminal justice system. Border Force is a Home Office command that deals with all threats from individuals and goods at the border. Its activities are prioritised in accordance with the Border Force Control Strategy, which is refreshed on a six-monthly basis and places threats within five categories A-E. There are a number of potential smuggling routes for class A drugs to reach the UK and a range of transport methods used. For example, heroin tends to reach this country from Afghanistan through three different main routes and can be transported by sea, air, post or train. This makes seizure by border control very difficult. Cocaine is most commonly transported from South America to the UK by sea and the quantity seized by Border Force has increased considerably in recent years, although this is likely to reflect an increase in global supply rather than a step change in enforcement activity. These seizures are unlikely to dent the profitability of established Organised Crime Groups but could de-stabilise or deter newer entrants to the market. There has been a significant increase in the use of post and parcel services to traffic drugs across the EU, often linked to web-enabled transactions. Prescribed medicines such as synthetic opioids and drugs available in pill form like ecstasy are often delivered via post and fast parcel. The overall volume of legitimate parcel traffic has increased significantly over recent years, making it increasingly difficult for law enforcement agencies to detect and intercept all but a fraction of suspicious packages. The sheer volume of regular parcels makes the risk profiling approaches used for container searches more difficult. Border Force is intercepting a small but significant proportion of illegal drugs entering the country but there is an inherent problem in penetrating supply further, given the sheer number of routes into the country, modes of transport and volume of traffic. Border Force faces competing priorities that are subject to change as political priorities shift and has limited resources. There are some welcome developments, such as the investment in new detection capabilities. However, the evidence suggests that efforts to restrict the supply of drugs rarely have lasting impacts on their availability or usage, given the resilience of drug markets to enforcement activity. The National Crime Agency NCA is an operationally independent agency, founded in to fight against organised crime, human, weapon and drug trafficking, cyber-crime and economic crime across regional and international borders. It is the leading source of intelligence on Organised Crime Groups at or near the top of the supply chain and focuses on both the operations and the profits of Organised Crime Groups. Organised Crime Groups will typically launder the proceeds of crime through a variety of means, including cross-border movement of physical cash. Denying these profit-focused groups their money and assets is likely to be much more effective than prison as a means of shrinking the market. This requires specialist financial investigative resource in both the NCA and within police forces. Investing more in this area should be a key focus for Government, given the key role profits play in driving supply. The NCA has a key role in tackling county lines. In September , a new multi-agency team of experts from the National Crime Agency, police officers and regional organised crime units were brought together to form the National County Lines Co-ordination Centre. The NCA has absorbed a range of responsibilities from the various organisations it subsumed or replaced. It has a considerably smaller budget than that of those previous organisations combined. This means it must ration activities across competing priorities, which change over time in light of political preferences. In recent years, for example, it has focused heavily on child sexual exploitation and victims of modern slavery. There are 44 police forces in England and Wales. They are operationally independent bodies, held to account by an elected Police and Crime Commissioner who sets out their strategic priorities in a Police and Crime Plan for the area. Police forces primarily tackle street-level drug dealing, whereas the NCA leads on the Organised Crime Groups further up the supply chain. Over the past decade, tackling drugs has fallen down the priority list for nearly all police forces. The police were traditionally key partners in the local authority-based Drug Action Teams that brought together social care, health, housing and education to develop collaborative local strategies to address substance misuse. They were also the lead partners in the Drug Interventions Programme, which received significant central funding and oversight from the Home Office to identify and divert drug users away from the criminal justice system and into treatment. The demise of Drug Action Teams and the Drug Interventions Programme over recent years has contributed to the fragmentation of partnership working in relation to drugs at a local level and this has particularly impacted on police engagement. Efforts to find and convict drug dealers is largely discretionary for police forces, whereas responding to crimes reported by victims is not, so the former activity has been squeezed. The number of drug seizures by police forces has fallen over the past decade for all of the main drug types. The dramatic increase in violence associated with the growth of the county lines model has led to an increased focus by police forces most affected but this is mostly to tackle the violence and to seize weapons, rather than drugs. An increasing number of young people are being arrested and convicted for drug supply offences. In , around 1 in 3 people sentenced for supplying crack cocaine and 1 in 4 sentenced for supplying heroin were aged under It is a similar picture for the supply of cannabis. In principle, the prison system presents a huge opportunity for positive government intervention on both the demand and supply sides of the drugs market. We estimate that just over a third of the prison population of approximately 82, people on a given day are there for a drugs-related crime. On a given day approximately 20, people, or nearly 1 in 4 prisoners, are detained because of offending related to their drug use, as opposed to being involved in supply. Over the course of the year the number is 50, These prisoners are generally cycling in and out of prison, serving short sentences, largely for theft. The crimes mostly acquisitive relating to drug use are therefore generating a huge pressure on the prison system. The availability and speed of treatment within prisons appears to be good. Statistics on treatment in prison show almost all prisoners seeking treatment are triaged within three weeks and treated within a further three weeks. However, those in prison treatment tend not to be there long. When offenders serve short custodial sentences of up to six months, the median time in prison is just six weeks, meaning these prisoners spend little sustained time in treatment. However, prison treatment is operating in a challenging environment, with a high turnover of prisoners who have limited contact with family and friends and little purposeful activity. It is therefore not surprising that the review heard that prison drug treatment is generally limited to stabilising prisoners and not aiming to achieve longer-term recovery. There are significant problems with the transition of prisoners to community treatment on release. Only a third of people referred for community treatment after release go on to receive it within three weeks. For non-opiate users, the figure is only 1 in 10 and these are much more likely to be younger prison leavers. There is considerable variation geographically, with the north of the country doing considerably better than London, for example, and the worst Local Authorities doing six times worse than the best. Accessing treatment is, of course, only one of the transition problems on leaving prison. There are also well-known problems of accessing housing, the benefits system and employment, which if not addressed are likely to increase the chances of people returning to drug use post release. These transition problems are very likely contributing to the evidence that community orders and suspended sentences are better than short sentences at reducing re-offending, particularly amongst those with a previous history of offending, including problem drug users. However, community sentences and drug rehabilitation requirements have reduced dramatically over the last five years, despite an increase in problematic drug use. This problem is concentrated mostly in male local and category C prisons but there is significant variation between establishments, linked to the quality of the prison generally. In particular, a lack of purposeful activity and the sense of boredom and hopelessness that this engenders is a significant factor in driving the demand for drugs and the data shows that prisons with better purposeful activity scores have lower rates of positive drug tests and drug finds. Most prisoners tend not to continue to use psychoactive substances after leaving prison, so we do not believe prisons are creating a market for these substances on the outside although this needs to be monitored as the use of Spice has increased amongst the homeless population, for example. However, drug use in prison is causing unrest and violence in prisons, disrupting the chances of recovery for those with pre-existing problems and creating opportunities for violent Organised Crime Groups to make significant profits. For the first time, there will be comprehensive guidance for governors on how to deal with drugs issues and an innovative, holistic approach to drug use prevention is being trialled at HMP Holme House. Replicating the Holme House approach widely would be resource-intensive and require significant structural and cultural change in other establishments. Government has long recognised that effective drug treatment makes a significant contribution to limiting drug supply by reducing demand. However, political views have shifted over time on where accountability should lie and on what constitutes good treatment. Treatment services are provided and commissioned locally. Services expanded rapidly in the s in response to the growth in heroin and cocaine use. The NTA was jointly accountable to HO and DH Ministers and was given responsibility for overseeing spending of a pooled treatment budget, introduced to supplement local spending. The number of adults in treatment more than doubled over that time, with England having one of the highest rates of heroin users in treatment in the world and average waiting days fell from 12 weeks to 5 days. The Health and Social Care Act moved treatment funding into the public health grant, making Local Authorities fully responsible for the commissioning of drug treatment and prevention. The current intention is for the public health grant to transfer into full business rates retention from April , meaning there will be no ring-fenced funding for public health services and Local Authorities will face difficult choices about treatment and other public health services alongside all of their other pressures. Previous treatment commissioning arrangements included a high degree of accountability between local partners, including health, Local Authorities, and criminal justice partners, each holding others to account. Since Local Authorities have been solely responsible for commissioning drug and alcohol treatment, this cross-cutting local accountability has fallen away. Funding reductions are exacerbating gaps in treatment provision. As funding pressures have increased, some services have disappeared altogether such as out-reach services targeting newer users , whilst others have been rationed such as in-patient detoxification for people with complex and multiple problems, heroin assisted treatment and residential rehabilitation. Because treatment is commissioned separately from other healthcare and is outside of the NHS, it is much harder to control the quality of care and clinical safety. Providers compete for commissions on price and, increasingly, a small number of third sector providers have dominated the market, offering basic services with no incentives to enhance quality. The drugs treatment market operates in a very similar way to that of adult social care. Like in the adult social care market, drug treatment providers have been squeezed, staff are paid relatively badly and there has been high turnover in the sector and a depletion of skills, with the number of medics, psychologists, nurses and social workers in the field falling significantly. The unregulated role of drug and alcohol or recovery worker, which is inconsistently and poorly defined, makes up the vast majority of the workforce. The number of training places for addiction psychiatrists has plummeted from around 60 to around 5, meaning there is no capacity to train the next generation of specialists. All of this means that, even if more funding became available which is vital , there would be a lot of work to do to build up capacity and expertise in the market. Most current treatment capacity is absorbed by the long-term cohort of opiate users, many of whom have been in treatment for a long time 1 in 6 have been in treatment for over a decade. Some of these are also now using crack cocaine, creating new health problems. Providers often have to prioritise meeting the urgent health needs of this population, meaning the capacity to develop expertise and services to meet the needs of other cohorts is limited. Geographical variation. Most of the national indicators of performance for treatment completion rates, deaths in treatment, estimates of un-met need are going in the wrong direction. There are huge geographical variations. For example, nearly all the Local Authority areas with the lowest rates of opiate completions are in the north of the country, with the highest rates primarily in London or the South East. Some of this variation reflects the differences in the drug-using population and deprivation. But there are also big variations in the degree to with Local Authorities have prioritised spend in this area and commissioned effective services. Recovery is much wider than treatment alone. The Drug Strategy stressed the importance of integration at local and government level to achieve this, but progress has been slow, and a scarcity of some wider support services and opportunities has compromised the outcomes achieved by drug treatment. Homelessness and rough sleeping are the most visible examples of services not meeting needs. The recent spike in the deaths of people experiencing rough sleeping has been mostly attributable to drug poisoning. Since the publication of the Rough Sleeping Strategy in , there has been an increased focus on how to address the needs of people who experience rough sleeping. A greater focus on homelessness prevention is needed to prevent people from having to experience rough sleeping in the first place. The Housing First model offers a potential contribution. Housing First is an internationally-proven approach to supporting people experiencing rough sleeping, many of whom have multiple and complex needs including mental ill-health and substance dependency , into long-term accommodation. It has been widely adopted across the US, Canada and parts of Europe. On employment, it is well known that standard offers of employment support do not successfully engage people with drug dependency, who often have a range of other complex issues alongside their dependence. People in treatment or with a history of drug dependence often face stigma and negative perceptions from employers. Despite the positive impact employment can have on treatment and recovery, it can be incredibly hard for someone to get a foot on the ladder of the employment market, particularly when disclosure to the employer might be required to accommodate their treatment programme. Nearly a quarter of all IPS participants have self-reported finding work since the trial began. This is over three times the rate in the control group. Half of the jobs have been sustained for 13 weeks or more. Many of the heroin users finding work have not been employed for many years and some never. The most alarming development in the recent evolution of the UK drugs market has been the widespread involvement of children and young people in drug supply. The most visible example of this is the county lines model, discussed above, where vulnerable young people have been actively drawn into street-level supply. Frontline practitioners suggest that some young people may initially be attracted to drug dealing, tempted by the promise of money, status and a certain lifestyle, but underestimate the risks attached and are subsequently exploited and can become both perpetrators and victims of violence. They report a complex picture that mixes elements of conscious choice with grooming and exploitation against a backdrop of poverty, widening inequality and a lack of alternative opportunities for these young people. This overlap between victim, offender and conscious choice presents challenges in the current response, where there can be a binary approach in categorising individuals either as victims or perpetrators. Guidance exists for Youth Offender Teams and frontline practitioners on how to use the National Referral Mechanism if they believe a young person is a victim of a Modern Slavery trafficking offence, but many young people involved in criminality will not meet the threshold for referral and support. A conviction can have a lasting negative impact on a young person and their wider life chances , risking them being caught up in a cycle of crime and violence. Children and young people are widely involved in the most violent segments of the drugs market, such as the retail supply of heroin and crack cocaine. Another key factor appears to be the rapid increase in permanent exclusions from school over the past five years. There is clear evidence that those young people, disproportionately young black men, drawn into county lines and related activity are much more likely than other young people to have been affected by adverse experiences such as neglect, substance misuse problems in the family, domestic violence, poor mental health, and exclusion from school. All of these economic and social factors have coincided with the nearuniversal availability of social media. Social media is used in the recruitment and tracking of young people within gangs, whilst the use of smartphones is used extensively in the marketing and selling of recreational drugs. This appears to be occurring across a wide range of substances and across most demographics. However, there has been a sustained and significant decrease in the number of young people receiving specialist interventions for their drug use. Those who are accessing treatment interventions have complex needs, including poor mental health, self-harm, offending and experience of sexual exploitation. The needs of young people who have drug use problems can only be met through a combination of specialist treatment and wider health and social care, which addresses all the challenges they face including their family circumstances. Dame Carol Black invited a group of experts from across the drug misuse sector to act as a challenge group to the review. The aim of the group was for members to provide advice, insight and constructive challenge to the review as it proceeded. Ultimately the views expressed in this report are those of Carol Black. As part of fact finding for the review, Dame Carol Black undertook the following visits, meetings and roundtable discussions. An online call for evidence opened on the Gov. It received 63 completed responses, including from members of the public, academics, individuals working in the sector and from the following organisations:. To help us improve GOV. Please fill in this survey opens in a new tab. Cookies on GOV. UK We use some essential cookies to make this website work. Accept additional cookies Reject additional cookies View cookies. Hide this message. Home Crime, justice and law Review of drugs: phase one report. Home Office. Contents 1. Foreword 2. Acknowledgements 3. Summary of key findings 4. Why we have done this review 5. Part One - the illicit drugs market 6. Part Two - Government intervention 7. Appendices Print this page. Dame Carol Black February 1. Foreword My independent review of drugs, commissioned in February by Sajid Javid then Home Secretary , was to be in two phases, an up-to-date analysis of the problems and then recommended policy solutions. Why we have done this review The illegal drugs market has long existed but has never caused greater harm to society than now. Part One - the illicit drugs market 5. Part Two - Government intervention 6. Geographical variation Most of the national indicators of performance for treatment completion rates, deaths in treatment, estimates of un-met need are going in the wrong direction. Appendices 7. Back to top. Is this page useful? Maybe Yes this page is useful No this page is not useful. Thank you for your feedback. Report a problem with this page. This field is for robots only. Please leave blank. What were you doing? What went wrong?

When Gotham Was Heroin's Capital

Port Said buying Heroin

That distinction belongs to heroin. In , an estimated 1 in 40 city residents was a heroin addict. Justice Francis T. Murphy Jr. Opiates arrived either as taxed, legal imports or as contraband smuggled to avoid custom duties. Refined opium, which smokers used, was the most heavily taxed, frequently smuggled and widely condemned form of the drug, owing to its Chinese and criminal associations. The first opium smokers were Chinese immigrants. Some criminals preferred a syringe of morphine to a pipe of opium; still others, a new drug called cocaine, whose nonmedical use spread rapidly in the s. Not all Victorian-era morphine addicts were gamblers or prostitutes. These doctors relieved with injections of morphine. And relieved, and relieved, and relieved. If medical addicts were numerous in the Victorian era, they were also secretive, isolated and ashamed. They seldom spread addiction to others. Not so their counterparts in the underworld addict subculture, which attracted newcomers and which persisted long after doctors wised up and quit addicting as many patients to narcotics. As age and illness thinned the ranks of medical addicts, New York was left with a self-sustaining core — to police, a hard core — of nonmedical addicts. Needing pricey daily fixes to keep withdrawal at bay, they were apt to pick pockets and locks as well. Increasingly, the money they hustled went to purchase heroin. A derivative of morphine, heroin provided a powerful rush. Dealers liked it because it was easy to cut. Adulterated or pure, heroin could be sniffed, a bonus for those who shunned the needle. And it staved off withdrawal for those who could not score prepared opium, whose legal import was banned in , or morphine, whose sale and prescription were subject to stricter controls between and Not every heroin user was a confirmed opium or morphine addict. The drug caught on with young drug users, mostly men from poor immigrant neighborhoods. Friends introduced them: Here, take a whiff. Some kept whiffing. There were more whiffs to go around in New York than elsewhere. Shady New York pharmacists would also sell to customers without legitimate prescriptions, or no prescriptions at all. In , the federal government forbade the importation of opium for the manufacture of heroin. Yet heroin continued to gain in underworld popularity. Gangsters such as Arnold Rothstein bought heroin from European manufacturers then shipped it to New York disguised as ordinary merchandise. One consignment, labeled bowling equipment, turned out to be pounds of heroin, seized after delivery to a toy store. Mid-level dealers had other dodges. Customers of a Cobble Hill barber shop slipped money under the shaving towel. Military purchases drove up opiate prices, and the war interrupted international shipping and smuggling routes. Arthur, one of several dozen older addicts I interviewed in the early s, described the results:. No drugs. Arthur became so desperate that he boiled down paregoric, an opium tincture used against diarrhea. He dissolved and shot Nembutals, barbiturates purchased on the streets. After the war, he returned to heroin, only to be disappointed by the quality. He supplemented with Dilaudid, a semi-synthetic opioid secured with prescriptions from doctors in Manhattan and the Bronx. Catch as catch can. By the early s, New Yorkers had taken to calling addicts 'junkies,' after their habit of picking through junkyards for bits of saleable metal. Other users remarked on the increasing adulteration of heroin, which some blamed on Mafia greed. Most of the new addicts were young African American and Puerto Rican men, often the children of immigrants. Doctors who interviewed them noted the psychic traumas of racial discrimination and slum life, but also the easy availability of the drugs that soothed them. One block in Harlem had 13 dealers. They did business at all hours. It was easier to buy marijuana and heroin than cigarettes, the patients reported. Young whites dabbled too, though they had to venture to entertainment districts like Times Square or bohemian enclaves like Greenwich Village to buy heroin. It did not come to them the way it did to residents of East Harlem. Not so after the great urban migrations. Youthful experimentation with readily available drugs in impoverished, segregated neighborhoods was also the basis for the much larger wave of baby-boom heroin addiction that engulfed the city in the late s and early s. Asking around, Severo discovered the means by which young addicts, hardened beyond their years, supported their habits: stealing, robbery, burglary, forgery, prostitution, dealing. A year-old sold rat poison as heroin, killing two other addicts in the process. Asked why, he said he needed cash to buy his own heroin. The one liberals preferred was expanded access to methadone. A long-acting oral opioid, methadone was the basis of an experimental maintenance treatment launched by Drs. Though they violated the taboo against providing narcotics to ambulatory addicts, well-run methadone programs provided clear-cut evidence of improved behavior and health. No more bags of rat poison. Addicts fed up with bad heroin could resort to legal substitution. Conservatives had another answer for the heroin-related crime that was gutting the city. Rockefeller called for mandatory life sentences for traffickers. Punitive legislation, famously and forever known as the Rockefeller drug laws , soon followed. Narcotic trafficking continued anyway. What fueled it were new sources of increasingly pure heroin, notably from Colombia, and an abundance of retail outlets. A young writer living in a Lower East Side apartment near Stanton and Ludlow, who started using heroin in , discovered that he had to venture no farther than his doorway. It was a hangout for local dealers. Beepers and cell phones further simplified access. By the s, heroin could be delivered like pizza. It was, and not just in New York City. Mexican immigrants driving beat-up cars, the Xalisco Boys memorialized by journalist Sam Quinones , fanned out across the country. They sold cheap but potent black-tar heroin in mostly mid-size cities to mostly white customers. Hello, Columbus. Convenience and discretion were in, guns and violence out. The Xalisco Boys avoided the gang-dominated urban drug markets on the East Coast. Another, unexpected development in the s and early s nationalized narcotic supply and, for a time, altered the pattern of narcotic addiction in the city. Andrew Kolodny saw it firsthand. A young psychiatrist who began practicing in Manhattan and treating addicted patients with buprenorphine — basically, methadone lite — Kolodny was surprised in the early s by an influx of white, middle-class addicts from New Jersey, Westchester County and Staten Island. They used prescription drugs like OxyContin and Vicodin. They did not use heroin — not yet, anyway. They got the opioid painkillers from their doctors, who had again begun prescribing them as analgesics. Or they got them from friends and dealers who siphoned them from the expanded legal trade in prescription opioids. Either way, access and exposure were again at work. With a twist. Opioid prescribing for chronic non-cancer pain, promoted by pharmaceutical marketing, was a national phenomenon. The capitals of this type of opioid addiction were places like Huntington, West Virginia , not ports of entry like New York. The geography of addiction was no longer determined largely by where the Mafia landed its heroin. The new keys were Pharma-shaped prescribing behavior and distributor failures to stop opioid orders to suspect outlets like internet pharmacies or off-the-interstate pill mills. In the s, as prescription opioids became harder to come by or, in the case of reformulated OxyContin , harder to abuse by snorting or shooting , the narcotic kaleidoscope turned again. The most conspicuous shift was to heroin, which was readily available, relatively cheap and highly potent. Active cuts, fentanyl or one of its analogs, further increased potency, often lethally so. Here too was something new. Midth-century dealers often adulterated heroin with inactive cuts such as powdered milk or baby laxative. Fentanyl flipped the script. Overdoses now occur because of too much active cut. That is true not only for heroin, real and nominal, but for other street and counterfeit prescription drugs into which fentanyl is often mixed, unevenly and fatally. This is why methadone or buprenorphine remain effective treatment options for opioid addicts. Reduced to essentials, the history of narcotics in New York City is a history of changing prices and availability for drugs that an unusually large number of addicts needed on a daily basis to keep from getting dope sick. The surest way out of the trap was, and is, supervised medical maintenance with licit opioids of known strength and quality, prescribed with safeguards to minimize further leakage. Sign up for our newsletter. Sign up. David Courtwright December 13, A brief history of what opioids have done to the city. David Courtwright is presidential professor emeritus at the University of North Florida. Up next

Port Said buying Heroin