NEIL MCKEGANEY ON DRUG MISUSE RESEARCH

LAST WEEK politicians on the health and sport committee of the
parliament were told that government spending on tackling Scotland's
drug problem had topped UKP431 million. The winners and losers in how
that money had been divided were drug enforcement, drug treatment and
drug prevention.

Drug treatment saw its share of the 2007 budget increase by 11% over
the figure in 1999, while the allocation for drug enforcement fell by
9% over the same period. Drug prevention attracted only 11% of the
drugs budget in 2007. Given that Scotland has a drug problem greater
than almost all of our European neighbours, one might have thought
that the proportion of the budget allocated to drug prevention would
have gone up rather than down.

The first question anybody would ask about a drugs budget nudging
towards half a billion a year is whether that money is being wisely
and effectively spent. Unfortunately, that is virtually impossible to
answer. The reason is because of a number so small that you almost
need scientific instruments to spot it. That figure is one third of
1%, which is the proportion of the drugs budget allocated to
research. What this means in effect is that 99.6% of the drugs budget
is being spent on the basis of evidence obtained on the basis of the
remaining one third of one per cent.

On the basis of those proportions, if we identify a successful way of
tackling our drug problem in Scotland it will be a matter more of
luck than judgement. What is more likely is that we will continue to
throw ever larger sums of money at tackling the drug problem without
really knowing if we are being effective.

The scale of our ignorance in tackling Scotland's drug problem is
staggering. Here are a few examples of things we should know but
don't know. How many people on our UKP12 million-a-year methadone
programme are leaving the programme drug-free? The answer: "Don't
know". What is the effect of giving community sentences rather than
custodial sentences to those found guilty of dealing drugs in
Scotland? Again: "Don't know." And what do we know about the
long-term effects on children of living with a drug addict parent? Is
it better for them to continue to live with their parents or for them
to be moved to a family without a drug problem? "Don't know".

Importantly, these are not matters of abstract ivory tower concern,
but are of enormous practical and urgent importance. In Scotland
today we have doctors providing more methadone, to more drug users,
at more expense, than at any time in the past. We have courts
awarding community sentences to drug dealers and we have social
workers struggling to decide whether it is in the child's best
interests to live with their addict parents or to be moved to a place
of safety. For the most part these decisions are being taken on the
flimsiest possible evidence base.

The current Scottish government may end up being more supportive of
research in this area than previous administrations. It is a sad fact
that they will have to do so little to achieve that laurel, but the
prize will be in finding out whether the half-billion pounds of
public money spent on tackling the drug problem is being wisely and
effectively targeted.

The answer to that question is a necessity, not a luxury.