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The tragic human story behind our drug markets
street drug deal
Dame Carol Black's Review of Drugs is perhaps the most important drug-related publication of the 21st century.

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The facts about our drug markets

The review of drugs

Last week (27 February 2020) marked the publication of perhaps the most important drug-related report of the current century. The first phase of Dame Carol Black’s Review of Drugs provides a detailed and rigorous analysis of the complex and overlapping markets for illegal drugs.

The quote below is taken from the foreword to the report.

"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 27,000 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 2018 were the highest on record. Since 2012 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. The total cost to society of illegal drugs is around £20 billion per year, but only £600 million is spent on treatment and prevention. So the amount of un-met need is growing, some treatment services are disappearing, and the treatment workforce is declining in number and quality. Ultimately, we need to transform our approach to treatment, investing in it but also innovating so that treatment services are able to respond to today’s drugs market and future developments.."

Dame Carol Black- Developer

Summary of key findings

This report is so seminal that I have taken the unusual step of reproducing all of its key findings in full below:

  1. The illicit drugs market is big business, worth an estimated £9.4 billion a year.Around 3 million people took drugs in England and Wales last year, with around 300,000 in England taking the most harmful drugs (opiates and/or crack cocaine).
  2. Drug deaths have reached an all-time high and the market has become much more violent. Taking the health harms, costs of crime and wider impacts on society together, we estimate the total costs of drugs to society are over £19 billion, which is more than twice the value of the market itself.
  3. 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.
  4. The demand for opiates and crack/cocaine, and deaths from misuse of these substances, is closely associated with poverty and deprivation. 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.
  5. 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.
  6. 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 30. The demand for these drugs is strongly linked to the night-time economy and alcohol.
  7. 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.
  8. Government interventions to restrict supply have had limited success. The key institutions involved are Border Force, the National Crime Agency (NCA) and police forces. 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.
  9. 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.
  10. 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 in to the community. They are very likely to re-offend.
  11. Drugs within prisons are widely available, with around 15% of prisoners testing positive to random drug tests. 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.
  12. 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. There is significant local variation, with some Local Authorities having reduced treatment expenditure by 40%.
  13. Local Authorities commission treatment from NHS Trusts and third sector providers. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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 report is accompanied by a 125 pages of detailed evidence, most of it presented in easy to understand charts and infographics. The material covers drug-related harms, drugs production and trafficking, drug-related violence and much else and I intend to publish a series of blog posts looking at these individual issues in more detail over the coming weeks.

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