Examination of Witnesses (Questions 160
- 179)
TUESDAY 6 NOVEMBER 2001
MR DANNY
KUSHLIK, MR
NICK DAVIES,
MR ROGER
WARREN EVANS,
MR ALUN
BUFFRY AND
MR CONOR
MCNICHOLAS
160. At the moment doctors can prescribe.
(Mr Davies) Of the 200,000-500,000 heroin users in
this country, less than 500 have heroin prescriptions. Heroin
prescriptions are extremely rare. The friend I have talked about—I
am trying to find him a doctor to prescribe and I cannot.
161. You are saying that most doctors will not?
(Mr Davies) Firstly, you have to get a licence from
the Home Office—there are only 120. Have you talked about
the Orange Book, the prescribing guidelines produced in 1999.
That is 132 pages long, all of it is about prescribing methadone.
There is one paragraph about prescribing heroin which says it
is of limited clinical—I can find you the quote. There is
this enormous policy discouragement. Within the 120 doctors who
are licensed to prescribe, they tend to be based on the drug dependancy
units in the hospitals, where the policy is to prescribe methadone.
Nobody actually knows how many methadone prescriptions there are,
but it is probably about 20,000—again, it is a minority.
Then there are a few psychiatrists, like the one in the television
programme in Plymouth whom we interviewed, who are outside the
DDUs who have managed to get a licence, and they will prescribe
diamorphine to their patients. Thank God they are there, but it
is a tiny, tiny handful.
Mr Cameron
162. Under your version of "prescription"
would you still have a criminal penalty against people selling
heroin?
(Mr Davies) I would not mind if you did; but I would
not expect it to be particularly necessary. If you adopt the full
blooded form I am talking about, which is what we had in this
country up until the late 1960s, it is for economic reasons. If
the doctor down the road will give you free heroin—and do
not surround it with hurdles; do not say, "And you've got
to have five sessions of therapy"—why would you get
it from a dealer?
163. Your analysis of what has happened since
1971 I think many of us would share—it has been a disastrous
policy. The question, like the Irish one, is: where do you go
from here? You would not start from here, but we have got to.
It all turns on the point about the increased availability and
will that lead to increased use? In London, Manchester and Birmingham
you can buy heroin and find it in 20 minutes in a pub. In large
parts of the country, in the areas I represent in West Oxfordshire,
it is not prevalent. The police will tell you that they are just
about keeping it out of the small towns and villages. Under your
system of prescription, and basically not having a criminal penalty
against people selling it, there would be more availability in
those parts of the country, surely?
(Mr Davies) How are you seeing that happening? Where
is the availability coming from in your picture of the future?
164. Because you have got doctors prescribing
it there is a source; and because some people want to make some
money out of it you will still get pushers and more people outside
the school gates saying, "Try a bit of this".
(Mr Davies) Why would the pusher be able to sell it
to someone for money if it is available free from the doctor?
165. The doctor is not going to give the 16
year-old pupil at school heroin if they just turn up and say,
"I've smoked cannabis, I've tried some ecstasy, I've been
told this hard stuff's great, I want some". The doctor is
not going to give it, you would accept that?
(Mr Davies) There are two points about it. If you
talk to Professor Howard Parker from Manchester he will tell you,
there are long-term heroin addicts who are under 16 years-old.
If a child like that goes to a doctor and says, "I'm a heroin
addict", and if the doctor has reason to believe that child
then he must, in order to save that child's health, life and social
function. Let us take this hypothetical child, who I think is
something of a fairy tale, who says: "I want to volunteer,
via my doctor, to start taking heroin. My friends aren't trying
to sell it to me, there is no longer that culture but, nevertheless,
I want to try and do it"; I think in the first instance the
doctor should say, "No, this is about treating established
users". I think the onus should be on the doctor to disprove
the claim.
166. I accept the doctor would say that, but
there is still going to be a black market.
(Mr Davies) The worst case scenario is if he turns
the 16 year-old away on the basis that that is not a user; and
that person then goes to somebody who has got a prescription and
says, "I'll give you a fiver for some stuff". You would
then develop the beginnings of a black market. Two things: first,
which one would you rather have—a black market with 200,000
users like we have; or a black market with 5,000 users? We would
be that much better off. Secondly, once he is established as a
user you can plug him into the doctor.
167. I see the point of taking heroin users
out of the criminal justice system, prescribing and treating.
The question is: should we legalise heroin? If we legalise heroin
you are going to make it more available.
(Mr Davies) I think you should come back to your original
point: it is available now.
168. In London, Birmingham, Leeds and Manchester
I accept.
(Mr Davies) I live in a small market town; it is easily
available there. If you wanted to you could parachute somebody
younger than me into any community into this country and they
could get you gear within a couple of hours—any community.
It is a bit hypothetical, this fairy tale person who has suddenly
decided that for some reason they must have their heroin; not
because their friends are pushing it, smoking it, whatever. They
will find it. If they can be bothered to go to the doctor and
try and con him; if they can be bothered to find this person who
has already got a prescription, they will find it now. You must
compare reality with this fantasy. We already have this huge pool.
The worst outcome I think, on the basis of the Home Office memo
last week, is that we end up with a tiny sliver of the black market
we now have.
(Mr Evans) Specifically on Mr Cameron's point, we
have addressed this in discussions in The Angel Declaration
group. Yes, we would accept that if prescription only were the
right regime and our National Drugs Agency came to the same conclusion,
most of us I think would agree that, for heroin, prescription
only would be the right regime certainly for an interim period.
Yes, the criminal sanctions would remain for unregistered dealers.
Mr Watson
169. I think we can take it as granted you all
think the government drugs policy is failing totally. Are you
saying that is only because of the principle of prohibition, or
are there other factors to do with the national strategy?
(Mr Kushlik) UK drugs policy, like a lot other domestic
drug policies, exists within a global framework, where we signed
up to an international treaty which says that you must do these
various things with this particular set of substances. What we
can do is compare what goes on with that set of substances—heroin,
cocaine, cannabis, amphetamines and all the ones that are currently
prohibited—compared with the ones that are either supplied
mainly on prescription or through legal retail outlets. There
is a complete difference in terms of what goes on there. We do
not have an enormous amount of resource to put in to catching
people who are robbing houses as a result of supporting a tobacco
habit. We have a million tranquilliser addicts in this country,
mainly older women, imagine if we prohibited that. Imagine that
group of people sat by the bus stop asking you for 10p for a cup
of tea or a quid to get into a hostel and robbing you on your
way to work. It does not happen. The main reason is because they
are given it for free.
Chairman
170. We would not have a million tranquilliser
addicts if we had not been handing them out like sweeties.
(Mr Kushlik) That is another issue; and it points
to some of the other problems with the current policy, where we
do have pushers who are not your normal pushers—they are
GPS and they are pharmaceutical companies. So there is an issue
here about how you deal with drugs outside of this thing. I also
wanted to return briefly to the question of availability. If we
were to prescribe heroin, or change the system in some way to
make it, in our view, in terms of prescribing, less available
rather than more available—even if we still saw a black
market continuing for a small number of people—what if the
prison population declined by a third, prostitution reduced by
half, turf wars were reduced by three-quarters, homelessness was
reduced by a quarter, the whole face of what goes on in Miami
and Colombia would change.
Mr Watson
171. Is it just a prohibition problem?
(Mr Kushlik) Prohibition is the main problem. I used
to work with drugs workers. I worked with people on conditions
of treatment, court order treatment to come to see me. They were
heavy end crack and heroin users. I was seeing people whose main
underlying problems were the fact they had been abused; that they
were poor; that they had an unresolved bereavement; and all the
things that go along with social depravation. I was seeing these
guys in prison. That seems to me to be a singularly inappropriate
way to deal with those underlying problems, which had then led
them into misusing drugs. The issue here is: what is the most
effective way of dealing with the underlying issues that lead
people to misuse drugs, whether they are legal or illegal. It
seems to me that focussing on resourcing those initiatives through
the criminal justice system is missing the whole point. On top
of that, criminalising them, socially excluding them and marginalising
them just makes everything that much worse, and actually mitigates
against any kind of work that you would want to do with these
incredibly damaged people.
(Mr Davies) I have not understood what you are looking
for. I have not understood the question.
172. There is a spectrum of argument here, and
I am trying to find out if you think there are other elements
of the drug strategy that do not work. Are there any circumstances
where you think that prohibition might succeed as a drugs strategy
with any other drugs currently available?
(Mr Davies) "Succeed" means extinguish supply.
173. Reduce.
(Mr Davies) I think there are circumstances in which
you can reduce supply. This is what is now called the Peter Lilley
argument; he finally saw the link between black market cannabis
and black market heroin. Cannabis supply was restricted in the
late 1960s so the price went up, so people found a cheaper way
of getting stoned by snorting and smoking heroin. Over a period
of time, over a phase, you can reduce supply, but you will not
extinguish it. I am not sure there is an example of reducing long-term
either.
(Mr Evans) I do not think prohibition is the only
problem. I think the key problem is a wrong focus for government
policy. I think the focus on the reduction of supply generically
is completely wrong. I have not got the faintest idea what the
present figures are. If you start examining illegal activities
of any kind you have not got any reliable figures to start with.
I think it is quite wrong. I worked for many years for Sainsburys,
and since Sainsburys and the supermarkets have taken over wine
supply they have vastly increased the consumption of chardonnay:
but that is not the issue, the question is alcoholism; the question
is the malfunction. I say, just as the European Assembly report
says which you have seen this morning, the focus of government
policy should be on the harm and not the total supply.
174. We have been bombarded with facts and figures,
and for the government to change its policy it must base its policy
on facts. You would agree with that. To what extent do you think
the Government have the right information on facts and figures.
Perhaps, Conor, you could talk about some of the underground drug
use. I am thinking of drugs like GHB. Do you see any Government
evidence to show increased drug use amongst these areas?
(Mr McNicholas) The figures I have seen just simply
do not tally with my personal experience. From growing up and
having people around me, at school, and friends who were smoking
cannabis, to growing up and going to a nightclub where drugs are
incredibly prevalent , they are a major part of youth culture
now. In fact, drug use (particularly ecstasy use) is driving an
enormous youth culture industry in this country. It is one of
our most successful exports as well. The ecstasy culture in this
country employs hundreds of thousands of people, be they in record
companies, working in nightclubs or associated clubs. It seems
to me that young people, in my experience, are experimenting more
and more with new drugs. Essentially what you have is a bunch
of very bright, very able young consumers; and they have been
taught to consume products in our modern society. They demand
product launches because they get very bored with the products
they have already. Every so often a new alcopop will be launched
once every 12 months and they can all transfer over to them. One
of the problems we saw with drugs over the last couple of years
in the dance/drug context was that for a lot of young people ecstasy
use was entirely normalised. It is not a particularly interesting
thing to do; it is something they have been through; that their
older siblings have been though; and, for quite a lot of people,
their parents have been through as well; and they were looking
for something new and something different. Which is why you saw
this move over to increased use of GHB, and people experimenting
with ketamine, and people experimenting with cocktails of all
of the above, plus cocaine. There is this huge demand among young
people to really identify who they are and build a personality.
A large part of that comes through the brands they associate themselves
with; the clothes they wear; the things they do; the records they
buy; the posters they have on their wall; and part of that is
also the drugs they take.
175. Do they know what they are putting into
themselves?
(Mr McNicholas) Absolutely, yes, they do. Most of
these kids are very well read. Certainly when I was working on
Mixmag our attitude was, the more information we could
give these kids the better. Extra information is not going to
harm them—really quite complex information about the effects
of these drugs. Young people are very clever about treating their
bodies as chemistry sets. They know what goes in will have certain
effects. If they are taking ecstasy they will probably take Vitamin
C beforehand, or take multivitamins to account for drug use. They
will take drugs such as over-the-counter health supplements such
as 5-HTP which can counter some of the depression they might get
during the week. The effect that the drugs have on individuals
varies widely. There is no one experience from any particular
drug. Young people are very bright and very able and do know what
they are taking. At least, when they are putting pills down their
neck, they assume they know what they are taking. It is very interesting,
within my peer group and younger, when you hear of somebody dying
in a nightclub context where ecstasy has been implicated (and
let us not call it an ecstasy death because 99 per cent of the
time people just do not know) ie. they have taken ecstasy and
maybe drunk too much water, or not enough water, the reaction
is not, "Oh, my God, that's a bit scary, maybe I should think
about my drug use". The reaction from most people is, "How
selfish. How stupid is that person. We all know how to manage
our ecstasy experience. We all know what we should be doing to
make sure we look after ourselves and each other". The reaction
is very much that those people who are not looking after themselves
are ruining it for everyone else.
Chairman
176. You may move in a world where virtually
everybody is using these kinds of drugs, but in the real world
although there are quite a lot of people using drugs it still
amounts to less than a fifth of the young people. Do you accept
that, or not?
(Mr McNicholas) It is difficult, I do not have access
to specific figures. I take your point, yes, it is the world in
which I operate. There are two things going on here—either
you are seeing a bubble of drug use that is simply going to move
up the demographic and shows no sign of abating and this is something
which is generally part of society; drug use, recreational drug
use, the kind of things I am talking about—ecstasy, perhaps
now with changing attitudes to cocaine. It is something that is
absolutely woven into youth culture completely and that is not
going to go away.
177. It is some part of youth culture.
(Mr McNicholas) Virtually all of youth culture. The
knock-on effects it has had are astonishing. Even things like
when Hooch first came out, the alcoholic lemonade, where it has
a little smiling lemon on it; those kinds of images were acid
house culture images. A flood of ecstasy coming into the country
in the late 1980s had kicked off this whole youth culture movement;
and dance culture is now the dominant form of youth culture in
this country.
David Winnick
178. Presumably you do not want drug use to
increase?
(Mr McNicholas) I am much more in favour of young
people making informed decisions. Given the sheer volume of ecstasy
that is taken already, and nobody has any kind of accurate figures,
from working in the club industry for a good few years now it
does seem to be round about two million ecstasy tablets that are
taken every weekend. Those are certainly the kind of figures Customs
& Excise are happy with. You are looking at a million and
a half ecstasy experiences every single weekend. There are a lot
of people taking it already and some are doing it with very, very
clear informed decisions, but perhaps others are doing it without
that clear information. In terms of would I like to see increased
drug use, that is entirely up to the individuals. It is a question
of social harm, and how much harm is being done by ecstasy use
at the moment.
179. It is up to the individual—if you
take legalised forms of what could be described as "drugs",
which is indeed part of the argument of those who want to legalise
drugs, namely tobacco and alcohol, the whole emphasis in the last
few years has been to reduce consumption. Therefore, I would be
surprised, if you take a neutral line which apparently you are
doing, saying "If youngsters want to take drugs so be it",
what you are saying in effect is that it is up to them. If we
want to reduce the amount of smoking for very obvious reasons,
to reduce alcohol abuse which is a very serious matter for many
people, surely at the same time we want to reduce drugs, or am
I wrong?
(Mr Davies) You are wrong. We want to reduce the harm.
Look at what happened when they prohibited alcohol. Did that make
people safer to have their alcohol brewed by gangsters using methylated
spirits which made them blind? Did it help that there was an explosion
of organised crime? Did they reduce alcohol harm by prohibition?
No. They did the right thing to lift prohibition so we can see
and regulate it. I have a 17 year-old daughter; she goes into
clubs and people will offer her ecstasy. I want you to create
a world in which she at least has as much information about that
pill as you and I have, for example, on the side of a Vitamin
C bottle, which gives you the exact contents, the precise dosage
and gives you a warning not to exceed it. Our politicians ensure
that my 17 year-old daughter takes ecstasy in the dark. She has
no idea what the twerp in Amsterdam in his laboratory has put
in there.
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