Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 160 - 179)



  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.


  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.


  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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