Examination of Witnesses (Questions 260
TUESDAY 6 NOVEMBER 2001
260. That is what we have been doing for the
last two hours, now Mr Prosser is asking how we set off on the
journey you wish us to embark on.
(Mr Evans) You set off first of all by talking about
it. I am delighted to say that Paul Flynn signed the Angel Declaration
but I have not got any other MP at the moment.
261. What about the next step?
(Mr Evans) The next step is to build up a parliamentary
majority in favour of reform. I suspect there is a larger minority
than is suspected at the moment, because I suspect a lot of MPs
are guilty of maintaining this appalling regime. It is a fundamentally
insensitive regime and we do not need to go very far for examples
of fundamentalism. This is one. I do hope that more and more MPs,
taking your lead, will sign up.
(Mr Davies) What I think you can is give a clear,
undiluted declaration of principle that says the prohibition strategy
has failed, shows no signs of succeeding, has in many respects
created the very problems which it originally sought to solve.
So a clear statement of principle from this group would start
the debate on the right territory. Secondly, I would say, in the
real world of politics, it is not going to be possible for you
to do what I believe you should do immediately, but what you might,
so to speak, get away with is something like the Swiss have done,
which is to set up a serious programme of prescribing heroin,
which is my particular beef, to recidivist, long-term users.
262. In a geographical area as a pilot?
(Mr Davies) The Swiss did it in half a dozen different
places but they focused on a client group. I would like to see
anybody addicted to heroin having access to the drug. Why not
take the most difficult end, but it has to be done properly, there
is no point putting it in the hands of Home Office officials who
will say, "Let's ration the drug, cut the supply within six
weeks." That will not work.
263. You are saying the Health Department should
(Mr Davies) Yes. If you set up a decent, honest pilot,
running over a period of a year or two, that would then provide
the evidence to continue it. But it has to be on the right basisjust
as we were talking about the worried constituentthat you
make a declaration of principle and provide the evidence to show
it is helpful, that you have not gone mad, you have suddenly seen
the truth, you are going back to 1926 and the Rolleston Committee.
264. A moment ago you said that we should not
be under the misconception, or words to that effect, that people
on drugs want to come off them. But you see, I do want them to
come off them, in the same way, if I can draw the analogy, I want
people off tobacco. If the tobacco manufacturers were before us,
which is obviously a legal business, the point we would be making,
some of us at least, is the need to ban tobacco advertising even
more effectively and take all the other steps because I, and my
colleagues round the table as well, want to reduce the number
of people who smoke for all the obvious reasons. Likewise alcohol
abuse but let's stick with tobacco. If I want people to come off
tobacco, and we have not succeeded with certain types of youngsters
but we have with other people fortunately, and we all know the
dangers of smokinglung cancer and the restwhy should
I not want to see fewer people, not more, using drugs and try
and persuade them likewise?
(Mr Kushlick) You can want that and you can try and
persuade them, but some of them will not do what you say.
265. Like tobacco, but at least we can try.
(Mr Kushlick) It is important to try, it is important
to put resources into informing people about the dangers of drug
use and misuse, but we have to admit that at some point throughout
that process people will say, "I am not listening to you,
I am doing exactly what I want".
266. But that is the argument about tobacco.
People say to us, "All the bans on advertising will not work"
but that does not stop us from trying and, to some extent, we
(Mr Kushlick) And it is important that we continue
to do that.
267. You agree on that?
(Mr Kushlick) Yes, I do, but I think it needs to be
kept in proportion. The important thing is to reduce the harm
associated with those people who are already users and perhaps
causing problems to other people surrounding them.
268. We do not disagree on that.
(Mr Kushlick) If we did prohibit the use of tobacco
as well as trying to get people to stop smoking tobacco and trying
to undermine that market and stop supplies and stop people dealing
and all the other things going on, you would also have people
robbing your house to fund their habit, and all the other stuff,
so the issue is how best do you reduce prevalence and where does
prevalence appear within all the other indicators that you want
to achieve as a result of your social policy. It is the same as
with anything else, it has to be balanced against all those other
things. That is all we are saying. It is just a question of balance.
David Winnick: I understand.
269. I just want to confirm something I think
Nick Davies said earlier. If you had what you wanted, which is
doctors prescribing heroin to all the heroin users who wanted
it particularly at the hard end, would you keep a criminal sanction
for heroin dealing, and would it work?
(Mr Davies) I am perfectly happy for you to keep a
criminal sanction against heroin dealers, I predict that the need
to use it would shrivel.
270. So what you are suggesting with heroin
in many ways is not actually that radical.
(Mr Davies) You can do it without changing the law.
271. You are not asking for legalisation of
heroin. The pusher at the school gate or in the high street or
in the pub is still going to be targeted by the police. There
will be far fewer of them because the users will not need to deal
themselves. Your fundamental thing is prescribing heroin by doctors?
(Mr Davies) And we do not need to re-write international
legislation. You are familiar with the Rolleston Committee in
1926 which dictated British policy for all those years, there
was no black market, not a single doctor got into trouble for
over-prescribing, with the result that the Home Office tribunal
which was set up to police them fell into disuse, so that when
those three characters in the late 1960s did break the rules there
was no internal policing. I want to go back to that.
272. In terms of what you do next, would you
do that before any other move on cannabis?
(Mr Davies) For heroin it is absolutely urgent. I
would say to any parent whose child got addicted to street heroin,
find a doctor somewhere in this country who will prescribe them
pure heroin, get them out of the black market. The disaster is
that there are only 400 or 500 people who have those prescriptions.
Let's get on with it. Don't go into royal commissions and all
that stuff because there will be more death and damage while we
wait for the result.
273. We do understand that. One thing the Home
Office says to us is that the main reason for the change as regards
heroin was the clinical benefit of injectable methadone and then
(Mr Davies) This is the change in the early 1970s?
274. They said the late 1960s. "The current
limited use of heroin for carefully selected patients has arisen
because of decisions, based on research evidence and experience
of practitioners since the late 1960s. The main reason for this
change was the clinical benefit of injectable methadone and then
(Mr Davies) If you can take the drug orally instead
of injecting it, you get round the inherent risks of injection,
so for that reason methadone looks better. If you only have to
take it once a day instead of three or four times a day, that
may make life easier. But since then we have learnt a lot more
about methadone, and the gap between the therapeutic and the fatal
dose is narrowed with methadone and people who use it find it
harder to come off. If you go back to the original thinking about
harm reduction, by all means continue with methadone maintenance,
there are users out there who prefer that, but open up the gates
on heroin, so you can bring more people in. Methadone has failed,
not just because it is more dangerous and more addictive, but
because so many users do not like it, so they do not come into
the system, so we have lost them to the black market.
275. To be absolutely clear about what the next
step you would take would be, quite a lot of heroin users, as
I understand it, start off smoking it and only go on to injecting
(Mr Davies) Yes.
276. Under your next step, would you allow doctors,
would you encourage doctors, to actually allow people to smoke
it, like Dr Marks did?
(Mr Davies) Exactly. Well done.
277. You would do that?
(Mr Davies) Yes. The criterion is, what can I do to
stop this person using the black market version of the drug which
has all these physical and social problems attached to it. So
if the patient walks into the doctor's office and says, "I
am a heroin user", I would suggest, first of all, the onus
would be on the doctor to disprove the truth of that statement,
because the balance of benefit is in favour of taking him out
of the black market. If it turns out he is only smoking, not injecting,
still on the basis of the balance of benefit, prescribe to him.
Mr Cameron: Thank you.
278. Mr Kushlick, if we were going step by step,
the first step would be heroin, as Mr Davies suggests, if you
were in our position and you had to make one recommendation, would
you go along with what Mr Davies says?
(Mr Kushlick) Absolutely, I would go along with that.
279. Mr Evans? You would as well?
(Mr Evans) Yes.
(Mr McNicholas) Not my area of expertise.
(Mr Buffry) From a health point of view, I think it
is essential that heroin is prescribed by doctors, from the point
of view of the greatest injustice I think it is essential that
cannabis is legalised.
(Mr Kushlick) In the wider context in terms of the
recommendations you could take forward without taking an overtly
dangerous political position, call for an audit now of current
expenditure and the cost benefit analysis of that expenditure.
It is important that is done because once that is done you can
begin to find out where resources are best spent. Even within
what we are doing now, it is not a dangerous recommendation to
make, it is just one which calls for an increased evidence base
as to what works and what does not.