Examination of Witnesses (Questions 440
- 459)
TUESDAY 20 NOVEMBER 2001
COMMANDER BRIAN
PADDICK, MR
FRANCIS WILKINSON
AND MR
GEOFF OGDEN
440. Do you think that should be indulged without
any imposed reduction on dose, for example?
(Mr Wilkinson) It is a very interesting point because
it is one that bothers doctors. If you just take a patient centred
approach and look at the individual you try and get the individual
off, but if you look at the public health effects of criminalising
heroin, because that is what we have done, if anybody wants heroin
they have to get it on the criminal market except for a tiny number
that is so insignificant it is not worth talking about, then the
public health effects of that in terms of hepatitis, in terms
of impurities in the supply they get, in terms of the people it
is passed on to who do not know what they are getting and overdose,
are much worse. The public health effects of our current policy
result in a lot more deaths than supplying clean heroin. Overdosing
on clean heroin is almost unheard of.
441. Would you accept that any user's own habit
is harmful to others in as much as they are likely to make themselves
ill and, therefore, will need health treatment and we have other
people waiting for new knees or whatever?
(Mr Wilkinson) I quite understand the argument and
that is why I think tobacco advertising is such a bad thing, but
does that mean we make a law saying it is illegal to smoke cigarettes?
I do not think it does.
442. It would be difficult to do that retrospectively.
(Mr Wilkinson) Of course, it is different, yes, and
so we admit defeat, or whatever. I do not believe with the extent
of cannabis use at present that it is sensible to say we are simply
going to pretend that it is illegal and people must not do it.
Chairman: Now Mrs Dean has some questions for
Mr Ogden, who has been waiting patiently.
Mrs Dean
443. Mr Ogden, you have been very patient and
I am sure there have been lots of comments made that you would
disagree with from your earlier point. I understand that in general
you believe the strategy is working?
(Mr Ogden) It is starting to work. It is certainly
starting to work in my area although there needs to be some improvement
of it. It is the first time in 30 years of British drugs policy
that the strands of enforcement, education and health have been
brought together. I disagree strongly with Mr Wilkinson, the only
way we can reduce the number of heroin users is by vigorous enforcement,
extremely effective treatment and first class drug education and
prevention. That is what is the National Drugs Strategy. If it
has not worked over the three years it is because it has had some
people along the way who have actually undermined that strategy
in some of the debate we have had. I think we really have to take
it forward and make it work with the right sort of resources properly
co-ordinated and properly commissioned.
444. What would you say the success is that
you are having already in the East Riding and Hull DAT?
(Mr Ogden) First of all, it has been extremely difficult
to pull together all departments of local government in the same
way that Keith Hellawell had difficulty pulling together all departments
of central government. We have had the same problem but we have
got there. We have got combined commissioning, we have got core
budgets. We have got a vigorous drug education prevention programme
that not only does drug education through the national curriculum
of science and personal social health education but other programmes
that go into schools in support of that. The evidence we are getting
from young people from local surveys, not properly evaluated yet
because we have got a long way to go, is that less young people
are now drifting new into class A substances, it is not cool—to
use the expression—to be a smackhead, but it is cool to
take cannabis because it is going to be legalised shortly. That
is the view that young people have. When the Home Secretary made
his announcement before this Committee as your first witness,
I was inundated by head teachers ringing my office asking "what
is going on?" I circulated the Home Secretary's press statement
which put more balance to that to head teachers, "this is
what the Home Secretary is saying". That is how concerned
they are about it. I think the National Drugs Strategy can work.
We have had a real problem with treatment. Treatment historically
has been poor, poorly commissioned, poorly co-ordinated. We have
wasted millions of pounds over the years with treatment. You have
had evidence from Paul Hayes, the Chief Executive of the National
Treatment Agency, and it is a massive progressive step to put
some real standards into effective treatment. We have really got
to give that a chance to work and we think it will do.
445. Have you, in your area, got enough treatment
facilities now?
(Mr Ogden) No. We are having to apply the principles
of shared care because we have to move away from agencies referring
to one single agency. The problem with treatment is everybody
refers everybody to a specialist, they want GPs. We want every
GP's practice to have the confidence, the ability and the training
to be able to treat drug users as they are able with somebody
going with the flu or with a broken arm. They are known as generalists.
We then want to have, and we have got them, specialist generalists,
GPs who are trained to a higher standard who want to specialise
in it. Those GPs will be supported by nursing staff, by councillors,
dealing with more problematic drug use. The third tier is the
really chaotic drug user who almost needs daily titration clinics,
possibly to prescribe diamorphine in larger quantities than it
is at the moment. That is the way that we are moving. Before we
spend any more money on it we have to make sure that the money
that is there now is sharply focused because until these last
few years it was not, it was all over the place. Methadone was
being prescribed in vast quantities in some parts of the country,
even in my area, and it was killing people. A prescribed drug
was killing people because there was no co-ordination. It took
four years for the clinical guidelines on methadone to be produced.
People died in that time. A third of the deaths that I reviewed
involved people who had taken methadone and other drugs. We are
getting there.
446. What percentage of drug users who are in
treatment in your area are being treated with methadone?
(Mr Ogden) I would think about 70 per cent of those
who are in treatment are on some sort of methadone programme but
it is not now just a methadone programme. I really wish that when
people refer to treatment they would not put that word "methadone"
in front of it because methadone is not a panacea. If you apply
the principles of sorting their lives out, sorting their accommodation
out, their employment, their financial situation, even some education,
take a holistic approach to treatment, then it will work. Methadone
on its own without anything else will not work. That is what we
are trying to introduce.
447. We have been told that there are more deaths
of people on methadone than on heroin in some instances. You favour
the prescribing of heroin rather than methadone, do you?
(Mr Ogden) Not necessarily. I would not favour prescribing
heroin in many cases. This is something that the National Treatment
Agency has got to come to grips with, that for people who are
extremely chaotic users it may well be that the prescribing of
diamorphine in a very specialised clinic is necessary but we really
have to move people away from intravenous use of drugs full stop
through effective treatment. When I first started to review deaths
four years ago, a third of those people who died had died of methadone
overdoses. I have not reviewed a methadone overdose death for
over two years because most methadone now is taken under supervised
conditions in pharmacists. We have got to work on that.
448. That has improved that. Although you say
you believe the strategy is working, what changes do you think
are still needed to improve it?
(Mr Ogden) I have read Keith Hellawell's evidence.
I think the targets and the objectives were right when he produced
the national strategy. We have all got some difficulty with the
numbers of young people under 25 moving to Class A drugs, we have
to look at that particular target. We have got to put more resources
into enforcement. I have heard the figure that 62 per cent of
all budgets is spent on enforcement. That was the case in 1998
but it is now much less than that in the overall scheme of things.
We have got to look at what happens with the importation of drugs.
We certainly need more resources with Customs and Excise. I am
very worried about the attitude to money laundering. I am very
pleased that money laundering is now an issue but, sadly, it took
11 September to raise the profile of money laundering. Bureaux
de change and travel agencies have been laundering money for years
and no-one has taken any notice of it. Those people who whinge
and complain about drugs are actually probably involved to some
extent with aspects of money laundering. Until we have high ethical
standards in business and people properly reporting money laundering
to the National Criminal Intelligence Service, particularly retailers,
we are not going to get all that far with getting at the money
launderers and getting the right sort of intelligence to get to
the middle and top tier dealers. Customs and Excise need more
support and Customs and Excise, which is part of the Exchequer—drug
trafficking is now back with the Home Office, before it was with
the Cabinet Office—probably need to look at the prosecution
side of things because most prosecutions are through Customs and
Excise lawyers and not through the Crown Prosecution Service.
We need specialised lawyers, I think, within the CPS to prosecute
drug cases.
449. You obviously are not in favour of decriminalisation
or legalisation from what you have already said, but what do you
see as the main dangers of such a move?
(Mr Ogden) Further use. We have already got quite
enough problems with alcohol, with under-age drinking, with binge
drinking, with bootleg tobacco, with bootleg alcohol, let us not
make the situation worse with drugs legally available. We have
got a national strategy. It is very difficult pulling together
all those agencies but I think we can get there and we would have
moderate use. We have seen it now with cannabis, that just by
the announcement that cannabis may well move from Class B to C
young people think "that is cool" and will carry on
using it. It is not good because in a developing brain it causes
very significant problems.
450. Is not one of the arguments for prescribing
heroin more widely that you then take up the need, as we have
heard others say here today, for them to sell it on and thereby
reduce the number of people coming on-stream as users?
(Mr Ogden) I think this really does need very careful
looking at. When I say prescribe it more widely, I think very
specialist agencies can probably increase the number of people
who prescribe diamorphine on the premises, not to go away and
inject it in shooting galleries, which is something that I would
not support and my Drug Action Team would not support.
Chairman
451. On what premises?
(Mr Ogden) On the premises of the specialist agency,
the third tier of the very specialist agencies with all the clinical
support available for them at that time. That occurs now and maybe
there is a chance to extend that, but I would not advocate wider
use of that because we have got to move people away from this
intravenous drug using culture that this country, and certainly
my area, has had since the early 1980s.
Mr Watson
452. Mr Ogden, you have put a very robust case
in defence of the National Drugs Strategy and if I could focus
on the prevention and education side of that. You said that the
reclassification announcement has increased cannabis use amongst
young people. Have you any evidence to show that?
(Mr Ogden) The word on the street for a long time
about cannabis is the youngsters think it is going to be legalised—
453. That is anecdotal.
(Mr Ogden)—so it is cool to use it. More recently,
head teachers contacted me immediately after the Home Secretary
gave evidence to this Committee expressing their concern.
454. It has been said that the problem with
the existing messages that Government and agencies of Government
are giving out on drugs in their education programmes, is, for
example, we are saying that ecstasy, being a class A drug, is
as harmful as heroin, being a class A drug, and that patently
is not the case.
(Mr Ogden) I do not agree with that. If you have got
good drug education, and good drug education starts at the age
of five when you talk to a youngster about what a fantastic human
machine the body is and what you put into it pollutes it and then
you build on that through the national curriculum on personal
social health education, if you have got effective drug education
as youngsters get older you will deal with specific drugs and
give them the facts about specific drugs, about the harm that
those drugs will do. They have then got to make their informed
choices on it. We would not say heroin and ecstasy are the same,
we would go through the symptoms and effects with them in a very
structured drug education way.
455. Nevertheless, the classification of drugs
does put them in the same category. One thing that we have had
a large amount of evidence on is that there is confusion amongst
young people and they do not believe the messages that are being
presented to them because they know through their own anecdotal
evidence and their own experiences that ecstasy is less harmful
than heroin, cannabis is less harmful than ecstasy. Other people
have said to us that the reclassification of cannabis is actually
sending a clearer signal out about the harm different drugs can
do to you.
(Mr Ogden) We would not agree with that. I just go
back to what I said previously. If you have good drug education
you explain the effects that those particular drugs would give.
The reason that the Government in 1971 decided to put ecstasy
in class A in the same way as they put cannabis in class B was
cannabis in 1971 was far milder in THC content than it is in 2001.
Cannabis oil is still, I presume, going to be a class A drug because
it is very strong and yet some of the cannabis that is now around
blows your mind because of the strength of it. How do we know
that if you are just going to warn them on the street and take
no further action without saying "What exactly was that?
Was it skunk? Was it Northern Lights? What was the strength? What
else have they got back at their house?"
456. So there is a case for reclassifying some
derivatives of cannabis, maybe increasing the classification of
some and possibly decreasing—
(Mr Ogden) Possibly. This is something the Advisory
Council needs to take a very, very close look at because it may
be slightly different now and some cannabis may well need to be
higher in classification.
457. You are not against the principle of reclassification?
(Mr Ogden) I personally think that the whole thing
wants looking at very, very carefully. I do not think it has been
and there has not been an informed debate on this. We were very
surprised when the Home Secretary made his announcement before
this Committee.
Mr Cameron
458. I am just very surprised at this point
about children saying "it is going to be legal so it is cool
to take it". Have you met any teenagers who have said something
like that?
(Mr Ogden) Yes. These are the myths. Head teachers
asked us to give more information on cannabis and we have provided
a lot of information for them. This is what youngsters are saying:
"It cleans out the lungs. It helps you concentrate. It is
no different from smoking cigarettes. It is not as harmful as
alcohol. It is going to be legalised. It is legal in Holland.
Cannabis does not make you aggressive like alcohol. It is okay
to drive on cannabis. Cannabis does not have any long-term effects.
It is not addictive. It is not physically addictive. I know what
I am doing when I take cannabis. It calms the baby down if you
smoke when you are pregnant. It helps in exams. It helps you lose
weight. It does not cause cancer". All wrong.
459. Is this an argument for education or prohibition?
(Mr Ogden) It is an argument for education, but by
suggesting that cannabis is less harmful than it was in 1971 when
it is more harmful than it was in 1971 we believe undermines the
drug education programmes that many, many Drug Action Teams have
now got in place in a very comprehensive manner.
Mr Cameron: Thank you.
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