Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 500 - 519)



  500. So broadly speaking it is the dancing which is killing them not the drug.
  (Professor Henry) Exactly. But the drug gives them the ability to dance for that period of time, so it is a bit of a Catch 22 situation. The other point is that a strange adverse effect of this drug is that it causes a rise in anti-diuretic hormone, which is the hormone that stops your kidneys passing urine. If I were to drink a couple of glasses of water, my levels of this hormone would go down and I would filter out the water and pass it. However, if I took a couple of ecstasy tablets before, the kidneys would just not respond to that water and if I drank enough water, it would stay in my bloodstream and my brain would just swell up and it could be fatal. I would initially become confused and I might develop convulsions and I could die.

  501. So it is a double thing. That is a very good point. Some people, having been told that if they dance they must drink lots of water, then drink lots of water, but because the MDMA is affecting their kidneys that actually kills them.
  (Professor Henry) Yes.

  502. So it is a double effect.
  (Professor Henry) Yes. That message is a fatal safety message. The message is if you are dancing you must drink fluid, if you are not dancing do not drink any fluid after taking ecstasy. It applies obviously to people who have not taken the drug also. Shall we say it does not do any harm to people who have not taken the drug.

Angela Watkinson

  503. Really reinforcing the previous question. We have had witnesses in previous sessions who have suggested that all drugs, with the possible exclusion of crack cocaine, are harmless and even are beneficial. Could I put that question to all of you? Would you support that view?
  (Mr Hickman) I saw the evidence about the notion of clean heroin and the absence of impurities. Most of the epidemiological evidence around overdose dismisses the notion that it is impurities in heroin overdose which lead to the fact that people overdose. It is because people take too much heroin and/or they take it with alcohol and other depressants. It clearly is unsafe. Heroin use is the largest cause of drug-related overdose in the country and probably kills six per cent of young people, 15 to 35. We can dismiss the notion that all drugs are safe.

  504. Is it the effect of the drug on the mind which affects the decision taking which affects behaviour? Is that the cause and effect?
  (Mr Hickman) No, sometimes you just take too much. You do not know what your tolerance is and you can lose tolerance. There is some evidence to suggest that different environments give you different tolerances. You are playing with a dangerous drug which can lead to respiratory depression, can lead to overdose. Because you want the euphoric effect, you have to take a bit more than would just give you pain relief.
  (Professor Nutt) There is another very important angle here, which is that on the street you do not know what you are getting. Some deaths are caused by new batches of better quality, stronger, higher percentage heroin coming in and people die as a consequence of that. There is also the added complication that there are drugs which are even stronger than heroin, like ventonil, which addicts like to get their hands on on occasions and those are even more toxic, even more likely to cause respiratory depression. There is often this attempt always to get more of a hit by taking more and more dangerous variants of heroin or other drugs.

  505. Professor Henry, may I ask you the same question? I think your previous answers probably anticipate what you are going to say.
  (Professor Henry) You could start the hypothesis by saying that cigarettes are harmless and alcohol is harmless. Drugs are probably more harmful than cigarettes and alcohol in many ways, although there are so many criteria by which you can measure the harm that you may come up with different messages.


  506. Is that not the truth about all drugs? It is just a question of some legal and some not.
  (Professor Henry) Yes.
  (Professor Stimson) I would not differ. Clearly all drugs can be harmful, either they have intrinsic harms or they may be harmful in the way they are used. We may have some control over the level of harm that is attached to their use. You also raised a question about whether drugs are beneficial.

  507. Somebody had suggested that they had benefits, particularly the dance type of drug.
  (Professor Stimson) Often as researchers we are looking for the problems and not for the benefits. I can think of few studies which have looked for the benefits, but clearly many people think they are beneficial because there would not be so many people using them if they were not enjoying using them.

Bridget Prentice

  508. I want to go back to a couple of things which Professor Henry said. Making a distinction between straight cocaine and crack cocaine, you said that there were fare more infrequent users of straight cocaine than regular users and those numbers were reversed when it came to crack. Does that mean that we can or cannot draw a line between people who start on straight cocaine and move on to crack cocaine, or do people come on to crack cocaine from a different route?
  (Mr Hickman) We do not have enough information about crack cocaine. Certainly if you look at arrest referral data or treatment data crack cocaine is more associated with heroin use. You get people who are using both of those drugs. What we have not yet got is a sufficient research base to say, how many people are just using crack cocaine or how many people are using crack cocaine and then going to heroin or using heroin to go to crack cocaine. The relationship with cocaine is slightly different and I do not know of much evidence to suggest in England or in the UK that there is that strong relationship. We are at the beginnings of any epidemiological research around crack cocaine and that is one of the things we need to do over the next few years.

  509. Why do we have so little evidence? You said we did not even have a lot of evidence of long-term cannabis use and yet my understanding was that people have been using cannabis in this country for at least a generation.
  (Professor Nutt) The use has increased. The current figure is that about nine per cent of the population are using it. People would have tried it in a very temporary way many years ago, whereas now there is a considerable cohort of regular users. You have to wait with cigarettes, you have to wait 30 to 40 years before you see the effects of long-term use and we certainly have not reached that stage yet.

  510. On the subject of ecstasy, you talked about a distinct change in memory ability after even one year. Do you consider that a long-term use of ecstasy?
  (Professor Henry) No, that is relatively short-term use. If people use it for many years, their mental abilities are going to deteriorate, particularly in respect of memory.

  511. Do we have any evidence to suggest that people do use ecstasy for many years?
  (Professor Henry) Yes. I have looked with a colleague at a cohort of users and we found considerable numbers of people who have been using for 10, 12 and more years. There are people who use it regularly.
  (Professor Stimson) You asked why we do not know and there is a real problem in research funding and research capacity in this country. The annual research spend on looking at all aspects of the drugs we are looking at in the UK is probably about £3 to £4 million a year and if you compare that with the annual spend on drugs problems, which is estimated at about £1.4 billion, the research spend is about 0.04 per cent of the total spend. You asked me a lot of questions to which there should be answers, but there are often no answers because the work has not been funded and has not been done.

Mrs Dean

  512. Is the evidence that the memory loss is long term or does it recover when ecstasy stops being used?
  (Professor Henry) It is very unlikely that it will recover. Also, there is a risk to which David and I have alluded in the past, that the damage to certain types of nerve terminals will lead to depression longer term. That has not yet come out epidemiologically. Although there are isolated cases of depression and suicide we do not know with relatively long-term use how that will lead to depressive illness in the future.
  (Mr Hickman) The thing to bear in mind is that the long-term users are a fraction of the total recreational users of ecstasy.

Mr Cameron

  513. In terms of the Misuse of Drugs Act, would I take it from what you said about cannabis and ecstasy, that you support the re-classification of cannabis and you would be happy or would like to see ecstasy moved down the scale?
  (Professor Nutt) Yes, you can take that from me.

  514. Any dissenting voices?
  (Professor Henry) Re-classification is one thing and it may be strategically appropriate to re-classify, but one has to accompany that with a very clear educational programme otherwise people will take it that the Government are not interested in drugs or think they are harmless and that would be a tragedy.

  515. But the classification should be changed in order to reflect what we were talking about earlier: harm, short term, long term, addictiveness. Is that generally the view?
  (Professor Henry) Yes.
  (Professor Nutt) Yes.


  516. Professor Henry, would you go along with that?
  (Professor Henry) Just. If it is thought to be appropriate, yes, one can accept it, but one must send out the right signals. Smoking has been driven down steadily over the years by appropriate policies and drugs can also be driven down by appropriate policies.

  517. Accepting that, the point has been put to us that having unrealistic classifications does not achieve your aim because most of those who use drugs know that they are unrealistic and therefore do not take the education seriously. Would you accept that?
  (Professor Henry) Yes.

  518. Everybody would accept that would they?
  (Mr Hickman) Yes.
  (Professor Stimson) Yes.
  (Professor Henry) Yes.

Mr Cameron

  519. What would you change to the strategy in terms of treatment? At the moment there is a target of getting more people into treatment. What else is needed? What would you target instead, given that you do not think the strategy is working?
  (Professor Nutt) It should be possible for anyone who wants treatment to get it within a week and we are so far away from that that it is probably the biggest single hurdle we have. Certainly in Bristol if you are a street heroin user there is no treatment available unless you have some other problem like a psychiatric disorder or you are pregnant, because the services are so stretched dealing with the complicated cases that there is no resource for the simple cases. That to me is the obvious way forward, to try to make treatment available to everyone who would like it.
  (Professor Henry) There comes a point in the career of many drug users, alcoholics and cigarette smokers when they ask themselves what they are doing. That is the opportunity to intervene. They have to go onto a four-month waiting list and it is the end.

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