Examination of Witnesses (Questions 500
TUESDAY 27 NOVEMBER 2001
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
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.
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.
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
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
(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.
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.