Examination of Witnesses (Questions 520
- 539)
TUESDAY 27 NOVEMBER 2001
PROFESSOR GERRY
STIMSON, MATTHEW
HICKMAN, PROFESSOR
JOHN HENRY
AND PROFESSOR
DAVID NUTT
520. When you say treatment are you defining
there day centres and residential centres, the whole gamut or
is it the particular form of treatment you are thinking about?
(Professor Nutt) You need the full portfolio; different
people want different forms of treatment.
521. So getting people into treatment should
be the goal. Would you have a broader public health goal as well
in terms of harm reduction?
(Professor Stimson) I certainly would because treatment
is only relevant for a very small proportion of the population.
Even for those hard drug users who would benefit by treatment
there is a long time lag between the development of their drug
problem and when they come into contact with treatment services.
People are at risk for many years and you do need to have a public
health component to the strategy which is partly about teaching
people the risks and how to avoid the risks of various drugs and
in the case of injectable drugs providing them with the means
to use those drugs in a safer manner. There are other changes
to the Misuse of Drugs Act which I would suggest, but perhaps
we shall come back to that.
Mr Cameron: The general question we are trying
to get to grips with is whether you can focus more on treatment
within the current framework of law or whether the current framework
of law needs to change. That is at the heart of what we are discussing.
Chairman
522. We shall come to that in a minute. Shall
we just let Professor Stimson say whatever he wants to say about
the Misuse of Drugs Act?
(Professor Stimson) Section 9A, which deals with drug
paraphernalia laws would be best done away with altogether. There
has been so much argument and nonsense about amending and changing
it so you can allow certain things to be distributed, but it is
just a useless encumbrance in the Act. There is an exemption for
syringes but not for other equipment which may make drug use safer.
523. Could you explain what the effect of that
would be?
(Professor Stimson) It is not an offence to supply
drug paraphernalia of any sort.
524. What would be the purpose of doing away
with that?
(Professor Stimson) Some of the drug paraphernalia
makes the ingestion of drugs safer.
(Mr Hickman) Hepatitis C.
525. Everyone agree with that?
(Professor Stimson) It is in the Act to discourage
drug use but I do not see that it actually does. It was put in
for cocaine sniffing kits and all the rest of it, but it does
not really have an impact on discouraging drug use.
526. What other changes to the MDA?
(Professor Stimson) Section 8, which is about allowing
premises to be used for the consumption of drugs. That was recently
extended from cannabis and opium to all drugs and it is a very
problematic section, partly because drug paraphernalia can be
used as evidence of drug use on premises and that makes the harm
reduction effort more difficult. It is a difficult section because
people who are working with hard-to-reach drug users may often
be in circumstances where drug use may be taking place and it
makes their task very difficult to have that piece of the Act.
527. In relation to heroin are we talking about
what they call shooting galleries?
(Professor Stimson) Yes.
528. So you can do it in safe circumstances
and you do not leave the needles lying about in the street.
(Professor Stimson) There are not many shooting galleries
in this country; there are in other countries. Obviously the thing
from a public health point of view is to get in there and to make
the drug use safer in those settings. It is very hard under the
current legislation to see how that can be achieved.
529. You are saying you would like to see—for
the purposes of the discussion let us call them shooting galleries—introduced
or encouraged in this country.
(Professor Stimson) No, I am not saying that, but
I am saying that if there are such then they should be made safer,
but I am not saying I would encourage them. There is a difference:
dealing with the reality that they are there, but not saying one
should set them up.
530. Some countries, Germany for example, have
gone a stage further, have they not and have set them up as a
way of getting the problem off the streets and into a safe environment?
(Professor Stimson) The safer injecting room idea,
which is probably a good idea for some drug users who have a range
of other problems including homelessness and if you do not have
somewhere to inject quietly, it is hard to avoid risks if your
life is pretty disorganised. We had safe injecting rooms in this
country in the early days of the drug clinics from 1968 to about
1972 and some of the drug clinics had a place where people could
inject their drugs in safety. One of the drug projects I was involved
in had a safe injecting room in Camberwell but it became a little
bit chaotic and difficult to control. There may be some merit
in a safer environment in some cities where you have fairly high
concentrations of drug users who have high levels of social disadvantage,
may be homeless and so on and so forth. There is some merit in
looking at that idea.
531. Do other witnesses agree with Professor
Stimson?
(Professor Nutt) I agree. It is one element in a package
of improving health care and reducing harm.
(Mr Hickman) Yes. It is better than having shooting
galleries which are unlicensed to have safer injecting premises,
if the reality is that you have them.
532. Yes, perhaps safer injecting premises is
a better term than shooting galleries. I am happy to stick with
that. Professor Stimson, did you want to add to the point you
were making?
(Mr Hickman) If I may, I wanted to go back to your
question on what we would change about the treatment objective
within the strategy. The treatment objective is a good objective
and the only criticism I would have is to include other aspects
of prevention activity such as needle exchange and prevention
of overdoses which are not to the fore within the strategy.
Mr Cameron
533. Have those as objectives.
(Mr Hickman) Yes.
(Professor Stimson) May I make one comment about treatment?
There is a question of treatment for what. The expansion of drug
treatment is to a large extent being driven by the argument that
treatment will reduce crime, but we also have to remember that
treatment can improve health.
534. Would you be specific about that in the
objective?
(Professor Stimson) I would. There is a clear danger
of talking about treatment in a very broad way without specifying
why you are delivering it. In the evidence that Paul Hayes gave
from the National Treatment Agency, I was rather surprised that
he did not say what treatment is for and there were no words in
there like "health", "addiction", "mental
health", "well-being". It was a bit surprising
to have evidence given about treatment which does not say what
the treatment is meant to be doing.
535. That seems to be a very sensible point.
Looking at the picture as a whole, do you still think that there
is too much emphasis on criminal justice in the strategy as opposed
to treatment? Would you still like to see an expansion of that,
almost giving that aim a higher ranking than the others?
(Professor Nutt) I would.
(Professor Stimson) Yes.
(Mr Hickman) When the Americans looked at their drug
misuse research they had this notion of looking at the whole of
drug misuse in terms of a public health framework. The question
was whether a criminal justice initiative led to a decline in
dependence in addiction or a drug related harm. It is that overview
which is missing from the strategy. Criminal justice interventions
are fine if there is enough evidence to suggest that they will
lead to the desired objective, which is a reduction in dependence
and a reduction in harm. We do not seem to have that evidence
and they seem to go on separately from "What are they for?".
David Winnick
536. Reference was made earlier on to tobacco
and alcohol abuse. Regardless of any change in the law, at a time
when efforts have been made, say in the last ten years, to reduce
tobacco use and alcohol use, would it not be unfortunate if drug
reformers, however much they may be right about changing the law,
gave the impression that we should not be too much concerned about
any form of drugs including even soft ones.
(Professor Nutt) It would be unfortunate but I do
not think changing the law would necessarily give that impression.
(Professor Henry) I made an allusion to education
earlier on and it is very interesting how overall drug use is
going down year on year at the moment, whereas some of the harder
drug use in young people is going up, possibly because of more
aggressive marketing by those who make a lot of money out of it.
The fact that overall drug use is going down bodes well for the
future because the fewer people who start smoking, who start taking
alcohol, who start using cannabis, eventually the fewer who take
to hard drugs, because people do not leap into hard drugs suddenly.
It may well be that educational policies are already working and
that aspect has to be stressed so that the longer term will be
to reduce overall drug use in the community, be it alcohol, tobacco,
cannabis or whatever. There is a positive opportunity there.
537. While that may well be so, and it is encouraging
indeed if drug use is going down, should we work on the reasonable
basis that just as we are not going to get a situation where people
give up smoking entirely or anywhere near it unfortunately, especially
among some youngsters, and alcohol abuse is not going to disappear,
the same applies for drugs, does it not? The possibility that
only a very, very tiny number will continue to use drugs would
be far too optimistic I assume.
(Professor Nutt) The reality is that drug use is with
us, it will always be with us and the best way of dealing with
that fact is to try to minimise the damage that the use does to
the individual and to society.
(Professor Henry) I would add: to find ways of discouraging
people from starting drugs in the first place. If they do not
start, they never end up with problems.
Chairman
538. I am conscious that Professor Nutt had
some other suggestions for changes. When we asked what changes
you would make, you said that what Professor Stimson was proposing
was only one aspect of it. Do you have others you would like to
put to us?
(Professor Nutt) In terms of changing the Misuse of
Drugs Act?
539. No, in terms of changes you would make
to government policy across the whole range. If you were the Home
Secretary, what would you do.
(Professor Nutt) Improving treatment would be one
undoubtedly and the other key one is education in terms of trying
to get people to have a balanced view of the relative risks and
also research; that has already been mentioned, but we do need
a lot more research.
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