Examination of Witnesses (Questions 1000
- 1019)
TUESDAY 15 JANUARY 2002
DR CLAIRE
GERADA, MRS
CHRISTINE GLOVER,
DR ROB
BARNETT AND
DR ANDY
THOMPSON
1000. Any other views?
(Dr Barnett) I would support everything that has been
said. We have treatment packages that are available and I do not
think this is a route that we would want to contemplate going
down in the primary care setting. That is from the medical point
of view; never mind the dispensing side of things and the effect
that would have on our pharmacist colleagues.
(Mrs Glover) There is a very limited cohort of people
who need heroin. They have needle addiction as well as heroin
addiction. You have to have well defined criteria as to why they
should be having it prescribed and it should be in well regulated
clinics, not just out in primary care.
1001. Assuming he goes ahead and increases it,
from a practical point of view, what additional support resources
would you require?
(Dr Barnett) One of the problems we have locally already
with specialised services is getting drug addicts treated. There
are quite ridiculous waiting lists. Those services are already
over-burdened. If we were to go down the route of this as well,
I do not think the services would survive.
(Dr Thompson) Realistically, it is going to take an
hour per day per drug addict in terms of supervising four injections
a day and you are going to have to do that 365 days a year.
Chairman
1002. We are coming to the nub of the inquiry.
As the witnesses have rightly identified, there is a conflict
between the interests of the criminal justice system that wants
to put an end to the chaos and the fact that 60 per cent of acquisitive
crime is prompted by the need to feed a habit; and the needs of
the health service which are to treat those who wish to be treated.
Those may be two conflicting and separate ambitions, neither of
them necessarily wrong but they might have to be dealt with separately
rather than together. Would you agree with that?
(Dr Barnett) I think it would be very difficult to
treat them together at the moment. We do work with probation services
in looking after drug misusers but what is being expected, or
what you are suggesting, would not fit into the health care model
that we are currently operating.
1003. If your ambition was not to cure people
who do not want to be cured and may not even be registered with
doctors in many cases but are committing enormous amounts of mayhem
in order to feed a habit, leaving needles lying around where they
might be picked up by children—I have them in my own street—and
if your ambition is to address that problem would it not be logical
to go down the road of controlled availability of heroin?
(Dr Thompson) Yes, it would but do not use doctors
and the NHS to do it.
1004. We would need doctors to cooperate somewhere
along the line. I understand you are arguing that you do not want
them cluttering up your surgeries.
(Dr Thompson) It is not a matter of cluttering up
the surgeries. At the moment, if someone wants to take heroin,
they walk into a pub in the middle of Birmingham and in 20 minutes
they have their heroin. A doctor is not involved in that supply.
Most of the harm around that activity is the contact with the
criminal underworld and the fact that they do not know how to
inject safely and that they are not getting clean equipment. They
are sharing with people with viral illnesses. If you want to make
sure that supply is safe, does not involve acquisitive crime or
contact with guns and the gang culture in the inner cities, sharing
equipment and passing on viral illnesses or unsafe injecting practices,
then set up licensed premises where people can walk in and get
their heroin fix under supervision from perhaps a health care
professional who is making sure that they are injecting properly,
but do not involve primary care under the guise of it being some
sort of treatment.
1005. You are not disagreeing with our previous
witnesses. You are saying, "Not us, guv"?
(Dr Thompson) No; I am saying do not prescribe it.
It is not a treatment. What we are doing is treating those who
want to come off their opiates or who want to stabilise their
lives and who want treatment for the psychological and social
problems which have taken them into addiction.
(Dr Gerada) I agree and I like the division between
licensed dealing and government funding. We always forget that
there is significant evidence that treatment works. I know you
have heard of the National Treatment Outcome Research Study. We
know that methadone works in reducing high risk sexual behaviour,
acquisitive crime and all the health indices associated. We know
that one pound spent on treatment saves three pounds for the victims
of crime. Though it may appear to be a pragmatic solution to be
providing heroin either on the NHS or turning a blind eye to shooting
galleries, why not invest that sort of money and energy into getting
people off the street, into treatment? Every single day we have
drug users dying on the street because they cannot access care.
In my profession it is getting better but it is by no means there
so why not invest that money? It is not sexy; it is not controversial;
but it works.
David Winnick
1006. I want to ask if you feel that the present
policy adopted by successive Governments, including the present
one, towards the use of drugs is working? There are penalties
for those who are found guilty of using drugs.
(Dr Gerada) I think the drug strategy is working in
as much as increasing treatment availability and effectiveness
of treatment—ie, the part of the drug strategy that talks
about attracting 60 per cent by 2004 and 100 per cent by 2006.
I have views about locking young people up for drug related offences.
I think far too many young people are locked up for dealing or
possession and I do not believe the drug strategy, in terms of
reducing supply, is working.
1007. I ask because in the evidence we have
had from witnesses who are very much involved in the treatment
of drugs, including the chief executive of Drug Scope and Mike
Trace, director of performance at the National Treatment Agency,
they told us that the use of drugs in Britain is amongst the highest
in Europe. That does not mean to me at least that the drug policy
of successive Governments is working.
(Dr Gerada) We have a very high background level.
I do not know the European comparisons. I sometimes worry about
comparing like with like because I do not always think we do.
Nevertheless, every single country in the world has a problem
with drug misuse. I think we treat drug users very humanely. We
probably have, within our armoury of treatment, the most varied
care in Europe, from shared care, primary care, harm reduction,
methadone, Naltrexone to rehabilitation and diamorphine services.
I cannot comment on the drug strategy in terms of the supply of
drugs and the numbers of users. You have obviously heard evidence
to the contrary.
1008. The Government has shifted on cannabis
despite what it said in the previous Parliament. The present Home
Secretary has said that there will be almost certainly a reclassification
regarding cannabis. As we know, it is not likely that those who
use small amounts of cannabis will face prosecution. Do you believe
that is the right approach?
(Dr Barnett) One of the problems is that we still
do not know enough about cannabis and its overall effects. As
you are aware, research is ongoing at the moment which the BMA
has been involved with, looking at the effects of cannabis when
it comes to use in treatment of patients with, for example, multiple
sclerosis. Until we have the results of that, it is difficult
to know whether moving down the road of decriminalisation per
se is the right way of going about things. We do know that
there is an increased risk of lung cancer with those who take
cannabis and the question is if you move down this road of decriminalisation
are you going to get more people using such drugs.
1009. A significant minority of people apparently
in all social classes, it would appear, do use cannabis. That
is a fact of life. How are you going to overcome that if you continue
to make it illegal?
(Dr Barnett) If you make it more available and legal,
are you going to get more people who are using it? We look at
the side effects of people smoking tobacco and the problems we
have now trying to help those who are suffering because of that.
Alcohol is readily available. Society has to cope with the effects
of people who misuse that and the effect on health services generally.
I do not think there is enough evidence to support that making
it more readily available is safer for society.
1010. I happen to agree that it would be undesirable
for people to start on cannabis and I speak as a layman. I am
not an apologist for the use of drugs and I hope never would be
but you refer to the problems caused by drink and smoking. We
know only too well the problems which are caused, especially from
excessive smoking: lung cancer and so on, but no one has suggested
that following prohibition in the States in the 1920s that alcohol
or cigarette smoking should be illegal. You are not suggesting
that, are you?
(Dr Barnett) No, but we are now embarking on quite
a big campaign to try and encourage people to stop smoking because,
whereas 30 or 40 years ago we did not know the harmful effects
as we do now, we know it kills people. Are we going to go down
the same route now with drugs? We are legalising them and, when
we have analysed the 400 ingredients that are involved in cannabis
and we know how carcinogenic they are, are we going to realise
we have made a mistake?
1011. Legalising it would not mean that the
state or doctors or a combination of all involved would be saying,
"Use drugs" in the same way that those smoking are not
illegal. No one has suggested they should be. Propaganda to try
and prevent people from smoking has had some effect, although
not as much as we would like. Can you therefore combine the legalising
of drugs with much more emphasis on the dangers involved in starting
drug taking in the first instance?
(Dr Barnett) I would accept that if it were not for
people who were smoking cigarettes because whilst we talk about
the harmful effects of cigarettes we see younger and younger people
taking up the habit. I suppose the commonsense response is: would
you have the same problem again with drug misusers? We heard earlier
about the importance of education, of making sure that people
do not start in the first place, but that is a very difficult
process and needs a lot of resources and time going in to make
it work. I think you would have the same problem.
1012. Do I take it from the other witnesses
that there would be no wish to see drugs, cannabis and other drugs,
legalised with the sort of controls from the medical point of
view which do not exist at the moment? It would all be legal and
it would be up to the doctors to prescribe and to recommend treatment
and the rest of it. Would there be any wish amongst the four of
you for such a drastic change in the law?
(Mrs Glover) No. You have to recognise that we here
are in the health business and I think the Government has a responsibility
to be in the health business. People like to do things that are
not good for them. You have to point out what the risks are about
doing that but at the end of the day not being popular and changing
the legislation is the sensible thing to do for a government that
has a completely over-burdened health service and does not know
how it is going to deliver what it has to deliver in the next
20 years with demographic changes. To add to that, because we
do not know what the long term consequences are, seems to me to
be folly. If you take Ecstasy, what are we storing up? In 30 years'
time, are we going to have a generation that have huge problems
with their brains because they have taken ecstasy every Saturday
night for the last 20 years? We do not know. We certainly do not
need to be endorsing it or encouraging it.
1013. Would legalising it encourage and endorse
it? Are we endorsing and encouraging the excessive use of alcohol
and cigarettes?
(Mrs Glover) Yes, we are. You are sending out a message.
(Dr Gerada) Of course we are. If alcohol and tobacco
came in today, they would undoubtedly be illegal. They would not
be sanctioned. We are sanctioning the use of alcohol. We have
children of 9, 10 and 11 starting to smoke. We have the best informed
15 year olds about the harmful effects of tobacco but does it
stop them? Of course it does not. They could tick the MCQ boxes
on what tobacco does. If we think it is going to be any different
with cannabis which has probably a nicer effect, we are up a gum
tree.
1014. I take it that the consensus amongst you
is that there is no need for any change in the law regarding the
use of drugs.
(Dr Gerada) I agree with the Police Foundation report
about moving cannabis down a notch. That is not legalising or
decriminalising it. I do not think we should send cannabis users
to prison.
Bob Russell
1015. Dealers?
(Dr Gerada) We are emotive about dealers. If you are
in organised crime, bringing in vast amounts, yes, but the occasional
person selling a bit to their friends—
David Winnick
1016. The other argument is not one that I accept,
that the medical profession are not particularly concerned about
the manner in which drugs are used so extensively in Britain and
this gives tremendous profit to the gangsters who are involved.
Legalising it would remove that to a large extent but not entirely.
Presumably that is not a view that you would wish to comment on.
(Dr Thompson) This is not an NHS Alliance policy;
this is my own personal view. I see a large number of addicts
of heroin and cocain and other substances, many of whom have come
into contact with the dealers of those substances through their
initial cannabis use. I have some sympathy with the idea that
decriminalisation would collapse the black market and take people
out of that very dangerous underworld which many get into. I practise
in an area where, if there is not a gun crime every day, it is
a holiday. Most of that gun crime is related to drugs and their
distribution. We see children of 15 and 16 stealing cars to order
to fund their habits and their friends' habits. It is not a medical
issue and I am not commenting as a doctor. The Home Office and
criminal justice system do need to look at those proposals fairly
seriously. Criminalising Ecstasy has not stopped two million Ecstasy
tablets being consumed every weekend. Criminalising cannabis has
not stopped a huge amount of cannabis being smoked around the
country. I do not think that the arguments for prohibition are
as persuasive as some of my colleagues like to think.
(Dr Gerada) Criminalising it might not stop young
people but it stops us round this table using cannabis and ecstasy.
It stops the vast majority of people walking up and down Westminster
using them. If you look at lifetime prevalence of cannabis, there
is a massive bulge in young people and then it stops, in part,
because it is a criminal activity and people just get on with
their lives.
Chairman
1017. Or people grow up and stop going to parties
every night.
(Dr Gerada) Heroin does not do that.
1018. Heroin hooks you but cannabis does not,
does it?
(Dr Gerada) It may be that but my argument is what
do we know about anything that is made more available? You get
an increase in use and more abuse. We know that from cigarettes.
1019. One witness, a medical person with a lot
of experience of drug addicts, said that we should let people
go to hell in their own handcart. You can explain that they are
adults; you can explain the risks to them and provide facilities
for getting them off if they get hooked and if they want to get
off but otherwise why should you prevent them and can you effectively
prevent them?
(Dr Gerada) Why have a speed limit? You could have
the same analogy. Who would suffer?
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