Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 1000 - 1019)



  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.


  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.


  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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