Examination of Witnesses (Questions 1020
- 1038)
TUESDAY 15 JANUARY 2002
DR CLAIRE
GERADA, MRS
CHRISTINE GLOVER,
DR ROB
BARNETT AND
DR ANDY
THOMPSON
1020. Other people.
(Dr Gerada) Not other people but the sick, those who
could not run across the road quickly enough or children, the
vulnerable people. If we removed any laws for drugs, who would
suffer most? Certainly not those who have parents who can take
them to Phoenix House to look at ex-users and sort their lives
out. The people who would suffer most are those from disparate
lives, the poor and deprived.
1021. They are the people who are already consuming
disproportionately anyway.
(Dr Gerada) Your argument was let them all rot in
hell.
1022. No. This is not my argument. I am attempting
to put an argument we have heard several times before this Committee,
that adults who are perfectly capable of assessing the risks for
themselves should be allowed to go to hell in their own handcart,
subject only to the qualification that it should not disrupt the
lives of other people. With crack cocaine where everybody knows
it makes you behave completely uncontrollably, that would not
be an argument but in the case of heroin, which almost dumbs you
down and ditto I suppose cannabis, why not?
(Dr Thompson) I agree that to a certain extent, again
personally. Also, if we look at the amount of resources that would
be freed from enforcement which could be used for treatment, there
is a fairly strong argument.
1023. This is what we call thinking outside
the box. Up to now, the discussion has taken place on the basis
that you are all associated with health and wanting to make people
better but now I am asking you to imagine that you are the Home
Secretary and not a doctor and you have this massive problem which
is getting worse and worse.
(Dr Barnett) One of the problems is that there are
a lot of people who smoke and who wish they had never started.
Having started, they find it very difficult to stop. There are
a lot of people who drink alcohol who wish they had been able
to control what they had been drinking but it has escalated and
the same happens with drug misusers. A lot of people start, the
habit becomes addictive and they find it very difficult to stop.
They just wish they had had the willpower not to start in the
first place. I smoked a cigarette at the age of 11, coughed, hated
it and as a wimp did not continue but a lot of people persevered
because they felt it was big to do so. The same happens with drugs.
If there is peer pressure, you will continue.
1024. When you and I were 11, smoking cigarettes
was represented in some quarters as a sacrament rather than something
that would get us into serious difficulty later in life. We have
all become aware that it can seriously damage your health, to
coin a phrase, and the government is about to ban, I hope, the
advertising. No one is talking about advertising cannabis or marketing
heroin; we are just talking about harm reduction and minimising
harm that has already taken place in controlled circumstances
or whether we allow the mayhem to go on.
(Dr Barnett) I think we still need more research on
the harmful effects of cannabis to make sure that people are fully
informed about what they are doing. We have talked about the pleasurable
side of taking cannabis but we need to have the evidence, like
we have now with tobacco smoking, which shows what the damage
is to you. If that was more readily available and there was evidence
to prove it, that may be a useful argument for some people.
1025. Except for the purpose of arguing that
cannabis is damaging—most people accept that, certainly
if you smoke it on the same scale as people tend to smoke cigarettes—why
not explain what the risks are but not exaggerate them, because
that just encourages people if they do not believe you, make it
available to adults and let them take their own risks?
(Mrs Glover) There is a cost to that because at the
end of the day these people end up with chest problems, collapsed
veins if they are injecting, and so on. Is that something we want?
Mr Cameron
1026. There is a huge black market from smoking
but that does not mean we make it illegal, so that argument does
not follow.
(Mrs Glover) It does because you have a choice here.
The problem with smoking is that it arrived before we had the
evidence of what it did. We now know that if you spend a lifetime
injecting heroin you are likely to have a completely collapsed
system. You are likely to have people who become amputees.
1027. Has making these things illegal helped?
If you look at the use of drugs, the use of cannabis, Ecstasy
and heroin, they have all rocketed up, as it is illegal.
(Dr Gerada) You would have to prove that that would
not happen if you made it legal. I am sorry if I talk in a conservative
health way but I see every single day patients who use drugs and
have terrible problems.
David Winnick
1028. Despite the fact that it is illegal. The
argument is not that we should encourage the use of drugs, although
we should warn people constantly of the dangers. In my view, much
more should be done, to what effect I do not know, but the argument
is that, despite the fact that these drugs are illegal, including
cannabis, people are using them.
(Dr Gerada) I cannot see the argument that you would
get more of them if you made it more legal or less illegal. You
say give it to adults. I would like to see how that would be done.
Cigarettes are meant to be sold to adults and yet we see children
smoking cigarettes. Alcohol in children is rising considerably.
It is a Pandora's Box and once it is open it is too late.
1029. You believe, if it is to be decriminalised
if not legalised, far more people would use it?
(Dr Gerada) Yes.
1030. That is the view of you all?
(Dr Thompson) That is not my view. I see users who
are virtually kidnapped by dealers. They are trying to get off
their methadone and dealers hang around the community drugs teams.
They take them into their cars. They make them buy their heroin.
Dealers are very sophisticated businessmen who develop their markets
with a skill which puts some of our businessmen in this country
to shame. They are very good at it and there is no doubt that
there are those users who, in order to fund their habit, introduce
it to their friends. If they did not need to do that, I am not
sure necessarily that drug use would decrease but I am sure there
is an argument there which says that drug use would not increase
as a result of legal supply and a less costly supply.
Mr Cameron
1031. What about the question of harm? We have
had people in front of us who said even if you accept that use
might go up harm would go down. If you look at the fact that 40
heroin addicts died in Scotland because of impure heroin and two
million Ecstasy tablets are being taken every weekend and we have
no idea what our children are putting into their mouths; if you
look at the sort of cannabis that is being smoked—skunk
and super skunk, incredibly powerful stuff—what about the
argument, as medical people, about would getting rid of prohibition,
particularly for soft drugs, reduce harm?
(Dr Gerada) For the current users, yes, of course
it would. If you take someone buying illegal heroin off the street
and you made it legal, for whatever reason, to that individual,
putting themselves at risk, day in, day out, robbing or whatever,
it would have a lot of health and criminal justice benefits. My
argument is it is such a risk because we then do not know what
is going to follow. We use the analogy of tobacco but we sort
of ignore: it is all right; it is just cigarettes, but it is a
legal substance that still causes 100,000 deaths a year. People
know about the harmful effects. You only need to smoke four cigarettes
to be addicted for life. 80 per cent of smokers want to give up.
It is a not a matter of mind, motivation or self-control; it is
the drug. I worry that if you do that you have let out something
that we can never get back.
Bob Russell
1032. How many people have died from cannabis
smoking?
(Dr Gerada) Cannabis is a different issue because
there are not a lot of cannabis users at the moment in terms of
long term, chronic, heavy use. If you let cannabis out of the
bag, it is higher strength; it is frequently smoked with tobacco.
It certainly causes all the cancers that tobacco causes and it
brings forward schizophrenia and psychosis. Let us look at the
evidence extensively and let us not be driven by the `something
must be done' type of scenario rather than looking at this properly.
1033. You mentioned the people who come to you
for treatment or support on drugs. How many of those are cannabis
smokers?
(Dr Gerada) The funny thing about general practice
is we see all the addictions, whereas in specialist care they
only see heroin and cocaine. I see cannabis smokers wanting to
give up cannabis, high level cannabis users whose lives are dominated,
maybe smoking 10 to 15 a day, who want to give up. The treatment
is very much of a motivational interview type. I have seen a Coca-Cola
addict who drank three litres of Coke a day.
(Dr Thompson) There is a difference between what you
can do with decriminalising cannabis and other drugs and what
happens with alcohol at the moment. Alcohol and tobacco are very
heavily advertised and promoted. They are also widely available
and the restrictions on its supply are largely ignored. If you
had a better regulated, legal and cheap supply, you could avoid
a lot of the effects of that sort of promotion, which does promote
the use of alcohol and tobacco.
David Winnick: You have certainly given us a
different viewpoint on the subject from other witnesses and we
will undoubtedly take it very much into consideration when we
draw up our report. It is in conflict with a good deal of evidence
we have heard and that is not a bad thing because we needed a
balance of view and clearly we have had it today.
Chairman
1034. I do not want any of you to leave here
feeling that you have not made some point that you feel is essential
to our inquiry which has not already been made. Dr Thompson?
(Dr Thompson) I would like to expand on a point that
we made in our written evidence about what happens within the
prison service. I understand that it is a matter of resourcing.
Resourcing and training are improving but even within the prison
service it appears that there is an idea that maintenance methadone
ought not to be used except in exceptional circumstances. All
the evidence that we have in opiate abuse is that in moderate
to high dose maintenance methadone is the most effective treatment
while waiting for people to realise that they want to come off
opiates. The fact that the prisons will not countenance that is
stopping many heroin users from revealing their heroin use when
they are admitted into prison. The result of that is that, rather
than getting any treatment in prison and seeing any resettlement
workers, they end up buying heroin which is freely available on
the wings and injecting it. They cannot use a needle exchange
because the prison service will not allow needle exchange to take
place in prisons, so they are encouraged to bleach that equipment
which is known not to be as effective as providing proper, sterile
equipment. It is particularly disheartening to see people who
have been on methadone programmes go into prison; they know they
are not going to get their methadone and they do not tell their
warders that they are on methadone. They buy their heroin on the
landings and come out again using heroin or with problems from
having injected. If we are going to take the access to health
care seriously to prisoners because they have an equal right to
whatever health care they would have got outside, they need to
have access to maintenance methadone on the same basis that they
have in the community.
1035. Does everybody agree with that?
(Dr Gerada) I agree. Please do not forget alcohol.
I know we are looking at drugs but we have a crisis in young people's
drinking which is often linked to Ecstasy and cocain. It is just
ignored because we all drink and we all think there is no problem.
1036. We are looking at drugs at the moment
but you are quite right to put it into perspective. Alcohol is
an even bigger problem.
(Dr Gerada) Far greater.
(Dr Barnett) We talked earlier about what happens
in primary care and it may be useful if I submitted to you our
shared care guidelines which explain the roles of everyone working
within the primary care team and the extended team, trying to
manage the situation in a primary care setting.
1037. That would be extremely helpful. If you
could give the BMA a friendly kick in relation to their approach
to this subject, we would be grateful.
(Dr Barnett) I shall ensure that if there is anything
else the BMA wishes to add it is brought in writing to you.
(Mrs Glover) I really would like pharmacy to be included
in the loop when you have these discussions. If you look at the
evidence you have taken, you would not know that pharmacy was
doing anything out there. The problems of having pharmacy representation
when strategies and policies are being rolled out—if you
cannot get a pharmacist there and you do not have a pharmacy coordinator
working on that patch, they are just missed off the agenda. It
is such a pity when they are doing so much to support the system.
1038. That is a very important point. Thank
you very much. You will notice that we have included pharmacy.
(Mrs Glover) Absolutely.
Chairman: Can I thank all our witnesses for
a very stimulating session. The inquiry is closed.
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