Examination of Witnesses (Questions 1120
- 1139)
TUESDAY 22 JANUARY 2002
MR DAVID
RAYNES, MR
FRED BROUGHTON,
OBE, MRS MARY
BRETT AND
BARONESS GREENFIELD,
CBE
1120. You make a direct relationship between
cannabis and going on to harder drugs?
(Mr Broughton) There is a cultural fashion about drugs
and it moves in different groups of people and in different age
groups. We know where the cocaine is being used in society, it
is being used by people in their late twenties and early thirties,
that is where cocaine is the most highly used drug, the American
experience shows that and the evidence is coming through this
country as well. There are fashions and cultures in relation to
drugs, always has been always and always will be, it is a moving
fashion and a moving culture.
1121. Can I then move you on to the question
of your concern about public health, a number of you touched on
that area, is that related to the increase in prevalence? Are
you saying that decriminalisation will increase problems in the
public health sphere because there will be an increase in prevalence
or do you see it as another issue entirely, Mrs Brett?
(Mrs Brett) Professor Greenfield touched on some of
the harms of cannabis on the brain, which is most of my submission,
actually, because I did not know she was being called today. There
are a tremendous number of other harms cannabis can do, I will
run through them quickly, there is the carcinogenic effect, which
she did mention. There are about four different studies of cancers
in the United States, head and neck cancers are very rare in the
under 60s, they used to be and now they are becoming much more
common in young people, and that has been tied up with cannabis
use. We are going to have cancers, we are going to have to have
these people looked after in hospitals, etcetera; bronchitis and
emphysema, just as you get with cigarette smoke you get it with
cannabis smoke; you will get lung cancer as well. There are one
or two papers dealing with lung cancer but the BMJ had a photograph
about two or three weeks ago in its journal of a lung shot through
with holes, and it was a cannabis user, where there should have
been lung tissue; it affects the hormones particularly in young
people when they are going through puberty, the hormone production
in sex hormones is affected, it is interfered with. This causes,
and this has been seen in lots of papers, the sperm count to decrease
and you can even get impotence occurring. That goes down very
well with my pupils when I tell them. Menstrual cycles are disrupted
and women can harm their unborn babies. There is a chap who has
done a lot of research in Ottawa called Fried and he has followed
children, I think he has them up to about 10 or 12 now, and he
has looked at these children of women who smoked while they were
pregnant and there are attention difficulties, behavioural problems,
learning problems and, as I say, they are now about 9 or 10, these
problems are still coming out in the children long after that.
There are loads of other effects on the body but the other main
thing is its effects on the heart, it increases blood pressure
and heart rate. There was a very recent paper which came out that
said the chance of having a heart attack in the hour after smoking
a joint are increased fivefold. Again, we would have the consequences
of that to deal with in hospitals, and so on. Professor Greenfield
also mentioned traffic accidents, and again there is a lot of
evidence on traffic accidents, because that is harming the community
as well. In one survey I was reading, even though nine to ten
times as many people use alcohol cannabis is implicated in a similar
number of traffic accidents.
1122. You would say even if the evidence showed
there was no increase in prevalence the public harm effects are
so strong now that decriminalisation would only make that worse
regardless?
(Mrs Brett) It would be an absolute disaster, it really
would be a disaster.
1123. Do Mr Raynes and Mr Broughton agree with
that?
(Mr Raynes) The Alaskan experience is clear. We keep
being asked this. It is interesting for me how the Committee has
drifted in its questions into the decriminalisation argument.
We were given 10 advanced questions to talk about and about seven
of them were down the decriminalisation avenue, yet my original
thought was that the Committee was going to examine government
policy. I think you have been dragged down this decriminalising
road by taking witnesses who were for that very, very early on,
and a lot of them are very small constituencies, people like Transform
have a very, very small constituency.
1124. Very often the people at the end get the
opportunity to redress the balance. I would not worry about the
fact that we took evidence some time ago that opposes your particular
view. I think we would put your case extremely strongly. In a
sense I am wondering whether it is worth pursuing this line because
you are so evangelical about your position that I will just draw
you out a little further, in relation to drug related deaths what
would be the effect on those if through decriminalisation they
were tied in with lots more health and safety information and
also the other harm reduction particulars?
(Mr Raynes) Are you thinking about heroin?
Chairman: We are going to come to heroin. I
want to get off cannabis, we have spent about an hour on it and
I think we have covered most of the waterfront.
Bridget Prentice
1125. I think it would be difficult not to mention
heroin if we are talking about drug-related deaths.
(Mr Raynes) I go back to the British System in the
60s, because I was a law enforcement officer then, and we had
something called the British System, where we prescribed heroin
for registered addicts. We had something like 2,500 registered
addicts in the 60s. What is often forgotten about, Mr Wilkinson,
the ex-Chief Constable of Gwent talks about this a lot, is about
going back to a system where every registered addict could get
free heroin. At the time we had the British System we had an illegal
market and a legal market and the legal market overflowed into
the illegal market. The illegal market was made up of heroin that
addicts sold to make business, they used to come out of Boots
in Piccadilly with their scripts, sell some of their legal heroin,
then they use to used some of that money, strangely, to buy street
heroin. The illegal market was at that time funded by Chinese
heroin, because at that time the heroin market was controlled
by the Chinese, it is not any more, but it was then. These things
went along in parallel. It has been suggested that we should prescribe
heroin to everyone who wants it. I do not agree with that. In
Holland, which I say in my paper, they have a fairly strict system
about this. I think the public appetite here does agree with prescribing
heroin in certain circumstances where it is involved in a campaign
to get the user free of addiction and people will be content with
that. Will the public and your constituents be content to prescribe
heroin for anybody who wants it on a lifetime basis open ended,
to maintenance heroin? The resources on the National Health Service
are incredible. Last year in March the NHS was short of 2,400
something GPs. To implement the changes in the NHS that are envisaged
it needs 10,000 GPs, those are not my statistics, they were a
letter in the Independent last week from the head of the
GPs' Committee. There will need to be an enormous swing of resources.
Open-ended heroin maintenance I do not think is not on the public
agenda, I think there is a place for maintenance heroin in controlled
circumstances. In Holland you have to have two previous supervised
attempts to get off, a minimum age of 24, it is on a reducing
basis and it is for six months. I do not think we should go much
further in the United Kingdom. Whether or not there is enough
treatment available is another issue, that is a separate thing.
1126. Can I direct my final question to Mr Broughton,
which is, if drugs were supplied within a legal framework would
that not ensure that they would be purer and, therefore, do less
harm and there would not be the need to use some of the more dangerous
versions?
(Mr Broughton) First of all, it is quite good that
David and I disagree on this because I can get out of the evangelical
box and be more practical for you. What I have seen and what colleagues
were just talking about yesterday and this morning, just a stone's
throw from this building there are people in stairwells injecting
themselves with heroin or other things. There is a huge problem
just a couple of miles south of this building, where we have a
major problem with intravenous drug use and heroin use specifically.
If you get the chance to go there late at night you should take
a look, it is a very depressing place to be. We used to hear about
this in Glasgow, friends were talking about the problems in Glasgow
and we have it here in this City. It is quite a controversial
thing for me to say, I am stepping outside of my policy, it seems
to me to be a highly sensible way of trying to take out addicted
people that are in a very tough world of buying illegal drugs.
In the context of the United Kingdom drug policy, which was treatment
based and some rehabilitation, it was to try and take those people
out and deal with that specific problem at the top of this drugs
culture that we have. It seems sensible to me, understanding what
happened in the past about the leakage and the way that prescribed
drugs were being fed back into the legal system you have to have
some guarantees about the way the system works. There needs to
be a debate about that. David talks about what happens in other
places. The methadone system of replacing heroin, there is a big
debate in drug culture about that, it just seems sensible to me
that on top of this drugs problem you get addicts, into some form
of treatment and if that treatment is about supplying them with
heroin during that treatment that seems to me to be a first step
of trying to take that particular problem out. The health and
safety issue of hepatitis and HIV is one that we have to take
seriously.
Chairman
1127. Many of our witnesses have, even those
who take a fairly hard line on drugs, advanced the same point
about heroin use. The objection to that put to us last week by
Dr Gerada was in her experience people once on heroin or methadone
do not wish to come off and so you are often talking about maintenance
for the indefinite future. Even allowing for that, it is perfectly
arguable, it at least gets the problem off the streets, which
is where it is at the moment. Mr Raynes, would you be completely
against that?
(Mr Raynes) Open-ended maintenance for ever?
1128. Getting the problem off the streets?
(Mr Raynes) That is what it means.
1129. Leave it on the streets for ever.
(Mr Raynes) I think we have to have a double approach,
we have to try and get some people into treatment, those committed
to get off heroin. A lot of people unfortunately are not committed
to get off it, we have to have something somewhere within the
system, a pressure point, that tries to get them off heroin. I
do think there is a social will to maintain the whole population
on heroin, and if heroin today, what tomorrow?
1130. What whole population?
(Mr Raynes) The community at large.
1131. Nobody is suggesting putting the community
at large on heroin!
(Mr Raynes) No, no, no, the community at large and
their view of maintenance heroin for every one who wants it. That
is going to have huge social costs.
1132. You mentioned the strictly regulated experiment
in Holland and there is another one going on in Switzerland, would
you be against us trying that out?
(Mr Raynes) At the moment we have 100 doctors, maybe
a few more now, who have a licence to prescribe heroin, and only
about one dozen of them regularly do so. The Association of Chief
Police Officers have taken advice from a doctor in Cleveland,
I heard that doctor in Cleveland speak at the Cleveland Drugs
Conference and he did not know you could get a licence to prescribe
heroin. If only a dozen doctors out of 100 who have licences are
regularly prescribing it what I suggest to you is there is not
a substantial appetite from the medical profession to do this.
It is very nice to get people off the street but if the medical
profession do not want to do it and do not see it as their role,
and we cannot persuade them when we are 10,000 doctors short,
what we need is a bit of reality seepage here.
1133. We had the medical profession along last
week and you probably read their evidence which was, yes, it would
require changes, certainly GPs would not want their surgeries
cluttered up with addicts, it would have to be done in controlled
circumstances. They did not seem to be, unless I misunderstood
them, against properly supervised with no leakage.
(Mr Raynes) It has to be very closely supervised,
even now it has to be very closely supervised and there will be
leakage, because addicts are duplicitous, they divert methadone
now.
1134. Nobody is suggesting we have a switch
down some new alleyway. The only way you find out what works and
does not is by running a pilot or two. My question is, are you
in favour of that or not?
(Mr Raynes) It would be a mistake to forget history,
when we had the British system we were the only nation that had
it, and the continent has taken our system. We already have doctors
who can prescribe heroin but not very many of them do.
1135. History in this respect, when it was prescribed
it was a very small problem, although there was certainly leakage,
and that is what lead to it not being prescribed. Since our prohibition
the problem, for whatever reason, has mushroomed. That is the
history.
(Mr Raynes) You are on to my one area of expertise,
why we had an explosion of heroin in the 70s. We had a culture
in the 60s of people using cannabis with a small user population
of heroin, an iceberg with registered addicts at the top of the
iceberg and some submerged addicts in the black market, and there
was a black market. In the 70s Iranian heroin came in, whereas
the Chinese had brought in heroin before they did not mix and
sell very well to what they called the whites, the Iranians did,
and in London we had a different explosion of heroin use, the
smoking of heroin to a generation that had been brought up on
cannabis and saw smoking a substance as non-threatening. That
is what led to the explosion in heroin use. From then on the Turks
took over and the rest is history.
1136. The fact is it did explode. Can we put
the genie back in the bottle and if we cannot how can we control
it?
(Mr Raynes) I do not think we can put the genie back
in the bottle. I think it would be a mistake to go into a new
British system without understanding what was wrong with the old
British system.
1137. We do understand about the old British
system, it leaked, we do understand that. Everyone who has been
to see us has acknowledged that.
(Mr Raynes) The impression that is given by those
who proselytize about legalising heroin prescription is that we
would legalise it and we would not have an illegal market.
1138. Although it is true that some people proselytize
about that, what we have found is that witnesses like Mr Broughton
have come to that view after years of thinking about it, starting
out often from an opposed view and have come, rather reluctantly,
and against their instincts, to that view because they acknowledge,
as Mr Broughton explained, the problem on the streets within two
or three miles of here, where, incidentally, I have lived for
the last 27 years on and off.
(Mr Raynes) At the beginning of the 70s I was a pretty
strong advocate for the British system and I have gone the other
way, and I have been thinking about it for just as long. There
is room for the prescription of heroin to some addicts but it
has to be, I think it needs to be, in a campaign to get them off.
I think the Dutch have it about right, and we have it about right,
there may need to be more resources. Prescribing heroin solves
nothing for these people, they have to have management, counselling,
and so on. It does take a lot of resources.
Chairman: Mr Russell has one brief point about
roads accidents.
Bob Russell
1139. A couple of references have been made
to drug related road traffic crashes. I think society now regards
drink driving as one of those offences which are totally unacceptable.
I understand that the figures show, the last figures in July last
year, that something like one fifth of drivers, passengers or
pedestrians killed in road incidents had recently taken cannabis
or ecstasy, an increase of 600 per cent in a decade, that means
that 600 or 700 road deaths a year are drug-related. Is the law
and are the police equipped to tackle the problem of people driving
under the influence of drugs?
(Mr Broughton) I think we made the point in our written
evidence about the equivalents available and the training which
is available we are saying is not good enough at the moment. We
are covering your point. We understand that the alcohol-related
incidents are well managed in terms of testing and the drug-related
offences are we are not dealing with as well as we should, that
is about equipment that is available for officers in relation
to testing and about the training that has to be in place to enable
that to happen. I agree with you there is a problem that we need
to solve in relation to that.
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