Select Committee on Home Affairs Appendices to the Minutes of Evidence


Supplementary memorandum submitted by the British Medical Association (BMA)

  At the oral evidence session on 15 January 2002 Dr Rob Barnett, who was giving evidence on behalf of the General Practitioners Committee of the BMA, offered to send in supplementary evidence on behalf of the BMA as a whole. Set out below is information from the BMA on our policies in relation to drug use.

  The BMA has worked on the issue of illicit drug use for many years, resulting in the publication of The Misuse of Drugs and The Therapeutic Uses of Cannabis in 1997.

  The Misuse of Drugs provided an authoritative overview of drug misuse in the UK as of 1997, and made 28 recommendations aimed at improving services for patients. It stated that central government needed to develop a co-ordinated strategy for the care of drug misusers which involves health and local authorities, the prison and probation services and the health education authority.

  The recommendations included call for:

    —  increased, protected resources;

    —  an expansion of the AIDS prevention budget to become a "bloodborne virus budget" with a new emphasis on the prevention of hepatitis C;

    —  better training, support and remuneration for GPs, and the GP practice team so that drug misusers can be treated in general practice under shared care arrangements;

    —  a full range of services, including residential detoxification facilities to be available where needed in all local areas;

    —  harm reduction schemes, including access to sterile injecting equipment and safe disposal for users;

    —  prisoners should have the same standards of care as other drug misusers and injecting users should have access to sterilising materials;

    —  a national comprehensive, confidential information system to provide up-to-date prescribing information on individuals. This is to allow GPs and other prescribers to check whether a patient has already been prescribed a controlled drug by another doctor;

    —  changes to prescribing practice and prescribing regulations to combat the misuse of and dependence on benzodiazepines;

    —  information for GPs on over-the-counter drug misuse and warning labels for patients.

  The BMA has taken these and the other recommendations forward in discussion with policy makers, health care commissioners and with Government. The recommendations in terms of prisoners, for example, have extended our previous work on harm reduction in prisons and relate closely to our discussions with the prison medical service on equipment cleansing facilities, and provision of needle exchange and condoms for prisoners.

  As is clear from the recommendations the report supports the development of a variety of systems to offer holistic care to those who misuse drugs. There is a clear role within primary care, as well as a need for more resources within the specialist secondary care community.

  The BMA's policy report on cannabis concentrates almost exclusively on its use in the therapeutic context. The Therapeutic Uses of Cannabis provides an outline of the pharmacology of cannabis and cannabinoids relevant to medicinal aspects, followed by short reviews of the main proposed therapeutic uses. The BMA's consideration of the legalisation or decriminalisation of the drug is made only with regard to its therapeutic use by patients under medical supervision, for particular medical conditions. In 1998 the BMA submitted oral and written evidence to the House of Lords Inquiry into Cannabis.

  Throughout both reports there are a number of references to the debate about decriminalisation. We make the point that this is outside our normal remit. The BMA, while preparing these reports, reviewed the evidence and published opinion on decriminalisation. We believe that there is no clear and compelling evidence either way on the impact this might have on levels of drug use and upon the medical consequences and harmful effects of such use. We believe that the non-medical (ie criminal justice) issues may give a clearer lead; but if the consequence of a change in law was to increase the numbers of people physically or psychologically dependent upon drugs this should be given great weight in decision making. However, we repeat that the arguments about the numbers of people who would become users, and possibly dependent, if decriminalisation occurred are not persuasive in any one direction.

  In the oral evidence sessions members of the committee enquired as to the coverage of drug dependency issues within the medical undergraduate curriculum. This is a matter for the GMC's education committee. We have welcomed their approach to medical undergraduate training, which is increasingly to concentrate on areas such as the skills needed to evaluate evidence and to communicate effectively with patients, rather than to be proscriptive about what must be included in the detailed curriculum. The latter approach too often leads to curricula which fail to encourage teaching and learning on areas not specifically mentioned, or which artificially divide the course into tiny time slots. The patient-centred, and often problem-based approach, requires teaching and learning to be holistic and based upon the problems of the patient. No medical school operates independent of the local population. All medical students will work with patients who have drug misuse as a factor in their presentation to the health care system.

  The BMA continues to work in the area of illicit and licit drug use, and is currently investigating the issue of the potential effects of drugs on driving. We hope to publish information on this topic later this year, to help doctors and patients assess the implications of both types of drug use on driving behaviour and safety. We continue to keep a watching brief on the wide-ranging area of drug use and will undertake further work as and when we feel we can contribute meaningfully to policy formation.

January 2002

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