APPENDIX 20
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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