MEMORANDUM 12
Submitted by the Centre for Addiction
Studies
Report to the House of Commons Home Affairs
Committee from;
Dr Mohammed Abou-Saleh
Dr Colin Drummond
Dr Sally Porter
Mrs Jan Annan
Ms Alison Keating
On behalf of the Centre for Addiction Studies,
Department of Addictive Behaviour, St George's Hospital Medical
School, Hunter Wing, Cranmer Terrace, London, SW17 0RE.
Dr Andrew Johns, Consultant Forensic Psychiatrist
at the South London and Maudsley NHS Trust also contributed to
this submission.
This submission was prepared specifically for
this enquiry by the Centre for Addiction Studies, a research,
education, training and clinical centre addressing substance misuse.
(1) DOES EXISTING
DRUGS POLICY
WORK?
1.1 The current drug policy agenda, initiated
in 1995 and revised in 1998 places its emphasis on the wider aspects
of demand reduction, rather than concentrating solely on availability.
The policy has not been fully operationalised, but it is clearly
a strategic approach in the right direction. Additionally other
existing policies have been broadly successful in limiting the
spread of HIV/AIDS in the UK, with prevalence rates amongst the
lowest in Europe.
1.2 The limitations of the strategy include:
— It is not complemented by a similar
strategy to tackle alcohol misuse
— The current practice related with
the strategy does not always adhere to the principles underlying
the strategy (eg consultation and joint working).
— There is a significant human resource
deficit with associated recruitment difficulties
— There is the need for a strategic
approach and broader availability of training in the substance
misuse field
— Some interventions are based on custom
and practice rather than as evidence base (although it is recognised
that the strategy is addressing this issue)
— The lack of a co-ordinated response
between the health and judicial responses to drug-related crime
lead to lost opportunities for diversion from custody, lack of
treatment for incarcerated drug misusers and poor link between
prisons and local drug-treatment facilities
(2) WHAT WOULD
BE THE
EFFECT OF
DECRIMINALISATION ON
(A) THE
AVAILABILITY OF
AND DEMAND
FOR DRUGS
(B) DRUG
RELATED DEATHS
AND (C)
CRIME?
2.1 Decriminalisation is likely to lead
to an increase in the availability of and demand for drugs. Rising
demand and availability will be translated into an increase in
drug-related deaths and criminal activity. In all other substance
specific markets eg alcohol, tobacco, removing sanctions has increased
consumption.
2.2 It should be remembered that for many
people the fact that drugs are illegal is a major deterrent. Previous
experience also indicates that whenever there have been periods
of unrestricted prescribing this has lead to an increase of drugs
moving from the licit to the illicit market, an increase in demand
and consumption and a corresponding increase in drug related deaths.
For example at one stage dipipanone (Diconal) and the barbiturates
were widely used as drugs of abuse. Tighter controls on restrictions
have led to the abuse problems with these drugs diminishing significantly.
Greater availability of state-sanctioned heroin or cocaine could
lead to direct deaths through overdose as addicts tend not to
be able to limit their own consumption. There is a high mortality
rate among heroin addicts on prescribed methadone because they
continue to misuse other drugs.
2.3 Most of the decriminalisation debate
has centred on cannabis. Whilst the dependence liability of cannabis
is lower than that of some other drugs it is a mistake to consider
cannabis a "soft" drug. About 10 per cent of those presenting
to drug treatment clinics in the UK are seeking help with their
cannabis use1. There is increasing evidence to suggest that cannabis
is at least as carcinogenic as tobacco, with the World Health
Organisation stating that cannabis is twice as carcinogenic as
tobacco2 and it is also problematic for the cardiovascular system3.
The likely increase in use created by decriminalisation would
therefore lead to an increase in morbidity and mortality. Furthermore
for those vulnerable to mental health problems cannabis can give
rise to an acute psychotic phenomenon (cannabis psychosis) that
can be easily misinterpreted as schizophrenia and it also worsens
treatment compliance and prognosis for those with other functional
mental illness. The classification of drugs into "soft"
and "hard" is not based on rigorous scientific factors,
for example a small amount of oral methadone or morphine in a
stable person is much "softer" than ten "joints"
of cannabis of 20 per cent THC.
2.4 Another reason that decriminalisation
is not desirable is due to the likely effect on offending. Whilst
those who support decriminalisation argue that such a strategy
would lead to a reduction of offending, even in Holland most drug
dealing does not take place through the regulated channels. It
is likely that that when cannabis is regulated and taxed it will
be more expensive than when sold illegally4 and the illegal market
will therefore continue.
2.5 Whilst acquisitive crime might reduce
if drugs were decriminalised, it is known that alcohol consumption
is linked to increasing rates of violent and impulsive offending.
There is therefore likely to be an increase in impulsive offending
driven by stimulants and cannabis misuse for example. This is
likely to be most evident amongst those who also have a mental
health problem.
(3) IS DECRIMINALISATION
DESIRABLE AND,
IF NOT,
WHAT ARE
THE PRACTICAL
ALTERNATIVES?
3.1 The evidence presented illustrates
that decriminalisation is not desirable due to its adverse effects
on public health, increased drug-related morbidity and death,
the negative effective on crime and the increased risk of an individual
acquiring harmful or addictive patterns of use. To use an analogy,
many people break the speed limit, but the speed limit is not
increased. Instead greater effort is put into education, preventative
measures and catching law-breakers. This is what the national
strategy is now working towards.
3.2 Additional methods of addressing this
problem include:
— An educational campaign about the
true risks of cannabis.
— Ensuring that treatment provision
is increased and based on best evidence.
— Increasing the consistency of interventions
and penalties nationally.
— Ensuring that penalties imposed by
the court are proportionate to the substance misuse related action.
September 2001
REFERENCES
1. Runciman R, Drugs and the Law: Report
of the Independent Inquiry into the Misuse of Drugs Act 1971.
London: Police Foundation, 1999.
2. World Health Organisation. Programme
on Substance Abuse. Cannabis: A Health Perspective and Research
Agenda. Geneva: World Health Organisation, 1997.
3. Hall W, Solowij N, Lemon J. The Health
and Psychological Effects of Cannabis Use. National Drug Strategy
Monograph No 25. Canberra: Australian Government Publication Service,
1994.
4. Drummond C, (2001) Cannabis should not
be legalised: The Pot Smoking Gun. British Medical Journal (in
press).
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