Select Committee on Home Affairs Memoranda


Submitted by Dr Stefano Cannizzaro

  1.1  I write this memorandum as a general practitioner who established and manages Torbay's Primary Care Addiction Service. For one day a week I treat specialist drug clients from the specialist service waiting list, and for the remainder of the week I work as a general practitioner, but I also look after drug clients within my surgery.

  1.2  I was very pleased to learn that the Parliamentary Commission had been established, and you will see from the attached letter[2] dated 8 December 2000 to Jean-Claude Barjolin of the Substance Misuse Management General Practice Journal that I raised similar questions to the ones that you are looking at.

  1.3  I feel strongly that this enquiry will succeed only if it can detach itself from some of the current preconceptions that surround the drug debate. There are two main issues which I would hope this committee would look at:

    (a)  Whether a policy of criminalising drug misuse and drug prohibition is cost effective.

    (b)  The second major issue is that current debate seems to hinge upon an artificial distinction between hard and soft drugs, and "non-drugs" such as tobacco and alcohol.


  2.1  I had always assumed that the reason for criminalising drug misuse was to limit supply of the drug and therefore the harm that occurs. Certainly in Torbay there is an unlimited supply of illicit drugs, and addicts can obtain as much heroin as they require 24 hours a day. Our town centre is alive with a trade whereby young men gather in groups of five or six near phone boxes and then go off down a back alley to complete the deal. You cannot distinguish between dealer and addict, and most addicts wheel and deal to afford the cost of their criminalised drug supply.

  2.2  I am sure with the right remit that a statistician could provide that just as alcohol prohibition failed in the United States during the 1920s, drug prohibition has similarly not been successful. Politically, both nationally and internationally this may be a "bitter pill to swallow" and whatever the statistics, holes could be picked in the statistics. To move the debate on may need a large multi-centre trial to examine whether supplying addicts with pharmaceutical heroin (Diamorphine) legally would be more cost effective than criminalising its use. Technically, if we were to establish a large multi-centre prospective cross-over trial using Diamorphine first line as a substitute therapy for heroin, we could at the very least establish the cost to society of addicts obtaining illegal supplies of prohibited heroin and compare this in the cross-over part of the trial to providing legally prescribed Diamorphine. I am not sure who would be interested in setting up such a trial; it may be of interest to the National Institute for Clinical Excellence, or the Department of Health directly, or it may be one of the academic units, and a teaching hospital could take this on.

  2.3  Ultimately we need to establish whether the cost of criminalizing drug misuse is money well spent by society, and whether decriminalising the misuse would be more cost effective. I am not sure whether the Audit Commission has that kind of experience and expertise to answer this question.


  3.1  At the present time we have a misleading system of describing different categories of drugs and non-drugs. We have soft and hard drugs, we have non-drugs, such as alcohol and tobacco, and we have different schedules of drugs based on their legal category. These categories of drugs have little scientific basis, but rather arise from society and culture. It is an accident of history that Sir Walter Raleigh came back from his travels with tobacco rather than opiate or marijuana, and through this accident tobacco has the status of a non-drug, whereas since 1915 opium has been criminalised. I feel that if we are to make progress in this area we need to establish new nomenclature which is independent of history, culture or society. One way of achieving this would be to look at all drugs whether they be soft, hard, alcohol or tobacco, and consider their safety profile. When we are making decisions as to which category to place drugs in, or whether to criminalise or decriminalise a drug we could then look at those decisions in the light of the safety implications that arise.

  3.2  We also need to look at safety, not just in terms of street heroin which is available which is impure and the techniques of injecting which are dangerous, but if a pure form of heroin was available with sterile equipment, automatically the safety of this drug would improve, and it is often the criminalising of a drug that makes a drug contaminated and dangerous. Below I use a couple of examples in which we could develop a new safety profiling;

    (i)  For heroin (Diamorphine) short-term side effects include constipation, nausea and sedation. Heroin has no long-term side effects.

    (ii)  In overdose heroin can be fatal because it stops one breathing.

    (iii)  Health problems; these are mainly associated with an impure and criminalised supply and risky injecting practice, these include abscesses, hepatitis B and C, HIV.

    (iv)  The safety rating of heroin under this system, because of the lack of long-term side effects and assuming a pure pharmaceutical supply, come out as being good to fair.

  3.3  Comparing this with tobacco:

    (i)  Tobacco has few short-term side effects, however,

    (ii)  It has long-term side effects including cancer, aschemic heart disease, arterial disease, stroke and respiratory disease which kills more than 100,000 per year in the United Kingdom, and incapacitates many others.

    (iii)  Tobacco would, therefore, have a poor safety rating and clearly as a pharmaceutical product it would either not be licensed and be withdrawn.

  3.4  I hope that I have illustrated that be accidents of history we have ended up in the perverted situation where non-drugs, such as tobacco which have horrendous long-term side effects, kill over 100,000 people a year. "Hard drugs", such as heroin, which has pariah status, have no long-term side effects, and most people are killed as a result of society's decision to criminalise it.


  4.1  I do not have the answers to the current problems. However, I feel that unless we ask the right questions and tackle the problem with a new approach we will never by any further forward. In the meantime I will continue chipping away at the coalface and do what I can within the constraints of the current system.

September 2001

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