MEMORANDUM 13
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.
COST EFFECTIVENESS
OF DRUG
PROHIBITION
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.
"HARD"
V "SOFT"
DRUGS
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.
CONCLUSION
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
2 Not printed. Back
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