MEMORANDUM 62
Submitted by Dr Karl Schmidt
Does existing drugs policy work?
The answer must surely be negative. The reasons
are:
(a) No clear goals have been set. I would
have expected the formulation of a clear goal in the 1984 Task
Force Report, the 1998 National Strategy from the Office of the
Drugs Coordinator, the 1999 Guidelines and in other documents.
There is certainly none in terms of achieving a significant reduction
in Prevalence.
(b) The policy has shortcomings in its methodology,
its use of neuro-biological knowledge and in its concept of epidemiological
effectiveness. Effective treatment programmes must deal with four
aspects of the human personality (i) the physical ie the neuro-biological,
(ii) the psychological, (iii) the social—most addicts live
in dysfunctional social systems and (iv) the existential/spiritual—if
you have no goals in life why not become an alcoholic or other
type of addict?
So far as (i) is concerned my experience has
shown that cure of addictions is possible and can lead to epidemiological
change. In order to lay the basis for a curative programme it
is necessary to overcome the Drug Withdrawal Syndrome (DWS). We
have shown that this can be done by non-pharmacological means
(thus avoiding further drugs) through the use of electro-stimulation
(ES). This has no connection with ECT treatment and is entirely
different being non-invasive and controlled and administered by
the client him/herself.
(c) there appears to be an imbalance in priorities
if (as The Guardian said on 22 September 2001) the system
spends 62 per cent of its budget on enforcement which does not
work and only 13 per cent on treatment which my experience shows
can work.
EFFECT OF
DECRIMINALISATION
A slight initial increase in demand is likely
but not to the extent of changing the statistics for ill-health
measurably. There would obviously be no increase in dealing whereas
one could predict a fall in acquisitive crime.
DESIRABILITY OF
DECRIMINALISATION
The Home Affairs Committee report of 8 June
2000 clearly stated that the law does not seem to be a deterrent
even though it is strong in terms of fines and imprisonment. The
Committee did not see a deterrent in the law working.
The WHO Officer in Charge of addictions stated
in 1991 (at the 13th IFNGO Conference in Manila) that however
much money was spent on the prevention of trafficking there was
no evidence it could be reduced irrespective of the number of
seizures.
I believe that any significant decriminalisation
would need to balance by an energetic campaign for the concept
of responsible living and wider, easier availability of curative
treatment.
COMMENTS ON
RESEARCH
There is considerable hard neuro-biological
research demonstrating the mechanisms in the human body which
produces and releases the endorphinergic group of neuro-transmitters.
These help bring about a harmonious physical state ie the "feel
good factor". Much of this research which is easily available
in specialist journals and major works eg The Role of Endorphins
in Neuropsychiatry (The Max Planck Institute, Munich) appears
to be neglected in current treatment approaches.
The point is that in the case of the addict
this natural mechanisms is suppressed and replaced by a drug induced
mechanism. Remove the drug and the addict no longer has the means
to feel good. Further, use of methadone which is itself addictive
actively interferes with this mechanisms and the body's in-built
healing process. There is a strong case for treating DWS by non-pharmacological
means which do not impact upon the body's natural "feel good"
processes.
A crucial and well known paper from the Maudsley
team in 1984 dismissed ES as a valid treatment for DWS. Though
the paper is outstanding in its way, however, the data does not
appear to justify the conclusions reached. Further the practice
of my own teams (one in Somerset) and associates has shown different
results.
One problem with the Maudsley conclusions is
that they were reached on the evidence of a single trial with
a small number of cases. As Dr Guy Edwards noted in the BMJ in
1992 a single trials rarely if ever justifies an unequivocal claim
of superiority there being potential imperfections eg selection
bias and chance factors. It is also a fact that certain therapies
have in the past been dropped on inadequate evidence and the verdict
has entered the collective consciousness of mainstream psychiatry.
Dr N Stratton, an Australian psychiatrist, highlighted this in
1990.
COMMENT ON
NTORS
The reported reduction in criminality among
those investigated is very encouraging as is the reduction in
the volume of addictive substances consumed. However:
(a) was anyone cured or converted into an
abstainer?
(b) there is no percentage figure for relapse
over, say, two years;
(c) also missing is a record of the number
of clients who returned to work and became taxpayers;
(d) there seems to be an uncritical acceptance
of methadone programmes; and
(e) the research is very thorough but there
is no clear statement of Prevalence of addictive behaviour in
the communities studied or nationwide. Nor is there any reference
to incidence. Without these it is impossible to set goals which
can lead to favourable epidemiological effective change.
CONCLUSION
The goal of addiction management should be epidemiological
change. A significant reduction of Prevalence of addictive behaviour
should occur. Such a goal is poorly if at all defined in available
Government and Government-associated publications. Thought should
also be given to a reduction in incidence.
The curative programme which we designed and
practised within the NHS in East Somerset between 1980-82 achieved
a significant reduction in addiction problems. We did not do so
well with alcoholism because we had not then discovered that three
times weekly follow-up for two years was necessary. Our relapse
rate (all addictions) was 10 per cent over two years.
I have seen marked cases of lowered incidence
in my various overseas appointments.
I should be happy to offer my services in both
the curative and epidemiological fields.
September 2001
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