APPENDIX 2
Memorandum from Parents Against Lethal
Addictive Drugs (PALAD)
OUR PERSPECTIVE
Parents Against Lethal Addictive Drugs is a
voluntary organisation concerned with drug education who campaign
for an integrated, evidence-based implementation of the Misuse
of Drugs Act. We support the statutory requirement to teach all
young people that alcohol and tobacco are harmful drugs, in accordance
with the United Nations' definition of "drugs" and the
scientific evidence. We agree with the Government's view that
"drug laws must accurately reflect the relative harms of
different drugs if they are to persuade young people in particular
of the dangers of misusing drugs". We believe the Advisory
Council on the Misuse of Drugs has a statutory duty to advise
Government about the relative harmfulness of the intoxicant drugs
alcohol and cannabis. We have spent two years attempting to find
out how the Home Office and ACMD use scientific evidence in drugs
policy making.
SUMMARY
1. The Misuse of Drugs Act 1971 (MDA) drug
classification was initially based upon UN drug Conventions. The
intention was that the classification system would evolve with
the scientific evidence base, with independent scientific advice
provided by the Advisory Council on the Misuse of Drugs (ACMD).
ACMD have a statutory duty to advise Government about harmful
drug use "sufficient to constitute a social problem"
and to provide Government with regulatory recommendations for
"restricting the availability of such drugs". There
is no indication that ACMD advice should exclude any harmful drugs
on the basis of tradition or that their regulatory recommendations
should be limited to prohibition.
2. The current classification is framed
by two non-transparent assumptions that underlie UN drug Conventions:
2.1 Drugs traditionally used in the west
should be excluded irrespective of their harmfulness.
2.2 Non-traditional drugs should be regulated
with an extreme precautionary principle irrespective of their
harmfulness.
3. Exclusion of traditional drugs:
3.1 Contrary to Government claims, policy
on harmful drug use is not based on scientific evidence. The Home
Affairs Committee said harmful drug use "is a continuum perhaps
artificially divided into legal and illegal activity". When
the HAC Chairman asked the Home Office (HO) "Why are alcohol
and tobacco not integrated into the drugs strategy?" the
reply was that "any strategy has to take account of . . .
societal attitude" and ". . . UN conventions"—non-scientific
factors.
3.2 ACMD's advice to Government does not
include traditional drugs because their advice, intended to be
independent, depends on Government policy, not just scientific
evidence. When I asked why the ACMD do not provide advice on the
harmful drugs alcohol and tobacco the ACMD Secretariat replied
"Albeit independent, the ACMD as an advisory body has to
be aware of the Government's position, which has not given any
intention to consider the control of alcohol, tobacco and caffeine".
ACMD do not identify and refer to alcohol and tobacco as drugs,
contrary to scientific evidence. This leads to inaccurate and
misleading statements by ACMD. The Secretariat has declined to
provide reasons for this.
4. Application of an extreme precautionary
principle:
4.1 Government drugs policy is summarised
by their statement "All controlled drugs are dangerous and
no one should take them". Non-traditional drugs are identified
with their maximum harmfulness instead of differentiating, for
each drug, patterns of use that are (a) reasonable safe, (b) harmful
to the consumer (a health issue) and (c) harmful to others (potentially
a criminal issue), as occurs with the risk assessment of traditional
drugs. No mention is made of a cautionary or precautionary principle
but scientific evidence that use of a drug is not harmless is
used to justify the prohibition of all use. In contrast the Government's
response to this Committee's report The Scientific Advisory System
said "Application of the precautionary principle does not
usually mean imposing a ban. Its purpose is to ensure that where
uncertainty exists, decisions err on the side of caution and so
seek to avoid serious damage if things go wrong, yet meet criteria
such as proportionality and cost-effectiveness".
4.2 ACMD's review of the classification of
cannabis concluded that "the high use of cannabis is not
associated with major health problems for the individual or society".
This suggests harmful cannabis use is not "sufficient to
constitute a social problem", the criteria required by the
MDA. However the ACMD report continued "cannabis is not a
harmless substance" and consequently recommended that cannabis
remained prohibited, as a Class C drug, without assessing the
option of licensed regulation. Harmless substances do not exist
and to suggest the possibility is unscientific and misleading.
5. The ACMD Chairman's letter to The Times
demonstrates how these two assumptions combine to frame the problem
of harmful drug use unrealistically. He said "the classification
system for drugs does not mean that any of these substances are
harmless. If they were, they would not be included in the Misuse
of Drugs Act". Such a view is not compatible with evidenced-based
statements such as the World Health Organisation's that "More
deaths are due to tobacco than to any other drug".
6. The classification system has not evolved
with the evidence base, as intended by the MDA, because the ACMD's
independent scientific advice depends on Government policy (3.2
above) while Government drugs policy depends on UN drug Conventions
(3.1 above). The system is closed to scientific evidence—evidence
that alcohol and tobacco are equally harmful drugs and that reasonably
safe use of some non-traditional drugs is not only possible but
widespread.
7. The Government uses scientific evidence
selectively to:
— justify predetermined decisions or
positions (compliance with UN drug Conventions);
— erroneously frame issues as predominantly
scientific disguising moral or value judgements (traditional drugs
used by the majority are good, non-traditional drugs are bad—independent
of harmfulness); and
— delay making contentious or complex
decisions (assessing drug risks and regulations equally).
8. ACMD provide little confidence that the
MDA's classification is transparently evidence-based. The Chairman
said in The Guardian "The basis on which any of the
things were classified is obscure from reading the minutes".
The ACMD annual report of 1999-2001 said "Subjects considered
by Council: A review of the criteria used to consider whether
a drug should be controlled under the Misuse of Drugs Act 1971
and the development of a new risk assessment protocol. This work
is still in progress but should be completed in 2001-2002".
This remains unpublished in 2006.
9. ACMD do not assess risks and evaluate
regulatory options in accordance with Government guidance, as
required by the Code of Practice for Scientific Advisory Committees.
The HO does not follow Government guidance on the use of scientific
advice, risk assessment and better regulation.
10. The current MDA classification of harmful
drugs uses scientific evidence to justify discrimination between
traditional drugs used by the majority and non-traditional drugs
used by minorities. As a result the former have been under-regulated
and the latter over-regulated. Other examples where the traditional
majority discriminates against non-traditional minorities are
sexism and racism.
REPLYING TO
THE COMMITTEE'S
SPECIFIC QUESTIONS
11. What impact are departmental Chief Scientific
Advisers having on the policy making process?
Professor Wiles, the HO CSA, has assured me
that the Government does not interfere with the independence of
the ACMD and that ACMD have freely decided not to advise them
about traditional drugs. Concerning the lack of transparency surrounding
the selective use of evidence (the omission of alcohol and tobacco
from ACMD advice) he said "the ACMD is aware that the Government
has no intention of controlling tobacco and alcohol under the
Misuse of Drugs Act 1971. Alcohol and tobacco are so widely used
in modern society that criminalisation of their supply and use
is not considered appropriate". He appears to assume that
ACMD can only recommend prohibition, that prevalence of use is
a factor in determining the regulatory option for harmful drugs
and that a lack of transparency about these issues is of no concern.
12. What is the role of the Government Chief
Scientific Adviser in the policy making process and what impact
has he made to date?
Professor Sir David King replied to our concerns
by firstly asking the HO CSA to address them. Consequently Professor
King said "I note, of course, your concerns about transparency
and the need to avoid the selective use of advice. I agree with
you on these points. But in this case it is for the Committee
itself to decide what to investigate, and to ensure it adheres
to the Guidelines and Code". However the ACMD Chairman has
not replied to our subsequent letter and the ACMD Secretariat
has not replied to our last letter to them.
13. Are existing advisory bodies being used
in a satisfactory manner?
No. ACMD is used for independent advice on risk
assessment and evaluation of regulatory options. HO should evaluate
that advice following the Guidelines on Scientific Analysis in
Policy Making. However since both ACMD and HO assume that any
evidence of risk justifies prohibition, they do not follow Government
guidance on risk assessments (see 18 below) and the evaluation
of regulatory options.
14. Are Government departments establishing
the right balance between maintaining an in-house scientific capability
and accessing external advice?
No. ACMD members do not appear to have expertise
in risk or regulatory assessment. The full range of opinion is
not reflected in ACMD advice and HO evaluation, though experts
and the public hold entrenched polarised views in a sensitive
cross-cutting policy area. Examples of external advice include:
— The Department of Health. Their report
Dangerousness of Drugs [2001] includes the traditional drugs alcohol
and tobacco, discusses methodological problems of obtaining, analysing
and ranking evidence of drug risks and includes a wide range of
methods of assessing evidence of risk, including the EU drug risk
assessment guidelines of EMCDDA.
— The World Health Organisation advises
on all drugs irrespective of tradition and legal status and provides
scientific advice to UN drug agencies.
— Leading scientists. For example Colin
Blakemore, Chief Executive of the Medical Research Council described
the MDA's classification saying "It is antiquated and reflects
the prejudice and misconceptions of an era in which drugs were
placed in arbitrary categories with notable, often illogical,
consequences. The continuous review of evidence, and the inclusion
of legal drugs in the same review, will allow more sensible and
rational classification" [A Scientifically Based Scale of
Harm for all Social Drugs].
— Other stakeholders affected including
consumers, suppliers and producers.
15. What mechanisms are in place to ensure
that policies are based on available evidence?
None. The HO and ACMD appear unaccountable concerning
their failure to follow Government guidelines.
16. Are departments engaging effectively
in horizon scanning activities and how are these influencing policy?
No. There has been a continuous trend since
the 1950s when the risks from drugs traditionally used in the
west were under-estimated (they were not even viewed as drugs)
while the risks from non-traditional drugs were exaggerated, with
regulations proportionately biased. The change in the evidence
base is exceptional: in 1955 the World Health Organisation's report
Physical and Mental Effects of Cannabis stated "under the
influence of cannabis, the danger of committing unpremeditated
murder is very great; it can happen in cold blood, without any
reason or motive, unexpectedly, without any preceding quarrel;
often the murderer does not even know the victim, and simply kills
for pleasure". Six years later the first UN drug Convention
criminalised cannabis. In contrast WHO's 1995 cannabis report
states "cannabis appears to play little role in injuries
caused by violence, as does alcohol".
The trend is toward scientific evidence of actual
risk steadily replacing perceived risk with social attitudes altering
accordingly. Since 1971 public opinion in favour of drug policy
reform ("legalisation") has increased at around 1% a
year. Public opinion is now balanced roughly 50-50. Evidence that
traditional drugs are harmful drugs has increased dramatically
in the last decade. The long-term trend for traditional and non-traditional
drugs is toward integration as the evidence base increases. This
constitutes an inevitable risk to Government's currently dis-integrated
alcohol, tobacco and "drugs" policy but also a significant
opportunity. The UK could lead the world in integrating traditional
and non-traditional drug misuse policy based upon the Government's
modernisation program. This could lead to significant improvements
to substance misuse policy (drugs & food, see 17 below) and,
more generally, to policy relating to altering the unconscious
habitual unhealthy behaviour of the public.
17. Is Government managing scientific advice
on cross-departmental issues effectively?
No. ACMD has stated that society's risk tolerance
toward the legal drugs alcohol and tobacco influences attitudes
to illegal drugs, especially for young people (Drugs & the
Environment).
Alcohol is covered by the Department for Culture,
Media and Sport and their advisory body, AERC; tobacco by DoH
and their advisory body SCOTH; caffeine by FSA and their advisory
body, COT; and "drugs" by HO and ACMD. DoH and DfES
both identify and refer to alcohol and tobacco as drugs but HO
and ACMD do not.
The failure to integrate traditional and non-traditional
drugs policy has wider consequences. "Substance misuse"
is a term currently incorrectly used to cover the harmful use
of traditional and non-traditional drugs. The failure to correctly
define "drug" and "substance" results in the
failure to correctly identify harmful food consumption as being
a form of "substance misuse". The harmful consumption
of food and drugs is the largest public health problem and the
major common risk is dependency. Dieters have the same relapse
rate as recovering heroin addicts. Common risk and regulatory
assessments are required to provide an integrated policy toward
substance misuse.
18. Is risk being analysed in a consistent
and appropriate manner across Government?
No. ACMD and HO do not follow Government guidance
on risk assessment and management. They do not correctly frame
the problem as "all harmful drug use" but instead frame
it as "all use of only non-traditional drugs". Perceived
benefits (eg relaxation, enjoyment, socialising) are taken to
be risks of dependency, in contrast to alcohol policy. Risk impacts
are listed but not their likelihood. Risk factors, such as frequency
of use, route of administration and setting, are not sufficiently
analysed. Voluntary risks, usually viewed as a health issue, are
not distinguished from risks imposed on others, usually viewed
as a criminal issue. Perceived risks, known to be strongly influenced
by familiarity, are not identified and distinguished from evidence-based
risk. Non-scientific factors (eg public opinion, economic factors
such as competition and taxation, human rights and inequalities,
international law) are not identified and distinguished from scientific
factors. The ACMD's risk assessment is not consistent with that
of any other harmful product, especially those voluntarily consumed.
HO do not appear to carry out risk assessments to the public or
to Government, relying solely on the ACMD's assessment of risk
to the public.
19. Has the precautionary principle been
adequately defined and is it being applied consistently and appropriately
across Government?
No. See 4 above.
20. How does the media treatment of risk
issues impact on the Government approach?
The risks of non-traditional drugs have been
exaggerated and associated with intense negative value judgements
in the past, initially by Government and international authorities,
then by the media. Public opinion has been severely influenced.
These three groups have formed a self-reinforcing system of biased
risk perception fuelled by risk amplification and closed to evidence.
21. Is there sufficient transparency in the
process by which scientific advice is incorporated into policy
development?
No. There is no transparency concerning which
types of scientific and non-scientific evidence have been considered
relevant, how this has influenced policy-making and how conflicting
rights and responsibilities of stakeholders have been balanced
during policy making. ACMD do not publish minutes of their meetings,
contrary to the Code of Practice. HO have not answered our concerns
about the complete lack of evidence of risks to the public in
the Regulatory Impact Assessment for the prohibition of magic
mushrooms, though the RIA proposed criminalising one million people
as Class A drug users.
22. Is publicly-funded research informing
policy development being published?
No comment.
23. Is scientific advice being communicated
effectively to the public?
No. There is inconsistent use of the word "drugs".
The Government's drug education website, Talk to Frank,
says "Drugs are illegal" and then "alcohol can
play a major part in many people's social lives. That's why it's
easy to forget that it's actually a very powerful drug".
24. Are peer review and other quality assurance
mechanisms working well?
No. There appears to be little peer review or
quality assurance.
25. What steps are taken to re-evaluate the
evidence base after the implementation of policy?
None. Policy remains unchanged despite an improved
evidence base, significant changes in public opinion and increasing
non-compliance and enforcement costs.
When Home Office minister Bob Ainsworth was
asked by the Home Affairs Committee "what evidence do the
Government have to show that confiscation and the prosecution
of drugs suppliers have made any difference to the amount of drugs
use in this country?" he replied "As the law to date
has been so relatively ineffective, I doubt whether it has made
much difference at all".
26. OUR
CONCLUSIONS
To comply with Government guidelines, and perhaps
their statutory duty under the MDA, ACMD should reframe their
current advice to Government so it is consistent with the evidence
that:
— Alcohol and tobacco are harmful drugs.
— Harmless drugs do not exist.
— Legal and illegal drugs are equally
harmful according to scientific evidence.
— Different regulatory policies toward
legal and illegal drugs are determined by non-scientific factors,
not scientific evidence.
— Recreational drug consumption is
widely accepted in society—90% of adults consume the stimulant
and intoxicant drugs caffeine and alcohol.
January 2006
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