APPENDIX 9
Memorandum from DrugScope
INTRODUCTION
DrugScope is an independent registered charity
established in 2000 through the merger of the Institute for the
Study of Drug Dependence (ISDD) formed in 1968 and the Standing
Conference on Drug Abuse (SCODA) formed in 1971.
The primary mission of DrugScope is to inform
the public debate on the misuse of drugs and we do that through:
— the provision of a public access
database of over 100,000 documents on the misuse of drugs, one
of the primary English-language collections in the world;
— publication of a wide range of materials
both in print and through the website aimed at both the general
public and professionals working in the field;
— the provision of a comprehensive
information service available to anybody seeking drug information
which is non-judgemental, current and based on the available evidence;
— consultation with our membership
of around 1,000 individuals and agencies working in the drugs
field and related areas; and
— regular contact with the media working
both proactively and reactively to counterbalance much of the
misinformation which surrounds this subject.
REMIT OF
THE ENQUIRY
The Select Committee is investigating the extent
to which the classification of drugs under the Misuse of Drugs
Act 1971 is evidence-based. It is particularly interested in the
classification of cocaine, ecstasy, amphetamine, cannabis and
hallucinogenic or "magic" mushrooms. As we understand
it, the Committee is not making recommendations per se on
the degree to which the current classification of all or any of
these drugs is valid, However, should the outcome of the Enquiry
indicate a lack of evidence for the positioning of certain drugs
within the Misuse of Drugs Act, this should be addressed elsewhere.
We note the recent announcement of the Home Secretary to conduct
a review of the classification system.
BACKGROUND
International Conventions
Globally, the primary response to the misuse
of drugs is criminal sanction. Attempts by the international community
to control the manufacture, import, export, supply and possession
of certain drugs goes back to the early years of the last century—and
represents one the earliest examples of groups of nations convening
to discuss a social issue of common concern.
In 1961, various international treaties governing
the control of "narcotics"[40]
were consolidated in the Single Convention on Narcotic Drugs covering
opiates, cocaine and cannabis.
This was followed in 1971 by the Convention
on Psychotropic Substances which brought under control many of
the non-plant based, synthetic drugs such as LSD, barbiturates
and amphetamines. Some countries had already instigated controls
on these drugs. For example unauthorised possession of amphetamine
was already an offence in the UK in 1964, while LSD was controlled
in both the USA and UK in 1966, as responses to concerns about
non-medical use of these drugs by young people.
The main aim of these treaties was to control
the supply of drugs, rather than their use. In other words, signatories
to these treaties, were obliged to have in place laws against
the possession of controlled drugs, but it was unclear whether
this meant any possession including for personal use or simply
possession as a preliminary to onward supply.
This ambiguity appeared to have been resolved
in 1988 with the UN Convention Against the Illicit Traffic of
Narcotic Drugs and Psychotropic Substances. This was primarily
aimed not simply at curbing international trafficking, but also
to restrict the supply of so-called precursor chemicals used to
process and manufacture drugs and also to restrict the flow of
drug trafficking proceeds through money-laundering. In addition,
however Article 3.2 makes specific reference to an obligation
on the part of signatories to have in place domestic laws against
the possession of controlled drugs for personal consumption.
Even so, the Conventions allow considerable
flexibility as to how the law might operate in practice, especially
in regard to simple possession or possession for personal use[41].
This accounts for the fact that especially in Europe, Canada,
Australia and parts of South America, the international consensus
on drug control is nowhere near as solid as it used to be.
The Misuse of Drugs Act
Being signatories to the international conventions
means that the UK is obliged to have in place laws which control
the import, export, manufacture, supply and possession of proscribed
drugs. The first Dangerous Drugs Act was passed in 1920. As the
situation changed both nationally and internationally, there were
subsequent new Acts, modifications and amendments until the late
1960s.
Our current drug laws are enshrined in the Misuse
of Drugs Act 1971 [MDA]. The two innovations in this development
of UK drugs law were:
1. To create a body of science
and social science experts, the Advisory Council on the Misuse
of Drugs [ACMD] to advice the government of the day. Either the
ACMD or the Secretary of State at the Home Office can initiate
research into the workings of the Act, but the Secretary of State
cannot lay a draft order before Parliament without first consulting
the ACMD. However, there is no legal obligation on the government
to implement the advice given by the ACMD.
2. To group drugs into categories
of "harm" ranging through A, B and C with differing
penalties attached to each in descending order of severity. In
drafting the legislation, it was clear that "harm" meant
primarily physical and mental harms to the individual. However
the ACMD was also charged to keep under review drugs which might
be "otherwise harmful" and this can be more problematic,
not least because there is no clear definition in the Act of what
this actually means—although it is taken to mean "social
harm", any collateral damage to the individuals and the community
consequent on the use of the drug.[42]
THE CURRENT
EVIDENCE BASE
FOR THE
CLASSIFICATION OF
DRUGS UNDER
THE MISUSE
OF THE
DRUGS ACT
Some general points
1. As this is a brief submission, we can
only make general observations about the validity of the evidence
base rather than a detailed analysis.
2. While accepting the some problems caused
by illegal drug use are actually a product of drug prohibition
itself, neither DrugScope nor its members supports the blanket
legalisation of drugs. We have seen no examples of an alternative
control regime which would both substantially undermine the fortunes
of international organised crime while safeguarding public health
interests. Any moves towards a less rigorous control of drugs
must be undertaken incrementally with a proper review process
to monitor outcomes.
3. It is perfectly valid for the ACMD to
conduct early warning assessments of drugs which might become
problematic in the future and which should be kept under review,
although any moves to control should be accompanied by a robust
evidence base across physical, mental and social harms.
4. International obligations notwithstanding,
there is no ready evidence that controlling a drug under the Misuse
of Drugs Act actually deters use, especially where there is no
data on prevalence before control. A case in point might be ketamine,
controlled in January 2006 as a Class C drug, but with no prevalence
data against which to track the impact of control. But even if
we take a "common sense" view that controlling a drug
will deter some potential users, there is no evidence to show
that once a drug is controlled, the actual classification of the
drug has an impact on prevalence of use. For example, the latest
data on cannabis reveals a down turn in use among young people
despite the decision to reclassify the drug from Class B to Class
C.
5. The ACMD is charged with assessing the
evidence base for the physical, mental and social harms attached
to different drugs under consideration. Yet, the MDA does not
define the meaning of the term "harm" [let alone the
meaning of the term "drug"] and there is no standard
assessment tool or set of criteria of harm against which to match
the different drugs. However, the Independent Inquiry into the
Misuse of Drugs Act chaired by Dame Ruth Runciman [hereafter Runciman
Report] did suggest a set of criteria against which to make an
objective assessment of relative harm as part of the decision-making
process for classifying drugs. These are:
(iv) longer-term risk to life and health;
(v) potential for injecting;
(vi) association with crime;
(vii) association with problems for
communities; and
(viii) public health costs.[43]
A similar typology was adopted by the National
Addiction Centre [NAC], authors of a Department of Health report
Dangerousness of Drugs (2001). The NAC considered factors associated
with:
(i) acute adverse effects;
(ii) chronic adverse effects; and
(iii) a range of other facts which might
mediate or moderate the dangers eg route of administration where
for example, sniffing a drug is safer than injecting it.[44]
6. There has never been a thorough review
of the Misuse of Drugs Act in terms of the current appropriateness
of the drug classifications. As we outline below, doubt must be
expressed about the evidence base for some of the current classifications.
We also need more clarity on the different penalties that attach
to the different classes. With the exception of simple possession,
in the period 1973-85, there was in practice little difference
in the penalties between Class A and B drugs. Changes in 1985
saw a much clearer division between the three classes in terms
of penalties, a division which then disappeared when cannabis
was reclassified from B to C in 2004. As part of the political
horse-trading which allowed the passage of the reclassification,
the penalties for supply of Class C drugs were increased as to
make them indistinguishable from those in Class B[45].
However, if part of the purpose of the MDA is to educate the public
as set out in the original legislation, then it is important that
the drugs are appropriately categorised and penalised across the
three classes.
DRUGS OF
PARTICULAR INTEREST
TO THE
COMMITTEE
Cocaine
It is well-enshrined in international and in
the domestic legislation of many countries that cocaine should
be among those drugs most strictly controlled. There is a wealth
of clinical evidence to indicate the physical and mental harms
the drug can cause and the most general harms to society linked
to crime. Cocaine is a Class A drug and DrugScope would not wish
to call this into question.[46]
Nevertheless we would observe that, despite
the body of evidence comprising individual studies worldwide [primarily
from the United States], there has never been any international
scientific evaluations of cocaine with one exception. In 1995,
the World Health Organisation compiled such a study, but its publication
was blocked by the United States. There were apparently two reasons
for this:
1. The conclusion that the use of coca
leaves by the indigenous populations of South America was not
demonstrably harmful and might even confer some benefits.[47]
2. The conclusion that moderate and
occasional use of cocaine powder [hydrochloride] was not especially
harmful[48].
The contrasting levels of potential harm [by whatever index] between,
coca leaf, cocaine powder and crack support the Dangerousness
of Drugs contention that factors other than the chemistry of the
drug itself mediate or modify harm—in this case, the formulation
and the route of administration.
MDMA [Ecstasy]
This drug is part of the family of drugs which
are commonly described as having effects which combine those of
hallucinogenic and stimulant drugs. This is something of a catch-all
because there are several drugs in this group, some of which are
mild stimulants [like MDMA] while others are extremely powerful
hallucinogens such as PMA.
MDMA is a Class A drug. It was added to the
Act by a Modification Order in 1977. This was not because the
drug was causing concerns in the UK. In fact the first article
on what became known as Ecstasy did not appear in the media until
1985[49].
Nor does it appear that the ACMD were consulted on this. We have
spoken to one member of the ACMD at the time and she has no recollection
of a consultation process or report to the Home Secretary of the
day. The reason MDMA was included seems to be that it is related
to some drugs already controlled as Class A drugs. These are the
tryptamines and the phenethlymines. There is some suggestion that
there was evidence of the manufacture of the parent drug in this
family 3,4-methylenedioxyamphetamine, during the UK investigation
of 1975-77 known as Operation Julie which broke up what was then
the largest LSD manufacturing operation in the world. This may
have prompted a "pre-emptive strike" to control the
drug in the UK.
The drug did not become popular in the UK until
the late 1980s and the explosion of what became known as "rave
culture". The drug has been consumed in the millions of doses
and it would appear that the majority of consumers have come to
no permanent harm nor can there be said to have been any collateral
damage to society. In fact, anecdotally, at the early alcohol-free
raves where ecstasy was being consumed instead, the public order
problems for the police were greatly reduced in comparison to
a typical weekend in a town centre at closing time.
However, the drug carries risks: there have
been around 200-250 ecstasy-related deaths since the first one
was recorded in 1989 including the death of Leah Betts, arguably
one of the most famous drug-related fatalities of modern times.
Yet even with drug-related deaths, most of these were related
to the circumstances of use rather than a toxic reaction to the
drug itself. Of itself MDMA interferes with the body's temperature
control mechanism, but the danger is greatly amplified if the
person is in a hot sweaty environment and becomes dehydrated.
The advice from drug agencies about how to deal with this probably
helped save many lives. But the fatal adverse effects do seem
to be idiosyncratic and no studies have convincingly demonstrated
who might be especially vulnerable in this scenario. Concerns
have also been raised about possible long-term psychological effects.
But even though the drug has been prevalent in the UK for over
20 years now, there has been no reporting from general practitioners
or the psychiatric services of any correlation between past ecstasy
use and current levels of depression in those now in their early
forties.
The Runciman Report concluded that ecstasy did
not pose the same threat as other Class A drugs such as heroin
or cocaine and should be regraded to Class B. This was rejected
by the Home Secretary without reference to the ACMD.
Hallucinogenic or "magic" mushrooms
For many years, the classification of magic
mushrooms as Class A drugs represented something of an anomaly
in the Act. Under the Act, it was the psychoactive ingredient
of the mushroom, psilocin, which was the controlled substance
rather than the mushroom itself. This meant that so long as the
person did nothing to the mushroom to extract the chemical, it
was perfectly legal to pick and eat raw mushrooms. However, even
to dry the mushroom or make it to a tea or other preparation could
render the person liable to prosecution for possession of a Class
A drug—although it is likely that very few cases would have
appeared before the courts. The situation changed in recent years
due to a growing interest in hallucinogenic drugs and altered
states of consciousness consequent on the growth of rave culture.
The main drug to satisfy this interest had traditionally been
LSD. But manufacture and use of the drug had fallen dramatically
through the 1990s and magic mushrooms represented a legal alternative.
A commercial business grew up selling fresh magic mushrooms [largely
imported] on the high street. The internet also played its part
with individuals buying mushrooms and other so-called "legal
highs" online.
In general the psilocin experience is akin to
a milder LSD trip and as with all mood-altering drugs, it would
unwise for those with mental health problems to use the drug.
The other major danger is that the inexperienced might pick the
wrong mushroom: some varieties of wild mushroom are highly toxic.
But it does not appear from the evidence that the use of magic
mushrooms has been a cause of significant harm among users on
either count. Even so, a decision was taken to further control
the drug, so that the mushroom itself became a Class A substance.
This appears to have been done, not because the new situation
was causing new health problems, but because of the high media
profile given to what was seen as a commercial exploitation of
a loophole in the law.
The control of mushrooms was brought in as part
of the Drugs Act 2005 rather than through a Modification Order
under the Misuse of Drugs Act. We are not aware that the ACMD
was formally asked to consider the position of mushrooms and it
may be that the provisions of the Act whereby the Home Secretary
has to consult with the ACMD before presenting a Modification
Order before Parliament was obviated by the use of different primary
legislation.
If this set a precedent and the ACMD were not
to be consulted on all such changes to the MDA in the future,
then this would be a matter for concern.
Amphetamine
Amphetamine is a Class B drug. It was widely
prescribed in the 1950s and 1960s as a slimming drug and as a
stimulant for staying awake among long distance lorry drivers,
students and so on. Use without a prescription was banned in the
UK in 1964, but doctors continued to prescribe it primarily to
women into the late 1960s and early 1970s. Voluntary restraint
by GPs, the removal of amphetamines from the pharmaceutical market
coupled with control saw use in the general population decline.
However illegally manufactured amphetamine sulphate took the place
of pharmaceuticals and that is the situation which prevails today.
Amphetamines are still prescribed in the treatment
of narcolepsy and an amphetamine-like drug methylphenidate [Ritalin],
a Class C drug, is controversially prescribed widely for a range
of attention deficit disorders in children.
A unique aspect of Class B drugs is that if
prepared for injection, they become Class A drugs. This applies
to both amphetamines and barbiturates [formerly widely prescribed
for sleep disorders] and seems to be the legacy of the injecting
epidemics experienced with both drugs in the past. During the
late 1960s, there was an outbreak of amphetamine injecting [as
methedrine] among London drug users. The drug was being prescribed
by doctors no longer able to prescribe heroin and cocaine to users
in support of their habit through legislation passed in 1968.
Ten years later, there was a very destructive outbreak of barbiturate
injecting among young drug users again in London. The idea of
assessing the potential harm of a drug according to the dangers
posed by the route of administration as one marker of harm rather
than simply the effects of the drug is highlighted in both Runciman
and the NAC report.
Concerns were raised recently as to the presence
of methamphetamine on the UK drug scene in the form of "ice"—essentially
a smokeable form of amphetamine [as crack is to cocaine] but much
longer acting than amphetamine sulphate powder. At present, the
drug can be found in pockets of the gay scene, but sensational
media reporting suggested the UK was on the brink of a major drug
epidemic. The ACMD commissioned a report in 2005 which concluded
that while the situation should be kept under review, there should
be no change to the MDA.
Cannabis
Probably more has been written about cannabis
than any other drug used non-medically or recreationally. The
evidence base is vast. It has been the subject of several national
and international reviews going back to the Indian Hemp Commission
report of the 19th century.[50]
But despite all the controversy about the drug and the welter
of published scientific information, the following simple distillation
of the evidence base still holds true:
1. The majority of occasional users
come to no obvious mental or physical harm.
2. The main physical risks are
similar to those of smoking tobacco.
3. Those with mental health problems
or who may be at risk of developing these should abstain.
The background as to how cannabis was controlled
in the first place is too complex for this brief review. But sufficed
to say that the clinical and social evidence for international
control on a par with heroin and cocaine would not stand modern
day scrutiny.
It may be that cannabis represents some kind
of moral line in the sand when it comes to the behaviour of [mainly]
young people that will or will not be tolerated. Cannabis lies
at the junction between drugs which are clearly dangerous such
as heroin and a drug like alcohol which can be just as medically
and socially dangerous, but is tolerated for all kinds of socio-economic,
political and historical reasons. There is no evidence for this
view, except to quote from the French delegate to the 1973 session
of UN Commission on Narcotic Drugs:
"The question of the relative harmfulness
of different variants of cannabis, of taking the drug in large
or small doses etc, was doubtless of theoretical and clinical
interest and WHO should certainly continue its investigations
along these lines, but such investigations should not be allowed
to influence international control measures in any way whatsoever"[51].
CONCLUSIONS
1. As signatories to international conventions,
the UK is obliged to have in place laws to restrict a range of
specified drugs.
2. However, the Misuse of Drugs Act is quite
a flexible instrument and the UK is not obliged to either classify
drugs or penalise their distribution within any rigid international
framework.
3. This means that there is plenty of opportunity
for an overall review of the whole classification of drugs in
the light of current best evidence.
4. This is necessary because DrugScope would
contend that the evidence-base for the current classification
of drugs such as ecstasy and magic mushrooms is weak. There also
needs to be more clarity over the penalty tariff between classes.
5. DrugScope feels that when dealing with
such an emotional and highly-charged subject, it is most important
that the government continues to make best possible use of the
expert advice enshrined in the legislation.
January 2006
40 An American legal term to describe a range of drugs
including not only the opiates [opium, morphine, heroin etc],
but [incorrectly] also cocaine and cannabis. As the Americans
were the prime movers in driving international legislation forward,
it may be that the United Nations in turn adopted this terminology. Back
41
Dorn, N ed European drug laws: the room for manoeuvre.
The full report of a comparative legal study into national drug
laws of France, Germany, Italy, Spain, the Netherlands and Sweden
and their relation to three international drugs conventions. DrugScope,
2000. Back
42
The ACMD addressed the issue of definitions in the introduction
to its 1979 report to the Home Secretary, the major recommendation
of which was to reclassify cannabis to a Class C drug-advice which
the government of the day rejected. Back
43
Drugs and the law: report of the Independent Inquiry into the
Misuse of Drugs Act 1971. Police Foundation, 2000. p 50. Back
44
National Addiction Centre. Dangerousness of Drugs. Department
of Health, 2001, p 13. Back
45
This is supposition based on informed guess-work. But while the
ACMD social and clinical evidence is in the public domain, the
evidence that might have been presented from the enforcement perspective
is not. Back
46
Although in our submission to the Home Affairs Select Committee
into the government's drug policy [2002], we did take the view
that those found in possession of small amounts of any drug should
not be dragged through the criminal justice system. Back
47
The cultivation and use of coca leaf is legal in Bolivia so long
as the leaves are not additionally processed. Back
48
The report seems to have leaked out into the public domain as
it was summarised in the British Medical Journal 1 April
1995, but never formally published. In 1998, the USA also blocked
the inclusion of a comparative study of the dangers of cannabis,
alcohol and tobacco in the last WHO international review of cannabis-cf
Druglink, March/April 1998, p 8. While politics may determine
how the evidence base is used, these are far more invidious examples
of how politics can intervene to compromise the evidence base
itself. Back
49
Nasmyth, P Ecstasy. Face: Oct, 66, 1985, p 88-92. Back
50
DrugScope can provide a comprehensive list. Back
51
Bruun, K et al. The gentleman's club: international
control of drugs and alcohol. University of Chicago Press,
1975, p 202. Back
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