Examination of Witnesses (Questions 120-139)
PROFESSOR SIR
MICHAEL RAWLINS
AND PROFESSOR
DAVID NUTT
1 MARCH 2006
Q120 Dr Iddon: Thank you, Chairman.
Obviously the Home Secretary is looking at the reclassification
of drugs at the moment. Was that an idea that came from your Committee?
If not, where has the Home Secretary gained the idea that the
present system needs looking at?
Professor Sir Michael Rawlins:
Well, I think it is fair to say that I did have a discussion with
him about it and I said that if he felt that he wished to re-examine
the classification system the Council would welcome it.
Q121 Dr Iddon: Are you as a committee,
Professor Rawlins, commissioning any research into this aspect?
Professor Sir Michael Rawlins:
As to the question of the classification itself?
Q122 Dr Iddon: Yes.
Professor Sir Michael Rawlins:
No, we are not. What we are doing is using the system that we
are asked to use, and that is laid out in the Misuse of Drugs
Act. We collect scientific evidence in relation to our responsibilities
in that, but, no, we have not commissioned research into how one
might classify them. I think that is a more appropriate thing
to be done by the Government and the Home Office.
Q123 Dr Iddon: Because the classification
is set out in the 1971 Misuse of Drugs Act, could I suggest that
you are perhaps operating within a straitjacket and there is very
little flexibility?
Professor Sir Michael Rawlins:
There is some lack of flexibility and that is one of the reasons
why we welcome the Home Secretary's decision to review the classification
system and come out with a consultation paper.
Q124 Chairman: Why did you not suggest
it?
Professor Sir Michael Rawlins:
I did talk to him about it informally and I said if he felt that
he wanted to do that it would be strongly supported by the Council.
Q125 Dr Iddon: Is it not a fact also
that the United Nations Conventions—and there are more than
one of them—severely constrain the debate anyhow because
they lay out internationally how different countries classify
drugs?
Professor Sir Michael Rawlins:
Well, there is a wide range of ways in which the different countries
do this and it is summarised quite nicely in the Runciman Report
the various systems that are available, and I think it is a matter
of what suits us rather than necessarily borrowing somebody else's,
but obviously we can learn from their experience.
Q126 Dr Iddon: I agree that there
are cultural aspects we have to take into consideration. Which
countries would you advise the Government to look at in particular
that might have different systems than ourselves?
Professor Sir Michael Rawlins:
I am not an expert on the international dimension to this, but
my advice would be to look at all the systems in developed countries
in Europe and in North America and in Australia, look at their
strengths and weaknesses, look at their own experience of it,
and look at what we ourselves need in this country, but I am not
an expert in this area. Professor Nutt might have a comment.
Professor Nutt: I think we should
look across a spectrum. Obviously we have in the past been very
interested in the Dutch approach and, as shown in the RAND Report,
the Swedish approach is almost diametrically opposite, and other
European countries like Spain have gone through quite major changes
in the way they regulate drugs in recent years, so there are lessons
to be learnt there.
Q127 Chairman: Bearing in mind that
alcohol probably kills directly or indirectly about 32,000 people
a year, tobacco 130,000 people a year, and those deaths are far
in excess of all the deaths caused by the use of all illicit drugs,
why is your committee not enabled to look at tobacco and alcohol
as well as all the other substances?
Professor Sir Michael Rawlins:
I think the idea that we would control tobacco and alcohol in
the form of the Misuse of Drugs Act (which would thereby render
them illegal in terms of possession or supply) the Americans tried
in this Prohibition days in the 1930s, and it was a disaster and
just encouraged crime, and quite clearly it is not a practicable
proposition.
Q128 Chairman: But, Professor Rawlins,
that is exactly what has happened in terms of the drugs classification
system. It is exactly what happened with the prohibition of alcohol
in the States.
Professor Sir Michael Rawlins:
I would not disagree with that. I think it is important that the
Council does not exclude alcohol and nicotine entirely. One of
the very important things the Council does—and it is nothing
to do with classification—is it has a Prevention Working
Group looking at prevention aspects of the misuse of drugs and
its current programme, which is looking at the pathways to misuse
of drugs by children and adolescents, is particularly also looking
at nicotine and alcohol because we know that the early use—and
Professor Nutt may want to talk about this—of nicotine and
alcohol is a much wider gateway to subsequent misuse of drugs
than cannabis or anything like that.
Professor Nutt: Yes, I think it
is important for you to realise that we are aware of the harms
of tobacco and alcohol and we do bear them in mind, both in terms
of the issue, as Michael has said, of the gateway but also in
terms of the interactions. There are some drugs which by themselves
are not necessarily very dangerous or harmful but when used with
alcohol can become very much so.
Q129 Dr Iddon: I am not asking for
an ACMD view on this but a personal view. If you were to put alcohol
and/or tobacco in one of the present classifications, bearing
in mind the harm that they cause not only to individuals but also
to society, which classes would you put them in?
Professor Sir Michael Rawlins:
When the Runciman Committee looked at this it was very clear that
alcohol was at the border of A and B and tobacco was at the border
of B and C.
Q130 Dr Turner: Sir Michael, the
point has already been made about the defects of prohibition and
many senior police officers have told me that, in their view,
the way in which we operate the Misuse of Drugs Act is actually
counter-productive as far as dealing with drugs misuse is concerned,
particularly with its emphasise on criminalising personal possession
and use. Do you have a view on this?
Professor Sir Michael Rawlins:
Yes, I think the question of possession versus trafficking is
very much the criminal justice and the public health elements,
and I think for possession the public health issue should be paramount,
and I am particularly thinking of vulnerable sections of society.
Professor Nutt is much more expert on this than me, but we are
very conscious that people with schizophrenia may relapse very
readily if they use cannabis, and that cannabis consumption amongst
people with schizophrenia is extraordinarily high. The worst thing
you can possibly do with somebody with schizophrenia is to send
them to jail for two years or five years or any time, particularly
in relation to something like possession of cannabis. It is totally
inappropriate and I do not think that happens very much, but we
want to be helping them not to use it rather than punishing them
if they have a spliff in their pocket.
Professor Nutt: I have a lot of
sympathy with your view. I think the evidence base for classification
producing deterrence is not strong and we see that with a number
of drugs.
Dr Turner: Do you agree that there is
also a problem with the way in which we handle, for instance,
heroin addicts in that the substitutes could be as bad if not
worse than the primary product if they had access to a pure source?
Q131 Chairman: I would really like
to move on if you do not mind, Des, on this. Could I just finalise
with you, Sir Michael, you said you had an informal conversation
with the Home Secretary so there has been no formal recommendation
from your Committee that he should re-visit the classification
at all?
Professor Sir Michael Rawlins:
No.
Q132 Chairman: It was just an off-the-cuff
conversation between yourself and the Home Secretary?
Professor Sir Michael Rawlins:
It was.
Chairman: Margaret?
Q133 Margaret Moran: Can I pursue
the issue of your work programme and how it is determined. What
proportion of your work is in response to Home Office or government
departments and what proportion is proactive from yourselves,
and what processes do you use to decide what issues you will pursue
proactively?
Professor Sir Michael Rawlins:
I will start off and Professor Nutt will follow. I cannot give
you a breakdown in quantitative terms. Occasionally it is the
Home Secretary himself who asks us, but it has not happened very
often. Sometimes it is officials in the Home Office who may propose
things. Quite often it is also intelligence that we gather through
the Police or the Forensic Science Service that stimulates an
inquiry or a serious examination, but David?
Professor Nutt: Yes, my Committee
is called the Technical Committee and it incorporates individuals
with an expertise and knowledge of drug toxicity but also people
interested in the epidemiology, the natural history of drug use.
In the last few years we have initiated reviews of drugs such
as khat, based on, I suppose, public concern about sections of
society being distorted by the use of khat. Ketamine was driven
by concern from Customs & Excise about the very big increase
in the importation of ketamine, which was certainly mislabelled
as certain products. Basically we are reactive to social concerns,
I suppose.
Q134 Margaret Moran: I do not think
you clarified for me the exact process, so you are effectively
saying there is an issue that comes from the media or from general
public concern, and you think, "Okay, we should formulate
that into an inquiry"?
Professor Nutt: That is what we
have to do but we have also done other things. Systematically
since I have been Chair of the Committee we have worked through
two issues. One is how best to assess the harms and risks of drugs,
and you have that report from Sir Michael in front of you. We
have done that process; over a series of our meetings we have
evaluated across the whole range almost every drug in the Act
in a systematic way, given the current level of evidence. So we
have set up a system where we can be proactive in terms of individual
drugs and also we have reviewed the relative harms and risks of
all the drugs.
Q135 Margaret Moran: That is my next
question. Could you give us a couple of specific examples where
you have come across something where you think policy practice
needs to be changed?
Professor Nutt: I can give you
a couple of good examples from the process that the Technical
Committee has done. For instance, buprenorphine was Class C, and
based on our harm assessment we thought it should be Class B.
The same process was applied to cannabis back in 2002, where we
thought it should go from Class B to Class C, so those are two
examples of where we have used our expertise, applied the template
of risk assessment and come up with what I think are quite sensible
solutions, and from what we have seen at least one has been acted
on.
Q136 Bob Spink: I just wondered how
the ACMD actually assessed risk, what evidence it took, and how
it did the work of collecting that evidence. For instance, on
crystal methylamphetamine, did the ACMD go to see the devastating
impact of that drug on society and individuals in Thailand or
in America, and did it use the evidence that it gathered in that
way, if indeed it did gather evidence in that way, in making its
decision to hold it as a Class B drug rather than classifying
it as an A?
Professor Sir Michael Rawlins:
Can I in general terms answer on the approach we take. When we
look into a particular area we usually set up a small working
group. That small working group undertakes or usually commissions
a systematic review of the public evidence, the chemical, the
basic science and the social science evidence. That is supplemented
by a search for unpublished material from all sorts of sources,
not only from scientists we know are working in the field but
through our national and international contacts, and then we interact
with experts in the field, seeking their written evidence, seeking
oral evidence from them and seeking their views on the systematic
review and whether we have left anything out. That then forms
the basis of a draft report which is looked at by the Technical
Committee and then finally goes to the Council for further discussion
and consideration and sometimes a bit of iteration between the
Council and the Technical Committee. We have not paid visits to
Thailand on the crystal meth business as a Council but Professor
Nutt has visited.
Professor Nutt: The people we
worked with to produce the scientific overview—Farrell and
Marsden and colleagues—do research in Thailand on crystal
meth, they are world experts on it, so we felt very comfortable
with their expertise because they were part of our process.
Q137 Margaret Moran: Obviously your
direct relationship is with the Home Office but how often are
you consulted by other ministers or other departments or have
a dialogue with them about some of the issues that need to be
raised?
Professor Sir Michael Rawlins:
I do not think in my time in office we have been approached by
other government ministers outside the Home Office. The Act would
allow any secretary of state to ask for our views, but that has
not happened. We do have very close relationships with the Department
of Health. That is obviously very, very important and during the
time that I have been in the Chair our relations with the Department
of Health have got better and better, and it is very collaborative
and they are very, very supportive. We also have relations obviously
with the Department for Education and Skills, to some extent with
the Department of Trade and Industry, with the Foresight Programme
in particular, and we obviously have relationships with the Police—ACPO,
the Met, and so on.
Q138 Margaret Moran: When you say
relationships, have you actively gone to discuss issues with ministers
or representatives of those departments?
Professor Sir Michael Rawlins:
Yes, ministers in the Department of Health have talked to me about
misuse of drugs and the views of the Council in discussion. They
have not referred a topic to us but we have had discussions about
it, yes.
Q139 Margaret Moran: Just one quick
one. When you are finalising your advice to ministers, for example
anything about the reclassification of cannabis, how much has
the opinion of that minister helped to form the final policy judgment?
Professor Sir Michael Rawlins:
Not in the slightest. It is a very independent group. There is
no way I could persuade them to put something in a report because
the Home Secretary might like it. They are a very, very independent
group. They would walk out of the room if I even thought about
doing it.
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