Examination of Witnesses (Questions 420-439)
PROFESSOR COLIN
BLAKEMORE, PROFESSOR
JOHN STRANG
AND MR
ANDY HAYMAN
26 APRIL 2006
Q420 Chairman: Would you support
that, Colin?
Professor Blakemore: Yes, and
there are mechanisms for doing that. Calls for proposals highlighting
areas of research of particular interest, or even specific calls
for proposals with ring fenced funding, are both used by the research
councils in areas of particular interest, whether policy interest
or scientific interest.
Q421 Mr Newmark: How well do you
think the ACMD handled the two requests from the home secretary
to look into the classification of cannabis? To your knowledge
did the Council have and make proper use of the right expertise
in arriving at that decision?
Professor Strang: My understanding
is that ACMD were asked to give a view on cannabis with a relatively
short timescale in scientific terms. It is not an area that they
had either chosen to or had paid specific attention to for something
like twenty years. An initial opinion was given. Public opinion
was shaped by that and policing action was shaped by that. Then
some correction to that occurred. I am sorry to keep repeating
myself, but what an exquisite experiment: you have a situation,
you make those intriguing changes and then you even partially
reverse it. I do not know—maybe you know—what impact
that had on levels of use, levels of harm, levels of admission
with related problems. How could you make the next decision without
knowing the impact of the decisions you made recently had.
Q422 Mr Newmark: Do you think it
is in the correct category now?
Professor Strang: I genuinely
want to be helpful to the Committee but I am very much in what
I call the Andy Hayman camp on this. Personally I do not think
it is a hugely big issue. It obviously should be handled in different
ways from other drugs like heroin, for example. In practice it
is handled in a massively different way and it is the "in
practice" which is far more interesting than what letter
is attached to it.
Mr Hayman: I presume you are talking
about the first process, not the one that has recently been completed
when you are talking about classification. The interesting nuance
we have following that process is that it has gone into category
C but if you look at all the rest from the policing powers perspective
all the other drugs in C do not have the power of arrest that
was retained for cannabis. So it has retained its unique position
there and operationally that does present a very difficult challenge
for policing. It was an interesting development in the classification
of cannabis.
Q423 Dr Iddon: Professor Blakemore,
was the evidence about its causal or non-causal factor for mental
illness available before all the media fuss arose after the re-classification?
Professor Blakemore: It was not
really, no. I mean there was some epidemiological evidence which
was not very secure and I think it is fair to say that has grown
over time and there is now a broad consensus that there is a causal
relationship, although I would qualify that again by saying that
the effects are very small. I think the figure is an 8% increase
in the probability of schizophrenia as a result of substantial
exposure to cannabis. The evidence has grown from that point.
Q424 Dr Iddon: Of those people whose
schizophrenia is triggered by cannabis do they eventually develop
schizophrenia?
Professor Blakemore: Not always.
Amongst identical twins if one twin is schizophrenic the other
one has a 50% chance of developing schizophrenia. So it is not
inevitable that if you have the genes which seem to be associated
with schizophrenia you will always progress to develop the disease.
It depends on life events and cannabis appears to be a particularly
potent life event in tipping people into that, into a psychotic
episode.
Professor Strang: There was a
moderate body of evidence about a relationship with different
types of mental illness and as Professor Blakemore is saying it
is substantially stronger now than it was a few years ago, but
we have known about cannabis induced psychosis since the 1840s
so it is not that recent. What in a way has been disproportionate
has been the sort of flip-flop nature of the public and the political
view on it—that somehow it was completely safe or then completely
harmful. I imagine all three of us would be trying to say that
you have to find some understanding of it which is between those
two extremes.
Q425 Mr Newmark: What input did ACPO
give to the most recent review of cannabis classification and
what were the key factors influencing your position? I am particularly
interested in your answer in the context of lessons learned from
the Lambeth pilot assimilated into your policy making process.
Mr Hayman: We are talking about
the original process.
Q426 Mr Newmark: Yes.
Mr Hayman: I sat through every
session with ACMD. It has to be said that the majority of the
discussion was around the medical and scientific evidence that
was available and I think that was highly appropriate. When it
was appropriate for us to give input we did and that was around
the impact on the community, discussions around crime and there
were certainly discussions about drug driving. I think the work
that was pioneered in Lambeth did not have a major feature in
the considerations of ACMD because that was more about operational
application on the street. What I think it did do was that it
started to set a context from which maybe politically and maybe
from the community that rose up in terms of a priority of consideration.
We must not lose sight of course of the Foundation report which
talked about the classification of cannabis and I think that was
very influential. I think the two together set the context to
politically consider it. In answer to your question as to whether
it had much say in the consideration by ACMD it was minimal, if
any.
Q427 Dr Iddon: Professor Nutt and
Professor Rawlins told this Committee that they thought drugs
were classified according to the harm to society and harm to the
individual fifty fifty. Why then are psilocin and psilocybin in
Class A? I have never known anybody use them; I have never seen
them on sale; there is no public fuss about them so why are they
in Class A?
Professor Blakemore: I think the
short answer to that is because they were initially put in Class
A and it is awfully difficult to get a drug out of one class into
another, as we have seen with cannabis. This is one of the problems
with the Act. When a new drug appears on the street and new concerns
are raised about it the perfectly natural tendency is initially
to classify it as being harmful and then to reassess and reconsider
over time and have the opportunity to rethink how it should be
classified. But with distinct categories of harm (as in the MDA
system) it is difficult to move a drug from one category to another.
The placing of the hallucinogens in category A was a reaction
to the concerns about drugs which were newly available on the
street in the 1960s and 1970s with not much scientific evidence
about their actions and certainly their long term consequences.
You are quite right, the situation now is that they are not widely
used. The evidence of toxicity is very low. They are not addictive
and I would rate them very low in their potential for harm.
Q428 Dr Iddon: So what you are saying
to me is that in 2005 the Misuse of Drugs Act put magic mushrooms
into the wrong classification because the only reason for putting
them in Class A was they contained psilocin and psilocybin. Do
you agree with me?
Professor Blakemore: I would say
they are in a classification that if one could look at all the
evidence for harm available now, including social harms, one would
say it is wrong.
Q429 Dr Iddon: So the Government
were not using evidence based science to put them in Class A.
Professor Blakemore: I am sure
they were using the evidence that was available to them at the
time. The question is whether that evidence was fully formulated
and was quantitatively organised in a way that would inform the
decision well.
Chairman: The ACMD are supposed to review
these things.
Q430 Mr Devine: ACPO said it would
support a decision to re-classify ecstasy as Class B as long ago
as 2001. Why do you think this decision has not been taken?
Mr Hayman: I am trying to be really
helpful on this but I do not know. I gave evidence to the Home
Affairs Select Committee around that time and in fact the document
that I alluded to earlier in answer to one of the earlier questions
about the ACPO policy was in preparation for the appearance in
front of the Home Affairs Select Committee. That is where it was
positioned. Again, I do not know why that has not proceeded.
Q431 Mr Devine: Have you asked ACMD
to re-consider this?
Mr Hayman: It is not a matter
for us to ask that.
Q432 Mr Devine: Do you not take the
views of your organisation to that body?
Mr Hayman: Our positioning of
our view on ecstasy was in direct response to a question about
it looking to advance it or lobby for that. We were asked that
question and that is how we felt at the time. I would have to
go back to the membership to see whether it is a valid view. My
understanding was that as a professional body it was not really
appropriate for us to be saying to ACMD what we should or should
not be doing; it works in a slightly different way to that.
Q433 Mr Devine: Are you on there
as an individual or are you on there from the police?
Mr Hayman: It is our body that
is represented as a professional body. It just so happens I had
the privilege to be asked when I became the chair of it to sit
on it.[1]
Q434 Mr Devine: What about the others
on the panel, do you accept the view of the ACMD chairman that
the revaluation of the classification of ecstasy is not viable
because of the lack of scientific evidence?
Professor Blakemore: If we had
a flexible system of classification that would respond quickly
to changing scientific evidence then there could always be the
case for moving the classification of drugs. My own view—my
personal view, not of the Medical Research Council—is that
on the basis of present evidence ecstasy should not be a Class
A drug. It is at the bottom of the scale of harm. There has been
a great deal of scientific work on ecstasy in the last few years
but it is still a confused field. I think John would agree that
we do not have adequate evidence on the long term consequences;
there is a particular concern there.
Q435 Chairman: Andy, in 2003 (this
is the issue about whether cannabis is a gateway drug) you made
a very interesting comment when you were chair of the ACPO Drugs
Committee, that "The theory of `gateway drugs', ie someone
starts with cannabis and then migrates onto a more serious drug
does not stand up". We commissioned a report from RAND who
said exactly the same thing. In oral evidence to us this year
the chairman of ACMD said, "We know that the early use of
nicotine and alcohol is a much wider gateway to subsequent misuse
of drugs than cannabis or anything like that". Do you stand
by those comments? I wonder if the other two members of the panel
would also stand by those comments.
Mr Hayman: Those comments were
made on the basis of what I had read. I have no professional qualification
at all to make that statement but I read it in the research and
that was my interpretation having read that research. That is
why I made that statement. If we had a cop making those kinds
of statements that would be very safe.
Professor Strang: I am afraid
my answer is that it all depends on what you mean by a "gateway
drug". It is a correct observation that people who are using
heroin went through gates on the way to where they are now. The
crucial question is: if you had had the power to stop them going
through that gate would it have altered their subsequent journey?
It really does come back to experiments and opportunities that
are thrown up. I presume going to primary school is a gateway
to being a heroin addict but you are not implying there is a causal
relationship between the one and the other and that is the bit
that is missing from most of the debate. There will be individuals
where you can see it in that individual's personal development,
but that does not mean it is a generaliseable finding.
Professor Blakemore: I think one
should ask what is likely to be the causal basis of a real gateway
effect. I cannot think of a chemical or physiological basis. The
obvious basis is supply. If you are buying your first drug from
a person who then tries to persuade you to use a "better"
one and a stronger one then there is a causal relationship which
is determined by the supplier. The fact is that as I understand
it cannabis supply is, to a large extent, rather different from
the supply of harder drugs. There is numerical evidence though.
One can look to Holland where the attitude to cannabis use is
even more relaxed than it is in this country and where cannabis
use amongst the population is a little less than it is in this
country even though it is more easily available. Hard drug use
is about one third of the rate in this country. So the availability
and the legal acceptance of a soft drug is clearly in that case
not automatically leading to a high rate of hard drug use.
Q436 Mr Newmark: So you are saying
there is nothing physical, ie that taking something that has a
chemical reaction on you physiologically does not cause a certain
potential of people in the population then to want to crave something
harder after having used that other drug.
Professor Blakemore: I am sure
that John can answer that better than me but first of all I would
say that cannabis is not classically an addictive drug; it can
be very habit forming and produce dependencies but it does not
trigger the same mechanisms of the requirement for further and
higher doses that the opiates do. I do not know about cross-craving
between drugs and whether there is a physiological basis for that.
Professor Strang: I think it is
ever so important for you to get away from this notion (if you
have it at all) that there is just a vulnerable percentage of
the population who might develop problems and it is all right
for everybody else. With alcohol and tobacco you can look at it
exquisitely. With both price and availability and public acceptability
the levels of use will go up and down over the decades and the
amount of harm that society approves goes up and down and the
amount of addiction or dependence out there in society goes up
and down. You can measure it against price: roughly every 1% up
you get ½% down. You suddenly think that this is not a commodity
where there are just some people with the equivalent of brittle
bones; this is something distributed across the population. There
will be vulnerable individuals who are more likely to come a cropper
and that has to be laid on top of it, but that does not explain
the problems of alcohol, tobacco or illicit drug use in society.
Q437 Mr Devine: Do you say there
has been a lot of scientific evidence about re-classification
of ecstasy? My understanding is that something like nearly 60%
of young people going out at the weekend could be taking this
going to clubs and pubs and what have you with apparently no ill
effect. Is there a political reason why we are not re-classifying
ecstasy?
Professor Blakemore: I think there
is always a defensible political reason to be cautious about making
any substance which might have dangerous effects more easily available.
That is a natural conservatism and is entirely defensible. I do
think the accruing evidence on ecstasy has increased confidence
in one's judgment that this is not a very highly dangerous drug
in the way that crack cocaine and heroin clearly are and yet it
is in the same category as crack cocaine and heroin at the moment.
Chairman: Thank you very much indeed
Colin Blakemore, John Strang and Andy Hayman. I am sorry the session
has been rushed but, as always when you have an interesting subject,
you want to go on and on and on.
1 Note by the witness: In fact, under Cabinet
Office Guidelines, and public appointments rules, I was appointed
to ACMD in a personal capacity, although clearly, as with all
other ACMD members, my professional role, knowledge and experience
will have played a key part in being selected for appointment.
The Office of the Commissioner for Public Appointments approves
the process. Back
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