Examination of Witnesses (Questions 440-459)|
26 APRIL 2006
Q440 Dr Iddon: I would like to go
into a bit more detail as to what each of you think the home secretary
should be looking at. Could I put it to you that there are drugs
available over the counter and there are drugs that are prescribed
by doctors that are equally dangerous as some of the drugs that
are already in the classification system? Have we not got it all
wrong with this classification system and should we not start
from a zero place and build up a new system?
Mr Barnes: I think the fact that
the home secretary has announced a review is very welcome and
we do not yet know the full detail as to how the consultation
is going to happen, but obviously the wider, the more clean slate
it starts the better. I think there is an opportunity there to
address those issues of over the counter medicines but also there
substances that are not currently classified that can be bought
on Camden High Street or on the Internet. People looking at the
Internet in terms of those substances do not get terribly accurate
information about the possible harms so there is a gap and a potential
anomaly there as well that I think should be looked at, but it
is an extremely complex subject and I do not think there is a
Mr Rolles: I agree that we should
start with a clean slate and I also welcome the fact that the
home secretary has announced this inquiry and I also welcome the
fact that this Committee is looking at this issue. It is very
welcome to have the light of science pointed at this rather murky
corner of policy making which seems to have been fairly unbothered
by science historically. In terms of what they need to be looking
at, I think we need to go beyond just determining and ranking
the harm of drugs because that debate can go on forever. It is
important up to a point but more important they need to look at
the outcomes of this policy: is the policy effective at doing
what it is supposed to do? If it is actually doing the opposite
of what it is supposed to do if it is increasing harms and under
the auspices of this policy use is increasing and availability
is increasing, then you have to question the validity and utility
of that policy more generally. What I would like to see is the
entire scientific base of the policy itself examined. I would
like to see some examinations of outcomes historically and consideration
of possible alternatives to classifying drugs. We are talking
about public health policy in terms of drug harms but significantly
that is then transferred into criminal penalties. We have the
classic category error here where you have a lot of excellent
science in terms of determining harms of drugs which is then transferred
into criminal justice penalties which have incredibly poor science
in terms of determining the impact of the criminal justice penalties
on outcomes from public health. There is great research at one
end of the spectrum and a total absence of research and science
at the other end. I think that is where we need to focus and hopefully
the Committee and Home Office consultation will do that.
Mrs King-Lewis: I agree with Steve,
we need to close that link between having the research there and
very little output because it is based on those outcome measures
which then inform policy. That is the area that is missing. I
also agree with Steve to make it more of a public health agenda
as well. It is very much focused on the criminal justice element
but really looking from the start at what is the purpose of it?
What are the objectives? What are we trying to reach? Certainly
the public health agenda and advising the public as what the different
harms of the drugs are it is very limiting just by classifying
it A, B or C. We are not really giving the public much information.
To my knowledge I do not think we have ever done any public survey.
We do not even know if the public see that if a drug is in Class
A is that more of a deterrent or is it actually an attraction?
We cannot even answer those simply questions.
Q441 Dr Iddon: I asked the previous
panel if there are any other countries that get it better than
we do. I put it to you that the United Nations conventions are
the limiting factors because they do not encourage countries to
develop best practice.
Mr Barnes: I think it is true
that the UN conventions are a limiting factor but there is flexibility
within that. Look at the Netherlands, for example, which for certain
drugsby no means alltakes a more liberal approach
to issues of possession. There are countries, for example, that
have been piloting safe injecting rooms but there is a view that
that is against the letter of the UN conventions, so the UN conventions
are a potential stumbling block to very radical reform but I think
the parameters within which domestic policy can operate are reasonably
broad. I agree that we do need to look at the effectiveness of
the way the current legal enforcement of drugs operates. Steve
and his organisation come from the view point and are very clear
on this that they want to see a system of legalisation. I do not
think we are talking about science evidence base, that there is
the evidence to say that legalisation is going to be the way to
significantly reduce related harms. It is na-ve to believe
that if we had a system of legalisation it is going to take it
out entirely of the harms of criminals. There was an interesting
document published alongside the Budget this year looking at tobacco
smuggling. If we did a word replacement and instead of "tobacco"
put "cannabis" (assuming we have a situation where cannabis
is legal) I suspect very similar problems of smuggling and criminal
gang involvement would apply. Yes, we need to look at radical
reform; the problem is that it is very difficult to have a debate
about even cautious changes in drugs policy.
Chairman: I do not really want to go
down that road so I am not going to invite you in on that. Our
Committee is basically asking where is the scientific evidence
to justify the current policy. That is what we are looking at.
Q442 Mr Newmark: Would you be in
favour of using a scientifically based scale of harm to determine
a legal status of drugs? Why or why not? In view of the fact that
drugs policy is a politically sensitive area, what role should
scientific evidence play in influencing decisions? I am asking
the question in the context of David Nutt's analysis into which
I think Lesley had some input. Steve?
Mr Rolles: I think in terms of
a classification system as a public health tool then I think the
simple ABC classification is almost completely useless; I do not
think it is any use as a public health at all or it has very little,
it is marginal. I think in terms of young people and the classification
system I do not think it makes any difference really; it is must
more based on their personal knowledge and information they get
from their peers about risks and so on. I certainly do not think
that young people are leafing through Hansard before they go out
on a Saturday night. If anything they will ignore it completely.
In terms of a criminal justice tool I think it is actively counter
productive. I think criminalising drugs increases the harm associated
with those drugs. Not only does it create the secondary harms
associated with illegal markets, it also increases the harms of
the drugs themselves.
Q443 Mr Newmark: You are not answering
my question. My question has to do with a scientific base scale
of harm in determining drug policy.
Mr Rolles: The problem with the
ABC system is that it hugely over-simplifies quite a complex series
of drug using behaviours and the vectors of drug harm are far
more complicated than just ABC. There is a series of determinates
for any particular drug and any particular user.
Q444 Mr Newmark: You are moving to
classification again; I am not talking about classification, I
am looking at scientific evidence.
Mr Rolles: Obviously I believe
that you should have scientific evidence for any policy. In terms
of ABC I think that is a different area.
Q445 Mr Newmark: I am mainly focussing
on scientifically based evidence in determining harm and having
got that scientific evidence from a public platform then articulating
that this is the science behind the decisions we are making as
public policy makers.
Mr Rolles: I think I have answered
that. It is great to have good science in terms of deciding what
drugs are in which category, but there is no science for determining
the fact that the classification system itself is effective in
doing what it is supposed to do. I would just reiterate that point
Mrs King-Lewis: I think if we
had the scientific evidence and used it appropriately we would
not have the anomalies in the system today. It has already been
mentioned about magic mushrooms being a Class A drug and the classification
of other drugs. We have either ignored the evidence that exists
or have not used it or other priorities have come into play.
Q446 Mr Newmark: How can government
improve its approach in making policy decisions on drug classification
where evidence is inconclusive?
Mrs King-Lewis: Identify the research
gaps, fund it and get it funded by an independent body. The amount
of money invested in this country is £3 million to £4
million. That is the average R&D budget for a small public
Q447 Mr Newmark: Which is Professor
Mrs King-Lewis: Absolutely.
Mr Rolles: I think we would all
agree with that and with the previous panel that there is not
enough research into drug policy issues and drug harm issues generally,
but I think it is both of those. It is not just research into
harms and addictive behaviours and so on, it is also research
into outcomes specifically. Whilst we can identify holes in the
research with regard to magic mushrooms or ecstasy or whatever,
there are also huge holes in the research with regards to some
of the things Andy Hayman was talking about such as the deterrent
effect. The concept of the deterrent effect is central to the
entire classification system and indeed the whole prohibition
is paradigm specifically the idea of a hierarchy of deterrents
associated with a hierarchy of penalties, but there is no research
at allnot a single piece of research ever done by the Home
Office that I am aware ofinto the effectiveness of the
classification system as a deterrent and the independent research
that we do havewhat little there issuggests that
at best it is a marginal impact on drug taking decisions. To me
that is a striking gap in the knowledge that we have in terms
of determining this policy.
Q448 Mr Newmark: Lesley, you have
said you have reflected on what Professor Strang has also said,
that there needs to be more funding, but how responsive do you
feel government has been to your concerns? Have you had a chance
to articulate those previously? What needs to be done is more
funding, but should the primary responsibility for funding addiction
research in your view lie with the Home Office, health or research
Mrs King-Lewis: You have made
a very interesting point; it is not just with drugs. There are
different departments: alcohol is a department, sport and education;
nicotine is a separate department; drugs. We almost need one body
who has the accountability and responsibility for pooling research
into all the different drugs, the legal and the illegal drugs.
Obviously we are missing a trick there because there is no joined
Q449 Mr Newmark: Do you think that
as a result of that there would be more efficient use of limited
resources, ie money, by pooling it together so there would not
be competing groups effectively doing the same research?
Mrs King-Lewis: Exactly. There
are cases where the Home Office has actually commissioned research
which the Department of Health did not even know about and were
commissioning a similar issue. There is a frustration there.
Q450 Chairman: What was the issue?
Mrs King-Lewis: I will have to
get back to you on that. It is so frustrating when the little
amount of money that has been allocated is then duplicated or,
as has happened in the past when we have responded to a call,
information can be sat on for a long time or never published.
Q451 Margaret Moran: We have heard
the assertion that ACMD should be looking at the research gap.
Leaving that aside what other weaknesses do you see that there
are in ACMD? How could its effectiveness be improved?
Mrs King-Lewis: I have had personally
very little dealing with it but from my objective point of view
there seems to be very little transparency and it seems to be
reactive and not proactive so I think the opportunity to be proactive
would be great and would make a big difference.
Mr Rolles: I would agree with
both those points. There is a lack of transparency although I
did note that Professor Rawlins said that the minutes of meetings
would be made available and hopefully we will get to see those
at some point. Certainly the work that the ACMD actually produces
is first class and no-one is questioning the good intentions of
the ACMD. The problem is that the ACMD is set up within the framework
of the Misuse of Drugs Act so it exists within a system that is
signed up to the prohibitions paradigm and a criminal justice
approach to managing drug problems in this country and as such
it is very limited within that remit. It can question things within
a criminal justice system but it cannot question using the criminal
system per se as an effective tool in terms of dealing with drug
problems even though there would appear to be a mountain of evidence
to suggest that the criminal justice approach to managing drug
use has not historically been effective given that the problem
has got worse and worse over the last 45 years. I think the main
problem is the political framework within which the ACMD operates,
not the work that it actually does. The questions that they are
asked they answer very well; it is the questions that they do
not ask which is the problem.
Mr Barnes: As you probably know
I am here as DrugScope Chief Executive but I am also a member
of the ACMD which is possibly why I was not asked to comment on
the previous question. I am concerned when I hear words like "lack
of transparency" and "not reactive". The ACMD does
do proactive work. To give you an example, it published a report
three years ago on the issue of children living with parents who
misuse drugs, a report called Hidden Harm. It took the
Government two years to publish its response to that report; it
took 18 months to two years for a fantastic piece of agenda setting
work. On the issue of research one of its recommendations was
that we need more research into the issue of the effects of drug
use amongst parents of young people. The Government's response
was that we have enough research on that issue. The ACMD's report
on cannabis re-classification, the recent one, it did call for
more on-going research into the effects of cannabis on mental
health problems. As we have touched on, should it be the role
of the ACMD to commission research? Perhaps it could be more assertive
with government in terms of saying where the gaps are and what
needs to happen, but given the ACMD's role that it is there to
reach a judgment on the research, to gather it together, to look
at its robustness, to reach a conclusion from that, there could
be a tension between it being a commissioning body and also a
body that then has to take that evidence into account and reach
its judgments on the evidence it is looking at.
Q452 Mr Devine: How did you become
a member of the ACMD and what do you see as your role?
Mr Barnes: I sit in a personal
capacity but I would not have been appointed, I do not think,
had I not been Chief Executive of DrugScope. As Chief Executive
of DrugScope I hopefully bring to the Committee with all its range
of expertise of its members particular knowledge or perspectives.
Saying that, if I did not feel that the ACMD was a credible body,
as Chief Executive of DrugScope I would not have applied to become
Q453 Margaret Moran: We have heard
evidence both in the previous session and in written evidence
that the ACMD is supposed to be a scientific body therefore the
question is why do you have campaigning organisations on there?
What does that bring to it? Also there are significant gaps even
in the science that should be on the ACMD. What would be your
response to that?
Mr Barnes: Firstly I think if
you are referring to DrugScope in particular we do campaign but
we are not just a campaigning organisation. We have the largest
library of drug information in the world; we do conduct research;
we try to inform policy; we have a membership of around 900 organisations
that represent the broad spectrum of people working in the drugs
sector. So to have non-scientists if you like on there does bring
value to the work of the ACMD. There are also people who work
in treatment organisations and also people who work in education
and they do bring that broad perspective to the issues. I think
if the ACMD's role was simply to look at the narrow issue of the
scientific and medical evidence as to what harms drugs do to individuals
I think its role would be much clearer and easier, but its role
is to look at the issue of a drug related harm in the wider context
of wider harms, the harms that drugs can do not just to individuals
but to their families, to the community, et cetera. That is what
makes its role more challenging and, if you like, more complex
where the research itself does not necessarily give you the answerscertainly
not the easy answersas to what the policy response to drug
harm actually should be.
Q454 Mr Newmark: Lesley, you expressed
concern following the decision to re-classify cannabis as Class
C in 2002 that this could lead to an increase in the use by young
people in particular. What conclusions do you think we can draw
from the apparent decrease in the use that has actually occurred?
Mrs King-Lewis: I think it is
very interesting but again we did not measure it. We missed a
vital opportunity. The belief was that if we actually decreased
it we expected usageespecially amongst young peopleto
increase. Actually what happened was that we saw a decrease. But
that is all we know. What we do not really know is anything more
than that so again we missed the opportunity to evaluate the effect
of that change in policy.
Q455 Mr Newmark: There must be a
reason behind your concern.
Mrs King-Lewis: Yes, because we
had not expected the decrease. We expected that if we de-classified
it the message being sent out to young people would be that it
is okay, it is legal, we are no so concerned about the health
messages, it is okay for you to use cannabis. We were concerned
about the messages we were sending out to young people and we
were actually very surprised to see the overall trendand
the trend has been dropping for the last few yearscontinued
to decrease but we do not know whether it is because of an existing
trend, what other factors or because of the re-classification.
We are still left in that same ignorant position so if we want
to make another change on the cannabis policy we have not built
a body of information to make an informed decision.
Mr Rolles: There is a lot of talk
about sending out messages and the classification system being
used to send out messages, but firstly there is no evidence to
suggest it is effective at doing that at all which I think is
something which needs to be borne in mind.
Q456 Mr Newmark: It goes back to
your argument that in fact it should not really influence our
thinking; classification is a red-herring.
Mr Rolles: There is a bigger point
really. Why are we using the criminal justice system to send out
public health messages at all? It is not the role of law and order
to send out public health messages.
Q457 Mr Newmark: If something is
illegal and is deemed illegal by Parliament there has to be a
mechanism for enforcing the law and that is the whole point of
deciding what is legal and what is illegal and thereforegoing
back to what Andy was talking aboutyou then have to have
some form of classification to decide where should the resources
be put in enforcing the law.
Mr Rolles: Transform's organisational
position is that drugs should not be illegal and that making them
illegal has actually increased the harm associated with those
drugs. Just because something causes harm does not mean that you
necessarily criminalise it. We do not criminalise pork scratchings
or running with scissors. There are all sorts of things which
are potentially risky but if you want to reduce harm associated
with them you educate people and encourage them to make more responsible
decisions; you do not criminalise them or put them in prison.
That is not ethical and historically it has been completely ineffective.
Drugs are a superb example of that. Drugs are quite anomalous
in all of UK law and social policy where you use the criminal
justice system to send out a public health message. We do not
do that with tobacco or alcohol; we do not do that with glue sniffing
or prescription drugs or dangerous sports or all sorts of potentially
risky activities, but for certain drugs for reasons lost in the
mists of time we have decided that we are going to send out a
message using the criminal system which is quite bizarre.
Q458 Mr Newmark: To take a step back,
prescription drugs have to be prescribed before you can take them.
Mr Barnes: Can I just comment
on the cannabis issue and the continuing down trend? I think the
home secretary in his interview with The Times before Christmas
himself accepted that the Government could have handled the issue
of re-classification at the time better. There was ample opportunity
to have launched a comprehensive campaign, particularly for young
people, to explain why the category was being changed. We are
now getting a campaign sometime at the end of May and we look
forward to seeing that. One of the consequences of re-classification
with all the debate and controversy that it generated, is that
I do not think we have ever had a more in-depth public debate
about the known risks of cannabis. I can remember a couple of
years ago hearing somebody on the radio who advocated legalising
cannabis coming out with a statement that the worse that can happen
if you use too much cannabis is that you fall asleep. That is
Mr Rolles: I do not think Transform
would agree with that.
Mr Barnes: I did not say it was
you, did I? You are not the only pro-legalisation body. Let me
make it clear, I have every respect for Transform and the work
they do. I have no criticisms of that organisation so rest assured
that I was not having a go. We do now have a more open debate
which is difficult to have through the media admittedly. There
might have been some initial confusion but research now shows
that the vast majority of people do understand that the drug is
illegal. I think the next challenge to get across is that they
understand the potential harms that can go with its use. That
is still the challenge.
Q459 Dr Iddon: Is there not still
a big problem with the cannabis debate? People say today that
the cannabis sold on the streets is stronger than it used to be.
We are completely dishonest with young people. There are 23 varieties
of the plant and what we are selling on the streets today is not
the same plant extract that we were selling ten years ago on the
street. We have skunk now which was not available some years ago.
Is it not time we became honest with our young people and tried
to explain what they are buying on the street?
Mr Rolles: That is absolutely
right. What young people need is honest, accurate information
at the place and time that it is needed. Going back to the point
I made earlier, I do not think an ABC ranking system provides
that kind of detail and nuance for what is a really quite complex
set of variables in terms of determining drug related harms. It
just does not do that. Class C drugs can be used in very risky
ways; Class A drugs can be used in comparatively less risky ways.
There are an immense number of determinates like the dose you
take or the frequency of use or whether you are using certain
drugs with other ones at the same time can amplify harms; your
personal predispositions, whether you have pre-existing mental
health problems or certain physiological conditions which would
put you at risk. For all that complexity and all these different
variables of harm, the ABC system does not provide any useful
information at all.
Mrs King-Lewis: I agree; we need
to be far more honest. I think there has always been a problem
in this country and it is almost like we are reluctant to talk
to our young people and give them the information. We almost seem
to feel that we are going to create a problem by acknowledging
one exists and the information is not out there. They do not know
the different types; they do not know what the levels are or who
they are buying it from. We need to do a lot more work on educating.
We need to do a lot more work on prevention as well. It is interesting
because prevention does not come within the remit of the ACMD
or the Drugs Misuse Act; it does not seem to fall anywhere but
that is what we are particularly interested in, the prevention
side: how do we talk to young people and, more importantly, how
do we change their behaviour about drugs and alcohol? Information
has to be a key factor in that.
Mr Barnes: Could I just reinforce
the point that the system of drug classification within the context
as we have it is one response to reducing drug related harm. I
entirely agree that we also have to look much more at learning
lessons and other areas of research around what works in terms
of prevention. There is growing evidence that the link between
socio-economic factors and drug use moving from casual into dependency,
for example, and why are we not seeing tackling drugs as more
of a key potential outcome of that as well? Education in schools.
More investment around drug treatment. We have seen record amounts
going in but there is clearly more to do in terms of improving
the effectiveness of drug treatment. On the role of the ACMD it
has looked at work around prevention. It published a report in
1998 that emphasised that if we are talking about genuine prevention
we need to address the wider social factors, the upstream factors,
and at the moment it is doing a very good piece of work I think
in terms of looking at the effectiveness of policy responses in
terms of young people's drug use. That work is on-going; they
are meeting with officials at the moment to firm up the recommendations
and I think it is due to be reported later this year.