House of COMMONS
MINUTES OF EVIDENCE
science and technology COMMITTEE
scientific advice, risk and evidence:
how the government handles them
Wednesday 26 April 2006
PROFESSOR COLIN BLAKEMORE, PROFESSOR JOHN STRANG
and MR ANDY HAYMAN
MR STEVE ROLLES, MR MARTIN BARNES and MRS LESLEY-KING-LEWIS
USE OF THE TRANSCRIPT
Taken before the Science and Technology Committee
on Wednesday 26 April 2006
Mr Phil Willis, in the Chair
Mr Jim Devine
Dr Brian Iddon
Mr Brooks Newmark
Witnesses: Professor Colin Blakemore, Chief Executive, Medical Research Council and Professor of Physiology, University of Oxford, Professor John Strang, Professor in Addiction Research and Director of the National Addiction Centre and Mr Andy Hayman, Chair, Association of Chief Police Officers Drugs Committee, gave evidence.
Q372 Chairman: Good morning. Can I welcome everyone to this session which is looking at the classification of illegal drugs within an overall inquiry which is looking at scientific advice to government in terms of policy information. Can I particularly welcome our Panel One: Professor Colin Blakemore, the Chief Executive of the Medical Research Council and Professor of Physiology at Oxford University; Professor John Strang, Professor in Addiction Research and Director of the National Addiction Centre and Mr Andy Hayman, the Chair of the Association of Chief Police Officers Drugs Committee. Welcome to you all, thank you very much for giving us your time. Could I start by asking you, Professor Blakemore, you said in 2004 of the ABC classification system for illegal drugs: "It is antiquated and reflects the prejudices and misconceptions of an era in which drugs were placed in arbitrary categories with notable, often illogical, consequences". That was in 2004; do you stand by that comment?
Professor Blakemore: There are sometimes useful reasons for making what, with hindsight, might seem to be pejorative or hyperbolic statements, but I stand by much of what I said, although some of the adjectives could be attenuated. To call a system antiquated of course does not necessarily mean criticising it.
Q373 Chairman: But "illogical consequences" is pretty severe.
Professor Blakemore: The Monarchy, the House of Lords and Shakespeare's plays might be called antiquated by some people but they would not necessarily be dismissed by everybody. I think the logic on which the misuse of drugs classification is based is impeccable. The logic is that drugs should be classified according to their potential for harm and that classification should then guide particularly the judiciary in its attitude towards policing and sentencing.
Q374 Chairman: You no longer think it is illogical.
Professor Blakemore: I think the basis is logical, but I am not sure of the evidence on which drugs were placed in those arbitrary groups - they are essentially arbitrary; there is nothing that rationally could provide evidence of sharp boundaries in a scale of harm from drugs. I think that not all the evidence was taken into account in the initial classification and subsequent emergence of evidence has not easily been incorporated in re-classification.
Q375 Chairman: Professor Strang, do you accept Colin Blakemore's original hyperbole?
Professor Strang: It seems to me that people at a previous time have tried to place drugs in what they think is a ranking of the levels of concern which should be attached to them. Periodically it seems proper for us to re-visit that and decide whether the ranking is correct and also then the way in which we organise our responsibilities. Being concerned about the potential for harm we wanted to look at ways in which a harm that is otherwise going to hit individuals in society might be deflected by the system. I would have thought that in any system from yesteryear one is bound to see things that you want to change. Personally I was pleased to be reminded about your overall process, about looking at how science might or ought to be contributing to the process of government. I am not sure whether that is the correct terminology. It does seem to me that there are many examples where what you or me have is inherited and what we are wanting to know as well is a whether a move in one direction or another direction would bring benefit or more harm. That is a more urgent question, rather than whether people happened to get it right a number of years ago. What I crucially want to know is that when changes have occurred, when minor adjustments have been made to the classification - not just to the classification, to the way in which the law is applied, because the law may be an ass but it is a sometimes subtle ass - that it is not just what the documents say, it is the way in which is applied. We have lots of examples in the UK as well as overseas (but let us just stick with the UK) where we have changed the law or we have changed the way in which the law is applied. Examples in the last couple of decades would be that we have re-classified certain drugs.
Q376 Chairman: We will come onto that specifically; we want to know why we have done some of those things. The basic premise that I would like to start with this morning is: is the ABC category as exists now as illogical and is it as arbitrary as Professor Blakemore said. What is your opinion?
Professor Strang: I am being much more moderate about the view. I am not wishing to defend the precise drugs and I probably would not see it as my area of expertise. What I would say is that I think we are ill informed about whether the changes make it better or worse. We have changed the detail of it and we do not actually know whether that has made the situation better or worse, so changes we have made, what I would expect of government in science, is to be able to tell me: So you have made that change five years ago ...
Q377 Chairman: We would like to know why; what was the evidence on which it was based?
Professor Strang: Yes. Not only would we like to know the evidence of why but in particular did the effects that you expected happen? Even if your evidence base was rather weak and arbitrary, and it seems to me that the political process sometimes needs to make decisions with a pace that does not fit science and the gathering of evidence, but when a decision is made I would expect to know three years down the line had the trajectory carried on going up or had it taken off or had it got worse and for it to be sufficiently transparent that if it had got worse you would say that we made what we thought was a correct decision, we now see that it actually had a contrary effect.
Q378 Chairman: Mr Hayman, very briefly do you feel the current system of the ABC classification is antiquated?
Mr Hayman: If you want me to be very brief, no. If you want me to elaborate on that I don't actually know what the problem is in this discussion. Why do we have that classification? Is it because we want something very precise or is because we want something as a rough guide? If we want something very precise then it is a problem; if we want a rough guide it is not a problem.
Q379 Chairman: What do you think the purpose should be then?
Mr Hayman: From a police perspective it only does a couple of things really. It puts certain drugs in a category which then has certain powers associated to that category and also it gives a bit of a steer which normally comes from government or from the local policing priority as to what the priority would be for policing those particular drugs.
Q380 Chairman: Just to clarify that, from your point of view you think the classification is to deal with possession and trafficking and the penalties that follow from that. That is the main purpose. It is not about education; it is not about debate; it is not about the degree of harm; it is just about that.
Mr Hayman: Other people make the determination as to the degree of harm; we are not in a position to comment on that. What we do is that once those discussions have been held by the experts in that field they get put into those classifications and that will then direct police resources and priority. I think, on a really practical note here, even when you ask this question you need to have some kind of view as to what we would replace the system with if we were to rubbish it. I do not think there is an easy answer to that. You are going to have to have some kind of brackets, whether you call it A or 1 or any other division. What is going to direct you to put a certain drug into those categories? That goes back to my earlier point which is: why should we get too hot under the collar about it?
Q381 Chairman: Why bother having classifications at all?
Mr Hayman: Because then you will not be able to direct effort either in the health service or in policing or any other discipline to a given priority. They will all get given the same kind of even handed response. For me, as long as we all know that the determination is pretty crude, the way they go into these different categories, let us all go into it with our eyes open knowing it is crude. On the other hand, if you want it more precise then we will have to do some more thinking on it. I think, as ever, it is the middle ground. I think there is some decision there because it is directed by health and scientific experts; it is not as rough as some are making out but it is certainly not as precise as perhaps some of the other commentators would want.
Q382 Chairman: Would you be happy for it just to be left to the police to use their discretion?
Mr Hayman: We do anyway.
Q383 Chairman: So the classification is irrelevant to you.
Mr Hayman: No, it is not irrelevant. The discretion will be around the priorities that we give policing-wise to the different categories. Clearly a Class A drug is determined by the experts as being the most harmful and the criteria which is directed into that conclusion and therefore I think it would be illogical from the police perspective if we were putting a lot of effort into a Class C drug when actually Class A presents more harm. It is helpful in that regard.
Q384 Chairman: Alcohol, which is not in a classification at all, is a lot more harmful than most of the drugs that are in Class C.
Mr Hayman: I am not in a position to comment on that.
Q385 Chairman: Professor Blakemore, what do you feel should be the primary purpose of the classification?
Professor Blakemore: I would agree with Andy that the classification is intended as a useful guide to the direction of priorities for medical care, to policing operations and to the work of the judiciary in trying to deal with the problem of drug abuse. The question would be that if the system is acknowledged to be rough - I think Andy used that term, that it is only a rough guide - then where is the nuancing of the interpretation coming from and on the basis of what expertise is that nuancing occurring? Is it on the basis of some additional assessment of risk in the mind of a doctor treating someone with drug problems? Or a police officer considering whether to caution them or arrest them? Or the courts in dealing with the case? Is it an opportunity for the exercise of personal views and prejudices?
Q386 Chairman: Is the primary purpose then really, as Andy said, about helping in terms of policing and the judicial system? I am surprised, in your particular position, that you would not see it in terms of sort of degrees of harm and how we actually deal with it; a classification system which would actually support the work of the MRC and the health service.
Professor Blakemore: I am no expert on the law but I think primarily the classification is used to guide policing efforts. However, it also influences public and political reaction. The fact that a drug is classed in a category which is perceived as being especially risky influences the attitude of people, the media and politicians to that drug. If the placement of the drug in that category is only rough and if it not particularly rationally assessed then the attitudes to society and the media and politicians are misplaced.
Q387 Dr Iddon: I want to try to direct my questions to Mr Hayman, please. Do you think placing a drug in a higher category has any deterrent effect on the user at all?
Mr Hayman: You would have to ask a user that to get the best reply, but if you want my professional judgment based on my interaction with users I cannot envisage a user - a dependent user, that is - having any kind of thought as to whether it was a Class A, B or C drug they were consuming. They may know that but they may not; all they are worried about is the dependency that they suffer from. That is my professional take on it, but I think you would have to ask the users to get the most accurate reply.
Q388 Dr Iddon: Do you think there is any relationship between the classification of a drug and the amount of criminal activity? I put it to you that by placing a drug in a higher category with the higher risks involved of sentencing and the whole judiciary process, that puts a higher price on the drug so the criminals are more attracted to trading in those higher classification drugs.
Mr Hayman: It depends on what you are defining as the link with crime. We have to go back to first base. What is directing what classification of drug goes into is the scientific and medical harm. It has no relationship with the crime that might be associated with it. It would be a very interesting research project I am sure (which Colin would jump at) to try to determine whether there is a relationship as you have tried to suggest. For me there is well recorded academic research which shows that certain drugs have certain linkages with certain crimes. Some are violent; some are acquisitive, but to start making those links in with the classification I think we are going to mix up loads of different methodologies. For me it is very clear; there is a clear thought process as to why a drug goes into a different classification. Certain drugs have certain relationships with certain crimes.
Q389 Dr Iddon: Has ACPO ever discussed the classification of drugs, even before the home secretary decided to look at the system?
Mr Hayman: Yes.
Q390 Dr Iddon: What conclusions did you come to?
Mr Hayman: I think it was in 2001/02 when we wrote the ACPO policy statement right across the whole agenda of drugs which included classification. In fact at the moment we are just reviewing that for an update. You may see our position as a bit of a cop-out but I think it is a professionally reliable position. We do not have a view on what classification is; that is not our job. It is for experts to determine what classification drugs go into and once that is then linked to legislation and police powers and priorities we would then implement that. Our position on the re-classification on cannabis was that we all stand ready for the experts to express their opinion and then we will operate guidelines to implement that on the street.
Q391 Dr Iddon: We will be coming to cannabis shortly so I will not pursue that now. To any member of the panel, do we have the best practice operating in Britain regarding our classification system or is there a better one somewhere else in another country?
Mr Hayman: I have probably already shown my hand in the earlier questions, I really do not think we should get too hot under the collar around this classification. It is there to guide and it is as simple as that. If we get too sophisticated around that process we will be strangled by the sophistication of classifying a drug rather than getting on and doing the job both from a medical perspective and from a law enforcement perspective and for the greater good of the community. It might be very interesting to travel to other countries but actually we are in this country now and we have a job to do and I think we should just roll our sleeves up and get on with it.
Q392 Dr Iddon: In this early part of this evidence session I am getting the feeling that perhaps the home secretary is misguided by reviewing the system because everybody here seems quite happy about it. Why is the home secretary calling for a review of the system? Does anybody know?
Mr Hayman: He is the person to ask.
Dr Iddon: We will, of course.
Q393 Chairman: Can you hazard a guess, Colin?
Professor Blakemore: I think that the driver for the review was quite clearly the time, effort, deliberation and conflicting advice that impinged on the decision not to re-classify cannabis, and the realisation that the arbitrary (and I would defend that word) boundary between B and C was not easily defensible. If it took so much effort to consider one particular drug and whether it should be placed on one side or other of a boundary, does it not imply that the entire mechanism for classifying requires a new look? There are other issues too and I suspect that the Advisory Council pointed these out - that some drugs might simply have become lodged in categories on the basis of historical allocation, which might have seemed very reasonable at the time but the present position cannot easily be defended on the basis of present evidence. I point particularly to the hallucinogens in category A and also perhaps to ecstasy.
Mr Hayman: I think another interesting question to pose here is that, let us say this is such a grim situation that we are facing here and we have it all badly wrong. I do not mean this in a flippant way but, so what? What is the consequence of getting it so badly wrong and how much effect does that really have on the medical and law enforcement functions? I actually cannot see that there are major consequences.
Q394 Mr Devine: Surely if I had that Class A drug I would go to jail but if I had a Class C drug you would let me go.
Mr Hayman: Not necessarily, no.
Q395 Chairman: If you were caught selling magic mushrooms which are in Class A you would go to prison.
Mr Hayman: On the current classification and the current penalty.
Q396 Chairman: You have been arguing that one of the major reasons for the ABC classification is its links in terms with crime and punishment.
Mr Hayman: Having been classified the punishment is then linked to that.
Q397 Chairman: You are splitting hairs.
Mr Hayman: That is what I am saying. Exactly. I think the whole debate is very interesting but it does not take us anywhere at all. If we got members of the public in here now, even with the layman's understanding of it, and if we put all the different types of drugs on the table I bet they would be able to determine which were more serious than the others.
Q398 Mr Newmark: I am interesting in what you are saying here, Andy. On the one hand you are saying that you play a very passive role in this whole process of classification and that at the end of the day it does not matter because frankly if you see kids dealing in something in a playground in a village in Essex - where I am from - you will deal with it anyway, whether it is magic mushrooms or acid or heroin or whatever. You are just going to go there and do it. That is what you are saying. You say it helps guide your priorities, but you have not talked at all about what input you have in this process. You must have, as the police, some input because it is your resources that you are allocating at the end of the day. You are at the sharp end in seeing what is going on on the ground. I am really curious; you must have some input as a police force in determining what this classification is.
Mr Hayman: We do; we have two seats on the ACMD and we will make a contribution to it. When we had the re-classification of cannabis debate I was part of that discussion. It has to be said that the input from the police is going to be very narrow compared with other colleagues on ACMD because the main rationale as to why something goes into a different classification is based on medical and scientific evidence, not necessarily on what the police would bring to the party. I am not saying it is ignored because it is not and the chair of the ACMD is very inclusive, but I am not in a position to be able to offer that kind of technical advice. What I can offer are some of the points that I was asked before about the impact that certain drugs have on crime on the street and on the fabric of the community, and the consequence of drug misuse or dependency in the community under controlled circumstances.
Q399 Mr Newmark: Also the proliferation of drugs and therefore if you are seeing far more on the ground, ie people are using a particular drug far more, I have to believe that as a police force you then have input on determining what the classification or the re-classification of that drug should be. If something is something is suddenly Class C - hypothetically - and you are spending ten times your resources now dealing with that Class C drug, surely you are going to go back and say that this needs to be re-classified.
Mr Hayman: My understanding - and I might be wrong on it - is that that would not be a strong weighting or indeed a current criteria as to why something goes into A, B or C. It is very relevant material but it is not a show stopper for it.
Professor Strang: You asked a little while ago about what functions the classification system served. The other one that I hope you would consider is the way in which it shapes the general public's views on drugs. There is something about the way in which government and the public perception of drugs are portrayed which influences those early stages of drug use that I do not see any involvement in in my clinical work. In that regard it is strange that we do not peep over the garden fence at the alcohol and tobacco fields to try to learn lessons where you would presume there were generaliseable findings. The presumption would be that those observations would be generalised.
Q400 Chairman: When Brian Iddon raised this issue of the connect between a particular drug and crime the answer was that there is not a research base on which we can deliver the evidence in order to reform policy, and yet you have responsibility in many ways of delivering that research.
Professor Blakemore: I think there are some correlations between drug use and behaviours and their social impact which are very well documented. I think the police are in the best possible position to provide evidence about those relationships. For instance, the effect of alcohol and its impact on families, the tendency to produce aggression and violence; the same with crack cocaine - the link between violent behaviour and crack cocaine is very well established. I think when we talk about assessing drugs according to their harm it is very important to emphasise that we should not just be talking about medical harm - toxicity, damage to the body and the user - but the general impact on society. I think if we look at the impact of drugs in the last forty or fifty years the biggest effect has been on society rather than users. We know that ninety per cent of drug related deaths are attributable to alcohol and tobacco, and much of the remainder to methadone (prescribed methadone, at least initially prescribed and then illegally available methadone). We have to take into account the social impact of drugs when considering their harms.
Professor Strang: One of the reasons you do not have answers to your questions is that the UK does not invest in getting the answers. We are junior players when it comes to funding research that studies impact. If you look at the US and Australia they are orders of magnitude greater in investment. Our investment of our expenditure is about 0.1 per cent; they operate at between one to four per cent. I am not just saying there should be a little bit more. It is an embarrassment and it means that people like myself and my colleagues get lured away. Australia is populated by ex-pat addictions researchers who created a critical mass because of a better research funding environment. Supporting Andy Hayman's point, it may seem strange that people this side of the table are saying that it has less significance than perhaps your attention to it, but our interest is in the law as it is applied; it is not the same as what the paperwork says. Let is look at the cannabis example, if I remember the figures correctly between the mid-80s and mid-90s cautioning became what happened with more than fifty per cent of all cases. No change in the law occurred; it was how at a local level a change occurred. You ought to want to know and I ought to want to know whether that led to increased use? What did it lead to? There is not really any answer to that. Our interest needs to be in the law as it is applied, not some letter that is attached to it.
Q401 Mr Newmark: To what degree is the lack of both medical and social evidence in this area a limitation in determining the appropriate classification of drugs? In your experience how well does the Advisory Council cope with the challenge of making decisions on the basis of inconclusive evidence?
Professor Blakemore: I think I would challenge what you say about the availability of evidence on the medical effects of drugs. This is a rapidly moving, expanding field of knowledge. I am sure that John would say that because of funding this country is not in a position to make as big a contribution to that knowledge as we should. We know a great deal about how drugs act on the brain and how, in some cases they produce dependency or addiction, what their toxic impacts are and therefore what the medical implications are. There has, of course, also been a great deal of research on the social impact of drugs. I am no expert and I am not in a position to say whether that evidence is as full as the scientific and medical evidence. The problem is - and perhaps this is at the heart of your question - that evidence is never perfect; it is changing. That is the basis of science and the collection of data. For instance, five years ago I would have said that the evidence for a causative link between cannabis use and the precipitation of psychotic episodes was extremely low. I have changed my view; I think the evidence is overwhelmingly clear. The effects are small but definite.
Q402 Mr Newmark: That is because cannabis itself has changed and people are making it stronger.
Professor Blakemore: No, I do not think it is. We know the genetic basis of those effects now through work funded, I am glad to say, by the Medical Research Council at the Institute of Psychiatry, and we have a very good rational explanation for those effects. It is a very small effect but it exists. That, of course, gets to the heart of one of my concerns about the ABC system. Because it has these sharp boundaries between As and Bs and Cs it is quite difficult to move drugs around in the classification on the basis of new evidence; but science is constantly throwing up new evidence.
Professor Strang: I would agree with much of what Colin Blakemore is saying. We do have an increasingly good picture for understanding drug effects and drug problems in the sort of classic high tech science way. However I would actually like to draw your attention to the potential danger of that. As we have increasingly impressive scientific techniques, what we are likely to lose out on is low technology science that looks at things like the impact of whether at a low level of policing, a change to cautioning, leads to an increase or decrease. I think we crucially need to know that. But that type of proposed research would not have a snowball's chance in hell of getting funded as a project compared with someone imaging some particular bit of the brain that helps you understand how it works. Even though, in terms of answering the question that alters how you apply the law and how you run society, in my view it is much more valuable. Some mechanism for protecting lower technology policy type scientific studies is urgently required and the funding pressures on science means that there is likely to be even more of a contrast between the things that do get funded at the high technology end.
Q403 Mr Newmark: In order to improve the way we go about classifying we need more evidence; in order to get more evidence we need more money into doing the research. Is that what you are saying?
Professor Strang: I think so, but in terms of gathering more evidence you could go on in this field forever about getting a portfolio of information. But the special missing element in the existing research is an exquisite series of experiments of opportunity. You can easily list a dozen things where, if you knew that the changes you had made with temazepam capsules in the late 90s had led to less use and less harm because rescheduling or reformulation took place then you would be more confident about making a similar change with another drug. If you knew it had backfired on you and had gone the opposite direction, you would be pretty hesitant about going the same way again. You do not have that partly because a lot of your research machines are in-house government department research where the vested interest is in making sure that the departmental decision or ministerial decision is propped up against criticism.
Q404 Chairman: Do you think, yes or no, that ACMD is in fact coping with this agenda? Is it the right organisation, the right body, the right set up to actually deliver what is being asked of it?
Professor Blakemore: In a single word, yes. It has the right range of expertise. It takes a lot of time and trouble in considering the evidence. If there is a deficiency in the system I would say it is in the mechanism for communicating.
Q405 Chairman: It does not commission any evidence. It does not do any research.
Professor Blakemore: It does not need to do research; research is available, published. It looks at the available literature. Perhaps it would be useful if it could feed better into policies and the setting of policy priorities and strategies. That might be a valuable role, but I think the principal deficiency is how that huge mass of knowledge in the Advisory Council is able to feed into policy. And that is a reflection I think on the Misuse of Drugs Act classification.
Mr Hayman: My answer is yes. I do not know whether members have had the opportunity to go along and sit in and witness what goes on in the ACMD. I have been participating in workshops, weekends away and also the full meetings. I challenge the notion that you have to have them commissioning any research because actually they are blessed with the experts in the room.
Chairman: I will leave it at that because we will be coming back to it.
Q406 Mr Newmark: Professor Blakemore, you have been making presentations on the concept of a scientifically based scale of harm for some years. When did you first draft the paper with David Nutt and others proposing this scale? My next question is, why has there been a delay in submitting it for publication?
Professor Blakemore: I did not draft the paper; David did; he is the first author and I think it must have been about 18 months ago.
Q407 Mr Newmark: I am curious as to why it has not been done. There are these scales that are out there to do with physical harm, dependence and social harms and in some ways it struck me that you are trying to make a science out of an art, particularly when it comes to social harms. I am curious as to why this analysis has not been published yet.
Professor Blakemore: It sometimes takes quite a time to get a scientific paper, particularly with four authors, into a form that everybody accepts is ready for publication. If I could explain the basis of the study, it did grow out of talks that I gave on the possibility of creating a sort of matrix in which numerical values could be given to assessments of harm in order to rank drugs, not just illegal drugs but also including the familiar, acceptable, legal drugs as a kind of calibrator for the scale as a whole. An 18 month delay in getting a paper ready finally ready for publication is not unusual, I am afraid, in science.
Q408 Mr Newmark: Are you in favour of using a scientifically based scale of harm to determine the legal status of drugs?
Mr Hayman: If I could see the detail of what that looked like I could give an opinion on it but I would be worried that we are just shifting from a classification process at the moment to a different style one which would still have the frailties that are currently in the present system.
Q409 Chairman: The concern is that on that scale of harm alcohol, ketamine, tobacco and solvents are all incredibly high up on the categories and yet none of them appear in any of the classifications at all. That is a concern we would have.
Professor Blakemore: I think the most striking conclusion from the study is that although it purports to do what the Misuse of Drugs Act says is the basis of its classification the result is not statistically correlated with the ABC classification at all. In the ranking of drugs according to nine categories of harm of the top eight most highly ranked drugs in terms of harm three were Class A drugs and two were legal (at the time legal - ketamine has just been classified as C). Of the bottom eight, in terms of harm, two were legal (khat and alkyl nitrites) and three were Class A drugs (LSD, ecstasy and 4-methylthioamphetamine).
Q410 Mr Newmark: I have to come to the conclusion then that part of the delay in coming out with this publication is that having come up with these parameters they are not quite fitting with your argument because of these other drugs that have been mis-categorised based on historical evidence of the way they have been categorised.
Professor Blakemore: I do not think that it is our argument. What it implies is that one of the ways of classifying drugs according to harm - the ABC system or ours - is wrong, or they are both wrong. They certainly do not agree with each other.
Q411 Margaret Moran: Professor Strang, I think the point you are making about the lower level research is very important. The fact that that research has not been done, is that a reflection on the effectiveness - or lack of effectiveness - of ACMD? Who should be commissioning that research?
Professor Strang: I think the lack of this type of research severely handicaps the ACMD and it severely handicaps government's process of making decisions. Personally I think it would be ill-conceived to expect ACMD to be the body that commissioned work of this sort ACMD needs that work to be done, but its membership is not the right kind of membership for trying to get good quality work done that feeds into it. I have had either the privilege or the curse in previous times of being on ACMD, and that type of research needs to be done - but ACMD is the wrong type of body to conceive, consider or commission the specific research.
Q412 Margaret Moran: Who should be commissioning it if not ACMD? They are supposed to be the body who advises on it; surely they should be making the very point that you have been making.
Professor Strang: I think if you looked around the room at ACMD you would see very few people with a research pedigree. It would be an unfair request to ask ACMD members to adjudicate between a good proposal versus a poor proposal. I think they need that to be done just like Parliament needs it to be done, but then that is different from it being the commissioner of it. You would like to say that government departments with interest and responsibility in the area were the obvious people. However we must have serious doubts about that because I think they become pre-occupied with just blindly defending the decision that was made yesterday. What you want, what we need, is an investigation that has enough integrity and independence to be able to say that it was a well-intentioned decision but actually it has backfired and that is completely missing. I do not think the ACMD would achieve that; it would still have that heavy hand of the civil service on it.
Q413 Margaret Moran: What you are suggesting then is that ACMD is not sufficiently independent of the Home Office secretariat. Is that what you are telling us?
Professor Strang: I do not think that was what I was saying but I would have thought that probably is a correct observation.
Q414 Margaret Moran: What about the other members of the panel? Would you say that ACMD is not sufficiently independent of the Home Office?
Mr Hayman: I am not in a position to be able to comment on that; I just do not know.
Q415 Chairman: You are on it.
Mr Hayman: I might be on the ACMD but I do not have a clue what the secretariat of the Home Office does so therefore I am not in a position to be able to comment.
Q416 Margaret Moran: I am talking specifically about membership of the ACMD.
Mr Hayman: I am independent of the Home Office and I am on it.
Professor Strang: I was not referring to the members as individuals; I was referring to the body of this operation. I am sure the individuals have independence and integrity outside the process.
Q417 Margaret Moran: There is a suggestion that as currently constituted there is insufficient breadth of experience on ACMD. There is a suggestion that the breadth of expertise on ACMD is not sufficient to address the questions that it is being asked to deal with. Is that your view?
Professor Blakemore: It is a very big committee with a wide range of expertise. You are raising a very important issue about whether ACMD should be in a position to commission research. It is music to my ears that John would say that history shows that the best way of getting good research done is to do it independent of ministerial control. We know of examples in which research commissioned by a government department has produced the results that the department has wanted - there is an understandable tension. On the other hand if, in the research councils - which is where the independent research is done - there is no response to policy needs then there is a kind of disconnect between where the high-quality work is done and what government needs to know. It is joining up those two things which I think we need to think about carefully. We have a very good opportunity to do so in the medical field with the proposal that the funding of the Department of Health R&D and the Research Council funding of medical research might be conflated in some new way. This not only would increase the money for addiction research and other areas of research, but also perhaps give us a way to re-think the input of policy questions into independent research.
Professor Strang: It seems to me that you need to recognise the vulnerability of the field and where you look at countries that have deliberately pump primed the process (the US went from zero in the 1960s through to producing an amazing addictions research machine, so did Australia in the 1980s) you would have to protect the operation of that otherwise it just gets trampled underfoot with the bigger research players. That would be resisted because you would normally say: Throw it in the market place and the best researchers and topics will win. But with this one you would have to say: We have a special need to make sure that we support this. With the drug addiction research machine in the US we are talking of just over $1 billion per annum for NIDA (the National Institute on Drug Abuse), so where I say we are of a different order of magnitude, we are several orders of magnitude out and what we end up with in the UK is a Mickey Mouse operation compared with others.
Professor Blakemore: Could I say that I was glad you introduced me as being both from Oxford and being from the MRC. What I have said so far has been, as it were, as an independent academic but what I can talk about on behalf of the MRC are the figures for spend. In 2003 to 2004 we spent £2 million in total out of a £450 million budget on addiction research. The total budget of the three NIH institutes that work in this area is $2.9 billion so even if one takes a conservative estimate of how much of that is actually devoted to addiction research it comes out to about five hundred times higher than in the UK - in other words about a hundred times more per head of the population.
Q418 Chairman: If you take an issue like young people and drugs and the effect, for instance, that it has on young people's learning, I would have thought that the MRC or indeed something which would be commissioned through the ACMD ought to be looking at that specific area rather than just saying "we think" and yet we do not. I am sure you would agree with that.
Professor Strang: The current position in which the MRC and any funding body operates is: Does that compete with some other high technology bid? It will not, and your choice is then to leave it in the market place and say that if it sinks we will have to do without it or to say that it has such importance to our societal process that we must protect it. There are special themes in all sorts of research initiatives and that would be a proper way of addressing it and that is currently absent.
Q419 Chairman: I just think perhaps that ACMD ought to have a budget or at least the power to be able to commission some of that research.
Professor Strang: They should certainly be able to identify areas where they felt handicapped by not having answers.
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 eight per cent 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 fifty per cent 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.
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 one per cent up you get half a per cent 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 sixty per cent 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.
Witnesses: Mr Steve Rolles, Information Officer, Transform Drug Policy Foundation, Mr Martin Barnes, Chief Executive, DrugScope and Mrs Lesley King-Lewis, Chief Executive, Action on Addiction gave evidence.
Q438 Chairman: My apologies for starting this session a little late, but I am sure you were fascinated by the comments of Panel One. Could I introduce Mr Steve Rolles, the Information Officer for Transform Drug Policy Foundation, Mr Martin Barnes, the Chief Executive of DrugScope and Mrs Lesley King-Lewis, the Chief Executive of Action on Addiction. You are all very, very welcome. Mr Rolles, because you are in the middle could we ask you to field questions wherever necessary. You have been chosen as the chairman of your panel by a unanimous decision of our Committee. The ACMD told us that the purpose of the ABC drug classification system was to "classify the harmfulness of drugs so that the penalties for possession and trafficking should be proportionate to the harmfulness of the particular substance". Do you think the classification is effective in achieving that objective?
Mr Rolles: I suppose that in the context of an ABC system up to a point. There has obviously been some discussion about anomalies of certain drugs and certain classifications and there will no doubt be more discussions on that. I do not think that anyone is disagreeing that there are anomalies within that system. I would say that the objections of the classification system are actually more than that in that it is at the very heart of the Misuse of Drugs Act and broader prohibition is paradigm, the aim of which is to reduce drug use and misuse, to reduce drug availability as a way of reducing drug use and misuse and more broadly to reduce harm related to drugs in society. I think if you look at the evidence of the last 45 years it has transparently not done any of those things. Drug use has gone up exponentially; drugs are more available than they have ever been and drug harms have increased correspondingly to an astonishing degree. On any criteria you choose with regards to misuse, availability and overall harm the classification system and the policy that it sits within have failed in quite spectacular fashion.
Mrs King-Lewis: I very much agree with Steve and I think we have missed that opportunity, in that we failed to measure any of the impacts which John Strang mentioned earlier. We have had so much opportunity to actually look at what is the impact that classification has had on society at large. Have we seen an increase in cannabis use? Have we seen a decrease? Have we seen more users within young people? What has been the actual effect and the impact? We have failed to measure all that so what we would really welcome is automatic review of outcome measures whenever there is a change of the classification or a change that has implemented policy. We have missed so much opportunity to gather that vital evidence.
Q439 Chairman: When you say "we" who do you mean?
Mrs King-Lewis: That is a very good question. We, as a research charity, are calling for government and ACMD and in respect of the previous argument I think a weakness there is that there is no-one who is proactively determining a research strategy for this country. There is no-one who is commissioning research and there is no money available. We really need an independent body to actually implement the research. I think there is a very good role for the ACMD to be more proactive identifying what the gaps are and then having the budget attached to it but getting it commissioned by an independent body. That is very important; it has to be independent.
Mr Barnes: I agree with Steve to some extent that if the goal is to reduce drug use or prevent drug use then clearly the lessons of the last thirty years show that we have not succeeded but I do not think you can put the blame just on the system of drug classification per se. We have the wider debate about the divide between legal and illegal drugs. You have covered alcohol and tobacco this morning in terms of the comparisons of harm, but within the context of setting a legal framework for illegal substances the drug classification system as it operates is far from perfect. However I think there is actually flexibility built into the system. The issue is perhaps why have we not seen since the Act was introduced sufficient change in the way certain drugs have been categorised. What are the triggers that should lead to those reviews and those changes? I think more importantly what are actually the barriers? We have covered a lot in previous inquiries in terms of anomalies where current drugs sit, the role of the ACMD but all of that operates within the political context, the way the media covers these issues and the fact that when we deal with the issue of drugs and drugs policy it is very difficult on almost any level to have an informed, objective, evidence based discussion. More often it is heat rather than light that it is generated and politicians are nervous about drugs policy; they are nervous about being seen to make changes and if we needed any evidence to confirm that just look at what happened with the cannabis re-classification. Historically it is a significant change but in terms of the system overall it is not that big, but that was not the way it was reacted to politically or in the media.
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 simple answer.
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 drugs - by no means all - takes 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 naïve 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 really.
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 company.
Q447 Mr Newmark: Which is Professor Strang's point.
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 all - not a single piece of research ever done by the Home Office that I am aware of - into the effectiveness of the classification system as a deterrent and the independent research that we do have - what little there is - suggests 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 councils?
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 up thinking.
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 a member.
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 answers - certainly not the easy answers - as 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 usage - especially amongst young people - to 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 trend - and the trend has been dropping for the last few years - continued 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 therefore - going back to what Andy was talking about - you 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 patently nonsense.
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.
Q460 Dr Iddon: The previous panel gave us the impression this morning that the ACMD were rushed into making a decision. You have just implied that more research is needed on cannabis so why did the ACMD make a recommendation to change the classification from B to C in view of what the previous panel and in view of what you have told us just now?
Mr Barnes: Firstly I was not on the ACMD, which recommended a change, the original recommendation was made and, as you know, it was not just the ACMD but in its recent report it did say, if I remember correctly, that there was a need for on-going and more research into the issue. It was asked by the home secretary to look again at cannabis re-classification and under the Act it had to do so. It spent two days considering the evidence. It was not rushed into a decision, it was at least a nine month process in terms of capturing the data, witnesses were called to give evidence on the first day of the inquiry as well. The report itself went through various stages. It went to the technical committee, it went back to the full ACMD. It was not a rushed process but in terms of reaching its conclusion to keep the classification at C but with a list of other recommendations as well, not least the need for a robust and comprehensive public education campaign, it could only base its decision on the evidence that we currently have.
Q461 Dr Iddon: Do we have it right now? Is cannabis in the right classification system?
Mr Rolles: The problems with the ACMD's deliberations were not that they did not look at all the evidence of the impact of cannabis on mental health and so on, but their decision in terms of recommendation for re-classification or not was based on an assumption that re-classification has some impact on levels of use and therefore mental health of cannabis users and there is absolutely no evidence at all to suggest it does so the whole exercise is just a big distraction. The whole thing is about the classification system and what impact that has on harms and because we do not measure it we have no idea so you can argue until you are blue in the face about which category it should be in. I have been trying to think of a metaphor for this and the best one I can come up with is that it is like arguing over what colour to paint a square wheel. Even if all the experts agree it should be blue it does not matter because that wheel does not turn. The classification system does not do what it is supposed to do, it does not reduce harm, it does not reduce misuse, it does not reduce mental health problems. In fact it seems to do the exact opposite so the whole thing is an exercise in distraction as we are concerned.
Q462 Dr Iddon: Have we not got it right based on the evidence available?
Mr Barnes: Yes, but let us keep it under review. I think coming back to the issue of research - and I was interested in Michael Rawlins' comments about ecstasy - firstly our knowledge base changes over time in terms of the harms or otherwise that the drugs themselves can do. Also the way that those harms interact with individuals and why society changes over time. Drugs do change in fashion and in use so research itself has to be an evolving on-going process. A word of caution is that we have to be careful that the research itself does not overly drive the public policy responses because a piece of research could reach what appears to be quite a firm, definite conclusion. If you respond too quickly to that and then find that a later piece of research contradicts or challenges - as so often happens, not just in the drugs field - that previous research, you are going to have a system of drugs bobbing in and out of classification. That would not be a better response I do not think.
Q463 Dr Iddon: I hope we are talking about peer review as well.
Mr Barnes: Yes.
Q464 Chairman: Lesley, yes or no?
Mrs King-Lewis: Only no in a few years time once we have evaluated the decision.
Q465 Mr Devine: Today the Scottish Police Federation are debating the legalisation of drugs and as politicians you can imagine our primary role is to be re-elected. If we came out and said, "Legalise all drugs" we would be crucified by the media. I just wonder about media attention and how you think that that influences government decision making and how do we get what you want, a reasonable debate in the media and a discussion with young people about the real impact of drugs.
Mr Rolles: I think the problem really is that we have two generations of demonising drugs and demonising drug users and it is a highly politicised area. It is a very emotive issue and it is very difficult to step back from all that and just look at the evidence and rationally discuss the alternatives. I think as politicians it is behoven upon you to say, "Okay, this policy we have at the moment, all the outcomes are not what we would expect, they seem to be going the wrong way, are there other alternatives we can look at and consider in a rational and scientific way?" I think the key to that is to move away from its emotive war on drugs rhetoric or some of the polarised debate where you have the drug warriors on the one hand and the evangelical drug legalisers on the other hand and consider that actually there is a lot of common ground. We all want to reduce the harm drugs cause, let us look at the policy alternatives and see from the evidence which one is most likely to achieve the best outcomes. I think that by approaching it in a rational, non-confrontational way we can have a sensible debate and it does not necessarily mean that your election chances are going to be jeopardised.
Mr Barnes: My concern when we debate legislation is that there is a danger of focussing on that as the issue when actually there is a long way to go in the meantime in terms of incremental, radical and potentially controversial reform. It is at that stage itself that it is quite difficult to have an objective, informed debate. The recent front page article in The Times claimed "cocaine floods playgrounds" on the basis of an apparent report that showed an increase in cocaine use amongst seven to 15 year olds from one to two per cent. That was the headline that parents on a Saturday morning would have seen when they opened their papers. The issue of crystal meth, some of the ways that that has been reported - I know it is easy to criticise the media, we all so it - quite frankly has been irresponsible. I see in the ITV news van as the lead a story about Britain on the verge of a crystal meth explosion. The tea-time news explained that details about how to manufacture it are on the website and can be made with home made ingredients. Just coming back to the issue of the ACMD, when the recommendation was published by the home secretary, members of the ACMD were contacted by The Daily Mail to be asked, "Have you ever used drugs?" When we look at the issue of the transparency of the ACMD bear in mind that the people who sit on that committee have a very difficult role, have to tackle and make judgments on very difficult and potentially controversial decisions and I think to inform that role and to do it robustly there has to be some degree of protection in terms of those individuals fearing that they have the confidence to expose themselves in that way and take part in that process.
Mrs King-Lewis: We are keen to move the debate from a criminal justice angle to a public health, really informing the public, the young people in particular, of the different levels of drugs and the different and varying harms that they can do to themselves. We need a much more rational debate.
Q466 Dr Iddon: Bearing in mind that it appears that fresh magic mushrooms were put in Class A because psilocin and psilocybin were already there (which, of course, they contain) do you think we got it right in classifying fresh magic mushrooms as Class A drugs?
Mrs King-Lewis: No.
Mr Rolles: Absolutely not. There was a legal market there; that legal market did not seem to be causing a huge amount of problems before the 2005 Drugs Act but there were clearly issues in that the sale of these magic mushrooms was completely unregulated and unlicensed. What Transform was suggesting was that vendors were licensed and appropriate controls were put in in terms of age and information available at point of sale and various other appropriate restrictions. What did not happen in the Misuse of Drugs Act is that the regulatory impact assessment that was done on that particular clause within that particular Act should have, under regulatory impact assessment guidelines, considered in detail what the different options were and they did not consider in any detail the regulatory option, it was a throw away line in that regulatory impact assessment.
Q467 Chairman: Martin, yes or no?
Mr Barnes: I would say no.
Q468 Dr Iddon: Were the ACMD consulted about this?
Mr Barnes: I am not aware that the full council were asked to deliberate on this. I think because it was going through primary legislation and I think it was wrong for the home secretary to seek to enact it in primary legislation without properly consulting the ACMD and giving it time to deliberate on it. In terms of the classification the evidence has indicated that it is in the wrong classification, but I suspect that if the home secretary is presented with a fully considered report from the ACMD recommending change I think the answer would be no.
Q469 Dr Iddon: Is that going to happen?
Mr Barnes: I am not aware that the ACMD is planning to look at it; it certainly has not been asked by the home secretary to look at the classification of magic mushrooms.
Chairman: On that note could I thank you. I am sorry it has been a helter-skelter run through, but the bell is just about to go for the announcement of the session. Steve Rolles, Martin Barnes and Lesley King-Lewis thank you very, very much indeed for helping us today.
 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.
 Note by the witness: Although any increase is a concern, the actual increase was from 1.4 or 1.5 per cent to 1.9 per cent.