House of COMMONS
MINUTES OF EVIDENCE
SCIENCE AND TECHNOLOGY COMMITTEE
HOW GOVERNMENT HANDLES THEM
Wednesday 1 March 2006
PROFESSOR SIR MICHAEL RAWLINS and PROFESSOR DAVID NUTT
USE OF THE TRANSCRIPT
Taken before the Science and Technology Committee
on Wednesday 1 March 2006
Mr Phil Willis, in the Chair
Mr Jim Devine
Dr Evan Harris
Mr Robert Flello
Dr Brian Iddon
Mr Brooks Newmark
Dr Desmond Turner
Examination of Witnesses
Witnesses: Professor Sir Michael Rawlins, Chairman of the Advisory Council, and Professor David Nutt, Member of the Advisory Council and Chairman of the Technical Committee, Advisory Council on the Misuse of Drugs, gave evidence.
Q107 Chairman: Good morning everybody, and could I make an especial welcome to Professor Sir Michael Rawlins and Professor David Nutt. You are very, very welcome this morning. Could I remind everyone that this session is being televised and, as with the Big Brother house, we want to make sure that all actions and words are commensurate with broadcasting licence agreements. This is the first case study in an over-arching inquiry into scientific evidence which the Government uses to inform policy. It is a particularly important area in terms of drug classification. I have to say that we are focusing specifically on the process and we are not making any judgments about drugs policy. We are very interested to make sure that the classification process is something that stands up to scrutiny. I shall start by asking our two eminent witnesses, beginning with you Sir Michael, to spend no more than one minute introducing themselves and say what their role is within their organisation.
Professor Sir Michael Rawlins: Thank you very much. I am Chairman of the Advisory Council on the Misuse of Drugs (the ACMD) and I am Professor of Clinical Pharmacology at the University of Newcastle. I have been Chairman of the ACMD since 1998 and I have been in Newcastle since 1973.
Q108 Chairman: Thank you very much indeed.
Professor Nutt: I am David Nutt. I am a psycho-pharmacologist at the University of Bristol. That means I am a medical doctor, a psychiatrist, who is interested in drugs and the brain. I have been Chair of the Technical Committee of the ACMD for the last five years and have a research track record in the field of drugs of addiction and mental processes. I spent two years working in the National Institute of Health in the States in the 1980s so I have some experience of the US system as well.
Q109 Chairman: Thank you very much indeed. I wonder if I could start by asking you, Professor Rawlins, what is the purpose of the ABC drug classification system that we have got at the moment?
Professor Sir Michael Rawlins: The purpose is to classify the harmfulness of drugs so that the penalties for possession and trafficking should be proportionate to the harmfulness of the particular substance.
Q110 Chairman: Harmfulness to whom?
Professor Sir Michael Rawlins: Harmfulness to the individual and harmfulness to society.
Q111 Chairman: Which is the balance between the two?
Professor Sir Michael Rawlins: We take both of them into account, both the individual and the individual's family and society, and one does not overrule the other.
Q112 Chairman: Do you feel you have been proactive in achieving that objective and that the ABC classification has done what it has set out to do?
Professor Sir Michael Rawlins: I think in terms of what it was intended to do, that is to say to try and make the penalties proportionate to the harmfulness of the substances that were being used or traded, yes. Of course, in the United Kingdom over the last 30 years the use of these substances has increased dramatically, not just in Britain but in most other countries as well, so in another sense one can say that we need more than that. I think one of the important things about drugs misuse is that it is not just a criminal justice problem, it is also a public health problem and one has to be certain that one is looking at it from both angles.
Q113 Chairman: We did not know when we started this inquiry what the priority of the Government is in terms of those two angles; public health and law enforcement.
Professor Sir Michael Rawlins: My view is that it is both a criminal justice problem and a public health problem, and a social problem as well.
Q114 Chairman: Yes, but when somebody like Professor Colin Blakemore, Chief Executive of the Medical Research Council, says this about the ABC classification system: "It is antiquated and reflects the prejudice and misconceptions of an era in which drugs were placed in arbitrary categories with notable, often illogical, consequences", this is a man who has got a certain reputation to uphold and he is saying really it is a bit of a waste of time.
Professor Sir Michael Rawlins: And he is a good friend of mine and a good friend of David's as well.
Q115 Chairman: So do you think it is a waste of time as well?
Professor Sir Michael Rawlins: No, I do not think it is a waste of time but I think it is right that the Home Secretary is relooking at it. There are various ways in which one could do this sort of thing. Different countries have different arrangements. The notion that the penalties for possession and supply should be proportionate, broadly speaking, to the harmfulness seems to me reasonable, but it does not necessarily have to be done that way, so I very much welcome the approach that the Home Secretary is taking, that he is reviewing it and is going to produce a consultation paper shortly. I am not sure how far away "shortly" is.
Q116 Chairman: What worries me here, and perhaps Professor Nutt you can comment on this as well, is that there does not seem to be a blind bit of evidence which your Committee uses to make any of the decisions on which you advise the Home Secretary. Indeed, Paul Flynn, the Minister responsible, one of our eminent MPs, described government policy decisions on illegal drugs as "largely evidence-free" in evidence to this Committee.
Professor Sir Michael Rawlins: I cannot answer for him but if you look at the way we examine the evidence, there is a lot of evidence that we are able to look at. It is not perfect by any manner or means. There are gaps and in some areas there are large gaps, but there is evidence and there is evidence that we can use.
Q117 Chairman: But have you then ever provided evidence to ministers which they have just disregarded?
Professor Sir Michael Rawlins: Not since I have been Chairman, no.
Q118 Chairman: Have you ever given them advice which they have disregarded?
Professor Sir Michael Rawlins: No.
Q119 Chairman: So in perfect harmony?
Professor Sir Michael Rawlins: In the past ministers have rejected the Council's advice but not during my tenure of office and David's.
Chairman: I will pass you on to my colleague.
Q120 Dr Iddon: Thank you, Chairman. Obviously the Home Secretary is looking at the reclassification of drugs at the moment. Was that an idea that came from your Committee? If not, where has the Home Secretary gained the idea that the present system needs looking at?
Professor Sir Michael Rawlins: Well, I think it is fair to say that I did have a discussion with him about it and I said that if he felt that he wished to re-examine the classification system the Council would welcome it.
Q121 Dr Iddon: Are you as a committee, Professor Rawlins, commissioning any research into this aspect?
Professor Sir Michael Rawlins: As to the question of the classification itself?
Q122 Dr Iddon: Yes.
Professor Sir Michael Rawlins: No, we are not. What we are doing is using the system that we are asked to use, and that is laid out in the Misuse of Drugs Act. We collect scientific evidence in relation to our responsibilities in that, but, no, we have not commissioned research into how one might classify them. I think that is a more appropriate thing to be done by the Government and the Home Office.
Q123 Dr Iddon: Because the classification is set out in the 1971 Misuse of Drugs Act, could I suggest that you are perhaps operating within a straitjacket and there is very little flexibility?
Professor Sir Michael Rawlins: There is some lack of flexibility and that is one of the reasons why we welcome the Home Secretary's decision to review the classification system and come out with a consultation paper.
Q124 Chairman: Why did you not suggest it?
Professor Sir Michael Rawlins: I did talk to him about it informally and I said if he felt that he wanted to do that it would be strongly supported by the Council.
Q125 Dr Iddon: Is it not a fact also that the United Nations Conventions - and there are more than one of them - severely constrain the debate anyhow because they lay out internationally how different countries classify drugs?
Professor Sir Michael Rawlins: Well, there is a wide range of ways in which the different countries do this and it is summarised quite nicely in the Runciman Report the various systems that are available, and I think it is a matter of what suits us rather than necessarily borrowing somebody else's, but obviously we can learn from their experience.
Q126 Dr Iddon: I agree that there are cultural aspects we have to take into consideration. Which countries would you advise the Government to look at in particular that might have different systems than ourselves?
Professor Sir Michael Rawlins: I am not an expert on the international dimension to this, but my advice would be to look at all the systems in developed countries in Europe and in North America and in Australia, look at their strengths and weaknesses, look at their own experience of it, and look at what we ourselves need in this country, but I am not an expert in this area. Professor Nutt might have a comment.
Professor Nutt: I think we should look across a spectrum. Obviously we have in the past been very interested in the Dutch approach and, as shown in the RAND Report, the Swedish approach is almost diametrically opposite, and other European countries like Spain have gone through quite major changes in the way they regulate drugs in recent years, so there are lessons to be learnt there.
Q127 Chairman: Bearing in mind that alcohol probably kills directly or indirectly about 32,000 people a year, tobacco 130,000 people a year, and those deaths are far in excess of all the deaths caused by the use of all illicit drugs, why is your committee not enabled to look at tobacco and alcohol as well as all the other substances?
Professor Sir Michael Rawlins: I think the idea that we would control tobacco and alcohol in the form of the Misuse of Drugs Act (which would thereby render them illegal in terms of possession or supply) the Americans tried in this Prohibition days in the 1930s, and it was a disaster and just encouraged crime, and quite clearly it is not a practicable proposition.
Q128 Chairman: But, Professor Rawlins, that is exactly what has happened in terms of the drugs classification system. It is exactly what happened with the prohibition of alcohol in the States.
Professor Sir Michael Rawlins: I would not disagree with that. I think it is important that the Council does not exclude alcohol and nicotine entirely. One of the very important things the Council does - and it is nothing to do with classification - is it has a Prevention Working Group looking at prevention aspects of the misuse of drugs and its current programme, which is looking at the pathways to misuse of drugs by children and adolescents, is particularly also looking at nicotine and alcohol because we know that the early use - and Professor Nutt may want to talk about this - of nicotine and alcohol is a much wider gateway to subsequent misuse of drugs than cannabis or anything like that.
Professor Nutt: Yes, I think it is important for you to realise that we are aware of the harms of tobacco and alcohol and we do bear them in mind, both in terms of the issue, as Michael has said, of the gateway but also in terms of the interactions. There are some drugs which by themselves are not necessarily very dangerous or harmful but when used with alcohol can become very much so.
Q129 Dr Iddon: I am not asking for an ACMD view on this but a personal view. If you were to put alcohol and/or tobacco in one of the present classifications, bearing in mind the harm that they cause not only to individuals but also to society, which classes would you put them in?
Professor Sir Michael Rawlins: When the Runciman Committee looked at this it was very clear that alcohol was at the border of A and B and tobacco was at the border of B and C.
Q130 Dr Turner: Sir Michael, the point has already been made about the defects of prohibition and many senior police officers have told me that, in their view, the way in which we operate the Misuse of Drugs Act is actually counter-productive as far as dealing with drugs misuse is concerned, particularly with its emphasise on criminalising personal possession and use. Do you have a view on this?
Professor Sir Michael Rawlins: Yes, I think the question of possession versus trafficking is very much the criminal justice and the public health elements, and I think for possession the public health issue should be paramount, and I am particularly thinking of vulnerable sections of society. Professor Nutt is much more expert on this than me, but we are very conscious that people with schizophrenia may relapse very readily if they use cannabis, and that cannabis consumption amongst people with schizophrenia is extraordinarily high. The worst thing you can possibly do with somebody with schizophrenia is to send them to jail for two years or five years or any time, particularly in relation to something like possession of cannabis. It is totally inappropriate and I do not think that happens very much, but we want to be helping them not to use it rather than punishing them if they have a spliff in their pocket.
Professor Nutt: I have a lot of sympathy with your view. I think the evidence base for classification producing a deterrent is not strong and we see that with a number of drugs.
Dr Turner: Do you agree that there is also a problem with the way in which we handle, for instance, heroin addicts in that the substitutes could be as bad if not worse than the primary product if they had access to a pure source?
Q131 Chairman: I would really like to move on if you do not mind, Des, on this. Could I just finalise with you, Sir Michael, you said you had an informal conversation with the Home Secretary so there has been no formal recommendation from your Committee that he should re-visit the classification at all?
Professor Sir Michael Rawlins: No.
Q132 Chairman: It was just an off-the-cuff conversation between yourself and the Home Secretary?
Professor Sir Michael Rawlins: It was.
Q133 Margaret Moran: Can I pursue the issue of your work programme and how it is determined. What proportion of your work is in response to Home Office or government departments and what proportion is proactive from yourselves, and what processes do you use to decide what issues you will pursue proactively?
Professor Sir Michael Rawlins: I will start off and Professor Nutt will follow. I cannot give you a breakdown in quantitative terms. Occasionally it is the Home Secretary himself who asks us, but it has not happened very often. Sometimes it is officials in the Home Office who may propose things. Quite often it is also intelligence that we gather through the Police or the Forensic Science Service that stimulates an inquiry or a serious examination, but David?
Professor Nutt: Yes, my Committee is called the Technical Committee and it incorporates individuals with an expertise and knowledge of drug toxicity but also people interested in the epidemiology, the natural history of drug use. In the last few years we have initiated reviews of drugs such as khat, based on, I suppose, public concern about sections of society being distorted by the use of khat. Ketamine was driven by concern from Customs & Excise about the very big increase in the importation of ketamine, which was certainly mislabelled as certain products. Basically we are reactive to social concerns, I suppose.
Q134 Margaret Moran: I do not think you clarified for me the exact process, so you are effectively saying there is an issue that comes from the media or from general public concern, and you think, "Okay, we should formulate that into an inquiry"?
Professor Nutt: That is what we have to do but we have also done other things. Systematically since I have been Chair of the Committee we have worked through two issues. One is how best to assess the harms and risks of drugs, and you have that report from Sir Michael in front of you. We have done that process. Over a series of our meetings we have evaluated across the whole range almost every drug in the Act in a systematic way, given the current level of evidence, so we have set up a system where we can be proactive in terms of individual drugs and also we have reviewed the relative harms and risks of all the drugs.
Q135 Margaret Moran: That is my next question. Could you give us a couple of specific examples where you have come across something where you think policy practice needs to be changed?
Professor Nutt: I can give you a couple of good examples from the process that the Technical Committee has done. For instance, buprenorphine was Class C, and based on our harm assessment we thought it should be Class B. The same process was applied to cannabis back in 2002, where we thought it should go from Class B to Class C, so those are two examples of where we have used our expertise, applied the template of risk assessment and come up with what I think are quite sensible solutions, and from what we have seen at least one has been acted on.
Q136 Bob Spink: I just wondered how the ACMD actually assessed risk, what evidence it took, and how it did the work of collecting that evidence. For instance, on crystal methylamphetamine, did the ACMD go to see the devastating impact of that drug on society and individuals in Thailand or in America, and did it use the evidence that it gathered in that way, if indeed it did gather evidence in that way, in making its decision to hold it as a Class B drug rather than classifying it as an A?
Professor Sir Michael Rawlins: Can I in general terms answer on the approach we take. When we look into a particular area we usually set up a small working group. That small working group undertakes or usually commissions a systematic review of the public evidence, the chemical, the basic science and the social science evidence. That is supplemented by a search for unpublished material from all sorts of sources, not only from scientists we know are working in the field but through our national and international contacts, and then we interact with experts in the field, seeking their written evidence, seeking oral evidence from them and seeking their views on the systematic review and whether we have left anything out. That then forms the basis of a draft report which is looked at by the Technical Committee and then finally goes to the Council for further discussion and consideration and sometimes a bit of iteration between the Council and the Technical Committee. We have not paid visits to Thailand on the crystal meth business as a Council but Professor Nutt has visited.
Professor Nutt: The people we worked with to produce the scientific overview - Farrell and Marsden and colleagues - do research in Thailand on crystal meth, they are world experts on it, so we felt very comfortable with their expertise because they were part of our process.
Q137 Margaret Moran: Obviously your direct relationship is with the Home Office but how often are you consulted by other ministers or other departments or have a dialogue with them about some of the issues that need to be raised?
Professor Sir Michael Rawlins: I do not think in my time in office we have been approached by other government ministers outside the Home Office. The Act would allow any secretary of state to ask for our views, but that has not happened. We do have very close relationships with the Department of Health. That is obviously very, very important and during the time that I have been in the Chair our relations with the Department of Health have got better and better, and it is very collaborative and they are very, very supportive. We also have relations obviously with the Department for Education and Skills, to some extent with the Department of Trade and Industry, with the Foresight Programme in particular, and we obviously have relationships with the Police - ACPO, the Met, and so on.
Q138 Margaret Moran: When you say relationships, have you actively gone to discuss issues with ministers or representatives of those departments?
Professor Sir Michael Rawlins: Yes, ministers in the Department of Health have talked to me about misuse of drugs and the views of the Council in discussion. They have not referred a topic to us but we have had discussions about it, yes.
Q139 Margaret Moran: Just one quick one. When you are finalising your advice to ministers, for example anything about the reclassification of cannabis, how much has the opinion of that minister helped to form the final policy judgment?
Professor Sir Michael Rawlins: Not in the slightest. It is a very independent group. There is no way I could persuade them to put something in a report because the Home Secretary might like it. They are a very, very independent group. They would walk out of the room if I even thought about doing it.
Q140 Chairman: It is more likely if the Daily Mail wants it?
Professor Sir Michael Rawlins: Not the Daily Mail, sir!
Q141 Dr Harris: What is your relationship with the media and indeed other opposition politicians? I use the term other opposition politicians because clearly statements are made and demands are called for which influence ministers by these groups, and indeed opposition politicians, without the benefit of a formal relationship with you. Do you have any form of relationship with these groups so that you could let them know if some form of work is ongoing in particular spheres, particularly when they state something as fact which is not a fact? Do you do anything?
Professor Sir Michael Rawlins: No, to be honest.
Q142 Dr Harris: Do you think you should?
Professor Sir Michael Rawlins: Perhaps we should. Our role in the Act is to advise the secretaries of state, particularly the Home Secretary, but I think you are probably right, maybe we should talk more to parliamentarians and the opposition parties as well but we have not really done that in the past.
Professor Nutt: I did a presentation. I think you were present.
Q143 Dr Harris: The All-Party Group. If I am offered I pitch up but I think we are arguing for more than a meeting of an All-Party Group, to which I am sure you will be regularly invited. You just mentioned you did this thing on khat because of perceived public concern.
Professor Nutt: It was not just that.
Q144 Dr Harris: Did I mishear?
Professor Nutt: There was unquestionably public concern which came to us through people working in drug services but also through the Department of Health, which I believe had some ongoing research looking at the potential risks of khat use in certain communities.
Q145 Dr Harris: I do not know how you measure public concern. It is hard to measure. A good way is to talk to 2,000 people and ask them which of these they are most concerned about. Some form of large-scale survey is probably the best and only way. I do not know what you mean by public concern. Do you mean ministers saying we are concerned? Do you mean a newspaper headline?
Professor Nutt: I think it would be fair to say that we do try to be evidence-based. A simple newspaper headline would not drive us to do a major piece of work.
Q146 Dr Harris: Are you confident that what you have said was the basis of public concern about that particular substance was evidence-based or is that just your impression?
Professor Nutt: The concern was raised, as I say, through a number of sources - health sources, drug addiction workers - and based on that, and in parallel with ongoing research by the Department of Health, we did our report. I do not really quite understand what you are getting at.
Q147 Dr Harris: You said public concern and I am saying what is the evidence that there is broader public concern?
Professor Nutt: I was not talking about the general public, I suppose, so maybe I misunderstood you.
Q148 Chairman: You seem to be giving the impression - and I would not want the Committee to be unfair - that this is a very ad hoc sort of organisation, where there is a lack of transparency about where you get advice from. You have loose conversations with ministers which may or may not change policy. The Daily Mail, or some other organ, may exert undue influence. You may or may not have conversations with the Department for Education and Skills, even though drugs policy in schools is a massive issue. Are we being unfair here?
Professor Sir Michael Rawlins: Grossly unfair, yes. The way issues like this come through will be multiple routes and finding out about, for example, khat, which is used by a very small group of people, there is not a way in which one can have a routine mechanism for flagging up issues. Yes, I had the conversation with the Home Secretary, but that is about the only thing I can think of that I have ever talked to him in that way. We publish reports which are fully referenced and fully detailed. The methylamphetamine report and the khat report are all fully detailed with the sources of the evidence and the evidence base. As for being influenced by the Daily Mail, you have only got to read the Daily Mail and read what they say about me and Professor Nutt to realise we are not influenced by them.
Q149 Chairman: I am sure that will be reported tomorrow.
Professor Sir Michael Rawlins: I look forward to it.
Q150 Dr Harris: I want to ask you about this ability to do proactive work. You have not done Ecstasy - I could phrase that better!
Professor Sir Michael Rawlins: I know what you mean, Dr Harris!
Q151 Dr Harris: We are going to take ecstasy later in the question but the Runciman Report and these other reports stated clearly that they thought there was a case for reclassification, and indeed I think the Home Affairs Select Committee did as well. These were not trivial pieces of work. These were serious pieces of work, yet, remarkably, despite having the ability (although you have not been asked by the Government and in fact one might say because you have not been asked by the Government) and in the face of these reports, you have not done a report following that up. That gives the appearance, would you not agree, that if ministers are not keen on something then you are not going to do it, even if other august bodies, who do not take perhaps as rigorous approach as you, have done it. It just seems odd.
Professor Sir Michael Rawlins: Yes, ecstasy was placed into Class A in 1977. Since that time ---
Q152 Dr Harris: Without your being advised?
Professor Sir Michael Rawlins: 1977 - that was when we were both medical students.
Q153 Dr Harris: Without the ACMD being advised?
Professor Sir Michael Rawlins: I do not know in 1977. I presume it was on the advice of the Council. I presume it would be then because the Act was already there. Since that time the amount of research on ecstasy is minute. There has hardly been any good scientific research at all on ecstasy. What has been done is a few animal studies and little bits of epidemiology on deaths which are very, very difficult to interpret and, frankly, if we keep on going back --- so there is no evidence base now to change the decision.
Q154 Bob Spink: Leah Betts' parents might challenge your assertion that there is no evidence base.
Professor Sir Michael Rawlins: There is no change in the evidence base; it is almost non-existent.
Q155 Dr Harris: So the limiting factor is not resources? You have enough resources to do proactive reviews?
Professor Sir Michael Rawlins: Absolutely.
Q156 Dr Harris: My last area of questioning is you said that you had said to ministers that if they were minded to look at the way the classification system worked then the ACMD would support that. Does that mean the ACMD discussed that?
Professor Sir Michael Rawlins: We did discuss it very briefly at the end of our meeting on cannabis.
Q157 Dr Harris: It is a bit peculiar because a lot of organisations do spend time thinking about it and in case they are asked by those who set their terms of reference, "It would be really good if the terms of reference could change ..." they have a piece of work ready. Would you say that it is something that really ought to be done, that there ought to be serious consideration so that if someone says, "Shall we do this?" you can say, "Yes, and here is some work that we have done that would support the idea of a change from a rigid ABC"? Select committees do that. They are always looking at the way they work.
Professor Sir Michael Rawlins: Our terms of reference are independent of the classification system if you look at our terms of reference in the Act. This came at the end of two days of very intense discussion on cannabis, and we had not actually discussed it previously and this was not a moment to start going into what might be, and anyway I think it is an issue that would be more appropriately done by Home Office officials and by government ministers and then followed by broad consultation. It was not appropriate at that stage, as I said, at the end of two days of very intense discussions to try and unpick it in any sense.
Chairman: I am going to try and change direction a little bit because I am very conscious of the need to move on. Des?
Q158 Dr Turner: Sir Michael, looking at the list of members of your Committee, there is quite an impressive breadth of expertise there and just about every stakeholder that I can think of that needs to be represented is there. Is this a function of your influence or is it decided by the Home Secretary? Who actually determines the membership?
Professor Sir Michael Rawlins: What happens now is that there is an advertisement to join, but I have also indicated that there are certain slots that we needed to have filled. We needed to have, for example, senior police officers. I was very keen on having a judge. I have been very anxious recently to have people with experience of teaching, particularly current, practical experience of teaching rather than, with great respect, directors of education, so real, actual working teachers. So I have influenced it and there has been no political suggestions at all as to the range of individuals. I have also been keen on trying to get a few younger people on it because most of us are my age or a bit younger, like Professor Nutt here, but we felt we needed some younger people who knew the culture and the environment rather better than fathers and grandfathers like me.
Q159 Dr Turner: Clearly your influence is very strong in this. The only thing of course is that although your minimum membership is 20, it has expanded to 38 members. Is it in danger of getting cumbersome?
Professor Sir Michael Rawlins: I would not want it to go any larger, but the breadth of expertise, knowledge and understanding is very important to the Council, and you will see from the membership that it includes very distinguished scientists who are Fellows of the Royal Society as well as people who have experience of looking after and helping individuals who misuse drugs, and their families, so it is a wide range, as you say.
Q160 Dr Turner: Of course one of the other facets of work of the Advisory Committee, or regulatory committees that we have come across before, is that sometimes decisions are not necessarily consistent because they depend on who is there on any given day, so out of your large membership what is the quorum, how many people are normally there, and do you take any steps to try and ensure consistency of approach?
Professor Sir Michael Rawlins: I think consistency is obviously something that I as Chairman and Professor Nutt as Chairman of the Technical Committee would want to make sure that we did not make inconsistent decisions. I quite agree with you, that is very important. I cannot tell you what the average attendance is offhand but I can write to you afterwards and let you know, but it is 75 per cent plus most of the time as far as I am conscious of it. There are a few critical people particularly on various discussions, but they all almost invariably attend and so it works reasonably well.
Q161 Bob Spink: And the quorum?
Professor Sir Michael Rawlins: Is seven.
Professor Nutt: I think the point you make is a very important one because when I joined the ACMD and took on the Chair of the Technical Committee, I was very exercised by the potential for random decision-making based on individuals being present or not. That is one of the reasons I have set up this system of a very systematic appraisal so that all drugs we appraise we do in the same way. We have the same parameters and we have the same process, where possible, of having a detailed up-to-date, scientific report, in order to try and even out some of the possible inconsistencies.
Q162 Bob Spink: Could I just come in here, Des. The ACMD is there to benefit society at large. What do you think society at large would think about the over-representation of liberal elements within the 38 people making up your body?
Professor Sir Michael Rawlins: People with liberal views towards drugs?
Q163 Chairman: It is an accusation that is often made against the Council that the Council has liberal views?
Professor Sir Michael Rawlins: By the Daily Mai!.
Q164 Bob Spink: No, Chairman, could I just say that I am not talking about the Daily Mail, I am talking about the 90,000 people in Castle Point whom I am elected to represent, who take a very strong view about the liberal attitude towards the illegal use of drugs and the damage that it does to individuals and to society.
Professor Sir Michael Rawlins: I cannot answer the question as to either whether the membership is liberal or how other people would view it. We are basically a scientific advisory committee and we have to give advice on the basis of the science as we see it. I would hope that the 90,000 people you represent would understand, if they had the opportunity to sit there and listen, the reasons why we come to the conclusions that we do. I would accept that it is very difficult to produce in reports the flavour of the judgments that have to be made because although ACMD is a scientific body, all advisory scientific bodies have to make judgments, and those judgments are very difficult to explain in written words, but I would hope that if your constituents (some of them anyway) attended they would realise that the decisions we reached and the conclusions we reached were ones that they would understand why we reached them.
Q165 Bob Spink: It would perhaps help them to understand if the ACMD published the minutes of its meetings, for instance. Why do you not do that?
Professor Sir Michael Rawlins: We have not done it to date. Anyone who asks would get a version of it. There is sometimes material in the minutes that we would need to remove because they are based on intelligence that would not be appropriate in the public domain.
Q166 Bob Spink: Would my 90,000 constituents think it was perhaps a little loose that you had 38 members, that the membership of the your body was over-representative of the liberal attitude to drug-taking, and that you have a necessity of only seven people in a quorum to make decisions?
Professor Sir Michael Rawlins: Sorry, the quorum is laid out in our instruments and I do not think it has ever met with a small group like that. The other question was about the liberal elements. I do not know whether you would call them liberal or illiberal or whatever. What we have to do, though, is realise that over the last 30 years the use of drugs has dramatically increased in this country, and that the criminal justice system has not prevented that in any way.
Q167 Bob Spink: Nor has the ACMD.
Professor Sir Michael Rawlins: We do not know because we do not have a scientific basis to make that assessment, with great respect. We do not have a control trial of half the country with an ACMD and half the country without. We do not know what would have happened. All we do know is that in every Western society drug use has increased astronomically despite all sorts of different approaches. The Americans give 20 years minimum to life for a second offence of having cannabis in your pocket and that still has not made very much difference. Crack cocaine in America is widely used. Penalties and the criminal justice approach has not worked very well. It may have been worse if we had not got it. Where I think we are all at fault, not just the ACMD but all of us are at fault, is not being better at explaining to young people particularly the dangers of drugs.
Chairman: Which is what makes it even more surprising that there is not a stronger link between your organisation and the Department for Education and Skills.
Q168 Mr Flello: I just wanted to pick up on a point that was made. You have referred many times to the fact that it was a scientific committee and you are looking at the scientific base. With the greatest respect to the judges and senior police officers that are on there, do you feel you have got enough scientists?
Professor Sir Michael Rawlins: The Council itself is broadly based. The Technical Committee is much more focused on scientists, particularly clinical scientists and social scientists.
Q169 Mr Flello: How many scientists have you got on the Committee overall as a percentage?
Professor Sir Michael Rawlins: I will have to write to you with that. I have not got it on me.
Q170 Dr Turner: Coming back to the minutes, obviously if you did publish the minutes then any concerns that people have about the transparency of your operations would be greatly diminished. You said that you could not publish the full minutes because some of the information was not suitable for the public domain. The only circumstances I can think of for that is if it concerned specific individuals or named specific individuals. Is that the case? If so, can you not report it anonymously in the minutes?
Professor Sir Michael Rawlins: Yes, there are also some intelligence matters that would be inappropriate to be in the public domain, but it is a couple of lines, that is all. It would not be a major issue.
Chairman: Can I move on to you, Brooks.
Q171 Mr Newmark: An important part of everything that we are doing and that you are doing comes down to the evidence and hard evidence - and I will go into what I would define as hard evidence a bit later on. As a start, do you see the role of the ACMD to contribute to the evidence base or merely to review it?
Professor Sir Michael Rawlins: It is primarily to review the existing evidence base, although individual members professionally are involved in capturing information and data. Primarily we are there to examine the evidence that is available.
Q172 Mr Newmark: You are both intelligent individuals and you are clearly going to find gaps, I suspect, in that evidence. Do you have the power to commission any academic research or any study to fill that gap that you and your team might well identify?
Professor Sir Michael Rawlins: To some extent, yes.
Professor Nutt: We do not have the resources to do extensive novel research. I think the point you are hitting on is an important one and linking with organisations that might have those resources is, I think, something we should be looking to do, and I am particularly concerned that the ACMD is embedded in the Home Office and the Home Office does not have any particular representation at the MRC. I have written to Colin Blakemore about that. Obviously the Department of Health has representation but the Home Office does not. I think that is a possible reason why there is a mismatch between research needs in addiction and research outcomes.
Q173 Mr Newmark: That is something you maybe could take away to your Committee and try and achieve that objective? It seems fairly common sense to me.
Professor Sir Michael Rawlins: We will also talk to Colin Blakemore about it and ESRC as well.
Q174 Mr Newmark: To Professor Nutt: when did you develop the risk assessment matrix and what role has it played in the ACMD's deliberations?
Professor Nutt: The matrix was developed when I was working on the Runciman Report because it became quite clear that we did not have any systematic way of conceptualising the range of harms and any way of properly categorising them and rating them, so that was very much a pilot. When I became a member of the ACMD and Chairman of the Technical Committee, we set in process this procedure of getting all the members of the Technical Committee to work through in a systematic way the drugs, doing about four or five drugs a meeting. We have two meetings a year and we slowly worked through the drugs in the Act.
Q175 Mr Newmark: Is there a direct relationship then between the scores given to a drug using your matrix and the recommendations made by the ACMD about respective classifications?
Professor Nutt: There are anomalies, there is no question about that. One of the anomalies is buprenorphine which we suggested was moved up. Another anomaly was cannabis which we suggested was moved down. As you almost certainly know, another anomaly was ecstasy. We have not progressed that at present because, as Sir Michael said, the evidence on which to do a systemic review in terms of the real harms of ecstasy has been a bit slow in coming.
Q176 Dr Harris: Is it possible to use a scientifically-based scale of harm to determine the illegal status of a drug? I notice your matrix has "other things" in there.
Professor Nutt: I think it can inform. It depends how you want to make laws. I suppose you could just add the numbers up and say that is how the law would be, but I suspect you would always want to look at other factors, particularly the prevalence of the drug in society, which obviously is another factor in terms of the harm.
Q177 Dr Harris: I was intrigued - and this maybe goes back to Dr Iddon's point - Professor Blakemore has argued for a scientifically-based scale of harm for all drugs with alcohol and tobacco included in some form of calibration. I am curious as to your thoughts on that.
Professor Nutt: I think it is a very sensible idea.
Professor Sir Michael Rawlins: I think inevitably, as David says, it will inform the decision but it will not determine it. These things cannot be entirely algebraic.
Q178 Dr Harris: You have not done that. You have got this matrix that you sent us, which you did not send us originally but you kindly supplied it later, which is very interesting and I think it is possibly among your interesting memorandum the most interesting. If you did this scale and you put in tobacco and alcohol then that would be a useful thing. I cannot understand, since you have agreed it would be useful, why you have not done it, unless it would show that the current ABC would not ---
Professor Sir Michael Rawlins: We can send to you the paper that David has been preparing.
Professor Nutt: We have done this.
Q179 Dr Harris: Has it been published?
Professor Nutt: No, it has not but the plan is to send it to The Lancet, get it peer reviewed, and hopefully have it in the public domain.
Q180 Dr Harris: Has there been a delay? If you have done it, why not publish it?
Professor Nutt: Because it takes some time. It is an iterative process. There are four authors and it has taken some time. It is not trivial writing a quality paper for The Lancet.
Professor Sir Michael Rawlins: David is more than willing to share a draft (I have not been party to it) with the Committee.
Q181 Mr Newmark: Professor, you discussed the importance of science, yet to what extent can an assessment of the parameters that are used in the assessment matrix be objective and how much of it ends up being more a judgment call or subjective? I raise that question because the ACMD told us that social harms tended to be "the weakest data set because of the inherent problem of gathering relevant information." For example, there is often little reliable evidence - and again I quote here - "about the quality and potency of material used by consumers, their pattern consumption, and the social consequences of their use". That is not scientifically based. That comes down to as much to a judgment call or a subjective decision.
Professor Sir Michael Rawlins: Absolutely. I think it is very important that the Select Committee understands that scientific advisory committees look at science but they also have to make judgments. I have been on scientific advisory committees for 25 years and I have been very conscious that there are judgments that have to be made, and they really fall into two groups. There are scientific judgments that you have to make. There are judgments that you have to make about the reliability of the evidence, how generalisable it is, how good it is, is it flawed in some way, and so on, because the scientific evidence is never perfect, it has always got gaps it in. Bodies like the ACMD also have to make social judgments, and that is the difficult part in many respects. Many scientific committees have difficulties over this and over the years I have become more and more uneasy about social judgments because I am not sure that scientists are the right people to make them. The ACMD, I think, is very fortunate in having at least a broad range of views so that those sorts of judgments do have some sort of resonance, but I think it is an area which is not just confined to the ACMD because almost every scientific advisory committee that I have ever been on has had to make these social judgments too, and in another organisation called NICE we have set up a Citizens' Council to help us in getting that, but it is a difficult area and I am very grateful to you for raising the judgment bit.
Q182 Chairman: I think that is exactly what this inquiry is about - actually seeing in terms of making critical judgments (which in fact can take away somebody's liberty for a long period of time) that we have a situation as to where is the balance of evidence between, if you like, the scientific evidence, which I accept is always flawed at the margins at any rate and indeed the sociological evidence which you have got to make decisions on, and that is why we are having this inquiry because I think it is absolutely crucial that we get to that. In terms of the participatory committee which NICE have set up, why do you not do that yourselves?
Professor Sir Michael Rawlins: Maybe we should. The NICE Citizens' Council is very much an experiment. I do not think any other organisation in the country has done anything quite like this. Dr Harris is giving one of those old-fashioned looks.
Q183 Dr Harris: It is a focus group.
Professor Sir Michael Rawlins: It is not, no, it is much more than a focus group.
Q184 Dr Harris: Do you think that the people who make decisions like citizens' juries in the case of NICE, about whether you let older people die because you want to treat younger people first should be made by elected representatives who are accountable rather than, let me be more polite, a glorified focus group?
Professor Sir Michael Rawlins: Yes except, by and large, elected representatives find those sorts of decisions very difficult to take and over the years they have not really done it, with great respect.
Q185 Dr Harris: We can agree that it ought to be done and if they are cowards then you are forced to go down a less satisfactory path. On this issue of the social harms, let us just deal with this point about science. Is what you are saying because it is harder to measure social harms because social scientists would claim they are scientists it is a softer outcome?
Professor Sir Michael Rawlins: No, I am not saying that at all. I am saying the work has just not been done for all sorts of logistic reasons. This is a very difficult area. For example, on the strengths of tetrahydrocannabinol, THC, the main active ingredient of cannabis, the strengths that we know of from that which has been seized by law enforcement officers. Whether that relates to what people are actually using is a different matter. We have no idea and collecting what people are using is not so easy. I have never bought cannabis so I do not know where you would buy it from, but you have really got to go to the consumers and find out what they are using, not what the law enforcement officers have seen. That is just an example.
Chairman: We are going to return to that when we are dealing with cannabis.
Q186 Dr Harris: You said you did not think scientists were best placed to measure social effects.
Professor Sir Michael Rawlins: No.
Q187 Dr Harris: I was not disagreeing with you. I just think what you are saying is that it is harder to measure and you would rather scientists did it than artists.
Professor Sir Michael Rawlins: There are two aspects. One is social sciences and the sociology and of course they can measure that. It is the values of a community and a society which are much more difficult to capture.
Q188 Dr Harris: In this matrix you include under "social harms" intoxication, health care costs, and other social harms. Included under "other social harms" do you include the harm that stems from criminalisation itself?
Professor Sir Michael Rawlins: Yes.
Q189 Dr Harris: You do not spell that out but that is understood?
Professor Sir Michael Rawlins: Yes and whether it leads to acquisitive crime.
Q190 Dr Harris: You think it should feature more highly in your parameters or not because it is not scientific?
Professor Sir Michael Rawlins: It is scientific. It is a matter of weighting.
Q191 Dr Harris: I am just asking the question.
Professor Sir Michael Rawlins: I know it is something that David has been thinking about. One of the reasons why they have not published their paper is whether one should weight certain aspects more than others in the matrix.
Bob Spink: I am becoming a little worried, Chairman, about the way in which the ACMD arrives at its decisions within this rather big body of 38 people. On crystal methylamphetamine, for instance, I notice that Judge Joseph felt that the evidence had grown since it had last been considered by the ACMD and yet Professor Nutt felt that nothing much had changed.
Chairman: We are coming back to that.
Q192 Bob Spink: On this particular point, the thing that worries me is whether in fact the members of the ACMD are able to withstand the pressure from strong individuals like, for instance, Professor Nutt, the Chairman of the Technical Committee, or whether certain key individuals are able to push through this action rather than the body taking the right action? How are they actually considering the evidence?
Professor Nutt: We are clearly not the right people to answer that question, that is all I can say.
Q193 Dr Harris: Can I come back to what is a key issue with the social harms thing and you will see where I am coming from in a minute because there are a couple of questions I want to go through. In this matrix you have got "other social harms", which I think contains a lot of stuff and I am somewhat surprised that it is not spelt out for our benefit, but is one of those the impact of criminalisation and acquisitive crime, and do you think that should be one-ninth, as it appears to be, or should it be of greater consequence than one-ninth? You have got three under "physical harm", three under "dependence" and three under "social harms". It seems to me for my constituents it matters hugely whether everyone is shoplifting because you cannot get it legally or the price has gone up because it is criminal.
Professor Nutt: This is a very fair point and we have discussed it a lot and we do not know what the appropriate weightings should be. What we have done is we have come up with probably the most sophisticated way of assessing drug harms that there is available in the world. What we would like to do is move to the next stage, get it published, then have informed feedback, but then modify it into an instrument that really does capture those sorts of concerns.
Q194 Dr Harris: I think if this had been published quickly the work you are doing would have been better. Were there any influences on deciding that it would be not be a good time to publish because of the Government's reaction to the paper you are talking about being published in The Lancet?
Professor Nutt: No specific restrictions but obviously the individuals who worked with us have had some concerns as you have raised. Some of the sociologists themselves have said, "We are not sure we fully can endorse that particular element of the social harm", for the reasons you have raised.
Q195 Dr Harris: Your recommendation recommending classification into a particular class creates social effects, does it not?
Professor Nutt: Indeed it does.
Q196 Dr Harris: Because obviously it brings criminal justice along with it and that affects the price and availability and so forth. Do you recognise that? Your own actions impact on the evidence. Did you feed that back in before you made the recommendation?
Professor Nutt: We know it might happen but you can never be sure how big an effect that might have. I suppose the best example we might have now is cannabis. The natural experiment is happening. Cannabis has been reclassified. We will be able in a few years' time to answer that question for cannabis because it has changed its classification.
Q197 Dr Harris: Do you see any tension between the government's desire to send out messages with its drugs policy and its aspiration to use an evidence-based approach to policy development? Brooks also was seeking to ask this question.
Professor Nutt: I very much support what you are trying to do because I have been trying with my colleagues on the ACMD to develop evidence based assessment for the last five years. I guess what you are trying to do today is help us do that. I believe the educationalists on our committee would say the same, that in education the message has to be evidence based. If it is not evidence based, the people you are talking to say it is rubbish.
Q198 Dr Harris: What if the government say that by changing its drugs policy - let us say, making it tougher - we are sending out a message and there is evidence that sending out a message is a good thing and, secondly, there is evidence that it works, do you get into that?
Professor Nutt: We would if the evidence was there, yes.
Dr Harris: I do not think you say in your report how strong the evidence is for any conclusion. Your report says there is evidence and you give a reference but you do not make a judgment, which you have done in your evidence today, about the relative strength of that evidence. Is that something you might consider doing?
Q199 Mr Newmark: Specifically with different categories of drugs. There is a linkage between evidence and the perceived strength of those drugs, but there seems to be no stronger message with what may be a stronger drug. The message seems to be a fairly blunt instrument at the moment.
Professor Sir Michael Rawlins: In our two cannabis reports we have indicated areas where the evidence was not strong or where it was strong, so we have given a view but again it is judgmental. Going back to what Dr Harris was saying about the scoring system, the things he is raising indicate the reasons why in the foreseeable future it will be informed decision making, but it is not just arithmetic and mathematical. The science has not developed that far.
Chairman: We will look at some of these issues now with specific drugs. You see the Committee is very excited at having you here today and they are becoming very unruly.
Q200 Adam Afriyie: You recently reviewed the link between cannabis and mental illness. How did you determine the weight of the new evidence compared to the original evidence that had informed your advice in 2002?
Professor Sir Michael Rawlins: The evidence base had changed. Between 2002 and last year, there was a very significant change in the evidence base.
Professor Nutt: As you may well know, a number of studies particularly from New Zealand, following groups of children who have now grown up into their 20s, and in Holland and Germany, raised more evidence that cannabis could potentially cause psychotic disorders. When you have four or five new papers suggesting that there is potentially quite a big mental health problem ----
Q201 Adam Afriyie: Did the strength of that new evidence warrant review, in your view?
Professor Nutt: After the 2002 report, we decided that cannabis would be a continual item on the Technical Committee's agenda. We did take evidence from one of the researchers, Dan Zanit, about a year before where he presented his new data on reassessing the Swedish conscript cohort study. We were always conscious of the ongoing research in cannabis. Then it got to the point that there were four or five papers that were pointing in the direction that there might be an increased risk.
Q202 Adam Afriyie: That is what prompted your review? It was not the Home Secretary?
Professor Nutt: We have ongoing reviews but the big review that Michael chaired was prompted by the Home Secretary.
Q203 Adam Afriyie: You first published your advice in 2002 on cannabis and mental illness. You then needed to re-evaluate that evidence base. Does that show any weaknesses in the system because you had to review it so soon afterwards?
Professor Sir Michael Rawlins: No. It was an important area with more evidence about it. We did talk about it in 2002: could it precipitate or cause schizophrenia in vulnerable people?
Q204 Adam Afriyie: What changed? You alluded to this in the 2002 report. Were there no experts on schizophrenia on the panel? Are you saying the evidence just was not there?
Professor Sir Michael Rawlins: The evidence was not there. It was not a lack of experts. We had psychiatrists coming out of our ears. It was just the scientific evidence. This is a very tricky area and even now the epidemiologists that we recruited specially to advise us, on the balance of probabilities, think there is a causal link, but they are not 100 per cent certain because there are all sorts of confounding issues that bedevil the interpretation of the evidence. One of the difficulties is, when you take the confounding issues into account, the relationship becomes smaller and smaller. Technically it is a very difficult area.
Q205 Adam Afriyie: It seems to imply that the classification of drugs that we all read about from yourselves is dependent on the timing of when you choose to undertake a review.
Professor Nutt: No. It is dependent on the evidence. If the evidence base changes dramatically as it did from 2002 to 2003 ----
Q206 Adam Afriyie: You make that judgment as to whether the evidence base has changed?
Professor Nutt: No. The evidence base did change because there were many papers published in this area. It was not a judgment call; it was a fact.
Q207 Adam Afriyie: There was clearly a lot of media concern and confusion when cannabis was reclassified from class B to class C. Did this in any way influence your decision to leave the classification the same when you looked at it recently?
Professor Sir Michael Rawlins: Although people say there was confusion, surveys amongst school children showed that there was not much confusion. 95 or 97 per cent knew that it was illegal. The confusion, if anything, was in the newspapers.
Q208 Chairman: Or in the Home Secretary's mind because he was obviously confused as well.
Professor Sir Michael Rawlins: I could not possibly comment.
Q209 Adam Afriyie: You are saying you do not think there was much confusion. From my understanding, looking at the papers at the time and from people I spoke to at the time, there was a great degree of confusion. Some people thought it was now legal to take cannabis. Why do you think there was that confusion?
Professor Sir Michael Rawlins: I do not know whether there really was that confusion. We have made it very clear in our second report that it is essential that people understand - particularly young people - that it is illegal. It was quite interesting, when we were having this discussion. One of our teachers on the Council said, "That in many ways is much more potent than you think. I am not sure whether I am speaking correctly or not but I say to them that if they have ever even been cautioned for possession they will not be allowed into America." She said that had much more impact than many other things that she teaches the children, the fact that they might not ever be able to visit America.
Q210 Dr Iddon: One of the things that irritates me about the cannabis debate is that if I go into a coffee shop, as I have done but not to buy cannabis, and I have questioned the owner of the coffee shop, he will lay out all his different species of cannabis and tell you exactly what the THC content is. We talk about cannabis in this country as if it is a single substance. The fact is that the THC content of the cannabis being sold on the street has changed. Therefore, why should we keep talking about cannabis as a single substance? It is not a single substance.
Professor Sir Michael Rawlins: No, and the strength there is ten fold whenever it has been looked at in the material that is seized. What we do not know is what people are buying.
Q211 Mr Flello: There are reports in the media this morning that seem to suggest that the use of cannabis in the US has plateaued or is starting to plateau but, in mainland Europe, use is still on the increase. How do you feel, if at all, the reclassification to class C has made any difference whatsoever, given that it has continued to increase since it has been changed to a C?
Professor Sir Michael Rawlins: It has not increased. It has decreased. It has been decreasing in young people since about 1998 and it is falling at about one per cent a year. That fall has continued.
Q212 Mr Flello: That is just young people or across the board?
Professor Sir Michael Rawlins: That is across the board, but with young people in particular it is falling at about one per cent a year.
Q213 Mr Newmark: Is there substitution in there - i.e., are they taking some other drug?
Professor Sir Michael Rawlins: Not that we are aware of. These are figures based on self-reporting behaviour, so we are reliant on that.
Q214 Mr Flello: Do you feel that the reclassification to class C has had an influence on that?
Professor Sir Michael Rawlins: If you look at the graph, we only have another year and the line is not a very steep curve but it is going the right way. It has not changed as a result of reclassification, but we do not know what is going to happen.
Q215 Mr Flello: In terms of the mental illness use of cannabis, if I may widen it slightly to all drug abuse, what is your view on people who suffer from mental illnesses because of drug use or people who use drugs because they have mental illnesses?
Professor Nutt: It is a big question. Some drugs cause mental illness. Many people with mental illness use drugs, even though it makes them worse, and we do not understand that. If we just focus for a minute on cannabis, the brain makes its own kind of cannabis. In the brain there are more cannabis receptors, targets for cannabis, than all the receptors like serotonin and adrenalin put together. There is some evidence that during the course of schizophrenia the brain's own natural cannabis substances change in relation to illness. It may be that what people are doing when they smoke cannabis is trying to restore some internal deficiency which may make some aspects of their mental state better, but in many cases it makes the psychosis worse. That is an example of the sort of complexity.
Q216 Mr Flello: In terms of the classification of drugs and cannabis as a particular example, to what extent do you take into account the impact of people with certain types of mental health disorders using those drugs?
Professor Nutt: It is a factor we consider when we look at all drugs because it comes into the personal life issue. Also it is a factor we look at in relation to the cost to the NHS. It is counted twice.
Q217 Mr Devine: You said the drugs make psychosis worse. Is that evidence based?
Professor Sir Michael Rawlins: Yes. There is very strong evidence and there is no argument amongst psychiatrists.
Professor Nutt: That is some drugs, not all drugs.
Professor Sir Michael Rawlins: I am talking about cannabis. In patients with schizophrenia who are in remission, cannabis will precipitate relapse. There is no doubt at all. Even I know that.
Q218 Mr Flello: When the ACMD met to discuss the reclassification, were the same people on from the 2002 ACMD meeting present at the more recent one? Were any measures taken to exclude them?
Professor Nutt: It was very different because we had to extend by a month the life of the previous committee to get the 2002 report fully approved. So many were coming off.
Professor Sir Michael Rawlins: There was a big turnover after the publication in 2002. It was a rather different group. I cannot tell you how many. I can certainly let you know.
Q219 Mr Flello: It was not ever an issue to consider about making sure there were different members on the committee?
Professor Sir Michael Rawlins: No. A proportion will have been there previously but a significant proportion was new members who had not been involved in the 2002 decision.
Professor Nutt: To reassure you on the ad hoc members, we brought in a number of external experts to bolster the committee. We really covered all the bases, particularly the psychiatric and the epidemiology bases.
Professor Sir Michael Rawlins: They had not been involved in the 2002 decision.
Q220 Mr Flello: There was no undue influence?
Professor Sir Michael Rawlins: I do not think so, apart from the chairman.
Q221 Chairman: What discussions have you had, if any, with the research councils to encourage them to look for the application of resources to research projects to support your work? Does that discussion take place?
Professor Sir Michael Rawlins: No. That is probably remiss of us and I think we probably should and try to ensure that there are some formal channels of communication between the ACMD, the MRC and the ESRC.
Q222 Dr Iddon: Psilocin and psilocybin, which are the psychoactive constituents of magic mushrooms, have been class A for a long time. You said drugs are in classes according to the harm they either cause to individuals or to society as a whole. I do not see psilocin or psilocybin being sold in the shops, synthesised by many people and for sale on the streets. How on earth did those two compounds get into class A?
Professor Sir Michael Rawlins: Psilocin and the esters were originally class A right from the beginning of the Medicines Act. Magic mushrooms were in class A right at the very beginning, before the ACMD had been formed. Psilocin is a hallucinogenic compound with properties similar to LSD. At the time the Misuse of Drugs Act went through Parliament it was class A, but only for products of mushrooms, dried mushroom extract. The issue about fresh mushrooms was very unclear in law.
Q223 Dr Iddon: I want to know what the evidence was that psilocin and psilocybin should be classed as A. I have never known anybody use them.
Professor Sir Michael Rawlins: I have no idea what was going through the minds of the group who put it in class A in 1970 and 1971.
Q224 Dr Iddon: It is there because it is there?
Professor Sir Michael Rawlins: It is there because it is there. However, since that time there have been very few publications on psilocin. It has hardly been investigated at all. It was looked at in the 1950s and 1960s at the time of Aldous Huxley, mescaline, LSD and those sorts of things. Since that time, there has been virtually no work done on it at all.
Q225 Dr Iddon: Could I suggest that there should be and that they are in the wrong classification because they are not causing great harm to any individuals I have ever known and certainly not to society at large.
Professor Sir Michael Rawlins: There is no doubt that people do still take magic mushrooms.
Q226 Dr Iddon: I am not talking about magic mushrooms; I am talking about psilocin and psilocybin as chemicals. I suggest that it was because psilocin and psilocybin were already there that magic mushrooms were completely put into the wrong classification, either by yourselves or by the government, because the two compounds were already contained in class A with no evidence for them to be there.
Professor Sir Michael Rawlins: The evidence that psilocin is a hallucinogen is very strong. There is no doubt about that and no argument about it. The evidence upon which one should change now is non-existent because there has been very little work done on it. To leave fresh magic mushrooms available when all the other forms of mushrooms were class A is causing grave difficulties. Although you may think that psilocin is pretty harmless, as a physician sometimes I get kids who have been eating fresh magic mushrooms grown on the Newcastle town moor, accidentally apparently.
Q227 Dr Iddon: Arsenic is very dangerous; so are a lot of other chemicals but they are not being widely used and neither are psilocin and psilocybin. What evidence was there to put magic mushrooms in class A?
Professor Sir Michael Rawlins: Magic mushrooms were being sold in farm shops and so on by the kilo. Very considerable quantities of magic mushrooms were being sold two or three years ago, fresh, which escaped the law. They do have an hallucinogenic effect. There is no question about it.
Q228 Dr Iddon: How many deaths have there been due to taking magic mushrooms?
Professor Sir Michael Rawlins: I do not know.
Q229 Dr Iddon: The figure I have seen is one.
Professor Sir Michael Rawlins: I do not know.
Q230 Chairman: We have had some research done for the Committee as a background piece of work by RAND. You have had a copy of it and that report made clear that the government's decision about class A was not based on scientific evidence, that the evidence on mushrooms is small with very little research on their effects and the positioning of them in class A does not seem to reflect any scientific evidence that they are of equivalent harm to other class A drugs. Do you not think that brings into question the system that we have for classification, full stop?
Professor Sir Michael Rawlins: One has to be very careful about the issue of things like hallucinogens. They can cause serious problems. There is no benefit to anybody by taking hallucinogens in a medical sense. It is all down side. If one is operating something approaching a precautionary principle - and I hope you will not ask me to define it in the way you asked Sir David King to - it is frankly unwise to encourage in any way the use of this hallucinogen. It may be better in B rather than A. The trouble is that the evidence now is so old. It all dates back to the 1960s and there was not very much evidence then, but one does know anecdotally, if nothing more, that they are hallucinogenic. I have had kids in my ward who have needed antipsychotic drugs for 12 months.
Q231 Dr Iddon: Your committee was consulted by the government and asked to review magic mushrooms.
Professor Sir Michael Rawlins: It was slightly different. The government asked us about it but they did not have to because it was going into primary legislation in the last Drugs Bill.
Q232 Dr Iddon: I was on the Standing Committee for that Bill, the 2005 Drugs Act, and I had the impression that the whole thing was rushed through. My feeling was that the whole business was rushed through in 2005 because the election was coming and the Bill had to be on the statute book but, more importantly, because there were two court cases outstanding where the government were trying to prosecute shopkeepers for selling fresh mushrooms on the basis that they were not fresh mushrooms; they had been frozen in freezers and that fell into the law. It was illegal to prepare mushrooms in any way and the government was trying to prove that by freezing the mushrooms that was a kind of preparation of fresh magic mushrooms. I contested that when I was on the Standing Committee and I did not think it should have gone through the Standing Committee, frankly, because of those two very loose court cases that the government was in danger of losing. Have you or has the government ever classified a drug on grounds of clarification of the law, because that is what happened in my opinion.
Professor Sir Michael Rawlins: I cannot answer that question. I do not know what has happened over the last 35 years but since I have been on the ACMD I do not think it has happened. I cannot recall another case.
Q233 Mr Devine: Do you support the fact that amphetamines are classified as class A or B depending upon the method of preparation?
Professor Sir Michael Rawlins: It is really the method of administration.
Professor Nutt: I do, because there is undoubtedly much greater harm from amphetamines given intravenously than amphetamines taken orally.
Q234 Mr Devine: It is not the method of preparation?
Professor Nutt: The method of administration clearly determines the risk to the individual and to society.
Q235 Mr Devine: If the form of the drug can affect its status in this case, why is there no distinction made between, for example, cocaine prepared for snorting and coca leaves prepared for chewing?
Professor Nutt: That is a very good question.
Q236 Mr Devine: Is there any answer?
Professor Nutt: We are not as sophisticated with cocaine in terms of the law as we are with amphetamines.
Q237 Bob Spink: In the answer you have just given to Mr Devine about the way in which the drug is administered, you said intravenous is much more serious than taking it orally and yet methylamphetamine in its pure, crystal form can be smoked. In that circumstance, it is extremely dangerous because it is very highly addictive, like crack cocaine, and it has a massive psychotic impact on the individual and causes great harm in various societies like Thailand and the USA. Why should that particular drug be classified as a B rather than an A?
Professor Nutt: That is an extremely good point. There is no doubt that methylamphetamine, because it can be smoked, is more dangerous than traditional dexedrine amphetamine sulphate. When we reviewed the whole issue of methylamphetamine, we clearly accepted that it was more dangerous than amphetamine sulphate. The issue is would you minimise risk to society by moving it into class A. The reason I believe we did not recommend it at the time was mostly because there could be a perverse effect. If people saw methylamphetamine as a more dangerous drug, a more class A amphetamine, we might well have begun to see importation. There is a peculiar phenomenon in the UK at present which is that we do not have very much methylamphetamine. That is based on a couple of historical facts which relate to precursors and also the preference of the population.
Bob Spink: Added to the dangers of the drug, we have the availability of the drug, which is something you said you take into account. This is changing in the UK, largely driven by the internet, but the precursor chemicals like red phosphorous, for instance, are increasingly available and people can make this drug in their kitchen and are doing that now. Given that and given the dangers, should we not take the precautionary principle and reclassify this drug before it becomes a major societal problem, as it has in other societies, in order to protect our children and young people; or should we just wait until a lot of them suffer from that and society gets a real pain in the butt on this and then reclassify?
Q238 Mr Devine: We are very pleased that you are not influenced by The Daily Mail, but I wonder if you are influenced by The Metro, which describes the drug as a dance and sex drug, more addictive than crack cocaine and as fast becoming a global problem, the United Nations has warned. It also makes reference in the article to sites being set up in Europe and in England for the making of this drug.
Professor Nutt: There is no question that methylamphetamine is a huge, international problem. It has caused devastation in Thailand. It has caused an enormous amount of personal harm and social harm from the chemical factories in the USA. We do not have a big problem. We looked very hard when we did the methylamphetamine review to find evidence of its use in the UK and there is not a great deal of use. It is a very fine judgment as to whether moving it to class A because it is smokeable - and I think we could do that - would reduce the chances of it becoming popular in the UK or whether it would give a message that it is a better quality product. It might get people who import drugs to realise it would be extremely easy to import this from Holland particularly. At the time the decision was made that it was probably better to wait and see. With many drugs, these epidemics have cycles. They are fashion driven and it may be that we would get lucky and not get a wave of methylamphetamine here.
Q239 Bob Spink: Are you aware or is there any evidence that this particular drug is used by a certain sector of society - in particular, the homosexual groups - and that this drug encourages and promotes risky sexual behaviour which that particular section of society can least do with because it causes the spread of diseases? Is this a concern?
Professor Nutt: It was a great concern. If you read our report, which is a very systematic report, that is a big concern. One of the targets for monitoring the possible increasing use of methylamphetamine is to try to monitor clubs which are frequented by the gay community because we think that may well be the first sign of an upswing in use. If there was a serious change in the usage or a trend upwards, we would have to review the classification.
Professor Sir Michael Rawlins: The Council thought very long and hard about this and it was a judgment at the end of the day as to which would be the least damaging thing to do. When it took the decision to advise that it should not move, it also made sure that there were measures in place so that if there was any hint of a problem emerging we could have a meeting - that is why the CoWRM seven were quite important - within hours to change our advice.
Q240 Bob Spink: This would not require waiting for one of your biannual meetings?
Professor Sir Michael Rawlins: No.
Q241 Mr Flello: Having listened to your evidence this morning, I am left with the impression that these things seem to be very ad hoc. You can have magic mushrooms where I understand there has been one death but fresh mushrooms were pushed into class A on a precautionary principle. On a similar precautionary principle cannabis is class C and on a similar precautionary principle some of the amphetamines are class A and some are class B. It seems complete nonsense, does it not?
Professor Sir Michael Rawlins: I have sat on government advisory committees for 25 years, mainly in terms of medicine but others as well. There is a misunderstanding around in the world that scientific advisory committees just make their decisions purely on the science. They have to take judgments too and judgments are very important in scientific advisory committee meetings. Sometimes people do not realise they are making judgments but they are. It is very important to realise that we all have to do it. I think your Committee also understands that scientific advisory committees look at the science and then they have to make a judgment.
Q242 Chairman: Our frustration this morning is that time and time again you seem to have responded to Members of the Committee that there is a lack of evidence or you have agreed that there is a lack of evidence to make certain decisions. We want to know why the ACMD has not done more to promote research in those areas where there is a lack of evidence. Do you think it is your job to do it or have we misjudged what the purpose of the committee is?
Professor Sir Michael Rawlins: It is arguable whether it is our job. This is an area in which it is extraordinarily difficult to do research, not just for legal reasons but for real reasons. Would I, for example, be prepared to do volunteer studies with Ecstacy? Would I be prepared to give volunteers Ecstacy? I could probably get the Home Secretary's approval. It is schedule one and it is possible. I am not sure I would. I do not know what an ethics committee would think about it but how would I think about it? We start getting into very real problems of doing research in this area. It is all very well people saying, "You should promote research" but you have to promote research that can be done, not research that we would just like to see.
Q243 Chairman: Could I ask whether the Council has ever formally asked the Home Secretary for permission to carry out research in any of the areas that we have talked about this morning?
Professor Sir Michael Rawlins: Yes, and it does commission research.
Q244 Chairman: You could give us some background?
Professor Sir Michael Rawlins: Yes. We can let you know of areas we have asked for research to be commissioned in.
Q245 Dr Turner: When questions fall outside the massive expertise you already have in the committee, who do you look to and how do you choose specific people to go to for advice?
Professor Nutt: Essentially in the scientific arena we look for people who publish in the field. Methylamphetamine boards will have brought in people like Charles Marsden who is a world expert on the effects of amphetamines in the brain. We make searches of the published literature to find people.
Q246 Dr Turner: Do you ever set up sub-committees to pursue specific issues?
Professor Nutt: Sometimes.
Q247 Dr Turner: Do these report separately? Do those reports reach the public domain?
Professor Nutt: They come in through the committee structure with the technical committee.
Professor Sir Michael Rawlins: They form the report that goes to the Council and it is published on the internet.
Q248 Chairman: Do you mean original research, or is this a review of existing research?
Professor Nutt: The ACMD does not have a budget that could remotely fund proper research in the sense of original, primary research. The average research grant that the MRC funds now is about a third of a million and I think the whole committee is run on less than that. It does not have any resources to commission primary research.
Q249 Chairman: It has no mechanism to ask somebody else to commission it?
Professor Nutt: We have worked with the Department of Health who do have a research budget.
Professor Sir Michael Rawlins: And the Home Office sometimes.
Q250 Chairman: When we are talking about magic mushrooms, could you say, as a simple yes or no, when the government decided to put magic mushrooms in class A, was that evidence based? Yes or no?
Professor Nutt: Magic mushrooms contain the active substances which are in class A.
Q251 Bob Spink: They are not in class A based on evidence. They are there because they were there.
Professor Nutt: That is exactly right.
Q252 Dr Harris: It is not evidence based; it is historic.
Professor Nutt: Historic evidence, yes.
Q253 Chairman: Was the Council split on that? Do you ever have disagreements about an issue like that?
Professor Nutt: It seemed somewhat illogical given the fact that we had not done a systematic review of psilocin et cetera, but we did understand that under the current Act it was a class A drug.
Professor Sir Michael Rawlins: The other thing the Council was particularly worried about was that people who had magic mushrooms perchance growing in their fields would suddenly be prosecuted. We made the point that in the fields belonging to the Duke of Northumberland if, by chance, there were some magic mushrooms growing he was not necessarily going to have to go to jail.
Q254 Dr Harris: I am very interested in this risk assessment approach, which is methodical. It is flawed.
Professor Sir Michael Rawlins: Flawed?
Q255 Dr Harris: It is not perfect because of the issue of the lack of evidence. I thought you did very well, Professor Rawlins, in setting that out. When it came to magic mushrooms where the government asked you in a rush what your view was, I had the perception that you did not have time to find an expert. Maybe there was not an expert. You did not have time to do a full technical review. You were asked for your opinion: shall we stick this in class A as well? You defended your decision not to object or to approve by starting in on the precautionary principle and historically hallucinogens had always been in class A. Feel free to write but would you consider, after a review of what you have said, that it might be an alternative approach to say, "On reflection, we did not really have time to do this properly and that is not our fault; it is just the timing. If the government are going to do this they can do it but we should not have given it the imprimatur to imply that a full risk assessment model had been given to it by the fact that we wrote to them saying, 'This is fine, people understand that we do these risk assessments and that might have been the impression they got'." Would that be a fair way of putting the situation?
Professor Sir Michael Rawlins: No. If we were to do a review of psilocin now, the evidence base upon which to make any sort of decision, bar knowledge of the fact that it is hallucinogenic and causes hallucinations when you take various preparations of vegetables that contain it, is about as far as we would ever get. Frankly, I do not think it is worth it. There are bigger, more important issues to worry about than whether fresh mushrooms join the rest of the other things in class A. It is not a big issue.
Q256 Dr Harris: If you get thrown into prison it is a big issue.
Professor Sir Michael Rawlins: That is only if you are supplying and trafficking.
Q257 Mr Devine: There have been recommendations that Ecstacy should be changed from class A to class B. I wonder if you have given the government any advice and, if you have not, why not? There have been various committees that have now made recommendations about the reclassification of Ecstacy.
Professor Sir Michael Rawlins: It is class A. The difficulty is it is one of these other areas where there is very little research done on it. We do not even understand how it kills people. It does. I am afraid the report from the RAND Corporation managed to mangle up the mechanisms of its toxicity but perhaps I could write to you separately about that. The estimates of the mortality rates with it vary some ten to twenty fold, depending on certain assumptions that you have to make. They are either half as harmful as road traffic accidents or they are ten times as harmful. There is a huge, wide variation in the estimates. Frankly, I do not think we would get anywhere by a review at the present time. This may change. There may be better evidence that comes forward but it is vague and imprecise and I do not think we would get very far.
Q258 Mr Flello: Just to pick up on Dr Harris's point about it being an issue if you are caught supplying magic mushrooms and you get ten years, what is your view on perhaps having a twin track approach whereby perhaps all drugs are classified as class A if you are supplying them and dealing in them, but if you are using them for personal use it is in the existing category?
Professor Sir Michael Rawlins: There are various ways in which one could do this. One could change the whole pattern and disaggregate the supply. That is a very fair approach to it, to separate possession and supply from trafficking.
Q259 Chairman: When the Home Secretary made his statement on 19 January he stated that clinical medical harm is the Advisory Council's predominant consideration in terms of classification. Would you agree with that?
Professor Sir Michael Rawlins: We also look at social harms.
Q260 Chairman: So it is not predominant?
Professor Sir Michael Rawlins: It takes equal weight.
Q261 Chairman: The Home Secretary was wrong?
Professor Sir Michael Rawlins: I could not possibly say that.
Chairman: We thank you enormously for your contribution this morning. It has been thoroughly enjoyable. Thank you very much for coming along.