Examination of Witnesses (Questions 40-59)
MR VERNON
COAKER, PROFESSOR
SIR MICHAEL
RAWLINS AND
PROFESSOR DAVID
NUTT
22 NOVEMBER 2006
Q40 Mr Flello: I was going to say
to Professor Nutt, in terms of your take on this issue, what do
you see as the deterrent effect of the existing system? Do you
think that a new system might have a greater deterrent effect?
Professor Nutt: I think one of
the problems with the current system is that there are, I believe,
and I think many people think there are, anomalies in terms of
where drugs sit, so I think an ABC system where the drugs were
appropriately positioned would probably have a deterrent value,
yes. It would at least be fair in terms of the way the law is
enacted.
Q41 Mr Flello: So do you think there
are gaps at the moment in terms of deterrence?
Professor Nutt: No, I think the
deterrents are right, but I just think some of the drugs are in
the wrong categories.
Q42 Mr Flello: So if there is a drug
which you think is in the wrong category, do you feel that people
are not using that drug because they are deterred by the system?
Professor Nutt: I think in some
cases that may be true, yes, and in other cases there may be punishments
which perhaps are inappropriate.
Q43 Chairman: Can I just follow this
up because I just do not know where you are coming from on this.
You, Professor Nutt, stated in evidence to us, "I think the
evidence base for classification producing a deterrent is not
strong".
Professor Nutt: I do not think
it is strong, no.
Q44 Chairman: You maintain that that
is the case and you stand by that statement?
Professor Nutt: I do not think
it is strong, but I do not think it is in the negative direction.
I think it is very likely there is an effect, but I would not
say it was a strong effect.
Q45 Chairman: Vernon, in response
to us, you said that the Government "fundamentally believes
that illegality is an important factor when people are considering
engaging in risk-taking behaviour . . . It believes that the illegality
of certain drugs, and by association their classification, will
impact on drug-use choices". Where is the evidence for that?
Mr Coaker: That is the belief
and the judgment that the Government have.
Q46 Chairman: I did not ask you that.
People believe in creationism and they are entitled to do that,
though I do not agree with that, but I am asking you, where is
the evidence?
Mr Coaker: To be fair to the response
that we tried to make in response to the Committee where the Committee
has challenged us, we have ourselves said that we need to do more
research into the deterrent effect, that we need to establish
a better evidence and research base for that, so we have accepted
the point of the need to actually do something about it, but we
do believe, and strongly believe, that the classification of drugs
in the current system, A, B and C, with respect to Class A does
act as a deterrent system. That is a judgment we make, it is a
belief that we have and we have accepted that there is more to
do with respect to that.
Q47 Adam Afriyie: If when you carry
out and conduct this research the evidence shows that you are
completely mistaken in that view, will change your view?
Mr Coaker: I cannot prejudge what
any research is going to tell us. Clearly you make judgments about
the research that you receive and that is obviously the point.
Q48 Chairman: Vernon, you have not
commissioned any research and nor have the ACMD.
Mr Coaker: No, but what we have
said in response to where the Committee challenged us and said,
"Where is your evidence base for that?", as we have
done with a number of other things, we said that we understand
that point, we accept that point and we need to look at establishing
a better evidence base for that, but it does not alter the fact
or change the fact that the Government believes that the tripartite
system, the classification system, does send out a strong message
and does impact on, and affect, behaviour. I do not want to labour
this point, but I do think that if it is the belief of people
that it does not have an impact, why were people so keen to see
methylamphetamine reclassified?
Q49 Chairman: With respect, we will
return to methylamphetamine because we are waiting for that.
Professor Nutt: Can I say that
there is some evidence. The Runciman Committee did a MORI survey
which looked at this question, amongst others, and did show that
the legal status did have some deterrent value. It was not the
top of the list of the reasons why people did not use drugs, but
it clearly has some deterrent value and it undoubtedly has some
deterrent value amongst professionals.
Q50 Chairman: But cocaine is the
fastest-growing designer drug, a Class A, and it is being used
by basically middle-class professionals, it is not being used
by kids in schools, and yet they are the group who would be the
most deterred, one would imagine, from doing a Class A drug.
Professor Nutt: You might. I suppose
if there were prosecutions, then the deterrent effect might be
more apparent, but certainly I think amongst medical students,
amongst doctors, amongst health professionals, drug-use is to
some extent constrained by the fears that prosecution and conviction
will have on their careers.
Q51 Chairman: But ACPO, when they
were before us, said not and, if anything, said it was of little
consequence or words to that effect.
Professor Nutt: But it is of some
consequence and I still think it is meaningful. It is not a major
effect, but it is probably a meaningful one.
Q52 Dr Turner: Let us come back to
harm. I think the Committee has every sympathy with the fact that
you say that harm is one of the most important factors in classification,
so I guess we are a little, not miffed, surprised that you have
rejected our recommendation that the actual assessment of harm
should be more scientifically based because this would give the
whole classification structure a greater validity, so why did
you reject that?
Mr Coaker: What we say, as a government,
is that we take scientific advice on the classification of drugs
and we take that from the ACMD who are our scientific advisers
with respect to classification. We have every confidence in them.
We believe they offer us good advice and we believe that the eminent
scientists that we have with us here today, they examine the evidence,
they look at the evidence and they provide advice to the Government
on the scientific basis on which drugs should be classified, but
that is not the only judgment we make. Again the evidence that
I gave to the Committee before, as well as the scientific evidence,
we also have to make judgments about the social harm, about the
consequences to communities of all of those and the Committee
itself, and correct me if I am wrong, also recognises the importance
of including that in the judgments that you make about where drugs
should be classified as well.
Q53 Dr Turner: But, following from
that, it is clearly important that if you place a substance in
Class A, that substance really should be in Class A on the basis
of its harm and there are cases, as will be referred to later,
where there is some doubt about that. Now, that does not do anything
for the credibility of the system. Do you not think it would be
wise to look again at purely the scientific evidence of the harm
that these substances do to ensure that that they are correctly
classified?
Mr Coaker: As I say, if you maintain,
as we want to do, the tripartite system of A, B and C, there will
always be a debate about whether the drugs are appropriately categorised,
whether they are in the right category or not. That debate will
continue and if you move drugs around, the debate will continue
about whether it was the right decision or the wrong decision
even amongst scientists and they will argue whether it is right
or wrong, so whatever system you have, even if you scrapped the
A, B and C system and ranked drugs according to another scale
of harm, there would always be a debate and people would argue
whether that should be in that, how much ranking you should give
the social harm, how much science should be a part, whether it
should have three points, two points, one point. That debate will
never go away, so what we try to do is to say that we have a science
committee which we respect which gives us good advice and looks
at the scientific evidence. They themselves take into account,
as Professor Nutt's matrix in its development stage as it is is
also trying to wrestle with this problem, that you have a classification
system where they receive the scientific evidence, they give us
their judgment, we listen to what they have to say and make judgments
accordingly, but we also have other things which affect the decisions
which we make.
Q54 Dr Turner: Well, let us ask the
scientists for their view. Sir Michael, would you like to see
a stronger scientific evidence base in the assessment of harm?
Professor Sir Michael Rawlins:
One of the duties of scientists is always to say that we want
more evidence. We always say that about everything even when it
is transparently obvious. One of the important things actually
about scientific advisory committees and scientific advisory bodies,
as pointed out by the greatest statistician of the 20th Century,
Austin Bradford-Hill, who pointed out that scientists have to
be prepared to give advice on inadequate evidence, we have to
do that and we have to exercise a judgment in parallel. In relationship
to the classification of drugs, we, generally speaking, have a
fair idea of the physical individual harm it does, the dependence
produced, but often the great difficulty is the degree of social
problems it is causing and that is sometimes often qualitative
rather than quantitative. Of course it would be helpful to have
more evidence of that sort, but it is very difficult to acquire
sometimes and we do go to quite considerable lengths to acquire
it, but in the case of khat which is used by the Somali community,
Dr Gerada, who is leading that work, actually met with a whole
group of Somali women to find out their attitudes towards it.
It is qualitative, but it is important that we try and do it and
I am sure, with the passage of time and that sort of qualitative,
sociological research, the methodology will become better developed.
Q55 Dr Turner: Professor Nutt, do
you have a view on the scientific evidence base of the assessment
of harm?
Professor Nutt: As Sir Michael
says, you could improve data at a range of levels. You could improve
data in terms of what the drug is doing in the brain. We have
very few systematic studies on any of the drugs in drug-users,
so if you were to say to me, "Does ecstasy actually damage
the brain or not?", I could not show you a definitive study
either way because that research has not been done, so we clearly
need better evidence at that level. Obviously any evidence we
can gather in terms of absolute level of use and damage in terms
of social damage and family damage would also be very helpful,
so our judgments would be better if we had more research.
Dr Turner: So do you think it
would be wise to commission such research?
Q56 Chairman: And who should do it?
Professor Nutt: The scientific
community should do it, but as to who should commission it, personally
I think it should be commissioned by some consortium which comprises
the MRC, the ESRC and the Department of Health. I think we do
not do enough research on addiction in this country. The amount
of research, as I said before, spent on addiction is very small
in proportion to the scale of the problem and in relation to other
research spends and other medical social problems.
Q57 Dr Turner: Vernon, given that
the Home Office must have some figures, and I personally do not,
in terms of quantifying the amount of damage to society in financial
terms that drug-addiction does, therefore, could you make a case
for even spending however much, and I will not mention a figure,
on commissioning research to get better baselines?
Mr Coaker: Again part of the response
that we have made to the Committee is that this research has been
published not just by ourselves, but all of the time and indeed
in the not too distant future there will be more reports published.
You will know that the European body, and I cannot remember the
name, is publishing a report tomorrow which looks at the scale
of drug-use and the scale of harm.
Q58 Dr Iddon: EMCDDA.
Mr Coaker: Yes, thank you, Brian,
so there is a number of different bodies which are publishing
reports as well as the Home Office. What we need to do is always
to look at where there are gaps in knowledge and how we can fill
those gaps in knowledge to better inform the policy that we make,
and that is one of the things that the Committee challenged us
to do. I think the Committee is right to do that and we need to
look at that, to try and get a better evidence base for the work
that we do, but, as I say, there is research being published all
of the time and indeed in the not too distant future there will
be two or three more reports published which will deal with one
or two of the points you are making.
Q59 Dr Turner: But there is a deficiency
of systematic clinical studies of the effects of drugs.
Professor Sir Michael Rawlins:
Yes, I think both the Council and the Government in its response
accept that we should be doing more research and we take those
comments very seriously.
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