House of COMMONS
MINUTES OF EVIDENCE
SCIENCE AND TECHNOLOGY COMMITTEE
Wednesday 22 November 2006
MR VERNON COAKER MP, PROFESSOR SIR PHILIP RAWLINS
and PROFESSOR NUTT
USE OF THE TRANSCRIPT
Taken before the Science and Technology Committee
on Wednesday 22 November 2006
Mr Phil Willis, in the Chair
Mr Robert Flello
Dr Evan Harris
Dr Brian Iddon
Mr Brooks Newmark
Dr Desmond Turner
Examination of Witnesses
Witnesses: Mr Vernon Coaker, a Member of the House, Parliamentary Under-Secretary of State for Policing, Security and Community Safety, Home Office, Professor Sir Michael Rawlins, Chairman and Professor David Nutt, Member and Chair, Technical Committee, the Advisory Council on the Misuse of Drugs (ACMD), gave evidence.
Q1 Chairman: Good morning and welcome to this one-off evidence session in response to our Drug Classification: Making a Hash of It? Report which came out as part and parcel of a series of three reports which underpinned our scientific advice to the Government which was also published this month. Could I welcome back Professor Sir Michael Rawlins, welcome back Professor David Nutt and a very warm welcome to the Home Office Minister, Vernon Coaker, who has retained his job!
Mr Coaker: So far.
Q2 Chairman: I am sure that this morning's session will enhance your reputation across the nation. Could I also say a very, very warm welcome to a number of guests we have this morning from the Royal Society Parent Scheme. You are particularly welcome to join us in this evidence session. Vernon, the Government said that the classification system has stood the test of time. How do you respond to the criticism which in fact came from the Chief Executive of the MRC that it is antiquated and arbitrary?
Mr Coaker: I think in the evidence that was given there was reference to that, but I think that he himself admitted that perhaps he had overstated his remarks, but we believe the classification system has now stood the test of time. It ranks drugs according to harm, both social harm and individual harm, we think it is necessary on that basis to set penalties accordingly, and we take advice from ACMD with respect to that. Of course that is one part of our strategy, and we have the classification system which we think does all of that, and then, alongside that, we have a drugs strategy, a wider drugs strategy which deals with a whole range of things to do with education, to do with how the law is enforced and to do with treatment and getting more people into treatment.
Q3 Chairman: Could I just be specific with you, Vernon, because this whole inquiry was really about evidence-based policy and I just wonder what evidence do you have or do the Home Office have that their classification system discharges its function effectively because that is what you have just said, that it discharges its function effectively, and we could not find any real evidence for that. Where is the evidence?
Mr Coaker: One of the things we have said in our response to you is that, as I say, we believe the classification system ranks drugs according to their harm, both individual and social, and we have set out the way in which we come to that conclusion and how we make the judgments for that. We take the advice from ACMD, we then, on receiving that advice, make political judgments, we make judgments on the advice we receive from ACPO and from other people, and we take a decision on that. That of course is informed by a whole range of different reports that we receive and research which we commission ourselves, but, as I say, we also accepted in the evidence, in trying to be responsive to the Committee, that we appreciate there is more work to be done with respect to the deterrent effect and so on, but, as I say, the important point I want to make to the Committee this morning is that we see the classification system as an important way of saying to people that this is the way in which we rank drugs according to harm and I have indicated there how we define harm, both on an individual basis and a social basis, but, alongside that, a whole series and a whole range of work to do with enforcement of the law, treatment of individuals and education of our young people.
Q4 Chairman: I do not think we are ever saying, and I would not want you and certainly Sir Michael to feel, that the Committee feels that the Government is not well-intentioned and that obviously we are not well-intentioned in terms of what we are trying to do. What we are trying to get at is: where is the evidence to underpin the current classification system? I wonder if I could turn to you, Sir Michael, and ask, do you really feel that the classification system should be evidence-based?
Professor Sir Michael Rawlins: Of course, of course the classification system should be evidence-based, yes, and the current classification system is based on placing substances into three classes based on their harmfulness to individuals and society and of course it should be evidence-based.
Q5 Chairman: But we found a number of glaring discrepancies, did we not, and I think you would agree they were glaring discrepancies, in terms of classification where there was no evidence whatsoever to put a particular drug into a classification?
Professor Sir Michael Rawlins: Which particular classification are you talking about?
Q6 Chairman: Well, we will take magic mushrooms which we will come on to later, but I am just giving that example.
Professor Sir Michael Rawlins: I do not accept the point you are making about magic mushrooms, to be frank.
Q7 Chairman: Well, my colleague will deal with that.
Professor Sir Michael Rawlins: I am sure he will!
Q8 Chairman: Professor Nutt, you clearly have some misgivings about the classification system and indeed feel that we could have a better way of actually demonstrating harm in a much more evidence-based fashion, so are you happy with the current system?
Professor Nutt: I would say a few things. What I have worked hard to do in the last few years is to try to work out a methodology for assessing harm and that has been a relatively successful process, at least I think the process we set up is an effective and transparent one. We are still in the process of trying to convince the scientific community that what we have done is valid.
Q9 Chairman: I will come back to your actual classification system which I hope is going to be published soon, but in terms of the principle, do you feel that the current ABC system is sufficiently evidence-based to stand up to robust examination?
Professor Nutt: I need to understand whether you are saying, "Is a tripartite classification system a good way of dealing with drugs?" or "Is the current allocation of drugs within ABC correct?" Which of those questions are you asking?
Q10 Chairman: Well, actually both, but the underpinning question is: are you satisfied that there is sufficient evidence to support the classification of the current illegal drugs which are in each of those classifications, yes or no?
Professor Nutt: I would have to say no. I do not think that all the drugs are correctly classified according to the current classification system which is one of the reasons why my committee has been systematically reviewing the harms of drugs.
Q11 Dr Turner: Vernon, successive home secretaries have dithered a little bit on the question of reviewing the classification system. When you made your response to this Committee's report, the Government finally said that it had decided not to pursue a review. Can you explain all of your reasons for not reviewing the system?
Mr Coaker: Well, this is a consistent problem and you will know that the Home Affairs Select Committee in 2002 looked into the whole issue of the effectiveness of the Government's drugs policy and they actually came to the conclusion that it was fit for purpose. There was a report in 2000, the Runciman Report, and the Police Foundation Report which as well said that the drug classification system was appropriate, relevant and fit for purpose, so, as I say, it is an ongoing debate. Essentially, when it comes to today, 2006, we think that the classification system where we are ranking drugs, A, B and C, the tripartite system, as you know, where different drugs are allocated according to individual and social harm which we believe they cause, it is based on the evidence that we receive from the ACMD and we think that that, as one part of the Government's drugs policy, is an important part of the strategy. It sets out clear penalties for the possession and supply of those drugs and, as I say, ranks them according to what we believe their individual and social harm is. There will always be debate and discussion as to whether the different drugs are in the right category, that will always happen, which are the most dangerous drugs, which category, if you have a tripartite system, should they be in. We thought that, on that basis, we had a system that works well, we thought and we think, but we also then say that we do not want to be diverted into an argument about which categories different drugs should be in, whether the Government is relaxing its efforts towards a particular drug, whether this means that the Government is saying that a particular drug is something that is softer than other drugs and, therefore, okay to take. What we wanted to do was concentrate our energy and our efforts, and I know that this is a common goal that everyone shares in this respect, on the things that we think are particularly important and which we think are making a very real difference. That is clearly enforcement of the law, that is clearly about making sure that law enforcement is effective and getting the dealers off the street. I know that is something everybody wants and there is no difference between us, all of us accept that. Alongside that, we want more people into treatment. We realise there are public health issues with respect to this and that is why we have massively increased the amount of money going into drug treatment, so huge numbers, record numbers of people are now going into treatment and what we want to do now is make that more effective so that we retain people in treatment, so that we get wrap-around services with respect to housing, with respect to employment, with respect to benefits, with respect to family relationships, all of those things done as well. Then of course we want to have education and we want to educate particularly our young people with respect to drugs and with respect to the dangers of drugs. We thought that concentrating on the drugs strategy that we have got, and I would just refer you to the introduction in paragraph 11 which lists a whole range of different things which, we think, have demonstrated the effectiveness of the strategy, that is what we wanted to concentrate on.
Q12 Chairman: Why then, Vernon, when the previous Home Secretary was in place did he feel that we did need to have a review of classification? Surely the same officials are there, the same evidence is still there, Sir Michael is still there, so why in such a short period of time did things change so dramatically?
Mr Coaker: Well, these are obviously judgments that people make and when we began to see particularly the massive increases in the numbers of people coming into treatment, particularly when we, as I say, see what the results of the Government's drugs strategy has been where there has been real success on the ground, we believe, and of course we are not complacent about it, of course we know that too many communities are still affected by drugs, too many people are still affected by drugs, but we saw the drugs strategy as being effective. The judgment we made was that we did not particularly want to get into a debate about how you rank particular drugs, we think we have got a system that effectively does that. What we wanted to do was to say we have got to clearly recognise ----
Q13 Chairman: But what changed? Was it just simply the fact that the Home Secretary changed or was there some material evidence which came to the Home Office through ACMD which actually made the decision to review the whole system and to scrap it?
Mr Coaker: I think what we began to see were increasing results from the drugs strategy that we were dealing with and this was brought into focus really by the fact we are now reviewing the drugs strategy. We introduced it in 1998 and it was reviewed and refreshed in 2002 and obviously we have to do that again in 2008. We started to look at that, saw the very clear results and just said, "Where do we want our efforts to go? Where do we want the drive, enthusiasm and determination to go?", and we felt that, by doing it with respect to the drugs strategy, that was the appropriate place to put our efforts, and we felt that if we had a big row about the classification, then we might be diverted away from that effort.
Q14 Dr Turner: But, Vernon, since the drugs strategy itself is very heavily predicated on the drug classification, do you not think it is logical, if you are reviewing the whole strategy, to review the classification in the process?
Mr Coaker: We think that, if we did that, we would actually spend all of our time arguing about that rather than concentrating on the things that are making a difference on the street. We accept, as we tried to do in the response to the report, the need for us to continue to look at how we use evidence, how we use science, how we use all of the various other ways to inform that, but, as I say, the judgment that we made was that we wanted to concentrate on the drugs strategy while looking at how we improve the evidence base of the classification system.
Q15 Dr Turner: That is almost tantamount to saying that the drug classification per se is much less important than the drugs strategy.
Mr Coaker: No, not at all. I am not saying that at all and that was evidence ----
Q16 Dr Turner: There is an argument for that.
Mr Coaker: Let me just say this very clearly, that it is not a way of saying that. Of course the drug classification system is important and the evidence of that is the fact that, as you know, we reclassified methylamphetamine from a Class B to a Class A drug because we thought that was an extremely important thing to do on the basis of the advice from ACMD, on the basis of what the police were telling us and on the basis of the evidence that we were receiving. I do not expect that anybody actually objected to that because they realised the dangers that potentially crystal methylamphetamine posed for the country, posed for communities, so do not mistake what I am saying. Of course the drug classification system is extremely important alongside the drugs strategy, but all I am saying is that we wanted to concentrate on the drugs strategy and let the drug classification system do its work, as I think it demonstrably did with respect to methylamphetamine where everybody, everybody has welcomed the move of it going from B to a Class A drug.
Q17 Dr Harris: Can you just say, therefore, given what you have said, whether you believe, and it is a yes or no, that the decision to drop the plan to review the classification system itself was an evidence-based decision?
Mr Coaker: I think the evidence that you take is a variety of evidence.
Q18 Dr Harris: I am not asking what the evidence was yet, I am just asking you whether you thought that decision to not do the review was an evidence-based decision?
Mr Coaker: It was based on the evidence we have received and the judgment that we made at the time.
Q19 Chairman: Have you published that evidence?
Mr Coaker: No, but it is the evidence that we have received on the basis of the drugs strategy, it is the judgments we make, and this is the point and it comes through, to be fair, in what the Committee are saying as well, that of course science informs the decisions that we make, but there are all sorts of other things which affect it.
Q20 Chairman: We are not disagreeing with that, but you said in response to Des that in fact it was the evidence of your drugs policy that actually made you abandon the review and what we are saying is: is that evidence available?
Mr Coaker: If I could refer you again to the evidence in the introduction of paragraph 11, when we reflected on the success that the drugs strategy was having, in the evidence that we sent back to you on paragraph 11 where there is a whole range of different indicators with respect to enforcement of the law and with respect to numbers into treatment, these were the sorts of things we saw were happening that we reflected on and decided, as a consequence of that, that the drugs strategy was the thing that we needed to concentrate on.
Q21 Dr Turner: Sir Michael, when you came to see us before, you said that you welcomed the prospect of a review of the classification system.
Professor Sir Michael Rawlins: Yes.
Q22 Dr Turner: Have you changed your mind on that or are you concerned that in fact it is not open to review?
Professor Sir Michael Rawlins: No. As I said, I think, last time, the classification system had been around for 35 years and I thought it was worthwhile having another look at it and seeing if there was an alternative or perhaps an even better way, but it is a judgment we make on these sorts of things and the present system ain't broke, we have been using it and if the judgment of the Home Secretary is that he would rather keep it as it is, that is fine, that is the judgment. I do have to say what I said last time, that advisory committees like the ACMD, we look at the evidence, but we also have to take judgments. Every scientific advisory committee I have ever sat on, and I have sat on many, always has to make judgments alongside the evidence. The evidence is never complete on anything and, as William Blake said, "God forbid that we base our decisions solely on algebra", and that was 200 years ago.
Q23 Dr Turner: That is very nicely put. Can you think of any particular flaws or objections to the present system and any ways or different approaches we could take?
Professor Sir Michael Rawlins: Well, a judgment has to be made about the balance with all the harm. Decisions can be informed by the sort of analysis that David Nutt has developed, but at the end of the day one still has to make a judgment about which category one puts them in, and that has to be a judgment and I am unashamed to admit that it is a judgment. Another group of people on another day might well come to a different judgment, and I accept that too, that is the nature of judgments, so it is judgments based on the science, but there is still a judgmental element to it.
Q24 Dr Turner: Since we have Professor Nutt here, do you have any comments on the system? Would you wish to see the system reviewed and, if so, can you give any pointers?
Professor Nutt: Yes, I think I would say a few things. I think it is important to know that those of us who work in this area continually are interested in finding an optimal system and we have looked, as you did in your own report to us where you looked across the world at different systems in different countries, we have done that, the Runciman Committee did that, did a very systematic review, and always in our dialogue with colleagues in other countries, we look to find a system which might be better. I think if there was obviously a system which was an improvement, then we would surely recommend it. I think at present there is no clear direction in terms of a system of structuring drug harm classification which is obviously better than what we have at present which is, I think, why the Runciman Committee came to that conclusion, and that is the problem. Now, beyond that, there are interesting issues, issues that you yourselves picked up in relating to drugs which are not in the classification system, like alcohol, for instance. These present huge problems to groups like ours who are looking at illegal drugs, but they clearly are very relevant to society as a whole, and a system which at least brought those into consideration, I think, would be something that we might aspire to, but again it is not obvious just how you do that with the current situation of those drugs in relation to illegal drugs.
Dr Turner: It would be a little awkward, would it not, if you looked at alcohol and classified it as a Class A as that would just be penalising everybody in the country?
Q25 Dr Harris: Perhaps I could just clarify something with Sir Michael. The ACMD has never formally discussed this question. Is that right?
Professor Sir Michael Rawlins: That is right.
Q26 Dr Harris: I find it a little strange because the paper that we referred to, of which Professor Nutt was the lead author, said, "The current classification system has evolved in an unsystematic way from somewhat arbitrary foundations with seemingly little scientific basis". Now, that is quite a strong comment, I think, in your paper.
Professor Nutt: I will just see if it is still in the final version.
Chairman: It is the version you gave to us.
Q27 Dr Harris: That is quite a strong view and ----
Professor Nutt: Yes, and I think it is true though, is it not?
Q28 Dr Harris: Yes, and it is a strong view and Sir Michael said he agreed that the Home Secretary was correct, and he says, "I think it right that the Home Secretary is relooking at it". That was your view. Another member of the committee, although he gave evidence as Chief Executive of Drugscope, said, "I think the fact that the Home Secretary has announced a review is very welcome". Now, given all those comments coming from members of the ACMD, in a sense it is a little surprising, given that you as Chairman expressed a view, that you have not actually discussed it, given that it is a key issue and in fact that the Minister has just said that the view not to do it was based on evidence. Now, you are the key person and the key committee involved in giving evidence, so I am a little surprised that you have not discussed it as a committee before giving your view. It might have been helpful.
Professor Sir Michael Rawlins: Actually we have not met since then, since your report, because the Council only meets twice a year. I think the issue is whether there is obviously a better scheme. Now, as Professor Nutt has said, different countries have enacted all sorts of schemes and some countries have a sort of nine- or ten-points scale.
Q29 Dr Harris: I am sorry, I do want to go down the path that Des has explored already because I am sure you have a view as to what other countries do, but do you think it would have been worthwhile the ACMD discussing this so that you could have fed into the evidence base that the Minister just quoted on this key question, and it is a key question and the Home Secretary has made a big fuss about it previously and is now not doing so, not to do it? That is my question.
Professor Sir Michael Rawlins: No, it is a political judgment which has to be made about some of these sorts of things and I think that is a perfectly appropriate one for the Home Secretary and ministers to make. If they want to keep and retain the present system, okay.
Q30 Chairman: But you do not agree with it?
Professor Sir Michael Rawlins: It is a judgment and it is not black and white.
Q31 Chairman: What is your view?
Professor Sir Michael Rawlins: I would have personally liked to have had a review to see if there was anything better, but a judgment has been made and I am more than happy to accept somebody else's judgment on these things and leave it as it is.
Q32 Dr Harris: But it was not just a political judgment. The Minister has just said, I heard him, I asked the question, that it was based on evidence and I am not disputing that. If it is partly based on evidence and members' political judgment on top, which our recent report says is quite okay, then your job, I would have thought, is to feed in on these key questions your view of the evidence. I am just surprised. Do you think, at least in retrospect, that it might have been a useful exercise even if you did not do it, that it might have been a useful exercise?
Professor Sir Michael Rawlins: I am not sure actually, I am not sure. I have not thought about it in that context, but I am not sure.
Q33 Dr Harris: Then, on that basis, I would put it to you that you are wrong to reject outright the suggestion that it might have been useful because all you can say is that you are not sure whether it would have been useful, yet your response to us rejects outright the accusation that we made, and you might not accept it, that there was a dereliction of duty by failing to recommend, ie consider and then provide evidence, that the classification system be reviewed, not changed, reviewed. You are quite forthright in response to us and now you are prevaricating.
Professor Sir Michael Rawlins: You stated that there had been a dereliction of our duty not to have considered it before.
Q34 Chairman: Yes.
Professor Sir Michael Rawlins: I reject that, then as now. What you are now asking is should we have done it since your report and in relationship to the decision of the Minister. That, I think, is what you are saying now because it is two slightly separate things: one, should we have done it in the past; and, secondly, should we have done it in response to a request from the Minister.
Q35 Dr Harris: Given what Professor Nutt is on record as saying and Professor Blakemore and Martin Barnes and you about welcoming the review, then I would have thought that you in particular, as Chairman of the ACMD because you were not commenting in any other capacity, would have discussed it, that at least there was an argument. That is why I question whether you are right to reject outright our suggestion that it would have been useful had you discussed it because then you would have been in a position to feed in evidence upon which the Minister could then make a political judgment.
Professor Sir Michael Rawlins: Yes, but our response was to your recommendation 42 where you had accused the Council of a dereliction of duty. That is strong language, strong language, and I resent it actually and reject it.
Chairman: Well, we are going to move on because we are not going to resolve that matter.
Q36 Mr Flello: I would like to move on to the deterrent effect that classification may or may not have. In the report, the Committee explored whether placing drugs in a higher class has some kind of a deterrent effect. Vernon, I would like to ask what the purpose of the drug classification system is in deterrence. Should the classification of a drug be used to send out signals about its use?
Mr Coaker: As I say, we believe that the drug classification system, as it currently stands, is well understood, the tripartite system of A, B and C. We think that it is well recognised by people that Class As are generally understood to be the most serious drugs, the most harmful drugs, whether based on individual harm or social harm, and we think it is, therefore, appropriate to actually then couple that with penalties. We do not believe that decoupling the classification system from penalties is the appropriate way forward. We have accepted in the report that that is our belief and that is the judgment that we make, and what we have said is that we recognise, in response to what the Committee have said, that we ought to do more research with respect to that deterrent effect and that is one of the recommendations, I think, the Committee made ----
Q37 Chairman: Yes.
Mr Coaker: ---- and one of the things that we said we need to do more research on, and again the Committee itself recognised that when talking, I think, about Professor Nutt's own matrix, that it is as much an art as a science. The Committee itself put that in the report and these are judgments that people make as well taking into account all of the various things. I am not trying to evade the question on that because we have accepted that we need to do some more research with respect to that deterrent effect, but I just pose the question again as a rhetorical question: if nobody believes that it actually acts as a deterrent, why was there so much universal acceptance by everybody about moving crystal meth from B to A?
Q38 Mr Flello: I just want to go back to the issue of decoupling the penalties later on, but in terms of sending out the signal, do you feel, and I accept that you will be looking further into this issue, that there is a difference in the perception about the deterrent effect or otherwise between perhaps the wider community and drug-users themselves?
Mr Coaker: I think that is certainly a part of what we need to look at, what deters drug-users as well as the wider community. I think the wider community understand that and I think drug-users understand it. Again I think in some of the surveys we have done with offenders, it is apparent, although not hugely apparent, that some notice is taken of the class of a drug, particularly with respect to Class A drugs, and I think there is an OCJ report or something which actually concludes that, so I think there is an effect on drug-misusers and there is an impact on the wider community. Again this is partly why I referred to the evidence we had about the drugs strategy, that the evidence we have had, talking to drug-misusers, is the importance of treatment, the importance of the availability of support, the importance of trying to have a wrap-around service which we know we need to develop, and they have talked about that. That is why we are saying okay, for the wider community the drug classification may be something that works and maybe for drug-misusers it is the drugs strategy as well which actually informs that debate and helps with that debate, as I say, with respect to the issues which I have just raised.
Q39 Mr Flello: Can I turn now to Professor Rawlins. In terms of if a drug is in Class A, do you feel that that is a deterrent or an attraction to a drug-user?
Professor Sir Michael Rawlins: My instincts say it is and of course particularly dealers, who I think are the real people one needs to get to, also recognise the difference in the penalties for Class A drugs and of course, because the penalties are so much more severe, the price of Class A drugs tends to be a lot higher. I am not sure whether the Committee has seen the latest British Crime Survey report on drug-use, but since 1998 Class A drugs generally have either declined or remained stable, the reported use of them, with one exception and that is cocaine powder, so I am not sure if that answers your question or not, but I will try again if it does not.
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 the evidence shows when you carry out and conduct this research that actually you are completely mistaken in that view, then you will change the 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 Rada, 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: EATA.
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.
Q60 Dr Turner: So will you, Vernon, consider commissioning this research?
Mr Coaker: We will always consider it. I cannot make any categorical judgments on these things, but we will always consider these sorts of reports. It is actually the EMCDDA, this report out tomorrow. Do not ask me to say exactly what that stands for. Actually it is the European Monitoring Centre for Drugs and Drug Addiction.
Q61 Chairman: Just before we leave this and move on to Robert, I actually find this exchange quite disturbing because you, Professor Nutt, have clearly stated that there is inadequate research and to actually say, as you have done a few moments ago, that, in terms of the effect on the brain of ecstasy, there is no definitive research either been commissioned or carried out, I find that quite an alarming statement to make, and I think it is a very honest one, if I might say. It flies in the face of what the Minister has said in his response to us when we made the comment that UK investment into addiction research is woefully inadequate. Your response to us was, "The Government rejects the assertion that addiction research is woefully inadequate. Significant research has been undertaken by the Home Office et al". There is a real issue there where your technical adviser, Professor Nutt, is saying it is woefully inadequate and you are saying that you are rejecting that. That worries me.
Mr Coaker: The point that we have made, and I am not sure Professor Nutt said it was woefully inadequate as a general comment about the whole of research, and correct me again if I am wrong, but it was with respect to ecstasy, I think, the point. What we reject is that it is woefully inadequate across the whole of government. What we have accepted is that there are issues where more research is needed and again, in trying to be helpful in responding to the Committee, we will look at ----
Q62 Chairman: In terms of methylamphetamine, in terms of magic mushrooms, in terms of ecstasy and in terms of cannabis addiction, can you point to a single study that the Home Office has commissioned, an in-depth study to actually inform the Government about those four key areas?
Mr Coaker: Well, we have a number of research policies.
Q63 Chairman: Is there any research in any of those four key areas, high-profile, public areas, and the answer is no.
Mr Coaker: I could not specifically refer to one piece of research. There are a number of research papers which will no doubt deal with some of the points which you make with respect to that, but I cannot point to one specifically at the moment.
Professor Sir Michael Rawlins: I think it would be unfair to say that the Home Office was not, and it would be very unfair to the Chief Scientist at the Home Office to say that he was not, commissioning research in relation to this because he is unquestionably. A lot of it is secondary research, not necessarily primary research, but secondary research and very important. Also there is of course research undertaken by the police, some of which does not actually get published for reasons which I think are obvious, so I do not want you to go away with the idea that there is no research being done at all, but I think what people like David Nutt, who is really very close to this area, would say is that he would like to have access to better research and it is something that he and I will bring up with Colin Blakemore and the ESRC to see how we can move this forward. We take that point and we hold our hands up.
Q64 Dr Iddon: But the main drug charities, Drugscope, and I could name a whole string of them, have been very critical certainly in the ten years I have been in Parliament about the amount of research that has been done in the United Kingdom on drug-addiction and all the issues we have discussed this morning. We rely apparently mainly on research coming out of the United States of America who, by a proportion of GDP, spend far more on research and development than we do here. Would you agree with that?
Professor Nutt: That is correct, that is a fact.
Q65 Chairman: It would be very useful for us just to be able to have a handle on what research is being commissioned by the Home Office into these things.
Mr Coaker: We did commission the ACMD to look at crystal meth, to review the evidence on methylamphetamine after the initial decision.
Chairman: After it had already been wrongly classified. We will come back to that.
Q66 Dr Harris: I think what the Chairman is after, as Sir Michael said, the Home Office has commissioned some secondary research and what we are after is a list of that commissioning, which you can send us later, particularly in response to the ACMD's 2002 report on cannabis, its 2003 report on hidden harm and its 2004 report on ketamine, all of which requested, we are told by the ACMD, the research to be commissioned.
Mr Coaker: To be helpful, we can write to you.
Q67 Mr Flello: I would like to return, if I may, to the issue of decoupling penalties from the classification system. During the inquiry, Andy Hayman the Chair of the ACPO Drugs Committee argued that a classification system was useful to "direct effort" in health services and policing but since the police could use their discretion in determining their responses, it was not a problem that the classification system was "pretty crude". Given that the police use their discretion in determining their responses anyway, what would be the disadvantage of decoupling the ranking of drugs from penalties?
Mr Coaker: As I understand, Andy Hayman was saying it does influence the policing decisions that they make in the community. What he was saying, however, was these are operational matters for the police as to how they best police their own communities. We also know, for example, that the Serious and Organised Crime Agency is directed predominantly towards tackling Class A drugs so, as I say, the police officers who speak to me - ACPO and so on - understand the classification system and they use that as part of the information they use in determining operational matters within their localities, so I think in that sense that is what Andy Hayman was saying and I think it is an important contribution to it. It directs activity, the dealers in particular know the consequences of their actions, and it is part of the way that we try again as part of our drugs strategy not only to tackle people who misuse drugs but to deal with those people who supply drugs as well.
Q68 Mr Flello: Professor Nutt, can I address the question to yourself. Do you see a disadvantage in decoupling the ranking of drugs from penalties?
Professor Nutt: In a way I probably do because at some point someone has to decide what the penalty is. It may be easier for a committee such as ours to look at rankings rather than the police or the judiciary themselves. At some point we have got to do it.
Professor Sir Michael Rawlins: It seems to be a principle of British justice that the penalty fits the crime. The more severe the crime and the more nasty stuff you are purveying then you go to prison for longer periods of time. That seems to be a perfectly reasonable approach to justice and I had always believed it to be the approach underpinning the classification system; the nastier the drug the longer you go to jail if you start trading in it.
Q69 Chairman: Nastier means the degree of harm to the individual and to society?
Professor Sir Michael Rawlins: Exactly.
Q70 Chairman: Which is why we sell alcohol in every supermarket!
Professor Sir Michael Rawlins: It would be a very brave Home Secretary who declared alcohol a controlled substance.
Q71 Adam Afriyie: I think that leads me to my line of questions. It is quite clear that alcohol and tobacco to some extent, and maybe even caffeine one could argue, but there is no doubt that alcohol causes a tremendous amount of crime, anti-social behaviour and all sorts of societal problems to the individual and to society overall. I wonder how you would rank alcohol and tobacco in the scale of harm that the ACMD uses.
Mr Coaker: Can I just say as an introduction to that, the Committee itself - and I thought it was a very sensible finding - was not suggesting that you make alcohol and tobacco illegal and the Committee itself recognised that. I think what we are talking about with respect to alcohol rather than tobacco is the Government's position is that it is the misuse of alcohol that we wish to address.
Q72 Adam Afriyie: The question was where would you rank alcohol?
Mr Coaker: I think misuse and abuse of alcohol rather than alcohol per se is something that is obviously very harmful, and that is why the Government has spent a lot of money and a lot of time not just in the Home Office but working with other government departments trying to address the harm that alcohol causes when it is misused.
Q73 Adam Afriyie: With the harm caused by alcohol and arguably tobacco, in my view looking at the scales, they should be rated far higher than LSD and ecstasy. Where do you think it would be positioned on the table?
Mr Coaker: First of all, there is a distinction between illegal and legal drugs, as I know you are aware, and what we have got is a classification system that ranks illegal drugs. What we also have alongside that is issues with respect to substances which are legal, as alcohol and tobacco are, and that we know cause harm, particularly with the misuse of alcohol. The misuse of alcohol is a serious problem. I have seen what people have said as to where it should be placed. I think somebody was recommending somewhere on the border of A and B. I do not know whether that is the appropriate place for it but I stress again, Adam, it is the misuse of alcohol and we do have significant policies in government to try to tackle a problem which we know is a very real one.
Q74 Adam Afriyie: Okay, but do you think it might be helpful in the Government's aim to tackle the misuse of alcohol and perhaps even the use of tobacco, to educate people by including it in that table of harm so they can see very clearly where they fit as mind-altering drugs?
Mr Coaker: If you have retained the classification of illegal drugs, as we have done, I do not think you could put it in that categorisation. What we are doing ---
Q75 Adam Afriyie: --- But that is based on the harm to individuals and society and surely you can place alcohol within that table?
Mr Coaker: The judgment that we have made is a distinction between legal and illegal drugs, but what we have also recognised, however, is that you have got a classification system dealing with illegal drugs, then we have got legal substances - and again there is no division between us on this - and we know where alcohol is abused there is a real issue. We know that we need to tackle that. We have an alcohol harm reduction strategy which we are looking at, and we are working with the industry, working with education, working with health, working with all other government departments to try to tackle that.
Q76 Adam Afriyie: The only short point I would make and ask for a comment on is why does the Government feel the need to withhold that information, if you like, as to the harm to individuals and to society of legal drugs like alcohol? Why is that not in the table? Would that not help to educate people to see the impact that these substances have on society?
Mr Coaker: We are not trying to withhold information about the harm that the misuse of alcohol does. We know the misuse of alcohol is extremely harmful. There has been a lot of publicity about it, the information is out there, there have been a lot of debates in Parliament and so on about all of that. What I am saying is that we would not put it in a classification system at the current time where we rank illegal drugs.
Mr Newmark: That is only for historical reasons. The fact is that both alcohol and tobacco alter people's mental functioning. If we are trying to educate the public as to the harm of drugs that are illegal, then I do think there is some sort of relativism in order to be honest with the public with respect to alcohol and tobacco. That is not something we are saying you should do but it is something that should be considered. Again, for historic reasons we have said that marijuana is illegal and yet we know of many young people who take marijuana and who say it is no more harmful to them in terms of altering their mental functioning than two glasses of alcohol of some form. I think it is important if we are going to be honest with the public that we do tabulate it. We could have one column that says "illegal" and one that says "legal". The fact is just because for historic reasons we have decided marijuana is illegal and alcohol and tobacco are legal does not alter the fact that both actually alter people's mental functioning, and I think that is the important message we need to get across to people.
Q77 Chairman: Do you agree with that?
Mr Coaker: First of all, marijuana - and I know you are not saying this, Brooks, but just to be clear about this - will stay a legal drug. I know that you were not suggesting that it should not be. Just to repeat the point, I think the important message is about the harm that the misuse of alcohol does. That is the message that we need to get out there. That is the message that we are trying to do. I am not sure to put that in a list with illegal drugs is the most appropriate way to do that. There is an issue about ensuring that everyone is aware of the harm that misuse of alcohol causes.
Q78 Dr Turner: I think the point, Vernon, is not so much that anyone is suggesting that tobacco or alcohol should be made illegal but that it should be pointed out that were they illegal drugs this is where we would put them on a scale of harm.
Professor Sir Michael Rawlins: Can I come in here. In another life I live every day with the problem of alcohol and tobacco, which cause more misery and suffering than the whole of the misuse of drugs together. Collectively it causes about 150,000 premature deaths every year. Our response to that has to be very different to the response to the substance misuse issue. It is a massive problem, it causes, as I said, untold misery, and our reaction to it has to be predominantly a public health one. There are limits to what the law can do. Everybody knows that too much alcohol is bad for you, everybody knows that. Kids are also taught at school about the harm caused by tobacco. What is very disturbing is the fact that the early use of tobacco and alcohol by kids is probably the main gateway to substance misuse later on, and I think we really do need as a society to recognise the importance of tobacco and alcohol in relationship to kids and do more in schools. However,, frankly, putting it into the classification system I just do not think is going to get us anywhere. We have got to focus our effort on what will really, really work.
Q79 Mr Newmark: This goes back to my point, therefore if you are trying educate children - and I agree as someone who is a non-smoker and non-drinker myself - as to why drugs are bad (and I agree with Vernon's statement that that does not mean that we should make anything legal that is illegal) we must show young children in particular, if we are saying marijuana or LSD or anything else kids take is bad, in the exact same table that alcohol and tobacco are just as bad or relatively as bad as the other drugs on the table. That is part of the education process. If you are saying one is a public health issue because for historic reasons we have said alcohol and tobacco are perfectly okay but for other reasons we have said dropping LSD and smoking marijuana is not, I think it is very misleading to the public, and in particular to young people, and I think it shows that we are being hypocritical.
Mr Coaker: The only point I would make, just to repeat, is we have got a classification system for illegal drugs; we have got legal substances, alcohol and tobacco, which we try and regulate through other means such as through public health messages.
Q80 Mr Newmark: In terms of its impact on society ---
Mr Coaker: And we try to address that in different ways through public health messages that we put out and through education.
Q81 Dr Turner: I think the point is that you cannot necessarily put them into totally distinct categories because if you talk to anyone who drinks a bit and certainly anyone that smokes, nine times out of ten they will say, "I do not do drugs", but of course they do.
Professor Sir Michael Rawlins: Coffee, tea, the whole lot; we all do drugs.
Dr Turner: Tobacco is a lethal drug. All I am suggesting is that you draw the parallels and you use this as part of your public education to the effect that alcohol and tobacco are examples of potentially very harmful or even lethal drugs
Mr Newmark: And addictive.
Dr Turner: Which are as harmful if not more harmful than many Class A illegal drugs. I think that sends out a very powerful message if you link the two.
Chairman: To be fair, one of the most disappointing aspects of the response from the ACMD and the Government was the total rejection of a new scale of harm decoupled from criminal penalties to put alcohol and tobacco and other substances within that scale of harm. I will not ask you for a comment, Professor Nutt, because I know you totally agree with my comments!
Mr Newmark: I would put at the far end of the chart that you would put there how many deaths are created by each of these drugs and alcohol and tobacco, so people can see the harm of alcohol and tobacco.
Q82 Chairman: I think we have made our point very forcibly to you and I know that you will take it away, Vernon.
Mr Coaker: Always, of course.
Q83 Dr Iddon: As you know, we looked at individual drugs in our inquiry and I want to start by looking at methylamphetamine, ice, crystal meth, or whatever you wish to call it. In November 2005, Professor Rawlins, your Committee advised the Government not to move crystal meth from Class B to Class A on the basis that "reclassification could have had the unintended consequence of increasing interest in the drug amongst potential users". Then on 25 May 2006 you did a u-turn and recommended to the Government that crystal meth became a Class A drug. What was the evidence on which you based your first decision and what was the new evidence that caused you to do a u-turn?
Professor Sir Michael Rawlins: I think I made it perfectly clear but I will repeat it. The first time round there was virtually no use at all in Britain and the police and the forensic services had virtually no evidence of use, and so we had to consider very carefully whether making it a Class A drug would promote its use rather than deter it. That was an honest decision. Whether it was political I do not know, it was a judgment we made and because it was such a serious judgment I very consciously went to talk to the then Minister Paul Goggins about it and to explain why we were recommending it as we were, but I said we would keep a close eye on it. Six months later we had intelligence from the police to suggest that they had found a number of laboratories that were starting to manufacture it and they had intelligence in relationship to a small increase in usage, and we felt that under those circumstances we should recommend classifying it as Class A. The business about drawing further attention to it by that stage had probably been overwhelmed by the beginnings of the emergence of laboratories. You may call it a u-turn but we were acting on additional evidence subsequent to our initial review.
Q84 Dr Iddon: In your response to our report you mention that you are not simply a scientific forum but you consider social impacts of drugs misuse as well?
Professor Sir Michael Rawlins: Yes.
Q85 Dr Iddon: We would agree with that but where does your evidence come from about the social aspects of drugs misuse? Where do you get your evidence from?
Professor Sir Michael Rawlins: The evidence comes from a number of sources. It may come from publications, it may come from surveys that we are aware of or surveys that we commissioned (like in the case of khat where we undertook ourselves some qualitative research in relation to its use), and we get information also - not conventional scientific evidence - data, evidence, if you like, from the police and from other sources, from Customs & Excise, from the forensic science laboratories, and we have patterns of epidemiological use from the British Crime Survey, so they come from a number of different sources.
Dr Iddon: Let me turn now to magic mushrooms which, as you know, is a special interest of mine.
Chairman: I hasten to add for the record that he does not use them. Maybe this is why the Committee is always so happy!
Q86 Dr Iddon: Why did you recommend to the Government that magic mushrooms were classified as a Class A drug?
Professor Sir Michael Rawlins: Psilocin and psilocybin are hallucinogens. They have long been known to be hallucinogens and they have hallucinogenic properties very similar to lysergic acetate, the underlying element of LSD. Psilocin and psilocybin has been a Class A substance since the Medicines Act started, and I think perfectly reasonably. Hallucinogens are unpleasant things to have in a community. Psilocybin and psilocin, whether it is in dry mushrooms or wet mushrooms or any other sort of magic mushrooms, have the same pharmacological effects. There is not a bioavailability problem between fresh mushrooms and dry mushrooms. You absorb the same amount of psilocin and psilocybin from each. Psilocybin and psilocin are controlled substances and dried magic mushrooms are controlled substances and so should wet ones or fresh ones be.
Q87 Dr Iddon: Why was it decided to put psilocin and psilocybin in Class A?
Professor Sir Michael Rawlins: That was the decision of the group that originally ascribed substances to various classes at that time and, not unreasonably, they put all hallucinogens into Class A.
Q88 Dr Iddon: What is the difference between a psychedelic drug and an hallucinogenic drug?
Professor Sir Michael Rawlins: I would rather like my colleague to answer that question because he is a Professor of Neuropharmacology.
Q89 Dr Iddon: Because some people, David, would say that magic mushrooms produce a psychedelic effect and they use them in an almost religious way and would deny the fact that they are having hallucinations of the type that LSD causes, for example.
Professor Nutt: It is a complicated question and what is almost certainly the case is that there is a spectrum of effects across the range of drugs which act on the neuro (?) systems, like psilocin and like LSD, and there are two main factors which seem to determine the effect that individuals have. One is the effects of the pure pharmacology of the drug receptor, and LSD, I think you are right, probably does cause a greater effect in terms of changes than psilocybin but also psilocybin is much shorter lasting, so there is a kinetic difference as well.
Q90 Dr Iddon: That is the point, it is much shorter lasting. What evidence is there that psilocin, psilocybin or especially magic mushrooms are as dangerous as cocaine, crack cocaine, now ice of course, and heroin, because I do not see psilocin and psilocybin on sale anywhere and I have not heard of anybody dying recently in the last few decades from psilocin and psilocybin, so if you are basing your penalties on classification and basing your classification on harm, which is 50 per cent to society and 50 per cent to the individual, where is the evidence that these substances should be in Class A?
Professor Nutt: I would agree the evidence is not strong. A lot hinges on your interpretation as to how damaging the possible very negative consequences that drugs like LSD can have in some people and how much you weight your decision on that. I think in the 1970s there was a considerable concern that LSD, if it was very widely used, might produce a lot of very unwanted effects in term of psychosis. The social evidence that that happens is weak. It would be difficult, I think, to justify having those drugs as Class A, but I do understand why at the time they might have been seen as that.
Q91 Dr Iddon: Bearing in mind the penalties for using magic mushrooms now are as severe as using crack cocaine, for example, will the ACMD be recommending to the Home Office that we review the classification of psilocin, psilocybin and magic mushrooms?
Professor Nutt: My view is that what we should be doing on a regular basis is reviewing all the drugs. I would like to see a five-year cycle where all the drugs in the classification are reviewed in a systematic way using the kind of frameworks that I have set up.
Q92 Dr Iddon: Would you agree that if the classification of drugs is to be believed by the outside community and particularly misusers of drugs, it has to a credible system and that the way you have treated magic mushrooms has made the system almost incredible?
Professor Sir Michael Rawlins: Dr Iddon, can I come in. I am not quite sure what you would have expected us to do. Would you have expected us to have found evidence that fresh mushrooms as opposed to dried mushrooms were causing harm or do you think that just dried mushrooms is in the wrong place?
Q93 Dr Iddon: What I am saying, Professor Rawlins, is I see the evidence clearly as you do of the damage that crack cocaine and heroin are doing to society and to individuals - people are dying - but I do not see the same evidence for magic mushrooms.
Professor Sir Michael Rawlins: What I do not quite follow, frankly, is that you seem to think that because fresh magic mushrooms were not Class A, before we recommended it, we should have done research to see whether fresh magic mushrooms had the same pharmacological effects as dry ones.
Q94 Dr Iddon: I was not suggesting that at all. I am suggesting that neither the prepared mushrooms containing psilocin or psilocybin or the fresh mushrooms containing psilocin or psilocybin should be Class A.
Professor Sir Michael Rawlins: I see, so you are really questioning the whole question of whether psilocybin and psilocin ---
Q95 Chairman: Because you have no evidence to say that anybody is buying these substances and manufacturing them for illegal use.
Professor Sir Michael Rawlins: Oh, we had.
Q96 Chairman: In 1970?
Professor Sir Michael Rawlins: I do not know about the evidence in 1970, I was a little lad in 1970, but we had evidence about sales going on in 2005.
Q97 Dr Iddon: Would you agree there has been an unintended consequence of what the Government has done in classifying magic mushrooms as Class A in that previous users of magic mushrooms have now turned to more dangerous and similar material, namely fly agaric, which is catching on now in the shops and whose contents are far more toxic than magic mushrooms, so there has been an unintended consequence of this decision? I wonder if you agree with that.
Professor Sir Michael Rawlins: I do not know the evidence for that.
Professor Nutt: I think there is a little bit of evidence that ---
Q98 Chairman: Vernon, are you prepared to look at this issue again?
Mr Coaker: Prepared to look at?
Q99 Chairman: The reclassification of magic mushrooms, given the fact that there is little evidence to associate its use with Class A, according to your existing definition of degree of harm to individuals and to society?
Mr Coaker: Not at the current time. We have no plans to do that, no.
Q100 Chairman: So having a drug in the wrong classification is all right?
Mr Coaker: If the ACMD looked at it and we received advice from them then obviously we would make a judgment. All I am saying is that at the current time ---
Q101 Chairman: Professor Nutt was just saying that he would like to see a five-year examination of the existing drugs classification, a systematic review in order to make sure that there is public confidence within the classification system. You are rejecting that?
Mr Coaker: I thought you were asking particularly about magic mushrooms.
Q102 Chairman: I am using that as an example.
Mr Coaker: I am sorry, I misunderstood your question. It is always open to the ACMD, they do not have to wait for us to ask. The ACMD if they wish to do so can look at drugs and make recommendations to us and then we make judgments accordingly. All I am saying is that if the ACMD came forward with a recommendation we would obviously look at that. Whether we would accept it or reject it would be a matter of judgment that we made on the basis of the evidence we received and from other evidence as well.
Professor Sir Michael Rawlins: I do not think Professor Nutt really wants to look at everything every five years. There is no point in looking at crack cocaine and heroin and things like that every five years. You have to be selective in some ways.
Q103 Dr Harris: Professor Nutt pointed out that there is very little evidence of social harm that justifies putting the pharmacological agents of fresh magic mushrooms in Class A and indeed that there is some evidence of a perverse effect in so doing. If the ACMD were asked for its opinion by the Government before fresh mushrooms were added to Class A. I wonder therefore whether it was not unreasonable for someone to suggest that the ACMD might have looked at this and suggested that it was perhaps not the right category to put either the fresh variety or the unfresh variety in Class A, for the reasons that Dr Iddon and Professor Nutt have set out. That is not an outrageous suggestion, is it, Professor Rawlins?
Professor Sir Michael Rawlins: I think I probably misunderstood your report. It seemed to me that the criticism was that we had not done a special study of the fresh mushrooms rather than dried mushrooms.
Q104 Dr Harris: Who prepared your response?
Professor Sir Michael Rawlins: I did.
Dr Harris: You did? Could you clarify ---
Chairman: Were you pretty angry at the time?
Q105 Dr Harris: Angry is not the word; paranoid maybe - and we will come on to that.
Professor Sir Michael Rawlins: One of us should stop taking the pills!
Q106 Dr Harris: Did you point out given our discussion and now that the light has dawned on you about what our report actually says, will you confirm or retract the assertion in your own work that the Committee (presumably Dr Iddon and myself as the two who questioned you on this) displayed "considerable ignorance about the basic principles of pharmacology" underlying the questions that we have just had. I think that would also apply to Professor Nutt then since he agreed with Dr Iddon.
Professor Sir Michael Rawlins: I accept that but perhaps the Committee's report could have been written in a way that a pharmacologist could understand. It seemed to me that you were criticising the fresh magic mushroom decision without, allegedly, having evidence of fresh magic mushrooms causing harm. What I was saying was that psilocybin and psilocin ---
Chairman: We will take that as an apology. Brooks?
Q107 Mr Newmark: On the subject of ecstasy, the ACMD has said that it will assess the evidence on ecstasy to establish if there is enough to undertake a review. Given that in March you, Sir Michael, said that there was not sufficient evidence for a review, how likely is it that the ACMD will undertake a review now?
Professor Sir Michael Rawlins: We will undertake a review. You have asked us to undertake a review and we will undertake a review. What we will be looking for is not just the question of classification but two other aspects. Firstly, we will be looking to see whether better methods of harm reduction can be used, because that is an important part of our role, and also what other research questions arise from it.
Q108 Mr Newmark: If there is not enough evidence relating to ecstasy, who should be responsible for plugging the gap in the evidence base?
Professor Sir Michael Rawlins: It rather depends on the nature of the gap. If it is neuropharmocological or clinical then we would look to the RCs (?) or the NHS R&D programme. If it was more sociological then we might look to the NERC or to the Home Office.
Q109 Mr Newmark: If the ACMD discovered new evidence when it undertook the review, would you consider reclassifying ecstasy?
Mr Coaker: We would consider their evidence. As I say, we have no plans to reclassify ecstasy. The ACMD is independent of government, we obviously respect what they say, and they will bring their report forward, but the Government has no plans and no intention of reclassifying ecstasy.
Q110 Dr Harris: You say that you do not propose to move ecstasy and it will remain a Class A drug. Is that an evidence-based policy?
Mr Coaker: That is a judgment the Government makes on the basis of what we believe to be something that is in the interests of the public at large to keep ecstasy as a Class A drug.
Q111 Dr Harris: Is it an evidence-based view?
Mr Coaker: It is a judgment that we make based on all the --- we have had no recommendation from anybody to reclassify ecstasy from an A to a B. We think it is a drug which is harmful. There is no safe dose of it. We were talking about alcohol earlier on and one of the problems you have with alcohol is there probably is a safe dose. Like many here, I have a drink now and again, but there is no safe dose of ecstasy, we think it would send out totally the wrong messages and, as I say, we have no intention of reclassifying ecstasy.
Q112 Mr Newmark: Because it kills unpredictably?
Mr Coaker: As I say, there is no safe dose. This is the point, just half a minute ---
Q113 Dr Harris: There is no safe dose of tobacco.
Mr Coaker: It just does make the point very well, the exchange that we have just had between two members of the Committee, quite rightly, about the difficulties that there are in this area and the different views and opinions that people have. I think what we all wrestle with is using evidence and using science and also trying to think about it from a non-scientific point of view in the social judgments and the individual judgments and the community judgments that we make. We wrestle with that and, as I say, as a Government we have no intention of doing anything with respect to ecstasy because we do not believe there is a safe dose, it is harmful, it kills unpredictably, as Brooks has said, and we just think that it is a very important way to use the classification system.
Q114 Dr Harris: If the ACMD reviewed the evidence and that review made recommendations to you, are you saying now it is not worth them doing it because your decision on this will not be evidence based, it will just be a reassertion of your "no intention to reclassify ecstasy"? Even if they said there will be fewer deaths, for whatever reason, if it is reclassified, are you saying that you will never consider an evidence-based decision on this drug?
Mr Coaker: I am not saying that at all. What I am saying is the ACMD, of course, can conduct research and look at whatever they wish to with respect to drugs and make recommendations to the Government. What I am saying quite clearly is that we have no intention of reclassifying ecstasy.
Q115 Dr Harris: I am keen to pursue this one. I understand you have no intention and I assume that is current because I do not think you could bind your successors if the evidence changed. Is it your view that all drugs for which there is no safe dose should be in Class A or is there something special about ecstasy which means it is one of the drugs for which you say there is no safe dose which means it must be in A?
Mr Coaker: In talking about ecstasy, it kills unpredictably, we do not believe that there is a safe dose; we will not reclassify ecstasy.
Q116 Dr Harris: Does that apply to all drugs that meet those criteria?
Mr Coaker: What we try to do where we have evidence and where people come to us with recommendations is make individual judgments, as we will do whenever people come to us. All I am saying with respect to ecstasy is that we have no plans and no intention of doing so.
Q117 Dr Harris: So do you think you are wasting your time, Professor Rawlins, if you end up doing a review in this area?
Professor Sir Michael Rawlins: No, I think we will give advice on whatever we feel is appropriate but perhaps in a way more importantly we will also be able to, I hope, give better advice on harm reduction, which is actually rather important, and on what further research is needed in order to understand the dangers of it.
Q118 Dr Harris: Will the fact that the Minister has said quite categorically that he is not going to change the classification have any bearing on whether you follow through and do a report?
Professor Sir Michael Rawlins: None at all because we are going to do it.
Q119 Dr Iddon: Can you tell us, Professor Rawlins, the current situation on cannabis? We understand that your Committee is reviewing cannabis use yet again. That is the first question. The second question is would you agree with me that there are difficulties with cannabis in that it comes in various varieties and we do not tend to differentiate when we are talking about cannabis between the different varieties. As much as 70 per cent of the material sold in Britain, I understand, is grown in Britain and is skunk, which has a particularly high content of tetrahydrocannabinol. Do you feel, as I do, that we should get the message across that it really depends on which cannabis the person is using?
Professor Sir Michael Rawlins: We produced a report relatively recently earlier this year on cannabis and we have no intention of revising it as of today, but of course if new evidence emerged we would. The point you make about the tetrahydrocannabinol (THC) content is very well made. There are two points really. One is that some forms, particularly with the flowering heads, have much higher levels of THC in them than the leaves and the stalks. Secondly, the surveys which have been done have shown extraordinarily wide variations even between the seeds and the heads. We made this very clear in our report that just because you once smoked some pot and you had not come to any harm, that does not mean to say that you will not come to any harm next time because the last lot may well have had almost nothing in it. The real difficulty we have, which we also made clear in our report, is that the material that everything is based on is seizures by the police where they are going to prosecute. What we really need is the material that is, frankly, bought the normal way and you should look at that, and we recommended to the Home Office that research in that area should be done to find what is actually being used, not what the police seize and are going to prosecute on.
Mr Coaker: What we have done, Brian, just to reassure you about the enforcement of the law and tackling this as a problem, there was a recent operation by the police on cannabis farms, Operation Keymer, which was very successful according to the police. We have also reinforced in the drug education pack which looks at cannabis which we send to schools (which I think is an important message to send out from this Committee) the fact that cannabis remains an illegal drug and is an illegal drug. Alongside that, we have also just launched a few weeks ago an advertising campaign through TV and cinemas and so on particularly related to cannabis and mental health risks, which we called Brainstorm.
Q120 Adam Afriyie: Just two short questions here because we have already covered the territory, Minister; what factors would spark the Government to reconsider the classification of a particular drug? What factors are in the Government's mind when it comes to reviewing a drug?
Mr Coaker: Ultimately if the Government felt that it would contribute to tackling the drug problem in the country, but we do not believe that it will do that. The evidence that I mentioned before, Adam, which is evidence from the drugs strategy rather than evidence with respect to the drugs classification system, I think shows that the drugs strategy is making a difference, so in terms of the answer to the your question, the Government would make a judgment about what impact it would have in terms of tackling the drug problem in the country. If the Government felt that it would make a contribution to that rather than as we feel at the moment diverting the strategy we have got, then of course the Government would consider and think about it.
Q121 Adam Afriyie: My second question is to Professor Rawlins. Professor Nutt has already mentioned that he would like to see a systematic quinquennial review of the classification, not all of them of course, so what stops the ACMD from systematically reviewing drugs classification at the moment?
Professor Sir Michael Rawlins: We do on occasions certainly, but we tended in the past - and perhaps wrongly and I would accept that - to have looked at the new problems rather than going back very often over the old ones. We probably should have done and I would accept that.
Q122 Dr Harris: Professor Rawlins, you say that your report is written by you. It is entitled "Response of the Advisory Council on the Misuse of Drugs to the House of Commons Science and Technology Committee's Report", so could you distinguish, if there is a distinction to be made, between you writing something and the Council giving a considered response?
Professor Sir Michael Rawlins: Yes, I produced the first draft and then all the members of the Council had an opportunity to consider both the original report and the response.
Q123 Dr Harris: By?
Professor Sir Michael Rawlins: By e-mail.
Q124 Dr Harris: You go on to say that our report contains significant errors of fact?
Professor Sir Michael Rawlins: Yes.
Q125 Dr Harris: Other than the pharmacological ignorance which you have retracted because you misunderstood what our report was saying (although the Government did not) what are the other significant errors of fact?
Professor Sir Michael Rawlins: The whole issue of social harms, and you went into some considerable detail about how we ought to take into account social harm and how there seems to be a lot of confusion around the place. There is no confusion; we take social harms into account and we give chapter and verse where we do it.
Q126 Dr Harris: Your report states that there were significant errors of fact. If you have an opinion, there is no confusion; if we have an opinion, there is no confusion. I want to know what are the significant errors of fact, so give us a fact and then say what the correct fact is with the chapter and verse, please, because I am very concerned that we get a report talking about evidence factually correct, because I could not find any in your report.
Professor Sir Michael Rawlins: Recommendation 5: "The ACMD must look at social harm in its considerations - it is impossible to assess accurately ..." That statement by your Committee suggests that we do not look at social harms. Recommendation 5: "The ACMD must look at social harm in its considerations - it is impossible to assess accurately the harm associated with a drug without taking account of the social dimensions of harm arising from its misuse."
Q127 Chairman: Then you go on to say that you agree with it totally.
Professor Sir Michael Rawlins: I agree with the statement but not with the implication behind it because the implication behind it is that we do not take into account social harm.
Q128 Dr Harris: What you are saying there is an error of fact is an implication that you have read into a statement because the statement said the ACMD must look at social harm?. You are agreeing with us.
Professor Sir Michael Rawlins: We are agreeing ---
Q129 Dr Harris: That is not an error of fact.
Professor Sir Michael Rawlins: But you would not have said it if you thought we had taken that into account.
Q130 Dr Harris: Not necessarily. I do not think you can say that.
Professor Sir Michael Rawlins: It is crystal clear, you were trying to say that there were various people out there who did not believe that we took into account social harms. You quoted individuals. You said that Andy Hayman did not know what the terms of reference were.
Q131 Dr Harris: He did not, did he?
Professor Sir Michael Rawlins: You were talking about the previous Home Secretary and then you told us that we must look at social harms in a way that quite clearly indicated you thought we did not. I remember the exchange we had at the time. What I am trying to do is to point out that we do look at social harms and we give chapter and verse of that.
Q132 Dr Harris: Let us be clear here, it was not us that said you were wrong on this issue. We said to the man sitting next to you, on your right, do you agree with Sir Michael rather than the previous Home Secretary - if you remember the previous Home Secretary said that clinical medical harm is the Advisory Council's predominant consideration and you said that that was not the case and that equal weight is given. We asked him do you agree with Sir Michael rather than the previous Home Secretary and he said no, he did not agree with you or at least implied that he did not agree with you. If there is an error of fact it is in the misunderstanding of the previous Home Secretary not the Committee. I will draw your attention to question 1243 by our esteemed Chairman on 14 June 2006 in the minutes.
Professor Sir Michael Rawlins: The clear implication from Recommendation 5 is that we do not look at social harms. That is crystal clear to me.
Q133 Chairman: Sir Michael, I really do not want to continue with this line. I think there is a genuine misunderstanding between what you felt the Committee were saying. We had a concern that what the Home Secretary at the time and what you were saying were at odds in terms of the degree of emphasis that was put on social harms in terms of the classification system, and you were agreeing with our broad statement, and certainly there was no intention of impugning your integrity or the integrity of the members of the ACMD. However, there was an important issue that the evidence we brought to bear in terms of making the classification should be quite clear and obvious to be seen, and we did not feel that that was the case. I think I would rather just leave it at that because we want you to go away happy. Professor Nutt, I want to raise one final question before I finish this session and that is you mentioned earlier that some drugs are in the wrong class. I just wondered if you could name which ones you think they are.
Professor Nutt: If you look at the assessment we did, I think MDA, LSD and ecstasy probably should not be classed there. I think that barbiturates might be worth moving up to Class A from Class B. I think those are the most obvious anomalies that we see, at least in this analysis that we have done.
Q134 Chairman: Okay, which brings me, Vernon, to really try to get from you if in fact the Chair of the Technical Committee of the ACMD - and certainly this Committee has huge respect for both Michael Rawlins and David Nutt in this area - feels that some of drugs are in the wrong place, could you re-visit your decision not in fact to have a review?
Mr Coaker: I think there are ---
Q135 Chairman: I know you cannot give me an answer.
Mr Coaker: I cannot give you an answer, but I think there were two parts to the question, with respect, and if I have misunderstood then please correct me. In terms of the review of the whole classification system and going from an ABC system, a tripartite system, then the Government is quite clear that we have no plans to move to another system. We wish to retain the ABC. With respect to individual drugs within the ABC categorisation, there will always be a debate about whether drugs are in the right category, and if the ACMD look at drugs and then come to us with a recommendation, of course we will look at it. Whether we then decide to act on that recommendation will be a matter of political judgment and will be a matter of the other factors that would influence what decisions we take. All I would say again, just to repeat, is that of course we have confidence in the ACMD, we have massive respect for all the members of the ACMD, and of course we will look at that. What I cannot say to you is that if the ACMD came to us with a recommendation about any of the drugs which are currently classified in the way that they are, that we would then turn round and say, yes, we will automatically do that.
Q136 Dr Harris: I have got a quick question about the issue of random drug testing in schools. BBC On-Line in their report on 5 November 2006 said: "The Advisory Council on the Misuse of Drugs also believes there has been a lack of evidence that testing is effective and has recommended that random tests be abandoned." That is not true, is it?
Professor Sir Michael Rawlins: That was in Pathways of Care.
Q137 Dr Harris: So that is?
Professor Sir Michael Rawlins: That is in the prevention working group.
Q138 Dr Harris: So if you have made that recommendation why do you think it is that the DfES do not particularly seem to be aware of your advice or have taken your advice?
Professor Sir Michael Rawlins: It came out about six weeks ago, it has only just been published.
Q139 Dr Harris: As I understand it, the Government are going to extend the existing arrangements from one school in Kent to a number of other schools.
Professor Sir Michael Rawlins: We will be having discussions with the Department for Education and Skills.
Q140 Chairman: Thank you for answering that. Professor Rawlins, Professor Nutt and Minister Vernon Coaker, can I thank you very much indeed for a very lively session this morning. We have enjoyed doing this piece of work. I hope we have built some of our bridges with you. At the end of the day I think our intentions are exactly the same as yours and hopefully the Government's (but it is a benign government). Thank you very much indeed.
Mr Coaker: Thank you very much.