Examination of Witnesses (Questions 40
- 60)
TUESDAY 9 JUNE 2009
MR MARTIN
BARNES AND
MR HARRY
SHAPIRO
Q40 Mr Winnick: We had a previous
inquiry into drugs in general. Now we are concentrating on cocaine
and we know that since our last inquiry, as has been confirmed
today, the use of cocaine has certainly increased. Do you think
that the existing legislation helps or hinders in trying to reduce
demand?
Mr Barnes: It is an important
question. This morning, for example, I was giving an interview
for a radio programme about the decriminalisation of drugs in
Portugal. About eight or nine years ago they did not legalise
drugs but they took penalties for possession of relatively small
amounts out of the criminal justice system and introduced essentially
administrative penalties. A general point to make is that when
it comes to drug policy, I probably do not need to tell you this
as Committee members, it is one of those areas where politicians
do get anxious; the debates, the issues can become quite polarised
and quite emotive. When people ask whether prohibition is working,
whether legalisation is the answer, the example I will often refer
to in terms of the difficulties of opening up the debate and changing
drug policy is if you look at the controversy around the reclassification
of cannabis which, on the scale of that spectrum between prohibition
and legalisation, was a very modest change. The maximum sentence
for possession was reduced from five to two years, the maximum
penalty for supply was increased to bring it in line with class
B, but one of the reasons the Government went against the advice
of its own advisory council on cannabis reclassification was because
it was felt that the decision politically, with hindsight, and
I do not necessarily share the view, was a mistake. We do need
to look robustly and ask important questions about the effectiveness
of current legal frameworks.
Q41 Mr Winnick: It would be useful
if the debate opened up rather than politicians constantly on
the defensive, accusing each other of being soft on drugs.
Mr Barnes: Yes, you have nailed
it. The public is probably more nuanced and sophisticated when
it comes to drugs as an issue than perhaps some—some, not
all—of the more extreme and alarmist headlines potentially
would suggest. On the point made about the changes in Portugal,
for example, a lot of people in Portugal are not even aware the
change was made. It has not generated that big controversy or
high-level debate. A couple of years ago, the previous Home Secretary,
Charles Clarke, when he gave a statement to Parliament about the
previous review of cannabis reclassification, did promise a review
of the Misuse of Drugs Act. We welcomed that, the advisory council
welcomed that, a few months later the Government dropped that
commitment. I do not think it is wrong to have that review, but
the key drivers essentially should be basically what the evidence
can tell us on what works; drug policy generally should be proportionate,
should be pragmatic, but the overarching template touchstone should
be how best we minimise the harms. If we can conduct the debate
within that sort of framework, it takes us forward a bit.
Q42 Mr Winnick: What do you say to
those who argue that whatever the defects in existing legislation,
at least it does prevent more people from embarking on taking
drugs and some of them of course really dangerous drugs?
Mr Barnes: It feels intuitive
to say that is what the current making drugs illegal achieves.
Recently, for example, one of the models of Transform, which supports
legalisation, in terms of what might happen if drugs were legalised,
does suggest an increase in use. The difficulty is that we do
not really have the direct evidence to establish that making drugs
illegal through the criminal justice system does directly impact
on levels of use. It feels intuitive but as yet we do not have
the evidence to support that. There is evidence that amongst young
people the legal status, that it is illegal, can reinforce the
negative attitudes towards drugs, can reinforce the resistance
when being offered drugs or peer pressure. However, on the wider
canvas, we must say we would like that direct evidence really.
Q43 Mrs Dean: Why do you think that
we have an ageing drug population? Why do you think young people
are not taking heroin and to some extent cocaine?
Mr Shapiro: A lot of it is to
do with fashion. That sounds a bit of a strange word to use in
relation to the illegal drug market but drug use does go through
different cycles which are to do with attitudes amongst people,
availability and the alcohol/cannabis dynamic is quite significant
here because of the ready availability of cheap alcohol which
is now a serious concern for those who are looking after young
people and also the increase in strength of cannabis which is
available now, although I have to emphasise nothing like the strength
which has been bandied about in the media, but stronger nevertheless.
Also, psychological barriers get thrown up in terms of what young
people see is what is fashionable, what is cool and all the rest
of it. There is a lot of resistance to the idea of using crack
amongst young people, but nevertheless, for those who are vulnerable
for all sorts of different reasons, there are ready substitutes
and increasingly they have become alcohol, cannabis and some other
drugs as well and have created a different kind of profile for
problematic drug use among young people, which is an issue for
the treatment system because it still is not really geared up
at the moment for helping those people who are not primarily opiate
users. This is a problem which is recognised within the treatment
system, but it may well have to modify and adapt its procedures
to accommodate this in the future.
Q44 Mrs Dean: The UN Office of Drugs
and Crime has criticised what it saw as the UK's celebrity cocaine
culture. How influential are celebrities?
Mr Shapiro: That is a massive
red herring, to be perfectly honest. Personally I think it is
completely ludicrous to start blaming celebrities whose alleged
use of dodgy, fuzzy photos of doing whatever are only made public
because the tabloid press are prepared to put them on the front
page and pay huge amounts of money for doing so. My take on this
would be that it is the media which is glamorising celebrity drug
use, not celebrities. Actually the All Party Drugs Misuse Group
in 2008 heard from a group of young people associated with Mentor
UK, which is a drug education charity and the MPs asked the young
people what they think when they read about Amy Winehouse or Pete
Doherty or any of these people. The general response was that
they felt sorry for them. They appreciate the fact that they are
good singers or good songwriters but they just wish they would
get their act together. There was a similar response on a radio
show 1Xtra which is also targeted at a young audience; they did
a phone-in and there was a similar kind of response. Nobody feels
that these people are glamorous or there to be emulated and when
young people get into using drugs, it is much more to do with
what is going on in their own environments, their own family,
their own community; very, very little evidence that celebrities
have any part to play in this at all.
Mr Barnes: The Liverpool John
Moores University did do a literature review in 2006 and concluded
that there was no evidence of a causal link between coverage of
celebrity drug use and young people's level of use or even attitudes
towards drugs. There is a related issue that one of the aspects
of drug education in schools is sometimes to challenge the perception
of some young people that drug use in some way is normalised.
There is evidence that young people often overestimate levels
of drug use in the population as a whole, indeed amongst their
peers. Although we do need to look at how more effective we can
make drug education, there is some research pointing to the fact
that when you challenge that, that can reinforce the sort of negative
attitudes to drug use, resisting peer pressure, offers of drugs.
I just echo what Harry said: this is an issue that undoubtedly
does hit the media every so often, it does generate debates. I
took part in a radio programme and one of the panellists said
in the context of Kate Moss's reported drug use that everybody
is using cocaine. No, they are not actually; it is too high, it
is a problem. It is that type of language and perception of the
issue that we need to put into context and challenge. The interesting
thing about Kate Moss of course was that it did not do her career
any harm and I have not really quite worked out what happened
there.
Q45 Mrs Dean: So you do not believe
the celebrity issue influences recreational use of cocaine either.
Mr Barnes: When we are looking
specifically at cocaine, the peak age of use is very late teens,
early twenties. Fortunately class A drug use, cocaine use amongst
younger people, those under 16, is still very rare. It does happen,
it is a major concern when it does happen, but it is still very
rare. The question is, if we are talking about the link between
celebrity use and cocaine use, surely you would expect people
in their late teens and early twenties to have a bit more of a
sophisticated understanding about celebrities as role models in
terms of affecting their attitudes and their use. Echoing back
what Liverpool John Moores' research suggests, when it comes to
younger people there is no evidence of that direct use. There
are some times, very rarely, when a celebrity will come out with
a prattish statement that will understate the harms that drugs
can cause and it is at that time that we will sometimes comment
to correct what we think is an unhelpful message around drug-related
harms. Generally, we do not have the evidence that reported celebrity
use leads to more people using the drug or increasing levels of
harms associated with the drug.
Q46 Chairman: Do you not feel that
the courts should be tougher if a celebrity is found using cocaine
because that would send out a greater message to those who may
want to use that person as a role model?
Mr Barnes: It is more appropriate
that the courts should approach the case on the facts and apply
the judicial mind in the right way. That is what people would
expect from the criminal justice system, an appropriate response
rather than trying to send out a message, whatever that might
mean or then be subsequently interpreted.
Q47 Bob Russell: Our two witnesses
seem to have dismissed as a serious issue the celebrity cocaine
culture. I wonder whether I could return to part of Mr Salter's
line of questioning because you appear to dismiss another tenet,
which is that there has been a sharp decrease in the purity of
cocaine being sold.
Mr Shapiro: No, I was not actually
disputing the purity.
Q48 Bob Russell: Could you clarify
it? As I understood it, you were saying that if dealers were selling
impure product then people would not go back to them and they
wanted to maintain sales.
Mr Shapiro: The point that I was
answering was the idea that drugs were routinely cut with extremely
noxious substances like Vim and brick dust, which have been mentioned,
rat poison, all that kind of stuff. If you look at the data from
the Forensic Science Service, you will see that those are rarely,
if ever, found in samples which they test.
Q49 Bob Russell: Let me try this
line then. SOCA has noted a sharp decrease in the purity of cocaine
being sold. Leaving to one side the different types of substance
which have been used to bulk out the drug, what are the consequences
of such a decrease in purity, if indeed there has been a decrease
in purity?
Mr Shapiro: In terms of what?
In terms of the harms caused by the impurity?
Q50 Bob Russell: I will let you answer
how you want and then I will put in a supplementary.
Mr Shapiro: There is no evidence
at the moment that the fact that cocaine has been traditionally
cut with sugars and is now often cut with phenacetin has made
any difference to the harms which are being caused by the drug.
You do not have people presenting for treatment or to A&E
with different problems; there is no evidence that you suddenly
have a wave of people presenting with different problems than
they would have done before on the basis of what is in the drug
they are buying.
Q51 Bob Russell: Are SOCA correct
then in noting that there has been a sharp decrease in the purity
of cocaine?
Mr Shapiro: Yes.
Mr Barnes: Yes, they are; we are
not challenging that. The evidence is clear both in terms of SOCA's
analysis and also the Forensic Science Service. We published this
in our magazine earlier in the year. In 1984 the average purity
of cocaine examined by the Forensic Science Service was 63%, in
2005 45%, October to December last year 26%; one in five samples
less than 9% pure cocaine. The evidence is clear that cocaine
is a much less pure drug than it used to be and that it is being
bulked out increasingly now with these new substances. It is an
important issue because the primary driver for SOCA and enforcement
agencies, and it is the right approach, is to minimise drug-related
harms. When we see the nature of the drug that we have been using
change, whatever the purity values, it is right that we ask whether
that is getting us closer to reducing the harms. It could be,
for example, that once the less naive drug user understands that
what they are buying and probably paying the same price for is
much less pure, it is heavily adulterated, there are substances
in there which the evidence suggests can be of themselves harmful,
that might cause more resistance and more people choosing not
to use the drug. As yet it is a bit too soon to say that is an
emerging issue because, as we said earlier, drugs do change over
time; they go in and out of fashion as well as wider issues which
can impact on levels of drug use.
Q52 Bob Russell: So cocaine being
a dodgy substance anyway making them less pure makes that drug
even less healthy.
Mr Barnes: It is difficult to
say because it then depends on what the effect may be on the person's
levels of use and patterns of use. One of the potential reasons
why there is less pure cocaine available is because more people
who use cocaine are mixing it with alcohol so they may not even
be bothered almost about the exact quality of the stuff they are
buying but the risk with that level of use is the potential increase
in the health harms, because the combination of cocaine with alcohol
creates that new chemical in the body which is potentially even
more toxic on the liver. It is difficult to point a cause and
effect and we do need more research. We need to look carefully
at what the impact on levels of harms to the individual might
be from the fact that the cocaine is less pure. What we might
see is an impact on overall levels of use and attitudes towards
the drug. It has lost a lot of its image of being in some way
a clean drug, which it is not; it is dangerous. It is no longer
seen as the drug of the rich and the famous and celebrities. The
levels of prevalence show us that, but it is almost going a stage
further in that as a drug it is almost going further down in terms
of its perception and those associations.
Q53 Bob Russell: You are saying that
the health consequences are clearly serious. What about the financial
consequences to the dealers if they continue to make this awful
drug even less pure?
Mr Barnes: There is no honour
amongst the dealers of course. What they are in it for is to maximise
their profits, but also to minimise the risk to their business.
This is partly where SOCA's work comes in; it is about intelligence
gathering, it is about looking at asset seizures, it is about
working out where the networks are. Part of the reason why they
are bulking it out is because, if they can sell it at the volume
and sell more of it, they maximise their profits. A European Commission
report was published in 2008 which does suggest that the revenue
return on cocaine may be slightly less than it was ten years ago
because of the overall decrease in the level of profits but as
yet there is not much evidence to show that overall there has
been any impact on the profits to the dealers. The point to make
is that most of the profits tend to be at the higher end of the
supply network. When you come down to the very low level dealers,
it is much less so.
Q54 Chairman: How effective do you
think the government advertising campaigns have been to try to
deter people, young people, those who are not young people, from
using cocaine? Do you think they have been effective?
Mr Barnes: We do not really have
the evidence to point to the fact that public information campaigns
reduce levels of use. There is a greater case for saying that
appropriate, well-targeted public information campaigns may reduce
levels of harm. They can raise awareness about the harms and the
risks associated with drug use. That is not to say that it is
not important to have public information campaigns; I am a big
supporter of that. It is similar in terms of drug education in
schools. If we expect or wish drug education to stop young people
using drugs, that is a very big ask and the evidence is not there
to say that it has that impact. What we do have evidence of is
that it can increase awareness about the risks, it can increase
coping skills and it can equip the older person to resist pressures
to use drugs. The direct answer to your question is that I think
public information campaigns are important for raising awareness,
but there is no evidence that it impacts directly on levels of
use across the population as a whole.
Q55 Chairman: Mr Shapiro, do you
agree with that?
Mr Shapiro: Yes. Behaviour change
through campaigns is very difficult to achieve. The evidence suggests
that where people can feel that they are at direct risk, the campaigns
in the 1980s around HIV/AIDS and the use of condoms, drink-driving
campaigns as well demonstrate that where people can perceive an
immediate risk there is a better chance of changing behaviour.
Similarly with young people and smoking, if you are trying to
project forward several years about the risk they might be facing,
that is a much harder one to do. In fact we have not been that
impressed with some of the way the Government have dealt not so
much having public information campaigns but we have felt that
some of the advertising aimed at young people has been a little
bit patronising.
Mr Barnes: We do have slightly
different views on that, just to air our differences in public.
Mr Shapiro: The evaluations that
there have been around public campaigns suggest that while behaviour
change is difficult to effect, it can at least reinforce negative
attitudes.
Q56 Chairman: Should the Government
be spending more and make it better targeted than it has been?
Mr Barnes: I am middle-aged now,
trying to get into the mind of a young person in terms of what
works around advertising. The focus groups and the young people
can tell us. I suspect around some of the public information campaigns,
particularly on illegal drugs, there is a tension between addressing
a wider audience, sometimes the parents, than messages which are
directly aimed particularly at young people. With some of the
messages around drugs you probably need to be a little bit more
slightly controversial about the risk to sexual health; those
are the sorts of messages which probably will have a bit more
impact on young people than some of the generalist campaigns that
we have been seeing.
Q57 David T C Davies: May I put it
a bit more bluntly than you were because I tend to agree. Talking
about people getting cancer and things in 20 or 30 years' time
has no impact, but telling them they might end up impotent will.
Mr Barnes: Yes, it does and similarly
with some of the health messages around anabolic steroids. Blokes
can develop breasts, they can shrink the testicles, that is the
sort of thing that young people relate to rather than those health
risks which might impact in 10, 20, 30 years' time.
Q58 Ms Buck: We have already gone
through a number of the factors which in different ways could
impact upon demand. In summary, what would you think would be
the priority of measures which might actually have an impact upon
demand, price, quality, health warnings?
Mr Barnes: Particularly looking
at cocaine the key is that there is still an issue where people
do underestimate the health risks and harms associated with its
use. I do not have a lot of evidence to support that; it is largely
anecdotal. I suspect that is largely older users who experiment
with the drug. The evidence you heard earlier, that we are seeing
more younger people presenting at A&E departments with heart
related problems, the fact that it is a drug you can become dependent
on, the increase in people presenting for treatment, is largely
a response to the fact that there is more capacity there, but
it is those messages which need to be reinforced and made stronger.
In terms of general drug use, widening it out a bit, there is
a role for education but I see prevention as being much more than
about education. We do know, particularly in terms of young people,
that some of the risk factors that can increase their likelihood
of using drugs and becoming problematic drug users are related
to factors such as poverty in the home, poor family relationships,
truancy from school, not doing very well at school. I think we
need to look at it as part of a broader canvas, to focus as much
if not more on those prevention measures, treat drugs more as
a public health issue. Yes, there is a role for enforcement but
despite the big increase in drug treatment—and long may
it continue because we do need it—I still do not think we
have entirely got the balance right.
Q59 Martin Salter: Similar question
to the one I put to Professor Strang. It always seemed to me that
any drugs policy ought to have the three Es—education, enforcement
and effective treatment. Where do you think that the major emphasis
needs to be in terms of a more coherent public response to the
challenges posed by cocaine addiction, cocaine use and the cocaine
trade?
Mr Barnes: We do need to do more
around treatment and a lot of work is going on around that area.
We do not have substitute drugs for cocaine use. It was described
earlier as fairly intensive intervention; that is not always the
case but it does quite neatly describe the challenge, that investment
around the public health, more intervention around the prevention
side of it. I just give a plug. There is an early day motion which
Dr Brian Iddon has tabled which basically recognises the importance
of drug treatment and what it can achieve, supports continue investment
and it would be a good thing if MPs could all sign it.
Q60 Chairman: An immediate recommendation
for the Committee. Before we go, as you know President Obama has
just appointed a new drugs tsar and though there is not an absolute
read-across between what happens in America and what happens in
our country, does this give you any indication as to the way in
which the new administration is going to deal with the issue of
drugs?
Mr Barnes: I think we will see
inevitably a more progressive and evidence-based approach than
we did under the previous administration. I do think that those
people who are seeing this as some massive step forward probably
need to be a little bit cautious because President Obama has also
supported the efforts of the Mexican Government in terms of the
enforcement activity going there which is turning pretty nasty.
I hope we are going to see a much more progressive approach because
the US still does have a very influential sway over the direction
of travel for international UN drug policy and there are times
when it has been directly unhelpful in terms of its positions
to reduce drug-related harms, for example opposing the introduction
of safe injection rooms, needle exchanges and a general harm reduction
approach.
Mr Shapiro: I think generally
the appointment of a new drugs tsar might be more felt inside
America in terms of its own domestic drugs policy than necessarily
any big sea change internationally.
Chairman: Thank you. Next week the Committee
are taking a break from drugs to look at the cost of policing
football matches, but we will return to this inquiry the week
after. Mr Shapiro, Mr Barnes, thank you very much for giving evidence
today.
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