Examination of Witnesses (Questions 124
- 139)
TUESDAY 20 OCTOBER 2009
MR STEVE
ROLLES AND
PROFESSOR NEIL
MCKEGANEY
Q124 Chairman: Could I refer everybody
present to the Register of Members' Interests where the interests
of all the members of this Committee have been noted. Can I welcome
our two witnesses to today's second session on the inquiry that
this Committee is conducting into the cocaine trade. I welcome
you Professor McKeganey and Mr Rolles and thank you for giving
evidence today. Could I start with you, Professor—and Mr
Rolles please feel free to come in whenever you wish to chip in—why
do you think people use cocaine and what are the social/environmental
conditions that underlie the problems of cocaine use?
Professor McKeganey: I think I
would have to stress that the evidence base in relation to cocaine
use is not strong. So just as much as treatment is focused on
opiates much of the research is also focused on the opiates; so
the reasons why people will use cocaine are not well understood.
The effects of cocaine are very different from the effects of
opiates and one imagines that part of the attraction of cocaine
is to do with those effects. So it is a much more sociable drug;
it is associated with a party atmosphere, excitement, et cetera,
et cetera, in contrast to the opiates which have a much more depressive
effect. So my assumption is that they are rather attracted to
the sociability aspects of cocaine use.
Q125 Chairman: Do you feel that it
is actually on the increase at the moment?
Professor McKeganey: Yes. In my
view cocaine is one of the most serious threats that we face in
relation to drug misuse. It is not yet in terms of problematic
use on a scale of heroin, but it has changed so dramatically so
recently in terms of increased levels of use and I think there
are characteristics associated with cocaine that make it more
appealing to a much wider range of people than heroin, for example,
which has traditionally been associated with states of some desperation
and desolation. Cocaine has none of those associations, and I
think the increased levels of use that we have seen are very worrying
and I think that the impression within the British Crime Survey
seriously underestimates the extent of, for example, crack cocaine
use, where research has estimated some 190,000 crack cocaine users
as distinct from 40,000-odd that the British Crime Survey has
postulated.
Q126 Chairman: Mr Rolles, you state
that "most cocaine use is non-problematic", yet according
to the UK Drug Policy Commission the number of cocaine users presenting
for treatment has risen. How do you define non-problematic?
Mr Rolles: I think not causing
significant problems either to the user, to their immediate family
or dependents, or to their community. Obviously there are issues
with any cocaine use in the current illegal environment because
if you are using cocaine you are by default causing problems down
the line in the illegal market, through sponsoring criminal activity.
But I think it is important to separate out the health problems
associated with cocaine use, both direct and indirect, and the
problems that are associated with prohibition and the illegal
cocaine market. If we are going to approach this issue rationally,
systematically and logically we really do need to separate out
those two things because one is a public health issue and the
other one is a policy choice. On the question you asked Neil about
why people use cocaine and what are the conditions that underlie
it, people use cocaine for the obvious reason that they like it,
they enjoy using it. It is a rational, personal decision that
people make; they do their own personal cost benefit analysis.
They are to a certain extent aware of the risks and they balance
them up with the pleasure that they get from it and they make
that decision. In terms of problematic use—and I think we
need to appreciate that there is a spectrum of cocaine use and
behaviours with cocaine powder but also within the different preparations
of cocaine—you have coca leaf, chewing and coca tea, which
is not really associated with any public health problems; and
at the other extreme you have injected cocaine or smoked crack
cocaine which is highly risky and associated with serious public
health problems; and in the middle you have cocaine powder which,
to a certain extent, is middling.
Q127 Chairman: We will be coming
on to explore some of those other spectrums in further questions.
Mr Rolles: In terms of problematic
use the underlying causes are really to do with social deprivation
of one sort or another. The evidence strongly points to that from
the work of the Advisory Council on the Misuse of Drugs and so
on. It is to do with low levels of well being, to do with poverty,
to do with social deprivation, to do with a sense of hopelessness,
unemployment, histories of abuse and mental health problems and
that kind of thing, and that is very clearly defined.
Q128 Tom Brake: I just wanted to
clarify. You have both talked about cocaine and the fact that
it is social and people enjoy it, but you are not lumping crack
cocaine in with that, are you? Or are you saying the same thing
about that?
Professor McKeganey: Crack cocaine
presently has a rather different position. That may well change
as patterns of cocaine use themselves evolve and the impact of
dependency starts to take its impact on a greater number of people;
but at the present time crack cocaine I think has a rather different
status than powder cocaine and it is more closely associated with
what one would traditionally regard as problematic use, although
my own personal view is that that is an unhelpful characterisation,
to appoint some drug use as problematic and some as not problematic.
I think that all of this drug use in various different degrees
is problematic.
Q129 David Davies: I detect a slight
disagreement there between the two of you because you are saying
that all drug use is problematic, but if I understand Mr Rolles
correctly you are suggesting that some is and some is not; is
that a fair summary of your positions, without wanting to open
up a debate on that?
Professor McKeganey: Yes, I would
agree with that characterisation.
Mr Rolles: Yes, I think there
is a spectrum of drug using behaviours and associated costs and
benefits from beneficial drug use all the way through to chronic,
dependent, highly problematic drug use; and we can easily make
that distinction with alcohol—the difference between having
a glass of wine with your dinner or a bottle of rum with your
breakfast—and we need to be able to make that distinction
for cocaine as well.
Q130 David Davies: Without wanting
to generalise, but we have to a little bit, would you suggest,
Mr Rolles, that the problematic end of the market tends to be
where you have lower levels of wealth—people taking less
pure cocaine; or is problematic drug use something that you find
across a spectrum of social classes and wealth?
Mr Rolles: There is problematic
use of cocaine use in all the socioeconomic strata where cocaine
is consumed, but the evidence does suggest, if you read the Advisory
Council on Misuse of Drugs, Drug Use and the Environment Report,
that generally problematic drug use is more concentrated in areas
of social deprivation and is related to things like mental health
problems and histories of abuse, as I was saying previously. It
is not just wealth; it probably more usefully comes under an umbrella
of well being.
Q131 David Davies: I wonder whether
one can question that a little bit. You say that low levels of
wealth cause problematic drug abuse, but could you not also argue
that if you are a problem drug user you are probably going to
end up frankly very poor and possibly outside of the usual law
abiding society. So it is not necessarily the case that one has
caused the other—the two go together—and that just
throwing a whole lot of money into an area does not necessarily
mean that everyone comes off drugs.
Mr Rolles: That is not what I
am advocating. There is obviously going to be a certain degree
of feedback, but the driver is socioeconomic deprivation and emotional
deprivation of one sort of another. It obviously then causes a
negative feedback loop but the drugs do not cause poverty.
Q132 Patrick Mercer: Gentlemen, taking
on Mr Davies' point a bit further, the phrase "recreational
use" I appreciate is inexact, but do you consider that a
recreational user is not addicted and will not suffer associated
problems with use of the drug?
Professor McKeganey: Perhaps I
could go first. No, I do not actually. I would not characterise
recreational users as in a particularly happy state and as not
perhaps on the road to dependency, especially where recreationally
they are using what many people would regard as the most dependency
inducing substance available. So my own view is that it is rather
a misnomer to characterise their use as recreational because it
may not yet be problematic in the terms which we currently conceive
of as problematic use, but they may well be on the road to developing
many of those problems; and given that they are using, even intermittently,
a drug with a known potential to become dependent upon very quickly
then I would not characterise them as recreational even if they
are presently not experiencing some of the most extreme problems
that we associate with those whose cocaine use has become more
habituated.
Mr Rolles: I do not think that
recreational use is a particularly useful term—it is not
one that we use very much. There is medical use clearly and non-medical
use of drugs and within the non-medical use there is a stimulus
that we are talking about here, there is a certain degree of functional
use. I had a coffee before I came in here to keep me alert and
able to concentrate and people use stimulants, be it coca, cocaine,
amphetamines or caffeine to help them get through the day, to
help them concentrate and so on. Then there is also a non-medical
use, which is more to do with pleasure seeking in social settings,
which I suppose you would call recreational, but I think non-medical/medical
is a more useful distinction and within non-medical I think functional
and recreational may be, but probably it would be more useful
to have problematic/non-problematic. But clearly within recreational
there is nothing about recreational that suggests it is risk-free
or can be non-problematic; certainly recreational use can be risky,
can be harmful, can lead to dependence, but there is no suggestion
that I am aware of that recreational use is safe or harmless in
that way.
Q133 Bob Russell: Gentlemen, where
does the term "recreational use" come from then because
you are professionals, as it were, in dealing with the issues
of illegal drug taking with the criminal activities associated
with it. I have never heard of a recreational crime, so where
does the term recreational use come from? Who actually coined
the phrase?
Professor McKeganey: I do not
know where the term originally came from. It arose, I think, rather
out of a degree of discomfort with the notion of soft drug use.
I think the forerunner of recreational drug use was the term soft
drug use, as distinct from hard drug use, and that term somewhat
fell out of favour in the mid-1980s, and I think that since then
there has been a tendency to use the term "recreational use"
to mean broadly what was previously referred to as soft drug use;
but these terms I think are wholly inappropriate actually.
Q134 Bob Russell: I am delighted
you have said it is wholly inappropriate because my concern is
that some people hearing the term "recreational drugs"
may think that there is something okay about it in the same way
as punishment beatings in Northern Ireland were anything but punishment
and were just thuggery. It is the wrong way and it gives a gloss.
Professor McKeganey: I think in
many respects the language which we use in relation to drug use
on occasion contributes to the problem. It adds to a culture of
acceptability around this pattern of behaviour, and I think that
is part of the problem.
Q135 Mr Streeter: A quick question
to the Professor on something you said to my colleague Mr Mercer.
In my layman's mind there is what I would call a slippery slope
and is there any evidence at all that people can start with soft
drugs, recreational drugs—okay, socially acceptable drugs—but
a proportion will slip towards harder and harder drug use. In
my layman's mind this is an obvious thing that must happen, but
is there any evidence that it does happen?
Professor McKeganey: I think you
are referring to the gateway theory—that is how it has been
couched; that the use of certain substances leads inevitably to
the use of other substances. I think that that theory has been
disputed and I think for good reason. There is not necessarily
continuation of these patterns of behaviour, so the use of one
drug does not in and of itself determine the use of other drugs.
However, what one does see are constellations of behaviours around
different drugs and it is invariably the case that someone who
has used heroin will also have used cannabis at a younger age.
That social patterning, which identifies cannabis use as a precursor
to heroin use, is the basis upon which the gateway theory has
been expounded, but we do not understand the causal, or indeed
even if there are causal mechanisms, and we cannot easily distinguish
between those features which are attributable to the drug, that
the use of that drug may to an extent lead to use of others and
to what extent its behavioural, cultural, the association with
other people using other drugs may increase one's likelihood of
experimenting with those substances.
Q136 Mrs Dean: Mr Rolles, if I could
turn to you. You mentioned medical use—is there a medical
use for cocaine?
Mr Rolles: Yes, there is. It is
quite limited. It used to be used quite sensibly as a topical
anaesthetic for I think ear, nose and throat surgery and I think
some ophthalmology stuff. It has increasingly been replaced by
synthetic cocaine alternatives, but there is still medical production
and use of cocaine. I think the interesting thing there is not
that that exists but that we do actually have a legal model in
place under which coca leaf is grown in Columbia, Peru and Bolivia
and it is exported to America under the auspices of the Drug Enforcement
Agency by a company called Stephan Chemicals. They process it;
the cocaine is extracted and then distributed around the world
for medical use. The "de-cocaine'ised" coca product
then goes to the Coca Cola company where it is used to make Coca
Cola which you can in fact buy in this building; so you can buy
Columbian coca leaf-based products here. I think that it is quite
interesting—not and in of itself—because when we are
talking about legal regulation of cocaine production we are not
talking about this as an entirely speculative thing, but it already
exists just as the legal production of heroin already similarly
exists. Opium is grown all over Hampshire, processed by Macfarlan
Smith in Liverpool and some of that heroin is then prescribed
to addicts. So whilst we have an illegal production we also have
a parallel legal production system for both heroin and cocaine,
and I think that is quite an interesting thing to bear in mind.
Q137 Mrs Dean: Transform advocates
decriminalisation of personal possession for adults and legal
regulation of the drug supply. In the case of cocaine, what evidence
do you have that decriminalisation would reduce prevalence of
use, harm to users and criminality?
Mr Rolles: We see prohibition
as a failed policy, as a reckless policy and as a radical policy
experiment that has failed; and an irresponsible policy. It has
clearly failed for a number of generations to deliver the outcomes
that it set out to; in fact it has delivered the opposite outcomes
of its stated goals consistently for generations now. Our view
is that given the reality of drug use in society, be it cocaine
or anything else, we would like to see the government regulating
and controlling those markets rather than violent criminal profiteers,
which is what happens at the moment by default. Prohibition does
not get rid of drug markets, it just gifts them to gangsters,
and we can see this very clearly with cocaine. We have been throwing
increasing amounts of enforcement resources at cocaine over a
number of decades and yet cocaine is becoming more available,
more people are using it, production in the Andean regions is
increasing and it is cheaper than it has ever been. Clearly as
a policy supply side enforcement does not work and demand reduction
clearly has not worked either. It is actually worse than that;
not only has it failed on its own terms but it has actually consistently
delivered a whole raft of secondary unintended consequences associated
with the illegal market. So we have a violent market in dangerous
drugs, controlled by gangsters, worth something like £300
billion a year globally and about £10 billion a year in the
UK alone. That is not for cocaine; that is for all illegal drugs.
We think that a better alternative, given that systematic long-term
failure, would be government regulation by the appropriate public
health agencies—the sort of regulation where you can control
products, you can control vendors, you can control the outlets,
you can control access and consuming environments, and so on.
Clearly that kind of regulation would not reduce use, although
we would argue that it might create a political environment that
would make reducing use easier in terms of redirecting resources
away from failed counterproductive enforcement into more proven
public health education/prevention type interventions. It would
certainly reduce overall harm and it would obviously reduce criminality.
Q138 Bob Russell: Mr Rolles, I think
I know the answer but just so that we get it on the record: does
the government have a duty to avoid making the use of harmful
drugs appear legitimate?
Mr Rolles: I think it is the government's
duty to try and increase the health and well being of its citizens
or subjects or whatever they are called in this country, and the
question really is about how you best go about that. I think after
50 years of quite staggering and counterproductive failure of
a policy it is the government's duty to start exploring alternative
approaches that might deliver better outcomes. We think that the
first way to do that would be to have an independent impact assessment
of the Misuse of Drugs Act and related legislation that would
look at the evidence and would consider alternatives and would
be objective. We are talking about the evidence here, let us look
at the evidence; and impact assessment is the standard tool. But
the Misuse of Drugs Act has never been subject to that kind of
scrutiny and it is time that it was. It is a proposition that
we made to the Prime Minister in a face to face meeting earlier
in June; it is one of our recommendations in our written submission
and I hope it becomes a recommendation in your report. It is an
objective, independent way of examining the current policy and
alternatives. I think it is something that Neil supports.
Q139 Chairman: Shall we ask him.
Professor?
Professor McKeganey: Perhaps I
can start by saying that I actually do feel that the government
has both a political and indeed a moral obligation not to do anything
or say anything which in any way could lead to an increase in
our drug problems. So I certainly occupy a very different position
to that which Steve has set out.
Mr Rolles: Drug problems are rising
at the moment.
Professor McKeganey: My own view
is that it is quite wrong to characterise our current drug laws
as a failure. I think that we have a persisting problem and there
is some evidence that it is an increasing problem, but in population
terms it is a remarkably small problem involving—in the
most extreme ends of the spectrum—less than 1% of the adult
population. I think that our drug laws have served us rather well
in not allowing the level of drug usage to expand anything like
we see in relation to the current illegal substances. So I do
not characterise our drug laws as failing and I would not argue
that we should seek to change those drug laws or dismantle them.
The government take on, it seems to me, the wholly inappropriate
responsibility of making drugs available in some sense because
there is a feeling that our laws have failed.
Chairman: Thank you. Would witnesses
make their contributions a little briefer. We would like some
briefer answers—there are many Members who wish to question
you on this subject. So if you could try to not expand too much
in your answers.
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