Examination of Witnesses (Questions 284
- 299)
TUESDAY 27 OCTOBER 2009
PROFESSOR DAVID
NUTT AND
DR FIONA
MEASHAM
Q284 Mr Streeter: Good morning, Professor
Nutt and Dr Measham. You have heard some of the evidence that
we have received and there will be more questions for you. Can
I just start please, Professor Nutt, by asking a little bit about
the Advisory Council's work? How often do you meet and do you
have your own agenda or is it an agenda given to you by the Home
Office?
Professor Nutt: The Council meets
twice a year, the working groups meet more frequently and the
technical committee meets three times a year formally now. Multiple
working groups meet as needed, so three to four times a year on
average.
Q285 Mr Streeter: Do you decide yourself
what you are going to look at or does the Home Office give that
to you?
Professor Nutt: It is a combination
of both. We have actually been given quite a lot of work to do
by the Home Office in the last year, part of which is relevant
to today; we have been asked to look at poly drug use and quite
a lot of cocaine use, as we have heard already, is part of a poly
drug culture, so we will be looking at cocaine in the next year.
We also develop our own themes of research or themes of investigation,
depending on where we see lacunae in terms of knowledge.
Q286 Mr Clappison: You just said
that you are looking at cocaine as part of a poly drug use; when
was the last time you looked at cocaine in itself?
Professor Nutt: Cocaine is one
of those yardstick compounds so whenever we look at any drugs
in terms of classification we always look at cocaine. I do not
know if you read the Ecstasy reports but we do use cocaine as
one of the clear demarcators of classification in that so we monitor
cocaine use, we monitor deaths from cocaine, we monitor its addictive
effect. Any time we review drugs cocaine is a key drug.
Q287 Mr Clappison: Have you published
any recent research on cocaine?
Professor Nutt: We do not do research,
we do not have a research budget; what we do is we assimilate
other people's research. We have a broad expertise in the Council
so we accumulate research which is produced both in this country
and elsewhere and then we interpret it in relation to our reports.
It would be unusual for any of our reports not to make some mention
of cocaine.
Q288 Mr Clappison: What is your reaction
to the reports which we have received of an increase in the use
of cocaine and an increase in the number of people entering treatment
as a result of cocaine use?
Professor Nutt: We are concerned
by it and we have observed that trend, we have observed the rising
number of deaths from cocaine. Just as an aside it was one of
the reasons why, in our report on Ecstasy, we noted that that
rise in cocaine was worrying; we explicitly said that in that
report. It was a factor in our scaling Ecstasy against cocaine
as a less harmful drug. It is something that we are genuinely
concerned with and we see it both in terms of powder cocaine and
also in terms of the problems with crack cocaine. I should also
say that as well as the working group now looking at the issue
of poly drug use we also have a working group which is going to
look at evidence-based treatment and clearly they will be taking
notice of what has been done today and what other information
they will be able to get relating to evidence-based treatments,
both for crack and for other forms of cocaine dependence.
Q289 Tom Brake: Professor Nutt, is
this a thankless task, being the chair of an advisory council
which analyses papers using, presumably, science and expertise,
makes recommendations which then the Government chucks out? Does
this depress you?
Professor Nutt: I am all in favour
of healthy debate and as long as we have a proper debate about
the nature of our disagreement about the recommendations I do
not think it is thankless. We have made a large number of recommendations
since I have been attached to the Council, maybe several hundred
in the last seven years, most of which the Government have accepted.
The issue seems to be around classification; most of the recommendations
we have made, looking at areas of gathering more information,
of interventions, of education, the Government has generally accepted
those. The area of tension seems to be around the classification
of drugs, where they sit in the Act, and there have been, obviously,
one or two major disagreements in the last year on that.
Mr Streeter: We will come to those later
on in the agenda.
Q290 Tom Brake: Obviously we are
aware of some of them in relation to the classification of cannabis
and so on, but are there any other significant areas of disagreement
where the Government seems to have a point of principle against
recommendations that you are making?
Professor Nutt: Only one, and
that came out of the Ecstasy review where we recommended that
it would be worth exploring the possibility of having some kind
of drug testing facility for users as the Dutch do. The Dutch
have a system whereby individuals who want to use stimulants can
have them tested so they know what they are taking; we thought
that was worth exploring in this country but the Government rejected
that. That is the only area other than classification where we
have had a rebuttal.
Q291 Tom Brake: You talked of a couple
of hundred recommendations; by the sound of it your success rate
in terms of getting the Government to accept them is 95% is it?
Professor Nutt: Of that order,
yes.
Q292 Mrs Dean: A previous witness
who is a therapist and ex-cocaine addict has levelled the accusation
that the Advisory Council is "too old, white, male and scientist
based" and argued that you need to take on some recovering
addicts. Is she right?
Professor Nutt: The question of
how you define too old, I do not know about that.
Q293 Mr Winnick: Do not apologise
about age, please!
Professor Nutt: I have two things
to say about that and one is that the lady in question does come
to our meetings and does represent from the floor, from the public
seats, her view, which is useful. We are considering how we can
involve users, addicts, ex-users and ex-addicts but it is not
simple because there are some quite extreme differences in philosophies
between users and ex-users so there is not a single voice that
we could tap into. What we have done very successfully is engage
with a number of treatment agencies, many of whose members are
ex-users, in relation to some of the specialist reports we produce,
particularly our Hepatitis C report which came out earlier this
year. We had quite a lot of involvement from user groups there
and we will endeavour to do that as much as possible. When we
can work out the best way of getting users or ex-users as members
of the Council then we will; we are not against it, it is just
a question of making sure we do it in a way which does not bias
or undermine our authority.
Q294 Mr Winnick: I may come into
that category mentioned by my colleague except that I am not scientist
based, otherwise I would be well within that category. What is
the purpose, Professor Nutt, of the classification A, B and C?
Does it really serve in practice much purpose?
Professor Nutt: The purpose is
essentially to determine penalties—that is how the Act was
originally conceived. So obviously penalties scale up as you go
through C to A.
Q295 Mr Winnick: According to danger,
obviously.
Professor Nutt: Yes, so the location
of drugs within the classification was to be determined by relative
harms, and that is what we do; we look at drugs and we scale them
and then we decide where they come in the ranking order of drug
harms. Then we make recommendations as to which classification,
which class they should be, and then it is up to the government
to accept that or not.
Q296 Mr Winnick: And how much assessment
is made in deciding whether drugs should come in one or the other
of the categories A, B and C. Are scientific experiments made
or looking at casework of those who have been addicted to drugs,
or what?
Professor Nutt: We do extremely
detailed assessments, very, very thorough assessments. We utilise
the whole range of expertise of the Council, which is enormous.
We gather vast amounts of data from published literature and also
from government reports both in this country and elsewhere; so
our reports are, I think, as good as you can get in terms of the
systematic appraisal of the knowledge base relating to the use
and harms of drugs. Then we have to make judgments across different
drugs so that we can position a particular drug in that league
table. That is obviously slightly more arbitrary, or there is
a more subjective involvement or process in that because since
almost all drugs are illicit we do not have proper controlled
trials to compare one with another, so it is always slightly greyer
than you would have with licensed drugs or pharmaceuticals, for
instance. But I think that we do as good a job as can be done
using this range of approaches. But I think there is another issue
that is in your question, and that is the issue of where the boundaries
are between the classes and that is in a way more complicated
and an even more arbitrary decision of why should some drugs be
A or B when within a class there is clearly a gradation. We rely
on the Act which says most harmful, somewhat less harmful and
somewhat less again, and we try to make our best judgment; but
there are no absolute legal definitions of what a class A drug
is or what a class B drug is or a class C drug is. That might
be quite an interesting thing to try to do at some stage—it
might help us.
Q297 Mr Winnick: Cannabis was indeed
reclassified, was it not—it was recommended for reclassification
by your organisation.
Professor Nutt: Correct. What
essentially happened was that about seven years ago we were asked
to look at cannabis and at that time some forms of cannabis were
class A, some forms were class B; so the first cannabis reports
came to the conclusion that they should all be class C and that
was accepted by the government. Then we were asked to look at
it again in the light of some supposedly emerging evidence of
changing concentration of cannabis in preparations and also concerns
about mental illness. So we reviewed it again and came to the
conclusion that it should stay as class C. Then we were asked
to review it again, so we have reviewed cannabis three times in
seven years. Again, we thought it should stay as class C but the
government decided that it should be class B.
Q298 Mr Winnick: We are not looking
into cannabis, of course, we are looking into cocaine. Can I put
this question to both of you? Are you at all surprised that this
is not considered purely and simply as an academic exercise or
scientific exercise; that politics is very much to the fore and
that there is a feeling in this place, in the House of Commons,
each party is the most determined to be anti-drugs. So to some
extent your work must be affected by this political controversy.
Professor Nutt: I think it is
to some extent, you are quite right. What we have endeavoured
to do by producing these very detailed and also very accessible
reports, we have given the evidence base to Parliament but also
to the public, and I think that the very least we have done is
to educate the debate about drug classification. It is not really
then an issue about knowledge or an issue about opinion if you
disagree with the way that we should classify it.
Q299 Mr Winnick: So you do your work
on a scientific basis, so to speak, and then you leave it to the
politicians?
Professor Nutt: We are happy to
debate with the politicians about why they disagree with us in
terms of classification.
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