Examination of Witnesses (Questions 320
- 329)
TUESDAY 27 OCTOBER 2009
PROFESSOR DAVID
NUTT AND
DR FIONA
MEASHAM
Q320 Mr Clappison: Have you any further
reflections to give us on how alcohol stands in relation to cocaine?
We did take some evidence that it was a gateway drug to cocaine
and about the usage in combination with cocaine.
Professor Nutt: It is very commonly
used with cocaine and I have heard that people go into pubs and
order in a gin and tonic and a line of coke and getting it over
the bar, so to speak. So there is a common use. There are several
reasons for the common use. One is that cocaine will keep you
awake so that you can drink more, so you do not fall asleep when
you are drunk. The other is that alcohol has a slight mood elevating
effect which can be accentuated by cocaine, so there is a synergistic
psychological benefit. I have already touched on the negative
interactions at the level of the heart, which is a combination
of cocaine and alcohol. Whether alcohol is a gateway drug, most
people who use other drugs have used alcohol, and most people
who have used other drugs have used tobacco. Proving that they
would not have used the other drug if they had not drunk is almost
impossible. It is not useful to speculate down there. Probably
in the sense that if people like taking drugs that change their
mind they look for other drugs and if they are drunk they may
take other drugs because their resistance and their judgment is
impaired.
Q321 Mrs Dean: You have obviously
talked about the priority being about polydrug users and the use
of alcohol as well as cocaine, but are there other particular
problems associated with polydrug use besides the alcohol connection?
Do you consider that users require different policy or treatment
responses?
Professor Nutt: Polydrug use is
a problem for a number of reasons. One is that it is more dangerous.
The second is that it may be more addictive, so people may be
more entrenched. The third is, if you are looking for complete
abstinence it will be much harder to achieve when you are dependent
on multiple drugs, and we have heard some of that evidence today;
so polydrug use is a problem. What we would see as an appropriate
target for drugs is certainly getting people off the most dangerous
drug, which is usually opiates, because those are the drugs that
tend to kill you; and then crack; and then working down. It may
be very hard to get people off all drugs simultaneously.
Q322 Mrs Dean: So it is one at a
time.
Professor Nutt: Even that outcome
would be good, let us put it that way.
Q323 Mrs Cryer: Can I ask you about
the current legislation, which is the Misuse of Drugs Act, and
associated legislation? The actual Act was approved by Parliament
in 1971 and so that is 38 years ago. Do you think that the time
has come to have an impact assessment of that legislation and
how it applies today? Is it still fit for purpose?
Professor Nutt: As I have already
said in answer to other questions, it is not perfect; I think
as a construct it is good. I think if it was made more evidence-based,
if the Act truly represented the harms of drugs rather than having
some other political overwrite or messages written into it then
I think it would be very powerful. I think my Council would be
quite comfortable if people wanted to review the Act actually.
Q324 Mrs Cryer: Do you would support
a total assessment of it?
Professor Nutt: I would be very
happy with that, yes.
Q325 Mr Winnick: Can I put this to
you, Professor Nutt, and also to Dr Measham? There is a growing
controversy—certainly in political circles but not confined
to political circles—whether all this prohibition serves
any purpose whatsoever; that people do not stop using drugs because
they are prohibited. Reference is made, of course, to what happened
in the States when prohibition of alcohol came in and we know
that that was a miserable failure. Although this is a matter obviously
to be decided by politicians, who are not likely to reach any
unanimous agreement, to say the least, do you feel that this debate
of whether or not drugs should be made illegal, in the sense that
they are at the moment, serves a good purpose—that is, to
have such a wide ranging debate?
Professor Nutt: I think it is
important to have the debate. I think the debate needs to be a
mature debate. It is interesting what you said about prohibition.
You said that prohibition was an abject failure but it depends
on the criteria you use. So if you look, for instance, in the
US at rates of liver cirrhosis which are almost all due to alcohol,
during prohibition they fell by about three-quarters. So in terms
of the liver, prohibition was good. In terms of society prohibition
was not good, and that of course is the debate we are having at
present. That is why it does become a political rather than a
scientific decision because we have seen people try to circumvent
the law; people are buying drugs over the Internet which are currently
legal, the so-called "legal highs", presumably because
there is a deterrent to getting illegal drugs. So I do not think
we can say that the law does not work. The law must influence
people to some extent, and it really is a question of getting
the balance right between the appropriate benefits of making drugs
illegal versus the larger geopolitical consequences of those kinds
of controls. It is a bigger decision than certainly my Council
can give.
Q326 Mr Winnick: Of course. The comparison
is also made that during prohibition the people who did so well
were the gangsters—and one in particular whose name remains
pretty infamous—and here the drug barons, those totally
indifferent, to say the least, to human suffering—you in
reply to Mr Clappison pointed out all the dangers of cocaine—the
drug dealers want to encourage as much use as possible. I wonder
whether the most effective way of dealing with the drug traders,
the criminal gangs and the rest of it is to review very seriously
the policy that has been pursued by successive governments.
Professor Nutt: As I said, a very
mature and wide ranging debate about the effects of regulation
or illegality on drug use is worth having. I would be surprised
if making drugs legal would actually reduce use. I think that
would be very unlikely. It is possible that there are some kind
of intermediate positions which would not increase use but would
possibly take away some of the perverse consequences in terms
of crime, et cetera. There may be other solutions and I would
encourage that debate. We would engage in that debate but we cannot
lead it.
Q327 David Davies: That picks up
on my question. My apologies; I had a medical appointment which
is why I am late this morning. My question would be this: as somebody
who has children, would my children be more likely or less likely
to take drugs if they were to some extent legalised? Legalising
might put the drug barons out of business but would it increase
or decrease or have no impact whatsoever on the number of people
who currently take drugs which are very easily available anyway?
Professor Nutt: It is a really
difficult question to answer. All answers could be correct. I
would say have the debate and we will help you have that debate.
Q328 David Davies: Thank you for
being honest enough to say you do not know because I do not know
either and I suppose that is one of the questions that we have
to answer.
Dr Measham: It might be different
for different drugs. If you look at attitudes towards smoking
and how those have changed in all of our lifetime a drug might
be come less socially acceptable even though it is still legal,
so the legality is not the only issue.
Q329 Mr Streeter: A final question
because we did promise to ask you about this pharmacological treatment,
Professor Nutt. Do you see anything on the horizon for cocaine
particularly?
Professor Nutt: Cocaine is particularly
difficult to develop drug treatments for, for two reasons. One
of which is that it may damage the brain and therefore you have
less to work on; the other is that we still do not know how it
works. We know what it does but we do not know how it does it.
So we do not have the same kind of simple target as we have methadone
for heroin, for instance. So where people are looking is in terms
of vaccination and there are programmes in human trials now where
you can vaccinate people against cocaine and then you produce
an immune reaction if you take it so that less cocaine gets into
the brain. So those trials are ongoing. It is not easy; it is
not an easy technology but I would have thought that within the
next couple of decades that would be available.
Mr Streeter: Thank you very much indeed
for your evidence, Professor Nutt and Dr Measham. That concludes
this morning's sitting.
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