Home Affairs Committee - Drugs: Breaking the Cycle - Minutes of EvidenceHC 184-II

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House of commons



Home Affairs Committee


TUESDAY 19 June 2012

Professor David Nutt and Dr Les King

Professor Les Iversen, Professor Ray Hill and Annette Dale-Perera

Evidence heard in Public Questions 295 - 374



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Oral Evidence

Taken before the Home Affairs Committee

on Tuesday 19 June 2012

Members present:

Keith Vaz (Chair)

Nicola Blackwood

Mr James Clappison

Michael Ellis

Lorraine Fullbrook

Dr Julian Huppert

Alun Michael

Bridget Phillipson

Mark Reckless

Mr David Winnick


Examination of Witnesses

Witnesses: Professor David Nutt, Independent Scientific Committee on Drugs and former Chairman of the Advisory Council on the Misuse of Drugs, and Dr Les King, former ISCD and former ACMD member, gave evidence.

Q295 Chair: Professor Nutt, Dr King, welcome to the Home Affairs Select Committee. Welcome back, I should say to you, Professor Nutt. The Committee is conducting its inquiry into drugs. It is a very wide and varied subject, but we would like to concentrate today on comments that both of you have made and the work and recommendations of the advisory group that you headed until 2008. Perhaps I can start with you, Professor Nutt. You became famous in 2008 for your comments about horse deaths and ecstasy: 100 people had died from horse-related deaths and 30 from ecstasy. That was your comment then. Are you still of the view that this is a valid comparison when we look at something like drugs?

Professor Nutt: Very much so. It was not an arbitrary choice of horse-riding as a comparator, it came from a patient I had seen who had suffered irreversible brain damage from falling off her horse, and she came to me for treatment. In fact I did treat her; I treated her with amphetamine. It did not help greatly but it controlled some of her impulsivity. But it got me thinking, "How dangerous is horse-riding?" I discovered, remarkably, that it was considerably more dangerous than I had thought. Then I thought that it was an interesting comparison because it is something that people do-young people do-and it is popular but dangerous. It is probably addictive as well; many riders find it difficult not to ride. I thought it would be an interesting experiment to compare this pseudo-drug, equasy (equine addiction syndrome), which a lot of people think is a drug now.

Q296 Chair: Is this because you believe that there is a lot of comment and speculation about drugs that is not based on fact, that there is not evidence to back up what people are saying?

Professor Nutt: Yes. I think people have a very exaggerated perception of the harms of drugs and they tend to minimise the harms of other activities that particularly young people engage in that are potentially as harmful or more harmful. I thought it is important if we are going to debate drugs and make laws about whether people should or shouldn’t use drugs and if these are going to be based on harms, we should know about proportionate harms. We cannot see drugs in a bubble; they are part of life, and they are part of the world.

Q297 Chair: Who is the best person or which is the best organisation to be able to put out a definitive list of drugs that are used and the effects, harmful or otherwise, of those drugs?

Professor Nutt: What we have recently is the new committee that I have set up and I am part of. I think our recent paper in the Lancet, which uses the multi-criteria decision analysis, is a very sophisticated approach to assess a range of drugs using 16 parameters. I think that is the state of the art at present. I think that Lancet paper, which you have, is as good as it gets. To be honest, it has been validated now by a number of studies in other countries and I think that is probably the status quo for at least the next decade.

Q298 Chair: Going back to your role as Chairman of the Advisory Council, do you think there ought to be a statutory requirement that will mean that Governments have to follow the recommendations of the Council?

Professor Nutt: If the Council was independent and properly constructed so as to represent the full range of expertise necessary to adjudicate in this field then, yes, I think there should be statutory powers. I like the model that we have now with the Bank of England. The Bank of England makes decisions about interest rates free of political interference, specifically to stop party politics contaminating sensible decision making. I think the ACMD or some other equivalent, maybe ISCD, an independent body should be constructed to do that.

Q299 Chair: But do you think it is the meddling politicians that get in the way of the science?

Professor Nutt: The reason the Misuse of Drugs Act was set up in the first place was to stop people playing politics with drugs, because it is such an easy area in which to score political points.

Q300 Chair: Do you think there is too much party politics?

Professor Nutt: Unquestionably, there is no issue whatsoever. In the 10 years I worked on the ACMD, politics dominated decision making much more than science.

Q301 Chair: You would make recommendations, Home Secretaries would look at them and then, because of a political decision, they would decide not to support your recommendations. Do you think that is wrong?

Professor Nutt: They would only support recommendations that made drugs more illegal or increased the sanctions. There was only one drug downgraded in the whole history of the Act, i.e. 40 years, which was cannabis; this used to be class A or B, depending on its formulation, that was reduced to class C. That is the only drug that has ever moved appropriately in the Act downwards. Lots of other drugs have come in and some have moved to absurd situations. Putting magic mushrooms as class A was almost a final nail in the coffin of any rationality in the Act. Politicians, essentially, are very happy if you have made drugs illegal or put them in a higher class; they are very, very unhappy to move them down. Only David Blunkett had the courage to actually allow a drug to move down.

Q302 Chair: You have said that 25% of the British public would switch to smoking the drug cannabis rather than drinking alcohol if it were to be available at Amsterdam-style cannabis cafes.

Professor Nutt: That is my estimate, and I think-

Chair: So you think it should be decriminalised?

Professor Nutt: Absolutely, yes, no question about that. I think the Dutch model, the Portuguese model, the current Spanish model are all very rational approaches. They would reduce harm in society because what we see now is a rising, rising, rising tide of damage from alcohol. There is no doubt a lot of people drink because it is legal and if there was an opportunity to use cannabis in a coffee shop-like model, they would not drink.

Q303 Chair: You maintain that alcohol is just as dangerous or more dangerous than cannabis?

Professor Nutt: It is considerably more dangerous than cannabis, yes.

Q304 Chair: Is cannabis a special case, or are there other drugs that you would like to see decriminalised?

Professor Nutt: My own view is that if society allows people to market the drug alcohol, then if people want to make a rational decision to use a drug that is less toxic than alcohol, they should be able to do that.

Q305 Dr Huppert: One of the questions we asked ISCD was whether detailed consideration ought to be given to alternative ways of tackling the drugs dilemma. The response was, very briefly, "Absolutely. The current approach to the issue of drugs has not reduced use or harms significantly at all." I know your book goes into this in much greater detail. I believe you have also published an analysis of lots of drugs, where alcohol, rated on a harm score, I think scored 72 and cannabis scored a total of 20 with lower harms to users and to others. Could you talk us through more about how that was calculated and how rigorous that assessment is of the comparative harms?

Professor Nutt: This uses a technique called multi-criteria decision analysis. It is, as far as we know, the best methodology for comparing harms across different dimensions. So here we are looking at harms from death at one extreme to international damage by wiping out jungles in Columbia at the other. These are completely different dimensions of evidence. Multi-criteria decision analysis allows us to pull those together in this sophisticated way. We went to Larry Phillips at the LSE, who is a world expert on this. We got him to chair the meetings in which we did this analysis. We used the very sophisticated 16-point scale that had been developed with me at the Home Office before I was sacked, to look at the harms to the individual and the harms to society. Essentially what you do is you score each harm for each drug on a ratio scale from zero to 100, and that then allows you to compare the relative harms across the different parameters. The key point about this process is that you can then weight it. You can make a decision as a group about which matters most and which matters least. You will see from the Lancet paper, if you look at the very detailed figure, that we decided that economic damage was the most important variable of all those 16 in the UK. You will see that is a significant contributor to the harms of alcohol. That analysis can be applied by anyone. We applied it as an expert group. It is an analysis that I would be very happy to work through with you. We can do that with you if you like.

Chair: Professor Nutt, this is absolutely fascinating and we are most grateful, but could we have just slightly briefer answers, because some of this stuff is going to be covered later on in the session.

Q306 Dr Huppert: The conclusions are obviously highly controversial, but how controversial are those particular ratings? Would most experts in the field agree that alcohol is roughly three times as harmful as cannabis?

Professor Nutt: Yes. As I said, we know that the Dutch have done a similar process and the Portuguese. Essentially, when people use this kind of analysis they come up with roughly the same scaling. I think this is as good as it gets. We have done a sensitivity analysis on that and if you were, for instance, to say you did not care whether alcohol killed people in road traffic accidents, you took that out completely, it would not change the overall ranking very much.

Q307 Chair: On traffic accidents, you know the Government’s proposals that somebody who is high on drugs should have the same penalties as someone who is drunk. Are you quite happy with that?

Professor Nutt: Provided you know what they are on and you know that it is harming them or impairing their ability, yes.

Q308 Alun Michael: I ought to declare that I am now a candidate for the role of police commissioner in south Wales.

In the suggestion of the way that things ought to go going forward, you made a comparison to the regulation of banking by the Bank of England. It is an interesting comparison because, of course, the banking failure if nothing else was essentially a failure of governance. We know your professional background and qualifications, but what is the governance of the Independent Scientific Committee on Drugs? How is it financed, how is it governed, how are its decisions and recommendations managed?

Professor Nutt: It has been set up as a charity. It is vested in a charity but will soon have charitable status of its own. We have a group of trustees, including members of this House, The Lords Rea and Taverne, the ex head of the MRC, Colin Blakemore, and other senior people. They monitor what we do.

Q309 Alun Michael: How did they become members of that? How were they selected?

Professor Nutt: We put out a public advertisement and people applied to be trustees. What we do is transparent. Everything we decide is on our website. People apply to be members, we have positions ranging from social scientists right through to forensic scientists, like Les King was. If positions become vacant they apply and we interview them.

Q310 Alun Michael: Is the decision made by the trustees?

Professor Nutt: The decision is made by the committee but ratified by the trustees.

Q311 Mr Winnick: You spoke about politicians; we are all politicians on this side of the fence, Professor. Do you think the problem to some extent, from what occurred and the fact that you were dismissed, arises from the fact that if one particular Government decides to relax the law, say on cannabis, the other side immediately, whoever the Opposition may be at any given time, jumps on the bandwagon and says, in effect, the Government is giving in to drug users? Do you think that is part of the problem?

Professor Nutt: I think that is the large part of the problem, yes. It is easy to score political points around drugs and that is why we have ratcheted up sanctions and classes over the last 40 years, because people have not had the courage to say, "No, it is wrong, drugs are in the wrong classes. MPs shouldn’t be simply trying to be more macho than the other parties on drugs."

Q312 Mr Winnick: From your point of view––obviously, Dr King will have a view––if there was a possibility of a political consensus, remote as that may be, presumably that would be very useful in dealing with the issue?

Professor Nutt: Totally, absolutely. It seems to me that drugs should be subject to that; political consensus is necessary to move this field on. We have got far too entrenched in these old positions.

Q313 Chair: You are absolutely clear that cannabis has no harmful effects?

Professor Nutt: Of course cannabis is harmful. All drugs are harmful. This water is harmful if you drink far too much of it. You cannot have a harm-free drug. Cannabis is clearly harmful, but proportionately it is less harmful than alcohol.

Q314 Michael Ellis: Professor, isn’t it irresponsible to play down the effect of drugs, as you are wont to do? Isn’t it also irresponsible to make some moral equivalency between things like horse-riding or bike-riding and the taking of drugs? For example, is it not the case that the misuse of drugs very regularly involves criminality and therefore affects others and that that cannot be said for the innocuous use of a horse or a motorbike? We are told that 50% of all organised crime groups are involved in drugs, 35% of prisoners admit injecting behaviour and 51% complain of dependency on drugs when they are in prison. What do you say to those who would suggest to you that making this moral equivalency is seriously flawed?

Chair: Dr King, feel free to come in on Mr Ellis’s questions. We will have specific questions to you so if you wish to come in.

Dr King: You mentioned criminality and drugs, but from my own area of expertise with new substances, there is very little criminality. The criminality is largely associated with heroin and cocaine. It is an important point that we must not see drugs as a single entity. They occupy a spectrum of harm, a spectrum of associated criminality, from heroin and cocaine at one end to new substances at the other end where there is very little other social damage going on. Most people who take ecstasy are not harming either themselves or anybody else in society.

Q315 Michael Ellis: Is there not an addictive behaviour to the misuse of drugs and cannot that very addiction lead to compulsive behaviour that involves the expenditure of monies that the user does not legitimately regularly have and that results in criminality?

Professor Nutt: Some drugs are addictive.

Dr King: Some drugs are not. Many new substances, mephedrone and so on, are not addictive substances in the sense that heroin and cocaine are. Remember alcohol is also an addictive substance, as is nicotine.

Professor Nutt: Just to get back to your point, I do not think it is irresponsible; I think it is completely appropriate. Activities like horse-riding, bungee-jumping, mountain climbing, and sun tanning are all activities that people do because they enjoy doing them. It is completely arbitrary to say that you should allow someone to ride a horse and not worry about the cost to the NHS when they fall off and break their brains. In fact, horse riders create quite a lot of road traffic accidents; maybe 100 major accidents a year are caused by horses losing control on the main road. So horse-riding is not simply putting the riders at risk; it is putting the public at risk. I think it is completely appropriate to say in the broader sense, if people want to make a decision about what they do with their life, if drugs is their decision, they should at least know how the harms of a drug compare with all the other activities they might do. I think that is completely appropriate.

Q316 Michael Ellis: The use of a drug, if it results in burglarising a house, affects other people.

Professor Nutt: It does, and of course the criminality of drugs is largely due to the fact that they are illegal. There is not much so criminality with alcohol because it is legal. If drugs were regulated in the way the Dutch have done and the Portuguese and the Spaniards are doing with cannabis, then they would not be illegal and there would not be criminality associated.

Q317 Michael Ellis: Could I suggest to you there is a flaw in your argument because there is criminality with the misuse of alcohol and that is a legal substance? A lot of the expenditure to the public purse of the National Health Service and law and order is from the misuse of alcohol.

Professor Nutt: That is the nature of alcohol. That is true. I think that is an excellent point and that is one of the reasons I made the comparison between alcohol and cannabis. We know the police would much rather people were stoned than drunk, because there is much less violence if people smoke cannabis than if they drink.

Q318 Mr Winnick: Professor Nutt, you are broadly critical of the Government stance on alcohol, and you have rated it as the most harmful drug in an article in the Lancet in 2010. If that is so, are you saying in effect that heroin and cocaine are less dangerous than alcohol?

Professor Nutt: No. Let’s be clear, that is the scale of harms in the UK at present. The point of that paper is to say if we really want to do something to reduce the harms of drugs, to stop the fact that within 10 years alcoholic liver disease will kill more men than heart disease, if we want to stop this rising, rising tide of alcohol admissions to hospital––over 1 million admissions last year––we have got to do something about alcohol because that is the most harmful drug at present. The harms are largely the harms to society. You will see from the scale that certainly heroin and crack are more harmful to the individual, but then there is the vast use of alcohol and the violence it causes-it is responsible for most spousal violence, most child abuse, a lot of other violence on the streets, it costs £6 billion a year to police the public disorder from alcohol. You compare it with cannabis. The recent research of Steve Pudney suggests that policing cannabis costs £500 million per year and that is largely arresting people for possession. Policing alcohol costs £6 billion, and that is arresting people because they are drunk and disorderly. So the huge harms of alcohol are driven by the public use and the disorder it produces.

Q319 Mr Winnick: If one takes the view, which obviously you do, that the laws should be relaxed-and I have a good deal of sympathy, as some of my colleagues know, with that view-do you accept that the regulations and prohibition on these more dangerous drugs should remain on cocaine, crack and so on and so forth? You are not suggesting-

Professor Nutt: I am suggesting we decriminalise possession of all drugs, frankly, but I am not suggesting we regulate access to drugs like heroin and cocaine except in medical circumstances. But I think we could certainly go down, with cannabis and the legal highs, a much more sensible, rational decriminalisation regulation route such as the Dutch and Portuguese have done.

Dr King: We do not need to just focus on cannabis. We can, for example, think about reclassifying MDMA and see what effect that has on usage and prevalence. We can take the example of methoxetamine, which is currently subject to a temporary class drug order. At the end of that period, which will be early next year, there may be a decision to classify it under the Act but what I would suggest is that we continue to have no possession offence there. We just put it into Part II of Schedule 4 of the Misuse of Drugs Regulations and see what happens. If the sky does not fall in that might advise us as to how we might next proceed. We might next move on to cannabis. But I think there is opportunity here for experimentation with appropriate monitoring of the situation before we get to that stage.

Q320 Mr Winnick: Thank you, Dr King. If I may come back to Professor Nutt, you have said you are in favour, if we can just state on the record, of the decriminalisation of all drugs?

Professor Nutt: Yes. I do not think you should criminalise drug use and personal possession because I think that they are either addicted, in which case they should be in treatment, or they are not addicted, in which case if you criminalise them the harms of criminal sanctions will have much greater impact on most people’s lives than the harms of the drug. We are seeing this in large communities of black men in this country who are being criminalised for cannabis possession and who, therefore, have much reduced aspirations in life because of their criminal records. That is wrong and it is destructive to society.

Q321 Mr Winnick: Presumably you take the view that the drug barons, the arch criminals, those who do everything possible to get people on drugs, harder drugs, would certainly be in favour of the present situation?

Professor Nutt: Unquestionably. Most economic analysis shows that prohibition actually favours crime, it favours profiteering and it increases harm.

Chair: Can I just say to colleagues, we are really slipping on time, partly because of you, Professor Nutt.

Professor Nutt: Sorry.

Chair: Not that you are not saying interesting things but we do have other witnesses that we need to deal with.

Q322 Mark Reckless: On that last point, Professor Nutt, the elasticity of demand, for addictive drugs-let us perhaps take heroin as an example. Do you consider that the success of enforcement activity, raising the price of it, is likely to lead to more or less acquisitive crime? Is the reduction in volume bought greater or less than the increase in the price, contingent on enforcement activity?

Professor Nutt: I think generally there is very little impact of pricing on use if people are addicted.

Dr King: There is good evidence that price is independent of availability. We have police officers regularly who say they have just seized 200 kg of heroin, "This will restrict availability in London, won’t it, the price will go up, won’t it", but it doesn’t. Price seems to be independent, and it is actually falling. All studies show that the price of drugs continues to fall, regardless of enforcement activity.

Q323 Nicola Blackwood: I share your concern about the problem of consumption of alcohol and the impact that it is having on society and I agree that action needs to be taken on that. Where I do not quite follow the argument is that the action that needs to be taken is to make another harmful substance more readily available in the form of cannabis.

Professor Nutt: I am certainly not just saying that.

Nicola Blackwood: Can you explain to me how that is going to address the problem of alcohol? Why do you not address the problem of alcohol consumption rather than making cannabis more readily available?

Professor Nutt: I think we should have a completely rational approach to all drugs. Separating the two is a mistake; we have to look at how we can minimise the harms of all drugs. With alcohol we know better regulation, reducing sales in supermarkets, increasing price will reduce use and reduce harms. Also a significant proportion of people use alcohol because cannabis is illegal so if cannabis was at least regulated and accessible people would switch from alcohol to cannabis. That would also reduce the harms of alcohol. My suggestion to you all is that a regulated market for those drugs is the best way forward.

Q324 Nicola Blackwood: What kind of percentages would smoke rather than drink?

Professor Nutt: I think you might find perhaps you would reduce alcohol consumption by about a quarter if we went to the Dutch model of allowing cannabis in something like a coffee shop.

Q325 Nicola Blackwood: So it is better for people to have lung cancer rather than liver cancer?

Professor Nutt: The point is that the harms of cannabis are less than the harms of alcohol.

Nicola Blackwood: All right, but they are still smoking, they are inhaling particles into their lungs.

Professor Nutt: They are. Cannabis is not safe. I am saying that in population terms I believe that that kind of regulation would have a net benefit on population health.

Q326 Nicola Blackwood: Can I ask a second question that is peripherally related to this? You have made quite a lot of complaints about the responses of politicians to the evidence base. I share those concerns, but I also have a big concern that there are too few scientists in Parliament. In fact, this is our only scientist in Parliament sitting right here. I wondered why you think that might be and why perhaps you think scientists are not more ready to stand for Parliament, given that many are willing to speak out about political issues?

Professor Nutt: I think politics is a different discipline. Maybe you have discovered that.

Q327 Nicola Blackwood: I am a musician by training, but I am still standing as an MP.

Professor Nutt: It is disappointing. We lost five scientists in the last Government. I do not know; it may be that there is disillusion among scientists that politics is not the place for them because political people are not interested in science.

Mr Winnick: You are being invited to join the Conservative Party.

Chair: Professor Nutt, on that subject, this is the House of Commons best scientist, Dr Julian Huppert. You are next, Dr Huppert. Impress the Professor.

Q328 Dr Huppert: I should be clear, there are other people with science qualifications in Parliament. Dr King, can I move us on slightly to new substances and how to deal with those? You have commented about the fact that the UK notifies a huge number of these. There is a real weakness in statistics. You have presumably seen the UK Drug Policy Commission’s report How should we regulate legal highs? and the ACMD’s report on taking drugs seriously. Both proposed the idea of using trading standards laws to deal with new drugs. What is your assessment of that?

Dr King: There are a number of options open beyond straightforward drugs laws. That document, which I contributed to, certainly talks about consumer protection legislation. It is a model that has been advocated by the New Zealand Law Commission, for example. There are other examples, but there are other possibilities. We could have unique legislation such as that enacted in the Republic of Ireland two years ago, which is the Psychoactive Substances Act, which is separate from the Misuse of Drugs Act of Ireland. Then we have the case of Sweden where they have modified the health and safety legislation to accommodate certain new substances. A general feeling around the world is that drugs legislation should be there to control harmful substances, and that is a principle that comes down from the United Nations international drug policies. With many of these new substances we cannot properly assess their harms so the feeling in many countries-and it should be here as well-is that we can’t properly put them into the Misuse of Drugs Act.

Q329 Dr Huppert: Ultimately there is a question on whose task it is to judge the safety. The current system in the UK essentially means that the state, through the ACMD, has to judge the safety of every new substance, whereas some of these other models––health and safety, trading standards––would involve the designer of the drug, the person supplying the drug, to have that onus. Who ought to have that responsibility? Who is better equipped to do so?

Dr King: I think at the moment we have a difficult problem that trading standards is controlled locally and we may have to move that to a model where it is controlled centrally, but we are not ever going to be in a position of demonstrating that these substances are safe, which is a requirement for consumer protection legislation. The world does not have very much experience yet of all these alternatives, and there are others. I have not mentioned medicines legislation, for example, which is possible and has been varied in some countries as another way of controlling these substances. We do not have a great deal of experience of these examples in the rest of the world at the moment, but I would suggest that we should look at them in more detail and see how they are working.

Q330 Dr Huppert: How can we improve the data available on these new drugs to work out which ones are worse than others, which ones we should-

Dr King: My comment on the official statistics is varied. First of all, could I start with the Home Office seizure statistics, which were last published in August 2011? There is no specific mention of new substances there. Mephedrone, for example, which was controlled in early 2010, is just bundled up with other class B drugs, and the same goes for some of the class C substances, the cannabimimetics and the piperazines. I had to put a freedom of information request into the Home Office to get this information. It was available but not published. That surprised me because I thought we had a Government that was seriously interested in the impact of new substances and yet it was not giving the detail in the seizure statistics.

Then if I move on to the offender statistics published by the Ministry of Justice, again when I came to write a submission to your Committee in November-December last year I found no information on offender statistics for new substances. So again I had to put a freedom of information request in to the Ministry of Justice. That information was there but at that stage-perhaps it has now been-it had not been published.

Chair: Dr King, it might be useful if you let us have a list of this and perhaps a note of all the areas you think information ought to be published when it has not been published and we, as a Committee, will pursue it.

Dr King: Certainly, yes.

Q331 Mr Clappison: I am very much a layman in these matters but I approach them with an open mind. I have to say I was not convinced by your response to the point my colleague, Nicola Blackwood, made that, because some present illegal substances can cause harm, we should therefore make legal presently illegal substances and thereby increase their consumption when we know that they will also cause harm. Perhaps you could have another go at that one.

Professor Nutt: It is not inevitably the case that decriminalising a drug will lead to increased harm. One of the interesting results of the Dutch experiment was that, having made cannabis available in the coffee shops, we discover there is actually less use of cannabis by Dutch youth than there is in the UK. It may simply be that they are not being pressured to use it because it is illegal, they do not have dealers selling it to them. It is not inevitably the case that there would be an increase.

Q332 Mr Clappison: We visited one of these coffee shops as a Select Committee and we got a bit of fun made of us as a result, but there we are. The Dutch do not seem to be embracing this at the moment. They seem to be rather going back on it.

Professor Nutt: No, as you know, there is an interesting political tension and they have quite a right-wing Government. I think, as with many governments, it is very easy to see drugs as a way of differentiating between the right and the left, and that is what is happening there. I do not think they are going to get rid of it.

Q333 Mr Clappison: You would agree that, for example, just taking cannabis which does cause harm, the world would not be a better place if more people smoked cannabis?

Professor Nutt: The world would be a lot better place if a lot less people drank alcohol.

Mr Clappison: No, that was not my question. That is the point that I am making.

Professor Nutt: Of course. What I am interested in is the net benefit to society of having rational drug laws. If we had rational laws, rational regulation, my anticipation is that there would be significantly less harm from alcohol, there would be somewhat more harm from cannabis, but the net benefit would be overwhelmingly positive.

Dr King: If cannabis were decriminalised, there would not be the harm resulting from criminalisation of many young people getting a criminal record. That is harm.

Q334 Mr Clappison: That may be another point. Can I pursue that a little further, and I have another point as well? Another thing as a layman I find very surprising is that in your multi-criteria decision analysis you rate alcohol as being much more dangerous both to users and to other people than tobacco, and I find that a surprise.

Professor Nutt: The reason for that is that alcohol harms a lot of other people in society through traffic accidents, through violence, domestic violence. Tobacco, by and large, just kills the people who smoke. Now we have legislation to stop people smoking in private places. Most tobacco smokers just harm themselves.

Q335 Mr Clappison: Hang on a minute, what about the misery that is caused to people when they lose close relatives because they have smoked tobacco and get lung cancer?

Professor Nutt: Of course. Tobacco is harmful, we know that. It tends to kill people later in life. Alcohol is the biggest cause of death in young men under 50 in this country.

Q336 Mr Clappison: I just find your analysis here surprising and I don’t-

Professor Nutt: It is surprising.

Mr Clappison: I am anti-tobacco. If I were the tobacco companies, I would be rushing out with this and saying, "Hey, look guys, tobacco isn’t as bad as alcohol." I think you will find there is a lot of public opinion and a lot of people with personal experience of close relatives who have died as a result of tobacco.

Professor Nutt: That is because you are rating lung cancer deaths much higher than the other 15 parameters. As I say, I am very happy to work with you on this to go through the process if you like.

Chair: That would be very helpful indeed.

Q337 Lorraine Fullbrook: Professor Nutt, your recent research deals mainly with the medical and social issues of misuse of illegal drugs. What you do not talk about-or there is one bullet point in your report-is the other side of the medical and social issues. The Committee has been to Turkey, the United States and Colombia to see first hand drugs coming in through Turkey, from Iran, Afghanistan, China. We have seen first hand the drug gangs in Colombia and the United States and the extreme violence that happens because of drug misuse and dealing by these gangs. Along with the misuse of drugs comes money laundering, illegal trade in firearms, people trafficking, people smuggling, and you do not talk about the other side of it. In the United States, we met six groups who were just like yourselves talking about the decriminalisation and the legalisation of drugs, all drugs-heroin, LSD, cocaine, cannabis-and you all talk about the existing people who are taking drugs and the treatment and rehabilitation of those people. None of you talk about the new entrants to the market if drugs were decriminalised or legalised.

Chair: Could you get to your question, please?

Lorraine Fullbrook: Yes. So you talk a lot about the Dutch. The Dutch have recently asked for their residents to be registered and have stopped drug tourism because of the crime that comes along with it to the residents. So what do you say to the other side of it? You talk about the social side, what about the extreme violence side and the misery that causes?

Professor Nutt: It is a big question; the short answer is this-

Chair: Please, a very short answer.

Professor Nutt: Most of this huge business of drugs, crack and heroin particularly, is illegal because the drugs are illegal and therefore it is beyond normal regulation. We are just saying a more rational approach might allow us to get more regulated access and that might do a lot of good for those-

Q338 Lorraine Fullbrook: But you said that you wanted drugs decriminalised or legalised.

Professor Nutt: I wanted drug use decriminalised, yes. I did not say legalised.

Lorraine Fullbrook: That does not take any account of the other side of the coin.

Professor Nutt: All I am saying is most South American Governments now agree with us that the criminalisation approach has led to the problem in South America, it is not solving the problem and it probably can never solve the problem. So we have to do something different, because the drugs trade is the second biggest trade in the world after oil and it is completely without any regulation.

Q339 Lorraine Fullbrook: So you are of the view that we are losing the war on drugs, not that we have not won the war on drugs?

Professor Nutt: We will never win. It is impossible to win the war on drugs the way we are fighting it at present.

Q340 Chair: On page 281 of your book you quote, "An ambitious UK back-bencher called David Cameron" and you go on to criticise President Obama as well. Lots of words from politicians, you are saying, but not enough action?

Professor Nutt: Precisely. That report is from this Committee 10 years ago saying it was not working then; it has got a lot worse now. We have had 100,000 Mexicans dead in those 10 years and nothing has been done. It will not get better the way we are doing it at present.

Q341 Lorraine Fullbrook: I have not had an answer to my question. What about the new entrants to the market? You talk about people who are currently taking drugs and the rehabilitation and treatment of those. What about the new entrants to the market if we have cocaine, heroin and cannabis free in the local shops?

Professor Nutt: No, I am not remotely saying that. What I am saying is that certainly I think it is worth experimentation with regulated access to cannabis. That might stop people using heroin and cocaine. The reason for the Dutch experiment was to stop young people who wanted cannabis having to go to a dealer who would try to get them on heroin. In this country most dealers deal crack, heroin and cannabis so if you want cannabis you are always vulnerable to getting addicted to something else. The Dutch experiment seems to have worked because they have lower levels of heroin and crack use in young people than we have in this country because of separating the markets.

Chair: If I could say to colleagues, we have another three sets of witnesses to come in and we do need to cut down on the length of our questions.

Q342 Bridget Phillipson: Apologies, Professor Nutt, that I have not been here for all your evidence. I agree entirely with you that alcohol is a major cause of social harm and I agree with many of your comments, but I would like to raise one note of concern in the suggestion that somehow alcohol causes domestic violence. I accept it is a factor, but would you not agree that, while it is a factor, individuals have to take individual personal responsibility for criminal behaviour and it is not simply a case of there being a direct causal link?

Professor Nutt: Most domestic violence is alcohol-fuelled. Okay, you can debate whether it is causal or not but the fact is less alcohol in the home equates to less violence. There is a beautiful study recently published from Glasgow showing that when people go and get drunk at football matches they come back and beat up their wives. Alcohol is a major factor in violence across society, in the home, on the streets, at social events. It is not causal but it is an unfortunate aggravating factor so if you reduce the amount of intoxication you will reduce violence, we know that. There is a great example in my book about Euro 2000 when two separate countries had two different ways of dealing with the drinking British football supporter. The country that gave them less strong alcohol, the Netherlands, had much less violence than the country that gave them strong alcohol, Belgium. We know therefore that less alcohol means less violence; that is a fact.

Q343 Bridget Phillipson: I agree in terms of the heightened incidents you often see around football tournaments, the role that alcohol can play, but my understanding is the evidence is quite mixed and that domestic violence will often be happening in those families anyway. It is sometimes exacerbated, it is sometimes worsened or perhaps the violence is more extreme, not necessarily-

Professor Nutt: Yes, I think you are right. Drugs do not cause people to do something that they would not have a tendency to do. Alcohol tends to disinhibit people and allows them to do things they would regret subsequently, but nevertheless it does increase harm.

Q344 Dr Huppert: Evidence on what would happen is obviously very hard to find, but are you aware of the studies in the Czech Republic when they penalised possession in 1998? They expected less illicit drug use and some very detailed studies found that availability didn’t increase, the price on the black market wasn’t changed, the use of illicit drugs didn’t decrease, it went slightly up, and it had no measurable effect on health indicators. Is that accurate?

Professor Nutt: Yes, it is. It is a very interesting experiment and it does show that you need a different approach. That is probably the best control trial we have of criminalisation. The Poles did the same and there was a very graphic apology from the Polish President a couple of months ago saying something along the lines of - "We got it so wrong. All we achieved by trying to crush drug use in young people through criminal sanctions is that we just criminalised a lot of young people and so screwed their lives over, and we shouldn’t have done it", and this country has now retracted that penalisation approach as well.

Q345 Lorraine Fullbrook: Professor Nutt, you have highlighted research into the effectiveness of ecstasy when treating post-traumatic stress disorder and LSD in treating addiction, which is ironic, and depression. Do you think there is enough support for research into the medical use of drugs that are considered to be recreational drugs?

Professor Nutt: I am so pleased you asked that question because this is one of my key concerns at present. What we have discovered-and this is an area I am working in at present-is that when drugs become illegal people stop researching them. So there were 1,000 studies on LSD before it was made illegal; there has not been one since. We have just done the first ever study of psilocybin in the UK and we have discovered that it may well be useful for treating depression because it produces the same changes in the brain as antidepressant drugs, and so we now have MRC funding to pursue that.

I think it is one of the great scientific scandals that we have not researched these drugs that have profound brain effects and the reason we have not is because the regulations make it almost impossible. They make it very expensive and going through the regulations is so time consuming that most institutions and most individuals will not do it. So we have this paradox now. We are in the process of setting up a trial to do MDMA in veterans with PTSD from Afghanistan. That study will be done with an expert, Jonathan Bisson in Cardiff. If it works, which I hope it will, we will then have the really bizarre situation that no doctor could use the drug because MDMA is a schedule 1 drug and it is not allowed to be used outside of research. So we do have to change the way we regulate at least these drugs in terms of research otherwise we will not utilise the full benefits.

Q346 Lorraine Fullbrook: You do not have to make drugs decriminalised or legal to do that, you just have to make them available to doctors to prescribe.

Professor Nutt: Exactly, but currently most of the interesting drugs are in schedule 1 and it is almost impossible, even for researchers like me who have a lot of willpower, to use them. We have to change those regulations. That would be a very powerful thing your Committee could recommend.

Chair: Professor Nutt, Dr King, thank you for coming in. You have made an offer to this Committee that we would like to take up. If you have any further information that is going to be helpful to us in our inquiry, please do let us know. We would like to have the list of information that you feel the Government has not published. We would like to get it published because we think it is in the public interest to do so. Thank you very much.

<?oasys [np[pg6,cwe1] ?>Examination of Witnesses

Witnesses: Professor Les Iversen, Chairman, Advisory Council on the Misuse of Drugs, Professor Ray Hill, Advisory Council on the Misuse of Drugs, and Annette Dale-Perera, Advisory Council on the Misuse of Drugs, gave evidence.

Q347 Chair: Professor Iverson, I apologise we are running a little late. You now chair the Advisory Council. Do you have politicians meddling in your affairs or are you able to make your recommendations with the full knowledge that no one is going to start meddling?

Professor Iversen: I would like to correct David Nutt’s statement that his committee is the only independent advisory group. The Advisory Council is an independent group, independent of Government-

Chair: Sorry, Professor, you will need to speak up because the acoustics are not very good in here.

Professor Iversen: We are independent of Government and therefore we are the expert advisory group and David Nutt is supplementing it in a useful way, but his is not the only one. On my left is Annette Dale-Perera who is chairing the new recovery committee looking at the best ways of recovery from addiction, and on my right is Raymond Hill, a pharmacologist, all council members.

Chair: My question was meddling politicians.

Professor Iversen: Yes. Well, that is not the way we look at it. We work with Government in the sense that we like to know what issues Ministers feel to be important. The Home Secretary every year sends out a letter suggesting our agenda and if we agree, we accept it, but we also have the ability to form our own agenda items. For example, we have done a very large review of cocaine recently-we are about to report on this in July-and the reason we took that up was our council members are worried about the increase in cocaine use in this country over the last decade and we are also worried about-

Q348 Chair: We look forward to receiving a list of all the things you are doing. If I could ask you specifically about prescription drugs. When the Committee went to Miami, we were shocked at the level of misuse of prescription drugs, doctors in America prescribing drugs that were then sold on to others. It has become a huge industry. Is this a problem in this country as compared with the use of cocaine and heroin?

Professor Iversen: We are aware that the US has declared an epidemic, which was the title of the report recently issued by the White House, and they have had particular problems with a new opiate painkiller called Oxycodone that has generated hundreds, if not thousands, of new addicts in the US and they are facing a very challenging situation. We are not aware-

Q349 Chair: What about us here?

Professor Iversen: We are not aware that the situation is as bad here. Nevertheless, we have the intention, as the council, to do a review of prescription medicine diversion to recreational use. We will be doing that next year. I might point out that most drugs, even class A drugs like heroin and cocaine, also have medical uses so there is no reason why a substance cannot both be a medicine and be a banned, illegal recreational drug.

Q350 Chair: One final question from me about the use of legal highs and the ability of your committee to look at these issues with the speed that is required. Obviously these come on the market very regularly. We had a witness previously whose daughter had died using a legal high who referred the Committee to a warehouse in Manchester that in her evidence was full of legal highs. As soon as one substance is banned another substance is created. Is this a problem?

Professor Iversen: Yes.

Q351 Chair: Why does it take so long?

Professor Iversen: You are quite right to say it is a problem. It is very high on our agenda and has been for some years. If I may, I will ask my colleague, Ray Hill, to give more detail.

Professor Hill: Sadly, there is no limit to the ingenuity of chemists all over the world to look at those substances that are controlled and to design another substance that has similar pharmacology but evades the controls. We see this as almost a continuing task, unless you institute something like the Analog Act that they have in the United States where you are allowed to cover not just the drug that you know about but any other drug that would act in the same way.

Q352 Chair: That is what you would like to see here?

Professor Hill: We would like to see this.

Q353 Chair: What about the speed with which you are able to ban these legal highs? We only get to know they are dangerous when someone dies and when that happens there is a huge public demand for them to be banned.

Professor Hill: I think there are two main problems. One is that often the drugs are not known by a defined chemical name and the first step you have to do is to find out actually what the chemical is in, for example, Ivory Wave or Black Mamba or whatever it is being sold as by the dealers. Even when you do have a chemical name, like in the recent substance methoxetamine, you still have a very limited amount of information on what that drug does. We are in the bizarre situation of getting dribs and drabs of information from clinical reports from clinical toxicologists that tell us all we know about those substances.

Q354 Chair: What would you like to see to improve that?

Professor Hill: We would like to be able to do research on these substances and find some way of paying scientists to investigate exactly what these substances do. Methoxetamine is a good example because it is an analogy of ketamine, which is a drug with known properties. It is being sold as supposedly a safer ketamine even though there is no evidence for that, and yet some of the clinical reports we are seeing suggest there are effects on the cerebellum leading to difficulties with walking, for example, which are seen with this new drug that have not been seen with ketamine. So it is clearly not just a clone of ketamine but we know very little about the mechanism.

Q355 Chair: Do you know where these scientists are who are producing these legal highs?

Professor Hill: All over the world. I think probably the biggest concentration is in China because that seems to be where most innovation goes.

Chair: That is what the Committee has been told. It is happening in the UK as well, is it?

Professor Hill: Yes. I think there are people in the UK and everywhere doing it, yes.

Chair: Dr Huppert, could we have brief supplementaries because we have a list of questions.

Q356 Dr Huppert: I will try to be very brief. Firstly, just as a matter of factual accuracy, as I understand it the current legislation allows you to describe things like alcohol derivatives or particular compounds so you do have some analogues that are-

Professor Hill: Yes, the problem is that you have to rely on the expertise of your chemist covering all the possible permutations of that molecule. Of course, it is like a game between the chemist making the illegal substance to think, "Well, he didn’t cover a methyl ester so I will put that in and that is now outside the coverage."

Q357 Dr Huppert: We heard earlier some suggestions about other methods that are used around the world that do not rely on a central body determining what is safe or not but options about health and safety, trading standards. Are you attracted by any of those?

Professor Hill: I think any system as long as it works, really. I would not claim that one is better than another but certainly I think as a pharmacologist you might expect me to say the pharmacological definition is probably the best one. If, for example, rather than defining the structure of substances that act like cannabis, you said everything that binds to the CB1 receptor, which we know is the site of action, is a controlled substance then at a stroke you have done it.

Q358 Michael Ellis: Legislators like Parliament cannot keep up with scientists who on the back of an envelope in a lab somewhere can put a couple of chemicals together and make something slightly different from what they had before and, hey presto, we have a new so-called legal high. So jurisdictions like those in the United States have this catch-all legislation that allows them to say that key constituent parts of these so-called legal highs are controlled in and of themselves. Is that right?

Professor Hill: Yes.

Q359 Michael Ellis: Can you therefore see that as being an effective method for this country so that rather than waiting to proscribe a new so-called fashion item drug like a Black Mamba or whatever it is called, you can then say, "Well if it has this constituent part in it it’s automatically controlled and we do not have to have separate legislation for each thing"?

Professor Hill: I think in theory what you say is absolutely true, but in practice there are no limits to what you can do in chemistry and the number of permutations is virtually endless.

Professor Iversen: The idea of a legal high is to mimic an existing illegal drug, so nearly all of these legal highs are mimicking one or other of the controlled substances. The American Analog Act is working quite well. They now have their own legal high problem with a product sold as bath salts-in this country they are sold as garden food-and the Americans have successfully closed down a number of internet sites selling these substances. As recently as Friday of last week they closed down a site using the Analog Act. So the Act is being used very effectively across the water.

Q360 Chair: Would you like to see this Act replicated in our legislation?

Professor Iversen: We would like to see something not necessarily identical to the US but along those principles.

Q361 Alun Michael: There has been a reference to the establishment of a recovery committee as a standing committee and I wonder if you can tell us a bit about that. How often will it meet, what is its brief, what is it currently working on?

Professor Iversen: Yes, it is a very important new committee for us. Annette here is one of the co-chairs so I will let her speak to that.

Annette Dale-Perera: The Inter-Ministerial Group on Drugs has asked the ACMD to set up a committee on recovery. That ACMD already had a committee looking at drug treatment and it was looking at some of the issues, but what we have done is constituted a totally new group and we are very pleased to be able to do that. The group will focus on two things, firstly, how can people be best supported to recover from dependence on drugs and alcohol-so for the first time ever we are looking at drugs and alcohol, which could be very beneficial-and, secondly, to look at how to prevent drug and alcohol misuse. The committee will set its own agenda but we have had a listening exercise where we have been consulting Government Departments to see what their priorities are. Our agenda will be both proactive and then also responsive to what the Government want us to look at, and the Government have asked us to prioritise focusing on recovery from dependence and then look at prevention further down the line.

Q362 Alun Michael: In its response to the Government’s consultation on the drug strategy, the council highlighted the issue of the lack of treatment options for non-opiate addicts. Is that therefore going to be something that the recovery committee is going to be looking at?

Annette Dale-Perera: We will certainly look at this. The last Government prioritised treatment for heroin and crack cocaine because of the high level of associated harms and a relatively good evidence base in terms of treating that. Drug patterns have changed in this country, and we know this. Heroin use is going down, particularly in London, which is good news, but we know that some other types of drug use are going up. In terms of the treatment systems that we have at the moment, non-opiate use is being treated. For example, in London about 40% of everybody coming to treatment is for non-opiate use, things like stimulants, cannabis and a range of substances, but we are very mindful that the patterns of drug use and patterns of dependency are changing and we need to keep up with it.

Q363 Alun Michael: The other concern that has been expressed by the council and by a lot of other stakeholders is the issue of less money being invested in drug treatment at a local level and therefore treatment not being immediately available. Is that something that the recovery committee is going to be looking at? I am just trying to be clear about what benefits we are likely to see coming from the committee’s work.

Annette Dale-Perera: The recovery committee, through the ACMD, has written to the Inter-Ministerial Group on this topic. From April of 2013-

Alun Michael: Yes, sorry, but my question was whether the committee is going to be monitoring the actual impact on the ground.

Annette Dale-Perera: Okay. I think it is beyond the remit of the committee to do monitoring. We would have to rely on other people to do that. We are a group of volunteers, but we have suggested that the situation is monitored, because we think that-

Alun Michael: By?

Annette Dale-Perera: We have requested that the Government look at how this is monitored, because we think that the potential disinvestment when there is a lack of ring fence on the drug treatment money is possibly the biggest risk to the recovery and treatment agenda in the drug strategy, and we have flagged this with Government through a letter.

Q364 Mark Reckless: On the drug treatment strategy, are you satisfied with the balance between harm reduction, including methadone maintenance treatment, and abstinence-focused treatment programmes?

Annette Dale-Perera: It is one of the things that we look at in detail. We have a very strong evidence base for drug treatment, particularly around some of the reducing harm aspects. The evidence base around recovery and how long people will take, who can recover, what are those characteristics––there is less of an evidence base there and one of the tasks of the recovery committee is to look at that. So our first output is a scoping exercise to look at what is the contribution of different factors to recovery agenda, and that includes things like housing, employment, communities, mutual aid and so on, so we will look at that.

In terms of the balance between harm reduction and abstinence, I think that the recovery ambitions and the ambition for everybody to be abstinent who has had a drug or alcohol problem is absolutely excellent. I think what we have to recognise is that when somebody is trying to overcome a dependency it is very difficult, and that if you force people to detoxify and they do not have the social and personal capital, they will relapse. An intermediate step in order to help them get there, if they have a heroin problem, could be a drug treatment like methadone substitution treatment and so on. It has had a big impact in terms of pulling people into treatment and reducing crime and helping people improve their lives, but the story should not stop there.

Q365 Mark Reckless: Do you see a role for faith-based organisations in drug treatment at all?

Annette Dale-Perera: I think it is almost a question of there is no one treatment that is effective for everybody, and there is a question of personal choice. We have an evidence base about what works, and a lot of what works are talking therapies in whatever format. Some of those, if the person requires, are faith-based or 12-step, so you cannot rule things out necessarily, and there is quite a strong evidence base for talking therapies.

Q366 Mark Reckless: Can I ask the other members of the panel, on the issue of legal highs, the evidence you gave is that these sought to imitate existing illegal drugs. Can the legal highs be more dangerous than the illegal highs because there is a lesser evidence base of their effect?

Professor Hill: Yes. I think there is good evidence for that already. I mentioned methoxetamine. Evidence is emerging that it is not just like ketamine, it has additional properties that may also be harmful. Of course, if something is introduced as a new medicine, it has to go through rigorous testing for its safety. These things are going straight from the chemist into the people who are taking them with no check on safety whatsoever.

Professor Iversen: I think methoxetamine, as a ketamine analogue, has special physical harm potential. It was recently recognised that ketamine itself can cause bladder damage and very severe bladder damage, to the extent of having to have your bladder removed and have a catheter for the rest of your life. This is quite different from the intoxicant effects, but there is no reason to think methoxetamine will not share this property, although it is being marketed as a bladder-friendly version of ketamine without any evidence whatsoever.

Q367 Nicola Blackwood: I wanted to go back to some of the points you were making about the recovery committee. Some of the problems that we have received evidence about are at points of transition, so the point between perhaps going on to a substitute drug and then going from that into maybe a residential rehab and then going from the residential rehab into a community-based programme, and perhaps problems with co-ordination between those different services. Are you taking evidence or doing research into those links and will you be able to give Government advice on those services, or is that not part of your remit?

Annette Dale-Perera: We will be looking at the contribution of various types of treatment systems to recovery and what the evidence says about what is good outcomes and what is not working, so it is something that is likely to come up through that channel. We are aware that continuity of treatment is most important, because people can fall through gaps, for example coming out of prison services and then getting into the community, and that continuity of care is very important.

Q368 Nicola Blackwood: I would like to go back to a point that was raised right at the beginning and following on from the evidence that we have just received. As members of the ACMD, given the previous evidence, can you say if you have had experience of providing scientific advice to the Government that has not been accepted, and do you think that it is possible to balance the benefits of evidence-based policy with the wishes of public opinion?

Professor Iversen: The ACMD by its nature is advisory. We offer the advice and the Government does not have to take it. As you will be aware, when David Nutt was chair and I was a member of the council, we recommended downgrading ecstasy from its present status as a class A drug, and we did not recommend the upgrading of cannabis from C to B, and in both those cases the advice was overridden, so we are used to that.

Q369 Nicola Blackwood: You are used to that and you do not feel that that undermines your independence?

Professor Iversen: It is the nature of an advisory group to offer advice, not to execute the advice.

Q370 Lorraine Fullbrook: The ACMD have recommended, and I quote, "A credible message approach that uses all the agencies in a coherent drug prevention strategy rather than the ad hoc arrangements that we have currently as a preventative measure." Can you explain to the Committee what this would look like?

Annette Dale-Perera: The evidence base on drugs education and prevention is not as strong as we would like it to be.

Lorraine Fullbrook: In what way?

Annette Dale-Perera: Evidence on drug education is that it does not necessarily impact upon behaviour. What it does is it impacts on people’s knowledge about substances, which is important, but I think there is an expectation sometimes that drugs education will prevent people using drugs and it does not work that way. There are some more promising methods called normative education approaches that involve interactive methods with young people, because that is important. Young people often overestimate how many drugs they use or how accepted it is by their peers, and if they realise that drug use is a minority activity and is not necessarily accepted, that can be used to modify behaviour. But the kind of messages and the data presented must be given by credible sources, otherwise the young people will not believe it. So these are slightly more promising approaches than other methods, but they have to be provided by people whom the young people respect, otherwise they do not take any notice of them at all. Then they have to be implemented with consistency and with competency and that has been a real problem in our schools, because we have not had that.

We also know that some messages do not work or have the opposite effect, so fear-based drugs education messages do not have any impact on behaviour and "Just say no" can send people in the other direction, so it can encourage use. So we have to be really careful about drugs education and prevention and we have to test things out with young people before they are implemented and then we have to evaluate them as they are rolled out and implemented, because we can get this wrong.

Q371 Lorraine Fullbrook: During this inquiry we have had many groups that we have met and some people that we have met who have asked for the decriminalisation or legalisation of recreational drugs, the ones we all know about, and nobody can explain to me what the world would look like if that happened. Can you explain to me what the world would look like if that happened?

Professor Iversen: In our evidence to the drug strategy document that the Government-during the consultation process and in our evidence to the Sentencing Council that recently reviewed what penalties should be available for drug offences––in both cases the Advisory Council recommended measures that would reduce the amount of criminalisation of recreational drug use. We will not go as far as David Nutt and we will not go as far as Portugal, which by the way has been described as a disastrous failure on one hand and as a resounding success on the other hand, so you pays your money and takes your choice there.

Lorraine Fullbrook: Well, they have more cocaine users than they have ever had before.

Professor Iversen: But what we would like to see is the discretion to divert from criminal penalties to civil penalties. Civil penalties might include obligatory education in a drugs education scheme, other penalties such as losing your driving licence for a while and so on, but to some extent this is what the police are already doing in terms of cannabis offences.

Q372 Lorraine Fullbrook: But that is assuming drugs are currently illegal. The people who are calling for decriminalisation or legalisation of recreational drugs, what does the world look like if that were to happen? If the Government decriminalised or legalised recreational drugs, what would the world look like tomorrow?

Annette Dale-Perera: I think it is impossible to say.

Chair: Excellent. That sounds like a very good end to that question.

Lorraine Fullbrook: But nobody has been able to answer.

Chair: Yes, but as the witness says, she finds it impossible. Dr Huppert has the final question. I am sorry, we have to move on.

Q373 Dr Huppert: Can I follow on from that? In your evidence you say, "Criminal justice interventions which involve young adult drug users gaining a criminal record or a custodial sentence may not be the best use of public resources, given the life-limiting effect or negative impact this may have on a young adult’s future employment and life prospects." Are you therefore advocating that we stop having criminal justice interventions for possession offences, in this case particularly for young adults? Is that how I should read that?

Professor Iversen: We are discussing discretionary diversion away from criminal offences. Discretion involves, for example, "Is this a first-time offence? Is this person likely to be a dealer? How many times has he been met by the police?", and so on. So you can judge the circumstances and then divert or not divert. I think it is discretion, really.

Dr Huppert: So part way to the Portuguese direction?

Professor Iversen: But we would like to see fewer young people given criminal records, because that has an impact on the rest of their lives in terms of getting a mortgage, a job, a college place and so on.

Q374 Dr Huppert: I was reading some work that has been done, I think in Mexico, about vaccines towards heroin and cocaine. Are these remotely realistic and what are the medical and ethical implications?

Professor Hill: Vaccines are obviously an attractive approach, because by one treatment you can potentially remove the craving for a drug, but vaccines are not easy to make, it takes a very long time and if you look at the current landscape, after about 25, 30 years’ work there is a single nicotine vaccine in phase 3 clinical trials, which may or may not become a marketed product. There is a cocaine vaccine in early clinical testing, and as far as we can tell nothing at all going on for heroin or other drugs. It is an option; I suspect it will not be a panacea. It could be just something else that would help people who are trying to give up a drug habit.

Chair: Thank you very much. This has been very helpful and there are going to be aspects of the Committee’s questions that you have not been able to answer because of time constraints, especially in response to Mrs Fullbrook’s question. It would be very good to have a note from you on that. If you could send us a note, that would be very helpful. It is just we are running very short of time at the moment. Thank you very much for coming; we are most grateful.

Prepared 8th December 2012