Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by David Marjot (DP044)
1. Personal Details
2. I am a consultant psychiatrist who has now retired from direct clinical practice but advises three Charities in the drug and alcohol field as well as writing and lecturing. One such Charity has in 2011 won two national awards for innovation in the field of alcohol harm in primary care. In 2009 I published a text book, “The Diseases of Alcohol”, that is a litany on the terrible damage caused by that drug.
3. As senor psychiatric registrar I worked for three years in Broadmoor Hospital. I joined the Royal Navy and became the senior consultant psychiatrist in the Royal Navy. My clinical findings and publications about the severe damage inflicted by alcohol on the Royal Navy led to the abolition of the rum-ration. On retiring from the Navy I was for 17 years Consultant in Charge of the North West Thames Regional Health Authority’s Alcoholism and Drug Dependence Unit. Other roles were 20 years visiting consultant psychiatrist to HPM Wormwood Scrubs and for five years to HM Borstal, Feltham. After retiring from the Regional Unit I was consultant forensic psychiatrist at Broadmoor Hospital for two years. My views are based on very substantial experience and could be thought to be relevant to your Committee’s enquiry.
4. Executive Summary
5. I will argue that current suppliers and users of illicit drugs are a persecuted minority as the male gay community, the black community and other minorities were until very recent times.
6. Submission to the Committee
7. Professor David Nutt was forced out of the Chair at the Advisory Council on the Misuse of Drugs in 2009 because he publically maintained that alcohol and tobacco caused comparable damage to heroin and cocaine and that the current classification of drugs into classes A-D is not rational. I share the views of Professor Nutt.
8. Our expert opinions raise a grave moral dilemma. A 16 year old grandson once asked me for a beer. From the moral standpoint giving my grandson a beer or tobacco is no better or no worse than giving him cannabis or heroin. We must not confuse morality, legality and respectability. It is legal and respectable to use alcohol but no more or less moral to use alcohol than currently illicit and stigmatised drugs. (We must not confuse the morality of drug and alcohol use with the morality that enjoins us to obey the Law).
9. Professor Nutt and myself have both argues that recreational horse riding is as dangerous as the use of Ecstasy. Why is horse riding not prohibited on grounds of harm? The prohibition of Ecstasy must be by a moral judgement unrelated to mortality.
10. Why then are alcohol and tobacco not prohibited and their users and suppliers severely punished? It is a standard argument that to prohibit alcohol and tobacco would give rise to all the disadvantages of prohibition such as seen in the USA with alcohol. This argument applies with equal force to all the drugs currently prohibited.
11. It has often been said that if alcohol were now to be introduced for the first time it would be prohibited. If such views were sincerely held then the holders of such views would immediately become total abstainers from alcohol and vigorously advocate such abstinence for everyone else. I do not see this happening.
12. As it is Laws that make crimes not immoral or indeed moral acts we must have profound concern if we criminalise some morally equivalent acts but not others.
13. I am horrified by the sentences both proposed and imposed by Parliament and the Courts. To sentence a person to imprisonment of a quarter to more than a third of their active adult life is a shocking event for an act that cannot be morally distinguished from similar acts that are unpunished, even rewarded.
14. I looked though the interests of some members of the House of Lords and found that at least four of the Lords whose names began with A or B is employed as a director of firms in the alcohol industry. You can be appointed a peer while making, supplying and importing large quantities of alcohol but sent to prison for a decade or even longer for importing a much more modest quantity of an arguably less harmful drug.
15. Our perception of risk colours our judgements. There appears to be considerable confusion about the risks of psychoactive substances usually called drugs. As the risks associated with the use of certain of these substances is used to justify their prohibition we must be clear as to the magnitude of the putative hazards of all such substances, whether their use is licit or illicit.
The dangers posed by such compounds can be described in a variety of ways. The “hardest” data is deaths caused by such substances. Adverse events are also reported but this is more difficult to quantify. These are roughly proportional to the death rate. These can occur:
(a)
(b)
(c)
(d)
(e)
16. The risk of death from certain events and experiences are known.
Calman (1996) gives the annual risk of an individual at age 40 of dying from various causes:
|
Causes |
Risk |
|
Smoking 10 cigarettes a day |
One in 200 |
|
All natural causes |
One in 850 |
|
Any kind of violence or poisoning |
One in 3,300 |
|
Influenza |
One in 5,000 |
|
Accident on the road |
One in 8,000 |
|
Leukaemia |
One in 12,500 |
|
Playing soccer |
One in 25,000 |
|
Accident at home |
One in 26,000 |
|
Accident at work |
One in 43,500 |
|
Radiation from work in industry |
One in 57,000 |
|
Homicide |
One in 100,000 |
|
Accident on railway |
One in 500,000 |
|
Hit by lightning |
One in 10,000,000 |
|
Release of radiation from nearby nuclear power station |
One in 10,000,000 |
The British Medical Association’s (BMA) “Living with Risk” quotes the Office of Population Censuses and Surveys (OPCS) for deaths during sports and recreations in 1987.
|
Activity |
Male |
Female |
|
Air sports |
20 |
4 |
|
Athletics |
2 |
0 |
|
Ball games |
5 |
0 |
|
Horse riding |
3 |
9 |
|
Motor sports |
10 |
0 |
|
Mountaineering and rock climbing |
8 |
1 |
|
Cycling |
2 |
0 |
|
Shooting sports |
3 |
0 |
|
Water sports |
9 |
0 |
|
Others |
7 |
7 |
|
Spectators |
2 |
2 |
17. We compare risks as risk is said to be the main driving force behind our reactions to drugs. We could illustrate this by assuming that Ecstasy causes 20 deaths a year but this against an annual use of at least 25 million doses or a death to dose ratio of 1: 1.25 million. Recreational horse riding caused 12 deaths in 1987, nine of whom were females. The number of rides is unknown but may be far short of 25 million Let us estimate 10 million individual rides a year; this gives a ratio of 1: 800,000. We will worry about the Ecstasy deaths but not those from recreational horse riding. The BMA (1990) also reports 1–2 injuries per 1,000 rides. Head injuries are relatively frequent and serious. Child riders account for 10–15000 attendance’s at A&E Departments with 2–3,000 admissions per annum. These casualties are largely girls aged 10–15 years. Should recreational horse riding be banned?
18. USA risks are probably very similar to the UK. The BMA (1990) quotes a risk of death for rock climbers of 1:1,500 per annum and for hang gliders 1:300–1:500 per annum in the USA. Hang Gliding and Rock Climbing have similar risks to Opiate use so why are these activities not prohibited?
19. In 2010 in the UK there were 407 deaths of motorcyclists. There are 1.2 motorcycles in the UK. The mortality ratio for motorcyclists is 1:2950.
20. The Institute for the Study of Drug Dependence issued a fact sheet in 1996 giving their best estimate of deaths from psychoactive compounds in the UK.
The number of deaths from a variety of such compounds from 1985–1994 was:
|
Compound |
Deaths 86–94 |
Per annum |
|
Tobacco |
1,100,000 |
110,000 |
|
Alcohol |
200,000–400,000 |
20,000–40,000 |
|
Opiates (methadone and heroin) |
2,395 |
240 |
|
Solvents (glue sniffing etc.) |
1,070 |
110 |
|
Amphetamine |
97 |
10 |
|
Cocaine |
67 |
7 |
|
Ecstasy |
60 |
6 |
21. We must relate this to the number of users and comparison with the risk of death.
|
Compound |
Users |
Risk |
|
Tobacco |
12,000,000 |
1:110 |
|
Alcohol (all users) |
36,000,000 |
1:10,000 |
|
Alcohol (heavy users) |
8,500,000 |
1:400 |
|
Solvents |
200,000 |
1:2,000 |
|
Opiates (injectors only) |
50,000 |
1:200 |
|
Amphetamines |
250,000 |
1:30,000 |
|
Cocaine |
250,000 |
1:30,000 |
|
Ecstasy |
500,000–1,000,000 |
1:100,000 |
There were no recorded cannabis deaths over that period.
22. I have calculated the mortality figures for England and Wales for 2010 from National Programme for Drug Deaths and the 2011 Government report on Drug Use in England and Wales. The population of the UK is 60 million and England and Wales (E&W) is 50 million so I adjusted the UK Drug Deaths accordingly for England and Wales.
Of the 1,170 drug related deaths for E&W deaths 495 were attributed to one drug alone and 675 to a combination of drugs but where one drug was significantly implicated. I have calculated mortality ratios for both sets of figures and for the combined figures. They are not directly comparable but give reasonable approximations.
4.4 million illicit drug users’ deaths 1,170 Ratio 1:38,000.
2.7 million Cannabis users’ deaths alone three ratio 1:900,000, in combination 17 ratio 1: 160,000, all deaths 20 ratio 1:135,000.
840,000 powder cocaine users’ deaths alone 40 ratio 1:21,000 in combination 150 ratio 1: 5,600, all deaths 190, ratio 1:4,420.
560,000 ecstasy users’ deaths alone 10 ratio 1:56,000, in combination 28 ratio 1: 20,000, total deaths 38 ratio 1:14,700.
360,000 heroin users’ deaths alone 180 ratio 1: 2,000, in combination 510, ratio 1:710, total deaths 690, ratio 1:510.
12 million tobacco users’ deaths 80,000–120,000 ratio 1: 150 to 1:100.
34 million alcohol users’ deaths approx 40,000, ratio 1:850.
Nearly all smokers are addicted to nicotine. Around 25% of alcohol users are using hazardous amounts of that drug and some of whom are dependent on/addicted to alcohol.
There are, of course, adverse effects from these compounds including alcohol and tobacco which do not cause death but they roughly correspond with mortality.
23. Another way of looking at these figures is to see what would be the expected mortality in England and Wales if all drugs were being used by the same number of people as those who are currently using alcohol—36 million ie the worst case scenario.
|
Drug |
Deaths per annum |
|
Alcohol |
40,000 |
|
Tobacco |
320,000–400,000 |
|
Cannabis |
260 |
|
Powder cocaine |
8,200 |
|
Heroin |
69,000 |
24. Calman (1996) again points out we qualify risk with other terms which affect our judgment of that activity.
Avoidable-unavoidable. This enables individual choice and the public to be involved in decision making. It still does not explain the difference between hang gliding and opiate use. Value judgements must be involved here.
Justifiable-unjustifiable. Again the above remarks apply.
Acceptable-unacceptable. Again the above remarks apply.
Serious-not serious. Again it does not make clear why one action is prohibited and the other not so when the risks are the same. The above remarks apply here also.
These four sets of terms appear each to be saying much the same thing; that separate sets of values apply outside of the rational reckoning of risks.
25. Our perception of risk has been analysed and is well discussed in “Risk; analysis, perception and management”, from the Royal Society (1992). They describe three factors influencing the perception of risk:
Factor 1. They call this factor DREAD .This dimension lies on a continuum between a lack of fear for certain risks such as an accident with household appliances to a clear cut dread of “drugs” An even greater dread is the fear of crime. The dread of the use of drugs (and crime) seems to lie behind our different responses to behaviours of equal risk.
Factor 2. This dimension is between unknown risk such as food irradiation and the familiar such as mountaineering.
Factor 3. This reflects the numbers of people exposed to the risk and the degree of personal exposure.
26. It is clear that a major Dread is Crime. If your beliefs make you dislike an activity the most powerful way of stigmatising that activity is to pass a law that makes those actions against the criminal code. This has the effect of automatically making those practising the activity criminals. Laws make Crimes. Actions, evil or otherwise, do not make crimes in the absence of Law.
27. Once certain erroneous beliefs become widely and deeply believed it is very difficult to change these views. They become part of that which we dread and then we will ferociously oppose any relaxation 0f sanctions even when faced with the harmful consequences of our beliefs and practices. We can see the relativism of much of our moral and criminal judgements when we reflect on the changes to the legal status of racial prejudice, termination of pregnancy and same gender male sexual activity over the past 50 years.
28. Contemporary attitudes to drugs are driven by this fear. Indeed our current attitude to drugs is to elevate dissent from these beliefs into the equivalent of heresy. I often reflect on the way so-called witches were treated in recent history. In current circumstances to prosecute drug dealers and drug users is a persecution as pernicious as that caused by prejudices such as racism, homophobia etc. Those subject to such drug supply and drug use sanctions are a persecuted minority.
29. While the Judiciary is there to sentence according to the will of Parliament if sentences are too draconian and lack any distinction between morally identical behaviours they will be part of a cruel, unnecessary and immoral system of punishment of a persecuted minority.
30. I am willing to give evidence in person.
31. References
British Medical Association. The BMA Guide to Living with Risk. 1990. British Medical Association. London.
Calman K. On the State of the Public Health. 1996. Health Trends. 28: 75–88.
Institute for the Study of Drug Dependence. (ISDD—now Drugscope). 1995. Fact Sheet. Mortality from Drug Use.
Marjot D. The Diseases of Alcohol. 2009. Southern Universities Press. London.
National Report of Drug Related Deaths in the UK. 2009. International Institute for Drug Policy. St. Georges University of London.
The Royal Society. Risk: Analysis, perception and Management: Report of the Royal Society Study Group. 1992. The Royal Society. London.
Statistics on Alcohol Use. 2011. Health and Social Care Information Centre.
Statistics on Drug Use 2011. Health and Social Care Information Centre.
Statistics on Smoking. 2011. Health and Social Care Information Centre.
Statistics on Transport Casualties. 2010. Department of Transport. London.
January 2012