Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Ewan Hoyle (DP061)

This submission will largely be concerned with whether detailed consideration should be given to alternative ways of tackling the drug dilemma, though it shall also touch on many of the other questions the Home Affairs Select Committee intends to consider.

It is this author’s belief that the “legalisation” of drugs can not be productively debated unless there are one or more regulatory models being explicitly proposed for discussion alongside the status quo. It is therefore intended for this submission to describe a regulatory model for cannabis which is a demonstrably strict control and regulation regime, and which has considerable potential to more effectively send a message that the drug is harmful, reduce access for under 18s, reduce the need for government health and criminal justice expenditure and deliver extra tax revenue to the exchequer. It is the author’s belief that such a model can also achieve all of the above while remaining well within the bounds of political acceptability as it does not fit comfortably in to the standard presumptions of “legalisation” such as “liberalisation” or a “soft on drugs” stance. Polling evidence will be presented to support this case.

This submission will also consider the potential benefits of the Portuguese model of administrative rather than criminal sanctions for drug possession, and heroin maintenance treatment for the most problematic heroin addicts. Again, suggestions will be made as to the political framing of these policy proposals to demonstrate their viability as policy positions for major political parties.

Ewan Hoyle was the lead author of the policy motion “Protecting Individuals and Communities from Drug Harms” which amended Liberal Democrat policy in September of 2011.

The Harms of Cannabis

There is considerable debate about the potential harms of cannabis to physical and mental health. In physical health, there are many of the same harms as there are with smoking cigarettes, and indeed cannabis and tobacco are often smoked together. Considerable improvements in health could be made by moving cannabis use towards safer use methods, such as vaporisation, which do not involve inhalation of the carcinogenic compounds in smoke.

In mental health the potential harms are even more contentious. The recommendations of this submission stem from an acceptance of the conclusions of the Royal College of Psychiatrists: “Regular use of the drug has appeared to double the risk of developing a psychotic episode or long-term schizophrenia ... There is a particular issue with the use of cannabis by adolescents ... If you start smoking it before the age of 15, you are four times more likely to develop a psychotic disorder by the time you are 26.”1

Additional to the harms intrinsic to the drug itself, there are potential harms associated with the unregulated illegal market. As well as accidental contamination, there have been recent instances of deliberate adulteration of cannabis with iron filings, lead, glass beads and sand2 , 3 , 4 that can sometimes have serious health consequences for the user.

Reducing the Harms of Cannabis

There are a number of ways we could reduce the harms cannabis causes in the UK. The most obvious is of course to reduce consumption, and mental health research indicates adolescents should be a particular priority if this is to be attempted. Physical health harms could be avoided if users were educated on the harms of smoking and encouraged to use vaporisers instead.5 Adulterants and contaminants could be avoided if growers and processors were subjected to rigorous standards regulations.

The mental health harms of cannabis could be ameliorated too if customers were educated on the early warning signs of psychosis and had available a variety of strains to be directed to if mental health is a concern. Cannabis has two main active ingredients—THC and CBD—with THC thought to be broadly pro-psychotic and CBD anti-psychotic in their effect.6 Being able to intervene in someone’s cannabis use and divert them to the use of less potent strains could hopefully prevent psychosis occurring.

A Model for the Strict Regulation of Cannabis Production, Distribution and Sale

So it is with the harms of cannabis in mind that the reader is asked to consider a model for the strict regulation of cannabis production, distribution and sale. This is just one of many models that could be employed,7 but the author judges it to be the model which optimises the likely political acceptability and the practical effect in reducing harm.

The ultimate point of sale should ideally be from a pharmacist, and the variety of strains available should be as extensive as is practical. If particularly potent strains are not stocked then there remains territory for the criminal market to exploit. Pharmacists are highly trained and could be further trained to deliver health advice, discuss effects and advise on switching to less potent strains if necessary. Should more pharmacies have to be provided in order to meet demand, the whole community benefits from this convenience. Dedicated cannabis outlets might not be so enthusiastically welcomed by communities.

On who profits from the production, distribution and sale of the drug, the public might be uncomfortable with private companies profiting from the increased consumption of what will have been until recently an illegal drug. To optimise the ability to limit marketing and incentives to promote use of the drug, it would be advisable for all stages of the process to be state-controlled. The price of cannabis (or each strain) should be determined by an independent panel tasked with the suppression of use balanced with the suppression of competing criminal supply. Any excess money raised by government from the process could be sensibly deployed in improved evidence-based education and treatment services for all drugs.

The Effect of State Control and Regulation on the Illegal Market

It is likely the legally available product could out-compete the illegal market on price, guaranteed quality and predictable effect, variety of choice and ethical considerations. Convenience is one area of concern that will need addressed as the illegal market is not restricted by opening hours or location.

The issue of price is an important one as some opponents of “legalisation” have asserted criminals “could always undercut the price that the government wished to charge because their costs are lower”.8 American researchers have estimated that “legalisation” of cannabis in the US would lead to an 80% drop in price as “Prohibition raises the cost of production by at least 400% because of information problems it creates in the market as well as imposing risk on producers/sellers”.9 Were this margin to be similar in the UK, the government could likely impose considerable costs in regulation of production, distribution and sale, raise a healthy profit, and still undercut the illegal market. The American evidence suggests few criminals would be likely to pursue a diminished profit from fewer customers.

The competitive advantages of the legal market over the illegal one should hopefully cause a very large proportion of the custom of over 18s to switch to legal purchasing. The rapid reduction in the size of the illegal market—and the number of illegal dealers attempting to profit from it—should cause the availability of cannabis to under 18s to rapidly diminish, so protecting children from the potentially serious mental health effects. A remaining illegal market that might try to target their product at children could be aggressively targeted by enforcement using resources freed up by the much diminished criminal market for adults.

The reduction in size of the criminal market would have many positive effects. The total illegal market in the UK is estimated at between £1 billion–£1.5 billion.10 It’s reduction would free up many thousands of homes currently used for growing cannabis, would reduce the trafficking of children that occurs to work in these cannabis factories, and would reduce the violence increasingly associated with the illegal cannabis market.11

Political Considerations. Is Strict Control and Regulation of the Cannabis Market Politically Viable?

There have always been serious problems with opinion polling on this issue. “Legalisation” is a process not a policy proposal, and so those asked “do you support the legalisation of cannabis?” have to create their own idea of what “legalisation” would mean in practical policy terms. In such polls carried out in the UK “legalisation” of cannabis typically receives minority support.12

It was the author’s judgement that such polling gave insufficient guidance to policy makers as to the actual opinions of the public on the matter. So it was decided to commission a more sophisticated poll which described three policy options and asked which would be most tolerable to a random sample of 2,000 members of the public.13 The policy options were “light regulation”—control of drugs much as alcohol and tobacco are controlled at present; “Strict government control and regulation”—a situation very similar to the model for cannabis described above; and “Prohibition”—the current approach to illegal drugs.

Cannabis was by far the illegal drug that the most people would tolerate being legal and regulated. 33% would most tolerate light regulation, 37% strict regulation, and 25% prohibition. So we see that, if the actual policy described above were to be proposed to the public, rather than be attacked as too liberal, the poll suggests more of the population would find it not liberal enough for their tastes than would instead prefer the laws to remain as they are now.

The polling agency also provided a demographic breakdown of the kind of people who were supportive of each model of regulation. The newspaper readership group most supportive of strict control and regulation were Daily Express and Daily Mail readers at 41% support. The single demographic group that most supported strict control and regulation was 35–54 year old females at 46% support. This group will contain a great many mothers of teenage children and so would be likely to be very interested in a policy that might restrict the ability of teenagers to access cannabis.

Presenting the Strict Government Control and Regulation of Cannabis as a Policy Proposal

The strict government control and regulation of cannabis has great potential to reduce the harm that both the drug and the criminals that currently produce and sell it cause to individuals and to communities. The policy proposal here can therefore be presented not as a liberalisation of drug laws, but a toughening of our approach. Much is made of the notion that the current illegality of cannabis sends a message that the drug is harmful. Under a tightly regulated regime allowing the sale of cannabis from pharmacies, that message on the harms of cannabis can be far more effectively delivered—and by a trained health professional—every time someone tries to purchase the drug.

On the question of what to do about the UN drug conventions, the conventions could only realistically be challenged from the standpoint that they severely restrict the UK’s ability to protect its citizens from harm. Given the regulatory model presented here, that would be a strong and eminently reasonable argument. The UK has sufficient international stature to take the lead in asserting the right of states to try alternative means of protecting their citizens from drugs and criminal activity.

New Policy for Other Illegal Drugs

Much of the model that I have described for regulation of the cannabis market could potentially be applied to the other currently illegal drugs in the future. Cannabis is an appropriate place to start only because of the state of public opinion and not because it is allegedly a less harmful drug relative to others. There should be ongoing rigorous evaluation of the impact a strict control and regulation policy for cannabis has upon public health, criminal activity and government spending and revenue. If the impacts are clearly positive serious consideration should be given to regulating other drugs in a similar manner.

In the interim for the other currently illegal drugs it would be highly desirable for the Portuguese model of decriminalisation of possession for personal use14 to be thoroughly examined with a view to the adoption of something similar in the UK. Once again this policy can be explained to the public in such a way that they can understand its potential to further restrict the harms that drugs inflict upon individuals and communities. One of the most attractive features of this policy in political terms is the fact that it does not involve turning a blind eye to drug use. Indeed police could be seen to be less tolerant of drug use as they refer every illegal drug user they encounter to a panel for assessment rather than have to make a judgement call on whether the offence is worthy of intervention and criminal proceedings.

Decriminalisation removes an important barrier between the drug user and treatment services. It should be especially popular with the families and friends of drug users as they could seek help for their loved one without any risk of them receiving a criminal record, and the presumed resentment and reduced life chances that would accompany it.

Heroin Maintenance for the Most Problematic Drug Users

Perhaps the area of policy which most conflicts with the wish for “strategies grounded in science, health, security and human rights” is the continued lack of widespread provision of heroin maintenance treatment clinics like those utilised in Switzerland and The Netherlands.15 Because of a continued failure to divert heroin users from the illegal market, it can be estimated from UN figures that UK heroin users inadvertently fund the Taleban in Afghanistan to the tune of £6–12 million each year.16 In diverting the most problematic users into heroin maintenance treatment programmes, funding can be restricted to terrorists and dangerous organised criminal gangs in the UK. Diamorphine (pharmaceutical heroin) reduces the patient’s criminal activity and street drug use far more effectively than the best methadone treatment.17 With rates of youth unemployment as high as they are at present, it is vitally important that user-dealers—who routinely recruit new users—are attracted into treatment. Policy-makers could also prioritise heroin-using street prostitutes—as a particularly vulnerable group—and habitual acquisitive criminals for heroin maintenance treatment in order to reduce the impact than heroin use from the criminal market has upon communities.

Again heroin maintenance treatment can be presented as a “tough on drugs” policy. The removal of customers from the criminal market and the targeting of user-dealers for treatment can be framed as a concerted effort to build a wall between heroin and the next generation growing up in areas of deprivation. With problem drug users committing the majority of acquisitive crime in the UK,18 widespread heroin maintenance provision can also be framed as the ultimate “Tough on crime, tough on the causes of crime.” policy. Efforts to eradicate street prostitution—again largely motivated by heroin addiction19—from Britain’s towns and cities can be realistically pursued with the deployment of excellent treatment provision with heroin maintenance at its centre.

January 2012

1 Cannabis and Mental Health
http://www.rcpsych.ac.uk/mentalhealthinfo/problems/alcoholanddrugs/cannabis.aspx

2 Lead poisoning due to adulterated marijuana. New England Journal of Medicine
http://www.nejm.org/doi/full/10.1056/NEJMc0707784.

3 “Some suppliers have added iron filings or sand to increase the weight of their shipments, a practice which has previously only been observed with cocaine and heroin.” Der Spiegel:
http://www.spiegel.de/international/europe/0,1518,585240,00.html

4 Scottish Executive: UPDATE ON SEIZURES OF CANNABIS CONTAMINATED WITH GLASS PARTICLES http://www.sehd.scot.nhs.uk/publications/DC20070517Cannabis.pdf

5 Journal of Cannabis Therapeutics: Cannabis Vaporizer Combines Efficient Delivery of THC with Effective Suppression of Pyrolytic Compounds
http://www.tandfonline.com/doi/abs/10.1300/J175v04n01_02

6 European Psychiatry: Anti-psychotic effects of Cannabidiol (CBD)
http://www.sciencedirect.com/science/article/pii/S0924933809704407

7 After the War on Drugs: Blueprint for Regulation (book)
http://www.tdpf.org.uk/blueprint%20download.htm

8 Professor Neil McKeganey: The Cocaine Trade - Home Affairs Committee examination of witnesses
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmhaff/74/9102003.htm

9 Legalizing Marijuana: Issues to Consider Before Reforming California State Law http://www.rand.org/pubs/testimonies/2009/RAND_CT334.pdf

10 Cannabis Policy: Moving Beyond Stalemate (book)
http://www.beckleyfoundation.org/cannabis-policy-moving-beyond-the-stalemate/

11 The Guardian: Cannabis farmers take up arms to defend crops in booming trade
http://www.guardian.co.uk/world/2010/aug/17/drugs-trade-drugs

12 Angus Reid Public Opinion: Britons Worried About Drugs but Low Support for Legalisation
http://www.visioncritical.com/wp-content/uploads/2010/01/2010.01.20_Drugs_BRI.pdf

13 Polling Public Opinion on the Legalisation of Drugs: Implications for Drug Policy Reform
http://bit.ly/LDDPRpoll

14 The British Journal of Criminology: What can we learn from the Portuguese decriminalisation of illicit drugs
http://bjc.oxfordjournals.org/content/50/6/999.abstract

15 Can Heroin Maintenance Help Baltimore?
http://www.abell.org/pubsitems/cja_HeroinMaintenance_0209.pdf

16 Drugs finance Taliban war machine, says UN drug tsar
http://www.unodc.org/unodc/en/press/releases/2008-11-27.html
UNODC World Drug Report 2010
http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf

17 Cochrane Summaries: Heroin maintenance for chronic heroin-dependent individuals
http://summaries.cochrane.org/CD003410/pharmaceutical-heroin-for-heroin-maintenance-in-chronic-heroin-dependents

18 Strategy Unit Drugs Project
http://image.guardian.co.uk/sys-files/Guardian/documents/2005/07/05/Report.pdf

19 Home Office Research Study: Tackling Street Prostitution: Towards an holistic approach. http://dro.dur.ac.uk/2557/1/2557.pdf

Prepared 8th December 2012