Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by J M Moore, University of the West of England (DP072)

Executive Summary

Current UK drug policy operates firmly with the paradigm of prohibition.

Prohibition is a policy choice.

Drugs are harmful. This applies both to substances which are currently prohibited and substances which are available from supermarkets.

The policy of prohibition generates considerably more social harm than the substances prohibited.

The substances which cause the most harm, alcohol and tobacco, are not prohibited and subject to different regulatory regimes.

The regulatory regime currently adopted in respect of tobacco has had considerable success in reducing the harm caused by that drug in recent years.

The regulatory regime currently adopted in respect of alcohol, largely characterised by deregulation, and has resulted in a considerable increase in the harm caused by that drug.

The regulatory regime for substances prohibited under the Misuse of Drug Act 1971 has failed.

Drug policy for all substances should be subject to a single regulatory regime operating within the paradigm of public health and designed to minimise harm whilst respecting individuals’ rights to partake in risky activities.

The regulation of individual substances within this regime should be based on a scientific assessment of the risk of harm they present and include controls on the substances (eg strength); supplier (eg supply restricted to licensed premises) and consumer (eg minimum age).

1. First do no harm

1.1 The minimum that can be expected of any policy is that it does not make matters worse. The consumption of drugs carries risks of harm to both the individual consumer and society. It is a legitimate aspiration for Government to mange that risk and to take steps to minimise the harm caused by drugs. However, when considering the harms caused by drugs the Select Committee need to look at those caused by government policy alongside those generated by the behaviour of individual consumers, producers and suppliers of currently illegal and legal drugs. If drug policy is increasing drug harms then the urgent priority must be to change policy.

2. The Misuse of Drugs Act (1971) and Harm

2.1 The Prohibition of certain classes of drugs is a policy decision. The core piece of legislation underpinning this policy is the Misuse of Drugs Act 1971 (MDA) which seeks to control specific drugs through criminal justice interventions based on the scientific classification of their harms. Although harm appears to be an established component of this regime this is an illusion than needs exposing. This has been highlighted by the work of David Nutt, an eminent scientist and former chair of the scientific committee, established by the MDA, to advise the Home Secretary on drug policy.

2.2 Nutt raises “the critical question of why society tolerates—indeed encourages—certain forms of potentially harmful behaviour but not others”, highlighting the comparative risks of ecstasy and alcohol, ecstasy and horse riding and the relative harms of legal and illegal drugs.1 In Figure 1 below Nutt compares the relative harms of the two E drugs, ethanol, better known as alcohol, and ecstasy and his figures make clear that the harms caused by alcohol are dramatically greater than ecstasy.

Figure 1

Source: Nutt, D J (2006). “A tale of two Es” pp 315–317 in Journal of Psychopharmacology No 20, Vol 3, p 316.

2.3 In fact what is clear from this is how much harm alcohol causes; 22,000 premature deaths, 1,500 road traffic deaths and over 10,000 cases of interpersonal violence per annum, and how little harm is caused by ecstasy. Yet ecstasy remains classified as a class A drug under the MDA.

2.4 In an interesting analysis Nutt et al attempted to incorporate both legal and illegal drugs in a single hierarchy of harm. The results, published in the Lancet and shown in Figure 2 below, clearly demonstrate the lack of any clear correlation between a drug’s harm and it’s classification under the MDA. Methodologically this study is not unproblematic and remains trapped in the paradigm of prohibition. For example, considering the most harmful drug, heroin, it fails to separate those harms intrinsic to it as a chemical substance and those harms that are generated by its legal status. Hopefully, this exercise will be repeated with the harms directly attributable to prohibition disaggregated. This would show that illegal street heroin has a significantly higher level of risk of harm than prescribed heroin?

Figure 2

Source: Nutt, D J, King, L A, Saulsbury, W & Blakemore, C (2007). “Developing a rational scale for assessing the risks of drugs of potential misuse”. Pp 1047–53 in the Lancet, Vol 369, p 1050.

2.5 The relationship between the prohibition of a substance and the harms caused are complex.2 Prohibition removes the opportunity for any quality controls, it has led to moral panics, misinformation and has potentially impacted on levels of consumption. Lack of quality control means the consumer has no reliable information about ingredients and this lack of regulation leaves the control of the exact composition of the product retailed, and the health and welfare of consumers, in the hands of organised crime. Illegality therefore certainly increases the risk of harms associated with the use of prohibited substances but does it deter use, thereby reducing the risk as well?

2.6 The Number Ten Strategy Unit, whose confidential report on drug policy to the cabinet in 2003 was leaked to the Guardian, concluded that “attempts to intervene have not resulted in sustainable disruption to the market at any level.”3 Figure 3 below is reproduced directly from the Number 10 Strategy Unit’s report to the Cabinet.

2.7 It demonstrates how use of Heroin has increased steadily since the introduction of MDA. This conclusion was backed up by the UK Drug Policy Commission whose research concluded that “seizures and enforcement efforts have had little adverse effect on the availability, purity and price of illicit drugs in the UK” and that “since 2000, average street prices in the UK have fallen consistently for heroin, cocaine, ecstasy and cannabis.”4 Illegal drugs are today widely available, at historically low prices, suggesting that prohibition has neither reduced supply nor demand, both of which have actually grown dramatically over the last forty years. Whatever their ambitions it is clear that the MDA and the prohibitionist paradigm in which it operates have not reduced harm by controlling use.

Figure 3

Source: SU Drugs Project (2003). Phase 1 Report: Understanding the Issues, p 38.

The lighter columns are addicts notified to the Home Office, and the darker columns from 1997 when the HO notification system was shelved, are numbers in treatment.

3. Prohibition—A failure to regulate

3.1 If we look at other aspects of prohibition we see the generation of significant violence and harms. The MDA makes all consumers criminals. A third of the population admits drug use in the British Crime Survey.5 Of course all these people are not subjected to criminal justice intervention, the system simply couldn’t cope, but all of them are liable to arrest, a criminal record and imprisonment. Events that could have a dramatic bearing on their lives. Jobs and homes are lost regularly by consumers who come into contact with the criminal justice system. These harms fall disproportionally on minority ethnic communities and working class people. The inequality generated by the selective enforcement of drug prohibition in Britain urgently requires detailed research. The Home Office was required to carry out an Equality Impact Assessment on their new drugs strategy in 2007. In response to the question: “Could the aims of the policy be in conflict with equal opportunity, elimination of discrimination, promotion of good relations?” the Home Office replied “NO”.6

3.2 The prohibition of some substances does not just impact on crime by criminalising their consumers. It has much wider impacts both within the UK and internationally and generates dramatic levels of harm. Central to this generation of crime and violence is prohibition itself, which in terms of policy, places the entire market, production, distribution, wholesale and retail, into the hands of organised crime. The illegal drug market is a state sponsored, tax free monopoly for criminals. The consequences of this are dramatic; however, because of limited space I will restrict myself to a few examples

3.2.1 Generation of acquisitive crime

Figure 4 shows the cost of drug use for a heavy user in 2003. Having a Cocaine or heroin habit is expensive, raising £300, £400 or even £500 a week is impossible for most people through legal means. They resort to crime.

Figure 4

Source: SU Drugs Project (2003). Phase 1 Report: Understanding the Issues, p 12.

The Strategy Unit estimated that 56% of the total number of crimes; some 36 million crimes, are “drug-motivated crimes” committed by drug users. This is illustrated in Figure 5, again copied from the Strategy unit report to the cabinet.

Figure 5

Source: SU Drugs Project (2003). Phase 1 Report: Understanding the Issues, p 22.

Home Office Research has estimated that drug-motivated crime in total costs victims just under 10 billion pounds per year and the economic costs to the community of the average “problematic drug user” is in excess of £44,000.7 The government’s own analysis finds that over half of all crime and victimisation are linked to behaviours generated by the economics of this market—which the government chooses not to regulate.

3.2.2 Prostitution of drug users

For many women and girls and a few men and boys, fund-raising is achieved not through acquisitive crime but by prostituting themselves. Research carried out for the Home Office has shown that the drug and sex markets are intrinsically linked.8 The same factors detailed above for acquisitive crime drive adults and children into prostitution. The Home Office’s Equality Impact Assessment makes no mention of the contribution of drugs policy in generating supply within prostitution nor does it acknowledge the gendered status of prostitution.9

3.2.3 Generation of Violence

Drug markets operate outside the law and have no recourse to legal procedure to resolve disputes. Drug dealers use violence to collect debts, they use violence to resolve disputes between themselves and they use violence to resist law enforcement efforts. Prohibition makes violence a cost effective business strategy. Prohibition introduces guns and knives on to our streets as routine business tools. Criminal justice responses generate perverse outcomes. As Sanho Tree has argued, law enforcement operates as a Darwinian natural selector removing less ruthless and less violent market participants.10 Over time law enforcement has driven out the non violent hippys like Howard Marks and replaced them with brutal, callous and vicious gangsters.11 The violence of the market raises prices; Caulkins & Reuter estimate that 33% of the retail price of cocaine is paid to compensate dealers for their risk of death or injury.12 This in turn increases the fundraising requirements of problematic users, thus increasing crime and its associated victimisation.

3.2.4 Destabilisation of producer and transit countries

As well as generating considerable levels of violence in consumer countries like the UK the drug business has a far more dramatic impact on producer and transit nations. In Latin America, the Caribbean, Africa and Asia nations have been destabilised as a direct consequence of the so called war on drugs.

4. So we legalise?

4.1 Given the scale of the harms generated by a policy of prohibition the obvious solution is to legalise the substances covered by the MDA. Whilst such a move would have immediate benefits it could also have significant costs. However what abandoning prohibition does do is open up the opportunity for Government to regulate the production, distribution and retailing of these substances rather than leaving them in the hands of organised crime.

4.2 Government has a mixed record in its performance regulating drugs not prohibited under the MDA. Recent alcohol policy with its emphasis on deregulation provides an example of Government policy contributing to increasing harms. Whilst prohibition would, based on the American failed experiment, result in greater harm, effective regulation could significantly reduce harm. Indeed an examination of the alcohol policy followed by the British Government during the prohibition era would provide an excellent case study in how to reduce drug harms.

4.3 The current public health based policy on tobacco provides a much more positive example of how effective Government control and regulation can contribute to a significant reduction in the harms caused by a drug. This could be adopted as a model for future drug policy for regulating both alcohol and substances covered by the MDA.

5. How can we control and regulate drugs?

5.1 The current policy of prohibition in many ways represents a failure of imagination. By rejecting this paradigm and moving towards a public health based approach a range of possible interventions become available to Government to manage the risk of harm. The level and form of regulation for specific drugs would need to be informed by scientific assessment of the risk of harm of the substance. These could include controls over the products on the market, such as the strength, form and packaging; controls over the retailing, such as controls on marketing, opening hours and the number and location of outlets; and controls over consumers such as minimum ages, consumption on premises and potentially registration. A detailed and comprehensive account of the menu of policies available to Government’s in effectively regulating and controlling drugs, After the War on Drugs: Blueprint for Regulation, has been produced by Transform Drug Policy Foundation and is worthy of detailed consideration by the Committee.13

6. Conclusion

6.1 Legal and illegal drugs contribute to a range of social harms. In exploring these harms we need to differentiate between those which are consequences of the substances and those which are generated by policy. We can not completely remove the harms of drugs; but an effective drug policy, covering both currently legal and illegal drugs can minimise the harms these substances cause. Such a policy must involve government taking responsibility for regulation of the markets for these substances. This would include intervention on pricing as well as allowing a range of controls, as set out above.