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UK: Science and Technology Select Committee questions the ACMD
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Friday 17 Mar 2006 Edited highlights from the uncorrected transcript of oral evidence given by: Professor Sir Michael Rawlins, Chairman of the Advisory Council on the Misuse of Drugs (the ACMD) and Professor of Clinical Pharmacology at the University of Newcastle. Professor Nutt: Psycho-pharmacologist at the University of Bristol. "That means I am a medical doctor, a psychiatrist, who is interested in drugs and the brain". Also Chair of the Technical Committee of the ACMD for the last five years with a research track record in the field of drugs of addiction and mental processes. ..to the Science and Technology Select committee inquiry:Scientific Advice, Risk and Evidence: How the Government Handles them (case study on drug classification). 1st of March 2006. The full transcript can be read here http://www.publications.parliament.uk/pa/cm200506/cmselect/cmsctech/uc900-ii/uc90002.htm Transform has used excepts to highlight important themes in the session. Please look at the full transcript to see these comments in the wider context of the session's discussion - use the question numbers to locate the quotes . Some explanatory comments are inserted by Transform in square brackets for clarity, and, ...... implies that a sentence or more has been edited from a paragraph. The Committee website notes that: 'the transcript is not yet an approved formal record of these proceedings. Any public use of, or reference to the contents should make clear that neither Members nor witnesses have had the opportunity to correct the record. If in doubt as to the propriety of using the transcript, please contact the Clerk to the Committee'. Further information: Details of the Select Committee inquiry Transform submission to the Select Committee Transform Press release 01.03.06 ---- Chairman: Professor Rawlins, what is the purpose of the ABC drug classification system that we have got at the moment? Professor Sir Michael Rawlins: The purpose is to classify the harmfulness of drugs so that the penalties for possession and trafficking should be proportionate to the harmfulness of the particular substance. Q110 Chairman: Harmfulness to whom? Professor Sir Michael Rawlins: Harmfulness to the individual and harmfulness to society. ---- Q112 Chairman: Do you feel you have been proactive in achieving that objective and that the ABC classification has done what it has set out to do? Professor Sir Michael Rawlins: I think in terms of what it was intended to do, that is to say to try and make the penalties proportionate to the harmfulness of the substances that were being used or traded, yes. Of course, in the United Kingdom over the last 30 years the use of these substances has increased dramatically, not just in Britain but in most other countries as well, so in another sense one can say that we need more than that. I think one of the important things about drugs misuse is that it is not just a criminal justice problem, it is also a public health problem and one has to be certain that one is looking at it from both angles. ---- Q115 Chairman: So do you think it is a waste of time as well? Professor Sir Michael Rawlins: No, I do not think it is a waste of time but I think it is right that the Home Secretary is relooking at it. There are various ways in which one could do this sort of thing. Different countries have different arrangements. The notion that the penalties for possession and supply should be proportionate, broadly speaking, to the harmfulness seems to me reasonable, but it does not necessarily have to be done that way, so I very much welcome the approach that the Home Secretary is taking, that he is reviewing it and is going to produce a consultation paper shortly. I am not sure how far away "shortly" is. Q116 Chairman: What worries me here, and perhaps Professor Nutt you can comment on this as well, is that there does not seem to be a blind bit of evidence which your Committee uses to make any of the decisions on which you advise the Home Secretary. Indeed, Paul Flynn, the Minister responsible, one of our eminent MPs, described government policy decisions on illegal drugs as "largely evidence-free" in evidence to this Committee. Professor Sir Michael Rawlins: I cannot answer for him but if you look at the way we examine the evidence, there is a lot of evidence that we are able to look at. It is not perfect by any manner or means. There are gaps and in some areas there are large gaps, but there is evidence and there is evidence that we can use. ---- Professor Sir Michael Rawlins:... What we are doing is using the system that we are asked to use, and that is laid out in the Misuse of Drugs Act. We collect scientific evidence in relation to our responsibilities in that, but, no, we have not commissioned research into how one might classify them [illegal drugs]. I think that is a more appropriate thing to be done by the Government and the Home Office. Q123 Dr Iddon: Because the classification is set out in the 1971 Misuse of Drugs Act, could I suggest that you are perhaps operating within a straitjacket and there is very little flexibility? Professor Sir Michael Rawlins: There is some lack of flexibility and that is one of the reasons why we welcome the Home Secretary's decision to review the classification system and come out with a consultation paper. ------ Q126 Dr Iddon: I agree that there are cultural aspects we have to take into consideration. Which countries would you advise the Government to look at in particular that might have different systems than ourselves? [omitting Proffessor Rawlins' response] Professor Nutt: I think we should look across a spectrum. Obviously we have in the past been very interested in the Dutch approach and, as shown in the RAND Report, the Swedish approach is almost diametrically opposite, and other European countries like Spain have gone through quite major changes in the way they regulate drugs in recent years, so there are lessons to be learnt there. ----- Q127 Chairman: Bearing in mind that alcohol probably kills directly or indirectly about 32,000 people a year, tobacco 130,000 people a year, and those deaths are far in excess of all the deaths caused by the use of all illicit drugs, why is your committee not enabled to look at tobacco and alcohol as well as all the other substances? Professor Sir Michael Rawlins: I think the idea that we would control tobacco and alcohol in the form of the Misuse of Drugs Act (which would thereby render them illegal in terms of possession or supply) the Americans tried in this Prohibition days in the 1930s, and it was a disaster and just encouraged crime, and quite clearly it is not a practicable proposition. Q128 Chairman: But, Professor Rawlins, that is exactly what has happened in terms of the drugs classification system. It is exactly what happened with the prohibition of alcohol in the States. Professor Sir Michael Rawlins: I would not disagree with that. I think it is important that the Council does not exclude alcohol and nicotine entirely. ----- Q129 Dr Iddon: I am not asking for an ACMD view on this but a personal view. If you were to put alcohol and/or tobacco in one of the present classifications, bearing in mind the harm that they cause not only to individuals but also to society, which classes would you put them in? Professor Sir Michael Rawlins: When the Runciman Committee looked at this it was very clear that alcohol was at the border of A and B and tobacco was at the border of B and C. ----- Q130 Dr Turner: Sir Michael, the point has already been made about the defects of prohibition and many senior police officers have told me that, in their view, the way in which we operate the Misuse of Drugs Act is actually counter-productive as far as dealing with drugs misuse is concerned, particularly with its emphasise on criminalising personal possession and use. Do you have a view on this? Professor Sir Michael Rawlins: Yes, I think the question of possession versus trafficking is very much the criminal justice and the public health elements, and I think for possession the public health issue should be paramount, and I am particularly thinking of vulnerable sections of society. .......... The worst thing you can possibly do with somebody with schizophrenia is to send them to jail for two years or five years or any time, particularly in relation to something like possession of cannabis. It is totally inappropriate and I do not think that happens very much, but we want to be helping them not to use it rather than punishing them if they have a spliff in their pocket. Professor Nutt: I have a lot of sympathy with your view. I think the evidence base for classification producing a deterrent is not strong and we see that with a number of drugs. ------ Q137 Margaret Moran: Obviously your direct relationship is with the Home Office but how often are you consulted by other ministers or other departments or have a dialogue with them about some of the issues that need to be raised? Professor Sir Michael Rawlins: I do not think in my time in office we have been approached by other government ministers outside the Home Office. The Act would allow any secretary of state to ask for our views, but that has not happened. ---- Q165 Bob Spink: It would perhaps help them [Bob Spink's contituents] to understand if the ACMD published the minutes of its meetings, for instance. Why do you not do that? Professor Sir Michael Rawlins: We have not done it to date. Anyone who asks would get a version of it. There is sometimes material in the minutes that we would need to remove because they are based on intelligence that would not be appropriate in the public domain. ----- Q166 Bob Spink: Would my 90,000 constituents think it was perhaps a little loose that you had 38 members, that the membership of the your body was over-representative of the liberal attitude to drug-taking, and that you have a necessity of only seven people in a quorum to make decisions? Professor Sir Michael Rawlins: Sorry, the quorum is laid out in our instruments and I do not think it has ever met with a small group like that. The other question was about the liberal elements. I do not know whether you would call them liberal or illiberal or whatever. What we have to do, though, is realise that over the last 30 years the use of drugs has dramatically increased in this country, and that the criminal justice system has not prevented that in any way. Q167 Bob Spink: Nor has the ACMD. Professor Sir Michael Rawlins: We do not know because we do not have a scientific basis to make that assessment, with great respect. We do not have a control trial of half the country with an ACMD and half the country without. We do not know what would have happened. All we do know is that in every Western society drug use has increased astronomically despite all sorts of different approaches. The Americans give 20 years minimum to life for a second offence of having cannabis in your pocket and that still has not made very much difference. Crack cocaine in America is widely used. Penalties and the criminal justice approach has not worked very well. It may have been worse if we had not got it. Where I think we are all at fault, not just the ACMD but all of us are at fault, is not being better at explaining to young people particularly the dangers of drugs. ---- Q171 Mr Newmark: An important part of everything that we are doing and that you are doing comes down to the evidence and hard evidence - and I will go into what I would define as hard evidence a bit later on. As a start, do you see the role of the ACMD to contribute to the evidence base or merely to review it? Professor Sir Michael Rawlins: It is primarily to review the existing evidence base, although individual members professionally are involved in capturing information and data. Primarily we are there to examine the evidence that is available. Q172 Mr Newmark: You are both intelligent individuals and you are clearly going to find gaps, I suspect, in that evidence. Do you have the power to commission any academic research or any study to fill that gap that you and your team might well identify? Professor Sir Michael Rawlins: To some extent, yes. Professor Nutt: We do not have the resources to do extensive novel research. I think the point you are hitting on is an important one and linking with organisations that might have those resources is, I think, something we should be looking to do, and I am particularly concerned that the ACMD is embedded in the Home Office and the Home Office does not have any particular representation at the MRC. I have written to Colin Blakemore about that. Obviously the Department of Health has representation but the Home Office does not. I think that is a possible reason why there is a mismatch between research needs in addiction and research outcomes. ---- Q176 Dr Harris: Is it possible to use a scientifically-based scale of harm to determine the illegal status of a drug? I notice your matrix has "other things" in there. Professor Nutt: I think it can inform. It depends how you want to make laws. I suppose you could just add the numbers up and say that is how the law would be, but I suspect you would always want to look at other factors, particularly the prevalence of the drug in society, which obviously is another factor in terms of the harm. Q177 Dr Harris: I was intrigued - and this maybe goes back to Dr Iddon's point - Professor Blakemore has argued for a scientifically-based scale of harm for all drugs with alcohol and tobacco included in some form of calibration. I am curious as to your thoughts on that. Professor Nutt: I think it is a very sensible idea. ----- Q188 Dr Harris: In this matrix [used to calculate drug harms] you include under "social harms" intoxication, health care costs, and other social harms. Included under "other social harms" do you include the harm that stems from criminalisation itself? Professor Sir Michael Rawlins: Yes. Q189 Dr Harris: You do not spell that out but that is understood? Professor Sir Michael Rawlins: Yes and whether it leads to acquisitive crime. ------- Q193 Dr Harris: Can I come back to what is a key issue with the social harms thing and you will see where I am coming from in a minute because there are a couple of questions I want to go through. In this matrix you have got "other social harms", which I think contains a lot of stuff and I am somewhat surprised that it is not spelt out for our benefit, but is one of those the impact of criminalisation and acquisitive crime, and do you think that should be one-ninth, as it appears to be, or should it be of greater consequence than one-ninth? You have got three under "physical harm", three under "dependence" and three under "social harms". It seems to me for my constituents it matters hugely whether everyone is shoplifting because you cannot get it legally or the price has gone up because it is criminal. Professor Nutt: This is a very fair point and we have discussed it a lot and we do not know what the appropriate weightings should be. What we have done is we have come up with probably the most sophisticated way of assessing drug harms that there is available in the world. What we would like to do is move to the next stage, get it published, then have informed feedback, but then modify it into an instrument that really does capture those sorts of concerns. ----- Q195 Dr Harris: Your recommendation recommending classification into a particular class creates social effects, does it not? Professor Nutt: Indeed it does. Q196 Dr Harris: Because obviously it brings criminal justice along with it and that affects the price and availability and so forth. Do you recognise that? Your own actions impact on the evidence. Did you feed that back in before you made the recommendation? Professor Nutt: We know it might happen but you can never be sure how big an effect that might have. I suppose the best example we might have now is cannabis. The natural experiment is happening. Cannabis has been reclassified. We will be able in a few years' time to answer that question for cannabis because it has changed its classification. --- Q223 Dr Iddon: I want to know what the evidence was that psilocin and psilocybin should be classed as A. I have never known anybody use them. Professor Sir Michael Rawlins: I have no idea what was going through the minds of the group who put it in class A in 1970 and 1971. Q224 Dr Iddon: It is there because it is there? Professor Sir Michael Rawlins: It is there because it is there. However, since that time there have been very few publications on psilocin. It has hardly been investigated at all. It was looked at in the 1950s and 1960s at the time of Aldous Huxley, mescaline, LSD and those sorts of things. Since that time, there has been virtually no work done on it at all. ----- Professor Nutt: The method of administration clearly determines the risk to the individual and to society. Q235 Mr Devine: If the form of the drug can affect its status in this case, why is there no distinction made between, for example, cocaine prepared for snorting and coca leaves prepared for chewing? Professor Nutt: That is a very good question. Q236 Mr Devine: Is there any answer? Professor Nutt: We are not as sophisticated with cocaine in terms of the law as we are with amphetamines. ---- Professor Nutt: .....There is no doubt that methylamphetamine, because it can be smoked, is more dangerous than traditional dexedrine amphetamine sulphate. When we reviewed the whole issue of methylamphetamine, we clearly accepted that it was more dangerous than amphetamine sulphate. The issue is would you minimise risk to society by moving it into class A. The reason I believe we did not recommend it at the time was mostly because there could be a perverse effect. If people saw methylamphetamine as a more dangerous drug, a more class A amphetamine, we might well have begun to see importation. There is a peculiar phenomenon in the UK at present which is that we do not have very much methylamphetamine. That is based on a couple of historical facts which relate to precursors and also the preference of the population. ----- Professor Nutt: There is no question that methylamphetamine is a huge, international problem. It has caused devastation in Thailand. It has caused an enormous amount of personal harm and social harm from the chemical factories in the USA. We do not have a big problem. We looked very hard when we did the methylamphetamine review to find evidence of its use in the UK and there is not a great deal of use. It is a very fine judgment as to whether moving it to class A because it is smokeable - and I think we could do that - would reduce the chances of it becoming popular in the UK or whether it would give a message that it is a better quality product. It might get people who import drugs to realise it would be extremely easy to import this from Holland particularly. At the time the decision was made that it was probably better to wait and see. With many drugs, these epidemics have cycles. They are fashion driven and it may be that we would get lucky and not get a wave of methylamphetamine here. ----- Q250 Chairman: When we are talking about magic mushrooms, could you say, as a simple yes or no, when the government decided to put magic mushrooms in class A, was that evidence based? Yes or no? Professor Nutt: Magic mushrooms contain the active substances which are in class A. Q251 Bob Spink: They are not in class A based on evidence. They are there because they were there. Professor Nutt: That is exactly right. Q252 Dr Harris: It is not evidence based; it is historic. Professor Nutt: Historic evidence, yes. Q253 Chairman: Was the Council split on that? Do you ever have disagreements about an issue like that? Professor Nutt: It seemed somewhat illogical given the fact that we had not done a systematic review of psilocin et cetera, but we did understand that under the current Act it was a class A drug.
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