Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 520 - 539)



  520. When you say treatment are you defining there day centres and residential centres, the whole gamut or is it the particular form of treatment you are thinking about?
  (Professor Nutt) You need the full portfolio; different people want different forms of treatment.

  521. So getting people into treatment should be the goal. Would you have a broader public health goal as well in terms of harm reduction?
  (Professor Stimson) I certainly would because treatment is only relevant for a very small proportion of the population. Even for those hard drug users who would benefit by treatment there is a long time lag between the development of their drug problem and when they come into contact with treatment services. People are at risk for many years and you do need to have a public health component to the strategy which is partly about teaching people the risks and how to avoid the risks of various drugs and in the case of injectable drugs providing them with the means to use those drugs in a safer manner. There are other changes to the Misuse of Drugs Act which I would suggest, but perhaps we shall come back to that.

  Mr Cameron: The general question we are trying to get to grips with is whether you can focus more on treatment within the current framework of law or whether the current framework of law needs to change. That is at the heart of what we are discussing.


  522. We shall come to that in a minute. Shall we just let Professor Stimson say whatever he wants to say about the Misuse of Drugs Act?
  (Professor Stimson) Section 9A, which deals with drug paraphernalia laws would be best done away with altogether. There has been so much argument and nonsense about amending and changing it so you can allow certain things to be distributed, but it is just a useless encumbrance in the Act. There is an exemption for syringes but not for other equipment which may make drug use safer.

  523. Could you explain what the effect of that would be?
  (Professor Stimson) It is not an offence to supply drug paraphernalia of any sort.

  524. What would be the purpose of doing away with that?
  (Professor Stimson) Some of the drug paraphernalia makes the ingestion of drugs safer.
  (Mr Hickman) Hepatitis C.

  525. Everyone agree with that?
  (Professor Stimson) It is in the Act to discourage drug use but I do not see that it actually does. It was put in for cocaine sniffing kits and all the rest of it, but it does not really have an impact on discouraging drug use.

  526. What other changes to the MDA?
  (Professor Stimson) Section 8, which is about allowing premises to be used for the consumption of drugs. That was recently extended from cannabis and opium to all drugs and it is a very problematic section, partly because drug paraphernalia can be used as evidence of drug use on premises and that makes the harm reduction effort more difficult. It is a difficult section because people who are working with hard-to-reach drug users may often be in circumstances where drug use may be taking place and it makes their task very difficult to have that piece of the Act.

  527. In relation to heroin are we talking about what they call shooting galleries?
  (Professor Stimson) Yes.

  528. So you can do it in safe circumstances and you do not leave the needles lying about in the street.
  (Professor Stimson) There are not many shooting galleries in this country; there are in other countries. Obviously the thing from a public health point of view is to get in there and to make the drug use safer in those settings. It is very hard under the current legislation to see how that can be achieved.

  529. You are saying you would like to see—for the purposes of the discussion let us call them shooting galleries—introduced or encouraged in this country.
  (Professor Stimson) No, I am not saying that, but I am saying that if there are such then they should be made safer, but I am not saying I would encourage them. There is a difference: dealing with the reality that they are there, but not saying one should set them up.

  530. Some countries, Germany for example, have gone a stage further, have they not and have set them up as a way of getting the problem off the streets and into a safe environment?
  (Professor Stimson) The safer injecting room idea, which is probably a good idea for some drug users who have a range of other problems including homelessness and if you do not have somewhere to inject quietly, it is hard to avoid risks if your life is pretty disorganised. We had safe injecting rooms in this country in the early days of the drug clinics from 1968 to about 1972 and some of the drug clinics had a place where people could inject their drugs in safety. One of the drug projects I was involved in had a safe injecting room in Camberwell but it became a little bit chaotic and difficult to control. There may be some merit in a safer environment in some cities where you have fairly high concentrations of drug users who have high levels of social disadvantage, may be homeless and so on and so forth. There is some merit in looking at that idea.

  531. Do other witnesses agree with Professor Stimson?
  (Professor Nutt) I agree. It is one element in a package of improving health care and reducing harm.
  (Mr Hickman) Yes. It is better than having shooting galleries which are unlicensed to have safer injecting premises, if the reality is that you have them.

  532. Yes, perhaps safer injecting premises is a better term than shooting galleries. I am happy to stick with that. Professor Stimson, did you want to add to the point you were making?
  (Mr Hickman) If I may, I wanted to go back to your question on what we would change about the treatment objective within the strategy. The treatment objective is a good objective and the only criticism I would have is to include other aspects of prevention activity such as needle exchange and prevention of overdoses which are not to the fore within the strategy.

Mr Cameron

  533. Have those as objectives.
  (Mr Hickman) Yes.
  (Professor Stimson) May I make one comment about treatment? There is a question of treatment for what. The expansion of drug treatment is to a large extent being driven by the argument that treatment will reduce crime, but we also have to remember that treatment can improve health.

  534. Would you be specific about that in the objective?
  (Professor Stimson) I would. There is a clear danger of talking about treatment in a very broad way without specifying why you are delivering it. In the evidence that Paul Hayes gave from the National Treatment Agency, I was rather surprised that he did not say what treatment is for and there were no words in there like "health", "addiction", "mental health", "well-being". It was a bit surprising to have evidence given about treatment which does not say what the treatment is meant to be doing.

  535. That seems to be a very sensible point. Looking at the picture as a whole, do you still think that there is too much emphasis on criminal justice in the strategy as opposed to treatment? Would you still like to see an expansion of that, almost giving that aim a higher ranking than the others?
  (Professor Nutt) I would.
  (Professor Stimson) Yes.
  (Mr Hickman) When the Americans looked at their drug misuse research they had this notion of looking at the whole of drug misuse in terms of a public health framework. The question was whether a criminal justice initiative led to a decline in dependence in addiction or a drug related harm. It is that overview which is missing from the strategy. Criminal justice interventions are fine if there is enough evidence to suggest that they will lead to the desired objective, which is a reduction in dependence and a reduction in harm. We do not seem to have that evidence and they seem to go on separately from "What are they for?".

David Winnick

  536. Reference was made earlier on to tobacco and alcohol abuse. Regardless of any change in the law, at a time when efforts have been made, say in the last ten years, to reduce tobacco use and alcohol use, would it not be unfortunate if drug reformers, however much they may be right about changing the law, gave the impression that we should not be too much concerned about any form of drugs including even soft ones.
  (Professor Nutt) It would be unfortunate but I do not think changing the law would necessarily give that impression.
  (Professor Henry) I made an allusion to education earlier on and it is very interesting how overall drug use is going down year on year at the moment, whereas some of the harder drug use in young people is going up, possibly because of more aggressive marketing by those who make a lot of money out of it. The fact that overall drug use is going down bodes well for the future because the fewer people who start smoking, who start taking alcohol, who start using cannabis, eventually the fewer who take to hard drugs, because people do not leap into hard drugs suddenly. It may well be that educational policies are already working and that aspect has to be stressed so that the longer term will be to reduce overall drug use in the community, be it alcohol, tobacco, cannabis or whatever. There is a positive opportunity there.

  537. While that may well be so, and it is encouraging indeed if drug use is going down, should we work on the reasonable basis that just as we are not going to get a situation where people give up smoking entirely or anywhere near it unfortunately, especially among some youngsters, and alcohol abuse is not going to disappear, the same applies for drugs, does it not? The possibility that only a very, very tiny number will continue to use drugs would be far too optimistic I assume.
  (Professor Nutt) The reality is that drug use is with us, it will always be with us and the best way of dealing with that fact is to try to minimise the damage that the use does to the individual and to society.
  (Professor Henry) I would add: to find ways of discouraging people from starting drugs in the first place. If they do not start, they never end up with problems.


  538. I am conscious that Professor Nutt had some other suggestions for changes. When we asked what changes you would make, you said that what Professor Stimson was proposing was only one aspect of it. Do you have others you would like to put to us?
  (Professor Nutt) In terms of changing the Misuse of Drugs Act?

  539. No, in terms of changes you would make to government policy across the whole range. If you were the Home Secretary, what would you do.
  (Professor Nutt) Improving treatment would be one undoubtedly and the other key one is education in terms of trying to get people to have a balanced view of the relative risks and also research; that has already been mentioned, but we do need a lot more research.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 22 May 2002