Select Committee on Home Affairs Minutes of Evidence


Examination of Witnesses (Questions 1020 - 1038)

TUESDAY 15 JANUARY 2002

DR CLAIRE GERADA, MRS CHRISTINE GLOVER, DR ROB BARNETT AND DR ANDY THOMPSON

  1020. Other people.
  (Dr Gerada) Not other people but the sick, those who could not run across the road quickly enough or children, the vulnerable people. If we removed any laws for drugs, who would suffer most? Certainly not those who have parents who can take them to Phoenix House to look at ex-users and sort their lives out. The people who would suffer most are those from disparate lives, the poor and deprived.

  1021. They are the people who are already consuming disproportionately anyway.
  (Dr Gerada) Your argument was let them all rot in hell.

  1022. No. This is not my argument. I am attempting to put an argument we have heard several times before this Committee, that adults who are perfectly capable of assessing the risks for themselves should be allowed to go to hell in their own handcart, subject only to the qualification that it should not disrupt the lives of other people. With crack cocaine where everybody knows it makes you behave completely uncontrollably, that would not be an argument but in the case of heroin, which almost dumbs you down and ditto I suppose cannabis, why not?
  (Dr Thompson) I agree that to a certain extent, again personally. Also, if we look at the amount of resources that would be freed from enforcement which could be used for treatment, there is a fairly strong argument.

  1023. This is what we call thinking outside the box. Up to now, the discussion has taken place on the basis that you are all associated with health and wanting to make people better but now I am asking you to imagine that you are the Home Secretary and not a doctor and you have this massive problem which is getting worse and worse.
  (Dr Barnett) One of the problems is that there are a lot of people who smoke and who wish they had never started. Having started, they find it very difficult to stop. There are a lot of people who drink alcohol who wish they had been able to control what they had been drinking but it has escalated and the same happens with drug misusers. A lot of people start, the habit becomes addictive and they find it very difficult to stop. They just wish they had had the willpower not to start in the first place. I smoked a cigarette at the age of 11, coughed, hated it and as a wimp did not continue but a lot of people persevered because they felt it was big to do so. The same happens with drugs. If there is peer pressure, you will continue.

  1024. When you and I were 11, smoking cigarettes was represented in some quarters as a sacrament rather than something that would get us into serious difficulty later in life. We have all become aware that it can seriously damage your health, to coin a phrase, and the government is about to ban, I hope, the advertising. No one is talking about advertising cannabis or marketing heroin; we are just talking about harm reduction and minimising harm that has already taken place in controlled circumstances or whether we allow the mayhem to go on.
  (Dr Barnett) I think we still need more research on the harmful effects of cannabis to make sure that people are fully informed about what they are doing. We have talked about the pleasurable side of taking cannabis but we need to have the evidence, like we have now with tobacco smoking, which shows what the damage is to you. If that was more readily available and there was evidence to prove it, that may be a useful argument for some people.

  1025. Except for the purpose of arguing that cannabis is damaging—most people accept that, certainly if you smoke it on the same scale as people tend to smoke cigarettes—why not explain what the risks are but not exaggerate them, because that just encourages people if they do not believe you, make it available to adults and let them take their own risks?
  (Mrs Glover) There is a cost to that because at the end of the day these people end up with chest problems, collapsed veins if they are injecting, and so on. Is that something we want?

Mr Cameron

  1026. There is a huge black market from smoking but that does not mean we make it illegal, so that argument does not follow.
  (Mrs Glover) It does because you have a choice here. The problem with smoking is that it arrived before we had the evidence of what it did. We now know that if you spend a lifetime injecting heroin you are likely to have a completely collapsed system. You are likely to have people who become amputees.

  1027. Has making these things illegal helped? If you look at the use of drugs, the use of cannabis, Ecstasy and heroin, they have all rocketed up, as it is illegal.
  (Dr Gerada) You would have to prove that that would not happen if you made it legal. I am sorry if I talk in a conservative health way but I see every single day patients who use drugs and have terrible problems.

David Winnick

  1028. Despite the fact that it is illegal. The argument is not that we should encourage the use of drugs, although we should warn people constantly of the dangers. In my view, much more should be done, to what effect I do not know, but the argument is that, despite the fact that these drugs are illegal, including cannabis, people are using them.
  (Dr Gerada) I cannot see the argument that you would get more of them if you made it more legal or less illegal. You say give it to adults. I would like to see how that would be done. Cigarettes are meant to be sold to adults and yet we see children smoking cigarettes. Alcohol in children is rising considerably. It is a Pandora's Box and once it is open it is too late.

  1029. You believe, if it is to be decriminalised if not legalised, far more people would use it?
  (Dr Gerada) Yes.

  1030. That is the view of you all?
  (Dr Thompson) That is not my view. I see users who are virtually kidnapped by dealers. They are trying to get off their methadone and dealers hang around the community drugs teams. They take them into their cars. They make them buy their heroin. Dealers are very sophisticated businessmen who develop their markets with a skill which puts some of our businessmen in this country to shame. They are very good at it and there is no doubt that there are those users who, in order to fund their habit, introduce it to their friends. If they did not need to do that, I am not sure necessarily that drug use would decrease but I am sure there is an argument there which says that drug use would not increase as a result of legal supply and a less costly supply.

Mr Cameron

  1031. What about the question of harm? We have had people in front of us who said even if you accept that use might go up harm would go down. If you look at the fact that 40 heroin addicts died in Scotland because of impure heroin and two million Ecstasy tablets are being taken every weekend and we have no idea what our children are putting into their mouths; if you look at the sort of cannabis that is being smoked—skunk and super skunk, incredibly powerful stuff—what about the argument, as medical people, about would getting rid of prohibition, particularly for soft drugs, reduce harm?
  (Dr Gerada) For the current users, yes, of course it would. If you take someone buying illegal heroin off the street and you made it legal, for whatever reason, to that individual, putting themselves at risk, day in, day out, robbing or whatever, it would have a lot of health and criminal justice benefits. My argument is it is such a risk because we then do not know what is going to follow. We use the analogy of tobacco but we sort of ignore: it is all right; it is just cigarettes, but it is a legal substance that still causes 100,000 deaths a year. People know about the harmful effects. You only need to smoke four cigarettes to be addicted for life. 80 per cent of smokers want to give up. It is a not a matter of mind, motivation or self-control; it is the drug. I worry that if you do that you have let out something that we can never get back.

Bob Russell

  1032. How many people have died from cannabis smoking?
  (Dr Gerada) Cannabis is a different issue because there are not a lot of cannabis users at the moment in terms of long term, chronic, heavy use. If you let cannabis out of the bag, it is higher strength; it is frequently smoked with tobacco. It certainly causes all the cancers that tobacco causes and it brings forward schizophrenia and psychosis. Let us look at the evidence extensively and let us not be driven by the `something must be done' type of scenario rather than looking at this properly.

  1033. You mentioned the people who come to you for treatment or support on drugs. How many of those are cannabis smokers?
  (Dr Gerada) The funny thing about general practice is we see all the addictions, whereas in specialist care they only see heroin and cocaine. I see cannabis smokers wanting to give up cannabis, high level cannabis users whose lives are dominated, maybe smoking 10 to 15 a day, who want to give up. The treatment is very much of a motivational interview type. I have seen a Coca-Cola addict who drank three litres of Coke a day.
  (Dr Thompson) There is a difference between what you can do with decriminalising cannabis and other drugs and what happens with alcohol at the moment. Alcohol and tobacco are very heavily advertised and promoted. They are also widely available and the restrictions on its supply are largely ignored. If you had a better regulated, legal and cheap supply, you could avoid a lot of the effects of that sort of promotion, which does promote the use of alcohol and tobacco.

  David Winnick: You have certainly given us a different viewpoint on the subject from other witnesses and we will undoubtedly take it very much into consideration when we draw up our report. It is in conflict with a good deal of evidence we have heard and that is not a bad thing because we needed a balance of view and clearly we have had it today.

Chairman

  1034. I do not want any of you to leave here feeling that you have not made some point that you feel is essential to our inquiry which has not already been made. Dr Thompson?
  (Dr Thompson) I would like to expand on a point that we made in our written evidence about what happens within the prison service. I understand that it is a matter of resourcing. Resourcing and training are improving but even within the prison service it appears that there is an idea that maintenance methadone ought not to be used except in exceptional circumstances. All the evidence that we have in opiate abuse is that in moderate to high dose maintenance methadone is the most effective treatment while waiting for people to realise that they want to come off opiates. The fact that the prisons will not countenance that is stopping many heroin users from revealing their heroin use when they are admitted into prison. The result of that is that, rather than getting any treatment in prison and seeing any resettlement workers, they end up buying heroin which is freely available on the wings and injecting it. They cannot use a needle exchange because the prison service will not allow needle exchange to take place in prisons, so they are encouraged to bleach that equipment which is known not to be as effective as providing proper, sterile equipment. It is particularly disheartening to see people who have been on methadone programmes go into prison; they know they are not going to get their methadone and they do not tell their warders that they are on methadone. They buy their heroin on the landings and come out again using heroin or with problems from having injected. If we are going to take the access to health care seriously to prisoners because they have an equal right to whatever health care they would have got outside, they need to have access to maintenance methadone on the same basis that they have in the community.

  1035. Does everybody agree with that?
  (Dr Gerada) I agree. Please do not forget alcohol. I know we are looking at drugs but we have a crisis in young people's drinking which is often linked to Ecstasy and cocain. It is just ignored because we all drink and we all think there is no problem.

  1036. We are looking at drugs at the moment but you are quite right to put it into perspective. Alcohol is an even bigger problem.
  (Dr Gerada) Far greater.
  (Dr Barnett) We talked earlier about what happens in primary care and it may be useful if I submitted to you our shared care guidelines which explain the roles of everyone working within the primary care team and the extended team, trying to manage the situation in a primary care setting.

  1037. That would be extremely helpful. If you could give the BMA a friendly kick in relation to their approach to this subject, we would be grateful.
  (Dr Barnett) I shall ensure that if there is anything else the BMA wishes to add it is brought in writing to you.
  (Mrs Glover) I really would like pharmacy to be included in the loop when you have these discussions. If you look at the evidence you have taken, you would not know that pharmacy was doing anything out there. The problems of having pharmacy representation when strategies and policies are being rolled out—if you cannot get a pharmacist there and you do not have a pharmacy coordinator working on that patch, they are just missed off the agenda. It is such a pity when they are doing so much to support the system.

  1038. That is a very important point. Thank you very much. You will notice that we have included pharmacy.
  (Mrs Glover) Absolutely.

  Chairman: Can I thank all our witnesses for a very stimulating session. The inquiry is closed.



 
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