Drug Politicking “Wash up”

Now we’re into the election period, there is horse-trading going on between the parties as part of what is known as the “wash-up” to push through outstanding legislation on which all agree. No doubt, as part of finishing of Parliamentary business, the classification of Mephedrone and the other Cathinones will also be concluded.

I was surprised at how much media attention my resignation from the ACMD provoked last week; also alarmed at the huge gap between the politicians and the overwhelming numbers of people who contacted me to express support for my arguments for a more evidence-based, Public Health-focussed approach to determining drug policy. Unfortunately, this seems a long way off. Not missing an opportunity to kick the Home Secretary, the Tory Shadow Chris Grayling said the relationship between the government and the ACMD had become “utterly shambolic”. However, just to make sure that we know that he’s ‘tough on drugs’ and, in line with Alan Johnson’s lack of interest in evidence, he added “The decision on Mephedrone was the right one.”

For those who haven’t read the ACMD’s report on the Cathinones (including Mephedrone), which I received after my resignation and which was still in draft form at the time the Home Secretary was appearing on television, announcing the ban “as a result of the council’s swift advice”, it includes the following:

• Data on Google and FRANK searches – I’m not clear what that’s supposed to tell us other than that people have been curious and/or concerned. This could of course have been due to the media hysteria.
• Re- acute toxicity: “there are very few clinical data available”.
• Data that when users consumed massive amounts over 3-day binges they “described vivid hallucinations…However, the quantities consumed are not likely to mirror those of most users.”
• “anecdotal reports from members of the public that when taken in conjunction with other drugs e.g. amphetamines the effects can be quite marked and lead to personality changes, paranoia and sometimes violent episodes.”
• Re-deaths: In England Mephedrone has been present at 7 post mortems but inquests have still not taken place. To date, in 1 case, the death was judged to be ‘natural’.
• In Scotland 1 death has been reported as the result of “adverse effects of Methadone and Mephedrone”.
• 1 person has been reported as dependent in Glasgow.
• “Media reports” have indicated that children have been missing classes because of Mephedrone. However, the report later states “Although recent media profile has presented much apparent public health information it is not always credible or consistent.”
• “At present there remains only limited evidence of a relationship between Mephedrone and anti-social behaviour”…this is judged to be due to the drug being openly dealt and consumed. Would that we could say the same about alcohol!

For those who have accidentally or deliberately misunderstood my position, I am not saying that this drug is safe. I really do empathise with parents who are worried and I believe they and their children need clear, accurate information and advice. Moreover, they need to have adequate support to provide help if they are getting into difficulties with this or any other legal or illegal drug. Rather, I have argued that:

• Last week ACMD did not have sufficient evidence other than pharmacological evidence presented to us to help us judge harms.
• We were unduly pressured by media and politicians to make a quick, tough decision to classify.
• We did this without adequate consideration of how and why young people use this drug and how to develop effective prevention and early intervention strategies.
• We made a recommendation to the Home Secretary on a partially considered and inadequate report. For political reasons, he heard the bit he was most interested in – Class B! – and accepted a report which hadn’t even been completed.
• We failed to consider in any detail what the impact of our recommendation to potentially criminalise young users of Mephedrone and to drive its use underground might be.

The House of Commons Public Accounts Committee has just published a report, “Tackling problem drug use”. The report is severely critical of the Home Office’s failure to evaluate the impact of its drugs strategy:

“Given the public money spent on the strategy [£1.2 billion per year] and the cost to society, we find it unacceptable that the Department has not carried out sufficient evaluation of the programme of measures in the strategy and does not know if the strategy is directly reducing the overall cost of drug-related crimes.”

The report also states that the Home Office “does not know how to most effectively tackle problem drug use.” It goes on,

“We consider that measures to reduce problem drug use by young people have had limited impact. Preventing young people from becoming problem drug users is important in bringing down the future number of problem drug users and the associated costs to society.”

Hear! Hear!

In a paper presented to the Commission on Narcotic Drugs in March 2010, Antonio Costa, the Executive Director of the United Nations Office on Drugs and Crime, stated

“Placing human rights at the centre of drug control, crime prevention and criminal justice provides an organizing set of principles that dissolves boundaries between the fields and promotes a single coherent response.”

It should be a human right for young people with problems, rather than simply being criminalised, to be helped to overcome their problems, to have aspirations and support to achieve these. Strategies to prevent and reduce drug harms need to be based on evidence of effectiveness. I hope that in the electoral debates over the next few weeks we might hear some commitment to a root and branch review of drug policy. Which of the leaders is prepared to commit to this and to address drugs as a Public Health issue, shifting responsibility for the drugs strategy to the Department of Health or perhaps to the Department of Communities and Local Government?

My ACMD resignation letter to the Home Secretary

1st April 2010

Dear Home Secretary

Resignation from Advisory Council on the Misuse of Drugs

With regret and sadness, I am tendering my resignation as a member of the Advisory Council on the Misuse of Drugs.

I was honoured to be appointed to this position and I had hoped that my substantial experience of managing drug prevention and treatment services might help influence the Committee, and thereby the Government, to think about drugs as more of a Public Health issue rather than focussing narrowly on the Criminal Justice aspects. This has not been the case.

My main interest and competence is in the field of prevention and early intervention with young people. I have grown increasingly disillusioned not only with the lack of attention paid to this by politicians and the media but also by the ACMD’s apparent lack of interest in the subject (with a few individual exceptions). At our meeting earlier this week, the update report on ‘Pathways to Problems’, published on the same day, received scant attention. Indeed, there was no time for questions on the report due to the  haste with which we were being pushed to make a decision about classifying Mephedrone; this so that the Chair could come to meet with you later in the day and you could do a round of press announcements.

Re-Mephedrone; we had little or no discussion about how our recommendation to classify this drug would be likely to impact on young people’s behaviour. Our decision was unduly based on media and political pressure.  The report was tabled to the whole Council for the first time on Monday; the Chair came to brief you before the whole Council had even discussed all of the report. In fact, I still haven’t seen the final version. 

When, as Home Secretary, David Blunkett (note – should be Charles Clarke)announced that the entire classification system would be reviewed, I welcomed it and was disappointed when the idea was shelved. This needs urgently to be revisited. We need to review our entire approach to drugs, dumping the idea that legally-sanctioned punishments for drug users should constitute a main part of the armoury in helping to solve our country’s drug problems. We need to stop harming people who need help and support.

At the end of last year, I decided not to resign over the sacking of David Nutt, preferring instead to see how things panned out and to hope that the ACMD could develop a work programme which would help prevent and reduce harm, particularly to young people. I have no confidence that this will now happen, largely though not totally due to the lack of logic of the context within which the Council is constrained to operate by the Misuse of Drugs Act. As well as being extremely unhappy with how the ACMD operates, I am not prepared to continue to be part of a body which, as its main activity, works to facilitate the potential criminalisation of increasing numbers of young people.

Yours sincerely

Eric Carlin

My resignation from the Advisory Council on the Misuse of Drugs

I  resigned from the ACMD yesterday as a result of my grave concerns and misgivings about the processes we went through at our meeting this week and more generally about the lack of logic and sometimes morality in what we’re required to do.  I originally put myself forward as a member of the ACMD because I thought my substantial experience working in the drugs field would be useful. I believed that I might help influence the Council to think more broadly about its remit, so as to make public policy more effective in understanding the reasons why young people are increasingly attracted to drugs and to support the development of effective interventions to prevent and reduce harm. 

My main interest and competence is in the field of prevention and early intervention with young people.  I have grown increasingly disillusioned not only with the lack of attention paid to this generally by politicians and media but also by the ACMD’s apparent lack of interest in the subject (with a few individual exceptions). Since joining ACMD, I have played an active part in the ‘Pathways to Problems’ review process and enabled engagement of young people. I also spent a significant amount of time in helping to draft the recent response to the DCSF’s new draft guidance on Drugs Education in Schools. However, it is clear that ACMD is far more interested in analysing the chemistry of one drug as opposed to another and making decisions in relation to the potential pharmaceutical harms of one drug compared to another, rather than helping to improve our understanding of why young people use drugs and how we might intervene to prevent and/or reduce harm.  This was evident by the lack of attention paid this week by ACMD members to the report on ‘Pathways to Problems’ and also by the decision-making process we went through to make Mephedrone the latest banned substance. 

 The latter process has left me deeply concerned, intellectually insulted and morally compromised. I contributed little to the discussion on Monday, confused and disillusioned that our focus was not on what we should recommend to understand and influence young people’s behaviour so as to prevent and/or reduce harm. Rather, we made a decision to ban this, the currently most publicly demonised drug, based mainly on its chemical similarities to other Class B substances. If that was the main criterion, how could one not agree with the decision?  The problem is that the context of and rationale for our decision-making is a nonsense. What next?  How many more new drugs are we going to ban, without an adequate evidence base about the impact of banning on young people’s behaviour re-use of drugs? Do we just keep on going? Rather than banning each new drug that comes along, we need to shift resources into social research about young people’s behaviours, how to influence them and investment in interventions to support demand reduction. In terms of research, the Home Office Blueprint project was intended to help but ended in farce, vagueness and obfuscation, costing, I believe £6-7 million in the process; I don’t think the final cost was publicised. They were, never, however, held to account by ACMD as the subject fell off our agenda as a result of the David Nutt sacking issue.  And then the banning of Mephedrone took precedence…

 I’ve just been working with some young people who, honestly and seriously, told me that Cannabis, with all its risks, made them feel better about themselves, more able to assess their personal agency, manage their lives and feel more hopeful about the future. My current feeling is that the ACMD, with our focus on chemistry and legality, doesn’t contribute anything towards reducing the countless harms young people like these experience on a daily basis, including though not limited to harms from drug use.  Moreover, we are colluding in the sustenance of a system which may in fact disadvantage even further some of the most disadvantaged people in our society.

 When, as Home Secretary, Charles Clarke announced his intention to review the entire drugs classification system, I welcomed it and was disappointed when the idea was subsequently shelved. I believe this needs to be revisited. We need to refocus on drugs as a Public Health issue, rather than a Criminal Justice issue. We need to review our entire approach, dumping the idea that legally-sanctioned punishments for drug users should constitute a main part of the armoury in helping to solve our society’s drug problems. We also need to stop causing the harms we have undoubtedly caused to many who have needed help and support rather than punishment.  I do not underestimate the risks and complexity associated with such a radical change but this does not make it any less urgent or necessary.

At the end of last year, I decided not to resign over the David Nutt affair, preferring instead to see how things panned out and to hope that the ACMD could develop a work programme which would help prevent and reduce harm. However, I have now decided that I cannot continue to sit on a committee which is complicit in taking part in processes which are not only illogical in many ways but which also, by enabling the criminalisation of ever greater numbers of young people who require support rather than punishment, may even do more harm than good.