Chapter 20 - Public Policy In Other Countries - UK

Recent key reports and studies

 

Science and Technology Committee of the House of Lords

In 1998, the Science and Technology Committee of the House of Lords studied the issue of medicinal use of cannabis and tabled a report entitled Cannabis: The Scientific and Medical Evidence. The purpose was to examine the scientific and medical evidence with respect to the medicinal use of cannabis and determine whether current restrictions were appropriate. In addition, the Committee considered whether the prohibition on recreational use was justified based on the scientific evidence of adverse effects. However, the mandate did not include other issues such as the social and legal aspects of cannabis use.

The Committee discussed the long history of cannabis use both as a medicine (usually in the form of a tincture) and an intoxicant. The Committee noted that the "advent of a host of new and better synthetic drugs led to the abandonment of many ancient herbal remedies, including cannabis."[1][86] The Medicines Act 1968 allowed the government to licence pharmaceutical companies and products, and cannabis was still able to be prescribed under certain conditions. In 1973, cannabis’s licence of right was not renewed and the regulations under the Misuse of Drugs Act 1971 prohibited medical use altogether (by listing cannabis in what is now Schedule 1).

The Committee then went on to review the pharmacology of cannabis and the different ways it may be administered, the toxic effects of cannabis, including: the short and long-term effects of it; whether the user develops tolerance to the drug; and whether it causes dependence. The Committee found that although cannabis "is not in the premier league of dangerous substances, new research tends to suggest that it may be more hazardous to health than might have been thought only a few years ago."[2][87]

Concerning the current medical use of cannabis in the UK (quite widespread even though it is illegal) as well as the current medical uses of cannabinoids (certain cannabinoids are legally in current use in UK medicine), the Committee proposed new indications for cannabis-based medicines (including alleviating certain symptoms related to multiple sclerosis). The Committee stated that it "is important to distinguish the different substances and preparations; for instance, cannabis leaf must be distinguished from cannabis extract, and whole cannabis from THC. It is also important, although not always easy, to distinguish the various possible routes of administration, e.g. by smoking and by mouth."[3][88]

Based on evidence that cannabis can be effective in relieving the symptoms of multiple sclerosis and against certain forms of pain, the Committee recommended that clinical trials of cannabis for these conditions "be mounted as a matter of urgency." The Committee members did indicate that if a medicine became licensed (after clinical trials), they did not envisage smoking being used to administer it. Thus, they called for research into alternative delivery systems. The Committee also recommended that cannabis should be reclassified as a Schedule 2 drug so that doctors would be permitted to prescribe an appropriate preparation of cannabis, "albeit as an unlicensed medicine and on the named-drug basis"; this would also allow research without a special licence.

Compassion was the main reason for recommending the change to the law (a law under which patients risk prosecution to get help). Another reason was the inconsistent way in which the law was enforced, which brought it and Parliament into disrepute.

The Committee did note that cannabis-based medicine would not be appropriate for certain groups of patients such as pregnant women, people predisposed to schizophrenic illness or those with cardiovascular conditions. In addition, users would have to be warned of possible side-effects. The risk of addiction would have to be considered when deciding whether to prescribe. Thus, the Committee recommended that "if doctors are permitted to prescribe cannabis on an unlicensed basis, the medical professional bodies should provide firm guidance on how to do so responsibly"[4][89] and that "safeguards must be put in place by the professional regulatory bodies to prevent diversion to improper purposes."[5][90]

With respect to the recreational use of cannabis, the Committee added that although the harms must not be overstated, there was enough evidence of toxic effects of cannabis to justify maintaining the current prohibition.

The government rejected the recommendation to reclassify cannabis. It indicated that before cannabis should be available for prescription, its safety, quality and efficacy would have to be demonstrated and a marketing authorization issued by the Medicines Control Agency. In addition, the government indicated that allowing prescriptions of cannabis would reduce momentum in research. The government was also concerned with the possibility of prescribed cannabis being used for improper purposes.

In March 2001, the Science and Technology Committee of the House of Lords presented another report dealing with the current state of research into the therapeutic uses of cannabis, the roles of the Home Office and the Medicines Control Agency in the licensing of cannabis-based medicines, and more recent issues relating to the prosecution of therapeutic cannabis users. The Committee reiterated that cannabis should remain a controlled drug and that the legalization debate should maintain a clear distinction between therapeutic and non-therapeutic use.

With respect to the current state of research, the Committee noted trials recently approved for funding by the Medical Research Council. The Committee was concerned about the long timeframe for developing usable therapeutic preparations from these trials. It was more encouraged with the progress being made by G.W. Pharmaceuticals, both with respect to establishing the efficacy of a cannabis-based medicine and in developing suitable medical preparations (e.g., a sub-lingual spray).

The Committee also discussed the prosecution of therapeutic users of cannabis. They noted that the decision to prosecute varies from region to region and that, in some cases, juries have acquitted therapeutic users who do not deny the offence but plead therapeutic use in mitigation while others are found guilty. The Committee believed that the acquittal of cannabis users by juries on compassionate grounds brings the law into disrepute. According to the Committee, this problem underlines the need to legalize cannabis preparations for therapeutic use.

The Committee noted that the decisions made by the Medicines Control Agency appear to be inconsistent. For example, although it is satisfied that the information on the toxicological profile of delta-9-tetrahydrocannabinol is adequate, it is not satisfied with the toxicology data of cannabidiol. The Committee was of the view that the Medicines Control Agency had "not adopted a positive approach towards the licensing of a cannabis-based medicine." The Committee was concerned that the Medicines Control Agency’s approach places "the requirements of safety and the needs of patients in an unacceptable balance." The Committee concluded that the Agency’s attitude "means that cannabis-based medicines are not being dealt with in the same impartial manner as other medicines."

 

We believe that a thorough and impartial reappraisal of the published scientific literature on the safety of CBD and cannabis extracts should lead the MCA to reconsider their present overly cautious stance. We are at least encouraged that the MCA state that they are conducting a more detailed review of existing literature reports on cannabis and CBD. [6][91]

 

The Runciman Report

In August 1997, The Police Foundation set up an independent inquiry (chaired by Viscountess Runciman) to assess the UK’s legislation on the misuse of drugs. The main goal was to determine whether the legislation needed to be revised in order to be more effective and more responsive to the changes that had taken place in the 30 years since the original law was passed.

The report recognizes that the goal of drug legislation must be to control and limit the demand for and the supply of illicit drugs because eradication of drug misuse is not a realistic goal. The report also stated that the law must fulfil UK’s international obligations and noted that international agreements – while restricting some options – allow for room to manoeuvre, particularly in the areas of drug use and possession.[7][92] The report discussed different approaches towards drug use and possession and towards minor acts of supply taken by some other European countries and found that the UK had a comparatively more severe regime of control of possession offences.

The report indicated that the law should be based on the following principles:

··          as a means of reducing demand, the law is only one aspect of a broader agenda of health, prevention and education;

··          it should reflect the latest scientific understanding and the social and cultural attitudes of modern British society;

··          it should be realistically enforceable;

··          it should infringe personal freedom only to the degree necessary to restrain serious levels of harm to users or others;

··          it should target the drugs that cause the most harm;

··          it should reflect the relative harmfulness of activities connected with each illicit drug or category of drugs, and provide for sanctions proportionate to that harm; and

··          in its operation, the law should be accepted by the public as fair, consistent, enforceable, flexible and just.

The report noted a steady increase in the prevalence of both problem drug use (including injecting among problem drug users) and casual drug use in the UK over the past 30 years. Cannabis is the most widely used illegal drug, with age 30 being the big divide in drug use. Despite there being a steady rise in drug offences and seizures (including amounts seized) over the years, the report concluded that efforts to limit supply have in the most part failed. The report found that the public views health-related dangers of drugs as more of a deterrent than their illegality, availability or price. In addition, public attitudes to cannabis compared to other drugs were significantly different (cannabis was seen as the least harmful drug, its possession should be the lowest of priorities for police, and a number of people – a third to half – believe that the laws should be relaxed).[8][93] All age groups shared these views, although support for legalization was not as strong among older age groups. With respect to other drugs, strong drug laws were fully supported despite concern with health risks resulting from drug use. The public was much more concerned with trafficking than with possession offences. The inquiry found that there was a lack of data on drug use and the absence of detailed cost information about drug use (e.g., health care, enforcement and other social services costs). Thus, it was difficult to do any type of assessment of drug control and prevention strategies

The UK’s drug classification was reviewed and the report recommended keeping the current three-tier drug classification system (class A, B and C). This classification enables authorities to distinguish between the relative risks of different drugs and allows sanctions to be applied that are proportionate to a drug’s harm. However, the report found that the criteria by which drugs are classified should be clearly described. The classification should take into account modern developments in medical, scientific and sociological knowledge; as well, the main criteria should be dangerousness of the drug to the individual and to society. The report set out factors to consider, including: the risks of the drug itself (acute and chronic toxicity); risks due to the route of use; extent to which the drug controls behaviour (addictiveness/dependency) and ease of stopping; and social risks (costs to society in terms of crime, medical costs, social harm through intoxication, etc.). Based on these factors, the report recommended some changes to the drug classes to counteract what the members felt was a dangerous message, i.e., that all drugs are equally dangerous. The members of the inquiry believed that these changes would enhance the law’s credibility and that education and attention should be refocused on the more harmful drugs such as heroin and cocaine. The report recommended the following changes:

··          cannabis should be reclassified from a class B drug to a class C drug and cannabinols from class A to class C;

··          heroin and cocaine would remain in class A (the most dangerous drug category) while Ecstacy and LSD would move to class B; and

··          buprenorphine would move from class C to class B.

It is interesting to note that the members of the inquiry would have classified alcohol as a class B drug bordering on A, while tobacco would have been on the borderline between B and C, if these substances were controlled under the MDA.

The report found that possession offences should remain, even if for personal use. However, the law should minimize the harmful consequences of a contravention in appropriate cases. The report concluded that for the majority of possession offences, imprisonment was neither proportionate nor effective. It recommended that imprisonment no longer be available for possession of class B or class C drugs. Imprisonment should remain a possibility for possession of class A drugs, although the maximum would be shorter than what is currently set out. This would reflect what the courts are currently doing; the average possession sentence is fairly short compared to the maximum available. In addition, the report recommends lowering the maximum fines for all classes of drugs. According to the report, imprisonment for possession would be rare. Non-custodial responses would include fines, probation orders, probation orders with treatment conditions attached, and conditional discharges. These sanctions would be most suitable for possession of class B and class C drugs where a caution was not appropriate. The report noted that in over 50% of cases, police use cautioning. This approach was supported but the report felt that this discretion needed a proper framework. Thus, cautions should become a statutory sanction with guidelines set out in regulations. This would allow the enforcement of conditions attached to a caution. Finally, the report recommended that a caution should not carry a criminal record. If the recommendation to reclassify cannabis as a class C drug were carried out, it would have certain consequences, including that police would no longer be allowed to arrest for possession of cannabis. For arrestable offences, the police have powers to insist that suspects accompany them to the police station and to search their premises without a warrant. Police would still have the power to stop and search for all drugs, however.

With respect to trafficking, the report mentioned that there should be an attempt to differentiate between acts of different gravity with respect to supply offences (for example, supply between friends versus as part of an organized criminal group and supply of class A drugs versus other drugs). The report recommended a separate offence of dealing, the main ingredient of which would be the pattern of activity of illicitly transacting business in drugs. The offence would be a trafficking offence for the purposes of the Drugs Trafficking Act 1994. The report also recommended that the maximum penalty for trafficking in class A drugs be lowered to 20 years and that the maximum for class C drugs (including cannabis) be raised to seven years. The report also recommended the adoption of sentencing guidelines, for trafficking offences in particular. The report also mentioned the ineffectiveness of the laws dealing with confiscation of assets (in their view, a pragmatic problem rather than a legislative one). The report recommended improving the effectiveness of the current system by setting up a new national confiscation agency and making several other changes.

Although the inquiry members believed that the drug legislation in general did not need radical change, the legislation’s application to cannabis was the exception. Thus, many of the more significant changes apply to this drug. The report noted that it was the drug most widely used and most likely to bring people in contact with the justice system. The report also noticed the gap between how the law is written and how it is practised with respect to cannabis (due to the use of discretion). The members of the inquiry were of the view that cannabis was less harmful to the individual and society than other illicit drugs (although not harmless). With respect to cannabis, it was felt that the current law produces more harms than it prevents and that the law’s response is disproportionate to the drug’s harm. The report, thus, recommended penalties for cannabis possession for personal use be decreased and that imprisonment not be an option (normal sanctions for possession and cultivation for personal use would be out-of-court disposals, including informal warnings, statutory cautions or a fixed out-of-court fine). In addition, the report stated that cultivation of small amounts of cannabis should be prosecuted under section 6 (cultivation of cannabis) rather than section 4 (production) so that it not be considered a trafficking offence. The cultivation offence should be treated in the same way as possession of cannabis. In addition, permitting people to smoke cannabis on their premises would no longer be an offence. The members of the inquiry were of the view that the benefits of such a strategy outweigh the risks and that this would promote the targeting of enforcement on those drugs and activities that cause the most harm.

The report concluded that demand is not significantly reduced by the deterrent effect of the law. Education and treatment can be successful, however. Thus, the members recommended a less punitive approach to possession offences and a more punitive approach to trafficking (particularly with respect to profits obtained from drugs). The members believed that harm could be reduced with credible education and treatment when needed. They indicated that treatment is cost-effective in reducing problem drug use and associated criminal activity and recommended a substantial reallocation of resources from enforcement (currently 62%) to treatment (currently 13%).

With respect to the medicinal use of cannabis, the report concluded that the therapeutic benefits of cannabis for certain serious illnesses outweighed any potential harm. They endorsed the view of the House of Lords report that cannabis and cannabis resin should be moved to Schedule 2 (thus permitting possession and supply for medical purposes). Because the House of Lords recommendation was rejected by the government and because it would be years before a licensed cannabis product becomes available, the report recommended a new defence in law: duress of circumstance on medical grounds for those accused of the possession, cultivation or supply of cannabis for the relief of certain medical conditions.

In its reply to the report, the government rejected or referred for further consideration many of the recommendations made by the inquiry. On the key issues of reclassifying cannabis and the depenalization of cannabis, the government did not support the inquiry’s recommendations. With respect to the reclassification of cannabis, the government was mainly concerned with the health risks associated with its use. With regard to depenalization, the government rejected removing imprisonment as a possible sanction. In addition, they did not want the police powers of arrest to be abolished for these offences. In dealing with the medicinal use of cannabis, the government indicated that the quality, efficacy and safety of a medicinal form of the drug must be established before prescribing should be allowed.

As we now know, the government has since reclassified cannabis and abolished prison terms for possession for personal use.

 

Other reports

A Working Party of the Royal College of Psychiatrists and the Royal College of Physicians also published a report in 2000. Entitled Drugs: Dilemmas and Choices, the report examined key issues in preventing drug misuse. In particular, it states:

 

Spending on prevention: Three-quarters of UK expenditure is devoted to enforcement and international supply reduction. There is little evidence that this is money well-spent. The proven cost-effectiveness of methadone maintenance and abstinence-based programmes for heroin addicts suggests that more of the available budget should go to treatment programmes. New money for treatment announced by the Government is welcome, but calls for expansion of unproven and untested treatments must be resisted.

Research: Current UK expenditure on drugs research does not begin to match the magnitude of the problem. Just one per cent of the annual drugs prevention budget would inject £14 million into research – over double the current spent.

Improving the value of treatment: Systematic investment in staff training, monitoring of patients and essential support services is needed to bring improvement rates achieved by UK treatment programmes closer to those in the United States. In particular, more extensive drug treatment facilities are needed for adolescents.

Private prescribing: Private prescribing of substitute drugs leaves scope for malpractice that comes close to ‘buying a prescription’. Doctors treating drug-users outside the health service are not currently required to have extra training in addictions and receive little monitoring or regulation.

Drug-testing by employers: Although expensive and surrounded by legal and ethical issues, the technology exists for drug-testing of employees using hair samples. This provides a record of drug-use over the previous three months and could, therefore, have a major impact on the prevalence of drug-use in future.

Ecstasy: Many young people use Ecstasy, and some drugs education campaigns may have proved counter-productive. Any advice given to young people should take account of the likely impact on those who continue to use drugs as well those who will be deterred.

Amphetamine: Dependence on amphetamine, especially when injected, probably carries more risk to users and public health than heroin. Little research has been carried out into dependence or treatment.

Cannabis: Cannabis is not a harmless drug, but its ill-effects on health are almost certainly less than those of tobacco or alcohol, which are legal. More research is needed into the medicinal benefits and long-term ill-effects of the drug. Legislative experiments, as in the Netherlands, should be encouraged. People requiring cannabis to relieve disabling medical conditions, such as multiple sclerosis, should not be prosecuted.

Future policy: The Government’s Ten-Year Strategy for Tackling Drug Misuse recognises the need for greater investment in treatment. But there are no easy answers, and ambitious targets for reducing the proportion of young people using heroin and cocaine by 50 per cent by 2008 are unlikely to be achieved by the modest initiatives announced so far. Attempts to curb the illegal international drugs trade have consistently failed and will probably continue to do so. If the prevalence of drug-use and drug-related crime continues to rise, the pressure on the UK and other governments to change policies that are clearly failing is bound to increase. [9][94]