Advisory Council on the Misuse of Drugs

What is the ACMD's statutory duty under the Misuse of Drugs Act?

The ACMD have a statutory duty to advise Government about:

risk assessments of harmful drug use

regulatory assessments to prevent harmful drug use

ways to restrict availability of harmful drugs and regulate their supply

advice, treatment and after-care required by those affected by harmful drug use

ways to enhance cooperation to tackle harmful drug use

education of the public, especially the young, about harmful drug use

research required to help prevent harmful drug use

Why does the ACMD use the word 'drugs' to only mean illegal drugs, contradicting the use of the word in the MDA?

There is no exclusion clause in the MDA for the traditional drugs alcohol and tobacco. They are harmful drugs in every way that illegal drugs are. However the ACMD do not refer to them as drugs, instead using 'drugs' to mean only illegal drugs. Under Section 2 illegal drugs are referred to as 'controlled drugs' not 'drugs'. The ACMD's inaccurate use of the word 'drugs' leads to many inaccurate statements. This fundamentally contradicts their duty to provide advice about drug education: they imply alcohol and tobacco are not drugs.

Under the National Curriculum all children are taught at school that alcohol and tobacco are drugs. The Department for Education and Skills' Drugs: Guidance for schools [para 1.3] says "The definition of a drug given by the United Nations Office on Drugs and Crime is: ‘a substance people take to change the way they feel, think or behave’. The term ‘drugs’ and ‘drug education’, unless otherwise stated, is used throughout this document to refer to all drugs: all illegal drugs (those controlled under the Misuse of Drugs Act 1971), all legal drugs, including alcohol, tobacco".

The United Nations definition of 'drugs' [chap 2 , p.1]: "What are drugs? A very basic question but one that needs to be clarified. For, if we start thinking of drugs as just the substances that cause problems or are abused by people we know, then we are likely to ignore other substances that, for one reason or another, are not thought of as drugs by our immediate communities. A psychoactive substance is any substance people take to change either the way they feel, think, or behave. This description covers alcohol and tobacco as well as other natural and manufactured drugs".

Home Office guidance: The Home Office/DPAS publication Let's Get Real - communicating with the public about drugs [p.40] says "in the interests of encouraging a rational debate and combating knee-jerk prejudice, we need to continue referring to alcohol, tobacco and caffeine as drugs".

The Government's Talk to Frank drug education website says "drugs are illegal" but then states that "tobacco comes from the leaves of the tobacco plant. It contains a drug called nicotine which is highly addictive".

The ACMD have advised Government about the harmful use of medicinal drugs, legal substances (e.g. volatile substances) as well as illegal drugs so clearly they do not believe their duty is restricted to illegal drugs. For example, "Along with seven other drugs, Gammahydroxybutrate (GHB) will become controlled under the Misuse of Drugs Act 1971, after the Advisory Council on the Misuse of Drugs (ACMD) recognised that it was being widely misused and has harmful effects. GHB is a drug developed as an anaesthetic".

Why doesn't the ACMD advise Government about the drugs alcohol, tobacco and caffeine?

The ACMD Secretariat has told us "Whilst it can be argued that the ACMD has a remit to consider alcohol, tobacco and caffeine it has, to date, declined to do so. The ACMD consider that its resources are best served by focussing on controlled drugs or drugs likely to be controlled by the MDA 1971. Albeit independent, the ACMD as an advisory body has to be aware of the Government’s position, which has not given any intention to consider the control of alcohol, tobacco and caffeine".

Caroline Flint, Home Office drugs minister, has told us that "alcohol, tobacco and caffeine will not be considered by the ACMD for control". The Home Office's Chief Scientific Adviser, Professor Wiles, has assurred me that this only means the Government will not ask the ACMD to advise about these drugs rather than actively preventing them from doing so. However neither the ACMD Secretariat nor Professor Wiles have answered these questions I have asked: Why does an independent scientific committee focus its inevitably limited resources "on controlled drugs or drugs likely to be controlled" - in accordance with the current government’s Drugs Strategy - rather than on the most harmful drugs – in accordance with objective scientific evidence and, I believe, with their statutory duty? How did the ACMD decide that they have the legal authority to limit their statutory duty in such a way? Did the ACMD discuss this decision with the Home Office? Did the ACMD consider alternatives such as requesting sufficient resources to advise on all potentially harmful drugs? Did the ACMD consider any unintended consequences of their decision such as their consequent inability to assess the relative harms of the intoxicant drugs alcohol and cannabis?
See our personal correspondence with the ACMD and Home Office here. More on the importance of independence and sufficient resources in scientific advice provision here.

The Government has a conflict of interest: alcohol and tobacco may cause a fifth of all deaths but ninety percent of voters consume them and Government receives £20 billion a year in taxation from their trade. Government may be putting their own interests, job prospects and drug profits, before the public interest, public health considerations.

Risk familiarity affects the risk tolerance of Government, ACMD and public: familiar risks (e.g. traditional drugs) are underestimated and unfamiliar risks (e.g. non-traditional drugs) are overestimated. Regulations are proportionate to risk tolerance, not to the scientific evidence of risk of drug harm. Traditional drugs are just as harmful as non-traditional drugs.

The Government's drug education website Talk to Frank warns of this bias to risk perception saying "alcohol can play a major part in many people's social lives. That's why it's easy to forget that it's actually a very powerful drug".

The United Nations [chap 2 , p.1] is also concerned about the effect saying "if we start thinking of drugs as just the substances that cause problems or are abused by people we know, then we are likely to ignore other substances that, for one reason or another, are not thought of as drugs by our immediate communities. A psychoactive substance is any substance people take to change either the way they feel, think, or behave. This description covers alcohol and tobacco as well as other natural and manufactured drugs".

The Parliamentary Office of Science and Technology leaflet Safety in Numbers [p.2] describes factors affecting risk perception saying "Familiarity – People appear to be more willing to accept risks that are familiar rather than new risks".

The Department of Health’s Communicating about risks to public health says "Risks are generally more worrying (and less acceptable) if perceived to arise from an unfamiliar or novel source".

The ACMD's failure to provide consistent advice for all harmful drug use contradicts the Better Regulation Task Force's principle of Consistency in their Principles of Good Regulation. BRTF say "regulators should be consistent with each other, and work together in a joined-up way" but the regulatory advice the ACMD provide about non-traditional drugs is not consistent with traditional drug regulations. Traditional drug consumption, trade and production is regulated to tolerate reasonably safe drug use, educate against drug use harmful to the consumer, legislate against drug use harmful to others and to allow taxation of the trade to pay for all drug-related services. Non-traditional drug consumption, trade and production is prohibited resulting in the demand being met by the unregulated black market. As a result all non-traditional drug profits go to organised crime leaving the general taxpayer to cover the cost of drug-related services.

Why isn't the ACMD's advice targeted at harmful drug use instead of all drug use?

The ACMD's statutory duty only applies to harmful drug use, not all drug use. They have a duty then to define the boundary between harmful drug use and reasonably safe drug use, if such use exists. Their advice must then be targeted only at harmful drug use.

The ACMD interpret the word harmful to mean 'not harmless'. Under such a definition all activities are harmful and the word loses its meaning. No medicinal drug is harmless, all have side-effects. The intention of the MDA is to prevent unreasonably harmful drug use. The ACMD's report The Classification of cannabis under the MDA [para. 5.1] says "the high use of cannabis is not associated with major health problems for the individual or society" but they recommend continued prohibition because "cannabis is not a harmless substance and its use unquestionably poses risks both to individual health and to society". The ACMD Chairman wrote a letter to The Times saying "the classification system for drugs does not mean that any of these substances are harmless. If they were, they would not be included in the Misuse of Drugs Act". The Chairman seems to suggest that harmless drugs exist and even that alcohol and tobacco may be harmless as these drugs are not included in the Misuse of Drugs Act. The Strategy Unit's Risk: improving government's capability to handle risk and uncertainty [para. 5.29] says "A number of Departments we spoke to said that a widespread lack of understanding about basic risk concepts sometimes made it difficult for them to conduct an informed public debate about risks. The most frequent areas of concern were low levels of awareness about probabilities leading to disproportionate levels of concern about high-impact, low-probability risks and a reluctance to accept that no activity could be entirely risk free". The ACMD seems reluctant "to accept that no activity could be entirely risk free".

The ACMD's failure to target their advice at the problem, harmful drug use, contradicts the Better Regulation Task Force's principle of Targeting in their Principles of Good Regulation. BRTF say "regulation should be focused on the problem, and minimise side effects". Failure to target regulation at the problem results in unintended consequences. Reasonably safe drug use is prohibited as well as harmful drug use. As a result many people refuse to comply with a law that prevents them from persuing a reasonably safe activity so demand remains high and supply is met by the black market instead, an unintended consequence.

Why doesn't the ACMD's advice discriminate between drug use harmful to the consumer and drug use harmful to others?

Risk guidelines discriminate between the voluntary risk of self-harm and the risk of imposing harm on others; education is the appropriate intervention to reduce the risk of self-harm while legislation is appropriate to prevent the risk of harm to others.

The Strategy Unit's Risk: improving government's capability to handle risk and uncertainty says "the risks that the public faces may be voluntarily undertaken (for example, smoking or dangerous sports), with greater or lesser degrees of awareness of the risk, or imposed by other individuals or organisations" and "governments will not normally intervene where individuals take risks voluntarily and where they alone are affected. In these circumstances, governments have a role in ensuring that individuals are aware of their responsibility and of the consequences of the risk that they are taking".

The Cabinet Office/HM Treasury risk guidance, Principles of managing risks to the public, says: "Responsibility: Government will seek to allocate responsibility for managing risks to those best placed to control them. It will consider the need to regulate where risks are imposed on others. It will aim to give individuals a choice in how to manage risks that affect them, where this does not expose others to unacceptable risk or cost".

The Health and Safety Executive's Taking account of societal concerns about risk says "judgements about risk are very powerfully influenced by whether they are seen as voluntary or imposed" and "attempts to criminalise self-risk usually have undesirable consequences". It goes on to say "the freedom to control events in one's life is itself a jealously guarded reward. Impositions that infringe this freedom - whether in the form of regulations or risks are likely to encounter opposition" and "imposed saftey can be resented as strongly as imposed risk".

Individual responsibility for health choices:

the Government's Saving lives: our healthier nation [para. 3.25] says "it is the role of the Government to provide information about risk. But in most cases it is for the individual to decide whether to take the risk. And there is also a balance between risk and personal freedom. Some people enjoy pursuing outdoor sports which others would consider too dangerous to undertake. As long as people are aware of the risk which they are taking, it is their decision whether to put themselves at risk".

The Department of Health's Wanless report Securing good health for the whole population says "Individuals must be free to make their own choices about their own lifestyles. If government or other bodies do intervene, it is essential that social welfare is improved and that personal freedoms are respected". "Influencing and, over time, changing social attitudes to health and lifestyles is likely to be much more effective in the long run than a punitive approach that does not also aim for a change in attitude. Laws and regulations not accompanied by public support incur high enforcement costs, and could jeopardise the development of a consensus for future public health measures". "It is important that any government intervention is well managed, to protect against an inappropriate infringement of liberty or unintended consequences". "Where regulation is enacted, it is important that it is both efficient and respects civil liberties". "Limits to Government intervention: Interventions to improve public health have the potential to reduce significantly personal freedoms. This is most clear when government acts explicitly to prevent or restrict individuals from behaving in certain ways, or from consuming particular goods. In general, if the freedom to be curtailed or limited is a significant one and valued highly by the individual, the state would need strong reasons to impose its will over the individual on public health grounds. Usually, there should at least be a strong consensus, preferably public but certainly professional, that the public health measure is necessary to prevent harm to others. Government can of course legitimately intervene when one’s freedom to act would infringe human rights for example, a person with a highly infectious disease may need to be quarantined without consent. In other cases, however, the mere fact of social or professional consensus may not provide sufficient justification for action". "it is important to recognise that measures should be justifiable in the public interest and to individuals as a reasonable restriction of their freedom".

The Strategy Unit's Personal responsibility and changing behaviour [para. 3.5] says "the eventual aim is to entrench a habit of personal responsibility and restraint, and a self-sustaining social norm". "For many traditions of social and political thought greater personal responsibility is a good in itself: it enables society to function with a less coercive state and judicial system; it enables public goods to be provided with a lower tax burden; the exercise of responsibility strengthens individual character and moral capacity; and greater personal responsibility – in terms of restraint and support for others – enhances the quality of life of the whole community". "All modern societies suffer the consequences of prohibitions that are only partially effective – for example, against hard drug use. Clearly laws on their own have only limited efficacy where other powerful drivers of behaviour are involved. There is a mature and growing body of knowledge in psychology offering a more sophisticated approach to behaviour and behaviour change, but that remains largely untapped by many policymakers". "interventions to curb drug use have been popularly supported despite relatively modest evidence of significant impact". "An over-arching logic: helping people help themselves: ... policy must at once empower and give choices, but at the same time policy should set the default to be in the best interests of individuals and the wider public interest. To be effective, this twin approach needs to be built around a sense of partnership between state and individual. Hence in employment, while individuals are not ultimately forced to work, the strong default pressures are that they will. In education, young people are not forced to stay on in school and acquire qualifications, but the default pressures are that this is what they do. And in health, governments do not ban unhealthy foods or smoking, but seek to refashion the behavioural pressures towards healthier choices".

The ACMD's failure to target education at the voluntary risk of self-harm and legislation only at the risk of imposing harm on others contradicts the Better Regulation Task Force's principle of Proportionality in their Principles of Good Regulation. BRTF say "Regulators should only intervene when necessary. Remedies should be appropriate to the risk posed" and "enforcers should consider an educational, rather than a punitive approach where possible".

Harm to others: consumers impose risks on the public - e.g. drug driving, passive smoking and fire risk; suppliers impose risks on consumers - advertising and sales to young people; producers impose risks on consumers - lack of quantity and quality control and lack of health warnings; and the whole drug trade imposes costs on society - the cost of drug-related services, education, treatment and legislation; Government intervention imposes costs on all - e.g. imposing a risk of social exclusion and punishment on those who harm no-one else, an economic risk to the tax payer to pay for enforcement, an economic and health risk to society by denying competition between drugs (e.g alcohol v cannabis) and denying informed choice to consumers.

Why do the ACMD recommend punishment out of proportion to risk?

The ACMD's report The Classification of cannabis under the MDA [para. 6.2] recommended reclassifying cannabis from Class B to Class C on the basis of proportionality of regulation to risk. The report says "Cannabis, however, is less harmful than other substances within Class B. The continuing juxtaposition of cannabis with these more harmful Class B drugs erroneously (and dangerously) suggests that their harmful effects are equivalent. This may lead to the belief, amongst cannabis users, that if they have had no harmful effects from cannabis then other Class B substances will be equally safe". However the report also compares cannabis to alcohol and tobacco in terms of likelihood of taking risks, risk of accident, of violence, of respiratory depression, of cancer, of harming pregnancy and of taking other drugs: in all cases cannabis is said to be safer or no more harmful. Why recommend continued prohibition of a safer alternative to alcohol and tobacco when they are aware of the dangers of disproportionate laws? The Government's Updated Drug Strategy 2002 [p.22] points out the dangers again saying "it is vital that the Government's message to young people is open, honest and credible. Drug laws must accurately reflect the relative harms of different drugs if they are to persuade young people in particular of the dangers of misusing drugs". Quite.

The ACMD's failure to provide regulatory advice proportionate to risk contradicts the Better Regulation Task Force's principle of Proportionality in their Principles of Good Regulation. BRTF say "Regulators should only intervene when necessary. Remedies should be appropriate to the risk posed" and "enforcers should consider an educational, rather than a punitive approach where possible".

If regulations were proportionate to risk we would expect to see obvious evidence that illegal drugs are very considerably more harmful then legal drugs. Drug dealers may supply a drug that warns it kills, tobacco, alongside sweets for children in 200,000 outlets around the UK, but if they sell illegal drugs they are imprisoned for years. In fact there is no evidence that even heroin is more harmful than tobacco and alcohol. It is quite possible to be a heroin addict all one's life and suffer no harmful consequences. See the World Health Organisation's comparison of drug prevalence and harm here.

In providing regulatory advice does the ACMD clearly distinguish between the roles of scientific evidence about drug risk and regulation, public opinion, Government policy and international law?

The Code of Practise for Scientific Committees says "13. Where a committee is required to offer advice on social, ethical and economic considerations which bear on the scientific advice, it should be made explicit to the committee that this role is being taken on". The ACMD's statutory duty is clearly laid out by law, the MDA, and should take account of these factors - but none are mentioned.