Beckley Foundation/Strategy Unit
Alcohol & other recreational drugs [2003]
.

 

Seminar chaired by Sir Michael Rawlins, Chairman of the Advisory Council on the Misuse of Drugs.

Preface

The aim of the series is to encourage a rational overview of the scientific, medical, social and economic issues surrounding the use of drugs, both legal and illegal.

Executive Summary

In the UK there are approximately 40,000 premature deaths a year related to alcohol consumption. This puts into perspective the approximate 1,500 lives claimed by all the illegal recreational drugs combined. The same receptor mechanisms are involved in the tolerance, withdrawal and dependence seen in both illegal drug and alcohol misusers, underlying a common addictive potential. ... whereas alcohol in overdose can kill, cannabis cannot. The health risks associated with alcohol use are both more severe and more prevalent. Public opinion is moving towards the legalisation of cannabis. Britain regulates alcohol use by standardising quality and taxing consumption, so it is difficult to understand why cannabis use cannot be controlled in a similar way. Some consistency of legislation is required in relation to the relative harmfulness of these drugs.
There currently exists an indefensible imbalance between central spending on treatment and prevention for illicit drugs (95 million a year) compared to that for alcohol (1.1 million a year). The social costs of alcohol and tobacco are far greater than those of all the illegal drugs put together. The World Health Organisation places illicit drugs seventeenth on the scale of the world’s greatest social costs whereas alcohol is fifth.
... legislation is not always based on rational criteria and a host of other factors are involved. Alcohol was not a serious candidate for overall international regulation because alcohol taxes were (and still are) a crucial component of western finance, and alcohol industry interests were (and still are) allied with political interests. Over 90% of the population will use alcohol at some point in their lives and 10% will become problem drinkers. The current legal status of a substance determines the nature of the problems associated with its use. Alcohol and tobacco are at the top, or near the top, of every index of harm, yet hold legal status and are widely accepted in British culture.

 

A Scientifically Based Scale of Harm for Social Drugs
by Colin Blakemore, Chief Executive Medical Research Council

To be rational and consistent, any methodology for assessing the potential harm from illegal substances should include, as a calibration, an estimate of the harm associated with the use of legal drugs, especially alcohol.

Social drugs: This category includes both legal and illegal drugs. Illegal drugs are often termed “hard” or “soft”. They are classified by the Misuse of Drugs Act as Class A/B/C, an inflexible system of classification that is based on a mixture of scientific evidence, familiarity with the particular drug, and the needs of the legal system.

The acceptability of social drugs varies from culture to culture around the world, so there is no sharp global distinction between legal and illegal drugs. Alcohol is legal in the UK but not in some Muslim countries.

KEY QUESTIONS FOR CLASSIFICATION

A number of questions should underpin a rigorous system of classification of drugs.

• Does the drug in question harm any individual other than the user? A libertarian argument emphasises personal freedom, as long as it does not negatively impinge on other lives.

• Is its use costly to society in other ways, for instance placing additional demands on health and social services? This is the position taken by the Runciman Report (2000).

• Is it so patently dangerous to the health or well-being of users that society is obliged to protect them from their own wishes?

• How do the risks compare to those of legal drugs such as alcohol and tobacco? To keep a sense of proportion, it is vital to compare illegal drugs with others that are accepted by society.

CRITERIA OF ASSESSMENT

Consideration of mortality reveals some interesting facts: Tobacco claims more than half of all drug-related deaths: on average, every cigarette smoked removes 7 minutes from life expectancy. Alcohol accounts for the majority of deaths not caused by smoking. Between them, tobacco and alcohol claim about 90% of all drug related deaths. There were 27 ecstasy-related deaths in 2002. Analysis has shown that most deaths were associated with simultaneous use of other illegal drugs: it is very likely that alcohol was also involved.

CONCLUSIONS

Alcohol and tobacco are likely to be at or near the top of the comparative scale of harm for every criterion listed. This must be kept in mind when framing attitudes to other drugs, which are currently illegal and consequently viewed as unacceptable by society. The following proposal was put to the North Wales Drug & Alcohol forum (a large group with representation of the police, social workers, etc) in September 2002: This conference supports a re-examination of the entire basis of drug classification. The current A/B/C system and the deceptive “hard/soft” distinction should be replaced with a "scale of harm" for all drugs. Drugs (including alcohol and tobacco, to provide familiar standards for calibration) could be placed on the scale on the basis of a continuous review of the scientific and sociological evidence by panels of experts, with representation of the police, relevant NGOs and the public. 90% were in favour of this proposal and only 6% against. The present classification of drugs makes little sense. It is antiquated and reflects the prejudices and misconceptions of an era in which drugs were placed in arbitrary categories with notable, often illogical, consequences. The continuous review of evidence, and the inclusion of legal drugs in the same review, will allow more sensible and rational classification, putting illegal drugs in context with those already accepted.