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.