Archive for July, 2011

Question: Is Drug Policy Evidence Based ?

Introduction:

Drug Policies are a common feature of public health programmes world wide, and the question I have chosen to discuss in my essay is “Is Drug Policy Evidence Based”.
Every nation in the world will have some kind of drug policy, designed to protect their population from the harm that can be associated by the use of drugs either illicit or licit. This world wide  movement can be traced back to the emergence of the concept of capitalism in the 16th Century , just as western nations were taking their first tentative steps at colonisation and imperial expansion.
King James 1 with his “counterblast against Tobacco” could be cited as being the first attempt in Britain at controlling a substance with a policy of taxation (Barclay et al 2000), although within the Muslim world, alcohol had been controlled for centuries due to religious ideologies.
If we look at Britain specifically, there then followed a raft of substance control legislation , from the Gin Acts 1729  and 1736 (Barclay et al 2000), through the Pharmacy Act 1868 , Defence of The Realm Act 1914,and the Dangerous Drugs Act 1920 (Barclay et al 2000 and Rasool 2009) up to the recent Misuse of Drugs Act in 1971. All designed to control how the population used substances, and introduced to prevent substance related problems.  Globally, a Prohibitive Policy Structure has been followed since the inception of the United Nations Single Convention on Narcotic Drugs in 1961 which effectively declared a “war on drugs”, encouraging all member states to adopt a prohibitive stance within their local drug policies. This stance was further compounded by the Convention on Psychotropic Substances in 1971 and an amendment to the original 1961 convention in 1972.

We then need to ask, were these policies and legislation research based, and the evidence scientifically scrutinised, or were the legislation, and the policies that followed a way of forwarding another agenda.

Prohibition Vs  Decriminalisation/Legalisation:

Various nations have their own interpetation of the UN policy, and more locally, the UK uses the Misuse of Drugs Act 1971 as it’s main stay in the attempts to prohibit the use of controlled and illicit substances, (Barclay et al 2000), in effect criminalising the use of drugs which are used and accessed outside state control in line with the original 1961 UNDOC convention which looked to “limiting such drugs to medical and scientific use” (UNODC 1961)
In order to examine the question “Is Drug Policy Evidence Based ? “ we have to examine and contrast the two opposite stances, and as no country world wide has yet legalised the use of psychoactive substances we have to look at countries like Portugal who decriminalised all drugs in 2001 and Holland who has a more liberal attitude to drug use  and compare these policies with the UK who has a more prohibitive policy in place. To compare theses policies, we have to focus on a specific area, and examine the research followed, and how this research is transferred into policy.

Drug Consumption Rooms

Policies whether liberal, or prohibitive effect the population that they are used to protect and guide. Prohibitive policies are no different.

It could be said that whilst a prohibitive drugs policy designed to reduce consumption by preventing supply by using legal and social sanctions, it can at the same time isolate and marginalise sections of the population it intends to protect and all policies can have unintended outcomes as well as the intended ones.

In 2004, an Independent Working Group was established by the Joseph Rowntree Foundation, to look into, and gather evidence for the use of Drug Consumption Rooms, and their effects on the Drug Related Deaths due to overdose. The working group investigated, and visited sites throughout Europe, Australia and Canada, and looked at the current research, and published their findings, which were passed to the UK government, who rejected the findings “ for a number of reasons including lack of evidence , legal concerns, likely media and public hostility”. (IWG 2006)
The findings that were reported to the government at the time, included evidence that the introduction of these rooms would reduce the number of deaths, increase access to services, and lead to a decrease in blood borne virus cross infection.
Which were all issues which linked in to the “increasing emphasis within the Government drug policy on reducing harm” (IWG 2006 )

This seem s to be an interesting stance, when initially at the outset of the HIV epidemic in the early eighties, the UK government was among the first to encourage the use of Harm Reduction to combat the spread of HIV/Aids, and pioneered the introduction of Needle Exchanges, which has been instrumental in preventing an epidemic of HIV in the UK, but the same governmental apparatus seems to be resistant to the next “rational and overdue extension to the harm reduction policy.” (IWG 2006)

The more liberalised policies of some countries may be seen as allowing the move towards DCR’s , but as the IWG pointed out, the issues raised by the government for not adopting this policy were dealt with within the report, and the process used to gather information to formulate the findings. (IWG 2006)

As touched on previously, the historical context for drug control has always been that of prohibition, with the emphasis slowly shifting from a “voluntary “concept of control, prior to 1862, to a more coercive framework. This has been evident from the dawn of “New Labour” , who began to change terminology, to the point where “drug policy discourse of the New Labour Government largely focused on  drugs as an engine of crime” ( Hunt & Stevens 2004), this policy shift could maybe explain why the above issues have mainly fallen on deaf ears as it were.

The moral dimension of UK Policy

In a paper by Trevor Bennet and Kate Holloway, the two authors of the paper undertook a study looking at the above question,” Is drug policy evidenced based “but principally concentrating on current british policy & strategy and they studied case studies drawn from the four main strands of the current drug strategy to evaluate whether the strategy had its roots firmly in scientifically researched information. Out of the four main strands, almost all of three out of the four, had been grounded in , and could be linked to research around the subject, although on some of the flagship policy areas, there were some disparities on the way the research was used.  In the reclassification of cannabis, the government had basically based the decision on good strong reliable evidence, where it fell down was on how it had reported the findings of the evidence. (Bennet & Holloway 2010)
It was also apparent in some of the other case studies that some of the policy decisions were made prior to the publishing of the evidence “cited in the policy”. (Bennett & Holloway 2010)

Looking at this document, and taking into account the four main streams of strategy that the authors talk about, which are 1.  Protecting Communities through enforcement, 2. Preventing Harm to children, young people and families, 3. Delivering new approaches to drug treatment, and 4. Implementing public information campaigns, only one of the objectives nearly met all of the criteria, and this was the case study looking at cannabis re classification, and interestingly the other top scoring objective was objective 3 which looked at Dedicated Drug Courts. Interestingly enough both objective case studies were related to the coercive approach, of utilising criminal justice services to enforce policy, namely the enforcement of the re-classification of cannabis by the Misuse of drugs Act 1971, and the enforced treatment of repeating offenders with drug related criminal activities. This again hinting at a more hard-line doctrine within the government and policy producing apparatus. Therefore it could be argued that the government did not base the decision not to use Drug Consumption Rooms purely on the evidence in front of them but on an ideological stance as prescribed by previous governments.

Decriminalisation:

As we have seen , the UK at present prefers to use a prohibitive policy  stance when looking to protect our population from the harms of drugs, and as discussed, the majority of countries within Europe also subscribe to a prohibitive policy of drug control, there are however two exceptions to this , namely Portugal and the Netherlands. 
Both countries have embraced decriminalisation, The Netherlands in a limited form (mainly cannabis), and Portugal, almost exclusively.

The Netherlands & Cannabis.
The Netherlands has had  a unique policy, for many years. This is mainly due to the  way that the Dutch have distinguished between “Hard Drugs” & “Soft Drugs” , and the policy relationship built upon these definitions.
In the late 1970’s, the Dutch government formed a commission to inform, and advise on drug policy, called the Baan Committee, then published a report in 1976, which suggested that the definition of hard drugs and Soft drugs should be specific, this report was used to develop amendments to the Dutch opium act of 1919. The new amendment split the drugs available into schedule 1 and schedule2 drugs, based on the level of harm to health.  Schedule 1 covering substances such as heroin and cocaine, and “Hemp products such as Hashish and marijuana or “Soft Drugs” on Schedule 2 (Bloor et al 1998). This change in legislation, also increased the ease with which enforcement agencies could track and prosecute large scale importers, and with the addition of recognising the “expediency principle”  in effect decriminalised cannabis at street level, for recreational users as prosecutors would only pursue prosecutions that were in the public interest,(Bloor et al 1998) e.g. large scale traffickers not small time recreational users.
This model throughout the world at present is now held up as a possible alternative to total prohibition.

The UK and Cannabis

Interestingly, a similar approach was taken by the UK in 2004 when the then government re-classified cannabis to a class C drug on recommendations from the ACMD which led to the substance being reduced to category C within the Misuse of Drugs Act 1971. This was after the police commissioner in Brixton, had announced that his officers would no longer be arresting people for possession for personal use in 2001, and after the then Home Secretary David Blunkett had backed the “decriminalization” of  amounts for personal use This was when it was noted that 75% of drug arrests for possession were for possession of Marijuana. (King & Mauer 2006). Blunkett also went on to comment in further discourse “ this policy will permit Britain to concentrate efforts on the drugs that cause the most harm” (King & Mauer 2006).
As with most democratic states, the person in charge usually changes, as was the case when the prime minister at the time  moved on, and the Deputy Prime Minister, Gordon Brown took over the reins of power, this led to a renewed debate around the classification of this substance in 2007 based on its perceived dangers, and links to psychosis. A committee was established in December 2007 to examine all the evidence around the areas in discussion at the time, e.g. “ The Gateway Theory, Links to poor mental health, and potency to name a few.
“The outcome of the report was that the committee found “no compelling new evidence which would require the ACMD to alter its recommendation in 2006 to keep cannabis classified as Class C.” (UKDPC 2008), however Gordon Brown did follow through with the reclassification of the drug, in a very public way, against the advice within the report, with some of the media suggesting he was taking a “moral stance” against the drug.

Conclusion:

The question “Is Drug Policy Evidence Based?” may initially seem an innocuous, and simple question, but when you look deeper, it becomes evident that there is more at play when developing a drug policy than just discussing conceptual ideas around societies needs and the resulting protection of that society from spectres and monsters in the form of society destroying illicit substances.
When you examine in a micro way two or three initially straight forward seeming policy decisions, you see that political idealology also plays a big part in policy making as does the personal attitudes of the politicians.
Within this essay I have discussed several examples of policy decisions, made with the assumption of the general public, on good scientifically presented evidence, but under scrutiny, you see that in some cases, specifically with the example of the Drug Consumption rooms, and with the declassification then the reclassification of Cannabis, you can see a certain pattern of disinformation, arising when the information goes against the overall prohibitive stance taken by the government.
The United Nations Convention of 1961 was a prohibitive statement, but built within the convention is article 38, which allows the ratifying governments to “take all practicable measures for the prevention of abuse of drugs and for the early identification, treatment, education, after-care, rehabilitation  and social reintegration of the persons involved”, underlining the crucial  role of health and social interventions.”( UNODC 1961) This policy also enshrines the concept of policies designed around scientific research to enable the signatories to have fit for purpose  policies to protect their populations, and it could be suggested that in recent years, due to the influences of historical and artificially heightened public opinion around illicit drugs, and the use of combatitive language with regards to the policy of the “war on Drugs”, that in some way, this over arching concept of a policy fit for purpose has been lost in the quagmire of political and in some cases personal moral crusades against drug use and the population that uses the substances.
This is evident in the examples of policy decision cited in this essay, firstly drug consumption rooms, and the lack of enthusiasm for the UK government to accept and push forward in the words of the reporting commission “ a rational and overdue extension to the harm reduction policy.” (IWG 2006), again this is interesting due to the ground breaking policies in HIV harm reduction piloted by the UK in the eighties and then Cannabis re-classification debate of 2004-07 and the blatant disregard for the report by the UKDPC which backed up the classification of cannabis remaining at Class C when the Prime Minister of the time upgraded the classification , not only for what would appear to be personal moral reasons, but to reinforce a policy stance inherited by him from his predecessor. These facts in conjunction with many other instances which have not been discussed here, like the use of minimal pricing on alcohol, and the large cost of enforcing interdiction for small return, all suggest policy does not follow evidence based research, therefore drug policy could be deemed not to be principally based on evidence gathered by research, unless it fits in with already preconceived policy ideas e.g.  The coercive treatment approach as previously discussed within this easy.

References

Anderson S. and Berridge V. (2000): Opium in 20th Century Britain: Pharmacist’s regulation & the people, Addiction Vol.95 (1)

Barclay et al, Royal College of Surgeons ( 2000) Drugs, Dilemmas and Choices, London Gaskell

Bennet T. and Holloway K. (2010): Is UK Drug Policy evidence based ?, International Journal on Drug Policy  Vol. 21 pp 411-417

Hunt N. And Stevens A. (2004): Whose Harm? Harm Reduction and the Shift to Coercion in UK Drug Policy, Social Policy & Society Vol 3 . (4) pp333-342

Independant Working Group (2004) : Drug Consumption Rooms , summary report of the Independant Working Group , Joseph Rowntree Foundation

King R.S and Mauer M. (2006): The war on marijuana: The transformation of the war on drugs in the 1990’s: Harm Reduction Journal Vol 3 (6)

Rassool G.H., (2009): Alcohol & Drug Misuse: A handbook for Students and Health
Professionals,  Abingdon: Routledge

Bloor M and Wood F. (1998) Addictions and Problem Drug Use: Issues in Behaviour, Policy and Practice,  London, Jessica Kingsley Publishers.

United Nations Office on Drugs and Crime (UNODC) (1961): Single Convention on Narcotic Drugs 1961(amended in 1972), United Nations New York

Bibliography

Buchanan J and Young L ( 2000): The War on Drugs-A war on drug users?. Drugs :education, prevention & policy Vol.7 No4

Des Jarlais D.C (1995) :Editorial: Harm Reduction-A Framework for Incorporating Science into Drug Policy, American Journal of Public Health Vol 85. No 1