After the sacking of its chairman, Prof David Nutt, it seems likely that many of the remaining members of the Advisory Committee on the Misuse of Drugs (ACMD) will resign in sympathy and that nobody of any standing will serve on it unless the government repents. This it is unlikely to do for reasons that, I believe, have more to do with Britain’s relationship with the USA than with more strictly national considerations, never mind pharmacological or scientific ones.
Prof Nutt is one of our most distinguished neuroscientists, and the views for which he was dismissed are founded on good evidence. They are also neither new nor particularly radical and he has been expounding them for several years. I know him professionally rather than socially (we both had walk-on parts in a bit of research led by one of his colleagues [1]) and in 2001, I bumped into him in the House of Commons, where both of us had been invited to give evidence to a Home Office Select Committee[2] that was reviewing the law relating to ‘drug abuse’. (One member was a young and recently elected Conservative MP called David Cameron.) The reason that I insist on the quotation marks is that our main drug of abuse – by a very long way – happens to be alcohol, but it’s the one drug that consistently gets sidelined or entirely ignored in most discussions about ‘drug abuse’, a point that Prof Nutt has also made. It’s also the drug most popular with, and most likely to be visibly abused by, the politicians in both chambers who make our laws. A few years earlier, a couple of MPs actually complained to the Speaker of the House of Commons because I had suggested, in a newspaper article, that some Honourable Members were too drunk, at times, to legislate properly. That was before the late Alan Clark’s now celebrated admission that after a bottle or three of decent claret, he had once been too intoxicated even to read his ministerial brief properly. It might even be helpful if we could stop talking about ‘drugs’ and use the word ‘intoxicants’ instead. It is much more helpful for telling us what these substances do, why many people take them and why they can cause problems.[3]
Prof Nutt argued even then that the dangers of illicit drugs have often been overstated and sensationalised. He did not say (though he may possibly believe) that Prohibition is ineffective and worse than useless but I said exactly that, among other things of a more technical nature. I also pointed out that in Victorian Britain, many people used and abused opium and cocaine and yet despite their legality and ready availability, the British Empire did not grind to a halt. Rather to my surprise, the committee summarised this opinion in their final report and did so in what seemed to me a rather balanced and sensible way. They said that they did not agree with my views but that if the situation didn’t change within a few years, they deserved to be looked at again. As everyone – including the government – knows, the situation has not changed significantly. Since the 1960s, sizeable numbers of adolescents in most western countries have tried one or more illicit drugs and still do. A much smaller but far from negligible proportion of those adolescents go on to use them repeatedly in ways that cause problems for them and for society. Many more, it needs to be said, use alcohol in damaging ways. Happily, many – perhaps most – of them grow out of it, usually without any professional or other help. It is interesting and surely relevant that the drug whose use has declined most in Britain since the 1960s is tobacco, despite the fact that it remains legal and the lack of much in the way of anti-smoking campaigns until relatively recently.
With all intoxicants, taking large doses repeatedly, using them in concentrated form, or injecting them, can increase the likelihood of problems. The invention of distilling around 900AD (ironically, by Islamic scientists) led to the production of brandy, whisky and other eaux de vie, which were much stronger and more toxic than beer or wine. Similarly, pure morphine and heroin can cause more problems than crude opium or its liquid version, laudanum, though they are still far less damaging to the body than alcohol. Pure heroin, even when regularly injected, does not damage the liver or other vital organs, though injecting can damage veins and adjacent tissues. And of course, the excessive use of any intoxicant (other than coffee and tobacco, which are in a different league when it comes to effects on behaviour) can damage your reputation. All these relatively new effects of the over-use of intoxicants are essentially the consequences of technical progress, like car accidents compared with horse-drawn transport. We should remember that the amphetamine-like drug cocaine – the active ingredient of coca leaves – has been used for thousands of years by the precursors and descendents of the super-efficient Incas with relatively little obvious harm and some apparent benefit.
Prohibition of alcohol was an obvious failure in the USA. Any modest and transient falls in alcohol-related conditions were soon reversed or greatly outweighed by the growth of organised crime, of political and judicial corruption, and of widespread and often lethal poisoning from the adulteration of illicit alcoholic drinks. And all this even though an individual ‘drug dealer’ could hardly carry more than a bottle or two of spirits at a time. To prohibit the trade in illicit intoxicants that are so much more potent, gram for gram, than alcohol is even more difficult. The amount of crude opium (containing 10-20% morphine) obtainable from even two or three heads of the opium poppy would probably supply the needs of an average opium addict for a day or two. Does anyone think that the opium fields of Afghanistan are going to be defoliated any time soon?
Apart from the diminishing number of lawmakers and public figures who still support it, Prohibition has spawned whole industries and organisations for whom decriminalisation represents a major threat to their influence or existence. They include large chunks of the prison system, the police, and the vast drug-testing outfits that have sprung up in some countries. The whole methadone maintenance system would become almost entirely superfluous if opiate addicts were able to maintain themselves – and thus avoid incapacitating withdrawal symptoms – by buying opium (or its longer-acting pharmacological analogues, such as methadone or buprenorphine) at a pharmacy or some other dedicated supplier, as they were able to in Victorian times and as alcohol addicts still do.
Prohibition has also created a highly productive hypocrisy industry, of which the suspension of the former England team captain Ian Botham from first-class cricket for his admission, a decade or two ago, that he had smoked cannabis, was only one of many splendid examples. Several people pointed out at the time that he was suspended by a board that included at least two members who had been convicted of drunken driving – a type of behaviour considerably more dangerous to the health of the nation than the smoking of marijuana. While this lunatic dichotomy continues to dominate official thinking, it is useless to expect any improvement. Any country that honours and enriches the pushers and manufacturers of alcohol and tobacco while giving heavy prison sentences to the manufacturers and pushers (and consumers) of other intoxicants, surely deserves all the problems it gets.
Unsurprisingly for a long-established super-power, what America wants, America quite often gets, and even when what America gets is proving a disaster, it doesn’t give up easily. Consequently, those of us who question Prohibition in the 21st century, like those who questioned the existence of God in the 17th century, know what we are up against and do not expect rapid changes in public and institutional behaviour. The USA (as well as the force of legislative habit) is one of the main obstacles to sensible discussion. Another is the fact that Prohibition is mandated by various international treaties that are much more difficult to dismantle than the legislation enacted by individual countries. Nevertheless, an increasing number of solid, serious public figures and officials are now saying things that are much more challenging, in this respect, than anything that Prof. Nutt has so far said in public. They include senior judges and policemen, neither group famous for their bleeding hearts or radical politics. I believe that those of us who wish to see Prohibition put into the dustbin of history have a duty to spell out our practical proposals for a post-Prohibition era and many of us have done so. (The main British organisation in this field is ‘Transform’ and their website is a valuable source of information.) We should not, however, be too inhibited by the claim that repeal would be an experiment and that it might go terribly wrong. Prohibition itself was a massive experiment (even if it was described at the time as a ‘noble’ one) and almost every one of the predictions made by its promoters has been disproved. In contrast, many of the predictions voiced by its opponents have been confirmed by history.
I have spelled out my own slightly heterodox proposals in some detail[3] but the first point to make is that ending Prohibition does not mean ending controls. On the contrary, it means, at the very least, that control could pass from the gangsters, drug-barons and other ‘hard men’ to the community and its representatives. The legal regulation of production and supply and controlled availability at prices that do not make acquisitive crime almost inevitable should return us to something like the situation that existed in the late 19th and early 20th century. It would probably not have any immediate effect on the numbers of people using and abusing the various illicit intoxicants but it would remove a very important incentive for such people to steal or worse to pay for them. Appropriately taxed, the sale of these decriminalised intoxicants would, as with alcohol and tobacco, add significantly to government revenues. The realisation in the US, in the early years of the post-1929 depression, that Prohibition was depriving the government of very large amounts of tax revenue, and that its more prosperous citizens were paying much higher income taxes in consequence, was a powerful reason for its repeal a few years later. The reduction in prosecutions and incarceration would also save significant amounts of singularly unproductive expenditure. There is even an argument for taking the manufacture of these intoxicants out of the normal capitalist framework and entrusting it, at least partly, to a nationalised industry. This has happened with alcohol in some countries, including Britain, which set up a government brewery to supply the comparatively well-paid munitions workers of Carlisle during the First World War. (It survived until the 1970s.)
In some ways, the excessive use of intoxicants by a smallish minority of people is not so much a drug problem as a youth problem. Most of the hard-core group of problem users started using powerful intoxicants when they were still of school age, were legally obliged to attend school and, most importantly, were not regarded as meriting full adult rights and freedoms. That is why I differ from many of the people who, like me, argue for decriminalisation but who also argue against the idea of increased or random drug testing. It seems to me that by not testing school pupils up to the age of 16 (or whenever education stops becoming compulsory) we ignore a very valuable opportunity to influence the age at which intoxicant use starts. At the very minimum, a few controlled studies seem indicated but my eminently testable hypothesis is that if 15 or 16 year olds knew that their choice and use of intoxicants of all kinds would be measured and made known both to the school and to their parents as routinely as their height, weight, eyesight and school grades usually are (or used to be) it might – might – deter many of them from starting to use them until they could do so without making the fact semi-public. Especially if there were some sanctions against persistent non-compliers, such as having to attend somewhere for work, instruction or merely for detention on Saturday and/or Sunday afternoons.
Testing – both random and focused on pupils who appeared to be intoxicated – might greatly improve the attendance and performance of many pupils who at present come to school in an acutely or chronically intoxicated state and thus leave school considerably less literate, numerate and socialised than they might be. They are thus immediately at a strong disadvantage in the market for satisfying jobs, not to mention satisfying relationships or further education, when they leave school. To maximise this benefit, of course, we need to take very seriously the massive problem of truancy, but truancy is even easier to detect than the use of intoxicants, and the resources freed up from ending the generalised war on drugs could profitably be redeployed in a much smaller, simpler, more focused and probably more winnable war against under-age drug use – of all kinds – and the truancy that is often associated with it, both as cause and effect. Too many of the relatively small but disproportionately troublesome core group were already heavy users at an age when they could have been identified and, in at least some cases, possibly diverted from lives that too often turn out to be truly nasty, brutish and short.
And if, as we are regularly told by Prohibitionists, the War on Drugs is against such a serious threat to civilisation that it requires and justifies the major erosion of some basic civil rights, then let us at least try focusing this erosion on a part of the populace – children up to the age of 16 or so – who are universally agreed not to merit the same range of civil rights that adults take for granted in Western societies. In this respect, incidentally, scientific and technical progress has made life easier for the monitors and more difficult – but also more dignified – for those who would rather not be monitored. For urine tests, the collection of the specimen needs to be directly observed if cheating is to be prevented and discouraged. This is undignified at best and raises obvious additional problems when the private parts of young, sexually aware and sometimes very manipulative pupils have to be observed by adults. Fortunately, while urine testing still has an important role, testing of saliva, breath, sweat, hair and blood from a tiny finger-prick are alternatives that not only minimise indignity but also increase the range of potential intoxicants that can be detected.
Naturally, these testing programmes should cover alcohol and nicotine, for if we do not take cigarette smoking seriously, we are in effect saying that we do not much mind if a pupil of 10 or 13 gets addicted to a habit that is more likely than any other choice of intoxicant to damage his health and shorten his life. Hair testing, in particular, has a unique ability to detect intoxicants that have been used not just in the last few days but in the last few weeks or months, even if only occasionally. When people know that they are very likely to be detected and held to account for actions that are widely deemed unacceptable, the incidence of the actions in question usually falls, often sharply. It should be much easier to deter and reduce the incidence of under-age intoxicant use than of under-age sex. But, as I say, that is a testable hypothesis and as we approach the centenary of Prohibition, it should take very much less than a hundred years to complete this particular experiment.
Meanwhile, just as good secularists should not accept lessons on the sanctity of life from the leaders of religions with a bloodstained history, so British governments should quietly but firmly distance themselves from an America that apparently sees no inconsistency between waging a brutal war on ‘drugs’ and trying to compensate for falling tobacco and cigarette sales at home by promoting tobacco addiction in third-world countries. The USA has a long history of bullying and blackmailing countries that challenge the principle of Prohibition, or even propose small modifications that the USA doesn’t like, such as providing injecting rooms or heroin maintenance for refractory addicts. Britain’s ‘special relationship’ with the US (so special that, as they say, most Americans don’t know about it) may be an important reason for the Home Secretary’s defenestration of Prof Nutt but must we really, in this instance, always keep a hold of nurse for fear of finding something worse? Surely it is time to look at some of those Victorian Values again.
REFERENCES
[1] Daglish MRC, Weinstein A, Malizia AL, Wilson S, Melichar JK, Britten S, Brewer C, Lingford-Hughes A, Myles JS & Nutt DJ. Regional cerebral blood flow changes elicited by craving memories in abstinent opiate dependent individuals. American Journal of Psychiatry 2001;158:1680-6
[2] Report of the Select Committee on the Home Office, Cmd. 295. 2002.
[3] Brewer C. Social and economic benefits of ending the ‘War On Drugs’. In: (Ed; M Motlagh) Health Capital and Sustainable Socioeconomic Development. Taylor & Francis. 2008.
