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Drug Classification System

My Lords, I want to add my thanks to the noble Lord, Lord Cobbold, for raising the debate, not least because I agree with every word he said, and every word the noble Lord, Lord Desai, said, and with that tour de force by the noble Lord, Lord Mancroft. I am a psychiatrist, and your Lordships will expect that I will address some of the issues to do with mental health and cannabis. It is worth repeating some of the recent evidence, if only because I totally accept that it is less than clear and we need to carry out better research. The evidence emerging over the past 20 years will become much clearer. I am reminded of the evidence on the harmful effects of smoking, and how that emerged from the first early warning signs. I will speak a little about my experience on the drug issue. I am slightly concerned, particularly after the balanced report that I would have expected from the advisory committee on the misuse of drugs, that the evidence has been prayed in aid to both causes. It is typically well-written and well-researched and advice comes from a cautious scientific committee, but nevertheless they are looking at current evidence that could be said to be methodologically sound. That means that it is a cautious interpretation. However, as the noble Lord, Lord Mancroft, said, and we probably all agree, we want to minimise the overall harm that drugs can do to individuals, their families and society. I suggest that cannabis should not be reclassified as a class B drug; all the evidence points to further decriminalisation and probably also for many other drugs rather than a return to a punitive approach. I should say straightaway that I part company with my fellow members of the Royal College of Psychiatrists on the issue. We are one on the evidence of harm but differ in our approach to policy. What is the current research evidence linking cannabis use and mental illness? There are many community psychiatrists like myself who have witnessed a major increase in admissions of young people for transient and episodic scizophreniform psychoses, particularly in the inner city. That has not affected the national statistics, but if we look at inner city London and the admissions for schizophrenia and schizophrenia-like illnesses among young populations in inner urban areas, we will find that there has been an increase in drugs in those diagnoses and there has certainly been a dramatic increase in so-called dual diagnosis with psychotic illnesses of people taking both cannabis and also some other drugs. Of course, many of us had an increasing suspicion for many years that cannabis was the chief culprit for some of this. However, because so many people take a mixture of drugs, we never know when we are doing clinical work—we have no evidence; all we see is the people before us and we receive an overwhelming clinical impression of the effect. Certainly the interpretation of studies has always been difficult, but prospective studies from populations in Sweden, the Netherlands and New Zealand suggest that the lifetime risk of schizophrenia or schizophrenia-like psychotic illnesses is between two and four times as great over and above what it would be normally for both light and heavy users. We might say that that is still low, as the lifetime risk of incidence of schizophrenia and schizophrenic illnesses is between 0.8 and 1 per cent of the population. It is therefore extremely small. Nevertheless, an increase has a profound socio-economic and human effect on the family of those individuals who suffer from it. We should take it a little more seriously in terms of the general harm. I am not talking just about awakening a genetic predisposition. The effect is probably not simply a bringing forward of psychoses in predisposed individuals, although that clearly occurs too. The studies are not methodological and watertight. We need much better designed prospective studies and we must not downplay the current state of evidence, because we will see over the next few years a rise in some anxiety about its overall impact. However, it seems to me that pro-drug websites for regular users seem to be minimizing the risk and the serious educational challenge that exists. The risk seems to be dose-related—the higher the dose, the longer the period of exposure and the worse the effect—but that needs confirmation. These episodes of illness are clinically very difficult to treat because of the continuing use of the drug and the interference with antipsychotic medications. They tend to be highly relapsing conditions and—this is a personal view; we do not have any studies to demonstrate it—the lifetime outcome seems to be poor. We need to know a great deal more and have much longer studies of the outcomes. Of course, there are many rather more obvious and well-accepted side effects to heavy use of cannabis, notably the impact on driving and accidents generally; the adverse effects on a pregnant woman’s foetus; and so on. Again, those risks are linked to heavy consumption and therefore the evidence of serious harm to a proportion of drugs users exists. Despite that, I see no sense in turning back the clock. About a quarter of young people use cannabis regularly. As the noble Lord, Lord Mancroft, said, the figures are rather stable at present. It is hard to know whether they are going slightly up or slightly down, but they have not been changed since reclassification. I remind your Lordships that it was reclassified because in reality, especially in inner city areas, the police did not enforce the class B regime anyway. They were already implementing a class C approach. In inner east London we have known for years that the police would not prosecute for modest possession and were entirely uninterested in the endemic drug culture of our hospital mental health wards. Turning the clock back would have no impact at all. The horse has already bolted, young people smoke cannabis, and that is that. I do not see any evidence that the heavy approach ever worked. The empty rhetoric about getting tough and cracking down merely uses up a lot of police and court time, fills the pockets of criminals supplying illegal drugs and turns occasional drug users and misusers into criminals too. I would much rather we brought cannabis and indeed all potent psychotropic drugs under the same controls and fiscal opportunities as alcohol and tobacco, both of which are far more dangerous to more people than cannabis. We need a greater balance of government expenditure to go on realistic public education, especially in primary and secondary schools, about the realities of drugs and the real risks for some people. I believe that young people will respond well to accurate and balanced information, but they are rightly sceptical of inaccurate drug scares. They need to keep their eyes on the website to learn about the realities. We need far greater short-term and longer-term rehabilitation services for those already damaged by the drug, which would be a far better way to reduce the harm and allow parents and teachers to take a more realistic approach to this widespread habit. The recent debate about reclassification has helped raise awareness of the dangers of cannabis, but this needs to be reinforced by a major public health campaign. How much effective youth education can really be delivered by the £700 million or so that I was told we are spending on implementing an ineffective criminalisation policy on drugs?