Intended for healthcare professionals


Royal commission should be set up to look at UK drug policy, MPs say

BMJ 2012; 345 doi: (Published 10 December 2012) Cite this as: BMJ 2012;345:e8403

Re: Royal commission should be set up to look at UK drug policy, MPs say

Home Affairs Committee proposals for revolution in drugs policy – where next?

This year has been a good year for reports on drug problems and drug policy, if quantity is the measure of success. Culminating in the Home Affairs Committee report published this week there have been several useful additions to the vexed debate about the future of drugs policy in the UK and elsewhere (1). The Global Commission on the War on Drugs gave us a glimpse of the frustrations for those with a truly international perspective and, my own favourite, the UK Drug Policy Commission some sharp reminders of the counterintuitive nature of our own drugs policy and the inadequate investment in research, as well as the failure to pay attention to research results already available. The Home Affairs Committee report was wide-ranging in the evidence taken and issues considered but the headline chosen by the press and generating the immediate response from Number 10 was about legalising drugs of misuse to undermine the damage done by illegal trade and the proposal of establishing a Royal commission (2). Governments here and elsewhere must long for a solution that is politically acceptable and a pathway to follow to recognise the strength of some of these arguments as well as a policy that is guaranteed to be of benefit to those with a vested interest, the drug dependent patient, the families involved, the health and criminal justice systems and, well, all of us. It is, however, hardly surprising that politicians, at least when they are in power, recognise the hazards both domestically but possibly equally dangerous in the international arena from opening up serious avenues to decriminalisation.

Our own efforts to make a minor change in reducing penalties for cannabis possession were an extremely disappointing failure. The Advisory Council on the Misuse of drugs made a bold, but hardly reckless, move and a first step in reducing tariffs and acknowledging inappropriate coercive action on cannabis users (3, 4). The reaction was fascinating. The medical profession responded by protesting that medical consequences would be great although the ACMD fully recognised the medical issues and recommended a serious expansion of involvement in treating those affected. The political fallout was also interesting. Hiding behind the medical warnings and ignoring the reason for the change in the first place, which was all about the criminal justice tangle, the politicians chose to reverse the change. This, it should be said, was also allegedly heavily influenced behind the scenes by the international forces, particularly USA and Sweden and the INCB that ultimately control drugs legislations.

The bigger debate concerning decriminalisation seems to be a non starter.

Of great importance in this debate is the position of the medical profession. Serial committees regard the lead organisation, the Home Office, as inappropriate and almost all observers suggest that Health should take a bigger part and many say the Department of Health should be in the lead. All say there should be more research into treatments and other health interventions. When looked at it is extraordinary that NICE has to look for trials in the USA, Australia, Norway and Iran in order to make recommendations about methadone treatment as there are none carried out in the UK.

The medical profession and in particular the NHS and the BMA should take some ownership of these problems. The BMA has challenged international policy before leading to our rather unique position on the medical use of diamorphine which is completely unavailable in most countries and our approach to drug treatment has been individual in the past. The profession seems to have opted out in recent years despite a changing landscape of increasing medical complications from drug use in an aging drug using population. The main issue has always been addiction problems and the main lead branch has been psychiatry. The time may have come for a serious reappraisal. Health should be leading from the top and addictions physicians supporting psychiatry at secondary and primary care levels. All should be involved with research.

The new drugs policy debate would then be lead by medical information on the hepatitis C epidemic, the pathological consequences of injecting drug use and the collateral damage to families and communities. My guess is that there is the basis of a new policy report with some real evidence behind it and some clear direction for policy makers to follow.

1. Home Affairs Report. House of Commons. London
2. Royal Commission should be set up to look at UK drugs policy, MPs say. BMJ2012;345:e8403
3. Advisory Council on the Misuse of Drugs. The classification of cannabis under the Misuse of Drugs Act 1971 2002 Home Office London
4. Advisory Council on the Misuse of Drugs. Further consideration of the classification of cannabis under the Misuse of Drugs Act 1971 2006 Home Office London

Roy Robertson FRCP FRCGP
Department of Public Health Sciences,
Edinburgh University,

Competing interests: No competing interests

16 December 2012
Roy Robertson
Edinburgh University
1 Muirhouse Avenue, EH4 4PL