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Views & Reviews No Holds Barred

Margaret McCartney: Stop playing politics with illegal drug use

BMJ 2014; 349 doi: (Published 27 November 2014) Cite this as: BMJ 2014;349:g7273
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

It’s been called a revolving door; in reality, it’s a life that never gets off the ground. Drug addiction. Imprisonment. Unemployment. Poverty. Addiction. Imprisonment again. The UK Misuse of Drugs Act 1971 makes the possession and supply of a controlled drug illegal and punishable by substantial fines and custodial sentences.1

The system feeds itself. Almost a fifth of prisoners who have ever used heroin used it first in prison, and more than half of prisoners have committed offences—usually stealing—to buy drugs.2

A government of any persuasion would surely want to reduce the harm that illicit drug use causes. The home secretary, Theresa May, has said that she is “committed to an evidence based approach,” informed by the government’s Advisory Council on the Misuse of Drugs.3 But evidence and politics do not always play nicely. Famously, in 2009 David Nutt was fired from chairing the council after challenging the classification of drugs based on harm. The then home secretary, Alan Johnson, described Nutt’s comment that ecstasy was less harmful than horse riding as “a political rather than a scientific point.”4 5

But health is indeed political, although not necessarily party political. The health of the population reaps the consequences of parliamentary decision making—often obviously, from smoking laws or benefit cuts, but also less obviously, from the inequality created by political policy.

Policies of swapping criminalisation for healthcare have reduced problematic heroin use in Switzerland6 and have reduced associated harms in Portugal.7 In March 2013 the UK government said that it had “no intention of decriminalising drugs”3; however, a report from the Home Office last month found a “lack of any clear correlation between the ‘toughness’ of an approach and levels of drug use.”8

Are we approaching a breakthrough? A debate last month in the House of Commons resulted in agreement that the current law is failing and that “an evidence based approach is required.”9 Consensus is welcome; politicians have plenty of other stuff to disagree about.

Drug dependence is a problem that needs medical care and attention—not criminal sanctions. An evidence based policy on drug misuse could reduce health inequalities where they are often at their worst. And we need a government grown up enough to put policy where the evidence is.


Cite this as: BMJ 2014;349:g7273


  • Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on Quality and Outcomes Framework points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written a book and earned from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of Medact. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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