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Drug policy isn’t working, medical leaders and lawmakers agree

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3461 (Published 17 July 2017) Cite this as: BMJ 2017;358:j3461
  1. Richard Hurley
  1. The BMJ

UK policy is failing to prioritise the health of people who use drugs, medical and political leaders agreed at a dinner at the House of Commons on 11 July. Diners heard that the public’s respect for doctors, and their authority, made them ideal advocates to lead calls for reform on behalf of vulnerable drug users.

The four organisations that hosted the dinner—The BMJ, the BMA, the Royal Society for Public Health, and the Royal College of Physicians’ Faculty of Public Health—have all stated recently that criminal punishment for drug users had not prevented drug taking but instead encouraged stigma, driving vulnerable patients away from treatment.

In the week that saw the government publish its strategy for dealing with use of drugs such as cannabis, cocaine, and heroin,1 the dinner, sponsored by Ronnie Cowan, the Scottish National Party MP for Inverclyde, was convened to build a “coalition of the willing” among doctors’ representatives—or “evidence based courage,” as The BMJ’s editor in chief, Fiona Godlee, put it.

At the dinner were Norman Lamb, the Liberal Democrats’ health spokesman, whose party supports decriminalisation of all drug use and legal, regulated sale of cannabis; the Labour shadow Home Office minister Carolyn Harris, and Alan Howarth, a Labour peer who sits on the All Party Parliamentary Group for Drug Policy Reform.

Diners heard that although the public’s attitudes to drug policy reform had softened, politicians seemed uninterested in debating the issues. Shirley Cramer, chief executive of the Royal Society for Public Health, said that when the society called for decriminalisation of non-medical drug use last year, to her “delight and surprise” the public and media were generally supportive, “even the Daily Mail.”

Parveen Kumar, head of the BMA’s Board of Science, thanked Averil Mansfield, former head of the Board of Science, for her 2013 report that considered drug misuse from a medical perspective.2

John Middleton, president of the Faculty of Public Health, reminded diners that drug policy was really a question of inequality: “The poorest people suffer most impact of drug use . . . Prison is what sets people on a path that is difficult to come back from.”

Tajek Hassan, president of the Royal College of Emergency Medicine, said that drug policy had a huge impact on his college’s members.

Other dinner guests included Sue Bailey, chair of the Academy of Medical Royal Colleges; David Cohen, representing the Royal College of Physicians; and Rod Thompson, vice president of the Royal College of Nursing.

Some diners thought that mere decriminalisation of drug use was a “coward’s way out” and went further in calling for heavily regulated, legalised supply.

Few royal colleges have any position at all on drug policy, and some consider drug laws as beyond their remit. The Royal College of General Practitioners and the Royal College of Psychiatrists did not send representatives to the dinner.

Last year The BMJ called for drug use to be decriminalised and for legalised supply to be evaluated.3 The Royal Society for Public Health and the Faculty of Public Health have also called for decriminalisation of non-violent drug use; closer alignment of drug, alcohol, and tobacco strategies; and more investment in education and treatment.4

At its 2016 annual representatives meeting the BMA called for the Department of Health for England to assume responsibility for the UK’s drug policy and for legislation to prioritise treatment over punishment of drug users.5

Despite over half a century of the “war on drugs”—the prohibition of non-medical uses of drugs, enforced through criminal law—powders and pills of unknown potency and quality are widely available throughout the UK, including to children, without advice on safer drug taking or what to do about problem use.

A third of adults in England and Wales surveyed admitted having ever taken an illegal drug, government statistics show. One in 12 adults took an illegal drug in 2014-15. A quarter of 15 year olds have been offered cannabis, and a 10th have tried it. Opioid related deaths doubled between 2012 and 2015. A record 706 people died from drug taking in Scotland in 2015.

References

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