Intended for healthcare professionals

Editorials

Brexit is bad for our health

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2235 (Published 23 May 2018) Cite this as: BMJ 2018;361:k2235

The vital role the European Monitoring Centre for Drugs and Drug Addiction plays in the UK’s ability to respond to illicit drugs and organised crime

The vital role the European Monitoring Centre for Drugs and Drug Addiction plays in the UK’s ability to respond to illicit drugs and organised crime

Andres Roman-Urrestarazu1, Roy Robertson2, Justin Yang1, Alison McCallum2,3,4, Christina Gray4,5, Martin McKee6, John Middleton7

1. Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
2. Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
3. Public Health and Health Policy, NHS Lothian
4. Faculty of Public Health Special Interest Group for Mental Health
5. Faculty of Health and Applied Social Sciences, University of the West of England, UK
6. London School of Hygiene and Tropical Medicine, London, UK
7. President UK Faculty of Public Health, London

Corresponding author:
Dr Andres Roman-Urrestarazu
Institute of Public Health - IPH
University of Cambridge
Cambridge
Email: aer56@medschl.cam.ac.uk

None of the authors report any competing interest.

Much attention has been devoted to the consequences of the European Medicines Agency’s (EMA) departure from London because of Brexit.1 Yet exclusion from other EU agencies, including the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), will also have serious consequences for public health in the UK.

Founded in 1993 in Lisbon2, the EMCDDA derives its mandate from Regulation (EC) No 1920/20063 which involves: surveillance, establishing best practice, facilitating exchange of knowledge and data, providing leadership on new psychoactive substances (NPS) and assisting with policymaking at national and EU levels. By adopting certain “red lines”, including oversight by the Court of Justice of the European Union (CJEU), the UK will exclude itself from full membership. 2 3

The EMCDDA provided the EU and its Member States with accurate and timely intelligence and evidence-based overviews of the European drug landscape that support Europe-wide drug policies,4 as well as facilitating exchange of best practice and identifying priorities for research. UK-EMCDDA collaboration has been transformative, making a major contribution to national drug policy and the fight against organised crime. Exclusion from its operations poses a severe threat to both.

One priority will be to find a way to continue intelligence-sharing between the UK Focal Point on Drugs, a part of Public Health England (PHE) 5, and the EMCDDA, through the Réseau Européen d ́Information sur les Drogues et les Toxicomanies (Reitox) and other European agencies.6 The intelligence assembled by EMCDDA and Europol has been crucial in the UK’s response to organised crime and illicit trade in drugs.7 The UK will also need to find some way to continue to interact with the European Union Early Warning System (EU EWS)4 on novel psychoactive substances (NPSs), an area that is changing rapidly,8 so up to date knowledge is vital for the UK’s current drug strategy. The UK also risks exclusion from the EU Drugs Action Plan, an initiative which will strengthen surveillance in three domains: drug markets, drug-related crime and drug supply reduction.9 Finally, the UK will suffer from any barriers to communicating with the EMCDDA and Europol on strategic analysis of drug markets2, which are founded on the EMCDDA’s datasets and Europol’s intelligence on organised crime.10

Until the UK government can decide on a workable basis for its long term relationship with the EU, it is not possible to know how any future arrangements with the EMCDDA might work. There are some hints that it will accept CJEU oversight, at least in security, although this may not be acceptable to some of its MPs. If it is, it is essential that it includes the EMCDDA. Beyond that, there are concerns about the many multinational networks operating in this area in which the UK participates as a EU member State.

The EMCDDA has played an important, if understated role in supporting drug and health policy in EU member states, including the UK. Its contributions have included development of a strategic, situational, and holistic understanding of the complex and fast-moving European drug situation, identification of new threats to public health and security, and the establishment of best practice for effective interventions and informed policymaking. The challenges associated with Brexit arrive precisely when the UK relies most heavily upon the EMCDDA to address the rapidly evolving trade in illicit substances, especially involving organised crime, the consequences of which are seen on the streets and in emergency departments every week.
This Government has expressed its intention to ensure that the health and security of UK citizens shall not be negatively affected by Brexit but has failed to provide any information on continued collaboration with the EMCDDA. This presents substantial risks to public health and safety. However, a solution will not be simple, demanding urgent attention to address the legal and political barriers to ensuring continued cooperation with the EMCDDA. We call upon the Government to show leadership in taking all necessary action to ensuring continued collaboration with the EMCDDA, thereby enabling health professionals to keep ahead of the curve in a rapidly changing situation, allowing them to continue participating in surveillance systems, respond appropriately to emerging threats, and support policy and operational responses. Ministers have committed to ensuring that Brexit should not be allowed to undermine public health. This is an opportunity to show that commitment.

References

1. Gulland A. How "Brexit" might affect the pharmaceutical industry. BMJ (Clinical research ed) 2016;353:i2615. doi: 10.1136/bmj.i2615 [published Online First: 2016/05/12]
2. EMCDDA. EMCDDA, your reference point on drugs in Europe 2018 [Available from: http://www.emcdda.europa.eu/about accessed 20th April 2018.
3. European Union. Regulation (EC) No 1920/2006 of the European Parliament and of the Council of 12 December 2006 on the European Monitoring Centre for Drugs and Drug Addiction (recast). OJ L 376, 27122006, p 1–13 2006
4. EMCDDA. EMCDDA Partners 2018 [Available from: http://www.emcdda.europa.eu/about/partners accessed 20th April 2018.
5. Public Health England. United Kingdom Drug Situation: Focal Point Annual Report, 2017.
6. Public Health England. United Kingdom Drug Situation: Focal Point Annual Report. London: PHE 2017.
7. Council of the European Union. Council Decision 2005/387/JHA of 10 May 2005 on the information exchange, risk-assessment and control of new psychoactive substances. OJ L 127, 2052005 2005:32–37
8. Mounteney J, Griffiths P, Sedefov R, et al. The drug situation in Europe: an overview of data available on illicit drugs and new psychoactive substances from European monitoring in 2015. Addiction 2015;111(1):34-48. doi: 10.1111/add.13056
9. European Union. EU Action Plan on Drugs 2017-2020. OJ C 215, 572017 2017:21–58
10. Watson R. Cannabis, heroin, and cocaine dominate Europe’s €24bn illegal drugs market. BMJ (Clinical research ed) 2016;353

Competing interests: No competing interests

11 September 2018
Andres Roman-Urrestarazu
Gillings Fellow in Global Public Health
Roy Robertson, Justin Yang, Alison McCallum, Christina Gray, Martin McKee, John Middleton
Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way Cambridge CB20SR, United Kingdom