Sunday, 14 November 2010

Drug Policy Harm Part Four: The legal harms

Please note this paper was drafted April 2009 and has not been updated

Continued from ... Drug Policy Harm Part Three: The Failure to Regulate

Alcohol – A failure of regulation

Having highlighted the scale of the failure of prohibition and the ensuing violence in the case of illegal drugs my argument has been implicitly suggesting that these are problems that could be solved by abandoning the policy of prohibition. Using the example of existing policies applied to alcohol it is possible to highlight that whilst legalisation offers the opportunity of minimising harm, this potential can only be fully realised if the substances are subjected to a regime of control and regulation, driven by public health considerations which resist the pressure of commercial interests. As prohibition in America demonstrated alcohol would cause considerably more harm and generate a massive amount of violence if it was illegal. (Behr 1996) However it still causes considerable harm and generates levels of violence that could be significantly reduced by effective public health led regulation.

New Labour’s policy on alcohol has, since 1997, been driven by the demands of the alcohol industry and is characterised by progressive deregulation and a taxation policy that has led to alcohol becoming progressively more affordable. (Rayner 2006:179-181) The link between availability of alcohol, its consumption and alcohol related harms is clearly established. (Rush et al 1986) Availability can be controlled both by price and restrictions on where and when it can be sold. The 2003 Licensing Act was the culmination of the process of deregulation begun decades earlier. Public health considerations were effectively marginalised; when the 2003 Act was implemented in 2005, alcohol deaths in England and Wales had risen by 20% in the preceding five years. (ONS 2005) It was in line with the New Labour’s government’s commitment to the alcohol industry, summed up by its Better Regulation Task Force’s call for action to remove ‘unnecessary burdens from this important industry and allow it to grow in the modern world’. (Cabinet Office 1998) In an editorial in the Emergency Medical Journal the legislation was described as ‘an act of stupidity’ which, despite being unlikely to have an immediate impact, would contribute to the ‘continuing progression of an already depressing situation.’ (Goodacre 2005:682) But as we saw above when discussing ecstasy, alcohol kills on a scale that dwarfs the fatalities of all illicit drugs. Figure 8 below demonstrates how over the past two decades alcohol deaths have virtually doubled.

Figure 8 - Alcohol-related death rates by sex, United Kingdom, 1991-2007
(Source:  National Statistics 2009)
Despite an overwhelming body of scientific evidence showing links between availability, price, harm and death, the Government’s Alcohol Harm Reduction Strategy claims ‘our analysis showed that the drivers of consumption are much more complex than merely price and availability’. (Cabinet Office 2004:18) Figure 9 charts alcohol prices and levels of consumption. Price is showing a steady decline, consumption a steady increase and in Figure 8 we saw the upward trend of alcohol related deaths.

Figure 9 (Source: The Academy of Medical Sciences 2004:18)
  Andy Burnham, the relevant minister, in a statement last year claimed a review of the 2003 Act’s impact revealed a ‘mixed picture’, highlighting its successes as being ‘a considerable reduction in red tape – estimated at £99m per annum’ and that ‘millions of people have been able to able to enjoy … socialising in restaurants, bars and caf├ęs beyond 11pm.’ (Burnham 2008) His main conclusions were

that people are using the freedoms but people are not sufficiently using the considerable powers granted by the Act to tackle problems, and that there is a need to rebalance action towards enforcement and crack down on irresponsible behaviour. (Ibid)
In support of the Minister’s statement was a body of criminological research. (Hough et al 2008, Newton et al 2008) Hough et al (2008) conclude that there are not ‘any clear signs yet that the abolition of a standard closing time has significantly reduced problems of crime and disorder.’ (Hough et al 2008:1 Emphasis added) This report is unfortunately typical of much Home Office funded criminological research. For example it refers only in passing to the Alcohol Misuse Enforcement Campaign, a Home Office funded operation carried out by 43 police forces following the implementation of this legislation, implying it was an ‘existing … initiative’ and fails to consider the possibility that it potential caused a short term distortion to levels of alcohol related crime. (Norris & Williams 2008:264, Hough et al 2008:4) In looking at information from attendances at Accident and Emergency Departments Hough et al (2008) highlight the research of Sivarajasingam et al (2007) which reported on serious violence recorded by a sample of A&E departments. None of its data is specifically about alcohol and although it makes a number of assertions about the 2003 Act, there is no evidence base to sustain these. Research carried out in hospitals showing significant increases in alcohol related A&E attendances and by ambulance services is also mentioned although its evidence is not adequately explored. (Newton et al 2007) The London ambulance service figures at the time Hough et al (2008:9) completed their report showed during the first ten months following implementation of the Act, alcohol related call outs had increased by 2%. A year later they had increased by 12% and the most recent figures show a 28% increase. (London Ambulance Service 2009) The evidence, particularly from medical sources, suggests that the impact of the Act has been consistent with overall alcohol policy, and is contributing to increased harm and violence.

Regulating the legal harms
Earlier this year Liam Donaldson, the Government’s Chief Medical Advisor recommended a minimum price for a unit of alcohol. His advice was clear

Quite simply, England is drinking far too much. England has an alcohol problem. Alcohol is not simply a problem for the minority who are dependent on it - it is a problem for everybody … There is a clear relationship between price and consumption of alcohol … Price increases generally reduce heavy drinkers' consumption by a greater proportion than they reduce moderate drinkers' consumption. (Donaldson 2002:22)

Figure 10 (Source Donaldson 2009:21)
 Figure 10 illustrates this. The benefits of this policy would be considerable; the Chief Medical Officer argues that a 50p minimum unit price would reduce crimes by 46,000 a year and reduce hospital admissions by 100,000 a year. (Donaldson 2009:22) However the minimum price has been rejected by Prime Minister Gordon Brown because

It is right for society to bear down on, and deal with, anti-social behaviour that is associated with drinking ... (but) it is also right that we do not want the responsible, sensible majority of moderate drinkers to have to pay more, or suffer, as a result of the excesses of a small minority. (Cited in Independent 2009)
Yet again the problem is presented as being about individuals and the evidence of government policy generating harm and violence is ignored. Alcohol policy is more sensitive to the producers, distributors and retailers of the drug than it is to both the Government’s Chief Medical Officer and the substantial body of scientific research supporting his arguments.

Continued ... Drug Policy Harm Part Five: Conclusion (and bibliography)

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