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 cafés 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)

Drug Policy Harm Part One: Social Harm Theory -v- Criminology

This post is based on a paper I delivered at the University of Wales, Newport in 2009.  I am delivering a modified version at the University of Bath this Friday.

The Elephant in the Room: Drug and Alcohol Policy as Generators of Violence and other Social Harms

The wide-scale use and abuse of legal substances such as alcohol and tobacco inflicts far more harm on individuals and society than illicit drugs … We need a calm non-sensational approach to policy development in this area and one which places these serious problems in context. (Labour Party (1991) Drugs: A Consultation Document)

Things have gone from bad to worse; there is no possibility of an honest discussion now. Anyone who sticks their head above the parapet and calls for a rational consideration of the drug laws gets it shot off and kicked around by a horde of lunatics (Austin Mitchell, Labour M.P. 10 Feb. 2009 cited in Howker 2009)

This paper seeks to do two things. Firstly to introduce an emerging theoretical paradigm, social harm theory, which seeks to refocus our attention from behaviours defined as 'crime' to a wider set of behaviours, those that generate harm. Secondly it seeks to rethink the issues of alcohol and drug harms and violence by incorporating those caused by state policy alongside those generated by individual consumers, producers and suppliers of currently illegal drugs and alcohol.

My conclusion is that violence and other social harms associated with illicit drugs and alcohol could be dramatically reduced. However this reduction will not be achieved through a focus on the individual user or indeed on drug and alcohol services. Such initiatives, whilst undoubtedly making significant positive contributions to the lives of individual problematic consumers, are effectively swimming against the tide of avoidable violence and other harms generated by existing policy. Reducing violence and other social harms associated with both legal and illegal drugs requires the government to accept its responsibility for public health and to implement an effective framework to regulate all drugs.

Social Harm Theory

Criminology focuses on crime, the criminal and the resolution of problems through the criminal justice system. However, the events and actors we label crimes and criminals operate in a wider context that criminology often ignores. As Carol Smart (1990:77) has observed, the great weakness of criminology is that it:

cannot locate rape or child sexual abuse in the domain of sexuality or theft in the domain of economic activity or drug use in the domain of health. To do so … would involve abandoning the idea of a unified problem which requires a unified response.

This limitation has inspired the development of a social harm perspective which seeks ‘to move beyond the narrow confines of criminology, with its focus on harms defined by whether or not they constitute a crime’ and instead calls for ‘(a)ll forms of harms’ to be ‘considered and analysed together.’ (Hillyard et al 2004:1,2) We are all vulnerable to a wide range of social harms throughout our life course and social harm theory argues that to separate out crimes from other harms considered ‘outcomes of the market economy, … accidents or mistakes’ creates ‘a very distorted view of the world’. (Ibid:1,2) Social Harm approaches lead away from a focus on individual blame and towards policy responses designed to minimise future harms. (Dorling et al 2008)

Social harm theory rejects the boundaries of criminology and the exclusive focus on crime and criminals. It seeks to place crime in the context of other harms, an approach which allows us to respond to the totality of harms generated by a particular problem. For example it allows us in the case of alcohol to consider the harms generated by deregulation alongside the harms caused by the individual drunk and the harms suffered by the solitary middle aged heavy drinker in the quiet of his own home alongside the harms caused by the drunken teenager disturbing the peace of her local community. Social harm theory seeks to embrace not only physical harms but also financial/economic, emotional and psychological harms. (Hillyard & Tombs 2008:15)

Simon Pemberton (2007:33-36) has highlighted the potential of the social harm perspective to explain the failure of criminal justice policies and generate the space for alternative social policies which, freed from the rhetoric of law and order, can genuinely reduce the harm communities experience. Relating this paradigm to alcohol and unlawful drugs provides the opportunity of exploring the impact of these substances within a much wider perspective than criminology offers. It enables us to give equal consideration to legal and illegal acts, explore individual, corporate and state behaviours and to measure the harms directly associated with the drugs alongside the harms generated by failures to control and regulate their market places.  Most significantly for this talk it allows us to look at all drugs, both legal and illegal, within the same paradigm.

Continued ... Drug Policy Harm Part Two: Misrepresenting Harms

Podcast of the Public debate - Addiction: should we penalise or treat?

On April 8th I took part in a public debate at The Watershed in Bristol about how we respond to drugs.  The debate was recorded and is now available on the web as the August Philosophy Monthly Podcast.

You can listen to the Podcast here

Britain Safe for 48 hours

Following bold action by Home Secretary, Alan Johnson, the young people of England, Scotland, Wales and part of Ireland were safe for 48 hours this weekend.  Johnson in the early hours of Friday morning banned the drug Mephedrone following advice from the AMCD that they hadn't got a clue.

Websites that sold so called "legal highs" are temporarily closed as they stock up with a new product range

Hot tip is 5,6-Methylenedioxy-2-aminoindane normally referred to as MDAI which is very similar to ecstasy.

A quick internet search shows a growing wholesale market

Is it safer or more harmful than Mephedrone?  Is it safer or more dangerous than alcohol? 

Who knows?  Certainly the Government has no intention in providing good quality scientific advice.  Instead they will after a few months of soundbites end up banning it and giving us a 48 hour break before the next "legal high" hits the online retailers.

Meanwhile what is the bet this new product will be heavily promoted by media condemnation over the coming weeks?

Alcohol Kills but Meow Meow makes headlines

On the day before Mephedrone was made illegal I received a circular e-mail from the University's very own police office one PC Matt Holloway

For the information of all staff and students.


From 00:01 am on Friday 16th April 2010, Mephedrone (aka Meow Meow, Bubble and Mcat) and more than 10 other very similar drugs become controlled under the Misuse of Drugs Act to a Class B drug.

There is no "amnesty" period and anyone found in possession of the drug will be dealt with in exactly the same way as they would be for other Class B drugs such as Amphetamine (which Mephedrone is closely related to).

This brings penalties of up to 5 years imprisonment for possession and 14 years imprisonment for supplying or possession with intent to supply the drug.

Mephedrone is a very dangerous drug and has had a lot of media attention over the last few months but there are other very similar drugs in the same chemical group that are also used regularly and they too have been controlled under this legislation. The most common of these are Methylone, Methedrone and MDPV.

If you have any questions in relation to this then please contact the UWE beat manager PC Matt Holloway in Room 1E20. His contact details are found via the Police web page - Bristol UWE - Operations and Security

One phrase stuck out

Mephedrone is a very dangerous drug and has had a lot of media attention over the last few months

So I thought I would research PC Holloway's claims.   So I had a look at the latest edition of the Lancet which had an article on the ban.  It stated that:

the ACMD report, Consideration of the cathinones, which recommended the ban, documented the very scanty evidence on mephedrone, including the absence of a direct causal link between the reported deaths and the drug. ... There was little time to consider carefully the scientific evidence on mephedrone. The ACMD did not have sufficient evidence to judge the harms caused by this drug class.

 So on the one hand we have PC Holloway claiming that it 'is a very dangerous drug' and on the other the Lancet claiming that there is not 'sufficient evidence to judge the harms '.  Which one should I believe on this medical and scientific issue?

But PC Holloway is correct about the media moral panic coverage and we see a classic example of this today in the Daily Mail

The headline could not be clearer - someone died after taking meow meow.  However on reading
the article I find right at the bottom this paragraph

The Inquest heard that although meow meow and Valium were found in Miss Main's blood, it was a combination of alcohol and GHB which killed her.

So despite the headline it was not mephedrone but alcohol and GBH which contributed to her death. This is not an unimportant fact in the debate over mephedrone as it is likely that many users who are put off by it being made illegal will instead use alcohol. A drug with a very proven track record of harm and death. This displacement may end up causing more harm including more deaths. But does PC Holloway warn the staff and students of UWE of this killer drug?

It is a silence often shared by politicians and the media

See also - Daily Telegraph Moral Panic Journalism and Mephedrone Pushing

Addiction: should we penalise or treat? A public debate

If you are near Bristol and fancy hearing me speak in person I will be taking part in this event next week

What: Addiction: should we penalise or treat? A public debate

When: Thursday 8 April 2010, 18:30-20:00
Where: Watershed, 1 Canon's Road, Harbourside, Bristol, BS1 5TX
Addiction: should we penalise or treat? is the topical subject of a free public debate organised by University of the West of England philosopher, Dr Havi Carel. The event will take place on Thursday 8 April 2010 from 18:30 to 20:00 at the Watershed in Bristol.

The public debate is one of the events funded by the Arts and Humanities Research Council (AHRC) as part of the three year research project - The Concepts of Health, Illness and Disease. Project leader, Dr Carel explains, “This research project brings together researchers from diverse disciplines to develop an understanding of health, illness and disease. This is crucial to society as how we define illness can have ethical, social and economic consequences. Addiction is an emotive topic that clearly highlights these issues. One example is smoking - should the NHS pay for the treatment of nicotine addiction or are smokers just weak-willed? By drawing on the expertise of a multidisciplinary team of speakers, the audience will hear multiple approaches to the issue before being invited to join in the debate.”

The speakers are:

• Dr Nick Airey, an NHS psychiatrist specialising in addiction
• Dr Piers Benn, Medical ethics
• John Moore, Criminology, UWE
• Dr Giles Pearson, Philosophy, University of Bristol
• Dr Jonathan Webber, Philosophy, Cardiff University
• Chair: Dr Julian Baggini, Editor of The Philosopher's Magazine

This event is free of charge to the public and a large audience is expected. This event is free of charge but booking is essential, to book a place e-mail Dr Havi Carel - Havi.Carel@uwe.ac.uk

Dr Carel concludes, “The event has attracted interest from clinicians, drug and addiction practitioners, and service users. It promises to be a lively debate and is a chance for the public to contribute to our research. We are planning to record the debate as a podcast on the project website, as well as on the AHRC website and The Philosopher's Magazine website.”

Spot the difference

Tesco's current Corporate Page promoting its "responsible" attitude to the sale of alcohol

The same page before it was quoted as evidence against Tesco in their recent court action to be allowed to sell alcohol in one of its Cambridge stores in an area "with known disorder issues".

Tesco and socially irresponsible attitudes to selling alcohol

Tesco's drive to dominate the high street continues. Part of their strategy to achieve this means the promotion of high strength alcohol brands, often at less than cost prices.

Many of its express stores are located in areas where there are problems related to alcohol, particularly steet violence and where they are able to boost sales by targeting the proxy purchasing and pre-loading. The former refers to adults buying alcohol for children, the latter to clubbers getting tank up prior to going out on cheap tesco alcohol.

This week Tesco took Cambridge City Council to court over its refusal to grant them a licence to sell alcohol in their Mill Road store following police objections. this comes in the same week that Diageo, the world's biggest spirits seller is redirecting its marketing budget to supermarkets in an attempt to boast sales. Meanwhile in Leicester, Tesco has been caught out breaking its pledge not to sell high strength largers and ciders in a store in a new store in London Road.  These promises were made to help Tesco overcome objections to its licence application but appear to have been rapidly forgotten once the store was open.

Given this track record I was really pleased to see Tesco has lost its court action in Cambridge.

cdnt give a XXXX 4 lst ordrs? Vote labour on thrsdy 4 xtra time

In 2001 at the beginning of its election campaign New Labour under Tony Blair sent the following text to students:

cdnt give a XXXX 4 lst ordrs? Vote labour on thrsdy 4 xtra time

The text was intended to promote New Labours plan to liberalise alcohol laws.  These have included as well as 24 hour drinking, support for drink promotions and a taxation policy which has seen the affordability of alcohol enhanced.

Labour's policy has been driven by the Alcohol Industry who have been keen to maximise their profits.  Health and scientific advice has been ignored.

Interesting to see that this cynical policy is coming back to haunt them as this article in the Daily Mail and this one in the Daily Telegraph show.  The graph below shows the human cost of alcohol policy.

Minimum pricing will work as advocated by the Chief Medical Officer

The Sun says sorry

Regular readers of this blog will be aware of all the fuss surrounding Home secretary Alan Johnson's decision to sack David Nutt as Chair of the Advisory Council on the Misuse of Drugs for telling the truth. In classic New Labour style a nasty attempt was made to get at Nutt through press stories about his children. [Interestingly the evening that Nutt made his speech I ended up chatting to his wife about how alcohol represents the most dangerous drug for young people - our kids are roughly the same ages.]

Stephen Nutt his son complained to the Press Council and their website revealed that the Sun has removed the story from its website and published a letter from Stephen. This was unsurprising not widely published. A google search shows no newspapers reporting on it.

Despite this silence well done Stephen - few take on the evil Sun and win.


Lest we forget


This picture relates to the call to boycott the Sun over its scummy reporting of the Hillsborough tradegy when 96 Liverpool fans were killed. For background read here

Alcohol and the British - A Historical Perspective

A really interesting article in this month's History Today in which James Nicholls reviews attempts to regulate alcohol in Britain over 5 centuries.

In Britain, concerns over drunkenness go back a long way. The first Licensing Act, passed in 1552, required alehouse-keepers to acquire a licence from local justices on the grounds that ‘intolerable hurts and troubles’ arose from drunkenness in ‘common alehouses’. The following year rules were introduced strictly limiting the number of wine taverns that could open in any one town. This legislative distinction between common alehouses and more exclusive wine taverns reflected a long-standing social stratification of drinks in Britain. Lack of native viticulture made imported wine an elite drink,while ale, and later beer (made with hops,which were only widely used from the 15th century),were associated with more popular drinking cultures.

The full article can be read here

Those of you want a more up to date analysis of alcohol policy should read an excellent blog by Mark Easton of the BBC - The myths of boozed-up Britain


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