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 Two: Misrepresenting Harms

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

The Myth of the Misuse of Drugs Act and Harm


The prohibition of certain classes of drugs is a policy decision which has cross-party consensus with both the last Labour and the current Conservative/Liberal Democratic Governments supporting this arrangement and indeed keen to include any new drugs that emerge on the market.  The core piece of legislation underpinning this policy is the Misuse of Drugs Act 1971 (MDA) which seeks to control specific drugs through criminal justice interventions based on the scientific classification of their harms. (Jason-Lloyd 2007) Although harm appears to be an established component of this regime this is an illusion than needs exposing. To do this I want to highlight the work of David Nutt, an eminent scientist and former chair of the scientific committee, established by the MDA, to advise the Home Secretary on drug policy.

Nutt (2009:4) raises ‘the critical question of why society tolerates –indeed encourages – certain forms of potentially harmful behaviour but not others’, highlighting the comparative risks of ecstasy and alcohol, ecstasy and horse riding and the relative harms of legal and illegal drugs. (Nutt 2006, 2009 & Nutt et al 2007) In figure 1 below Nutt (2006:316) compares the relative harms of the two E drugs, ethanol, better known as alcohol, and ecstasy and his figures make clear that the harms caused by alcohol are dramatically greater than ecstasy. 

Figure 1 (Source: Nutt 2006:316)

In fact what is clear from this is how much harm alcohol causes; twenty two thousand premature deaths, one thousand five hundred road traffic deaths and over 10,000 cases of interpersonal violence per annum, and how little harm is caused by ecstasy. Yet earlier in 2009 the government choose to retain ecstasy’s classification as a class A drug under the MDA. (Home Office 2009, ACMD 2009)

In an interesting analysis Nutt et al (2007) attempted to incorporate both legal and illegal drugs in a single hierarchy of harm. The results, published in the Lancet and shown in figure 2 below, clearly demonstrate the lack of any clear correlation between a drug’s harm and it’s classification under the MDA. Methodologically this study is not unproblematic and remains trapped in the paradigm of prohibition. For example, considering the most harmful drug, heroin, it fails to separate those harms intrinsic to it as a chemical substance and those harms that are generated by its legal status. (TDPF 2009:12-13) Hopefully this exercise will be repeated with the harms directly attributable to prohibition disaggregated. Would illegal street heroin have exactly the same level of risk of harm as prescribed heroin?


Figure 2 (Source Nutt et al 2007:1050)

 In an editorial in the Journal of Psychopharmacology, Nutt returned to comparisons of the relative harm of two ‘e’s, this time Ecstasy and Equasy (Equine Addiction Syndrome). Figure 3 below summarises his results. The legitimacy of his comparison of their respective harms generated a strong backlash with, the Home Secretary, Jacqui Smith, declaring that she was  ‘sure most people would simply not accept the link that he makes up in his article between horse riding and illegal drug taking.’ (BBC 2009) 

Figure 3 (Source: Nutt  2009:4)


Melanie Phillips (2009) commenting on Nutt’s paper declared ‘The only reason there are not many more deaths from ecstasy is that unlike horse riding, it is illegal.’ In fact the relationship between ecstasy’s illegality and fatalities associated with use are more complex. Its illegality removes the opportunity for any quality controls, it has led to moral panics, misinformation and has potentially impacted on levels of consumption. Lack of quality control means the consumer has no reliable information about ingredients and this lack of regulation leaves the control of the exact composition of the product retailed, and the health and welfare of consumers in the hands of organised crime. Moral panics over ecstasy have undoubtedly created harm; Leah Betts, the iconic ecstasy victim, died from water intoxication, consumed on the misunderstanding promoted by the press that vast quantities of water were the antidote to ecstasy. (Joseph 2000:91) Illegality therefore certainly increases the risk of death but does it deter use, thereby reducing the risk as well?

The Home Office claims that ‘(d)rugs are controlled because they are harmful. The law provides an important deterrent to drug use and legalisation would risk a huge increase in consumption’; though they provide no evidence to support their assertion. (Easton 2009) The Number Ten Strategy Unit, whose confidential report on drug policy to the cabinet in 2003 was leaked to the Guardian, concluded that ‘attempts to intervene have not resulted in sustainable disruption to the market at any level.’ (SU Drugs Project 2003:104) This conclusion was backed up by the UK Drug Policy Commission whose research concluded that ‘seizures and enforcement efforts have had little adverse effect on the availability, purity and price of illicit drugs in the UK ‘ and that ‘(s)ince 2000, average street prices in the UK have fallen consistently for heroin, cocaine, ecstasy and cannabis.’ (Mc Sweeny et al 2008:48 & 40)

Figure 4 below is reproduced directly from the Number 10 Strategy Unit’s report to the Cabinet. It demonstrates how effectively use of Heroin has been controlled since the introduction of the MDA. Illegal drugs are today widely available, at historically low prices, suggesting that prohibition has neither reduced supply nor demand, both of which have actually grown dramatically over the last forty years. Whatever their ambitions it is clear that the MDA and the prohibitionist paradigm in which it operates have not reduced harms.



Figure 4 (Source: SU Drugs Project 2003:38)
The lighter columns are addicts notified to the Home Office, and the darker columns from 1997 when the HO notification system was shelved, are numbers in treatment.



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

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

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.

Alcohol deaths treble in Wales

Alcohol is a drug, and one that causes an immense amount of harm. But unlike many other less harmful drugs it is not only legal but has a powerful industry and political lobby supporting it. Last April I was invited to speak at a conference held at Newport University's Centre for Criminal and Community Justice on 'Drugs Alcohol & Violent Crime'



My paper was entitled The Elephant in the Room: Drug and Alcohol Policy as Generators of Violence and other Social Harms and I argued that far more harm and violence was caused by the government's policy on alcohol (and indeed illegal drugs) that was caused by individuals under their influence.




In particular New Labour (and before them the Tories) have allowed policy on alcohol to be determined by the commercial interests of the producers and retailers (the pushers) rather than public health interests. This policy is literally killing us. For example alcohol-related deaths in Wales rose from 199 in 1992 to 573 last year, with the sharpest rise taking place in the past two years. An individual drunk killing a person is deemed to have committed a crime, but a government who colludes with the pushers of a drug to increase its sales and kills thousands needlessly across the UK is not.