Ain't life a drag

In the current debate about legalisation, decriminalisation or de-penalisation of illicit drugs, many advocates of reform assert that our present system of control, based on the Misuse of Drugs Act 1971 and its various amendments, is a failure and should be abandoned.

Here, John Ramsey and Lindsay Hadfield challenge this view, and identify a number of pitfalls in the case for legalisation that its proponents normally choose to ignore.

Ain't Life a Drag

We already have three legal social drugs: tobacco, alcohol and caffeine. Use of the last is of little health consequence but alcohol causes considerable damage to some users and tobacco harms a large proportion of the people who use it - 50 per cent of tobacco users will die as a result of the habit.

It is often proposed that the illicit drugs which, it is argued, are no more harmful than our social drugs should be legalised, since a criminal conviction does more harm than the drug itself. This argument is used particularly for cannabis, often for ecstasy, and usually by middle class people least likely to be harmed by the drugs.

It takes no account of the vulnerability of the more socially disadvantaged who experience most of the problems associated with drug use.

We suggest a better course would be ensure that the law does not do more harm than the drugs and to do all we can to stop the use of tobacco and reduce the harm associated with alcohol. But it would be criminally negligent to make another drug administered by smoking more freely available.

The widespread and almost universal use of ecstasy at dance clubs (some surveys suggest 80 per cent of attendees had taken ecstasy that evening) is taken as a reason to legalise it and so prevent the harm caused by the illicitly produced, supposedly contaminated drug.

There is little serious pressure to legalise either heroin or cocaine (or crack) although it is often suggested heroin should be prescribed to addicts.

We consider the practical difficulties associated with these proposals.

Cannabis

The Dutch de facto legalisation experiment where "Coffee Shops" are allowed to sell small quantities of cannabis openly was adopted in order to separate soft drugs from hard, allowing cannabis users to buy and smoke cannabis without coming into contact with dealers of hard drugs. They claim to have broken the link between the supply of cannabis and the supply of hard drugs (heroin and cocaine). The law has not been changed; it is just not enforced. The sales of soft drugs are not prosecuted under certain conditions.

The coffee shops are required not to:

  • advertise

  • sell hard drugs

  • cause public nuisance

  • admit minors (under 18)

  • sell large quantities, more than 5 grams per transaction

  • sell alcohol

In addition local rules may also be applied:

  • no parking outside coffee shops

  • close at 10.30 p.m.

There were 1,200 coffee shops in 1995 (1 per 10,000 inhabitants) but this had reduced to 846 in by 1999. Most offer a wide range of hashish and marijuana products from different countries and of varying strengths but as the supply has not been legalised the coffee shop owners still have to buy on the illicit market.

The Dutch have employed their horticultural skills to grow cannabis products illegally and develop exotic high strength cultivars (Netherweed).

It seems unlikely that if we were to adopt a similar approach British retailers would be free to purchase drugs from illegal sources. Could the UK government really condone an industry that necessitated the transgression of our various international obligations with regard to trafficking in illegal drugs? Would we develop our own cannabis cultivation industry? It would have to be of a substantial size to meet the demand. However our climate is better suited to growing hemp for fibre rather than drug production so the quality would be poor and security impossible unless it was grown under glass, in which case it would be expensive.

We would therefore need to establish legitimate overseas suppliers otherwise retailers would inevitably be tempted to turn to the black market to supply the exotic sounding Nepalese temple balls, Thai sticks, Pakistani Black, and Skunk.

Could the legitimate outlets compete successfully with the illicit market? Probably not. The Dutch coffee shops charge £1.5 - £7 (5 to 25 guilders) per gram, the current UK street price (untaxed) is about £1- £5 per gram. Would the legitimate suppliers of cannabis sell a comparable product at lower prices than the black market? If not, would consumers pay a premium to get their drug from legitimate sources? It seems unlikely. The evidence with tobacco and alcohol is that increasing numbers of consumers are prepared to go to great lengths to avoid paying duty.

Moreover, the price differential between legal and illicit supplies would be increased by the need of the legitimate suppliers to include overheads such as the cost of insurance required to protect them and the producers from claims from aggrieved consumers who have been involved in accidents or suffered ill health. Cannabis has the potential to cause most of the health consequences of tobacco use plus the additional risks associated with intoxication, motor impairment and psychosis.

Would the tobacco industry, which in the US is facing "class action" suites for the health consequences of its current products, take on a new product with similar or even more severe health consequences? It might, because it seems probable that freer access to cannabis would lead to more nicotine addicts and more tobacco consumption.

There is also the question of who we should allow to retail cannabis - tobacconists, off-licences, pubs, coffee shops, supermarkets, pharmacists? Some recent advocates of legalisation naively assume that sales could be controlled so that the drug would not be more widely available than at present – the only difference would be that the sources would be legitimate. But the current suppliers – dealers – are in business to make money. And just as the current suppliers are interested in expanding their markets, so legal commercial suppliers will want to maximise their profits by developing their markets, even if advertising/sponsorship is not permitted. As discussed above, there will be significant costs in establishing legitimate sources of cannabis, so any commercial producer will have to price the product accordingly. They get the price wrong, the illegal suppliers would continue to flourish.

Deliberate confusion with medical use of cannabis.

Another argument put forward is that cannabis should be legalised so that it can be used for medical purposes. It seems likely that the clinical trials of cannabinoids currently in progress in the UK will show benefits for some medical conditions. This may well lead to licensed medicines derived from cannabis. However they will not be smoked and are unlikely to be at doses sufficient to cause a high. It is perfectly consistent to licence the medicinal use of cannabinoids while prohibiting the recreational use cannabis.

Ecstasy

The problems associated with legalising synthetic drugs such as ecstasy (MDMA etc.) are even greater. The drugs have never been manufactured by the modern pharmaceutical industry and so have not undergone any safety evaluation.

Presumably the Government would insist on the same safety checks on recreational drugs that the pharmaceutical industry currently performs on medicines. This is likely to cost millions of pounds for each compound.

Evidence from the dance/club scene shows that MDMA causes a small number of deaths (probably about 90 to date in the UK). Research also indicates that MDMA causes brain changes, the functional consequences of which remain unclear, but may manifest themselves as poor memory or depression. Acceptable safety and side effects are based on a risk benefit analysis. As a society we will tolerate a drug that makes us sick and our hair fall out if it is to treat cancer but not if it is to cure a headache. What level of side effects would we accept for a recreational drug?

It is difficult to see how legalisation could reduce the mortality associated with ecstasy. This is often precipitated by personal behaviour or the ambient environment in the venue. Users argue that legalising ecstasy would ensure a consistent unadulterated product and this would improve safety. In fact, almost all the known harm from ecstasy is caused by the pure compound MDMA. There is no good reason to believe therefore that legal escasy would be any safer. Moreover, there is little evidence that the harm is strongly dose related, which means that harm can be caused by "moderate" as well as "excessive" use. With greater numbers using the legitimate, but equally unsafe, product, the total number of fatalities would probably increase. Who would be held responsible, and liable? Just the consumers themselves? Perhaps, but the legitimate pharmaceutical industry will would have to think long and hard before taking on the manufacture of MDMA for recreational use. The exposure to third party risk is high and the ethics at least questionable.

Conclusions

Freer access to drugs will inevitably lead to greater use. Current users would use more freely. Many potential users who are currently deterred would feel free to start. This is especially true for ecstasy - uncertainty about the illicit product would be replaced by confidence in government approval. Use of the newly legalised drugs would become normalised and would inevitably lead youngsters to seek other illicit thrills supplied by the black market. The widespread use of GHB, ketamine, poppers (alkyl nitrites) and a legion other drugs on the club scene supports this fear.

The question is - does the law cause more harm than the drug? So the issue becomes just how seriously we should regard these offences. Let us change the law as suggested by Baroness Runciman. Make cannabis Class C rather than Class B, and move MDMA (ecstasy) from Class A to Class B. We should also apply the law evenly across the UK and stop giving people criminal records for supplying small amounts of these drugs in private social settings. This would bring the penalties more in line with the potential harm caused by these drugs.

John Ramsey
TICTAC Communications Ltd
St. George's Hospital Medical School
Cranmer Terrace
London
SW17 0RE

Lindsay Hadfield
Policy & Education Consultant
Medscreen Limited
Harbour Quay
Prestons Road
London E14 9PH

The opinions expressed are those of the authors and do not necessarily reflect those of the institutions they represent.