Misuse of Drugs Act 1971 (Amendment) Order 2021
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Baroness Williams of Trafford
That the Grand Committee do consider the Misuse of Drugs Act 1971 (Amendment) Order 2021.
The Minister of State, Home Office (Baroness Williams of Trafford) (Con)
My Lords, I beg to move that the draft Misuse of Drugs (Amendment) Order 2021, which was laid before the House on 25 March, be approved.
I am grateful for the advice provided by the Advisory Council on the Misuse of Drugs, which has helped to inform the order before the Committee. The proposed amendment to the Misuse of Drugs Act 1971, which I shall henceforth refer to simply as the 1971 Act, follows the ACMD’s self-commissioned advice published on 29 April last year about benzodiazepines.
The draft order before your Lordships relates specifically to three of those benzodiazepines: flualprazolam, flunitrazolam and norfludiazepam. Due to their potential harm and the evidence of the prevalence of these drugs in the UK, the ACMD recommended controlling all three substances under class C of the 1971 Act. The ACMD also concluded that these three benzodiazepines should be scheduled under Schedule 1 to the Misuse of Drugs Regulations 2001 because, as confirmed by the Medicines and Healthcare products Regulatory Agency, they have no recognised medicinal use in the UK. This is the first proposed addition to control further benzodiazepines under the 1971 Act since the control of 16 benzodiazepines in May 2017, which are also controlled under Class C of the 1971 Act.
Benzodiazepines are associated with a high dependency rate and severe withdrawal symptoms from even short-term use. Furthermore, their combined use with other recreational drugs—in particular opioids and other central nervous system depressants—is associated with an increased risk of mortality and contributes to a significant number of drug-related deaths each year. Data provided by the National Programme on Substance Abuse Deaths showed that in England between 2006 and 2015, there were 5,740 benzodiazepine-related deaths. Of these, just under 4% recorded benzodiazepines as the only compounds implicated in the cause of death, which may indicate the frequency with which they are associated with polydrug use.
I can provide some further background on the three benzodiazepines covered by this order. The first is flualprazolam. The ACMD’s report states that as of March 2020, there have been 12 flualprazolam-associated deaths in the UK recorded by regional statistical agencies. It also states that the European Monitoring Centre for Drug and Drug Addiction issued a report on flualprazolam in March 2019. This detailed deaths with confirmed exposure to the compound in 24 reported cases in Sweden and two in Finland. In eight of these cases, flualprazolam was cited as a contributory or possible contributory factor.
I move on to flunitrazolam. It is likely that the potency of flunitrazolam is greater than that of the already highly potent flunitrazepam, or Rohypnol, which is controlled as a class C drug under the Misuse of Drugs Act 1971. A small number of seizures were made at the UK border between October 2014 and 2019. The ACMD report highlighted that small-scale seizures of a mixture of tablets and powder had also been notified in Germany in 2016 and Denmark in 2017.
I move now to norfludiazepam, which has been identified in the UK twice, both in 2017: once from a police seizure and once by the drug identification provider TICTAC. Small-scale seizures also took place in Germany in 2016, Sweden in 2017 and Norway in 2018. There has also been anecdotal reporting of the use or purchase of norfludiazepam by PostScript 360, a charity that provides treatment for withdrawal from benzodiazepines.
As well as the recommendation for control under the 1971 Act, the ACMD also recommended that the three benzodiazepines be placed in Schedule 1 to the Misuse of Drugs Regulations 2001 and part 1 of Schedule 1 to the Misuse of Drugs (Designation) (England, Wales and Scotland) Order 2015, as these drugs have no known medicinal use in the UK. Subject to the approval of both Houses of Parliament of this draft order, it is intended that a further statutory instrument, subject to the negative resolution procedure, will come into force at the same time as this order, being 28 days after the date the Order in Council is made. This further instrument would make the amendments to the 2001 regulations and the 2015 order.
Parliament’s approval of this order to control flualprazolam, norfludiazepam and flunitrazolam under class C of the 1971 Act, and the scheduling of these under Schedule 1 to the 2001 regulations, as per the recommendations of the ACMD, would make it unlawful to possess, supply, produce, import or export these drugs except under a Home Office licence for research. The maximum sentence for possession of a class C drug is up to two years in prison, an unlimited fine or both, while for supply it is up to 14 years in prison, an unlimited fine or both.
We know that illegal drugs ruin lives and have a corrosive effect on society. It is clear from the advice we have received that these benzodiazepines can cause serious harm, and that is why we are taking this action. I hope I have made the case to control them, even though I have not managed to pronounce them very well, and I commend the order to the Committee.
Baroness Williams of Trafford (Con)
I thank all noble Lords who have taken part in this debate. It is worth stating at the outset that there are benzodiazepine medicines which can be prescribed by clinicians and have specific uses, but today’s focus is on illicit benzodiazepines.
As the noble Lords, Lord Mann and Lord Crisp, said, this is often about polydrug use. These tend to be drugs used not just in isolation, and deaths tend to occur when polydrug use is being practised. I totally take the point made by the noble Lord, Lord Mann, that the criminal justice system approach to drugs must be aligned to public health. When people have got themselves into illicit drug use, you do not want to criminalise them; you want to get them off the drugs that they are on.
The noble Lord, Lord Mann, made quite an interesting point about managed red light districts not working. I can think of a clear analogy: drug consumption rooms do not work. They are illegal. They exist in Scotland, but they do not work.
The point by the noble Lord, Lord Crisp, about support for those dependent on prescribed medicine is an important one. There is the Talk to FRANK website, which everyone will have heard about. I know that NHS England and NHS Improvement are leading a programme of work in response to the recommendations in Public Health England’s Dependence and Withdrawal Associated With Some Prescribed Medicines: An Evidence Review. The recommendation for a time-limited dedicated national helpline and website has been carefully considered as part of this work. They are also drafting a commissioning framework to help commissioners to optimise the prescribing of dependence-forming medicines, as well as providing support to patients experiencing dependence on prescribed drugs and symptoms of withdrawal. That framework is expected to be published later this year.
Anyone who develops a problem of dependence on medicines should seek help from their GP in the first instance. They might choose to go to a different GP from the one who prescribed the medication, if indeed the medication was prescribed.
The latest prescribing statistics I have are from the ACMD’s 2020 report, which states:
“Prescribing of benzodiazepines by General Practitioners in the UK has been discouraged and has fallen progressively in recent years … from 16.3 million in 2015-16 to 14.9 million in 2018-19”—
that is still huge. It goes on:
“In 2017-18, there were 1.4 million adults in England and Wales who received one or more benzodiazepine prescriptions.”
Public Health England undertook an evidence review of prescribed medicines, which was published in 2019. It concluded:
“Longer-term prescribing is widespread.”
The review covered adults and five classes of medicines, including benzodiazepines, Z-drugs, gabapentinoids, opioids for non-cancer pain and anti-depressants, and some 41 recommendations came out of that.
The noble Lord, Lord Paddick, talked about education. He is absolutely right: education is vital. He asked about reform of the Misuse of Drugs Act 1971. We keep drug controls under review but do not intend to reform the laws on drugs at this point in time. Drug legislation is part of the Government’s wider approach to preventing drug misuse, and education in schools is key to promoting healthy living, treatment and recovery and stopping the supply of certain drugs.
The noble Lord, Lord Paddick, also asked me about the specifics of each case where there was death. I do not have the specifics to hand but, as I said in my opening speech, benzodiazepines are often taken with other drugs and alcohol. With that, I finish and beg to move this statutory instrument.