Misuse of Drugs Act 1971 (Amendment) Order 2024
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Lord Sharpe of Epsom
That the Grand Committee do consider the Misuse of Drugs Act 1971 (Amendment) Order 2024.
Relevant document: 7th Report from the Secondary Legislation Scrutiny Committee
The Parliamentary Under-Secretary of State, Home Office (Lord Sharpe of Epsom) (Con)
My Lords, this draft order, which was laid before Parliament on 27 November last year, proposes amendments to the Misuse of Drugs Act 1971 to control 15 substances as class A drugs, four substances as class B drugs and one substance as a class C drug. To achieve this, it proposes amendments to Schedule 2 to that Act, which sets out what drugs are controlled and their classification.
Fifteen synthetic opioids, including 14 nitazenes, will be controlled as class A drugs under the 1971 Act. This follows recommendations from the Advisory Council on the Misuse of Drugs in its report of 18 July 2022 and addenda of 19 December 2022 and 6 October 2023. The Government commissioned the ACMD for its advice following international control of three of the synthetic opioids—at this point, I beg noble Lords’ indulgence because pronouncing some of these names is not easy; they are isotonitazene, metonitazene and brorphine—under Schedule 1 to the United Nations Single Convention on Narcotic Drugs 1961, to which the UK is a signatory.
In addition to reviewing these substances, the ACMD considered the harms of other similar synthetic opioids and concluded that they pose serious acute health risks, reinforced by reports of their involvement in a number of drug-related deaths and near-fatal overdoses. The ACMD determined that their potency and availability present a significant potential threat to public health and therefore recommended the highest level of control as class A drugs under the 1971 Act. This is for all 15 synthetic opioids, including the three controlled internationally.
Additionally, three stimulants—diphenidine, ephenidine and methoxyphenidine—will be controlled as class B drugs under the 1971 Act by this order. This follows international control of diphenidine under Schedule 2 to the United Nations Convention on Psychotropic Substances 1971 in April 2021, after which the Government commissioned the ACMD to review its harms. In its report of 25 May 2023, the ACMD noted the involvement of these substances in a number of drug-related deaths worldwide and recommended that they be controlled as class B drugs under the 1971 Act. This is in line with similar dissociative class B drugs, such as ketamine.
Also to be controlled as a class B drug is Cumyl-PeGaClone, a synthetic cannabinoid receptor agonist—SCRA—which, similarly to diphenidine, was added to Schedule 2 to the United Nations Convention on Psychotropic Substances 1971 in April 2021. Many SCRAs are currently controlled as class B drugs under a generic definition in the 1971 Act. However, owing to its structure, Cumyl-PeGaClone falls outside the generic definition. The ACMD report of 25 May 2023 recommended that the Government consult relevant stakeholders on modification to the definition, which the Government have agreed to do. In the meantime, to address the harm it poses and meet our international obligations more quickly, the Government have opted to control Cumyl-PeGaClone individually as a class B drug, in line with other SCRAs. We will consult on modifications to the generic definition in due course.
Finally, remimazolam, a benzodiazepine, will be controlled as a class C drug under the 1971 Act. Remimazolam is the active ingredient in a product given marketing authorisation, otherwise known as a medicines licence, by the Medicines and Healthcare products Regulatory Agency in 2021. The ACMD recommended in December 2022 that it should be controlled as a class C drug as its potential harms are commensurate with other benzodiazepine drugs already controlled under class C.
I am grateful to the ACMD for the comprehensive reports it has produced. Those reports have been the foundation of this legislation. According to the ACMD’s advice, all the substances are psychoactive and therefore potentially subject to the offences under the Psychoactive Substances Act 2016. The 2016 Act contains offences for the production, supply, possession with intent to supply, import or export of a psychoactive substance where a person knows, or is reckless as to whether, it will be consumed for its psychoactive effects. It does not, however, contain an offence for the simple possession of a psychoactive substance, other than in a custodial setting. Medicinal products are exempt from the provisions of the 2016 Act, and medicines based on remimazolam are therefore currently exempt.
The control of these substances under the 1971 Act would make it an offence to possess them and impose higher penalties and enforcement provisions for supply and production offences. Those found in unlawful possession of a class A drug could face up to seven years in prison, an unlimited fine or both. Meanwhile, those who supply or produce a class A drug could face up to life imprisonment, an unlimited fine or both.
One of the substances, remimazolam, has a known medicinal value in the UK as it has been granted a marketing authorisation. To enable its use in healthcare, remimazolam will be placed in part 1 of Schedule 4 to the Misuse of Drugs Regulations 2001 by a statutory instrument made under the negative procedure. It is the Government’s intention that it will come into force on the same date as this affirmative order. The other 19 substances will be placed in Schedule 1 to the 2001 regulations by that same negative statutory instrument. This is because they have no known medical or therapeutic value in the UK and will mean that they can ordinarily be accessed only under a Home Office-controlled drug licence. Again, this follows ACMD advice. Cumyl-PeGaClone will also be placed in Schedule 1, in line with other SCRAs already controlled under the 1971 Act and 2001 regulations.
These substances, excluding remimazolam, will therefore be added to part 1 of Schedule 1 to the Misuse of Drugs (Designation) (England, Wales and Scotland) Order 2015. Controlled drugs are designated where the Secretary of State is of the opinion that it is in the public interest for production, supply and possession of that drug to be wholly unlawful or unlawful except for research or other special purposes, or for medicinal use of the drug to be unlawful except under licence.
Drug misuse ruins lives and adversely affects society as a whole. The Government have a responsibility to protect the public, their safety and their health, and that is why we are proposing this action. As I have set out, these substances cause or have the potential to cause significant harm to both the individual who uses them and the communities in which they live, and must be subject to stricter controls. I commend this order to the Committee.
Lord Allan of Hallam (LD)
My Lords, in speaking for these Benches I would ordinarily speak from a health perspective. From our point of view, a lot of the drug abuse issues fall within that category. We are obviously dealing with a Home Office statutory instrument today, but I hope that the Minister will indulge me if I put some questions that come from that angle of considering the impact on individuals of the drugs we are due to control.
The first is around how we will monitor, in particular, the prevalence of the synthetic opioids that are to be classified by the instrument we are considering. I think we have all looked in horror at the situation in the United States, where the firewall that exists between heroin and other forms of drugs has broken down, in a sense, through the distribution of synthetic opioids to a much broader demographic who, it seems, feels more comfortable taking them than would feel comfortable taking heroin. But the medical harm is just as severe—in some cases, more severe—so I will be interested to hear from the Minister how the Government intend to monitor the prevalence and usage, particularly across different demographics, of these synthetic opioids, as well as prohibiting them, which is right. It is correct that we are following the advice of the advisory council here, but also really important that we understand the way in which these synthetic opioids are being consumed within the community.
The second issue I want to raise follows on from that, which is to consider how treatment services will deal with people who present because they have an addiction to the drugs we are considering. The numbers are quite stark: in 2021-22, just over 289,000 people presented for treatment services. Nearly half of them presented for opiate addictions and over 70% had mental health problems. It is critical to understand, as we broaden the net on the drugs that we bring into scope, how we will be able to respond to the people who come to the attention of the authorities because they are using these opiates—and get them off those. Just as important as any attempt to ensure that they are prosecuted is to get them out of that drug dependency and back into a normal state. Again, I want to understand what consideration has been given to how treatment services will need to be adapted to cover this broader range of synthetic opiates that we are bringing into scope.
Lord Ponsonby of Shulbrede (Lab)
My Lords, we too welcome the amendments in this instrument. I will start with two specific questions and then make some more general comments.
First, beyond adding the specific substances which the Minister referred to in his speech and in the document, what more are the Government doing to address the risks posed to our communities from drugs more generally? The second question is about a particular drug, xylazine, a non-opioid veterinary anaesthetic that is being used in combination with synthetic opioids to devastating effect. I understand that the Minister for Crime wrote to the ACMD in June to ask it to consider the harms of this drug and that he is still waiting for a response. How long should the Minister for Crime expect to wait before he gets either action or a response to his letter about this drug?
Those are my two particular questions. More generally, I want to use the same structure as the noble Lord, Lord Allan. The first question he asked was about monitoring the prevalence and usage of synthetic opioids. As I mentioned in other speeches, including in the King’s Speech debate, I travelled to North America in the summer and went to Portland, Oregon. I also went to Seattle in Washington state. I was shocked by the amount of drug use on the streets. I saw hundreds if not thousands of people sleeping rough on the streets of those two cities. I saw people shooting up in front of me in the middle of those cities—and I had young children with me. It was a truly shocking sight.
While I was there, I visited a court that dealt with drug issues. I also had breakfast with a district attorney who is an elected prosecutor. We spoke about the way their current drug policy is working. What was interesting and depressing to me was the uniform agreement across the political spectrum that it was a disaster, yet they did not agree on the solution to that disaster; there was an ongoing political debate on it. The district attorney also said to me—it is relevant to this debate—that there is a strong suspicion, or belief, that synthetic opioids are getting into prescribed drugs. He told me that he had gone on holiday to Mexico but had forgotten some of his normal prescription drugs, so he had to go and buy the drugs while in Mexico. He became aware that synthetic opioids are illegitimately getting into prescribed drugs. This is a very worrying development; it is all over the internet in that part of the world. It is something that we should be aware of as a possible problem over here as well. It really is a huge issue. I am sure that the Minister is aware of it, but it would be good to hear what is being done to monitor the scale of this problem, which is potentially coming our way.
The second point made by the noble Lord, Lord Allan, was about treatment services and more drugs being brought into scope. I am quite worried about the experiments being carried out in Glasgow. I suppose that would be a good question for the Minister to answer: what monitoring are the UK Government doing on the experiments being done around drug treatment centres in Glasgow? I will leave it there.
Lord Sharpe of Epsom (Con)
My Lords, I thank both noble Lords for their contributions to this short debate. I take on board the personal experience of the noble Lord, Lord Ponsonby, in the States; his observations are obviously extremely interesting. Perhaps it is worth pointing out that just under half of all drug poisoning deaths registered in this country in 2022 already involved an opiate of some sort. The noble Lord made some acute points; of course, the Government remain aware of the situation overseas and continue to monitor that as much as they monitor the situation here.
The noble Lord, Lord Ponsonby, asked me a specific question about xylazine. The ACMD is independent, so I cannot comment on its timeframes, but we are hoping for its response on this particular drug in early 2024. Obviously, we will come back to this as and when we have its response.
The noble Lord, Lord Allan, asked about monitoring and the noble Lord, Lord Ponsonby, backed that up. As I said, UK agencies are highly alert to the threat from synthetic drugs, including synthetic opioids such as fentanyl as well as synthetic cannabinoids and benzo- diazepines, which have been linked to drug-related deaths in this country. Along with law enforcement partners, the UK Government stand ready to respond to the threat from synthetic drugs. They have established a cross-government task force to monitor that threat and to lead and co-ordinate the government response to the risk from these synthetic opioids in the UK. The aim of the task force is to consider evidence-based policy; programmatic and legislative decisions in response to the level of risk; and the nature of synthetic opioids. Members of the task force include the Home Office, the Office for Health Improvement and Disparities, the Ministry of Justice, the National Crime Agency, HM Prison and Probation Service, Border Force and the police.
Through the UK’s drugs strategy, which was published in December 2021, we are implementing an end-to-end plan to disrupt the supply of all drugs at every stage of the supply chain from a source to the street. As part of that strategy, we have provided additional resources to the international networks of the NCA and the Home Office in key source and transit countries; this is for them to work with other Governments in identifying and disrupting cartels that seek to exploit the UK, as well as to seize drugs before and during their journey to the UK and the EU.
Also outlined in the strategy, we have increased the availability of naloxone, including naloxone nasal spray, to prevent drug-related deaths, and have committed to supporting local provision of a broader range of medicines, including newer medicines such as long-acting buprenorphine injection. We believe firmly in the importance of engaging with experts and delivery partners to respond swiftly to the evidence of emerging drug threats, including learning from international partners through international fora such as the US-led Global Coalition to Address Synthetic Drug Threats.
On the health situation that was brought up by both noble Lords, FRANK, the Government’s free drugs advice service, contains information on synthetic opioids, synthetic cannabinoids and benzodiazepines, which will be updated to reflect the changes when this legislation comes into force. The Department for Education has also worked with the Office for Health Improvement and Disparities to make sure that good-quality teaching resources are available for teachers providing drug, alcohol and tobacco education, and lesson plans on drugs, alcohol and tobacco are available on the PSHE Association website.
We are of course concerned that banning these substances will discourage people from access to treatment services, but the Government’s drugs strategy, From Harm to Hope, published in December 2021, is clear about the Government’s ambition to achieve stigma-free treatment, providing the full, positive impact of treatment services for those seeking help. But, noting the potential harms associated with misuse of these substances, we believe it is necessary to take action to restrict access to these drugs and reduce their misuse. Through the drugs strategy, we are investing more than £2.8 billion over three years to support people through treatment and recovery, which includes support for those who have used a range of drugs and suffered various health harms.
Of course, key to all this is reducing the demand for drugs. We are committed to reversing the rising trend of drug use in society, to protect vulnerable people from harm and exploitation. It enables us to keep our communities safe and we must therefore reduce the demand for drugs, which fuel violence and exploitative criminal markets. Around 3 million people in England and Wales report using drugs each year, putting themselves at risk and driving a violent and exploitative supply chain, including through so-called recreational drug use. Through programmes announced as part of the drugs strategy, such as drug testing on arrest, and our plans to roll out pilots to change behaviour and attitudes towards drug use, we will provide the powers and access to appropriate interventions and support. We also know that we need to step up action in addressing the visible forms of drug use within our communities, so we will work with our enforcement partners to see what more we can do to tackle this, while ensuring that those who need treatment and support are diverted into the appropriate services.
The noble Lord, Lord Allan, asked a very specific question about remimazolam. There are no known established legitimate uses for any of these substances except remimazolam. The Government recognise the importance of ensuring that that in particular remains available for legitimate and lawful purposes, so in line with the recommendations from the ACMD, remimazolam will be placed in part 1 of Schedule 4 to the 2001 regulations, as I said in my opening remarks. That will enable lawful access in healthcare settings, subject to the requirements of the 2001 regulations. The remaining 19 substances will be placed in Schedule 1, as I mentioned, and access will therefore be permitted only under a Home Office-controlled drug licence. That will ensure that organisations can still lawfully undertake research with these substances, should they choose to do so.
On the specific question about paramedics, that is a Department for Health situation: it would have to request that paramedics be able to prescribe or use this drug in the appropriate way. I hope that answers the questions that I have been asked and, again, I thank both noble Lords for their participation in this debate. These are dangerous substances with the potential to cause significant harm, and they should therefore be subject to the strict controls under the 1971 Act. With that, I commend this order to the Committee.
Lord Ponsonby of Shulbrede (Lab)
I specifically asked about the Glasgow drug consumption rooms and whether there is a UK oversight of the way they are operating, rather than just a Scottish Government oversight.
Lord Sharpe of Epsom (Con)
With apologies, I forgot that question and, as it happens, I also do not know the answer—so I will have to find out and write to the noble Lord.