Drugs

Baroness Hollins Excerpts

Thursday 17th October 2013 Lords Chamber

[Baroness Hollins (CB)]

My Lords, as my noble friend mentioned in her excellent opening speech, a report entitled Drugs of Dependence was published by the BMA’s Board of Science earlier this year. I declare an interest as the current chair of the Board of Science. The report sought to contribute to the debate on drug treatment and drugs policy through the eyes of the medical profession, and I wish to draw special attention to the role of doctors in our debate today.

The Chief Medical Officer, Dame Sally Davies, agrees that drug abuse should be treated more as a public health problem than as a criminal justice concern. She has said:

“We have a health problem, and we would do well as a nation to look at it as a health problem”.

But the lead for drugs and alcohol policy is the Home Office, and this Government are choosing to continue to treat it in that way. Can the Minister comment on this?

Professor David Nutt, the former chairman of the ACMD, told the Home Affairs Select Committee that drugs should be decriminalised and compared the harm caused by illicit drugs to that of alcohol. He said that,

“what we see now is a rising, rising, rising tide of damage from alcohol. There is no doubt a lot of people drink because it is legal and if there was an opportunity to use cannabis in a coffee shop-like model, they would not drink”.

However, Dr Clare Gerada, giving evidence to the committee as chair of the Royal College of General Practitioners and a former member of the ACMD, said that, in the case of cannabis, there would be significant direct health harm from decriminalisation, and that:

“Cannabis is not a … good drug to be on. It causes lung cancer. It causes oesophageal cancer. It causes failure at school”.

She reminded the committee that cannabis is very addictive and said that she would not advocate any person using it. She went on:

“We have just spent the last 60 years sorting out tobacco, let us not drop in the same problem now with cannabis”.

Clinicians all encounter the effects of drugs on their patients, whether they work in a hospital as a cardiologist, as a GP, a psychiatrist or as a public health doctor. There is consistent evidence that, in primary care settings, in hospitals and in mental health settings, doctors frequently do not address drug use. For example, a history of drug use is seldom documented, even when a patient presents with symptoms which suggest that drugs may have been used. What could be the reason for such a lack of documentation? One possible explanation for the reluctance of some doctors to explore drugs use is pessimism about being able to do anything.

The medical frame of reference is a useful one in which to approach drug use. Doctors are trained to be non-judgmental, factual and professional, and should be well positioned to provide information and advice and monitor progress. We have heard already today, and read in the BMA’s own report, that health should be at the centre of drug policy. Let us consider then how the medical profession could take a greater role in tackling the UK’s problem with drugs, recognising of course that the number of drug-related deaths has been falling steadily during the past few years.

The health and social impact of drug use is multifaceted, but I want today to highlight one area of impact: the mental health of drug users. A report from the UK Drug Policy Commission in 2012, A Fresh Approach to Drugs, highlighted that people who use illicit drugs have an increased likelihood of mental health problems, and vice versa. A study of people attending community mental health and substance misuse services found that 30% of those attending reported using drugs in the previous year and that 75% of those attending a drug service had had a psychiatric disorder in the previous year. These figures are very concerning, but the nature of the relationship is still unclear and varies between different drugs.

There is substantial research evidence that heavy cannabis use by adolescents increases the risk of depression and schizophrenia in later life, especially for those who already have a vulnerability to develop a psychiatric syndrome. This is compounded by concerns about the increased availability of stronger strength cannabis and synthetic cannabinoids, which are more harmful to health and more likely to cause psychosis.

Two of my children have been seriously assaulted by men who had been using cannabis. The man accused of stabbing my daughter had reputedly taken large quantities of stronger strength cannabis, with alcohol and ketamine—a cocktail—with devastating consequences for my daughter and for himself: he later committed suicide.

I have spoken about mental health, but I return to a key point that I mentioned earlier on how we can reduce drug-related harm: all doctors have an essential role to play in tackling the use of illicit drugs. Doctors from every part of the health system can improve their rates of intervention by opportunistically screening patients and identifying those with drug misuse. Commissioning the right services will be key to ensuring that adequate clinical pathways are available to patients. Education and training will be vital. The Royal College of Psychiatrists, with the Academy of Medical Royal Colleges, has reviewed the competencies required for doctors in relation to alcohol and other drugs to ensure that medical training gives adequate weight to every doctor’s role in this area. All royal colleges have committed to including these competencies in their curriculum, which is an important step.

Debate on the most effective approach to preventing and reducing the harms associated with illegal drug use must be based on sound evidence. Health impact is integral to that debate.