Psychoactive Substances Bill [HL]

Baroness Hollins Excerpts

Tuesday 9th June 2015 Lords Chamber

[Baroness Hollins (CB)]

My Lords, the Bill defines a new psychoactive substance as any substance intended for human consumption,

“capable of producing a psychoactive effect”.

It describes a substance causing a psychoactive effect on a person as,

“if, by stimulating or depressing the person’s central nervous system, it affects the person’s mental functioning or emotional state”.

I speak as someone who has been a psychiatrist for many years, although this is not my field of psychiatry. However, alcohol produces this effect. Antihistamines for hay fever do, too, as do many of the most helpful medications for neurological disorders such as multiple sclerosis. In fact, many medical drugs also have a value on the street, being taken by those seeking their psychoactive effects. Will future novel versions of these medicines also be banned before they have been through a definitive clinical trial? Will those trials even be allowed to take place? The Minister said yes they would in his opening words but many researchers have written to express concern that without dramatic revisions to the Bill such research will not take place and people with neurological disorders may be the poorer because of that.

According to the Home Office briefing, there was a doubling of NPS-related deaths in England and Wales between 2009 and 2013, from 26 to 60. However, even this low number of deaths is disputed by scientists. I have read statistics that put the number both higher and lower. That may be because of the inclusion of substances that if analysed would be found to contain illegal components, or due to different modes of reporting. Interestingly, the Home Office impact analysis expects to reduce the deaths caused by NPS by only 12 per year. I will return to that later. Although the use of new psychoactive substances is clearly growing, the evidence remains unclear about how many deaths are directly related to NPS. I suggest that that must be better understood before the law is changed, as must the infrastructure required to implement such a change in the law.

Ireland, along with Poland and Romania, tackled NPS through a general prohibition on the distribution of non-controlled NPS. The Irish Republic’s Criminal Justice (Psychoactive Substances) Act 2010 was enacted to target the proliferation of high street retail premises selling NPS. It is aimed at those involved in trading in NPS rather than users. Following the Act, as we have heard, the number of retail shops fell from 102 to virtually zero, which seems a good outcome. The expert panel convened by the Government concluded that the Irish approach,

“best addressed the key elements of the guiding principles that should be in the Act”.

Would Her Majesty's Government not consider that approach instead of seeking to prosecute the users—with, probably, the added effect of filling up Her Majesty’s prisons, which, after all, are already at capacity?

The policy objective is to reduce the harms caused by and associated with NPS while ensuring that the UK’s response to NPS is proportionate. Intended effects are largely to end the legal sale of NPS from high street stores and UK-based websites, to increase public awareness and to reduce harmful effects. In its own analysis, the Home Office expects that approach to save nearly £21 million from around 12 fewer fatalities a year. It is not clear to me how it produced that estimated saving. It is not from health costs, since the impact assessment suggests that around £200,000 per year would be saved to the NHS from fewer NPS-related hospital admissions. This gain appears to be a best estimate cost to the taxpayer of about £100 million. Surely that could not be considered proportionate. This is probably not taking into account new costs for the criminal justice system.

I wonder whether the Bill could have a disproportionate effect on young and/or vulnerable individuals, such as those with mental health problems. As a psychiatrist, I am aware that late adolescence and early adulthood are times when young people take risks in order to learn the safe boundaries of life. For some, this will include the use of NPS. This Bill is unlikely to change the human psychological developmental process; people will find a new way to experiment, or a new vice—and I guess they will always be ahead of government in that.

I welcome the increased focus on the hazards of NPS. I recognise the small but significant risk of adverse effects, including severe toxic reactions or overdose, heart irregularities, organ damage, psychosis and longer-term physical and psychological dependence. A report by the Royal College of Psychiatrists last year, called One New Drug a Week, highlighted the issue of health services being ill equipped to deal with the rise in NPS drug use. It is vital that there is an increase in the capacity and range of specialist addiction services to aid those wishing to stop using any of these drugs, particularly those that are addictive. To establish that capacity itself would incur additional costs. Given the rapid rise in the number of people requiring treatment—a 32% increase between 2011 and 2013 alone—could the Minister confirm whether the Government will commit to ensuring that increasing treatment provision is a key part of their strategy to protect UK citizens from the risks posed by psychoactive substances?

I agree with some of the comments made by Professor David Nutt on this subject. He says:

“We know that at least 85% of the population like to use recreational drugs since this proportion drink alcohol”.

He said that the Bill may,

“force individuals who wish to enjoy the recreational effects of”—

what they consider to be safe drugs,

“to use alcohol”.

Professor Nutt suggests that that is a far more dangerous and societally expensive drug. Hazardous alcohol use has health and social consequences that impact on individuals, their families, and the wider community. In 2013 alone there were 20,000 deaths related to alcohol and it remains the leading risk factor for deaths among men and women aged 15 to 49 in the United Kingdom. Public Health England has identified harmful drinking as one if its seven priority areas. Despite widespread media campaigns to educate the public, such as the Drink Aware campaign, few gains have been made in adults. Statistics published just this month show a gradually increasing trend in hospital admissions specifically related to alcohol, with the highest rise being seen in women, and alcohol-related mortality remains stubbornly high at 11.9 per 100,000 in England between 2011 and 2013. Despite this, hazardous drinking remains socially acceptable and culturally defined.

I do not support the progress of this Bill in its current format. I wonder what the mood of the House will be and whether, as I suggest, the Bill should be delayed until there is good evidence that this approach could work, in particular by reviewing the Irish data for an alternative approach. An amended Bill is required, which is more specifically designed to tackle the importation and supply of new harmful psychoactive substances, not the individuals who take them. I ask Her Majesty’s Government also to focus their attention on the considerable harms caused by alcohol and not least to introduce the minimum unit pricing that has been campaigned for by many over the past few years. The BMA and the Royal College of Psychiatrists—I declare an interest as past president of both—believe that a minimum unit price would lead to a decrease in the thousands of alcohol-related deaths. This is not just a health issue but contributes to public disorder, domestic violence and homicide, as well as to suicide.

In closing, I want to say something more personal. If you appeal to my emotions as the mother of two adult children who were assaulted in separate incidents by assailants who had been using psychoactive substances, I might wish that all psychoactive substances are removed from the market, but from a more pragmatic and, perhaps, intelligent stance, I end with a plea that health-related policy must be evidence-based policy and part of that evidence must be to demonstrate the likely effectiveness of a new policy. I suggest that this Bill does not do that.