The following letter was submitted to the UK Parliament’s Home Affairs Committee as evidence for their inquiry into drug policy. It was accepted by the Committee and published on their website on April 20th. The inquiry website is available at https://committees.parliament.uk/work/6534/drugs/publications/.
I am a citizen of the United Kingdom with an interest in transparent and democratic policy-making. This submission represents my personal views and is independent of any organisational affiliations.
The policy-making process is complex, and requires balancing the perspectives of many different groups in order to develop policies which are successful in achieving their stated objectives. Drugs policy is particularly fraught in this regard, not least because of the moral dimensions around drug use. In an attempt to appeal to the sensibilities of the general public, policy-makers may pursue policies which are ineffective in combating, or even amplify the harms caused by, drug production, distribution, and use, rather than adopting best practice interventions with strong evidence bases. In order to ensure that future drug policy in the UK is truly effective, it is necessary to evaluate the state of current policy, and to determine how policy-makers can craft narratives which align effective interventions with the moral demands of the public.
Implicit in Dame Carol Black’s reports, and in the UK Government’s 10-year drugs plan, is the idea that drugs themselves are responsible for the harms caused by their production, distribution, and use. However, this is a reductionist assumption which is not in keeping with a whole system approach, because it does not consider the role that drugs policy itself plays in amplifying harm. When the 10-year drugs plan states that “this Government will combat illegal drug use” and “[reduce] crime” which is “[fuelled by] a violent and exploitative market”, it is important to remember that drug crime is de jure created by the Government making these markets illegal, and that it is the illegality of these markets which creates an absence of regulations which would prevent violence and exploitation. Both Dame Carol Black’s reports, and the UK Government’s 10-year drugs plan, are completely devoid of any acknowledgement of this fact, and no consideration is given for options outside of the historical and present trajectory of full criminalisation. Instead, the 10-year plan simply claims that “decriminalisation […] would leave organised criminals in control”, while providing no references to any evidence either for or against this claim. In contrast, a recent review of international cannabis legislation models (Ogrodnik et al. 2015) concludes that:
Repressive cannabis policies are expensive and have limited impact on consumption. Consumption legalization significantly reduces expenses for repression and law enforcement, allowing for the allocation of more resources to other targets such as education and prevention. With legalization of supply along with consumption, repression and law enforcement costs are reduced even further. Moreover, a legal market would create employment and generate tax revenues that could be allocated to the prevention of increased consumption. Legalizing cannabis would not lead to a sudden rise in consumption, providing the duty imposed by the state kept the product at its current price.
Given that different drugs create different harms, it would seem prudent to begin to unbundle drugs policy in the UK and to consider the creation of regulated, legal markets for drugs which cause minimal harm, such as ecstasy and LSD (Nutt, King, and Phillips 2010), so that fiscal, policing, and health resources can be focused on addressing the drugs which cause the greatest harms.
This approach of per-drug regulated legalisation presents many benefits to policy-makers, not least by providing them with a flexible policy framework through which to deliver targeted and effective interventions to reduce and prevent harms, bringing drug policy in line with alcohol and tobacco policy. However, it may be a tough pill to swallow for a public which has grown used to a hard stance on drugs and who interpret government policy and law – tools used to mitigate harm – as forms of moral statements. In order to create an amenable narrative around evidence-informed interventions, three changes to the current policy approach are required.
First, the Government must plainly state the problems it intends to solve, and the objectives it intends to achieve, with drug policy. In alignment with Dame Carol Black’s reports and the UK Government’s 10-year drugs plan, I believe an appropriate primary objective of drugs policy would be to reduce the personal and social harms caused by drug use in the most cost-effective ways. Such a statement brings focus and clarity to an otherwise controversial policy domain; points to metrics by which different policy options and interventions can be evaluated; and allows the Government to begin to concentrate public discourse and sentiment on the true, if slightly nuanced problem with drugs: drugs are not inherently bad, it is the harms caused by drugs which are bad.
Second, the Government must commit to a transparent appraisal and publication of all evidence considered as part of the development of drug policy. This will provide the public with the opportunity to scrutinise the Government’s decisions about particular policies; and allow the Government to showcase its commitment to adopting interventions which are demonstrably effective. Unfortunately, there is a considerable gap between the current practice and the ideal around evidential transparency. Neither of the two reports published as part of Dame Carol Black’s review of drugs contain any academic references of any kind. This is extremely troubling, because this lack of referencing makes it impossible to scrutinise the figures and claims stated in these reports. Data are not value-neutral, rather the methods through which data are gathered must be subject to inspection and scrutiny in order to ensure that the data are suitable for addressing the particular research question to which they are being applied. In other words, data and statistics can only be correctly interpreted with knowledge of the process by which the data have been gathered.
For example, in Dame Carol’s first report it is stated that “drug deaths in 2018 were the highest on record (2,917)” this immediately raises a number of questions:
- Which countries of the UK does this statistic refer to? Does this just cover deaths in England and Wales, or does this include Scotland and Northern Ireland?
- What is the provenance or origin of this data? Is this number derived from coroner’s reports, from reports by emergency services staff, from some estimation procedure by the ONS, or from some other mechanism?
- Is this the number of people who have died as a direct result of an overdose or other complication brought on by the use of illegal drugs; or does this number include deaths where people were found to have consumed some quantity of drugs, but where drug consumption is not necessarily a cause of death?
Dame Carol’s reports and the UK Government’s 10-year plan are both littered with dozens, possibly hundreds, of statements like these for which no references or citations are provided. This prevents consumers of these reports from performing further investigation and scrutiny, and from understanding the provenance of, and implications inherent in, the data.
On Sunday 13th February I filed a Freedom of Information request with the Department for Health and Social Care, for the release of all evidence used as part of the construction of Dame Carol’s reports. Unfortunately I have still not received a response to this request, over 35 days later, and due to the deadline for this call for evidence, I have had to submit this paper to you before I have received a response. This has prevented myself and others from being able to draw on the evidence base already assembled by Dame Carol.
Finally, the Government must ensure that transparent monitoring and evaluation strategies are implemented as a core part of all policies and interventions. This will enable the Government to course-correct any policies which are failing to deliver on the primary objective; and will provide the public with confidence that the chosen policies are achieving the intended aim of harm reduction. Although the current 10-year plan does mention monitoring and evaluation of several policies included in the plan, no comprehensive protocols are established, and it is not clear what metrics will be measured.
Nutt, David J, Leslie A King, and Lawrence D Phillips. 2010. “Drug Harms in the UK: A Multicriteria Decision Analysis.” The Lancet 376 (9752): 1558–65.
Ogrodnik, Marysia, Pierre Kopp, Xavier Bongaerts, and Juan M. Tecco. 2015. “An Economic Analysis of Different Cannabis Decriminalization Scenarios.” Psychiatria Danubina 27 Suppl 1 (September): S309–314. https://pubmed.ncbi.nlm.nih.gov/26417786/.