Thursday, 22 September 2011

My speech to the fringe event on cannabis regulation

This is an edited version of the speech I gave to the fringe event "Legal regulation of the cannabis market: How, why and when" yesterday:

I said in my speech proposing the drug motion on Sunday that the documentary Killer in a Small Town was a major inspiration for me in my drug policy campaigning, but I do also have another personal motivation for my work that stems from my family's experience of insanity. I have a brother with schizophrenia and the effect of that upon my family is a major motivation in my wish that the government control and regulate cannabis. The science suggests that those who smoke cannabis have around a doubled risk of psychosis. There is a lot of debate about whether this link is causal or just correlation. Psychiatrists will tell you it is causal. Users will tell me that it is correlation often combined with some degree of personal abuse in my direction.

My position on the matter is that it is much better to be safe than to be sorry. I have a Masters degree in Neuroscience. I have read the evidence and find the causation explanation both biologically plausible and the best fit to the epidemiological data. If we sold cannabis from pharmacists then, even if it the relationship was mere correlation, an individual with a doubled risk of psychosis would be armed with the knowledge to identify the early warning signs in both themselves and their friends. If customers experienced problems with their use it is my hope they could go back to the pharmacist and be diverted onto other strains or encouraged to abstain if necessary.

I have settled on pharmacists and not coffee shops. The Dutch coffee shop model is absolutely not one we should follow. The continued illegality of the supply chain to these coffee shops means that they are generally controlled by organised crime groups. This is obviously not a satisfactory endpoint for regulation. But even if we regulated all aspects of the trade, if I am slightly offended by the sight of a cannabis outlet in an otherwise charming street in Utrecht, how would the genuinely conservative members of our society respond to it?

Why should cannabis be the first drug for which full legal regulation is proposed? It is pure political expediency. Myself and colleagues commissioned a poll last year which asked 2000 people whether they would prefer a variety of drugs were lightly regulated like alcohol and tobacco, were prohibited as they are now or were strictly controlled and regulated by the government.

The strict control and regulation measures described included things like pharmacy sale, age restrictions and bans on branding and marketing, prices set by an independent panel in order to maximally undermine criminals and yet deter use. Full education on harms given before people are permitted to use for the first time, and manufacturers, distributors and retailers competing for government contracts with profits directed into drugs treatment and education programs.

Cannabis came out very clearly as the currently illegal drug that people wish to be regulated by the government. 33% wanted it lightly regulated. 37% wanted it strictly regulated, making 70% in favour of legal regulation in total. The next most favourable result was Magic Mushrooms with 52%, while ecstasy had only 39% in favour of regulation. A much higher proportion for legal regulation than ever found in traditional polls, but not ready for the next step. The most striking thing in the cannabis figures however was the fact that regulation was appealing to many of the people you would presume would bristle at the thought of legal cannabis. Totals for legal regulation for conservatives were 67%. Daily Mail and Express readers 66%. When you break it down to examine those in favour of strict regulation, it becomes very interesting indeed. 42% of women favoured strict regulation, to only 32% of men.

The newspaper readership group most in favour of strict regulation. Any guesses?... The Daily Mail and Express at 41% support.

The single demographic group most favouring strict regulation... 35-54 year old women. Presumably the group containing the most mothers of teenage children. They understand that prohibition isn't working and strict regulation presents the best opportunity to restrict children's access to the drug. And we should be absolutely determined to do so. While adult risk is doubled if they use cannabis, under 15s who smoke regularly are thought to increase their risk of subsequent psychosis by 5-fold. The benefits of strict regulation don't need to be explained to these women. They can just look at a policy proposal and recognise its potential.

I'd like to pan out slightly at this point and look at the international picture.

The Americans look like they are going to be the first to legalise cannabis, and I really hope they are not. Looking at the Proposition 19 ballot that was narrowly rejected in California, there was nothing in it that suggested health harms should be taken seriously at all. I think this is a grave mistake.

I was talking to some researchers from the American RAND corporation at a conference in the Netherlands this summer, and they were saying that if they legalised cannabis the price would reduce by 80%. This creates some real problems. If they want to tax the drug sufficiently so that the price of it doesn't plummet, creating a presumed increase in use rates, then they risk retaining a massive black market in cannabis. Americans culturally just instinctively don't like strict regulations getting in the way of the market.

In the UK though, I'd hope that we could recognise that this experiment with legal regulation necessitates really strict control. I would be happy to see the state growing the plants, distributing them to pharmacists and using the proceeds for education and drug treatment. I am uncomfortable with there being anyone in the business who has a financial incentive for people to use more cannabis or for young people to start using. If there is that 80% gap in the UK market too, then we could spend an awful lot of money on regulating the market and still raise a fair bit of tax on top before we came close to failing to undercut the criminal dealers.

On the issue of the drug conventions. The more careful we are, the less the UN would be able to object to our measures. If we say that our state is going to grow all these different strains of cannabis securely for restricted sale to only those who are fully educated on health harms, then they might find it hard to say no. We have to go up to the UN and say these conventions are restricting our ability to protect our citizens from harm. As I said last year, the argument “the people of Britain would like to get high” isn't quite so persuasive. There are of course important medical issues to consider, and I would certainly welcome the day when people with serious medical conditions can use cannabis for those reasons.

The control and regulation process could work to get cannabis farms out of suburban houses, stops Chinese and Vietnamese gangs smuggling in child slaves to tend plants, reduce the proceeds for organised crime, and vastly increases public knowledge of the early warning signs of psychosis. If evaluation indicates a relaxation of the strict regulations would better reduce harm then those steps should be taken.

I think the new legal market could compete on price, quality, predictability of dose, choice and ethical considerations. We may have to seriously consider issues of convenience (a pharmacist is often going to be further away than a dealing neighbour or the plants you are growing in your basement), and stigma (do we need to give cannabis users pads of things that look like prescription sheets so that they can hand them over like everyone else does in a pharmacist and receive the drug in a closed bag)?

To finish, I just want to emphasise again that cannabis regulation has to be about reducing harm as far as is practically possible. It would be pure folly to start at the level of regulation we have for tobacco just to see how it goes. How we deal with all of our drugs from alcohol to heroin, to energy drinks that are attractive to children needs to be looked at.

But if the UK could demonstrate it is possible to strictly control and regulate cannabis effectively I think the world could breathe a sigh of relief and reap massive benefits from following our example.

Saturday, 3 September 2011

Tackling Corruption in Football has to Start on the Pitch

I don't like cheating, and like all football watchers I particularly don't like cheating when it happens against my team (like this diving **** in today's European Championship qualifier But what I particularly dislike is the attitude of the game's governing bodies towards cheating, and their failure to punish it in any way, thus sending the message "cheating is fine if you do it well". Instant review systems are employed in a variety of other sports in order for matches to be settled by skill, chance and all those other things that make sport interesting, but not by the mistakes of officials.

In top flight televised matches we could surely have an appeals system for contentious decisions without too much problem, and such a system could have been very useful in the case of the diving **** linked to above. But the system should also be used retrospectively after the end of matches. I propose the use of "Proper Sporting Effort" Commissions (the potential for a suitably stigmatising acronym is of course entirely coincidental) who would be tasked with the review of all tapes after games and the distribution of suitable punishments for A) Simple simulation where no contact has been made B) Going down easy (tested by the simple question "would the person have fallen over there if they were being chased by a hungry bear/zombie/father of a groupie?") C) Making deliberate contact with the tackling player where that contact would not have happened if the suspect had continued running normally or taken appropriate avoiding action. I do hope C) could become known as Lambert's Law because of the grievous assault Paul Lambert was subjected to by Jorg Albertz in a 1999 Old Firm game (video here medical report here: This particular "dive" left Lambert unconscious and knocked out a tooth or two but of course was punished with the award of a penalty to the offending player (12 years ago now and the memory of the injustice is still fresh).

I leave it up to the authorities to decide what would be appropriate punishment. Admittedly if it were left to me I would probably prescribe something between a year's ban from competitive football and jail time for the afore-mentioned Czech diving ****. And if you'd asked me a few hours ago the sanction could well have been a sight more medieval.


Cheating should not be so handsomely rewarded. It should not be "just part of the game" at any level.

Wednesday, 17 August 2011

It's time for the UK government to fully review drug policy

It is possible to access the full text of my BMJ "personal view" article "It's time for the UK government to fully review drug policy" through the link below.

I hope to have further articles in The House magazine and Liberator before conference. If anyone would like me write any other articles then I'd be happy to consider opportunities.

You can also read my views on the association between drug policy and the recent riots and looting here (I didn't approve the title)

Friday, 22 April 2011

If the No campaign is in the gutter, the Yes campaign has to go for the gut.

This has been a hugely frustrating campaign for me. I was passionately advocating for AV even before the election last year and am sorry to say that the Yes campaign has been a great disappointment. The No campaign is trotting out outrageous lies about how much AV will cost, the end to one person one vote and the implication that in a two-person race the loser could win (amongst others. They really have no shame). In response to these false, but highly emotive claims, the Yes campaign has been trotting out wooly assertions that "AV will make your MP work harder" and "AV will mean an end to safe seats", without presenting any great evidence that this will be the case.

If I was to be leading the Yes campaign, I would be trying to engage the voters' guts, to evoke in them an outraged visceral response to injustice. But unlike the No campaign, I think I could do it with the truth.

So what is that truth? The truth is that after First Past the Post elections we don't actually know the population's true political opinion. In 2010, 16% of voters voted for a party or candidate that was not their favourite. How can we call ourselves a democracy if our citizens' votes are disproportionately represented and on top of that our citizens' votes do not even represent their opinions? FPTP encourages the electorate to second guess the behaviour of others and to LIE in the polling booth. If we want a properly functioning democracy, we have to have an electoral system which encourages the citizens to express their true opinions.

Perhaps the Yes campaign have rejected this argument as only 24% of people have ever voted tactically, but surely there is a deeper sense of justice in the country that can be tapped into. Surely people don't want representation born out of their neighbour's deception. It's time everyone came clean, put their political cards on the table and we found out what kind of country or constituency we all want to live in.

An auxiliary argument to this is the fact that FPTP prevents rapid change. The expenses scandal heralded a renewed disgust among the population at the behaviour of their politicians, but FPTP holds us rigidly in a two-party (or three-party) system. Maybe it is time we had new parties or independents with new ideas entering into politics and widening choice and diversity. Consider if, under FPTP, the most wonderful new party that was all things to all men (and women), had all the right policies to make Britain great, and was just plain perfect strode on to the scene. That party would find it extremely difficult to overcome the wasted vote, "they can't win here" effect.

AV allows people to vote honestly for the party of their choice, no matter their electoral history. It allows us to sweep out the old guard and usher in the new. Politics can be fast, and dynamic, and INTERESTING. Single issue parties can arrive on the scene and force politicians to take notice and respond to their concerns. Everyone knows where everyone stands, so politicians can be genuinely responsive to the needs of the people.

In short, AV is democracy. FPTP is not. If the No campaign is in the gutter, the Yes campaign has to go for the gut. If we don't, I fear we lose.

Sunday, 6 March 2011

"Overshadowing" Nick Clegg's keynote speech

The Scottish Sunday Express this morning reported the Scottish Lib Dems' unanimous backing of the amendment I had written on diamorphine maintenance treatment.

Here's the speech I gave in support of the amendment, followed by the letter to the Express in reply to their coverage and the quotes from the other parties:

It is first important to place this motion in its proper context. The UN Office of Drugs and Crime report Scotland as having the highest prevalence of opiate use in Western and Central Europe. Drug related death rates here have doubled since the late 90s and are on a long-term upward trend. Scotland, with one of the worst heroin problems in the world, needs one of the best drug treatment systems in the world in order to combat it.

The persistent offenders project in Glasgow is a great example of police and addiction workers working together to produce positive results. POP identifies those addicts who commit the most crime and takes the time to engage with them and work through their problems. Savings of £14 to society for every £1 spent can not be ignored. In talking to one of the project leaders this week, I was delighted to hear there are plans to extend this outreach service to tackle street prostitution. These young women experience horrendous suffering in their daily routine. A civilised society can not stand back and let them endure it. The police and a drugs project working together managed to eradicate street prostitution in Ipswich after the tragic series of murders that happened in 2006. We have to believe that we can achieve the same in Scotland.

Projects like POP can only go so far though. There will always be a significant group for whom methadone or abstinence will be unattractive or ineffective. Switzerland, Holland, Germany and Denmark have all adopted heroin maintenance clinics in order to target this difficult population. Switzerland adopted the policy in the early 90s. In the referenda that have challenged the policy, the people have consistently backed the policy by large majorities. It is both effective and popular. The UK trial of this system was also a success, with substantial reductions in criminal activity and street heroin use by the participants. This model that is spreading is typically of twice daily supervised consumption on clinic premises, with no risk of the diamorphine that is prescribed getting out on to the streets. The routine of this treatment and its associated psychological, social and employment assistance creates stability in previously chaotic lives and often leads to patients moving on into other treatment options or to abstinence.

We need services that don't allow the most problematic or vulnerable drug users to slip through the cracks. And we need the best evidence-based treatment options so that we have the best chance of helping them to recover. Putting these services in place will save the lives and alleviate the suffering of a great many drug addicts, but also of great importance is that the more heroin users we treat, the less impact they will have upon Scotland's communities. By treating addicts we can reduce the viability of drug-dealing in our communities, we can greatly reduce the acquisitive crime committed to fund drug use, and we can reduce the likelihood of more young people getting drawn into the same mess.

We have a choice. We can spend a relatively small amount in tackling Scotland's drug problem head on. Or we can let addicts steal, prostitute and deal to meet the massively inflated prices of the criminal market. This money lines the pockets of organised criminals and a proportion finds its way to the Taleban, which gets approximately 50% of its income from the heroin trade. 89% of the world's illicit opiates come from Afghanistan.

Please choose the cheaper option and support this motion.

and the letter to the Express:

The statements from the other parties regarding the Lib Dems' plans to
provide diamorphine maintenance clinics demonstrate just how hard it
will be for Scotland to tackle its very serious heroin problem. It is
laughable for the SNP to recommend we "stick to proven methods" when
drug-related deaths have doubled in the last ten years and Scotland
has the 6th worst heroin problem in the world. Labour allege "blanket
provision" and "very limited trials", when in reality this service
would only be available to at most around 10% of the most disruptive
and vulnerable heroin addicts. All the trials of this approach have
shown it much better than methadone in reducing crime and street
heroin use, and the many European countries that have adopted it as
policy have found it both effective and politically popular.
Diamorphine maintenance IS a recovery programme and it frequently
leads to abstinence. I suspect what society wants most is for
politicians to adopt the most effective way to stop heroin users
robbing from the people to give to organised crime and the Taleban.
They want street prostitution eradicated and they want their children
to be safe from pushers. All the evidence suggests that the best
diamorphine maintenance services can help achieve these goals.

If any candidates want to discuss going on the offensive with this, then please let me know.