Congress Struggles To Come Up With Cool Name For Anti-Drug Initiative

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Congress Struggles To Come Up With Cool Name For Anti-Drug Initiative

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Police remain calm during meth panic

Methamphetamine, a drug that has caused substantial problems in many countries, notably the US, Canada and much of SE Asia, has yet to have the same impact in the UK. Indeed Alan Travis reports in the Guardian, that according to the police, the epidemic has yet to arrive on these shores to any significant degree.

His column thankfully doesn’t contain the more familiar emotive assertions and scare stories that we have witnessed from many other journalists over the past few months as the meth panic has been gathering pace. As with so many previous drug panics, the hype surrounding methamphetamine isn’t helpful at coming up with sensible policy responses. It tends to distort reality and push policy makers towards populist tough measures regardless of the consequences or evidence of effectiveness. See here for a Transform ‘how to…’ of creating a drug panic.

The meth panic has all the characteristics of previous drug panics, from crack in the late 90s, PCP and cocaine in the 80s, and going back further, cannabis in the 40s and 50s and alcohol during the height of the temperance movement. Much of the same language is used, typically deploying stories of crazed addicts, imbued with superhuman strength (grannies throwing police out of windows etc) immune to bullets, on sexual or violent rampages and so on – Even though such tales in no way describe the vast majority of using behaviours, it makes a good story, as lazy journalists and politicians have discovered.

This particular panic has resulted in political activity ranging from a high profile but almost certainly pointless reclassification, to the consideration of banning Lemsip. Whilst debate and action on the meth issue is welcome (the fact it hasn' t happened yet doesn't mean it wont at some stage, a lesson we learnt with crack), the epidemics in the US and Canada unfolded despite a schedule 1 classification and all manner of tough talk, rather demonstrating the irrelevance of such enforcement-led responses. Such political posturing ends up providing a smokescreen for more important problems – such as why we have drug epidemics in the first place, how to deal with the root causes of such problems and how to prevent them, and what are the appropriate public health responses for problem users.

ACPO suggest that methamphetamine is not yet a problem in the UK because of the increasingly cheap and available supply of cocaine. The low number of crystal meth users in the UK is more likely because demand for stimulants more generally is met by the existing and well established amphetamine market. Needless to say decades of enforcement have demonstably failed to have any meaningful impact on the price and availability of either cocaine or amphetamines. There is therefore to believe an enforcement response to meth, if and when it does arrive, would be any more successful.

Parliamentarians don’t support Reclassification of Pseudoephedrine

Below is copied a press release issued jointly by two all party parliamentary groups (drug misuse and primary care and public health) this week calling for the MRHA not to reclassify over the counter medicines containing ephedrine and pseudo ephedrine as prescription only.

This follows on from the recent kerfuffle about the dangers of cold remedies, such as Lemsip and Sudafed which contain the drugs in question (albeit in relatively tiny doses), being used in the illicit manufacture of meth amphetamine. As discussed here the recent War on Lemsip blog such a move would be largely gesture politics, and have no discernible impact on the production supply and use of meth amphetamine. As we have seen over the past century's experience of trying to prohibit drugs that are in demand, such moves will always fail. If there is profit to be made then illicit markets will always find a way to produce and supply.

Curiously though, in the UK at least there is no such demand. Methamphetamine use is relatively insignificant, with demand for stimulants being more than met with the more familiar amphetamine market (as well as other stimulants like cocaine and crack). Indeed the difference from a public health perspective between amphetamine and meth amphetamine is very little. Meth may be more potent and longer acting but of course there is nothing to stop the amphetamine user taking bigger doses more often. If banning lemsip etc is supposed to nip the problem in the bud then policy makers in the Home Office and MHRA are deluding themselves. Such moves have been tried in the US and shown to be completely ineffective. Similarly making the drug Class A as happened recently in the UK will be entirely ineffective as discussed on the blog here.

There is a danger here that we are buying into a classic drug panic. It is interesting to note that the language and discourse of the nascent meth panic is almost identical to previous drug panics, indeed apart from the drug name itself the latest accounts of misery, addiction, depravity and death associated with meth are virtually indistinguishable from those in the 90s associated with crack, the 70's and 80's with cocaine and PCP. Going back further still they are not that different from cannabis in the 30's and even alcohol in the 20's.

The parliamentarians are to be applauded for having the pragmatism not to throw the baby out with the bath water, and prevent legitimate access to everyday medicines because of a largely politically driven panic about an as yet non-existent problem.

Meth: coming soon to a drug den near you (maybe)

ALL PARTY PARLIAMENTARY GROUPS
Primary Care and Public Health
And
Drugs Misuse

Joint inquiry: Proposals to restrict the availability of medicines containing ephedrine and pseudoephedrine


Parliamentarians don’t support Reclassification of Pseudoephedrine

The Joint Inquiry Report into proposals to restrict the availability of medicines containing pseudoephedrine and ephedrine by the All Party Parliamentary Group on Primary Care & Public Health and the executive members of the All Party Parliamentary Drugs Misuse Group has been submitted to the MHRA in response to their consultation MLX 337. It has also been sent to Health Ministers and the Home Office.

The inquiry, which also held an urgent oral session on 18th April 2007, received evidence from multi-stakeholder organisations including patient and consumer groups, Drugscope (the drug charity), law enforcement agencies, MHRA, medical bodies and industry. Organisations that supported the MHRA proposal to reclassify medicines to POM were the BMA, Nursing & Midwifery Council, ACPO and of course the MHRA, the majority of evidence received however were opposed to the reverse switch.

In the Inquiry Report, the two Groups concluded that the evidence received by the law enforcement agencies and MHRA was not sufficient to justify the reclassification of medicines containing ephedrine and pseudoephedrine to prescription only. This is especially the case, according to the Groups, because the controls that are currently in place in the UK are similar to those that exist in countries where there is an acknowledged methylamphetamine problem.

The Groups recommended a mixture of statutory and non-statutory controls:

• reduce OTC medicine pack sizes to contain a maximum of 720mg through statute
• limit the sales of products to one pack per person
• tighten the pharmacy control of these medicines by working with the pharmacy profession to strengthen their vigilance in sale and supply
• ensure the monitoring of the situation on a regular basis by a stakeholder group including law enforcement agencies, MHRA, pharmacy and industry, enabling a quick response should the situation change to a high risk of harm.

The Groups also feel it is essential that the Department of Health and the Home Office consider using the Misuse of Drugs Act to add further controls, similar to those implemented in the US, to criminalise the possession or supply of quantities of pseudoephedrine greater than those required for normal use.

For further details please contact Libby Whittaker who provides the secretariat for the All Party Parliamentary Group on Primary Care & Public Health on 020 7421 9318 or email libby.whittaker@pagb.co.uk

The War on Lemsip

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The war on drugs is what Donald Rumsfeld would describe as 'multi-theatre warfare,' a battle being fought on numerous fronts. As well as the serious action in the Andes, Central Asia and our own crime-riven inner cities, there are a series of mini-skirmishes that should not be overlooked. On the Transform blog we've recently seen the war on hemp gummi-bears and the war on wheelie-bins, but it seems a new a new front could be opening in the endless struggle against the scourge of drugs:

be afraid

Health Minister Caroline Flint in response to a PQ from Mark Todd MP, said this:

There has been increasing concern from the Association of Chief Police Officers (ACPO) and the Serious Organised Crime Agency (SOCA) that pseudoephedrine and ephedrine can be extracted from over the counter (OTC) remedies relatively easily and used in the manufacture of methylamphetamine. Methylamphetamine was reclassified on 18 January 2007 by the Home Office as a Class A controlled drug, based on the recommendation of the Advisory Council on the Misuse of Drugs (ACMD).

Although the prevalence of misuse of methylamphetamine is believed to be currently low in the United Kingdom, ACPO are receiving increasing levels of intelligence about the prevalence of methylamphetamine. If methylamphetamine did secure a hold in the UK, the consequences would undoubtedly be very serious. The international experience shows that misuse can spread rapidly when certain conditions prevail and the advice of UK enforcement authorities is that most of these conditions now prevail in the UK.

In January 2007 the Commission on Human Medicines (CHM) considered the evidence of a risk to public health from OTC availability of the precursors to methylamphetamine, pseudoephedrine and ephedrine. The evidence to date centres on advice from ACPO and SOCA that the availability of methylamphetamine is increasing, evidenced in part by the increase in the number of illicit laboratories manufacturing methylamphetamine found by the police in the UK. The police have identified in specific cases that multiple packs of particular pharmacy pseudoephedrine containing products had been purchased and used in the illicit manufacture of methylamphetamine. They have also identified that, in part, these packs were obtained from numerous pharmacies to obtain adequate quantities for manufacturing.

The CHM recommended that changing the legal status of pseudoephedrine and ephedrine together with restricting the pack size was necessary to protect public health in the UK and that a consultation exercise should be conducted on these proposals. Ministers accepted this advice and a full public consultation exercise commenced on 7 March 2007 and can be accessed via the MHRA's website at: www.mhra.gov.uk

It's interesting that the media (including the Guardian, the Telegraph, and the BBC) have all jumped on this story today, when almost the exact same answer was given by Home Office minister Vernon Coaker to a question by Brian Iddon MP on March 21st, but went unreported.

Anyway, as ever there's a pointlessness about this latest proposed drug crack down, rather like the efforts of one over-enthusiastic US drug warrior who has been trying to restrict access to baking soda because it is used to make crack.

Ephedrine is widely available online , marketed as a stimulant (sometimes as a 'legal high' in the club/party scene) or 'diet aid' as it is apparently also a appetite suppressant. One of its isomers is pseudoephedrine which is a decongestant that appears in loads of cold remedies and decongestants like sudafed. Whilst cold remedies certainly have been used to manufacture meth, it is widely reported in the Russian federation for example, it is almost always going to be a small-scale user-led enterprise, with larger scale production avoiding all that messy syrup or annoying little sachets by using easily accessed bulk pharmaceutical supplies.

It is safe to say that restricting the availability of cold remedies will have absolutely no impact on meth production. None. Zero. Even if products containing ephedrine or pseudoephedrine are moved behind the counter in pharmacists, or even made available only on prescription it is impossible to see how this will stop evil meth manufacturers getting there hands on it. Initially, unless it is brought within the Misuse of Drugs Act, it will still be available on the grey market for import or via online sales - as are many 'drugs' that hover in the rather confused quasi legal world of 'lifestyle drugs' like steroids, viagra and so on.

Quite aside from this rather laughable attempt to be seen to be 'doing something' with regard the threat of methamphetamine, it needs to be acknowledged that even if, further down the road, ephedrine and pseudoephedrine are totally prohibited this still wouldn't make any significant difference to meth production. There are already loads of so-called precursor chemicals used in drug production that are prohibited by UK and international law, but that has evidently has not prevented their use, as demonstrated by the increasing supply and availability of heroin, cocaine and ecstasy, all of which are now cheaper and more available than ever before.

If the demand is there and the profits are there (and they clearly are), the drug manufacturers will always find a way, such is the reality of supply and demand within the totally unregulated market for illegal drugs. If precursors become harder to get, the price rises until it becomes worth someones while to smuggle them as well - the illicit precursors market follows exactly the same market rules as the drugs, and efforts to prevent there use have failed in a similar fashion. If production becomes problematic in one location it can always shift to another more conducive one, since international crime syndicates, illicit production and illicit profits have few geographical constraints.

This latest pitiful effort to prevent the much feared, but yet to materialise, meth apocalypse also suggests that despite all the tough talking bluster back in January, the Home Office is perhaps less than 100% confident that reclassifying meth to Class A will have the desired deterrent effect (as discussed on the blog here).

Meth is Class A - we can relax now.

So methamphetamine is, as of yesterday, a Class A drug. Well thank heavens for that, now we have nothing to worry about.

I am reliably informed that all the people who were really looking forward to trying it as a Class B drug have decided its just not worth the risk – the idea of 7 years in prison instead of a mere 5 was just too serious a worry. They are going to stick with old-school Class B amphetamines instead (but take twice as much).

And as for all the meth dealers and producers who before yesterday were lining up to cash in on the imminent meth epidemic, they too have apparently decided it’s just not worth the risk of life in prison and an ‘unlimited fine’ for nasty Class A dealing, and have decided to quit the life of crime go straight instead. Its just not like the good old days when meth was pansy-ish Class B and all they had to worry about was a piffling 14 years in prison and measely ‘unlimited fine’.

British kids saved from the meth epidemic by reclassification, photographed this-morning:



Hmmm. Maybe its time for a reality check.

Reclassifying will not prevent people producing it, selling it or using it. Meth has been Schedule 1 (equivalent of Class A) in the USA and Canada since way before their respective meth epidemics began, and over there people frequently get the obscenely long sentences the statute books threaten.

Maybe this suggests we should be even tougher? Maybe we should try the Thailand approach where selling the drug is likely to get you executed by the police. A horrific 2000 people were killed in Thailand's 2003 'drug crackdown'. Now that’s what I call tough! Nothing like those sissies in the Home Office.

Unfortunately, wholesale slaughter doesn’t seem to have worked either – the country still has the highest meth consumption in the world, in the region of 800 million tablets being consumed a year according to the Lancet .

Despite these grim tales from around the world, in Wednesday's Home Office press release an ACPO spokesperson is quoted reiterating the evidence-free myth that ‘people will be deterred by the penalties for making, dealing or using methylamphetmine’ . ACPO also state that ‘production and use of this drug in all its forms will now be substantially easier to combat as a result of this reclassification’ because ‘It will also become possible to close down, for long periods, premises used as illicit 'meth' laboratories (a power for Class A drugs only).’ You have to wonder if ACPO have bothered to look at the experience overseas or not, because if they have they can hardly be filled with optimism. Surely, after all these years of failure with heroin and crack, they must know that this sort of enforcement approach simply does not work, and can arguably make things worse by further inflating price for users and correspondingly increasing the volume of crime committed by addicts to support their habits (ref; heroin and crack).

Infact it is amazing really that the Government and police are still trumpeting this reclassification as any kind of sensible core response to the methamphetamine threat - despite the lack of evidence from anywhere that it will make the slightest difference. The Science and Technology Select Committee recently took a long hard look at the classification system and found it ‘was not fit for purpose’, hadn't achieved its stated aims (infact it had done the exact opposite), was unevaluated and was based on a series of false assumptions about its deterrent effects. But you don’t really need a select committee inquiry to figure that out. The idea that the classification system provides any useful public health information to young people, is an effective deterrent, or reduces drug use, production or supply is frankly laughable – just look at our experience over the last 36 years. (I have blogged – in bordering on tedious detail - about the classification system and deterrence, the Sci/Tech Committee report and the Government’s pitiful response to it here and there is a Transform briefing on the problems with the classification system, with links to the committee report, here).

Classification is almost entirely irrelevant to levels of use and availability;

- Ecstasy use went from zero to 2 million pills a week in the late 80s early 90s, it was Class A all the time, now its going down
- Cocaine use is rising sharply and it has always been Class A
- Crack use went from zero to ‘epidemic’ use in a couple of years and it has always been Class A
- Heroin has risen by more than 1000% (that's three zeros) over a period of 30 years and has been Class A all along
- Availablity of all major Class A drugs has increased steadily year on year

Perhaps more suprisingly, major players in drug field also offer qualified support for the move, including Drugscope which supports it ‘as a sensible precautionary move’ and Addaction who repeat the ACPO line that it ‘will allow the police to tackle crystal meth more effectively’. Both Drugscope and Addaction caveat their support with eminently sensible calls for better treatment and education services to be developed in anticipation of rising meth use, although this does suggest they can’t be overly confident that the reclassification is going to be effective at preventing much. But this support, albeit qualified, does beg the question of whether they think it is useful or indeed ethical for problem meth users (the clients these organisations are set up to support) to be criminalised and imprisoned? By supporting increased penalties you have to assume that is their position (even though I dont think it is).

This seems especially odd for Drugscope, which has gone on the record calling for ‘Criminal procedures’ to ‘no longer be initiated for the possession of small amounts of any scheduled drug’ on the basis that ‘there is no evidence that the availability of imprisonment deters simple possession or that it is effective longer term in stopping drug use’.

OK, in the context of the classification harm-rankings system as it stands, the move makes 'sense' - and lets be clear that no one is denying meth use is a serious health risk - BUT the ABC ranking system itself has no established public health benefits and is primarily used to determine the hierarchy of penalties that form the core of our drug policy. It is grotesquely unfair, malfunctioning, unscientific, and yes, it actually makes things worse - It actively increases harms (not that the Government bothers to evaluate it against meaningful indicators).

Whatever you say about other service provision, supporting the re-classification means support for increasing criminalisation, punishment and imprisonment of users - fact.