BMJ 2014;349:g7273 doi: 10.1136/bmj.g7273 (Published 27 November 2014)
Page 1 of 2
Views & Reviews
VIEWS & REVIEWS
NO HOLDS BARRED
Margaret McCartney: Stop playing politics with illegal
drug use
OPEN ACCESS
Margaret McCartney general practitioner, Glasgow
It’s been called a revolving door; in reality, it’s a life that never
gets off the ground. Drug addiction. Imprisonment.
Unemployment. Poverty. Addiction. Imprisonment again. The
UK Misuse of Drugs Act 1971 makes the possession and supply
of a controlled drug illegal and punishable by substantial fines
and custodial sentences.1
The system feeds itself. Almost a fifth of prisoners who have
ever used heroin used it first in prison, and more than half of
prisoners have committed offences—usually stealing—to buy
drugs.2
A government of any persuasion would surely want to reduce
the harm that illicit drug use causes. The home secretary,
Theresa May, has said that she is “committed to an evidence
based approach,” informed by the government’s Advisory
Council on the Misuse of Drugs.3 But evidence and politics do
not always play nicely. Famously, in 2009 David Nutt was fired
from chairing the council after challenging the classification of
drugs based on harm. The then home secretary, Alan Johnson,
described Nutt’s comment that ecstasy was less harmful than
horse riding as “a political rather than a scientific point.”4 5
But health is indeed political, although not necessarily party
political. The health of the population reaps the consequences
of parliamentary decision making—often obviously, from
smoking laws or benefit cuts, but also less obviously, from the
inequality created by political policy.
Policies of swapping criminalisation for healthcare have reduced
problematic heroin use in Switzerland6 and have reduced
associated harms in Portugal.7 In March 2013 the UK
government said that it had “no intention of decriminalising
drugs”3; however, a report from the Home Office last month
found a “lack of any clear correlation between the ‘toughness’
of an approach and levels of drug use.”8
Are we approaching a breakthrough? A debate last month in
the House of Commons resulted in agreement that the current
law is failing and that “an evidence based approach is required.”9
Consensus is welcome; politicians have plenty of other stuff to
disagree about.
Drug dependence is a problem that needs medical care and
attention—not criminal sanctions. An evidence based policy on
drug misuse could reduce health inequalities where they are
often at their worst. And we need a government grown up
enough to put policy where the evidence is.
Competing interests: I have read and understood the BMJ policy on
declaration of interests and declare the following interests: I’m an NHS
GP partner, with income partly dependent on Quality and Outcomes
Framework points. I’m a part time undergraduate tutor at the University
of Glasgow. I’ve written a book and earned from broadcast and written
freelance journalism. I’m an unpaid patron of Healthwatch. I make a
monthly donation to Keep Our NHS Public. I’m a member of Medact.
I’m occasionally paid for time, travel, and accommodation to give talks
or have locum fees paid to allow me to give talks but never for any drug
or public relations company. I was elected to the national council of the
Royal College of General Practitioners in 2013.
Provenance and peer review: Commissioned; not externally peer
reviewed.
1
2
3
4
5
6
7
8
9
Legislation.gov.uk. Misuse of Drugs Act 1971. www.legislation.gov.uk/ukpga/1971/38/
contents.
Light M, Grant E, Hopkins K. Gender differences in substance misuse and mental health
amongst prisoners. Ministry of Justice analytical series 2013. www.gov.uk/government/
uploads/system/uploads/attachment_data/file/220060/gender-substance-misuse-mentalhealth-prisoners.pdf.
Parliament.uk. Drugs: breaking the cycle. Government response to the ninth report from
the Home Affairs Committee session 2012-13. March 2013. www.parliament.uk/documents/
commons-committees/home-affairs/27248-Cm-8567.pdf.
Nutt D. Equasy—an overlooked addiction with implications for the current debate on drug
harms. J Psychopharmacol 2009;23:3-5.
Johnson A. Letter: Why Professor David Nutt was shown the door. Guardian 2 Nov 2009.
www.theguardian.com/politics/2009/nov/02/drug-policy-alan-johnson-nutt.
Nordt C, Stohler R. Incidence of heroin use in Zurich, Switzerland: a case register analysis.
Lancet 2006;367:1830-4.
Hughes CE, Stevens A. What can we learn from the Portuguese decriminalization of illicit
drugs? Br J Criminol 2010;50:999-1022.
Home Office. Drugs: international comparators. Oct 2014. www.gov.uk/government/
uploads/system/uploads/attachment_data/file/368489/DrugsInternationalComparators.
pdf.
Lucas C. House of Commons official report (Hansard). 30 Oct 2014: col 434. www.
publications.parliament.uk/pa/cm201415/cmhansrd/cm141030/debtext/141030-0002.htm.
Cite this as: BMJ 2014;349:g7273
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BMJ 2014;349:g7273 doi: 10.1136/bmj.g7273 (Published 27 November 2014)
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VIEWS & REVIEWS
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