Key Concepts in Substance Misuse: Drugs

Home , Misuse of Drugs Act 1971

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u d d n i r . 1 - t r a D P _ 3 6 1 0 B 8 0 4 1 B A Despite drugs causing an indisputable range of harms within societies range Despite drugs causing an indisputable B _ M What the aims and purposes of drugs policy should be and who decides purposes of drugs policy should be and What the aims and to These debates continue debates about drug use. lies at the heart of for continued prohibition be extremely polarised between arguments on ‘war the It is argued by some that legalisation. and those who favour at www.tdpf. Foundation Drugs Policy Transform drugs’ has failed (see of continued favour Those in and that a new approach is needed. org.uk/) and many governments) argue prohibition (such as the United Nations a duty to control that we have that drug use creates significant problems However despite the dominant prohibitionist paradigm and eradicate. processes which are challenging there are significant global events and Levine (2003) argued that global drug prohibi- the nature of this debate. the crises including harm reduction policies, facing a number of tion was of and the widespread use growing opposition to punitive drug policies, this we can now add that some countries To cannabis around the world. of decriminalisation or legalisation and jurisdictions are adopting policies either with respect to all drugs or to cannabis. of psychoactive using a range it would seem that people of all kinds enjoy any significant harm. substances and often do so without experiencing activity is then inextricably The debate about drug use as a legitimate It democracy. free choice and liberal bound up with notions of morality, is founded on the idea of is important to note that the idea of liberalism is concerned whereas democracy individual human rights and freedoms, any democracy so within a liberal with the idea of the collective will; circumscribed by the democratic individual rights that I enjoy are always between the two. there are tensions and invariably process, S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 1 1Pf CMBB4806 d2 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ P y 2 c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 • • • • • and robustdrugpolicies: (see Darkeetal., 2007)thathighlighttheimportanceofhaving good developing worldsincethe1990s. We canidentifyseveral otherfactors and deathshave increasedinthedevelopedworldsince1960sand use imposessubstantialcostsonsocieties, andrates ofillicitdruguse deaths arenotduetoaself-inflicted, freelychosenlifestyle. Illicitdrug that itseemstoimpairourcapacitychoose, andthatdrug-related 8 B 0 1 els favoured bygovernmentswhichfocusonpersonal responsibility. effects andwhichraise importantquestionsaboutrational actormod- the evolutionarycontext), which aretriggeredbyenvironmental Also therearegeneticfactors influencingaddiction(seesectionon cies andnotthosewhoaremosteffectiveincriminalising drug use. levels ofdrug-relatedharmsarethosethathave thebestwelfarepoli- Stevens (2011)demonstrating thatthecountrieshave thelowest in addressingdrugproblemswith, for example, researchcarriedoutby the alleviationofpovertyandinequalityaremostimportant factors nity disadvantage. Arguments have beenmadeabouttheways in which family conflict, parentalattitudes and individual, familyandcommu- having alowersocio-economic status; environmentalfactors suchas young, unemployed, lowereducationalachievement, beingunmarried, dependence islinkedtoparticularsocialcharacteristics: beingmale, However weknowthatanincreasedrisktoexperiencing harmsand entiated, rather than ‘one sizefitsall.’ dependent, thereforeapproachesneedtobedimensionalanddiffer- who usesdrugswillexperienceproblemswiththosedrugs, orbecome ence withthenumbersdecliningbetweencategories. Noteveryone cal distinctionsaremadebetweensubstanceuse, misuseanddepend- In diagnosticcriteria(seesectionondependencesyndromes), clini- that use?(Seesectiononaddictionasacomplexadaptivesystem.) identity-based behaviours thatdonotallow themtomoveaway from increase thepossibilityofpeoplebecominglockedintoservicesand ple movingaway fromdruguse; doestheuseofcriminalsanctions Importantly notalldrugusersremainwithmostpeo- treat cannabisorecstasyuseinthesameway asalcoholandtobaccouse? would wewant tocriminalisethisbehaviour; shouldforexamplewe However drugusecanbeanormalpartofadolescencesoassociety that weprotectyoungpeoplefromthepotentialharmsofdrugsuse. As druguse/dependenceusuallystartsinadolescenceitisimportant One ofthechallengesdruguse(andaddictioninparticular)is 6 3 _ P a r t - 1 . i n d d

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d d Drugs, Crime and Public Health: The Political Economy of Drug The Political Health: Crime and Public Drugs, n i . 1 14: 145–153. 14: -

t , r a P _ 3 6 1 0 Abingdon: Routledge. Abingdon: B 8 0 4 How or why would this situation be different to a person who has How or why would this situation be different 1 B A Policy. Policy. Cambridge: Cambridge University Press. Cambridge: of Drug Policy Case Study town on a veryA number of years ago I was walking through cold winter and I came across a man that morning (the temperature was below zero) appeared to be unconscious. I I knew lying by the side of the road who him to be alcohol dependent. had worked with the man before and knew I tried to rouse him; he was clearly very and only able to intoxicated mumble a few words. My primary of hypothermia concern was the risk the situation. They refused to and I rang for an ambulance and explained come out because the man was intoxicated. their failure to follow proper injured themselves on a mountain due to fallen asleep on a lilo? Do you procedure, or someone adrift at sea having the emergency services would think that under these circumstances refuse to attend? B _ M Stevens, A. A. (2011) Stevens, Darke, S., Degenhardt, L. and Matrick, R. (2007) R. and Matrick, L. Degenhardt, S., Darke, Levine, H. (2003) ‘Global drug prohibition: its uses and crises’, its uses and crises’, ‘Global drug prohibition: (2003) H. Levine, So clearly it is important to have drug policies that address the issues of policies that address drug it is important to have So clearly question of how we this then begs the but and social harms, individual to be an ethi- what would appear to balance the best ways should decide to choose to right an individual’s This dilemma is between cal dilemma. harms of that to protect people from the potential use drugs and the need to do when people the added dilemma of what however, is, There drug use. the best efforts of state despite harmful behaviour engage in potentially at a for example, can look, We them not to do so. and society to persuade mountain climbing as skydiving, such risky behaviours of potentially range activities present any unprotected sex and ask whether these and having this objectively, and society than using drugs? If, more risks to individuals with them so differently do we deal why in practise is not the case then drug use? criminalising for example, by, S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 3 0011_P ycrof ftt_K KCSMCSM_B BAB1408B0163AB1408B0163_P art -1 .i nd ddd 4 001/12/20141/12/2014 4 :5 500:0 088 P PMM M P

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t f d d n i . E 1 o - t r a .’ For Kant this categorical imperative binds human beings as this categorical imperative Kant For .’ P

_ 3 6 1 1 0 B 8 0 4 1 B 1724–1804) 1806–1873) Stuart Mill, 1748–1832 and John Bentham, Jeremy 384–322 BC) Aristotle, A B _ M rational agents precisely because they are rational, and reason demands that they are rational, agents precisely because rational becoming This respect is absolute, respect for all persons. we demonstrate applicable in all situations and circumstances and does nota universal law allow us to treat another person as a means to an end (see Utilitarianism). ethical dilemmas deontology argues the following: In evaluating Immanuel Kant ([1785] 1993: 30) established the principle known as the 30) established the principle known as Immanuel Kant ([1785] 1993: only according to the ‘Act that we should stating categorical imperative time will that it should become amaxim by which you can at the same universal law How we decide on the legitimacy of individual or collective actions and the legitimacy of individual or collective How we decide on ethics. actions falls within the realm of normative the limits of those understanding of how we should Normative ethics is concerned with an as are three main paradigms act under certain circumstances and there follows: 1. Deontology – duty and principle (associated with Immanuel Kant, 2. Utilitarianism – considering the consequences (associated with 3. (associated with ethics – the importance of character Virtue adapted the work of Banks (2004) I have each of the evaluations For to the subject matter and use- which provides an excellent introduction to analyse ethical dilemmas. ful frameworks S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 5 1Pf CMBB4806 d6 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ P y 6 c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 1. 7. 6. 5. 4. 3. 2. 8 B 0 Whatistheintentionunderlyingact? 1 any exceptionsundercircumstances. sible tomaintainarationalcommitment tothatlawdoesnotpermit universal law;presentyour lawtoagroupandseeifitispos- See ifyoucanthinkofsomething thatinyourviewshouldbecomea Exercise 6 ated The focusisontheact; thereforeonemustidentifytheacttobeevalu- question, canthisbemaintainedwithoutexception? under allcircumstances, anddependinguponmyanswertothis want therighttouseany drugtobeauniversallaw, forallpeople must beapplieduniversally, canIwillthisactontoeveryone? Given thattheactmustfollowcategoricalimperativeand therefore me butalsousesmysentenceasameanstodeterothers; isthisjust? deter example tousecriminaljusticelegislationandharshpenalties to Will ituseanypersonasameanstoanend? society, andlikewisedodrugenforcementlaws andactionsdothesame? the righttousedrugsenhancehumandignityatalllevelsofstateand Will thisactshowrespectforthehumandignityofeveryoneinvolved? tions helpormakethesituationworse? another person? Will criminaljustice ornon-criminaljusticesanc- drugs eventhoughthosemaywellhave beensuppliedby appropriate tousecriminaljusticesanctionsforpeoplewho and thecommongood, andarethetwoactuallyinconflict?Isit Do thedutiesconflict? some notionofthecommongood? are mydutiesdirectedtowards, isittoanindividual’s rightsorto What dutiesareinvolvedinthissituationandtowhomorwhat? prevent drugusesomepeopleneedhelpduetotheiruse. prohibition. There isanacceptance thatdespitethebesteffortsto reduction measuresanditssponsorshipbytheUNdespiteofficial exceptions tothoserules; agoodexampleisthegrowthofharm when wemakeabsoluterulestheninvariably wehave tomake in prohibiting, legalisingordecriminalisingdruguse?Interestingly about druguse?LikewiseifIamapolicymakerwhatismyintention in itselfharmful, isitselfish, andamIabletomakerational choices 3 _ P a r t . Isdrugtaking - 1 . i other n d d

6 people fromusingdrugs?Inthiscasethestatepunishes per se Isitpossibletobalancebothindividualrights Practical Evaluation anareaofethicalconflict, andwhy? Istheintentiontousedrugs Isitappropriatefor WouldI Does Does Who 11/0445 8PM 08 50 4 001/12/2014 1 / 1 2 / 2 0 1 4

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4 1 0 2 / 2 1 / 1 001/12/2014 4 50 08 PM Who is affected by drug use, Who is affected by drug use, UTILITARIANISM UTILITARIANISM Is drug use acceptable or not, or are there Is drug use acceptable or not, It is important to clearly identify the whole It is important to clearly identify the Practical Evaluation 7

d d n i . 1 - t A decisional calculus is made to arrive at a decision about A decisional calculus is made to arrive r a

P _ 3 6 1 0 B not? 8 0 4 1 B do the harms outweigh the benefits, and likewise for any actions and likewise for any actions do the harms outweigh the benefits, drug harms? taken to ameliorate then option 2 and so on. way. in a clear and rational of harms and benefits range between the good and the by the decision after calculating the differences bad effects. On this a majority decision. which is in effect the right thing to do, give more people the right to basis is it appropriate for example to A drugs without fear of punishment if the majority of use Class people desire it? some drugs which are of benefit to individuals and others that individuals and others that some drugs which are of benefit to are A Exercise After reading the sections on legislation (Chapter 2), prohibition (Chapter 4) and decriminalisation (Chapter 4) of drugs, weigh up as many of the pros and cons of these approaches as possible and reach a decision about the approach that has the most utility; but who would gain the most and who would lose the most based on your decision? B Identify all the options. benefits for all those affected under option 1, Describe the harms and Choose the option that produces the most benefits for all those affected Identify all those affected by the decision. _ M 3. 4. 2. 1. The principle of utility or the Greatest Happiness Principle argues that Principle argues Greatest Happiness of utility or the The principle the greatest happiness it tends to produce is right in so far as an action Utilitarians (also consequences. or the best overall for everyone affected, absolutely or argue that there is nothing known as consequentialists) that can be agreed to be benefi- only actions wrong, inherently right or of approach is fundamental to notions This number. cial to the greatest argue that Whereas Kant would and also human rights. democracy that rights are Bentham and Mill argued absolute, human rights are which produce the greatest and them to be, whatever society agrees of the with the latter approach is the tyranny A problem happiness. do not have or minority interests in society majority whereby minorities influence. access to power and S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 7 1Pf CMBB4806 d8 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ P y 8 c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 disagreements aboutwhatconstitutesavirtuewatch thefilm practice andpractical reasoningtodevelopvirtues(foragoodexampleof Sansfacon (2010)arguesthatthiscanbeachievedthrough reflective the helperasitisforthosewhoarehelpedandinpractice Pullen- Bersselaar, 2005). Inthehelpingrelationshipthisisjustasimportantfor to lifethatallowsanorientationofthewilltowards thegoodlife(Van den ties, andthatdespitedifficultiesitispossibletodevelopastableattitude to theimportanceofpotentialinallpeopleachievedifferentpossibili- discipline,Self-reliance, Tactfulness,and Tolerance. Thoughtfulness Loyalty, Moderation, Reasonableness, Self-confidence, Self-control, Self- ability, Fairness, Friendliness, Generosity, Honesty, Industriousness, Justice, Conscientiousness, Cooperativeness, Courage, Courteousness, Depend- Aristotle’s listofvirtuesincludes: Benevolence, Civility, Compassion, and KarlMarxallhave verydifferentunderstandingsandlistsofvirtue. argues that Aristotle, Paul ofDamascus, BenjaminFranklyn, Jane Austin virtues areessentialforeudaimonism. For exampleMacintyre(2007) make personsofexcellenceandthedevelopmentavirtuouscharacter. ties ortraits ofcharacter demonstrated throughhabitualactionthat (ethical) life(inancientGreek character andthekindofpersonthatI needtobecomelivethegood on thegreatesthappinessorpleasure; virtueethicsareconcernedwith neither doesittaketheutilitarianapproachofdecisionalcalculusbased because Godorthestatesomeoneinauthoritytellsmetodoso, and tion ofwhataretherulesthatrighttofollowfromasenseduty (see Annas, 2003). This approachdoesnotaskthedeontologicalques- Den Bersselaar, 2005; Pullen-Sansfacon, 2010)andsocialpsychology other codesandhasseenagrowingliterature insocialwork(see Van Virtue ethicsoffersadifferingperspectiveon moral agencyfromthese regions ofSouthern EuropeandtheProtestant North. differing perspectivesonthese virtuesintheCatholicwinedrinking perance cultures(see, forexample, Levine, 1993)showsthat thereare and evangelical notionsofpurityandself-discipline. Researchon tem- ‘sobriety’ isseenasavirtue whichisverymuchlinkedtoprotestant drug usesuchas Alcoholics Anonymous andNarcotics Anonymous, Emporer andCommoduscomparestheirlistofvirtues). by hissonCommodusafterhetellshimthatwillnot succeed himas and thescenewhereRomanEmperorMarcus Aurelias ismurdered 8 B 0 1 Inherentwithinvirtueethicsistheconceptof There isconsiderable debateaboutwhatconstitutesavirtue, andwhat Interestingly, withinabstinencebasedapproachestoalcoholand 6 3 _ P a r t - 1 . i n d d

8 VIRTUE ETHICS eudaimonia ). Virtues arepersonalquali- entelecheia which refers which refers Gladiator 11/0445 8PM 08 50 4 001/12/2014 1 / 1 2 / 2 0

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d d n i . 1 - . Am I consistent and just in my approach that is visible that is visible Am I consistent and just in my approach . t r a P _ 3 6 1 0 B 8 0 4 1 B my character so that when ethical dilemmas present themselves to me present themselves to me my character so that when ethical dilemmas will no longer face a dilemma in the future I will know what to do and of this kind that I serve? to the people that I work with and those ment and deterrence in dealing with drug issues. As a probation officer issues. ment and deterrence in dealing with drug As a sub- fair and appropriate? or a police officer is my use of coercion openness and such as empathy, stance misuse worker do I view qualities acquire in order to be effectivetrust as necessary virtues that I need to in my work? ous person and which virtues I will need to practise I must ask myself whichous person and which virtues I will need to to and explain these virtues, option in the dilemma allows me to practise these virtues and why the othermyself how this option allows me to practise options would not. I can become. I will identify which virtues I must practise in this situation I will identify which virtues I must practise I can become. virtu- why they are relevant to my goals of becoming and explain to myself moral character ous and developing good virtues that I would want to have, and to see in other people, and how and and to see in other people, have, to virtues that I would want drug use and self-control? might I consider the relationship between ways might it impact upon my character? Might I be concerned it impact upon my character? might ways and lives? Does characters affects other people’s about how drug use to live a good life? drug use enable me become to be the best person I can be. person I can be. become to be the best A Exercise Make a list of the virtues that you consider important for people with drug and their problems.alcohol problems to acquire in helping them to overcome Then compose a list of the virtues that you think are essential in pursuing excellence in your professional role in helping people with drug and alcohol problems. Compare the two lists and identify any key differences and discuss in a group setting. B part of I will then practise these virtues until they become habit and I should I must first ask what kind of person Regardless of the dilemma, to become the best person that then ask which virtues will allow me I must _ kind of person I will need to become to be a virtu- Once I have decided what M 4. 3. 2. In addressing moral dilemmas as a person with a moral character, I must character, with a moral as a person dilemmas moral In addressing potential and to reach my full or will need knowledge I have assess the virtuous person. become a 1. S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 9 1Pf CMBB4806 d10 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ 10 P y c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 Van denBersselaar, D. (2005) ‘Virtue-ethics asadevicefornarratives insocialwork: the Pullen-Sansfacon, A. (2010) ‘Virtue ethicsforsocialwork: anewpedagogyforpracti- Macintyre,(2007) A. Levine, H. (1993) ‘Temperance cultures: alcoholasaprobleminNordicandEnglish- Kant, I. trans. J.W. Ellington([1785]1993) . Drugs which areself-administeredandimpairhealthorsocial 4. Arestrictiontopsychoactivedrugsthatalter mood, cognitionand 3. Theusetowhich thesubstanceisput(thisexcludeslegitimate 2. Anychemicalentityormixture of entities, theadministration of 1. illicit drugusethroughtheoffourlevelsanalysis(see unodc.org): Through the World HealthOrganization, the UnitedNationsdefines Banks, C. (2004) Annas, J. (2003) ‘Virtue ethicsandsocialpsychology’, to drugpolicyandusers. use themasatoolofanalysistointerrogatethefollowingapproaches Having outlinedthemainparadigms ofnormativeethicsitisusefulto 8 B 0 1 possibility ofempowermentbymoralising’, cal reasoning’, of Alcohol andDrug-RelatedProblems. speaking cultures’, inM. Lader, G. Edwards, andD. C. Drummon(eds), edn. Indianaopolis: Hackett. 6 functioning. behaviour; and medical useforthealleviation ofdisease); which altersthebiologicalfunctionoflivingorganism; 3 _ P 2 a r t - 1 . i n d d N

1 0 Criminal Justice Ethics. Social WorkEducation a h t After Virtue. e i o

F I n r n Aaron Pycroft a a t Indiana: UniversityofNotre DamePress. REFERENCES m e l

r New York: OxfordUniversityPress. pp. 16–36. L , 29(4): 402–15. Thousand Oaks: Sage. e n Grounding fortheMetaphysicsofMorals Journal Europeend’EducationSociale, e w a g t o i i o s r A Priori, k l n a

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d d n i . 1 - t r a Convention on Psychotropic Substances 1971 Convention on Psychotropic Substances The Single Convention on Narcotic Drugs 1961 The Single Convention P _ 3 Narcotic Drugs and Psychotropic Substances 1988 Narcotic Drugs and Psychotropic Substances 6 1 United Nations Convention against the Illicit Traffic in Illicit Traffic United Nations Convention against the 0 B THE UNITED NATIONS CONVENTIONS ON ILLICIT DRUGS CONVENTIONS THE UNITED NATIONS 8 0 4 1 B A The UK is a signatory to all of these conventions and is required to B _ M This Convention provides comprehensive measures against drug traf- This Convention provides comprehensive including provisions against money laundering and the diver- ficking, It provides for international cooperation sion of precursor chemicals. deliv- controlled of drug traffickers, extradition for example, through, (See www.incb.org/incb/convention_ of proceedings. eries and transfer 1988.html.) uphold the aims and objectives of each convention in its domestic law to introduce It is possible for signatories to these conventions making. This Convention establishes an international control system for psycho- This Convention establishes an international of It responded to the diversification and expansion tropic substances. controls over a number the spectrum of drugs of abuse and introduced abuse potential on the one hand of synthetic drugs according to their (See www.incb.org/incb/ on the other. value and their therapeutic convention_1971.html.) The adoption of this Convention is regarded as a milestone in the history Convention is regarded as a milestone The adoption of this all existingThe Single Convention codified control. of international drug the existing control sys- treaties on drug control and extended multilateral mate- grown as the raw of plants that were cultivation tems to include the are to limitThe principal objectives of the Convention rial of narcotic drugs. and manufacture export, import, distribution, in, trade use, the possession, and scientific purposes and toproduction of drugs exclusively to medical to deter and international cooperation through address drug trafficking the InternationalThe Convention also established drug traffickers. discourage Board and the Central merging the Permanent Narcotics Control Board, (See www.incb.org/incb/convention_1961.html.) Drug Supervisory Board. The aim of this definition as enshrined within the conventions is to the conventions as enshrined within of this definition The aim developed and are only cultivated psychoactive substances ensure that they are not and to ensure that use, medical and scientific for proper illicit channels. diverted into S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 11 1Pf CMBB4806 d12 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ 12 P y c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 criteria –firstlywhetherthedrug isbeingmisused, secondlywhether itis why somedrugsaremoreharmful thanothers. The Act usesthefollowing accordingly. However the1971 Act isnotexplicitindecidinghowand each drugisjudgedaccording toits ‘relative harmfulness’and classified three classes– A, BandC–arelistedin Schedule2ofthe Act. Crucially to thedangersofdrugmisuse(Starketal., 1999). counter measuresandaimstopromoteresearcheducation inrelation ACMD) toassisttheHomeSecretaryinpreparation ofcontrolsand drug problemarises. The legislationestablished anadvisorycouncil(the pharmacists orpractitioners sup stances; andthe Act allows tions forthecontrolofproduction, supplyandpossessionofthosesub- the Act bringsnewsubstancesundercontrolandmakesnecessaryregula- powers toactquicklyinthecaseofoverprescribingbygeneral practitioners; the provisionofspecialtreatmentcentres; andgivestheHomeSecretary restricts theprescriptionofdrugsdependencetothem; the Act allowsfor (this was acontinuedrequirementoftheDangerousDrugs Act 1967)and continues torequirethenotificationofdrugaddictsHomeOffice trafficking andcreatesnewtrafficking offenceswith severepunishments; it class accordingly; the Act distinguishesbetweenunlawful possessionand danger (A, BandC)tograde thepenaltiesformisusingdrugsineach drugs andtodividetheseintothreeclassesindescendingdegreeof not covertheuseofalcoholornicotine. for useinscientificandmedicaleffortsthereforeinstancedoes tion isonlyconcernedwithdrugsthatarebannedorpermissible its inceptionhasremainedthecornerstoneofUKpolicy. The legisla- Government introducedtheMisuseofDrugs Act (1971)whichsince Following onfromtheseinternationallyagreeddefinitions, theBritish of drugpossessionandsupply’(paragraph 266). down specificcontrolmechanismswithinthebasicpremiseofcriminality edged. The committeearguesthatthisisbecause ‘the treatiesdonotlay issues, thereispossiblymoreroomformanoeuvrethanusuallyacknowl- restricts unilateral actiononthepartofUKwhenlegislatingdrug The SelectCommitteeonHome Affairs (2002)notesthatalthoughthis tions, buttheycannotintroducemorelenientapproaches(Fazey, 2003). stricter domesticlegislationthanthatwhichisdemandedbytheconven- 8 B 0 1 Drugs, which arecontrolledbythislegislationanddividedinto The purposesofthe1971 Act are toprovidemeansforcontrollingall 6 3 _ P a r t - 1 . i n d d

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d d n i . 1 - t r a P _ 3 6 1 0 B 8 0 CLASSIFICATION UNDER THE MISUSE OF DRUGS ACT 1971 UNDER THE MISUSE OF CLASSIFICATION 4 1 B A Possession of a controlled substance unlawfully Possession of a controlled substance with intent to supply it Possession Supplying or offering to supply a controlled drug (even where no charge is made for the drug) for Allowing premises you occupy or manage to be used unlawfully the purpose of producing or supplying controlled drugs Includes: tranquilisers, some painkillers, GHB (Gamma hydroxy- some painkillers, tranquilisers, Includes: ketamine. butyrate), in prison or an unlimited Up to two years possession: for Penalties or both. fine, or both. or an unlimited fine, Up to 14 years in prison dealing: for Penalties Includes: Cannabis, Amphetamines, Methylphenidate (Ritalin), Methylphenidate (Ritalin), Amphetamines, Cannabis, Includes: Pholcodine. in prison or an unlimited Up to five years possession: for Penalties or both. fine, or both. or an unlimited fine, Up to 14 years in prison dealing: for Penalties Includes: Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms (if crack, cocaine, heroin, LSD, Ecstasy, Includes: (if prepared for injection). amphetamines prepared for use), unlimited Up to seven years in prison or an for possession: Penalties or both. fine, or both. an unlimited fine, Up to life in prison or dealing: for Penalties B _ M likely to be misused and thirdly whether its effects are likely to constitute whether its effects misused and thirdly likely to be explicitly deter- in terms of problems Although this raises a social problem. from the perspec- into, drug should go category a particular mining which determine the criminal it is used to enforcement agenda tive of an (see Runciman, to the misuse of a particular drug sanctions that are applied sanctions deter people from drug use via criminal 1999) and seeks to 2005/6). Committee, Technology Science and (House of Commons • • • • S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 13 1Pf CMBB4806 d14 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ 14 P y c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 so astoensuredemocratic legitimacy for anylegislativeresponse be baseduponthebestevidence thatcanbeprovidedtogovernment criminal law, civillaw andgovernance. Itisimportantthatthese should The sanctionandcontrols related todruguseareenforcedthrough Stark, C., Kidd, B. andSykes, R. (eds)(1999) Runciman Report(1999) House ofCommonsScienceand Technology Committee(2005/2006) (2002) Report Committee Third Select Home Affairs Fazey, C. (2003) ‘The CommissiononNarcoticDrugsandtheUnitedNations homeoffice.gov.uk/drugs-laws/misuse-of-drugs-act/). cion’ thattheyareinpossessionofacontrolleddrug(seehttp://drugs. special powerstostop, detainandsearchpeopleon ‘reasonable suspi- imprisonment forClass A offences. Drug trafficking (supply)attracts seriouspunishmentincludinglife 8 B 0 1 Prevention, Treatment andEnforcement. Misuse ofDrugs Act 1971 Classification: MakingaHashofit? Is it Working? change’, International DrugControlProgramme: politics, policiesandprospectsfor 6 3 _ P F a S r t - o 1 . i n b c The InternationalJournal ofDrugPolicy, d d r 3

i 1 e m 4 e London: HMSO.

t n w T u t h l Drugs andtheLaw: ReportoftheIndependentInquiryinto e i a f . London: Police Foundation. e e i Aaron Pycroft t c

n i R n REFERENCES

K g P e London: HouseofCommons. n

l London: Arena. o To enforcethislaw thepolicehave a D o Illegal DrugUseintheUnitedKingdom: l t i r w i t o u i 14(2): 155–69. c l The Government’s DrugsPolicy: n g e s s

P h a g o n i e p l d

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d d n i . 1 - t r a P _ 3 6 1 0 B 8 0 4 1 B A Even if science is value free and objective how is this to be implemented free and objective how is Even if science is value decisions very important when making These decisions become of balance and move- both lead to psychomotor impairment Firstly, many similarities between Although it can be seen that there are B _ M (Stokes et al., 2001). However it is argued by Strang and colleagues and colleagues by Strang it is argued However 2001). al., (Stokes et is not drug policy debate concerning much of the public (2012) that and political by values and is driven by scientific evidence informed whether question about an important of course raises This processes. to whether ultimately we have or free, is value ‘scientific’ evidence outlined above. of actions by the ethical paradigms decide the impacts what is the utilised to inform policy? In particular in human society and These process? this knowledge and the democratic relationship between theAct 1971 and within the Misuse of Drugs problems are encapsulated and of particular drugs, in advising on the relative harms ACMD role of the on that advice. that the Home Secretary makes based the political decisions Act of Drugs should be controlled under the Misuse about which drugs or permanent especially in relation to 1971 and whether temporary this vol- Chapter 11, New Psychoactive Substances (see Bartholomew, harm and the evidence for In considering the concept of relative ume). alcohol (which is not controlled under the of decisions then the validity to make a It is interesting Act) provides a clear case of contradiction. similar drugs. comparison with cannabis as they are both cause length- Secondly, ment with an increased risk of accidents. and so can cause problems ened reaction times which are dose related this is linked to an impairment of Thirdly, accidents. such as road traffic increased aggres- and for alcohol risk taking, and increased judgement, drugs cause emotional changes and a decreased both Fourthly, siveness. significant risk of with alcohol causing a reaction to social expectations, of with a wide range Alcohol is linked self and others. violence towards whereas although treatment may physical and mental health problems, the health problems are similar to those for be required for cannabis use, 2006). smoking tobacco (see Roffman and Stephens, is particularly problematic because it is associ- alcohol these two drugs, psychological and social issues of medical, ated with such a wide range The and violent behaviour. and has the propensity to cause aggressive 360,000 costs from alcohol use includes 1.2 million violent incidents, and fear increased anti-social behaviour incidents of domestic violence, hospital over 30,000 on alcohol treatment, expenditure of crime, up to 22,000 Alcohol Dependence Syndrome (ADS), admissions for 17 million up to up to 1,000 suicides, premature deaths per annum, S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 15 1Pf CMBB4806 d16 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ 16 P y c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 number ofmentalandphysical healthproblems(Gossopetal., 2003). drugs andthemostseverely dependentdrinkersreportingthegreatest adult psychiatricinpatients experiencing problemswithalcoholand mental healthproblems(Meltzer, 1995), withbetween22%and44%of (also knownasSkunk). There isaclearrelationship betweenalcoholand problems, particularlyinrelationtothe useofthemorepotentSinsemilla the MisuseofDrugs Act 1971was theperceivedlinkwithmentalhealth One ofthemainreasonsforreclassifyingcannabisbackto ClassBunder (See alsoChapter16.) ranging adversephysicaleffects’ (Baboretal., 2003: 4). other commoditysoldforingestion, noteventobacco, has suchwide should notblindustothefactthatalcoholisatoxicsubstance …no Runciman, 1999)whereas ‘social customsandeconomicinterests recreational ortherapeutic use’(British Medical Association evidencein are verysafedrugsandnodeathshave beendirectlyattributedtotheir pared withalcohol ‘the acutetoxicityofcannibinoidsareverylow: they relation tomentalhealthproblemsandaddiction. However, ascom- concerns aboutitseffectshave becomemoreprevalent, forexample, in others; overall alcoholwas themostharmfuldrug. whereas alcohol, crack cocaineandheroinwerethemostharmfulto and metamfetaminewerethemostharmfuldrugstoindividuals, research byNuttandcolleagues(2010)foundthatheroin, crack cocaine actively creatingmorealcohol-relatedproblems. that population. Sobyincreasingsupplyandavailability governmentis population andthelevelofawiderange ofalcohol-relatedproblemsin is acorrelationbetweenthetotalamountofalcoholconsumedwithin (1994) andBaborcolleagues(2003)clearlydemonstrates thatthere liberalising supplyandavailability. The workofEdwards andcolleagues curtail use, theLicensing Act 2003effectivelydoestheoppositeby drug; however, rather thanseekingtocontrolanddisruptsupply, and clearly withinthecontextofMisuseDrugs Act thisisadangerous terms ofitstoxicity, prevalence ofmisuseandharmtosociety, then twice aslikelytoendindivorce(HomeOffice, 2004). children affectedbyparentalalcoholproblemsandwithmarriages working dayslostthroughalcoholrelatedabsence, upto1.3million 8 B 0 1 We canseethatascannabis usehasbecomemorewidespreadthen In tryingtoassesstherange ofharmscausedtoselfandothers, If wetakethenotionofrelativeharmandapplythistoalcoholin 6 3 _ P a r t - 1 . i n d d DRUG LINKSWITHMENTAL HEALTH PROBLEMS

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drug policy 4 1 0 2 / 2 1 / 1 001/12/2014 4 50 08 PM REFERENCES Alcohol: No Ordinary Commodity, Research and Public No Ordinary Commodity, Alcohol: THE GATEWAY THEORY THE GATEWAY 7 1

d d n i . 1 - t r a P _ 3 6 1 0 Oxford: Oxford University Press. Oxford: B 8 0 4 1 B A One of the key challenges for state and society is to determine what One of the key challenges for state and J., Gruenewald, P., Hill, L., Holder, H., Homel, R., Osterberg, E., Rehm, R., Room, Room, R., Rehm, E., Osterberg, R., Homel, H., Holder, L., Hill, P., Gruenewald, J., (2003) I. and Rossow, R., Policy. B _ M Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., Grube, Grube, K., Graham, N., Giesbrecht, G., Edwards, S., Casswell, R., Caetano, T., Babor, The Gateway Theory has been one of the major arguments against the Theory has been one of the The Gateway is that can- The hypothesis of cannabis. legalisation or decriminalisation This theory is based upon the use of harder drugs. nabis use leads to the This of cannabis use. a history have that hard drug users observation by Runciman (1999) who argued that this is partly reviewed theory was people to try dealers encourage linked to the drug markets in which into cannabis then the more other drugs and that the earlier the initiation any sustainable However, drugs. likely people are to progress to other of progression and not just that theory has to show the strong probability It is evident from the statistics that a heroin user has also used cannabis. otherwise there of cannabis users do not progress, majority the vast ‘hard’ drug users than there actually are. would be far greater numbers of of particular psychoactive is an acceptable level of use and availability tobacco usage, can we be serious about reducing In addition, substances. but at the same time liberalise through banning smoking in public places, These are difficult questions that go to the heart of the use of cannabis? but are nonetheless important to citizenship and freedoms within society for to ask smart questions; need Both student and practitioner address. when talking about cannabis or alcohol what are we talking example, and different pat- given the differing strengths and types of each, about, and to protect people from harm, terns of use? Government has a duty and so at the very suffering, drugs cause an inordinate amount of human approach to classifying harm is required. least a reasonable and rational Gossop (2000) argues that there is no convincing evidence that cannabis evidence that cannabis is no convincing argues that there Gossop (2000) of that the prevalence given and that, health problems causes mental that some it is obvious 1%, population is about in the general psychosis the point that can- He also makes will develop psychosis. cannabis users it is also the case however, existing problems; nabis use may exacerbate exacerbate form a part of poly drug use which may that cannabis may mental health problems. the risks of developing S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 17 1Pf CMBB4806 d18 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ 18 P y c Key concepts in r o f t _ K

C substance misuse S M _ B A B 1 4 0 Strang, J., Babor, T., Caulkins, J., Fischer, B., Foxcroft, D. andHumphreys, K. (2012) Stokes, G., Chalk, P. andGillen, K. (eds)(2001) Runciman Report(1999) Roffman, R. andStephens, R. (eds)(2006) Nutt, D., King, L. andPhillips, L. (2010) ‘Drug harmsintheUK: amulticriteriadeci- Meltzer, H. (1995) Home Office(2004) Gossop, M., Marsden, J., Stewart, D. andKidd, T. (2003) ‘The National Treatment Gossop, M. (2000) Edwards, G., Anderson, P.,Babor, T., Caswell, S., Ferrence, R., Giesbrecht, N., Godfrey, of acquisition, possessionandconsumption. Following decriminalisation, it nal offences. With regardtodrugs, itisusuallyusedtorefer todemand; acts which itisapplied. This meansthatcertain actsnolongerconstitutecrimi- Decriminalisation 8 B 0 1 Lancet ‘Drug policyandthepublicgood: evidenceforeffectiveinterventions’, New Directions. Misuse ofDrugs Act 1971. Consequences and Treatment. sion analysis’, London: OfficeofPopulation CensusandSurveys. The PrevalenceofPsychiatricMorbidityamon London: HomeOffice. 291–303. Outcome ResearchStudy(NTORS): 4–5yearfollowupresults’, Public Good e., Romelsjo, A., Room, R., Simpura, JandSkog, O. (1994) C., Holder, H., Lemmens, P., Makela, K., Midanik, L., Norstrom, R., Osterberg, 6 3 _ P a r t - , 1

. i 379: 71–83. n d d

. Oxford: OxfordUniversityPress. 1 8 4 The Lancet Melbourne: MelbourneUniversityPress. Living withDrugs. OPCS SurveysofPsychiatricMorbidityinGreatBritain: Report1: takesaway thestatusof criminallaw fromthoseacts to

Alcohol Harm Reduction Strategy forEnglandand Alcohol HarmReductionStrategy Wales A Drugs andtheLaw: ReportoftheIndependentInquiryinto P ,

l 376: 1558–65. London: Police Foundation. Aaron Pycroft r t Cambridge: CambridgeUniversityPress. o e DEFINITIONS r h Aldershot: Ashgate. n i b a i t t g i Cannabis Dependence: ItsNature, i v Adults LivinginPrivateHouseholds. Drugs andDemocracy: InSearchof o e n s

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d d n i . 1 is the process of bringing within the control of the law within the control of the law is the process of bringing - t r a P _ 3 6 1 0 B 8 0 4 1 B A Legalisation Medicalisation The medicalization model, by encompassing in the medical domain The medicalization model, by encompassing considerations to be deci- some phenomenon or problem, allows medical and in the choice of measures sive in the interpretation of that problem can respect to drug use, medicalization to resolve the situation. With When it means pro-have a broad range of meanings and consequences. to drug addicts, including the viding normal, good quality medical care as a positive develop-prescription of illicit drugs, it should be applauded frequent drug regular, medicalization also may define ment. However, as the only acceptable use as a mental disorder; designate abstinence compulsory treatment for all treatment outcome; and/or recommend casual users. The latter three users of illegal drugs, be they dependent or that, while the medicalization versions of medicalization demonstrate than repression of drug approach for drug policy seems more humane 2000: 351) (Polak, itself. use, it risks becoming a form of repression B _ M The aim of the United Nations Conventions had been to try and seek a The aim of the United Nations Conventions However convergence and consistency of drug policy across the world. over time a number of different countries and jurisdictions within coun- legalisa- taken differing approaches such as decriminalisation, tries have to harm particularly with respect The latter, tion and medicalisation. this volume) Chapters 17 and 18, reduction (see Shea and also Leighton, still is illegal to use, possess, acquire or in certain cases import drugs, but import drugs, or in certain cases acquire possess, to use, still is illegal sanc- administrative However, offences. are no longer criminal those acts driving or suspension of the fine, these can be a still be applied; tions can (See http://eldd.emcdda.org/.) or just a warning. firearms licence, and prohibited or strictly previously illegal that was a specified activity commonly applied to acts the term is most drugs, Related to regulated. use. manufacture or sale for non-medical production, of supply; use and possession, and mean that such activities, Legalisation would that it is legal to way in the same by states’ norms, would be regulated con- can still exist some administrative There use alcohol and tobacco. by criminal sanc- which might even be supported trols and regulations, a legal From are concerned). road traffic when juveniles or tions (e.g., to the current of legalisation would be contrary any form point of view, (See http://eldd.emcdda.org/) UN conventions. S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 19 1Pf CMBB4806 d20 dd i 1 t P BAB1408B0163 KCSM ft P 001 1 _ P y c r o f t _ K C S M _ B A B 1 4 0 8 B 0 1 6 3 _ P a r Table 4.1 Differing paradigms of drug control and treatment t - 1 . i n d d

2 Sweden Portugal Switzerland 0

Narcotic Drugs Punishment Act 1968. Law 30/2000 in 2001 Federal Drug Law 1975 saw an increase in decriminalised use, possession arrests and registration of illicit drug users. Commitment to drug free society. and acquisition of all illicit The law rejected needle exchange and substances for personal use (up to imposed onerous restrictions on substitute In 2006 the UN applauded Sweden’s approach 10 days’ supply is allowed). prescribing. as an exemplary model. This is not legalisation as The 1980s saw large gatherings of injecting Levels of drug use have been historically low in possession, growers, dealers and drug users in public places and the spread of Sweden. Whether this low level of drug use is traffickers are prosecuted. HIV was a major problem. due to the policy or other factors such as homogeneous culture, 87% Lutheran, with a Ended penal sanctions and To try and reduce crime and health problems strong temperance movement, is open to debate. introduced a system of referrals to in 1987 the Zurich authorities allowed a Commissions for the Dissuasion of needle park used by up to 1k people per day. This approach is based upon a collective Drug Addiction (CDT) made up of approach that values an individual’s need for social workers, legal staff and In the mid 1980s after a ‘revolt of the medics’ security and safety. medics. needle exchange was allowed.

Drug user seen as a fundamental problem and In 2000 drug use and related At Platzspitz harm reduction approaches out of control. problems were high particularly were taken dealing with overdose needle with injected heroin use and HIV exchange, hepatitis vaccination, condoms Therefore illicit drug use is explicitly criminalised. infections. Cannabis use was and other harm reduction approaches. 11/0445 9PM 09 50 4 001/12/2014 1 /

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n Sweden Portugal Switzerland d d

1 The levels of crime associated with drug use Police refer to CDT and the person This approach saw large numbers of people cover the spectrum of minor, ordinary and is seen within 72 hours. Can causing disruption to local residents and was serious. impose fi nes, community service closed in 1992. and aims to dissuade new drug Alternatives to prison exist but cases classed as users. In 1994 the Swiss Government established a serious have mandatory prison or treatment. policy based on the four Pillars of prevention, They assess status as being therapy, harm reduction and law enforcement. There is compulsory drug testing for all occasional and dependent users, offenders. with the latter receiving treatment. Heroin assisted therapy was central to this approach (HAT) providing injected heroin for Compulsory treatment also used for alcohol but Overall there has been an a subset of people living with dependency overall rarely used. increased use of cannabis, but not having good outcomes from other decreased use of heroin, interventions. Also low threshold methadone Therapeutic Communities have been popular but increased uptake of treatment, prescribing was introduced. expensive treatment models; so increasing use reduction in drug-related deaths. of 12-step programmes. Overall heroin use has declined and not increased as feared.

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C substance misuse S M _ B A B 1 4 0 The BeckleyFoundation providesaninteractive Cannabismapindicating thelegislative DrugScience: www.drugscience.org.uk/ The Transform DrugPolicy Foundation: www.tdpf.org.uk/ The EuropeanMonitoringCentreonDrugsandDrug Addiction: www.emcdda. The UnitedNationsOfficeonDrugsandCrime: www.unodc.org/ Table 4.1showssomeofthekeyfeaturestheseapproaches. drug use, andSwitzerlandhasfocusedonmedicalisationforopiate users. Sweden hasastrictprohibitioniststance, Portugal hasdecriminalisedall use attheotherend. Inlookingatdifferingexamplesofdrugpolicythen end oftheharmspectrum, andtheneedtoaddressproblemsofopiate been definedbyaddressingthewidespreaduseofcannabisatlower be contrary totheUNConventions. The debateaboutdrugusehasreally has beencontroversial, buttheformertwoapproacheshave beenseento 8 B 0 . Inyouropinionwoulditbemorepreferable toprovideheroinonpre- 6. beasopenaccessandlowthresh- Shouldharmreductionservices 5. Isitpreferabletousecivilsanctionsasopposedcriminaljustice 4. Withrespecttodecriminalisationisitacceptabletradeoffharms, 3. Isitethicaltodemandabstinencefromdruguseandcriminal 2. To whatextentdoyouthinkthatprohibitionistpoliciesactuallywork 1. 1 map/ map/ status ofcannabisforallcountries: http://reformdrugpolicy.com/cannabis-map/ europa.eu/ Exercise 6 3 _ P scription ratherthanasubstitutesuchasmethadone? old aspossible? sanctions andhowmighttheseworkintheUK? but anincreaseincannabisuse? so forexampleitwouldbepreferabletoseeadecreaseinheroinuse justice sanctionstoenforce this? should culturalvariationsbeallowedforwithinthisframework? all modelasdemonstratedintheUNConventionsandtowhatextent in preventingtheuseofdrugs?Isitpossibletohaveaone-size-fits- a r t - 1 . i n d d

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d d n i . 1 - t r a P _ 3 6 Fordham Urban Law Journal Fordham 1 0 B 8 0 4 1 B A practice see www.newhealthguide.org/Where-Is-Marijuana-Legal.html practice zation’, zation’, B _ M The Open Society Foundation: www.opensocietyfoundations.org/ www.opensocietyfoundations.org/ Foundation: The Open Society this means in cannabis and what legalised about countries that have information For Polak (2000) ‘Thinking about drug law reform: some political dynamics of medicali- reform: about drug law ‘Thinking (2000) Polak S C K _ t f o r c y P _ 1 001 P ft KCSM BAB1408B0163 P t 1 i dd 23