Jonathan Munday: "Medicalise" illegal drugs

> Policy summary

To "medicalise" the provision of currently illegal drugs, by providing them through NHS clinics to British Citizens. The sale is subject to an excise duty to help fund the NHS.

> Policy explanation

Prohibition of illegal drugs has failed just as much as prohibition of alcohol failed in the USA and with the same terrible consequences to public morality and law and order. But legalisation of drugs is politically inexpedient and would legitimise the businesses of some of the nastiest criminals in the UK.
Drugs should be available at cost plus an excise duty to registered users at special NHS clinics. The price in the NHS clinics should be adjusted quarterly so that it is half the then current street price. If need be, initially, the NHS would give the drugs away free until the monopoly was secured and the illegal drug industry driven out of business by the law of the market.

The NHS would become a monopoly supplier of illegal drugs and use the power of the market to undercut and drive out the dealers. Drugs would remain illegal and anyone caught dealing (or in unregistered possession) would be subject to the full might of the law and employers would be able to sack employees stoned on business. The clinics would dispense clean needles, syringes etc and provide uncut pure product. They would supply any drug requested in any quantity, provided it could be proved to be for personal use (by consumption of a test dose on the premises).

Ultimately, it must be accepted that prohibition has failed and will continue to fail. If children are going to take drugs, would you rather they got them from a gun-toting psychopath on a street corner or from a doctor in a clinic? Telling teenagers that drugs aren't daring or clever but mean that they are sick and need to go to the doctor for them is a very powerful message for that age group. Once the government had achieved a monopoly, it could start to raise prices to cut consumption, as with cigarettes.

This is not just a policy for drug addicts. They are buying and using the drugs now and it is better that this share of the GDP swells our government's treasury, rather than those of Afghanistan and Columbia. It is a policy for the rest of society. Most petty crime is drug related as addicts steal or prostitute themselves to maintain their artificially expensive habit. Cheap pure drugs would leave them too stoned to steal. Most of the medical consequences of drugs are a function of their illegality. Cut impure drugs risk overdosing and dirty needles spread HIV. This would be much less an issue.

What medicalisation actually does is to nationalise the illegal drugs industry. Nationalising an industry to ensure it decays and collapses is a very Tory policy - privatisation in reverse.

> Political risks and opportunities

The chief problem with the policy is the amount of political will it would need to see it through. Admitting that 50 years of drug policy was wrong is hard enough. Telling the Chief Commissioners that you no longer need half their police forces or most of the prisons and numerous social and charity workers that they can stop bothering now is an attack on some of the most vested interests in modern Britain.

Then there is the problem of the public brainwashed by 50 years of ceaseless official propaganda into just saying no - although the size of the current illegal industry does suggest that this might not be as big a problem as those some officials may expect. Finally, there is the attitude of several senior Colombian and Russian businessmen, who may "vote" against the politician that brought this idea forward.

It is vital that the logic of the system is carried through. In order to gain a market monopoly, the NHS must be prepared to dispense any quantity of any drug for personal use. There will inevitably be a view that dispensing the drugs indicates official recognition or support for drug taking. This is partly offset by their use remaining illegal to unregistered users. Drug counselling would be available in the clinics and might even become compulsory.

Dispensing illegal drugs would risk making Britain a Mecca for every addict in Europe, so clinics would only be open to UK citizens, via an Identity Card.

> Costs

The system has start-up costs, setting up the clinics (the legal production of illegal drugs costs peanuts) but much of this is already spent on hospital DDUs. NHS doctors could be invited to tender for the service in their locality. This also already happens to a limited extent with GP Enhanced services.

The system produces very considerable savings in the medium term:

a) £2-3 billion in excise duty would help fund the rest of the NHS.
b) Since 70%+ of minor crime is reckoned to be drug related and many city murders are score settling between drug gangs, the monopolisation of the market by the NHS will significantly cut crime resulting in huge savings in prison and police costs.
c) Cutting crime will also reduce insurance costs for home and car insurance
d) The current illegal drugs market is perhaps £9-10 billion. All of it is imported. Eliminating it involves a huge improvement in our balance of trade "invisibles".

 

Comments

[John Moss]

I'm in favour of this because the evidence from when we used to allow GPs to prescribe heroin, etc to addicts, was that it worked. It is only the criminalisation and glamourisation that has created the monster we see now.

However, it will only work for addictive hard drugs. It will not work for cannabis and it will not work for ectasy and speed and all the other clubber drugs floating around.

Personally, I think ALL the current class A, B & C drugs should simply be classed as "Illegal" and the penalty for possession, even of small amounts should be 12 months in a secure re-hab centre.

ONLY if you can demonstrate medical addiction should you be allowed the drugs on prescription and in most cases, you should be forced to accept secure residential re-hab as well.

[Andy Mercer]

The manufacturing cost of most illegal drugs is very low. Thus, any legitimate supplier (such as the NHS, or perhaps private clinics) would soon drive the illegititmate ones out of business.

Young people take drugs because they are "cool". If the monopoly supplier was a clinic, wouldn't it cease to be "cool"? Wouldn't that reduce the numbers taking up drugs?

[Machiavelli's Understudy]

Christ... What an utterly half-baked and ill-conceived idea this is! This is what happens when people with no relative knowledge or experience of the matter are given the opportunity to air their thoughts. All emotive style and no rational substance.

The problem with these superficially-compassionate ideas is that they aren't really doing anybody any favours. It still comes from the paternalist point-of-view that "we know best", when the reality is anything but.

How on earth can you medicalise recreational drugs? Considering nearly three quarters of a million people use MDMA in the UK (with between 500,000 and 2m pills consumed each week), how does the author propose that the NHS copes with the demand that even a fraction of that number would make on its capacity? How practical is it, really? More to the point, what exactly would be the point, anyway? Proportionally, far fewer people die from MDMA than from alcohol or cigarettes (and MDMA has been around since the earlier part of the 20th Century, so the idea of 'unknown dangers' is scare-mongering), so why labour an irrational aversion to recreational drugs like it?

Medicalisation of drugs is the wrong 'solution' to the 'problem' (what exactly is the problem, anyway? Criminal acts as a result of prohibition or the idea of individuals minding their own business behind closed doors?). More consistent and comprehensive treatment for addicts and the complete decriminalisation of drugs would be a step in the right direction- it's worked relatively well for Portugal, so far. For this to happen though, would require people to take a realistic view of what drugs are, who uses them and why. Then we would perhaps see more realistic policy proposals in future.

Perhaps, though, the medicalisation option being proposed could be used as a stepping stone towards a more realistic drugs policy, so it is with reluctance that I say 'YES'. Certainly, if it decriminalises the act of millions of ordinary, otherwise law-abiding people having a good time, it is preferable to the current nonsense.

[Jake]

"Young people take drugs because they are "cool". If the monopoly supplier was a clinic, wouldn't it cease to be "cool"? Wouldn't that reduce the numbers taking up drugs?"

This isn't a very sensible argument. Young people don't take drugs mainly as an act of rebellion. They take them because of the psychoactive effects, and because they underestimate the downside. Wouldn't we all give it a go at least once were there no downside (no sniggering at the back, David)? And in any event, this proposal would not make drugs socially acceptable so would not significantly reduce any rebellion element. As politically interested people, we tend to assume that the legal position is key - drugs would still be socially disapproved of and that is key to any "rebellion" issue.

That said, there is still some merit in the proposal. People seeking money for drugs rather than drugs themselves are the big issue, however sad it is to see people throwing their promising lives away over them.

[Matt Davis]

The problem with this particular approach is that it is essentially an extremely sensible way to maintain Herion addicts, but only Herion addicts, whilst ameliorating them as a cause of crime.That in itself makes real sense and ought to be supported for the greater good of society and us all, BUT, and here's the rub, the policy is proposed simply as a drug policy, not, as in imho it really ought to be, solely a Heroin addict harm reduction strategy policy.If you agree with Jonathan Munday, and I very strongly do, that the war on drugs was lost long ago, and becomes more unwinnable every day, then surely it becomes obvious that different strategies are required to control and limit the damage of, different drugs. For example this model would be completely inappropriate and ineffective to say the least for addressing Cannabis usage which would be far better dealt with by licensing and taxing it thereby totally removing it from the criminal drug dealer's lexicon.One of the key reasons that all Government initiatives against illegal drugs have failed is that they use the same broad brushstroke, all drugs and drug users are the same approach, which is to ignore the basic realities on the ground.

So, good idea Jonathan but writ far too wide I think.

[Denis Cooper]

As always, I look at this from the point of view of minimising the extent to which the state interferes with the lives of individuals, always recognising that children can't be expected or permitted to take full responsibility for decisions about their lives, and that adults suffering from mental or physical disability may also need the state to intervene on their behalf. However as the general rule adults should be treated as responsible adults, not as children, until such time as they show themselves to be irresponsible in some important respect, and the state should not interfere in their lives unless there's a very clear and compelling reason to do so for their own protection, or much more importantly the protection of others.

The opposite approach, based on the alternative model of a society in which an omniscient elite has a duty to seek every opportunity to regulate the lives of the ignorant, stupid and irresponsible masses, always ends badly.

[Opinicus]

I seem to have fallen between the two stools (isn't English a rich simile-laden language) of the authoritarian right who only want people to stop it and can't understand why they dont just obey and the libertarian right which only cares passionately that no one should care.

I firmly believe that current drugs policy is a miserable failure and wastes billions of public money in police & prison costs and in insurance claims and in damaged lives. I can assure Chris Palmer, that as a GP, I know of many patients (though not myself) who are recreational users and whose health nor wealth are materially affected by drug use. I also have several patients whose lives and families are wrecked by it. I really do not think that the public will wear legalising drugs. There is too much pre-conception.

This policy has been described as a half way house. I think it is the only realistic prospect of a way forward, out from under the monolith of failure that is current drug policy in the UK.

There are few practical difficulties. The NHS is easily capable of retailing drugs. Yet another anon is being sanctimonious if he thinks that these would be the only drugs supplied by the NHS for "non medical" reasons. The NHS has large retail arms eg opticians and dentists and could easily set up new drug outlets - these dont have to be based in GP surgeries or hospitals. Its not even strictly necessary to the policy that it be managed by the NHS at all but could be a quite separate nationalised industry, Britdrug.

The purpose of the policy is to use the law of the market to drive out the illegal dealers and pushers from this country and from peoples street corners, which law and guns have so miserably failed to do. This can only be achieved if it applies to all drugs or the pushers would remain for the others. A combination of medicalising and legalising (say just cannabis) might work but E speed crystal meth and cocaine are all too dangerous just to legalise unchecked IMHO. I have at least a dozen patients with permanent drug induced psychosis. Once the dealers are gone and there is only one supplier then it will be possible to reduce demand. I think drug taking is harmful. I have seen the damage it does. But I think it will hurt less when we stop banging our heads against the brick wall of current drug policy.

[Jake]

"E speed crystal meth and cocaine are all too dangerous just to legalise unchecked IMHO. I have at least a dozen patients with permanent drug induced psychosis."

Although equally, a couple of the cocaine users have VERY senior positions within... no, must stop.

[Machiavelli's Understudy]

"E speed crystal meth and cocaine are all too dangerous just to legalise unchecked IMHO"

Nobody's suggesting that these wouldn't be regulated in a retail environment. After all, it's not like it's a free-for-all for alcohol, tobacco and Sunny Delight manufacturers and retailers, is it?

Besides, so what if something fun IS dangerous ? Many things are dangerous, but it relies on probability being in its favour. I think our sense of proportion is way out in this respect. Why don't we ban parachute jumping? We know it's dangerous, and there's no real need for it. Or would that be another instance of the nanny state gone bat-shit mad?

[Green Libertarian.]

Cannabis is the only illegal drug that interests me personally, though no doubt at some point my life may be adversely affected by some heroin or crack addict stealing to support their habit.

Why not start with cannabis and go from there ?

The most worrying aspect for me of the present resurgence of "reefer madness", is the total lack of mention of the contaminants found in UK supplies - from the henna and boot polish in imported Hashish, via the sugar and glass beads being sprayed on low grade herbal cannabis, to by far the most worrying phenomenon - viz organophosphate pesticides which are routinely used at illegal levels. Surely this warrants investigation when "cannabis psychosis" is being researched ?

Why does this otherwise entirely law-abiding 46 year old citizen wish to indulge in this particular pleasure and not the more orthodox alcohol and tobacco ?
Well it's actually no one's business but my own.

[James]

A good idea poorly expressed.

[C.Orwell Jones]

There are in excess of 5 million adults in Britain, who use cannabis on a regular basis.
There are only 1 million or so unemployed.
No doubt, with legalisation, new jobs could be found within the drugs trade itself.
Wonderful vote-catching, and tax raising proposals, and builds up a home-grown-industry. Details later, oh sod the details, and pass me the pipe.

[Chris Palmer]

"If you agree with Jonathan Munday, and I very strongly do, that the war on drugs was lost long ago" - Matt Davies

I am sorry, but when was this mythical war on drugs of which you speak? In reality, there never has been one - that is our problem.

"whose health nor wealth are materially affected by drug use." - Jonathan Munday

Stop trying to perpetuate that lie, please Jonathan. Many other doctors and GPs would argue completely the other way.

As I said before, many/most of those advocating legalisation are of course the selfish addicts themselves looking for a cheaper fix. One look at this comment thread proves that much.

[Steve Rolles]

I think its very welcome that conservatives are engaing in the debate on this important issue. What is abundantly clear is that the current criminal justice oriented policy is a counterproductive disaster and new thinking is required. Moreover there is an oppostiunity to put some distance between the opposition policy and failed government policy - and indeed to offer a strong critique and new ideas to the electorate.

A public health approach based on evidence of effectiveness is clearly what is needed but we have to be clear that different drugs would require different regulatory models depending on there harm potential and respective population of users. Highly addictive drugs, predominantly used by chaotic users with multiple problems (like heroin) have established models for medical distribution . Infact this already happens in the UK and elsewhere in the world very effectively - reducing crime, social nuisance, ill health and saving substantial govt/tax spending.

For less harmful drugs a state monopoly would not be appropriate - some form of licensed sales would be more appropriate, and there are various models already in existence that can provide a model - pharmacy sales, off licenses, licensed premises and so on. We have generations of experience regulating legal medical and recreational drugs on which to draw on and learn from - obviously prohibitions would remain outside any such regulatory framework. Such changes could be phased inover a number of years with pilots and other research to find which wreb the most appropriate. criminal networks would be put out of business, street dealers and p[reostitutes would dissapear, aquisitive prperty crime, organised crime and turf war violence would decline dramatically - releiving the crisis in the prisons and criminal justice system, the savings from which could be invested in treatment for problem users, education about the dangers of drugs and prevention aimed at young and vulnerable groups - a post drug war 'Marshall plan'. There is no reason why pragmatic law reform cannot be compatible with a strong anti-drug message.

It's is an obvious, rational and politically expedient idea that conservatives should embrace if they are serious about challenging a failing government, embracing liberty and common sense.

[Chris Palmer]

Oh dear, rejected. How sad.

[pulse oximeters]

People just have to work out for themselves they are dangerous.

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