Thursday, 9 December 2010

Evidence based policy takes another hit

Government proposal calls into question the role of science in drug policy making

It is self evidently logical that those best placed to advise government on a policy are experts working in that, or a closely related field; be they scientists, front-line staff or academics. This does not always happen in practice; thankfully drug policy is one area where it has for several decades, though it must be noted that it has not necessarily translated into evidence based policy. That presupposes that policy makers are predisposed to implement the recommendations of their advisors. This is best illustrated in the refusal by successive governments to move drug policy away from the criminal justice system to the realm of public health.

Worryingly, drug policy looks set to drift yet further away from the healthcare system.  It has been reported recently that legislation will be passed in the British Parliament that will remove the legal requirement for scientists to be appointed to the Advisory Council on the Misuse of Drugs (ACMD).  The ACMD is a body comprised of experts from several fields including vetinary, medicine, pharmaceuticals and chemistry.  Their remit is to conduct research and advise the Home Secretary on how to regulate and legislate controlled substances in the UK.

This apparent act of sabotage appears ideologically motivated and as such, represents a body blow for evidence based policy making. Removing the requirement for scientists creates the possibility that the panel could be repopulated with acquisecent individuals willing to support the governments approach, free from the constrains of evidence.  The Council provided a sustained challenge to New Labour and their pretensions of evidence based policy making; the coalition seems set to neutralise it before it creates the same problems for them.

There is evidence and support for policies that view problem drug usage as a public health, rather than a criminal justice issue.  Instead of putting drug addicts in prison - where drugs and boredom are both in plentiful supply - put them into care; rehabilitation and medical care is not only more humane but also delivers greater results.  A key step toward this is decriminalisation, a policy followed in other parts of Europe with success.  Decriminalisation paves the way for addicts to be channelled into healthcare rather than the criminal justice system thus removing problem users from the cycle of drug abuse and crime.  It should be noted that despite billions of pounds of investment prohibition of drugs has not only utterly failed, but continues to exacerbate the problem; their availability to end users continues to increase as their price continues to fall.
Unfortunately decriminalisation (a key step toward reform of drug policy into an issue of public health) has been unpalatable for British governments since the 1960s when the current classification system was introduced.  The punitive populism harnessed by Michael Howard in the 1990s (subsequently continued by New Labour) pushed drug policy further toward the criminal justice system and away from the control of health professionals.  The ACMD ran into trouble with a number of New Labour home secretaries for having the audacity to perform its primary role; advise the government on drug policy using scientifically researched evidence.  It represented a contradiction; an expert source of evidence based policy for a government whose primary concern was the consideration of public perception.

This contradiction was played out when it came to reclassifying Cannabis and other controlled substances.  A particularly interesting report in which the government had no interest was published in 2007 and sought to rank controlled substances by their harm (both physical and social).  The report suggested that under the current classification system Ecstasy should be a Class C drug, Alcohol Class A; this was summarily ignored.  The Advisory Council also opposed the reclassification of Cannabis from Class C to B in 2009, stating a lack of evidence on which to base the move.  Several public clashes involving the head of the ACMD professor David Nutt occurred; in a particularly controversial article he compared the death rates for equestrian sports and ecstasy usage conclusively concluding that the former was a significantly greater risk to public health.  This use of evidence to illustrate holes in government policy was not welcome and following a further clash over the classification of alcohol  professor Nutt was sacked.  Several other scientists resigned over the incident.

Removing the requirement for scientists to sit on the ACMD is still just a proposal, yet it serves to highlight two things.  First that support for evidence based policy making has diminished; secondly that explicitly ideologically motivated policy has very much returned.  Sadly, it also augurs badly for the treatment of problem drug usage becoming a public health issue, a development that might actually begin to tackle it.  Tackling problem drug usage and related crime as a criminal justice issue is 'treating the symptoms' at its best.  The causes of the symptoms are complex and diverse, some medical some social; it is no coincidence that the majority of problem drug use occurs amongst the poorest and least educated members of society and that thousands of educated, stable individuals indulge in recreational drug usage each weekend without harm to themselves or those around them.  But just because an issue is complex and difficult does not mean we should not take the hard road, take the difficult decisions and begin addressing it in a logical, evidence based way.

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