The DrugScience group met on Thursday 1 June, and the major item for discussion was the new Psychoactive Substances Bill. The Bill will have its second reading in the House of Commons on 9th June 2015.
The following points were made and are presented here for public information and dissemination.
1 Issues of principle
1.1 The implementation of a new law with such wide-ranging impact is disproportionate to the challenge of new psychoactive substances, which is a health issue, and a lesser one relative to other drug-related problems. It will surely be a major concern to many citizens.
1.2 The principle of banning any psychoactive substances that might become available in future, with no evidence of their harmfulness, is a fundamental change in the way the UK law works. This sets and extremely worrying precedent for future legislation.
1.3 This Bill makes no discrimination between drugs carrying very different capacities to harm. People will be equally threatened by prosecution in relation to substances with risks equivalent to that of coffee or heroin. This undermines the basic principle of proportionality in UK law.
1.4 The main target of this bill is to close down “head shops” but this has already been shown to be possible through other approaches.
1.5 We already have the Misuse of Drugs Act 1971 that can deal with this issue – and indeed has done so successfully in the past decade as indicated by the fall in deaths from truly “legal” drugs in this period to now probably less than 5 per year at present. Higher figures quoted regarding deaths from so-called new psychoactive substances (NPS) are from drugs that are illegal and are generally NOT sold in “head shops”
1.6 Another set of regulations will be needed that will become conflicted with the Misuse of Drugs Act 1971, leading to confusion in the minds of the public and the police as well as being wasteful of public resources.
1.7 The proposed ban on N2O is particularly perverse and unnecessary. Laughing gas has been used for several centuries by some of the greatest scientists (Davy) philosophers (James) and poets (Southey, Coleridge). There is minimal evidence of harm from the recreational use of N2O balloons. The media term “hippy crack” should not be taken to suggest any true similarity to the risks of cocaine!
2 Issues of fact
2.1 The evidence used to pursue the ban – supposed increase in NPS deaths to 97 in 2013– is flawed in that almost all of these are ALREADY illegal so why would a ban on less harmful substances be of any use? (see King and Nutt 2014 Lancet)
2.2 The illegal drugs leading to deaths are not sold in “head shops”. In fact it is possible that “head shops”, which tend to sell relatively low risk substances, have contributed to the current situation where there are less than 5 deaths from truly “legal” NPS each year.
2.3 The Irish experience shows deaths go up when the market is driven underground by head shop closure as there is less quality control and NPS use increases (9% of Irish youth have used NPS – the highest rate in Europe) and deaths rise. Expert opinion and experience suggests this is because the ban of “head shops” will drive the market underground into the arms of dealers and the internet. This will result in more harms and deaths as quality control will drop (“head shops” need to ensure their clients are not harmed so they return), more dangerous drugs such as heroin will almost certainly be sold alongside NPS and there will be no source of education on responsible use.
2.4 The main purpose of this new law would appear to be to ban “head shops” for social reasons. Such ends could easily (and have already in some towns) been achieved by other mechanisms such as local trading regulations.
2.5 The proposed Act is therefore unnecessary and the proposed penalties disproportionate to the real harms of legal highs.
2.6 It will nudge individuals who wish to enjoy the recreational effects of drugs to use alcohol. We know that at least 85% of the population like to use recreational substances since that proportion drink alcohol. Alcohol is responsible for 22,000 deaths per year so is more harmful than almost all illegal drugs. As well as presenting this major moral dilemma driving use to alcohol, the proposed law will preclude the development of new safer alternatives to alcohol and other recreational drugs.
2.7 Despite the claims of the Local Government Association that this Bill follows the recommendation of the expert group on NPS in fact it goes much further than their report for they recommended that substances that are not harmful or have minimal harm are NOT drawn into this bill. Not all psychoactive substances are harmful, and some have clear benefits.
3. Problems with definitions
3.1. What does psychoactive mean? – will it include antidepressant and antipsychotic drugs? Will negative psychoactive effects also be covered (eg opioid receptor antagonists such as naltrexone that are useful medicines but can produce anhedonia, dysphoria and nausea for example).
3.2 How will the exempted substances be defined? e.g. Will alcohol be ethanol solutions – will coffee be based on chemical caffeine content – tea on having theophylline? (in which case what about herbal teas?). Many popular products contain guarana or ginseng both of which may have mild psychoactive effects. Many other widely-sold drinks contain potentially psychoactive substances, e.g. energy drinks such as Red Bull have taurine along with caffeine. Tonic water has quinine.
3.3 Who will decide whether a drug is psychoactive – the police making the prosecution? And where will the expert guidance come from?
3.4 It is critical that the definition of psychoactive be based on the effects in living humans. Many useful medicines resemble abused psychoactive drugs in the “test tube” but do not have psychoactive (e.g. loperamide, a potent opioid agonist that was developed for pain but didn’t work as it didn’t enter the brain so is now used to treat diarrhoea). Some cathinone preparations are effective antidepressant, anti-smoking and anti-obesity agents, despite not having immediate psychoactive activity. But innovation using newer cathinones has been stifled by the recent control of many new and as-yet –to be –made under the recent cathinone amendments to the MDAct1971. Similar and potentially worse impediments to innovation can be expected if this new bill is passed.
3.5 Will dosage influence illegality? Will low (non psychoactive) doses be exempt from any controls to allow forensic and other labs to hold standards for assay purposes?
4. Likely perverse and unplanned negative effects of the law
4.1 Experience with other drug laws and regulations tells us they often have a negative impact on research and development activities in universities and pharmaceutical sites. It is therefore imperative that ALL research establishments are exempted from this ban
4.2 We welcome the plan to exempt doctors – but the bill needs modifying to ensure that ALL medicines in the pharmacopeia are exempt – not just those with Marketing Authorisations (MA) as presently construed. Drugs with MA are not the totality of medicines that doctors can prescribe. (note; a Marketing Authorisation (license) is given by the MHRA to companies to allow them to market (sell, advertise, etc) their products, it does not define the use of such drugs, just what claims can be made by the company when they are marketed. A doctor working for the benefit of their patients and with knowledge of the efficacy of a drug can use drugs outside their MA; this is because many drugs with established uses are too old to have been through modern testing but are still useful medicines)
4.3 The same issues are raised with aromatherapy chemicals.
4.4 Will dietary supplements be exempt?
4.5 And lighter fluid refills (butane) and other solvents?
4.6 Camphor-containing inhalants have proven psychoactive properties
4.7 Even petrol when sniffed is psychoactive
5 Recommended amendments
5.1 Delay the Bill until there is good evidence that this approach can work by reviewing the Irish data
5.2 The NPS Bill be cut down to what it was intended to achieve i.e. control the IMPORTATION and SUPPLY of NEW HARMFUL psychoactive substances by professional drug suppliers and dealers who are set to make large amounts of money from this trade
5.3 if the Bill does progress then there should be specific exemptions for:
5.3.1 all medicines whether they have an Marketing Authorisation or not (see section 4.2 for explanation)
5.3.2 all research pharmaceuticals being used to developed new medicines or progress neuroscience research
5.3.3 all doctors
5.3.4 all bone-fide research scientists
5.3.5 Low (non psychoactive doses) should be exempt from any controls to allow forensic and other labs to hold standards for assay purposes.
5.4 Decisions on whether a drug meets the criteria for being significantly psychoactive to be controlled under a new Act be made by a new committee comprising experts nominated by the Royal College of Psychiatry, the British Pharmacological Society and the Academy of Medical Sciences.
5.5 Systematic evidence gathering of the effects of the new law be made part of the Bill. This must include monitoring deaths and other harms from ALL drugs, not just NPS to endure that any diversion of use into other substances is rapidly detected.
5.6 The impact on British research and productivity must be formally and annually monitored via appropriate bodies, e.g. the British Pharmacological Society and the Academy of Medical Sciences working alongside BIS.
5.7 Entertainment premises should be exempt from liability from their customers’ use of psychoactive substances. If the owners or directors of premises are liable under this Bill – this could have a severe and negative impact on many venues crucial to the night-time and social economy in the UK including: clubs, pubs, bars, and music festivals.
5.8 This Bill as drafted could also have a severe and detrimental impact on all those providing services for people who have multiple vulnerable needs and are more likely to take substances – leading to a situation where Directors of Services are liable for any instances of psychoactive substance use or supply on their premises including: prisons and mental health wards.
David Nutt on behalf of DrugScience June 7, 2015