COMMENTS by Mary Brett

Tackling Drugs To Build a Better Britain, 1998, had prevention as its priority, as did the previous, Tackling Drugs Together. So, in fact does the latest, Updated Drug Strategy, 2002. In David Blunkett’s foreward to this 2002 version, he lists prevention, education, harm minimization, treatment and effective policing as our most powerful tools. He ends with, “Future generations should never have to face the dangers and harm that drugs present to too many of our young people, their families and their communities today.”
The 2002 strategy talks about a stronger focus on education, prevention, enforcement and treatment to prevent and tackle problematic drug use, and aims to persuade all potential users, but particularly the young, not to use drugs. This, it says can be done by maintaining prohibition, which deters use, and by providing education and support.

I expected to find the word prevention or similar in 2.1, “Aim of drug education”.
I didn’t! I know that parents assume that drug education in schools is doing everything it can to strongly encourage their children to resist the use of all illegal drugs. Sadly many will find this is not the case. Why is this not the first aim of drug education? Nowhere in this section does it even hint that to resist drug use might be a good idea. Tobacco and alcohol ought to be mentioned at this point. The use of tobacco should be strongly discouraged, and information given about the sensible use and safe limits of alcohol.

Unfortunately, for the past fifteen years or so, the philosophy of harm reduction has been hi-jacked by most drug educators. Their view is, “kids will take drugs anyway, they must be told how to take them safely, and we must give them informed choices.” Apart from the fact that currently they do not receive true, accurate and reliable information about some of the drugs, especially cannabis (more on this later), there should be no choice – drugs are illegal. Do we let them choose to break the law by speeding or petty pilfering?

By no means do all kids use drugs. Maybe 30% to 40% do try them, but most give up after a puff or two. The vast majority, well over 80%, will never become regular or even occasional users. And as for safety, there is no guaranteed safe way to take any drug, including those on prescription.

Harm minimization, or the more usual term, harm reduction, has its proper place in dealing with known users, who already have drug problems, providing effective treatment and rehabilitation to break the cycle of dependence, while minimizing the harm that drugs can cause. Heroin users can be encouraged to “chase the dragon” (inhale the smoke), rather than inject, thus avoiding the blood-borne diseases.

I thought I might find the phrase “informed choice” somewhere, and I did, but I was more than surprised to find it in the section, 2.20, on Ofsted inspections for primary schools!
I would challenge anyone to convince me that children of seven to eleven have the necessary maturity and experience of life to be able to make an “informed choice”. Some of my sixth form boys lack this skill at seventeen! Recent research indicates that the brain does not fully develop till the mid-twenties, a lot later than previously thought.
At least in this section it does say, “helping them to develop and practice personal skills e.g. resistance skills”.

This government relies heavily, almost totally, on the charity Drugscope for its advice and information, and so, apparently does the DfES. It is an amalgamation of two previous charities, SCODA (Standing Conference on Drug Abuse), and ISDD (Institute for the Study of Drug Dependence). Literature from SCODA is quoted, The Right Choice, The Right Approaches and The Right Responses. On the covers we see a small logo with the words, “Good practice in drug education and prevention”, but inside we read, “ SCODA seeks to reduce the harmful effects of drug use through informed debate”. SCODA long ago abandoned any pretence at advocating primary prevention, they sometimes use the phrase “secondary prevention”, and say it is when children have already started to use. Anything after primary prevention, (stopping them from starting in the first place), is intervention and harm reduction. Even the DfEE Drug Prevention and Schools Circular, 4/95, also quoted, refers to “secondary prevention”. Pre-event, I would have thought, is quite clear in its meaning. Likewise the DfEE’s Protecting Young People, 1998, although emphasizing the aim of trying to encourage children to resist drug use, points drug educators in the direction of SCODA for resources.

 On page five of The Right Responses, 1999, it says, “Research indicates that drug education and prevention strategies are not able to prevent experimental use. There is growing evidence, however, of effective strategies which can reduce the misuse of drugs and the associated problems for young people, their families and their communities.” This is quite simply not true. The huge prevention campaign in the USA from 1979 to 1991 saw a 60% drop in drug use. Cannabis and cocaine use fell by fifty per cent. Twenty three million drug addicts fell to fourteen million. They then unfortunately, thinking the problem had been solved, took their eyes off the ball, and usage soared. A similar campaign is currently taking place there under the new drug tsar, John Walters, and once again drug use is falling. The Swedes have had excellent prevention programmes in place for many years, their level of drug use is around 2% to 3%. I have yet to find a harm reduction programme that matches these results.

I attended a session of the Home Affairs Select Committee (HASC) in March 2003, when Bob Ainsworth, the government spokesman on drugs was giving evidence. He talked constantly about harm reduction, and when questioned what he was doing about preventing young people from starting in the first place, he became hesitant and evasive. He said the government was doing lots of things, and when pressed, assured the MP, the Lib-Dem, Bob Russell, that the HASC was not going down the legalization route. Do politicians ever give straight answers to questions?

Children actually need rules and regulations, the only way they feel safe and secure is if they have boundaries to kick against. They have very little time for teachers who cannot control their classes. They often use their parents as an excuse when they want to get out of an activity with which they don’t feel comfortable. “Dad/Mum would kill me” is a phrase I often overhear. Ex-pupils who come back to see me are often the ones I have had to discipline most severely.
In The Right Choice, 1998, shock tactics are dismissed as lacking credibility and even glamourising drug use. Strangely enough it is claimed that “Just say no” falls into this category. In an English essay, set by one of my colleagues to year ten pupils, about what would put them off taking drugs, the commonest request was for accurate information on the harm they cause, but a surprising number said that shocking stories had a part to play. I never actually say, “Just say no” to my pupils, but I find that, if I give them the accurate, unexaggerated scientific facts about drugs and how they affect the body, add to that the adverse social, educational, emotional and family consequences of that way of life, spend some time discussing the various arguments surrounding drugs, and point out the employment potential of a drug user, most of them are deterred. I know, I get lots of feed-back. “Anyone would be mad to take drugs after that talk this morning”, was one of the comments overheard after my annual address to year twelve boys, reminding them of the dangers of cannabis. Earlier in their school career they have had sessions on self-esteem, peer-group pressure and other life skills, as well as being told of the dangers.

A few years ago, a former pupil came to see me. Having been a cannabis user, he had just managed to scrape into university with C and D grades. He was in his final year of a degree in pharmacology and wanted my help to write his dissertation on cannabis. I asked him what had stopped him. He looked surprised. “You did”, he said. “I could quote every word you ever said about cannabis, and all of it came true”. He also managed to stop some of his friends.

He got a first for his dissertation, spent a year as a technician with a friend of mine, a toxicologist, did an MSc in neurology, and is now researching brain diseases towards a PhD thesis.

“Harm minimization, on the other hand”, The Right Choice says, “reflects the reality that many young people use both legal and illegal substances ………… Those who advocate this approach acknowledge the importance of young drug users being aware of the risks associated with drug use, and aim to equip them with the knowledge and understanding that seeks to minimize them.” I reiterate, the vast majority of children do not use drugs.

Alcohol, of course is a different case entirely, section 2.5.1. Because it is a legal and widely used drug which can be consumed quite safely in moderation, harm reduction is perfectly acceptable. I would, however emphasise the need for a warning of the danger of overdose and death. Many children are surprised when told it can kill.

I have never understood why it is acceptable to be very tough and even authoritarian about tobacco and not about illegal drugs, section 2.5.2. “Discussions should make it clear that smoking is a minority habit”. So is regular drug taking. It is even more of a minority habit than smoking! “Opportunities to develop refusal skills are important”. They are even more important with illegal drugs but the guidance seems afraid to spell this out. “The question of smoking cessation should be addressed”. Of course it should!

Why does the emphasis shift when legal drugs are being discussed? I tell my pupils that they would be crazy to start smoking, but then I say the same thing about drugs. When you think about it, tobacco doesn’t cause the mental illnesses that cannabis does, nor does it stop you from concentrating and learning in class.

The word “prohibit” is used in this section in relation to members of staff. Prohibition is a dirty word with the pro-legalisation advocates. Just for the record, prohibition in the USA did work, at least in terms of health and economics. Cases of cirrhosis of the liver fell by one third, alcohol-related divorce, child neglect and juvenile delinquency in Massachusettes all dropped by fifty per cent. The overall murder rate surprisingly declined, and the incidence of psychosis caused by alcohol plummeted.

The problems arose because the use and purchase of alcohol were never outlawed, it was only the manufacture and supply. A huge loophole was its prescription for “medicinal purposes”. Also, at that time, an attempt was made to ban a legal substance that had been in use by most of the population for hundreds of years and which could be consumed without harm. Unlike cannabis: still only used regularly by a tiny minority, shunned by most people, and with no safe limits.

One of the most consistent characteristics of harm reduction advocates is the trivialization of the effects of cannabis. Drugscope has constantly stated that cannabis is not physically addictive. This is not true, and a quick look at the abundant research on this topic would show otherwise. Most drug education advice currently is at great pains to point out that “accurate and balanced facts” must be given, I wish they were! And they should not aim to “shock or horrify”. But drugs can and do do shocking and horrible things to people.

I personally know six people with young relatives who have developed cannabis psychosis and will probably never be truly well again. Psychiatrists will confirm that more and more hospital beds are now being occupied by young people suffering from psychosis or schizophrenia because of their cannabis use. Youngsters using tobacco, cannabis and alcohol have a twenty-six fold increase in their risk of suffering from depression. And Professor Robin Murray told a meeting of The Royal College of Psychiatrists in June 2003 that eighty per cent of the patients he assesses with their first psychotic episode have been using cannabis. He said, “The more cannabis that’s consumed, the more psychiatrists we are going to need”. A recent survey in New Zealand found that young male cannabis users were five times more likely to be violent than non-users. The risk for alcohol was only three times.

Cannabis smoke deposits three to four times as much tar in our airways than cigarette smoke, and causes rare head and neck cancers in young people, not seen in tobacco users till they reach the age of sixty and over. The British Lung Foundation has recently given a warning to young people. Lungs shot through with holes, and people of thirty waiting for transplants are all part of the sorry saga. The risk of a heart attack in middle aged users rises five-fold in the hour following the smoking of a joint.

Babies born to cannabis-using mothers are smaller and suffer from behaviour and learning problems as they grow up. Sperm counts are reduced, and cases of sterility and impotence have been reported. The immune system does not escape either, it is also badly impaired. THC interferes with the copying of DNA into new cells made in the body.

Vehicle accidents, as many as those caused by alcohol in some studies, have been documented in America, although nine to ten times as many people drink. Since the fat-soluble THC (tetrahydrocannabinol), the substance that gives the “high”, stays in the body for weeks, 50% is still there after a week, and 10% a month later, a person smoking a joint today should not be driving for at least twenty-four hours afterwards. This “clogging up” of the cell membranes by THC may even cause some brain cells to die. Brain cells are not replaced. Permanent brain damage is too high a price to pay.

Concentration, learning and memory are all adversely affected, causing pupils’ grades to fall. Often they miss out on university places. Even on one joint a month, a cannabis personality develops. Children become inflexible, fixed in their opinions and answers, can’t listen to reason, can’t plan their day or work out problems. Few children using cannabis even occasionally will achieve their full potential.

And cannabis can act as a gateway drug. Numerous studies in the USA, New Zealand, and the latest, using twins from Australia, confirm the trend. Of course not all of them will progress to more dangerous drugs, but almost 100% of heroin users started on cannabis.

The cannabis of today is at least ten times stronger than it was in the sixties, and skunk and nederweed, varieties specially bred in Holland, have THC contents of anything from 9% to 27%, up from the 0.5% of forty years ago. Today’s cannabis is a totally different drug.

Is all of this not shocking? The Drugscope website contains very few of these facts. There is no mention of effects on the heart, the immune system, reproductive system, long-term storage or increased strength of THC. Conclusive proof is demanded. We still have no conclusive proof that cigarettes cause lung cancer, but because of animal experiments and statistical evidence, we accept the link. Why is it different with cannabis? One of the booklets about cannabis, distributed by Drugscope, shows a picture of two young chaps in a field of cannabis plants, one of them is wearing a cap with the logo, “Have fun, take care”. What sort of message does that send to our impressionable offspring?

Unless Drugscope and other similar charities get their acts together and up-date their information to give our youngsters what they deserve, advanced warning of the true hazards of this insidious drug, then our children are being betrayed. No wonder there is a disclaimer about information on their website. How can our children “ make sensible informed choices” when they are not properly informed? They should be encouraged to access scientific papers and books to get the real picture.

This guidance is full of statements like, “accurate information”, section 2.1, “real dangers”, section 2.2, and “credible information which does not exaggerate but clearly explains the dangers of drugs ….”  If only this were true!
Drugscope does not want people in possession of small quantities of drugs to be arrested – any drugs! They enthusiastically endorsed David Blunkett’s proposal to down-grade cannabis from class B to C. An absolute disaster waiting to happen! The number of young boys using cannabis has jumped 50% from 19% to 29% since his ill-advised announcement. In May 2003, on radio four, Roger Howard, chief executive of Drugscope, advocated the re-classification of LSD and Ecstasy as well as cannabis.

In the Department of Health’s “The Dangerousness of drugs”, the information on cannabis is much better than that of Drugscope, if only teachers have time to access it. However it falls short in some respects e.g. the fact that THC stays so long in the body is not spelled out and no mention is made of the increased strength today. In the driving section, no warning is given of the long-lasting impairment of skills, and the dependence potential is played down. The possibility of people becoming violent is omitted, and in spite of the many studies on children born to cannabis-using mothers, the results are questioned, even those that have consistently found the weight of these babies to be reduced.

Turning to the reclassification proposal, section 2.5.3, the assertion that cannabis is less harmful than drugs like amphetamines is debatable. Amphetamines, unlike cannabis, disappear from the body within forty-eight hours, so don’t have the long-term effects on concentration, learning, memory and therefore academic performance. Nor do they cause cancers since smoking isn’t involved. The immune system is not impaired. Both drugs are associated with heart attacks, confusion, depression, aggression, psychosis and paranoia, but I have never read that amphetamines can trigger schizophrenia. Nor have I seen evidence of them adversely affecting the foetus.

Children want lessons from people who know what they are talking about, section 2.2, I could not agree more. But many teachers in charge of drug education are not biologists. A good number are RE staff. When they receive drugs literature in school, they must naturally assume it is reliable and trustworthy. Teachers are busy people and will use worksheets if they are provided. One of the worst I have seen is entitled “Absolutely Spliffing”.  Messages again! Another has a table to be filled in, signed by S.P.Liff!

The various games, debates and activities suggested in the guidance, section 2.9.3, are useless without the true facts being known. I have never been a great advocate of playing games to get over the point about drugs. One book, giving guidance on drug education, suggests using syringes, foil, matches, cigarette papers and drink bottles. This leaves me feeling distinctly uneasy. Debates are excellent vehicles for an exchange of views, but when the sources of information recommended to them are heavily biased, then the whole exercise is badly flawed.

Connexions, the organization now responsible for distributing information to schools on various subjects, including drugs, is obviously mentioned. I recently had cause to complain strongly about some of the drug leaflets they sent out. They were written by the “Clued-Up Posse”, a group of kids from Fife. Not surprisingly they had very little information in them, were written in “trendy” language and had masses of advice on harm reduction. My sixth form thought they were useless, patronizing, and positively encouraged drug use. They pointed out to me that the cannabis one was a replica of a Rizla packet. Again, what message does that send out? In my view this is totally irresponsible and one MP has tabled a written question for me. I await the reply.

The Department of Health is not above blame either. In a recent poster sent to school offering a list of resources, the charity Lifeline was given. When I gave oral evidence to the HASC on cannabis in January 2002, I showed them some of Lifeline’s publications. “How a joint is rolled”, a set of diagrams in their cannabis leaflet, “Don’t get caught in the first place”, advice to children on how to survive their parents finding out they are using drugs, and a hint not to use an old LP record to place their cocaine on as it gets wasted in the grooves, are just some of the “gems” of advice from this charity. Their “street-wise” literature is full of sexually explicit cartoons and four-letter words.

To give them their due, the committee was collectively shocked, they have launched an investigation, particularly into the funding, which comes mostly from local health authorities and central government. The reply to my MPs question as to whether they would withdraw the poster was that they had no plans to withdraw it and would have no reason to do so.

QCA literature is also recommended. I recently wrote a criticism of their 2003 guidelines on tobacco, drug and alcohol education. My comments were very similar to these ones.

National Helplines, section 2.23, do not always help! I have lost count of the number of  parents who have contacted me because the advice is, “Don’t worry, it’s only cannabis” These desperate people know full well what is happening to their children and they are frantically looking for information about the drug that fits in with their experiences. Most recently, a despairing mother rang me. She had been trying to get someone to listen for six years, and I was the first person who had actually related to her problems.

On November 28th, 2002, 14 of us gave papers on cannabis in The Moses Room in The House of Lords. The Conference, entitled Cannabis – A Cause for Concern? was chaired by Lord David Alton. Seven other people gave testimonies, among them a young girl, a non-user. She said, “—-you adults have to say that you care, that you feel strongly about what we do – don’t leave it as a choice. If you don’t want us to do drugs then say so – and say why. You don’t ask us to choose whether to steal, or to attack people, so why leave us to choose about drugs”?  It was like a breath of fresh air.

Prevention has always been better than cure and always will be. We have massive prevention campaigns for drink-driving, breast cancer, heart disease and so on. Why on earth can we not see that preventing drug use must be our greatest priority.