You
are in Medical / Veiws Minutes
of evidence taken before the Select Committeeon Science and Technology
7th February 2001DR
Brian Davis, Mr David Snowdon, Mr Charles Clarke and Mrs Judy Sanderson
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22 (Mr
Clarke) The broad issue is that Government is very much interested in and does
take notice of scientific research and development made in other countries such
as the licensing of Marinol, a medicinal form of dronabinol, the main active ingredient
of cannabis, in the USA. But evaluation and detailed consideration of such developments
is a matter for the Department of Health and the Medicines Control Agency. We
are also aware that there is growing interest in the possible medicinal uses of
cannabis in a number of other countries. You mention Canada in your question.
Dr Davis has answered about Canada earlier. We understand that the Canadian Therapeutics
Products Programme is currently examining the steps required for the cultivation
and distribution of a cannabis-based medicine. The Committee may be interested
to know that representatives of this programme have met with Home Office officials
to learn more about the UK's policy on this issue and about the licensing of cannabis
research in the UK. That is for the general reason that we are in favour of interchange
of information on these issues as much as possible. We are also aware of the so-called
"medical marijuana" programmes in several of the US states. Alaska,
Colorado, the District of Columbia, Nevada, Oregon and Washington State have voted
to allow the cultivation and use of cannabis by individuals for medicinal purposes.
However, whilst a few individual states permit the medicinal use of the drug,
the US Federal Government is opposed to the use of cannabis for medicinal purposes
ir, the absence of a scientifically proven medicinal form of the drug; i.e. broadly
speaking the position [ have been arguing before this Committee. The US Government
has made clear that it opposes such initiatives for the following reasons. Firstly,
that they undermine the medico-scientific process for establishing what is a safe
and effective medicine. That is precisely the issue for your Committee. Secondly,
mat they contradict federal drugs regulations and laws. We have indicated for
our part that, in the event we get a clear process, we are prepared to amend our
laws. Thirdly, that they might be vehicles for the legalisation of cannabis for
recreational use. I have tried to answer that in relation to Lord Howie's question
and then Lord Porter's question. We regaid the scientific question here as pre-eminent.
As far as the other European Union states are concerned, we understand that in
Holland the use of cannabis for both medicinal and recreational purposes remains
unlawful. However, whilst the possession of cannabis remains illegal, the laws
are not in practice enforced in Holland. Dutch drugs policy has facilitated the
sale and possession of cannabis for personal use through the system of coffee
shops and cannabis cafes. Under existing guidelines, the Dutch authorities take
no action against those in possession of small quantities of cannabis for personal
use, whether it is for medicinal or recreational use. As a question of actual
policy, the medicinal or recreational point is not a matter which they take into
account. Elsewhere in the EU, we understand that three other countries, Italy,
Spain and most recently Portugal, have decriminalised or want to decriminalise
the consumption and possession of small quantities of drugs, including cannabis.
Their | drugs
laws therefore facilitate the use of cannabis for both medicinal and recreational
purposes. So again a distinction as between medicinal and recreational is, as
I understand it, not drawn. I am sorry to have given such a lengthy answer but
I thought I had better get on the record the extent of our awareness of what is
happening elsewhere. The short answer is that we do try very hard to take account
of what is happening in other countries. We are very much focused on the medical
issues and what is happening in developments there. 46. Thank you very much
for putting that on the record. From what you have just told us, it is quite obvious
that ;n many countries where people from Britain trave! to or from on holiday
or for work the attitude is r* iher more tolerant than the attitude of the Government.
Do you think that this is going to help bring aoout maybe a swifter decision or
perhaps a more tolerant attitude of Government towards the medical use of cannabis?
(Mr Clarke) There are general issues involved in the use of cannabis where I think
you are certainly right. Experience in other countries will inform the public
debate in this country and indeed people travelling to other countries draw their
own conclusions about that process. But we distinguish, and have tried in this
Committee this morning, between the general use of cannabisabout which there
is a debate and discussion but which the Government strongly opposes, for the
reasons that have been set out and in particular we believe the likelihood that
consumption will increase which we consider will be generally deleterious to the
public interestand medicinal use where we have a much more. I hope the Committee
will agree, constructive approach. That is to be very positive about changing
the law in the event that the medicinal evidence stacks up in the way that we
judge by the MCA view. Baroness Walmsley 47. I would like to return to
the issue of the prosecution of therapeutic cannabis users to which you referred
briefly earlier. We have received evidence that there is enormous inconsistency
in the outcome, particulary of some of these prosecutions, ranging from acquittal
to custodial sentences. We know from what you said earlier that of course any
decision to prosecute is not taken by the Home Office but by the CPS. There is
a concern that the prosecution of therapeutic users of cannabis is currently very
inconsistent. We wonder what can be done about it. Do you think that the postcode
prosecuting of therapeutic cannabis users is fair? Perhaps this is where the Home
Office could come in: should there be national guidelines for the CPS in these
cases and, if so, who should lay them down? (Mr Clarke) Firstly, two contextual
points, if I might: I would not accept the phrase "postcode prosecuting".
I am aware that "postcode" is now put in front of just about any decision
where there is local discussion in the country to emphasise a point. As I am not
in favour of moving to a Stalinist state, where everything is decided locally
essentially on every issue that comes along, I have to reject the phrase. There
are serious issues about prosecution practice and
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23 Bareness
waimsiey conta.\ sentencing practice across the country in this area, as in
many other areas, and that is one of the matters that is currently being considered
by Lord Justice Robin Auld in his Review of the Criminal Justice System because
the question you raise in this area is highly relevant to other areas of law,
too. The question of what form of guidance and how we can move forward is a very
live issue. I am not going to prejudge the outcome of Lord Auld's report, which
will be published in the next few weeks. I certainly acknowledge on the record
that the concern you raise is one that does exist and exists right across a range
of different offences in the decisions that are taken. The second general contextual
point is that in 1998 there were 89,000 cases involving possession of cannabis.
1998 is the last year for which we have publised statistics. While we do not keep
data on any offences by reference to the defence offered by the accused, all the
available evidence suggests that the prosecution of persons using cannabis for
therapeutic reasons, as opposed to cannabis more generally, is rare. I say this
noting, as your question does, that such cases tend to attract a high media profile
and so it is unlikely that there are many more prosecutions of medicinal users
of cannabis than those of which we are aware. In view of the relatively small
number of such cases per year, I do not think there is sufficient data to support
the allegation of a serious distortion of practice across the country in this
particular area. In cannabis use more generally, there may be more of an anomaly
in particular areas, that is true. As I said earlier, prosecution is a matter
for the CPS and the Attorney General and I cannot comment on those things. As
far as the police are concerned, I would like to make some comments and about
the actions of the CPS based on our dealings with them. Firstly, we have to be
clear that possession of cannabis is a criminal offence, whether it is for recreational
or therapeutic purposes. However, in relation to both therapeutic and recreational
uses of cannabis, our criminal justice system, in my view rightly, provides for
the exercise of discretion at various stages. Firstly, it is for the police to
decide what action to take. The use of cautions by the police is widespread for
minor drugs offences but the extent of their use does vary between police force.
In order to address this and improve consistency between forces, the Association
of Chief Police Officers (ACPO) issued guidance on the use of cautioning in early
1999, for exactly the reason implied. That ACPO guidance includes a range of scenarios,
one involving a genuine case of the medicinal use of cannabis. It advises that
police officers verify, where possible, the medical condition of the offender
and that, depending on other factors such as any previous offences, a caution
may be appropriate. It is obviously early days in respect of the ACPO Cautioning
Guidelines that I have just mentioned but already provisional 1999 cautioning
data has shown a slight narrowing in the cautioning range, indicating that the
guidelines are beginning to have an effect on the practice and conduct on the
use of discretion by different police forces. I believe that the specific reference
in the ACPO guidelines shows that the police are sympathetic to those with genuine
medical conditions who are not helped by existing therapies in deciding how they
use their discretion in enforcing the law. However, there will inevitably be
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cannabis users who make false claims of medical need. In cases where the police
are minded to prosecute, the final decision rests with the CPS. CPS lawyers, and
this is the second point, are guided by the Code for Crown Prosecutors, which
constitutes national guidelines. In relation to drugs offences, I understand that
the Code says that possession of small amounts of drugs may not always require
a prosecution. That is what the current guidance issued by the CPS says. The Code
also requires prosecutors to weigh public interest factors. Such an assessment,
based on the individual circumstances, is right and proper. The Attorney General
has previously stated that it would be contrary to our legal principles to go
further towards a structured use of prosecutor discretion. That is one of the
issues being considered by Lord Auld in his review. The final discretion is of
course by the court. Where a case is prosecuted and a conviction results, the
court has discretion to take account of the circumstances of the offender and
the offence before passing sentence. At the three levels of discretion, (a) police
discretion; (b) the CPS discretion; and (c) the court's discretion in deciding
what to do, on the first there are guidelines issued by ACPO which try to narrow
the differences. On the second, the CPS, there are Crown Prosecution Service guidelines
which address these areas. Then of course the courts are a law unto themselves.
48. Would you therefore agree that, if we are relying on three levels of discretion,
we will still have these high profile inconsistencies, which could very well serve
to undermine the confidence of the public in the law and therefore to be regretted?
(Mr Clarke) As I said in the early part of my answer, the central thesis that
you make clear is one I accept, that wide variations in practice across many different
types of law can undermine confidence. That is why that is one of the issues being
addressed by Lord Auld in his review. The Prime Minister gave great attention
to that matter in establishing the review. On the particular question you raise
about prosecutions for the medicinal use of cannabis, I do not accept the fundamental
proposition. I think the variations issue is much less sharp than it is either
for cannabis misuse as a whole across the country or .indeed for some other offences.
Lord Quirk 49. Granted, as you say, that prosecutions of medicinal users of
cannabis are really rather rare, where they do occur, the media seize on them.
The second part of this question is the real nub of what I would like to raise.
The general public seems to agree with the courts being very lenient in such cases
when they are prosecuted. But in the three years since Lord Perry's sub-committee
reported in November 1998, do you feel that there has been a change in the public
perception of cannabis offences, whether for therapeutic or for recreational purposes,
and that the distinction between the two has become a bit blurred? In your answer
to an earlier question, you said that if we were to proceed to approve the medical
use of certain cannabis products, nonetheless it would remain illegal, even for
therapeutic purposes, to take something that had not been approved. Do you not
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24 Lord
Quirk contd.} feel that there will have to be more a serious look at the whole
issue of the illegal use of cannabis, with some help and guidance given to the
police forces which have to administer at the moment a law which many of them
feel does not have public support? (Mr Clarke) Firstly, I am speaking without
the benefit of public opinion research in terms of answering your particular question
as to how public attitudes have changed over the last three years, so I am speaking
impressionistically. I think the effect of Lord Perry's report, and indeed the
general debate, has actually been the reverse of what you imply, in the sense
that I think there is now a much sharper awareness of the distinction between
medicinal use of cannabis and recreational use of cannabis in the public debate.
As I have heard it since I have had this responsibility in this job, for 18 months,
I believe that the debate is quite different around the medicinal use of cannabis
to that around the recreational use of cannabis. I think that distinction is much
sharper than I certainly recall it being before. To what extent Lord Perry's report
can take credit for that, I am not certain, but I certainly think that debate
has sharpened in what I regard as a generally helpful way. Certainly the way the
Government has tried to respond is to try to draw distinctions in the way that
we approach this as to medicinal and non-medicinal use of cannabis. I should have
said, in answer to the previous question on guidance to the courts, that, obviously
while no actual guidance is given by the Government to the courts, the C'ourt
of Appeal has issued sentencing guidance covering drug offences, including the
possession of cannabis. That Court of Appeal guidance says that when only small
amounts are involved being for personal use, the offence can often be met by a
fine. I understand that sentencing data confirmes in that this guidance is being
followed. I should add that in response to the earlier position. That sets out
a set of attitudes which I have tried to go through- the police, the CPS
and the courtwhich I think reflects, shall I say, an understanding that
where cannabis is used for medicinal purposes, that is to be considered in a somewhat
different light to purely recreational use and certainly to the use of much more
serious drugs and drug dealing across the whole range. I still believe, and I
think the Government's position is absolutely right and defensible, that we should
focus on medicinal issues, which are in fact the issues that Lord Perry's committee
rightly focused on, and rest upon the medical authority for scientific evidence
which is developed through the MCA. 50. You made a very good point earlier
about the medical use of heroin as distinct from, so to say, the recreational
use of heroin. Is it your belief that such a clear distinction, which is apparently
widely accepted throughout our society, can be maintained in the case of cannabis,
if cannabis products do become medically acceptable? (Mr Clarke) My answer
is provisional on your final clause. In the event that MCA did come to the view
that authorisation ought to be offered, then I think the distinction can be drawn
in that way. There is a hypothetical question: in the event that that happened,
to what extent would, for example, MS sufferers want to use cannabis as opposed
to the | medicinal
preparation? That really is absolutely unknown until such a preparation were on
the market. I take the point and I do not think any speculation would be constructive
because, by hypothesis, if the MCA come to the view that it was efficacious and
its marketing ought to be authorised, then MS users who were benefiting, in their
perception, from cannabis would expect to benefit from this product if it were
available to them. Working on the assumption that it would not work for them but
cannabis raw, as it were, does is not a fruitful area until we have some idea
what the MCA position actually is. LordJenkin of Roding 51. Very briefly,
I hope the Minister is indeed right, that there is now a much greater understanding
of the distinction between the recreational and the therapeutic uses of cannabis.
You will remember that some of the views that the Committee had were very critical
of the legalise pot movement. There were processions through the streets with
MS suffers in wheelchairs, as if it was all part of the same argument. We heard
the argument that Lord Quirk has made about heroin and the example earlier from
Lord Wade. I do not believe for a moment that the fact that doctors can prescribe
heroin for cases of serious pain has in any way undermined the legal authorities'
position in treating heroin as a very .dangerous drug, which has to be available
only on prescription. Is not the lesson that if the Government can move towards
facilitating the therapeutic use of cannabis, that actually could strengthen their
hand against the widespread use for recreational purposes? (Mr Clarke) I agree
with that, always again subject to the proviso that medicinal use is an effective
way of operating. I can say to Lord Jenkin that as a practising politician who
opened a major retail centre in the middle of my constituency in Norwich some
years ago, one of my opponents in the last genera! election was a drug dealing
candidate. Harold Marks was a convicted drug dealer and he was standing in the
legalising of cannabis campaign. It was a serious aspect in the election and was
brought into my particular election generally. I do believe that Lord Jenkin is
completely right, that if we could sort out, (a) the cynicism of some of those
campaigning for that position, and (b) if we could get them to support issues
clearly, that would help facilitate the debate on the wider use. Chairman
52. May I ask a final question? We know that heroin is a far more dangerous drug
than cannabis. We also know that most of the new drugs that are licensed by the
MCA have much more serious side-effects than cannabis. Can we be assured that
the insistence on the work in the use of the normal programme of testing that
is used by the MCA for new drugs is not based on the fact that cannabis is used
recreationally? (Mr Clarke) I can give that assurance and I have tried to
say throughout, and I am happy to have the opportunity in closing to reassert
the point, that our | | Page
25 Chairman
contd.} policy concerns in this issue are entirely scientific and medical
and not more general, political, cultural, crime-related or whatever. It is that
medical and scientific basis upon which the Government will take its decision
whether to change the law. Again, to reassert it, we will not do it without some
substantive | medical
judgment being made on these matters in the appropriate way, which I think is
through the Medicines Control Agency. Chairman: Thank you very much. |
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