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You are in Medical / Veiws

Minutes of evidence taken before the Select Committeeon Science and Technology
7th February 2001

DR Brian Davis, Mr David Snowdon, Mr Charles Clarke and Mrs Judy Sanderson

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(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 cannabis—about 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 interest—and 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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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


some 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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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 court—which 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

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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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