Would decriminalising drug possession keep deaths down?

Finally, to consider what policy-makers should be doing to get on top of the problem we thought it pertinent to speak with David Nutt, chair of Drug Science and one-time chief drug adviser to the UK government. I began by asking him whether incredibly powerful drugs - such as Nitazenes - should be banned…

David - I think it makes sense in that potent opiates which aren't used medically should be controlled in some way to at least allow governments to seriously prosecute people who are caught stealing them. Whether it'll have any impact on importation or use ia yet to be seen, but it's consistent with the current policy. It would be not really sensible to have these drugs widely available because they are very dangerous.

James - There have been a small number of deaths directly affiliated with these drugs, but some public health officials have criticised the tracking system when it comes to the spread of them here in the UK. What are the problems? Is it by virtue of the fact that they're so new?

David - Well, there are several problems. The first is we don't have any kind of joined up science in the coroner system. So if coroners don't know these drugs exist, then why are they going to ask for them to be tested for? So the first thing we need to do is make sure that all unexplained deaths are tested for a range of drugs, not just nitazenes but also fentanyls and ideally other drugs which can kill you, so even maybe synthetic cannabinoids. The second thing is it takes several years before a drug death gets to the coroners and that really is absolutely inexcusable. We should have a system where at least the toxicology is done almost immediately, and if new drugs are found, they should be communicated to all coroners and also to the public health system straight away. And thirdly, and this I think is the most important one for this current episode, we need to have testing facilities available so that people can test what they have, particularly if they have taken something which has produced an effect which they weren't expecting. And again, that should feed in to the public health system. The Dutch have been doing this for nearly 30 years. It works. We still are hooked on this idea that if you scare people about drugs, they'll stop using them. Well, we know that's not the case, so let's change our attitude and be more adult about this.

James - Some say we've opened Pandora's box when it comes to synthetic opioids. It's fentanyl and nitazenes today, but because of the advantages these drugs pose to producers in that they can be made in clandestine labs and the ingenuity of chemists, nefarious or otherwise, it could be something entirely different tomorrow.

David - Yes. Which is why we have to test and why we have to have a very high level of, um, surveillance. But let me just say a couple of words about the opening of the box. We didn't open the box, particularly. The Americans opened the box. They opened the box by having an extraordinary overreaction to their prescribed opiate crisis, which then led to the rise of fentanyls. We are basically catching a cold as America sneezes. Fentanyl exists simply because there's not enough heroin. Luckily, in Britain, we're one of the very few countries in the world in which heroin is a medicine. We can actually make heroin available to opiate users legally, and that would be a great way of stopping them going to fentanyls.

James - There's also some who believe that we could go a step further by decriminalising and regulating these substances altogether. I wonder if you could explain the thinking behind why that's a good idea.

David - The problem with criminalising drug users is that, once they have a criminal record, it effectively excludes them from most employment. So they naturally turn to dealing drugs, and that creates the market. We know that in 1971 there were about 1000 heroin addicts in Britain who were getting prescribed heroin. It was called the British System and it was the envy of the world. Then, we decided to stop prescribing heroin, and we went from 1000 in 1971 to 200,000 by 1990. So allowing access to heroin is the way to stop people making others addicted to heroin. So decriminalisation and getting people into treatment is way the most efficient way of stopping the expansion or the rollout of opiate use.

James - As a proponent of this drug policy, what have you made of what's been happening in Oregon and in Vancouver where they've tried this, they've had extended periods of a year or three years where they've brought in a decriminalisation of the possession of small amounts of these drugs, but deaths, they're not accelerating in how fast they're increasing as opposed to before this policy was introduced, but they're still increasing. And in both of the cases I've mentioned, they're looking at watering down their approach.

David - Well, we'll certainly find out what happens if they do that. My prediction is things will get worse. The problem I think, with both the US and the Canadian system, is that they don't have a proper safety net of treatment. If you look at, for instance, Portugal and the Netherlands, there's two countries where they've had a very different policy on the use of opiates. What you see there is that treating people who use opiates humanely, getting them into treatment, taking them out of the criminal system, has massively reduced the harms. But that does require a joined up policy where it's not just decriminalisation, it's also providing the whole range of other infrastructures that will allow people to move out of drug use into employment. It requires prescribing drugs like methadone and buprenorphine and, to some extent and in some cases heroin. They didn't do that in the US and Canada. They hoped, I suppose, to see if they could get some benefit without investing. It hasn't worked as well as it could.