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Drugs Policy

Volume 776: debated on Monday 21 November 2016

Question for Short Debate

Asked by

To ask Her Majesty’s Government what policy changes they plan to introduce in response to the call from UN officials at the Special Session on Drug Policy on 19–21 April for member states to introduce evidence-based policies to promote public health and to place health rather than prohibition at the heart of drug policy.

My Lords, I want to put on record the significant change in the position of the United Nations on drug policy at the UN General Assembly special session in April this year. This is a transformation in the UN position after no fewer than 55 years of a destructive, prohibitionist interpretation of the UN conventions.

The stated objective of the UN conventions on drugs is to advance the health and welfare of mankind. That remains a good starting point today. The problem has been that the UN conventions of 1961, 1971 and 1988 were drafted without any evidence base. In 1961, there was virtually no understanding about how best to reduce addiction and the harms caused by drugs and the drug regime itself.

For a long time it was believed that prohibition and prison sentences would create a drug-free world. President Nixon famously predicted such an outcome. How wrong he was. For more than half a century, far from reducing drug use and addiction, the prohibitionist approach has been accompanied by an explosion in drug use across the globe. The regime has generated a trade worth more than $300 billion for criminal gangs and terrorists. What an outcome.

For the past six years, our All-Party Parliamentary Group for Drug Policy Reform has been promoting the arguments for a new interpretation of the drug conventions through our international meetings of Ministers and senior officials from Latin America and Europe, our European initiative, my meeting with the ECOSOC president, and our briefing of President Santos of Colombia—a key player—before the UNGASS this year. Our guidance on interpreting the UN conventions provided the text for our international work. Human rights and public health were central to our argument, along with the emphasis upon flexibility and evaluation of new policies to produce an evidence base for future drug policy. We produced the guidance with the support of the White House senior staff in Washington and senior officials on drug policy in Mexico. George Soros, who backs our ideas, provided an invaluable link between ourselves and the deputy Secretary-General of the UN. He, too, supports our arguments. It may seem fanciful but I am confident that our small input to the key players of the UN and US was helpful but, of course, the presence of President Obama in the White House must have been a key factor in these developments.

At the UNGASS in April, the deputy executive director of the United Nations Office on Drugs and Crime was one of a number of UN top officials who signalled this dramatic change of direction. He finally made absolutely clear that:

“The Evidence based public health approach is here to stay”.

Surely the new UN position requires a major rethink of drug policy worldwide.

What does this mean for the UK? The Government need to adopt policies supported by evidence that they will reduce addiction, particularly among young people, and will reduce the harm caused by drugs and the drug control system. Three policies could be adopted immediately by the Government on the basis of evidence. The first is the decriminalisation of drug possession and use, as pioneered in Portugal all those years ago, and extensively evaluated and shown to be a success. It is interesting that all political parties in Portugal support the decriminalisation policy. The second is heroin treatment clinic programmes pioneered by the Swiss and, again, proven to be cost-effective in rigorous evaluations. The third is the legalisation and regulation of cannabis for medical use. I will concentrate on the third. Cannabis currently sits in Schedule 1—the schedule for dangerous drugs with no medicinal value, believe it or not. This has become unsustainable, and I would say laughable if it were not so serious. We have abundant evidence to support a change of that schedule. The reason for urgency is that the current policy is contrary to the human rights of hundreds of thousands of patients with severe chronic illnesses who we know could benefit from this change. About 10% of these people go to drug dealers but the rest just cannot face it. Should a very sick person risk arrest and being placed in a cell simply to get their medicine? The current position is also a terrible waste of NHS resources and inhibits research into the medicinal potential of this rather remarkable plant. I should make it clear that I have no personal interest in this issue. I have never smoked a cigarette and certainly not a spliff either. My only addiction is to chocolate and I am lucky; it is legal.

We now have a comprehensive and professional analysis of the research evidence proving that cannabis is not only a great deal safer than many prescribed medicines which it can replace, but works more effectively for some patients—not all—than prescribed medicines. If the Minister were not so ridiculously overworked, I would hope she would read the report of Professor Mike Barnes, honorary professor of neurological rehabilitation at Newcastle University, and Dr Jennifer Barnes, a clinical psychologist. The Barnes report looks at research evidence across the world and sets out those conditions for which there is now good evidence, through random control trials and other research, which makes very clear the efficacy of cannabis in treatment. These include chronic pain, including neuropathic pain, spasticity, nausea and vomiting, particularly in the context of chemotherapy, and the management of anxiety. Barnes also found moderate evidence of success in a range of other disorders and some evidence for including a further list of conditions, including drug-resistant childhood epilepsies. Barnes emphasised the need for more research. He certainly did not exaggerate the benefits of cannabis—very far from it; he rather underestimated the benefits. In order for that research to take place and for those improvements to be seen, we need a change in the schedule of cannabis.

Is the Minister aware that in early October the Medicines and Healthcare Products Regulatory Agency published its opinion that products containing CBD—one of the two primary ingredients of cannabis—should be regulated as medicinal products? The absolutely correct position of the medicines regulator does not sit easily with the Government’s outdated cannabis schedule.

At present, many parents of children with treatment-resistant childhood epilepsies are buying CBD from private companies or on the web and, despite the risks, they find that it can have dramatic and positive results for their children. I have a video of a child who was suffering hundreds of seizures a day and was unable to do anything. He was expected to die within a week when his father went to his consultant, who agreed that the child should be given cannabis. That little boy remains alive. He has very few seizures—perhaps one or two a day—and is able to run about and play. I have had helpful discussions with the chairman and chief executive officer of the MHRA, who are keen to ensure that these severely ill children continue to gain access to their cannabis medicine. How can the Government continue to deny the medical value of cannabis?

The evidence for cannabis as a treatment for chronic pain, including neuropathic pain, is examined in detail in the Barnes report. One of the great benefits of cannabis compared with other drugs seems to be that the side effects are often very much milder or even negligible, in marked contrast to the many side effects of prescribed pain-relieving medicines. Cannabis can also help patients whose pain does not respond to prescribed medications at all. The Barnes report considers the pain-relieving qualities of smoked herbal cannabis, as well as the synthetic versions. Of course, smoked herbal cannabis is a much safer option than the synthetic variants. In studies where patients smoked cannabis with 8% to 9.4% of THC, it reduced pain significantly in 46% of them, with mild side-effects. Any doctor will know that that is a pretty good result.

I hope that others will talk about the growing number of countries and US states which already provide legal access to cannabis for medical purposes under regulations. If cannabis has no medical value, maybe the Minister can explain why Germany is passing a government-backed law legalising cannabis for medical use for 60 conditions. Professor Barnes pointed to only four conditions where he said there was good evidence. I would say that he was being very modest. How can the UK Government sustain that discredited position?

Our APPG inquiry into medicinal cannabis includes a recommendation that the UK adopt a system of regulation based upon the German model. This would involve rescheduling cannabis to Schedule 4, thus recognising its medicinal value, and introducing a system of licensing for producers and suppliers, with availability of cannabis through doctors’ prescriptions. I ask the Minister to take this proposal forward in the light of the new UN support for an evidence-based drug policy and the new Barnes report, which shows that we have that evidence.

My Lords, first, I thank the noble Baroness, Lady Meacher, for giving us the opportunity to debate this important subject and for her clear and comprehensive introduction.

I go to Mexico every year and have done so for many years. Perhaps that is why I have come to believe that the so-called war on drugs has been a catastrophic mistake. It has led in Mexico and elsewhere in the Americas to vicious gang warfare, murder, violence against officials, corruption and the accumulation of vast wealth by those involved, and it has done little to reduce the consumption of drugs worldwide. That is one reason why I have been a warm supporter of the APPG for Drug Policy Reform and its demand for evidence-based action.

We are holding this debate at a time when a rapidly growing number of countries are moving to a much wider legalisation of cannabis consumption than we are discussing this evening. During the recent United States elections, there were referendums that added four new states to the 24 that had already decided to legalise marijuana consumption. In this country, a committee in the other place has recommended that cannabis should be legalised. Its report refers to the UK’s “dark ages” drugs policy. We are arguing tonight for the legalisation of only medical cannabis, and this debate comes a few days after the British Medical Journal urged doctors to push for legalisation, stating that doctors have “ethical responsibilities” to campaign for change.

We have already heard of the hugely important change in UN policy and that at the United Nations General Assembly Special Session held in April, both the US and the UN leadership rejected a moralistic and prohibitionist approach and called for all the proposed changes contained in the admirable report of the all-party group.

I add only one other thought. There is a great deal of evidence that, despite the present tight regulatory system, a great many people are using cannabis to relieve pain and to treat their own particular illnesses, and they are doing so in the knowledge that they are breaking the law. The noble Baroness referred to that. My daughter, Sophie Sabbage, in her book The Cancer Whisperer, describes a similar situation among those suffering from cancer who have not been fortunate, as I have been, to have their cancer cured by amazing surgery. She refers to treatments she has had in Mexico, reinforcing the orthodox treatments she had in this country. She writes that,

“it is so damn difficult, and in some cases impossible, to access those cancer protocols here in the UK … Interestingly I am now plugged into a semi-underground network through which I have been able to access some treatments in the UK, but it isn’t easy, I have met fully qualified GPs as well as highly experienced health practitioners who have to fly under the radar in order to provide these services”.

I am sure the same thing is happening with cannabis. We need the Government to move to a regime where it is not necessary to fly under the radar.

My Lords, I congratulate my noble friend Lady Meacher on keeping drugs and the law on the agenda—not only in this House but on the world stage. She has done much to encourage other countries and the World Health Organization to revisit the UN conventions on narcotics, as she has told us. Until the last few years these were regarded as virtually set in concrete in a prohibitionist mode. I speak of her as my noble friend because on this issue, her position is closer to mine than is that of my party.

My credentials for joining this short debate are, first, that for 30 years I practised as a GP in inner London, which has higher than average drug abuse levels, and, secondly, that 18 years ago I was a member of your Lordships’ Science and Technology Committee, which was chaired by Lord Perry—Walter Perry—and looked into the medicinal use of cannabis. Now, that has been superseded by the Barnes report, mentioned by the noble Baroness. Things have certainly moved on internationally since our committee reported, but there has been little fundamental change in the UK, though several other countries have made cannabis—and other drugs—legally more available.

The Select Committee took careful account of the composition of cannabis and its effects, both beneficial and harmful. One important finding was that,

“no-one has ever died as a direct and immediate consequence of recreational or medical use”.

In other words, it is a very safe drug. It can, however, have ill effects, one being that, rarely, it can precipitate psychosis. Our report considered that,

“there is little evidence that cannabis use can precipitate schizophrenia or other mental illness in those not already predisposed to it”.

It is sometimes difficult to say which came first: cannabis use or psychosis. Heavy use, of course, may slow cognitive processes and impair concentration, and therefore driving, and heavy users may suffer academically. But short-term use appears to have no lasting ill effects. Some adverse effects, occasionally lung cancer, are due to the products of combustion in inhaled smoke, which frequently include tobacco.

Since ancient times, preparations containing cannabis have been used therapeutically for a number of symptoms. In particular, we noted how effective it sometimes is in relieving the painful spasms associated with multiple sclerosis, but it is not a cure for MS or any other illness.

To avoid the ill effects of inhaled cannabis a pure extract has been incorporated by GW Pharmaceuticals into an oral aerosol spray, Sativex, which now has a product licence. However, it is so expensive that NICE has disallowed it for prescription. Vaporisers for cannabis are available in the USA. The price is too high, but it is coming down.

The fact that there are some undesirable effects of this drug, and all other drugs, strengthens the case for these products to be decriminalised and made available on prescription or through regulated, licensed outlets. Their effects could then be monitored more closely and the strength and purity of the product be subject to scrutiny before a licence is granted. However, as things stand, and as the noble Baroness said, cannabis will continue to be used illegally for therapeutic as well as recreational use in this country. It is illogical that patients should have to break the law in the UK to gain relief, when in several other countries they do not.

My Lords, I would like first to thank the noble Baroness, Lady Meacher, for the dedication she has shown to revealing and reversing the completely illogical, indeed cruel, position we have in the UK on drugs policy. I will focus my remarks on medicinal cannabis. I attended every meeting of the noble Baroness’s inquiry into this. To me, the evidence in favour of a change in the law is overwhelming in terms of compassion, economics, public order, scientific progress and indeed logic. As the UN says, drugs are a health matter.

On the same day as the presidential election, two additional US states voted to legalise the medicinal use of cannabis. When we wrote our inquiry report, 24 states, plus DC and Guam, allowed such legal use under certain circumstances. Now, it is the majority of states. I read the words of an attorney from Florida who had been campaigning for the change. He said:

“Compassion is coming. This November, Florida will pass this law and hundreds of thousands of sick and suffering people will see relief. What Tallahassee politicians refused to do, the people will do together in this election”.

And they did. I suspect that the same would happen here in the UK if the question were put to the vote.

While I was listening to the evidence during the inquiry, two things struck me particularly: the evidence from patients, and the scientific and medical evidence of benefits to sufferers of many different diseases. Nobody who heard the testimony of these patients and medical professionals could accept the positioning of cannabis in Schedule 1 among drugs that are very harmful and have no medicinal use.

One patient, having explained her symptoms and described how cannabis helped her, showed us two pages of A4 paper on which she had listed the conventional medicines she had been prescribed by doctors, along with the unacceptable side-effects she had suffered. It was a horrific list. Nobody reading it could have doubted that conventional medical services had done their best to help her, but nobody reading it would have tolerated the side-effects any more than she did.

Determined not to break the law, that patient had to get her GP’s referral, go to the Netherlands several times a year, see a doctor there and get a prescription, collect the medicine, and make prior arrangements with Her Majesty’s customs to ensure that she would not be arrested when bringing her medicine back—perfectly legally—into this country. This whole procedure cost her thousands of pounds and enormous effort—and all because successive Governments have resisted the overwhelming evidence that the benefits of laying down a legal framework for the provision of cannabis medicines vastly overtake any small perceived harms.

I hope that the Minister will not tell us that to raise this issue within government is above her pay grade. She is in a much more powerful position than I am. She is inside government and trusted by her colleagues. If she went back to her department and said, “Look here, we need to talk to the Department of Health about this and we need to do something”, she would make her name as someone with an open mind who acts on the evidence. She would also be thanked by up to a million people who might benefit. Otherwise, perfectly law-abiding sick people are having to risk their reputation and their liberty by breaking the law in order to alleviate their pain. That cannot be right.

What is it about the UK that is different from 28 US states, Canada, Israel, Austria, Belgium, the Netherlands, Romania, Portugal, Finland, Italy, Switzerland, Spain, Australia, Chile, Colombia, Uruguay and, most recently, Germany? Why are we afraid of this medicine, which was used legally until the 1940s? The scheduling of cannabis medicines in Schedule 1, while Sativex is in Schedule 4, is a complete nonsense and contradictory, and most people know it. The Royal Society for Public Health put its finger on it in a recent report:

“Given the poor correlation between drug harm and classification, the current system risks sending misleading signals to the public about relative harm, and this may be contributing to avoidable risk”.

Cannabis is a valuable medicine. Its legal use is a health matter for up to a million people and it should be treated as such. Will the Minister please go and talk to the Home Secretary and tell her the facts?

My Lords, first of all I thank my noble friend Lady Meacher for initiating this debate and also for her outstanding and very effective contribution over the past five years to the movement for reform of global drug policy. She is very well known on the world stage for her efforts and it is gratifying that a Member of your Lordships’ House has been so very prominent. I too must declare an interest as an officer of the All-Party Parliamentary Group for Drug Policy Reform, and in that capacity I want to express my total support for the legalisation of cannabis for medical use.

In my brief remarks, I would like to concentrate on the implications of the conclusions of the UN special session for UK foreign and development policy and for the protection of human rights worldwide. The UN special session concluded that national drug policies should,

“fully respect all human rights and fundamental freedoms”.

It proposed that the balance between law enforcement and harm reduction should prioritise harm reduction.

I therefore ask the Minister—I appreciate that she is very overworked and will understand if she prefers to write to me rather than reply in the debate—to assure the House that Her Majesty’s Government never provide support, either directly or through multilateral agencies, to anti-narcotics law enforcement in countries such as Pakistan and Iran, where those convicted of drug trafficking face the death penalty. In the past, the FCO has made great efforts to ensure that United Kingdom money is not used when it might lead to a sentence of death. There was a Foreign Office document called The Death Penalty: Policy on UK Justice Assistance, which provided guidance to those making decisions on how funding from the UK could be used. Does this document still exist? Has it been amended recently? Does it still guide those funding decisions?

My second point is about the impact of the conclusions of the special session on the policies of DfID and the implementation of the sustainable development goals. To quote the United Nations development programme,

“in many parts of the world, law enforcement responses to drug-related crime have created or exacerbated poverty, impeded sustainable development”.

The description of Mexico given by the noble Lord, Lord Crickhowell, illustrates this vividly and accurately. At the special session of the United Nations in April, the Minister for the Cabinet Office, Oliver Letwin, said:

“We must ensure that our work is fully integrated with the Global Goals because the 2030 Development Agenda and our efforts to address drug harms are complementary and mutually reinforcing”.

How is this being implemented? Can the Minister tell the House whether DfID is planning, for instance, in the countries where it works to put resources into policies such as harm-reduction measures and treatment as part of its support for the sustainable development goals?

My Lords, I thank the noble Baroness not only for introducing this debate but for her impeccable timing in doing so when we are waiting with bated breath for the Government’s revised drug strategy to be published.

I hope your Lordships will forgive me if I start my remarks by using the same words that I did when finishing our last debate on this subject, which is that it is uniquely not party political. In views shared across the whole House, there is broad agreement on the objectives of drug policy; where we differ is on how to achieve those objectives and how to balance the need to control supply with the better target of trying to reduce demand.

There have been two significant changes since we last debated this subject. First, the overwhelming evidence now shows us that the attempts to control supply have failed. We have been saying this for some years, but there is now hard evidence that they have failed, particularly in relation to cannabis. Secondly, this view is now the pre-eminent view. Whereas it was the view of the minority in the past few years, it is now, following the recent United Nations meeting in New York, the view of most people throughout the world. As has been said already, 28 American states, including California, and a number of European states are moving in the same direction—a direction which has been indicated by the Royal Society for Public Health, as the noble Baroness, Lady Walmsley, said earlier. An all-party report today in the House of Commons also indicated the same direction.

All these reports are saying that we do not want devolution but evolution of our policy based on evidence. The All-Party Parliamentary Group for Drug Policy Reform report, which has been referred to by many speakers, produces that strong, scientifically supported evidence. What steps are Her Majesty’s Government taking towards the medicinal use of cannabis for the conditions we have already heard about, such as chronic pain, arthritis, insomnia, fibromyalgia?

This is not a movement that requires a matter of principle to be changed. Following representations from the royal colleges and a number of doctors, the Home Office Minister with responsibility for drug policy in 1953 told your Lordships that heroin was a uniquely effective pain killer for those with terminal cancer and that, as a consequence, Her Majesty’s Government had decided to change their policy and that heroin was not going to be prohibited in the United Kingdom but was to be a controlled drug, as it is now, because it is the most effective drug for those particular conditions. The Minister in those days could not have known anything about the heroin addiction that was going to sweep this country over the next 40 or 50 years, but there has been little seepage of legal heroin into the black market. The Minister said, “It is both uncivilised and cruel for the Government to deny patients a drug that uniquely alleviates their suffering”. My father was the Minister making that statement. I agree with what he said then and, if he was here now, he would agree with it too in respect of cannabis.

My Lords, I support the case of the noble Baroness, Lady Meacher, for legalising cannabis. It is a drug that helps and does not seem to harm. She has made the case very strongly. I note that the British Medical Journal has also called for the legalisation of illicit drugs. It is a source of expertise and is evidence that drugs can be helpful to those needing pain killers and could help stop illegalities. The international trade in drugs is colossal, particularly for heroin and cocaine. The current ubiquity of drugs in this country is a function of their illegal status.

I wish to draw attention to what is happening in Glasgow, where it is proposed that fixed rooms should be set up to enable people to inject under supervision, particularly heroin and morphine. Drug-related deaths in Glasgow so far this year amount to 345—quadruple the number of decades ago.

The nature of drug addiction is causing the international trade in drugs to be colossal. The ubiquity of drugs and the corruption and violence which illegality confers should be eliminated from society. The illegality of drug addiction spreads infection, and injecting equipment left in public areas is dangerous. They should be legalised.

Max Rendall wrote a book in 2011 called Legalize: The Only Way to Combat Drugs, in which he expresses the view that legalised drugs could be regulated and controlled. I wish to recommend this book to Ministers. The author is very knowledgeable about the problems in this area.

I am grateful to the noble Baroness, Lady Meacher, for bringing forward this debate.

My Lords, I, too, congratulate the noble Baroness, Lady Meacher, on raising the question and I declare an interest as an officer of the all-party group. It is five years since I tabled a Question for Short Debate asking what consideration the Government had given to establishing a royal commission on the law governing drug use and possession. The timing was deliberate, coming 40 years after the UN Single Convention on Narcotic Drugs was promulgated and the Misuse of Drugs Act was passed.

I made two points by way of introduction. First, I stressed that I believe strongly in having evidence-based policy. As I said then, I am appalled at how much legislation is brought forward more on the basis of hope than evidence. Secondly, the best way to affect attitudes and behaviour is through education and persuasion. I repeat what I said then:

“The law alone cannot achieve change, and indeed it can be dangerous to rest on the law in place of education”.—[Official Report, 9/3/11; col. 1673.]

I drew the distinction between drug use and prohibition. Prohibition can have and has had appalling consequences—a point made powerfully by my noble friend Lord Crickhowell. I advocated a commission or some other body of inquiry to examine the facts and to undertake an evidence-based inquiry.

The Minister replying to my question on that occasion said that the subject was one that excites disagreement. It may well do, but the only person who disagreed with me in the debate was the Minister. Everyone else who spoke, on all sides of the House, supported the case for review. In effect, what we were arguing for then is encapsulated in the call now by UN officials. It is crucial that the Government should recognise the problem as one of health, that we start from the problem of drug use and evaluate the evidence on the way to tackle the problem.

The danger is that the Government adopt a mindset that is resistant to change and, as a result of that mindset, are reluctant to consider dispassionately the evidence that does exist and are reluctant to commission evidence to help identify what needs to be done. Part of the reluctance appears to be a fear of public opinion. I think that fear is overblown and indeed not necessarily evidence based—but, in any event, what we need is what has been shown by some Governments elsewhere, not least on the American continent, and that is leadership to address what is a very real global and national problem.

I look forward to my noble friend Lady Williams confirming that the Government accept the need for evidence-based policy, for being as transparent as possible in sharing that evidence, and to hearing what the Government plan to do to acquire, evaluate and act on that evidence.

My Lords, I thank the noble Baroness, Lady Meacher, for this debate. Some 15 years ago, when I was a police commander, I suggested that the police should not arrest people for having small amounts of cannabis for personal use. Now, 15 years later, some things have changed. Police officers can now issue a fixed penalty for possession of cannabis or simply issue a warning on the street—effectively decriminalising possession for personal use.

When this House debated the Psychoactive Substances Bill, I moved an amendment to decriminalise possession of small amounts of all drugs for personal use, because in that legislation the Government did not seek to criminalise possession of small amounts of new psychoactive substances—“legal highs”, as they were known. Many of these new psychoactive substances are more dangerous than the drugs listed in the Misuse of Drugs Act, so this made perfect sense to us. Others did not agree—but, as the noble Baroness, Lady Meacher, mentioned, another change from 15 years ago is that we now have a long-running example of what happens when possession of small amounts of all drugs for personal use is decriminalised, and when drugs are treated primarily as a health issue rather than a criminal justice issue.

It is very difficult to establish causal links between decriminalisation and what has happened in Portugal, but the reality is that Portugal’s drug situation has improved significantly. HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialise. Among Portuguese adults, there are three drug overdose deaths for every 1 million citizens compared with 44.6 per million in the UK. The use of legal highs is lower in Portugal than in any of the other countries for which reliable data exist.

So why, when the Liberal Democrats tried to decriminalise possession of small amounts of all drugs, did the Tory Government and the Labour Party oppose the move? Another thing I said back in 2002 was:

“Not being cynical but politicians always have this dilemma: do the right thing but if it’s not popular and you lose votes, you lose power and then you cannot do anything. Do the popular thing, win votes and keep power and you could end up doing the wrong thing because there are more votes in it. Does that mean politicians make decisions on the basis of how many votes it will win/lose them or on the basis that it is clearly the right thing to do (or only when the two coincide)?”.

I guess that some things have not changed. Can the Minister please consider asking her colleagues in Government to base drugs policy on evidence rather than prejudice and to treat drugs as primarily a health issue, not a criminal one?

My Lords, like other noble Lords, I start by thanking the noble Baroness, Lady Meacher, for bringing this Question for Short Debate to your Lordships’ House. In the time allowed it is not possible to cover all the points I would like to, or to respond to all the points made by noble Lords. I know that other noble Lords will be with me on this: I hope that for all government policy decisions the starting point is a reasoned, evidential base at the heart of what the Government promote as a policy. The noble Lord, Lord Paddick, referred to that, but the fact is that all three parties have failed that test over many years.

The Question before us concerns evidenced-based policies to promote public health and to place health rather than prohibition at the heart of our policies on drugs. Of course, we have two legal recreational drugs that can cause serious problems, namely tobacco and alcohol. I am fully aware of the debate about the legalisation of cannabis and the contention that it is less harmful than the two legal drugs I mentioned. My position is that I would not legalise cannabis for general use. It may well be less harmful than alcohol or tobacco but that in itself is not a good enough reason.

I do, though, see the point that the Government should give careful consideration to the case for the use of cannabis or cannabis products as a medicine. As the noble Baroness, Lady Meacher, said, where there is medical evidence, the Government should consider the case for trials and consider rescheduling cannabis from Schedule 1 to Schedule 4. These trials would be with named patients only. There should be further research seeking to establish for which ailments cannabis could be an effective and inexpensive treatment.

With the passing into law of the Psychoactive Substances Act 2016, there is no criminal penalty for the personal possession or use of new psychoactive substances, such as the synthetic cannabinoid known as Spice. There has been considerable press coverage of the harmful effects of this product, and I recall a debate in the Moses Room with the noble Baroness, Lady Williams of Trafford, when this very subject came up. There is no criminal penalty for possession of this product, but it is still illegal to produce and supply the drug—criminal penalties still apply. There seems to me some inconsistency between the Government’s policy on Spice, a synthetic cannabinoid, and that on cannabis itself. The Government should look at that carefully and urgently to get both products on the same footing. Maybe the noble Baroness can address that tonight. If she cannot, maybe she can write to me after the debate.

I turn to some of the points raised by noble Lords. I accept, as mentioned by the noble Lord, Lord Crickhowell, and my noble friend Lord Rea, that many people in the UK are using cannabis for the relief of pain and in doing so are breaking the law. The noble Lord, Lord Mancroft, made an important point in saying that what we want is not revolution but evolution on an evidential base.

The noble Lord, Lord Maclennan of Rogart, addressed the serious issue of drugs in Glasgow. It will be important to evidentially assess the programmes and the results of work being done to deal with the serious problems there.

The noble Lord, Lord Norton of Louth, made an important point that the Government should review these matters on the basis of evidence and not get themselves stuck and be unable or unwilling to move.

I thank the noble Baroness, Lady Meacher, for bringing this Question forward for debate and I look forward to the Minister’s response.

If the Government were to move in the direction that the noble Lord talked about, would Her Majesty’s Opposition support or oppose the Government? That would make a huge difference to the Government’s position.

If the noble Baroness were to come forward tonight and suggest what I just described, I hope we would support them.

My Lords, that is good news, because somebody will agree with me tonight, I hope. I thank the noble Baroness, Lady Meacher, for securing the debate. I acknowledge the extensive work she has done in this area. Indeed, I thank all noble Lords, who have contributed very thoughtfully to the debate.

The Government used the UN General Assembly Special Session on Drugs to share our experience of delivering an evidence-based, balanced drug strategy within the UN drug conventions, and to strengthen international co-operation in tackling drug harms. The outcome document of the special session combines ambitious goals with operational recommendations that all Governments should consider implementing. The UK Government secured particularly helpful recommendations on our priorities on new psychoactive substances, proportionate criminal justice and comprehensive recovery.

We have heard that United Nations officials at the special session called for evidence-based policies that promote public health. These calls are fully in line with the Government’s approach. The noble Lord, Lord Kennedy, can rest easy about agreeing with the Government’s position. The Government are taking balanced action to prevent the harms caused by drug use. This includes educating young people about the risks, helping dependent individuals through treatment and supporting law enforcement in tackling the illicit trade. We are currently developing a new drugs strategy, working across government and with key partners, to identify what further steps we can take to tackle this issue.

We continue to take a broad approach to prevention, supporting investment in a range of programmes that have a positive impact on young people and adults. These programmes give them the confidence, resilience and risk-management skills to resist drug misuse. This includes the resilience-building resources available online, such as FRANK and advice services, as well as toolkits from Public Health England to support local responses.

Tough enforcement is a fundamental part of our drugs strategy, with action to restrict drug supply and reduce drug-related crime a key priority for law enforcement. We are tackling drug dealing on our streets, strengthening the border and combating the international flow of drugs to the UK to disrupt drug trafficking upstream.

Recovery remains at the heart of our approach. More adults are leaving treatment successfully compared to 2009-10. That can be only a good thing. The average waiting time to access treatment remains at three days. However, we recognise there is still further to go.

Drug treatment is invaluable to individuals, their families and the communities in which they live. It is vital that there is access to a range of options that can be tailored to individual need to provide the best possible chances of recovery. Such treatment should be provided alongside the wider recovery support essential to achieving and sustaining recovery, which includes access to training and employment, stable housing, and wider health services.

The Government are taking a leading role on drugs policy at the international level. Steering international action to strengthen our domestic response will be a key element of the new drugs strategy. The Government used the special session to strengthen our global leadership in the international response to new psychoactive substances. Our comprehensive action on this issue in recent years has resulted in, first, the formation of the UK-led International Action Group on New Psychoactive Substances, a group of more than 30 Governments and international organisations which drives the international response; secondly, in the establishment of a global early warning system at the United Nations; and, thirdly, in the first two tranches of international controls on some of the most harmful new psychoactive substances. I will write to the noble Lord, Lord Kennedy, on the Spice/cannabis differentiation, because I will not have a chance to respond on that point tonight. We will continue to press the international community to implement the recommendations of the special session outcome document, including on new psychoactive substances. They include enhancing the global collection of data on the health harms that such substances pose.

My noble friend Lord Crickhowell, the noble Baroness, Lady Meacher, and the noble Lord, Lord Maclennan, and others spoke about alternative drugs policies in other countries. We have heard this evening about some great successes in other countries which implemented policies that are not part of this Government’s approach, but we must be cautious when comparing the evidence between countries. Historical patterns of drug use, cultural attitudes, and policy and operational responses to drug misuse in a country will all affect levels of use and harm. Moreover, different countries have different means of collecting data, so it is often difficult to make direct comparisons.

Almost every noble Lord mentioned medicinal cannabis. I used to work with people who had multiple sclerosis—it was right at the beginning of the debate and what led to the development of Sativex. We recognise that people with chronic pain and debilitating illnesses are looking to alleviate their symptoms. It is important that medicines are trialled thoroughly to ensure they meet rigorous standards before being placed on the market and so that doctors and patients are sure of their efficacy and safety. The Misuse of Drugs Act 1971 enables the availability of controlled drugs which have recognised medicinal uses in UK healthcare, of which there are many. A clear regime is in place, administered by the Medicines and Healthcare Products Regulatory Agency—mentioned by the noble Baroness, Lady Meacher. This enables medicines including those containing controlled drugs such as cannabis to be developed, licensed and made available for medicinal use by patients in the UK. For example, Sativex has been granted market authorisation in the UK by the MHRA for the treatment of spasticity due to multiple sclerosis. It was rigorously tested for its safety and efficacy before receiving approval. The Medicines and Healthcare Products Regulatory Agency is open to considering marketing approval applications for other medicinal cannabis products should they be developed. As happened in the case of Sativex, the Home Office will consider issuing a licence to enable trials of any new medicine, provided that it complies with approved ethical criteria. The Government’s view is that cannabis should be subject to the same regulatory framework as applies to all medicines in the UK—I do not think that noble Lords demurred from that premise. To do otherwise would amount to circumvention of a clearly established regime.

My noble friend Lord Mancroft talked about decriminalising drugs. I am afraid to say to him that we have no intention of doing that. They are illegal because scientific and medical analysis has shown that they are harmful to human health. A number of noble Lords cited decriminalisation in Portugal. Successes cannot be attributed to decriminalisation alone, but I recognise them. At around the same time as implementing decriminalisation, Portugal made changes to its approach to drugs misuse, including widespread implementation of harm reduction programmes and investment in drug treatment. It is extremely challenging to disentangle the effects of decriminalisation from those of these wider changes.

The noble Baroness, Lady Meacher, and the noble Lord, Lord Maclennan, talked about other approaches, for example in Switzerland and Glasgow, and the heroin-assisted treatment. There is evidence from the UK and other countries that supervised injections of diamorphine or pharmaceutical heroin in a medical environment as part of a structured treatment plan can keep patients in treatment and out of criminal behaviour. In addition to cutting crime, the treatment also drastically reduces the risk of overdose. The Government’s commitment to that evidence is set out in both the 2010 drugs strategy and the 2016 modern crime prevention strategy.

We do not plan to change the law to enable drug consumption rooms to be established and operate in the UK because while there is international evidence that they can be effective in addressing the problems of public nuisance and reducing health risks in a very specific set of circumstances where open drug scenes presented a significant risk to public health, this is a complex and legally divisive solution to a problem that we do not have in the UK.

The noble Baroness, Lady Walmsley, talked about Schedule 1 of the Misuse of Drugs Regulations versus Schedule 4. Cannabis is controlled as a class B drug under the Misuse of Drugs Act 1971 and, given that it currently has no recognised medicinal benefits in the UK, a Schedule 1 drug under the Misuse of Drugs Regulations 2001. We recognise the value of important scientific research and the Home Office licensing regime allows that to take place in the appropriate controlled environment.

I am running out of time and will not be able to answer every single noble Lord’s question. I will finish with the noble Lord, Lord Kennedy, because it is a quick answer. On the Spice question, there may be no possession offence under the Psychoactive Substances Act as the harms of such substances may not be fully assessed. However, once assessed and if proven harmful, substances will be controlled under the Misuse of Drugs Act, which includes an offence for possession.

I thank all noble Lords for their contributions. I have not had time to answer everyone so I will do so in writing.