09 February 2006

Cannabis Reclassification - Where will Clarke go next?

After months of rumours and posturing, we finally got a decision relating to Cannabis. As the process had taken such a long time, it's worth recapping the sequence of events that led to this decision:

May 2002: the Home Affairs Select Committee recommends moving cannabis from Class B to Class C
July 2002: David Blunkett says he will follow the HASC recommendation relating to cannabis
November 2003: Legislation to reclassify cannabis finally passed
January 2004: Cannabis reclassified
December 2004: Mr. Blunkett leaves the Government
March 2005: Charles Clarke refers the cannabis issue back to the ACMD
January 2006: ACMD comes down against changing cannabis classification again
January 2006: Charles Clarke abides by the ACMD recommendation but proposes review of classification system

It's worth stressing some of the above milestones. The original decision, proposed by the Home Affairs Select Committee, was arrived at following interviews with experts and after a period of research. It was a decision supported at the time by large sections of the drugs field, though greeted with concern by others,including mental health professionals.

But in practice, the reclassification was bodged, with Blunkett coming under serious pressure from media and lobbying bodies. This included the change to the powers of arrest relating to cannabis and the penalties for supplying class C drugs.

Shortly after Blunkett's ignominious departure from the Home Office, Charles Clarke moved in to the recently vacated seat. He, no fan of cannabis reclassification, agreed to requests to review the reclassification and, quite properly, passed the matter to the ACMD. While his own views on the matter have been the subject of record, such decisions should be taken under the advisement of the ACMD, and a decision on Clarke's part to disregard their views would be unprecedented.

While the ACMD deliberated, various interest groups lobbied from the outside; Release, Transform, Turning Point, Rethink, Mind and many others offered thoughts on what should happen next.

The ACMD considered - and according to some sources came under pressure from ministers to reach an acceptable decision. The ACMD were firmly directed to review the reclassification in the light of "new" cannabis research related to the links between cannabis and mental illness.

But the ACMD - after extensive speculation - did not reach the decision Charles Clarke or Tony Blair had wanted. They agreed that while use of cannabis could have a negative impact on mental wellbeing, it was correctly classified in Clause C and that no reclassification was required.

This put Charles Clarke in an awkward position. While clearly personally favouring a move to Class B, this would have meant disregarding a recommendation by the ACMD - and an opinion that the Home Office had specifically sought. This would have been a hugely controversial move - to go against the stated opinion of the ACMD risked antagonising them and the possibility of resignations. According to some media reporting, key figures on the ACMD were prepared to consider their positions if the Home Secretary ignored their opinions.

In the end, Charles Clarke acceded to the wishes of the ACMD, and left cannabis where it was. As a sop to those who had lobbied so hard to see it reclassified to B, Clarke promised an awareness campaign to reinforce messages about cannabis risks and legal status.

But more worryingly Clarke also said that he intended to revise the whole system of classification. In his statement to the Commons he said:

The more that I have considered these matters the more concerned I have become about the limitations of our current system. Decisions on classification often address different or conflicting purposes and too often send strong but confused signals to users and others about the harms and consequences of using a particular drug and there is often disagreement over the meaning of different classifications. For example many people wrongly interpreted the reclassification of cannabis to mean that cannabis was not harmful and that its use was acceptable and even legal.

For these reasons I will in the next few weeks publish a consultation paper with suggestions for a review of the drug classification system, on the basis of which I will in due course make proposals.

Given Clarke's overall views on drugs, this probably does not bode well. It suggests that Clarke will get the outcome that he wants - tougher rules on cannabis - by a new tool: if the ACMD won't agree to moving it within the existing system, why not create a complete new system? Ironically, the point where we came in to all this - the Home Affairs Select Committee - also had worries about the existing classes of his drugs. That was why they wanted cannabis moved to Class C and Ecstasy moved to class B. This, they felt, would more accurately reflect the relative risks of these drugs.

So now Clarke is planning to review the legislation and possible revise the classifications. We must await his proposals with some trepidation.

But there is another way that Clarke, or his successor, will get their way. They can stack the ACMD in their favour. This, perhaps, has already started to happen. While new members can be proposed by existing ones, they are interviewed by Home Office officials before being offered their positions. And each is up for renewal every two years. By careful nomination and selection it becomes relatively easy to stack the ACMD to reflect Government Policy. So it is possible that this will be the last time that the ACMD reaches a decision that diametrically opposes the Home Secretary's own wishes. Both Clarke, and future Home Secretaries, will have noted this and be considering how they can avoid future repetition.

So while, for now, cannabis will remain within Class C, change is still in the pipeline.

07 February 2006

From Gillick to Axon - a wake-up call for drugs workers:


In January, the verdict was delivered in the case of Sue Axon, who challenged the legality of Government guidance on contraception advice to under 16s and a parent's "right to know." The case was not widely reported in the drugs field, which was strange as if the case had been found in favour of Ms Axon, it would have had profound implications for drugs work with under 16s, including advice work and needle exchange.

Axon challenged guidance that allowed for contraception to be provided to under 16's without parental consent provided that the child was considered "Gillick competent." This framework for working with under 16s has been an integral aspect of work with under 16s including drugs work, and has been enshrined in a number of strategy documents including the HAS report on work with young people, various Drugscope documents and resources from the NTA.

In the event, the court did not find in Ms Axon's favour, and so did not overturn the framework established in Gillick. Mr Justice Silber said: "Everybody involved in this case is agreed that a young person should be encouraged to involve his or her parents on any decision on sexual matters."

However, he added that there were unfortunate situations in which a young person needed advice when they were not prepared to inform their parents."

While the case upholds the concepts that emerged from Gillick, it does bring in to sharp focus the importance of careful assessment of a young person within the Framework. On the back of regular training sessions with a large number of wokers, it is clear that a number of workers in various agencies are unclear about their obligations to assess against Gillick.

All agencies working with under-16s must ensure that they have good assessment protocols to establish competence and effective procedures in place to assess when and how parents should be involved. The Axon case has reinforced the importance of dilligent assessment; workers must be able to demonstrate that they have made effort to encourage or facillitate disclosure to parents or carers, and they must be able to demonstrate how competence has been established. Failure to do could see future challenges to this important precedent eroded or worse, overturned.

More Water? - News on the Water for Injection situation:


We received a flurry of emails from concerned Needle Exchanges who were confused by apparently contradictory messages from different sources. On the one hand, Exchange Supplies mailed out their new brochure. It included promotional material relating to their 2ml ampoules of water - licensed for injection and conforming to the revised paraphernalia legislation.

But at the same time, the Guardian ran a big story saying that Needle Exchange workers were being threatened with prison for giving out too much water. Worried workers, in the throes of purchasing water, became worried that they were facing a new clampdown. So what's the reality of this situation.

The crux of the Guardian article was a restating the changes to the Paraphernalia laws relating to water (see drug news passim or click HERE. This made it lawful to distribute water to distribute ampoules of water for injection of 2ml or less, without prescription. Greater quantities would continue to fall foul of both the Medicines Act (by virtue of being a POM) and/or the Misuse of Drugs Act (as they would not fall within the revised paraphernalia legislation.)

But, with the greatest deference to Diane Taylor that the article, while technically accurate, is a little strident and liable to cause confusion and increase concern - possibly unecessarily.

The many organisations who have given out 5ml amps without a PGD have always been in breach of the law. They have typically been aware of this, and for most it's been a risk that they have been prepared to take.

Thanks to the industrious lobbying of Dericot, Preston et al the desired legislative change to the water legislation has been achieved, rightly making it lawful to distribute 2ml ampoules. It was unlawful to distribute 5ml ampoules without a PGD or similar; it remains unlawful to do so. In this respect the situation has not changed.

Granted, the non-availability of a licensed 2ml ampoule had been an issue, but as the Exchange Supplies website makes clear, they are now making available 2ml glass ampoule that is licensed and lawful.

So while the Guardian article is technically accurate when it says "But in practice the only plastic ampoules suitable for use by drug users contain 5ml of water," it unhelpfully neglects to mention availability of a glass article. Critics are arguing that the the Medical Regulatory Authority are being overly slow in terms of granting licenses to other products - most notable 1.4ml plastic water ampoules. They are right to stress these concerns. But the way that it has been reported has clearly confused some in the drugs field, which is far from helpful.

So if anything the situation is better now than it was a month ago, which is not clear from the article at all.