Health bodies call for drugs to be decriminalised

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.
The Royal Society for Public Health and the Faculty of Public Health said the government’s approach to drugs policy had failed.  There should be a greater focus on treatment and education, they added.

The report, called Taking A New Line On Drugs, said criminal sanctions failed to deter illegal drug use, undermined people’s life chances and could act as a barrier to addicts coming forward for help.

It called for a “sea change in approach” and said the UK should adopt the Portuguese system under which people caught using drugs were offered treatment and support rather than being punished. However, dealers and suppliers would still be prosecuted.

The report also suggested that drugs education be made mandatory, and that responsibility for drugs policy be moved from the Home Office to the Department of Health.

Royal Society for Public Health chief executive Shirley Cramer said: “For too long, UK and global drugs strategies have pursued reductions in drug use as an end in itself, failing to recognise that harsh criminal sanctions have pushed vulnerable people in need of treatment to the margins of society, driving up harm to health and wellbeing even as overall use falls.

“On many levels, in terms of the public’s health, the ‘war on drugs’ has failed.”

“The time has come for a new approach, where we recognise that drug use is a health issue, not a criminal justice issue, and that those who misuse drugs are in need of treatment and support – not criminals in need of punishment.”

Baroness Molly Meacher, speaking on behalf of the All-Party Parliamentary Group for Drug Policy Reform, welcomed the report.

She said the current system “criminalises some users of psychoactive drugs whilst very harmful psychoactive drugs including alcohol and tobacco remain legal”.

A Home Office spokesman said: “The UK’s approach on drugs remains clear – we must prevent drug use in our communities and support people dependent on drugs through treatment and recovery.

“At the same time, we have to stop the supply of illegal drugs and tackle the organised crime behind the drugs trade.”

The spokesman said there had been a drop in drug misuse over the past decade and more people were recovering from dependency now than in 2009-10.

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

AnE visits for alcohol poisoning double in six years

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.With the holiday season on us emergency admissions due to the effects of alcohol, such as liver disease, have also risen by more than 50% in nine years to 250,000 a year in England.

Rates were highest in deprived areas and in the north, and among men aged 45-64, the Nuffield Trust revealed.

The Nuffield Trust said their figures were an underestimate of the impact of drinking because they did not include alcohol -fuelled falls and fights, just illnesses such as alcohol poisoning and liver disease.

Nor do they count people who come to A&E drunk and are then sent home without being treated or admitted as a patient.

Half of all A&E attendances likely to be due to alcohol poisoning – when a person drinks a toxic amount of alcohol, usually over a short period of time – took place on a Friday, Saturday or Sunday, peaking between midnight and 2am.

Three in four arrived by ambulance – putting a strain on already stretched resources, said the Nuffield Trust.

Young women aged 15 to 19 were admitted to hospital for alcohol poisoning 1.4 times as often as young men in the same age group.

A&E attendance rates that are likely to be due to alcohol poisoning and emergency hospital admissions linked to alcohol were three to four times higher in the poorest fifth of the population, the figures showed.

The report also reveals the number of people actually being admitted to hospital with alcohol-related problems, such as liver disease.

Men aged between 45 and 64 made up the largest share of this group.

Joint author of the report Claire Currie said: “With the Christmas party season in full swing, it’s worth considering the full burden over-indulgence in alcohol is placing on our NHS, as well as the obvious human cost.

“Our research has uncovered a picture of rising and avoidable activity in hospitals, representing a stark challenge for the Health Service at a time when it’s already great pressure. Hospitals alone cannot tackle this issue – the government must consider measures such as minimum unit pricing, restricting availability and limiting marketing and advertising.”

In England in 2013, approximately 18% of men and 13% of women drank at a level considered to be putting them at increased risk of harm.

In 2013/14, approximately 1 in 20 emergency admissions in England were related to alcohol.

Figures from the Office for National Statistics suggest binge-drinking among young adults in Britain is continuing to fall, and more than a fifth of UK adults now say they do not drink alcohol at all.

A government spokesman said: “People should always drink alcohol responsibly – very busy ambulance services and A&E staff can do without this extra demand.

“The government has taken action to tackle cheap alcohol by banning the lowest priced drinks and we are already seeing fewer young people drinking on a regular basis.”

Health Direct repeats the maxim- please drink moderately over the festive break.

Drug firms accused of overcharging by CMA

Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging “excessive and unfair” prices for an anti epilepsy drug.

Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging excessive and unfair prices for an anti-epilepsy drug.
Phenytoin sodium capsules, used by 50,000 people in Britain, are made by Pfizer and sold by Flynn.

When Pfizer made the drug under its Epanutin brand name, the NHS spent about £2.3 million on the drug, the CMA said. This amount soared to £50 million in 2013.

The CMA said Pfizer sold UK distribution rights to Flynn in 2012, but continued to make and supply the drug to the company.

This is a provisional report, with allegations made by the Competition and Markets Authority. The companies now have a chance to give formal responses and a final ruling may not be made until next year.

But it comes at a time of intense debate about NHS finances, as patient demand and the cost of treatment rise faster than budget increases. NHS England is grappling with the need for ambitious efficiency savings. It has been under fire for reducing the number of treatments available to patients through the Cancer Drugs Fund.

So today’s provisional findings, with renewed scrutiny of drug spending, are the last thing the pharmaceutical industry needs.

It was after this deal that prices rose, said the watchdog in a provisional finding.

“The CMA’s findings on dominance and abuse are provisional and no conclusion can be drawn at this stage that there has, in fact, been any breach of competition law. We will carefully consider any representations from Pfizer and Flynn Pharma before deciding whether the law has been infringed.,” said Ann Pope, CMA senior director of anti trust enforcement.

Companies can be fined as much as 10% of annual sales for abusing a dominant position in a market, depending on the seriousness of the abuse.

Pfizer and Flynn can now supply their own views and evidence before the watchdog makes a decision, it said.

“Ensuring a sustainable supply of our products to UK patients is of paramount importance to Pfizer and was at the heart of our decision to divest the product,” said Pfizer in a statement. “Pfizer is co-operating fully with the CMA’s ongoing investigation.”

Study suggests safe alcohol guidance unrealistic

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits.

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits
Men are currently recommended to drink no more than three or four units a day, and women no more than two or three.

But the study found that the guidelines are largely ignored because most people do not drink every day. Instead they drink heavily at the weekend – in order to get drunk.

Many people taking part in the research also found the idea of alcohol “units” confusing as they measured their intake in pints, bottles and glasses.

The results suggested that people think the recommended quantities of drink are unrealistic, as they don’t recognise that many people are motivated to drink to get drunk.

When participants did regulate their drinking, this was usually down to practical issues such as needing to go to work or having childcare responsibilities, rather than health concerns or due to guidance on safe limits.

Researchers found that participants preferred the current Australian and Canadian guidelines, which include separate advice for regular drinking and for single occasion drinking, which were regarded as more relevant and flexible to occasional drinkers.

Australia recommends drinking no more than four standard sized drinks on one occasion, or two drinks a day.

The study was carried out by researchers from the UK Centre for Tobacco and Alcohol Studies, which includes the universities of Stirling and Sheffield.

They interviewed focus groups in Scotland and the north of England. The results have been published by the Addiction journal.

The chief medical officers in both England and Scotland are looking at new guidelines to be published next year, and the researchers have been feeding their results to them.

Prof Linda Bauld of the University of Stirling’s Institute for Social Marketing told BBC Scotland that the advice on “safe” alcohol limits was helpful, but needed to be revised.

And she said more emphasis should be put on helping people to drink more sensibly rather than simply telling them what they need to do.

Prof Bauld added: “The Scottish government is trying to push forward with pricing measures, for example, we need to look at marketing, we need to look at glass sizes.”

UK drinks more alcohol than estimated

The amount of alcohol people in England drink has been underestimated according to new research.

amount of alcohol people in England drink has been underestimated according to new research

In England surveys measuring typical drinking habits account for only around 60% of alcohol sold, the medical journal BMC Medicine report said.

Report author Dr Mark Bellis said this was because many studies do not include drinking on special occasions.

More than 6,000 people in England were interviewed for the study.

Accounting for special occasion drinking added more than 120 million UK units of alcohol – equivalent to about 12 million bottles of wine – to the population’s alcohol consumption in England every week, it found.

The results could have important implications for public health, researchers said.

“Nationally, we underestimate how much we drink – and as individuals we can turn a blind eye to our heavier drinking periods when we calculate personal consumption,” said lead scientist Dr Bellis, from Liverpool John Moores University.

“For many people, though, these sessions add substantial amounts of alcohol to their annual consumption and inevitably increase their risks of developing alcohol-related ill health.”

The equivalent of more than three quarters of a bottle of wine- or about three pints of beer per drinker every week goes unaccounted for, he said.

The survey measured a medium glass of 12.5% ABV wine as 2.2 UK units, and a 440ml can of 4.5% ABV beer as 2 UK units, but the amount of alcohol units in drinks varies depending on their size and strength.

Researchers conducted telephone interviews with 6,085 randomly-selected members of the public aged 16 and over in England.

Participants were asked about normal drinking patterns and those outside their usual circumstances, such as summer holidays, bank holidays, and weddings.

Most categories of drinkers, based on age groups and levels of typical consumption, reported increased consumption during holidays or special occasions.

People aged 24-35 drank 18 extra units a week on special occasions, the research suggested. The biggest increase was seen in 25 to 35-year-olds, who had the highest level of typical consumption.

People in this drinking category drank an extra 18 units (144g) of alcohol per week on special occasions, the research suggested.

Last year, the Organisation for Economic Co-operation and Development found that people over the age of 15 in the UK drank an average of 10.6 litres of pure alcohol a year – equal to 115 bottles of wine.

According to the Institute of Alcohol Studies, in 2012, men consumed an average of 17 units in the week before they were interviewed, compared with 10.2 units for women.

War on drugs is unwinnable

Four decades after President Nixon declared a “war on drugs”, US states have legalised the sale of marijuana and most Americans support legalisation.

War on drugs is unwinnableAcross the world, drug laws are being relaxed, from Uruguay to Portugal, Jamaica and the Czech Republic.

After many years prosecuting drugs offences as an Assistant US Attorney, growing frustration with the approach inspire

The US prison system is a disaster. There’s virtually no rehabilitation. Locking up low level individuals who have drug problems or who have limited other options is not effective, because they go to jail, they come out, they get involved with drugs again, and they go right back to it.

The war itself is at a draw- which will be maintained indefinitely unless there’s a dramatic change in our approach to drugs and drug trafficking.

Former Colombian President Cesar Gaviria worked on the Global Commission on Drug Policy report in 2011 which called on states to decriminalise drugs.

“Our recommendation is regulation for everything. That’s what Portugal did.

“If you look at the last 50 years, what has been done? In the US, 600,000 people in jail, £27 billion of spending a year. The highest rates of consumption of the whole world. You have to say that it doesn’t work. It’s a failed policy, and public opinion knows that.

“Ten years ago it was unthinkable that the US would move massively to the legalisation of cannabis. That taboo has been broken. In the US, a majority of people are talking about approving legalisation of marijuana.”

He cites the example of Uruguay, the first country to legalise the marijuana trade.

“All Latin America’s looking at Uruguay. It’s a country that also looks how to deal with the production, with the supply of the marijuana that is in the state hands. I don’t expect any major set back of the policy that the Uruguayans have put in place.”

“From the beginning in 1961, the objective of the UN Conventions has been to live in a world free of drugs, but it’s a utopia. It’s something unreachable. It’s not to recognise human nature.”

Professor Peter Reuter from the school of public policy at the University of Maryland has been a leading academic in the field of drugs policy for decades.

“The need for national leaders to stand up and talk about the scourge of drugs, and signal to the population that being tough on drugs was a priority was an important part of the war itself.

“There’s going to be less and less of that. I think there’s going to be a change both in tone and substance, so the ‘war on drugs’ will become a less and less plausible metaphor for describing policy. I think it’s going to be a public health rhetoric for the foreseeable future.

“I do believe that we have in a sense had an experiment with trying to be very aggressive about controlling drugs through use of prohibition. And we have a sense that that did not work well. And so we’re now trying to find better ways of managing the problem, and I think that’s welcome.

“If you look at the number of people who are in prison for drug offences, at least in the US, that’s an important indicator of the change in real policy, and those numbers are starting to go down. Not dramatically, but they are definitely going down, and many states are making changes that are likely to accelerate that decline.”

As drug laws soften he argues the question of regulation becomes key, as happened when gambling was legalised:

“Lottery play was always seen as a bad thing, you legalised it because you wanted to take money away from organised crime, but the result was that the state lotteries became the most aggressive promoters.

“You have slogans like ‘Why be a mug and work when you can play the lottery and win easily?’, just the kind of slogan you’d associate with the worst commercial promotion, but done by the state.

“Alcohol is still heavily promoted, and it’s promoted in states that have state liquor monopolies, and we’ve only recently really been able to restrict smoking promotions.

“You cannot with a straight face say that marijuana legalisation won’t lead to more marijuana dependence.

“Choose your problem. There is no solution. Use of psychoactive drugs is a social problem like a whole lot of other social problems. We manage it. And we may manage it better or worse, but the notion that we solve a problem is simplistic. We’re simply managing a problem.”

Police not NHS should deal with drunks

The Police rather than the NHS should be dealling with drunks claims the AnE boss.

Police not NHS should deal with drunksPolice should crack down on binge drinking to stop hospital staff being distracted by disorderly drunks according to a leading doctor.

Dr Clifford Mann, president of the College of Emergency Medicine, said the “softer approach” used for anti-social drunkenness did not seem to be working. Police could instead increase arrests, convictions and fines, he suggested.

Crime prevention minister Lynne Featherstone said the government was “determined to tackle alcohol-fuelled harm”, which she said cost society around £21 billion a year.

The coalition had improved the powers available to the police and licensing authorities to tackle alcohol-related crime, and had banned the “worst cases of very cheap and harmful alcohol sales”, the Liberal Democrat MP said.

Dr Mann said: “All I am saying at the moment is the softer approach – where we don’t any longer arrest many people for being drunk and disorderly – certainly doesn’t seem to be working.”

He said the number of people arriving at A&E units while drunk was increasing year on year, while the number of licensed premises in the UK was also increasing and alcohol was getting cheaper.

“I think these people, by the nature of the disorder, they are distracting medical and nursing staff from looking after other patients and therefore are wasting public resources,” he said.

“I think they therefore fall into the category of being drunk and disorderly in their behaviour and the police can act to take them away.”

Health Direct agrees with the suggestion. To use the Greens’ parlance of “the polluter should pay”- the drunks should be charged- literally and financially. Until the politicians, police and society in general starts to deal appropriately of issue of people drinking too much alcohol then it is unfair and detrimental to the expect the NHS to pick up the pieces.

Not only would this approach save the NHS money- but the police and courts would make money by fining people who have paid to incapacitate themselves- and who are after all breaking the law.

Painkillers linked to reduced skin cancer risk

Regularly taking aspirin and ibuprofen may help protect against some forms of skin cancer new research suggests.

Painkillers linked to reduced skin cancer riskAn Australian analysis of all studies to date found that non-steroidal anti-inflammatory drugs (NSAIDs) reduced the risk of squamous cell carcinoma by 18%.

The drugs have previously been linked to a reduced risk of other cancers, including colon cancer.  The theory that NSAIDs such as aspirin may protect against skin cancer has been raised before, but the overall evidence had been unclear.

So researchers did an analysis of nine studies looking at use of the drugs and the risk of squamous cell carcinoma – the most common form of skin cancer.

Reporting in the Journal of Investigative Dermatology, they found that taking any NSAID was associated with an 18% lower risk of developing the cancer.  And taking NSAIDs other than aspirin was linked with a 15% reduced risk.

It is the most convincing evidence so far that the drugs help prevent the development of squamous cell carcinoma.

But experts still cannot be sure of the effects because some factors – such as how much sun someone is exposed to or even what doses of the drugs they take – have been difficult to pin down with any accuracy.

It is thought that NSAIDs, which also include diclofenac, may prevent skin cancer because they inhibit an enzyme called COX-2, which is involved in tumour development.

The researchers did find a greater degree of reduced risk associated with use of the drugs in people with pre-cancerous growths or a history of skin cancer.

It raises the possibility that the drugs could be used as a preventive treatment in some groups.

Some people are prescribed NSAIDs long term for conditions such as arthritis, but they are not recommended for regular use in healthy people because of side effects, which can include, in rare cases, bleeding in the stomach.

Nearly half the population takes prescription drugs

Half of women and 43% of men in England are now regularly taking prescription drugs- according to the Health Survey for England.

Nearly half the population takes prescription drugsThe report by the Health and Social Care Information Centre (HSCIC) showed an average of 18.7 prescriptions per person in England in 2013 with the annual cost to the NHS was in excess of £15 billion.

All the figures exclude contraceptives and smoking cessation products.

Nearly a third of prescriptions were for cardiovascular disease with more than 65 million prescriptions for tackling high blood pressure, heart failure or cholesterol levels.

Simvastatin – which lowers cholesterol – was the single most prescribed item with 40 million prescriptions.

Dr Jennifer Mindell, one of the report’s authors at University College London, said: “This is the first nationally-representative study to report on the use of prescribed medicines taken by people in the community, not just those within the healthcare system.”

“That half of men over 65 are taking cholesterol-lowering medicines reflects the high risk of cardiovascular disease in this group.

“Stopping smoking, being a healthy weight, eating more vegetables and fruit, and being physically active reduce people’s risk of these diseases, for people who want to avoid taking medicines.”

This study focuses on the drugs patients say they are taking rather than the number of prescriptions written by a GP as up to half of such prescriptions are either not taken or not taken as recommended.

But figures for community prescribing – which include GPs and dentists, but not hospitals – show:

  • In Wales there were 74 million prescriptions in 2013.
  • In Scotland there were 99 million prescriptions in the financial year 2013-14.
  • In Northern Ireland there were 35 million prescription in 2010.

Analyses of similar data sets for England shows community prescribing, including contraceptives, increased from 650 million in 2003 to more than 1,000 million in 2013.

Antidepressants were taken by more than one in 10 women – double the figure for men.

The drugs were most commonly taken by middle-aged women and those from deprived areas – 17% of the poorest women took antidepressants compared with 7% of the richest.

Dr Sarah Jackson, at University College London, commented: “It’s well known that rates of depression are much higher among women than men, so I am not surprised to see that antidepressant use follows the same pattern in this study.

“People with depression are less likely to be in regular employment, and people who are unemployed or in low paid jobs are more likely to have depression.”

Overweight and obese people were more likely to need prescription drugs. More than half of severely obese people in England reported taking at least one prescribed medicine and a third took at least three.

Obesity is often associated with high cholesterol, high blood pressure, joint pain and depression. Lifestyle changes are always recommended in the first instance, but medicines can help to address the symptoms and this study shows that medicine use increases steadily with body mass index.

Millions of Ebola vaccine doses ready by end of 2015

Millions of doses of experimental Ebola vaccines will be produced by the end of 2015 the World Health Organization has announced.

Millions of Ebola vaccine doses ready by end of 2015The WHO said “several hundred thousand” would be produced in the first half of the year and vaccines could be offered to health workers on the frontline in West Africa as soon as December 2014.

However, the WHO cautioned that vaccines would not be a “magic bullet” for ending the outbreak as there is no proven cure or vaccine for Ebola.

In response to the largest epidemic of the disease in history, the WHO is accelerating the process of vaccine development- it normally takes years to produce and test a vaccine, but drug manufacturers are now working on a scale of weeks.

Two experimental vaccines, produced by GlaxoSmithKline (GSK) and the Public Health Agency of Canada, are already in safety trials.

The GSK vaccine is being tested in Mali, the UK and the US. Research on the Canadian vaccine is also under way in the US with further trials expected to start in Europe and Africa soon.

The results are expected in December. After that, trials will move to countries affected by Ebola, probably starting with Liberia. That will allow researchers to assess how effective the vaccine is and what dose is needed to provide protection.

Healthcare workers, who place themselves at risk when treating patients, will take part in the first trials in West Africa.

The WHO says we should have the first hints of how effective these experimental vaccines are by April.

There are no plans for mass vaccination before June 2015 but the WHO has not ruled it out.

The WHO says vaccines are likely to be key to ending the outbreak, even if cases fall in the next few months.

Dr Marie Paule Kieny, a WHO assistant director-general, said: “While we hope that the massive response, which has been put in place will have an impact on the epidemic, it is still prudent to prepare to have as much vaccine available as possible if they are proven effective.

“If the massive effort in response is not sufficient, then vaccine would be a very important tool. And even if the epidemic would be already receding by the time we have vaccine available, the modelling seems to say vaccine may still have an impact on controlling the epidemic.”

The vaccine plan was the culmination of a day of talks at the WHO in Geneva.

As well as the two vaccines already in trials, there are a further five in the pipeline which could yet play a role in the outbreak.

The World Bank and the charity Medecins Sans Frontieres will help finance the vaccine.

There are also suggestions that an “indemnity fund” could be set up in case people have a serious adverse reaction to a vaccine being rushed through, but until a vaccine is found to prevent the virus from spreading, treating and isolating sufferers will remain the key strategy for containing the outbreak.