On 27th May 1971 the UK government brought onto the statute books the Misuse of Drugs Act (MDA) and for the last 50 years this Act has dictated how drugs with a potential for misuse, controlled drugs (CDs), are handled by healthcare professionals and what punishments criminal courts must impose for possession or supplying illegally. The MDA created drug classes and drug schedules and the public often confuse these terms. “Class” determines the level of sanction for possession or supply whereas “Schedule” determines the degree of control. Methadone, for example, is a Class A drug and illegal possession or supply attracts the harshest penalties. It is also a Schedule 2 drug which means its lawful supply for the management of opioid addiction is strictly controlled; in the pharmacy, it must be stored in a secure drug safe and all supply recorded in a dedicated Controlled Drug register.
Over the last 50 years, there have been numerous amendments to the MDA which has taken into account changes in risks associated with drugs covered by the Act. Perhaps the most radical changes happened after the Dr Shipman Inquiry. Much stricter controls on supply to, and destruction of, medicines from healthcare professionals are now in place and believe me they are rigorous and strict.
As MDA turns 50 it is perhaps timely to consider how fit for purpose the act is. Many activists are promoting a more liberal approach to recreational drug use and are calling for a complete rethink of MDA. Cannabis, it is argued, is less dangerous than alcohol or for that matter tobacco and therefore should be in a lower Class if in any class at all. Currently, it is Class B but was, between 2004 and 2009, downgraded to Class C. In 2009 it was raised back to Class B against the advice of the Government Advisory Committee who rules on such matters. Professor David Nutt who was chair of the Advisory Committee was sacked for comments supporting the reclassification of many drugs based on his view that the Classes did not properly reflect the harms and risks the drugs presented to individuals and society.
The Transform Drug Policy Foundation (https://transformdrugs.org/mda-at-50) are using MDAs 50th birthday to seek a review. MDA in their view is as a blanket prohibition of psychoactive drugs for recreational use. That is precisely what it is. Ironically, they are suggesting that MDA should be repealed and replaced by a framework that already exists; The Medicines Act 1968 and the licensing laws for alcohol and tobacco, they are suggesting, are the regulatory frameworks by which society can repeal the MDA. This is ironic because the Medicines Act was designed to address the horrors of drug damage as witnessed by the Thalidomide Disaster of 1960-61. The Medicines Act controlled the supply of all licensed medicines in clinical settings but it was determined at that time that the Medicines Act was not capable of controlling the use of substances such as LSD and cannabis which did not, certainly at that time, have any clinical or therapeutic use only recreational use.
This group is suggesting that;
“drug supply should be regulated through a system of licensing based on an assessment of risk. This system would establish different levels of restriction – ranging from very lightly-regulated sale in shops to supply by prescription only.”
This is exactly what the Medicines Act does. The only, and very important, difference is that this proposal, other than in the Category of greatest risk, does away with the “prescriber” traditionally the doctor but more recently the nurse or the pharmacist. For most of the drugs currently controlled by the MDA they are suggesting “self-prescribing”.
They go on to say:
“This approach allows for nuanced, responsive and appropriate regulations to be applied; ensuring supply is safe, while preventing a market free-for-all. Each drug (including different preparations) would be regulated based on a detailed assessment of the risks it presents. We have identified five broad types of regulation through which currently illegal drugs could be supplied in future.”
Their five categories range from low risk drugs Category 1 such as caffeine which is not really regulated at the moment as far as I am aware, to high risk Category 5.
Category 2 is similar to the regulation applied to alcohol sold in pubs where the product is consumed on the premises. They see local licensing authorities having the power to issue licences and applying conditions.
Category 3 is supply for home use as in ‘off’ licences and tobacconists. Retailers need to acquire a licence for sale from their local authority. They are advocating State-owned retail outlets to ensure better control as they seem to fear the private sector might turn into legal drug deals. I really don’t see any difference between Category 2 and 3.
In Category 4 they recommend that sales be limited to specialist pharmacy outlets, with well-trained staff and tight restrictions on availability, product display etc. This is the model they recommend for the sale of most stimulant drugs, such as powder cocaine and MDMA. They also recommend that outlets are state-owned, as they see this as the best way to prevent excessive marketing and profit-driven sales.
In Category 5 they propose a prescription-only model but only for the highest risk drugs but they fail to elaborate on which drugs will be in this category. Drugs are prescribed to a named user by a qualified and licensed medical practitioner. They are dispensed by a licensed practitioner or pharmacist from a licensed pharmacy or other designated outlet. The Scottish Government have been keen to implement this type of prescribing for heroin in Scotland but they can’t change the law due to MDA being a reserved power in Westminster. Westminster is not minded to allow this change.
It’s an interesting if not niave suggestion for reform but I think MDA will be with us for some time to come because no matter how liberal you might be the harms from drugs are very real and increasing access will only serve to increase these harms. Happy Birthday MDA.
I am a pharmacist in Belfast.