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Time for a fresh look at drug policy governance

2010; Elsevier BV; Volume: 375; Issue: 9728 Linguagem: Inglês

10.1016/s0140-6736(10)60796-9

1474-547X

Ruth Runciman, Colin Blakemore, Tracey Brown,

Opioid Use Disorder Treatment

Your Editorial of April 17 (p 1319)1The LancetA collapse in integrity of scientific advice in the UK.Lancet. 2010; 375: 1319Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar looks forward to the outcome of David Omand's review of the Advisory Council on the Misuse of Drugs (ACMD) as a solution to the breakdown of confidence between scientists, experts, and policy makers in the UK. We believe that such broad expectations are overoptimistic and that a more fundamental review of the governance and leadership of drug policy in the UK is now needed. The ACMD was, until recently, the main vehicle through which government and parliament sought independent advice for drug policy, and that advice was respected and followed. In this respect, the Misuse of Drugs Act of 1971 provided a model for the development of evidence-based policy. However, great change has occurred over the past few years. In 1998, the government experimented briefly with the appointment of a “Drug Czar”. One of the unintended consequences of this was an undermining of the contribution and role of independent scientists and experts. We have seen drug policy increasingly affected by media pressure, sometimes hysteria, and by the ideological and polarised opinions of campaigning organisations and others, often based on flimsy evidence. Successive governments have tacitly acquiesced to this shift from evidence to opinion by not building an adequate evidence base along with suitable machinery and structures for independent scrutiny and evaluation. This point has been commented on by the National Audit Office and the Public Accounts Committee.2National Audit OfficeTackling problem drug use: HC 297, report by the Comptroller and Auditor General, session 2009–2010. Stationery Office, London2010Google Scholar, 3Public Accounts CommitteeTackling problem drug use: HC 456, thirtieth report of session 2009–10. House of Commons, London2010Google Scholar This changing pattern of influence has eroded the provision of objective advice for the development and implementation of drug policy. In effect, policy has become dominated by ideological rivalries. The mechanisms for building consensus through commitment to objective evidence and rigorous evaluation have been undermined. The Misuse of Drugs Act will be 40 years old in 2011 and it is time to look afresh at the governance arrangements for drug policy. Over the next 18 months, our Commission will carry out a serious review of drug policy governance and stewardship in the UK. We need to examine, as the Phillips Report did for food safety, how expert analysis, public opinion, political strategy, and economic and social factors might be more transparently and rationally integrated. Our initial view is that an effective mechanism to deliver effective and better “governance” of drug policy would have several essential ingredients including: (1)Solid investment in developing the evidence base to inform drug policy analysis and decision making;(2)An independent mechanism and body for the evaluation and scrutiny of policies;(3)Inclusive and transparent methods, machinery, and structures to take account of public opinion and “political” considerations, against a background of the best scientific evidence and expert advice;(4)Enhanced political accountability through parliament and devolved bodies;(5)Clear and open reasoning that people can understand and hold to account. The new government will now have an opportunity to reflect on recent events and make a fresh start in strengthening the overall governance of drug policy, rebuilding the processes, structures, and practices, so that a new consensus about the aims and directions of drug policy can be created. We hope that the work of the UK Drug Policy Commission can facilitate this much-needed review. RR was a member of the Advisory Council on the Misuse of Drugs (1974–95). She was also Chair of the Independent Inquiry into the Misuse of Drugs Act 1971 (1997–2000). CB is Professor of Neuroscience at the Universities of Oxford and Warwick. TB is the Managing Director of Sense about Science. A new dawn for drug policy in the USA40 years ago, the then US President Richard Nixon launched his “war on drugs”, declaring drug misuse “public enemy number one”. This approach criminalised the production, distribution, and consumption of illegal drugs. On May 11, US President Barack Obama took a decisive shift away from this policy with the release of his 5-year National Drug Control Strategy, which takes a more balanced approach to the problem and emphasises prevention and treatment, as well as law enforcement. This widely anticipated move, called for by the public health community, should be applauded. Full-Text PDF