Repeal section 9a!

Given the fact that it's no longer used by the police, we believe the most sensible option for the future would be full repeal of Section 9a.

We recognise that the emotive nature of media portrayal of drug policy issues means this might be perceived as difficult. As an alternative, we would urge the government to replace the list of exempted items with a general exemption for drug services to issue items that have the potential to reduce drug related harm.

This would more easily allow widespread and organised supply of items such as foil and permit development and supply of other items which have the capacity to reduce drug related harm. That said, we do recognise that the current state of affairs – with the gradual addition of items as and when recommended by the ACMD, coupled with the fact that the legislation is never used – is a vast improvement on the situation 5 years ago.

The article below 'Repeal Section 9a! – why section 9A of the Misuse of Drugs Act should be repealed' was written by Neil Hunt on behalf of Action on Hepatitis C, some years ago, but it remains relevant now as then.

According to the Department of Health 300,000 people in the UK general population are believed to have chronic HCV infection. The majority of these infections are among injecting drug users. Within England at least 30% of drug injectors are infected with hepatitis C (Ref 1) (HCV) and in Scotland the rate is twice as high at 60% (Ref 2). Prevalence rates are low for new injectors who nevertheless have an incidence rate of 6% i.e. for every year that someone injects they have a 6% chance of becoming infected (Ref 1). The majority of people who have been injecting for 10 years or more are HCV positive.

Conservatively it is estimated that there are about 100,000 recent injectors in Britain (Ref 3). This implies that about 6,000 new infections occur annually among this group. Within 30 years about 30% of infected individuals develop cirrhosis and liver cancer (Refs 4 & 5), and, besides the personal debilitation and premature death this causes, there is a substantial cost to the health service arising from testing and treatment (direct costs of treating infection using standard interferon-ribavirin combination treatment vary from £12,000 - £15,000 with the full costs including biopsy and testing estimated to be about £20,000 per person). People with chronic HCV who develop cirrhosis and cancer require liver transplantation, which costs £36,000 (Ref 6).

The cost of offering treatment to all new cases for just one year would therefore be about £120m (6,000 x £20,000) and this number of infections is occurring year-on-year. Of course, at present not everyone would choose to receive treatment and, despite evidence that injectors benefit from treatment while they continue to use drugs, they are not currently eligible for treatment until they are abstinent - a form of discrimination that is not medically justified (Ref 7). However, most people eventually become eligible when they stop injecting. As more sophisticated (and expensive) treatments become available the number of people electing to receive treatment is also increasing.

PREVENTION IS THEREFORE IMPERATIVE.

Needle exchange is the central plank of the UK's prevention efforts. Currently needle exchange schemes distribute about 27m syringes a year (Ref 8). However, infections also occur as a result of sharing other paraphernalia used to prepare drugs for injection - notably spoons, filters, acidifiers and water for injection. After controlling for sharing needles and syringes it is estimated that sharing spoons and filters gives a fourfold increase in the risk of infection with HCV (Ref 9) yet Section 9A of the Misuse of Drugs Act (1971) prevents distribution of sterile, one-use paraphernalia kits such as the 'stericup' that would prevent such infections.

This contradictory approach hinders HCV prevention and diminishes the public health benefit and value for money derived from the UK's substantial investment in prevention through needle exchange

Despite the law, some needle exchanges nevertheless provide this equipment for public health purposes but occupy a tenuous legal position being technically liable to prosecution. Many areas do not provide clean paraphernalia with the result that we have 'postcode paraphernalia' availability.

For these reasons a report by a working party set up by the Royal Pharmaceutical Society of Great Britain on pharmaceutical services for drug misusers recommends that citric and ascorbic acids, water for injections, swabs, tourniquets and filters be excluded from the Misuse of Drugs Act. This recommendation is echoed in the Police Foundation's Independent Inquiry into the Misuse Of Drugs Act 1971 (Ref 10) in their recommendations 50 and 51:
· 50 - Section 9A of the MDA (paraphernalia) should be repealed.
· 51 - The exemption for hypodermic syringes currently contained in section 9A should for the avoidance of doubt be inserted into section 19. It should be extended to other products.

The public health case for reforming the paraphernalia laws to strengthen efforts to prevent hepatitis C is compelling. Section 9A of the Misuse of Drugs Act should be repealed.

References

1. Judd A, Stimson G V, Hickman M, Hunter G M, Jones S, Parry J V and Madden P (2000) Prevalence of HIV infection in a multi-site sample of injecting drug users not in contact with treatment services in England. AIDS 14, 15: 2413-4.

2. Taylor A, Goldberg D, Hutchinson S et al. Prevalence of hepatitis c virus infection among injecting drug users in Glasgow 1990 - 1996: are current harm reduction strategies working? Journal of Infection 2000; 40: 176-83.

3. Wadsworth J, Hickman M, Johnson A M, Wellings K, and Field J (1996) Geographic variation in sexual behaviour in Britain: implications for sexually transmitted disease epidemiology and sexual health promotion. AIDS, 10: 193-199.

4. Tong M, El-Farrah N, Reikes A, Co R. Clinical outcomes after transfusion associated hepatitis C virus. New Eng J Med 1995; 332:1463-1466.

5. Poynard T, Bedpost P, Oolong P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997; 349:825-832.

6. Hepatitis C Action Group (2001) Recommendations for a National Strategy for Hepatitis C Virus (HCV) Infection in England and Wales. Information provided by St Mary's Hospital, London.

7. Edlin B R, Seal K H, Lorvick J et al (2001) Is it justifiable to withhold treatment for hepatitis C from illicit drug users? New England Journal of Medicine. 345, 3: 211-217

8. Parsons J, Hickman M and Turnbull P et al. (in press) Over a decade of syringe exchange: results from 1997 UK survey.

9. Hagan H, Thiede H, Weiss N S et al. (2001) Sharing of drug preparation equipment a risk factor for Hepatitis C. American Journal of Public Health. 91, 1: 42- 46.

10. Independent Inquiry (2000) Drugs and the Law, Report to the Independent Inquiry into the Misuse of Drugs Act 1971. London: Police Foundation.