David J. Nutt - Drugs - Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs

Drugs without the hot air

Minimising the harms of legal and illegal drugs

David Nutt

Contents

Chapter endnotes

To avoid interrupting the flow of reading, the book contains no footnotes. Instead, there are detailed lists of sources and references at the end of each chapter. In the text, a numbered link (e.g. 2) indicates the start of the text that the note relates to, and the chapters endnote repeats the page number and the original text, followed by the text of the note. For example, on page , October 10th 2009, which appears at the end of the chapter.

When reading the book for the first time, you may not want to bother with the endnotes as they often refer to specialist publications or articles. However, you will find them useful when you want to verify something in the text, or to find more information on a topic.

URLs and web links

To save space and duplication, URLs for webpages are shown like this: .

Acknowledgement

The author and publisher give special thanks to Deborah Grayson for her tireless work as project editor for this book.

Many people who dont recognise my name or know anything about my work will nonetheless remember me as the scientist who got sacked. In many ways my departure from the governments Advisory Council on the Misuse of Drugs is where this book began, so it makes sense to start the story there.

In October 2009, a lecture Id given a few months before was released as a pamphlet on the internet. For some reason perhaps it was a slow news day this got picked up by the media and I was invited on to BBC Radio 4 for an interview. This generated more interest and several more interviews. A few days later I got an e-mail from the then Home Secretary Alan Johnson asking me to resign from my position as chair of the Advisory Council on the Misuse of Drugs (ACMD). When I refused he released a statement saying that I had been sacked.

The lecture that sparked off this chain of events had covered a number of topics, but all the media wanted to talk about were my views on cannabis. In January 2009, against the recommendation of the ACMD, after four years in Class C, cannabis was re-upgraded to Class B, indicating increased harmfulness. Jacqui Smith, who was Home Secretary at the time, justified ignoring the recommendations of our report because, she said, her protect the public. In the lecture, I discussed whether this was a rational approach, and particularly whether putting a drug in a higher legal Class in order to err on the side of caution would actually protect the public and reduce harm.

Id called the lecture Estimating Drug Harms: a Risky Business? because I knew from experience that talking about the harm done by drugs in relative terms was considered politically sensitive. This had been made very clear to me when a scientific editorial Id written the year before, comparing the harms of ecstasy with those of horse riding, provoked questions in Parliament and an unhappy personal call from Jacqui. (You can read more about this episode on page .)

There had been a similar reaction to a (Table 1.1). Class B drugs should be less harmful than Class As, and Class C drugs less harmful than Class Bs. Incidentally, many drugs that have medical uses are both covered by the Misuse of Drugs Act, and regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Medicines Act (Figure 1.1).

Table 1.1: The maximum prison sentences laid down by the Misuse of Drugs Act.

Which brings us back to cannabis the only drug in the history of the Misuse of Drugs Act ever to be downgraded, following recommendations made by the

There was certainly a legitimate question as to whether new breeds of cannabis were more harmful than the sort that had been considered by Runciman and the ACMD in the past. As the governments advisory council, this is exactly the sort of issue that our research was supposed to address, and we undertook a very thorough study one of the most comprehensive ever. Our conclusion was that, although there probably was a causal link between smoking cannabis and some cases of schizophrenia, this link was weak and didnt justify moving the drug up to the next Class. Yes, there was a risk of developing a serious mental illness after using the drug, but it was smaller than the risks posed by other Class Bs such as amphetamines, which can also cause psychosis. This was the message that we wanted to send to the public by keeping cannabis in Class C.

Certainly, nobody was calling cannabis safe. However, as my 2007 report had shown, across a range of different sorts of harm it was by no means as damaging as many other drugs, particularly alcohol. This was a point I made in my lecture, and which got picked up in the radio interview: surely you cant be saying alcohol is more harmful than cannabis? I replied yes, thats exactly what Im saying, its there in my 2007 paper, which at the time was reported on the front page of the Independent and the Guardian so it was hardly a secret. But this question was repeated in the other interviews that week everybody wanted the quote that alcohol was more harmful than cannabis. It seemed like an entirely defensible thing to say, as it was based on my own scientific work, and backed up by a similar study from Holland which had agreed that alcohol deserved to be ranked among the most harmful of drugs. In these interviews I also observed that the government had asked the ACMD to determine which Class cannabis belonged in, and then hadnt followed our advice.

I responded in The Times that I didnt understand what he meant when he said I had crossed the line from science to policy, and that I did not know where this line was. The ACMD was supposed to advise on policy, and indeed it was set up by the Misuse of Drugs Act because even in the 1970s it was known that politicians liked to play party politics with drugs regulation. Of course, politicians have to take into account issues beyond pure scientific evidence in many of their decisions, but the legal Class of a drug is supposed to inform the public about relative harm, and those who designed the Act recognised this was best determined by a group of independent experts. By acting against our recommendations, the Brown government had themselves blurred the line between science and policy.

The subtitle of this book refers to minimising the harm done by drugs. This has always been my primary concern as a psychiatrist, and what I always hoped the ACMD was working towards. The upgrading of cannabis to Class B was the third time we had been ignored. (The other two were when magic mushrooms were made Class A without consulting us, and when the government refused to downgrade ecstasy to Class B despite our recommendation.) The longer the government went on creating policies that conflicted with the scientific evidence, the more harm those policies would do, not least because they undermined our ability to give a consistent public-health message, especially around the dangers of alcohol. The more hysterical and exaggerated any Home Secretary was about the harms of cannabis, the less credibility they would have in the eyes of the teenagers binge-drinking themselves into comas every day. If were going to minimise harm, we have to have a way of measuring it, and a policy framework that can respond to this evidence. Yet even comparing the dangers of cannabis and alcohol was considered a political act that overstepped my remit as a scientist and physician.