Oct 18 2012

Drugs without the Hot Air by David Nutt

Jacob Silverman

web exclusive

In 2009, David Nutt, a neuropsychopharmacologist who served as chair of Britain's Advisory Council on the Misuse of Drugs (ACMD), published a paper in a medical journal that offered a provocative thesis: horseback riding, he wrote, was more dangerous than taking ecstasy. Examining the two activities across a range of metrics, Nutt estimated that every 10,000th ecstasy pill leads to an "adverse event," while a rider is injured every 350th episode.

The story went viral and the details of Nutt's analysis were lost in the ensuing media tempest. His own organization tried to distance itself from him, saying that the article was part of his academic work. His governmental bosses were even more displeased: He was soon fired, earning the sobriquet "the scientist who was sacked."

This wasn't the first time that Nutt had flouted official orthodoxy. Also in 2009, he had publicly questioned the UK government's decision to move cannabis, which for four years had been a Class C drug, into the more restrictive category of Class B. Being sacked, then, might have been a liberation for Nutt, who later cofounded the Independent Scientific Committee on Drugs (ISCD), where he was joined by scientists who had resigned from the ACMD for holding similar beliefs. (Some scientists remained with the ACMD but decided to partner with Nutt's new organization.) The firing also gave him the freedom to write Drugs Without the Hot Air, a rigorous, evidence-based primer on drugs and drug policy that approaches the subject with a goal neatly encapsulated by its subtitle: "minimizing the harms of legal and illegal drugs."

Drug policy, in the U.S. and Britain alike, is currently based on imprisoning users and dealers en masse, and doesn't address what attracts people to drugs, or whether some drugs produce less adverse consequences than others. The result is that politicians have come to lump all drugs together as equally harmful—without paying attention to the dangers of legal drugs—and refuse to make effective or honest use of classification systems. Given this situation, Nutt argues that the "drugs problem" needs radical rethinking as a public-health crisis rather than a moral crusade." "Criminalising risky behaviour"—for decades the main tool in British and American arsenals—"is only one way to reduce harm," he says, "and not always the most appropriate way."

Nutt's definition of "harm" is based on sixteen variables that range from drug-specific mortality ("death from poisoning," i.e. an overdose) to drug-related mortality ("deaths from chronic illnesses caused by drug-taking"). He also factors in addiction, effects on mental functioning, harm to others, crime, economic and environmental costs, and loss of relationships.

Using this metric, the ICSD rated a number of drugs on a scale of 1 to 100. Psychedelics were in single digits, behind anabolic steroids, while cannabis clocked in at 20. Methamphetamine, heroin, and crack bore respective scores of 33, 54, and 55. Alcohol emerged as the most harmful drug, scoring 72.

Nutt is a social drinker, but his consideration of alcohol is bracing. One chapter title asks, "If alcohol were discovered today, would it be legal?" and states that the UK is "facing a public-health crisis of immense proportions," with forty thousand alcohol-related deaths per year and billions in health and policing costs. Nutt declares, "There is no such thing as a safe level of alcohol consumption," and adds that "there is no other drug which is so damaging to so many different organ systems in the body." He has similar contempt for tobacco, which, at current rates, will have killed a billion people by 2030.

Nutt devotes a chapter to each of the major classes of drugs, and weighs the possible benefits of each drug against its risks. (Alcohol, for example, receives the same sort of examination as amphetamine, and in every case, he considers a drug's possible medicinal uses, as well as its cultural and social context.) He laments that Germany and the U.S. don't allow heroin to be prescribed for the relief of extreme pain (the drug has been shown to be singularly effective in some cases), and advocates for the use of psychedelics in mental-health research—ecstasy for the relief of PTSD, LSD for treating alcoholism and salving the mental anguish of the terminally ill. Nutt recognizes that despite "a strict legal division" between drugs that enable users "to experience pleasure and to relieve suffering," things are never so simple. "In reality," he writes, "the line between them is very blurred."

The book doesn't offer a program to win over recalcitrant government officials, but it's loaded with studies and policy suggestions that, if properly applied, would certainly save money and lives. Decriminalization, needle-exchange programs, relaxing onerous restrictions surrounding medical research involving psychedelics and other illegal drugs, even allowing users to bring their drugs to hospitals to be tested (so that officials know what's out there and users know what they're taking)—Nutt's list is long, and his arguments convincing. But politicians, fearful of seeming soft, have shown little appetite for such thinking. For example, when ecstasy took off as a club drug, some venues started selling bottled water and providing "chill-out rooms" where patrons could cool off and hydrate. These measures caused authorities to accuse clubs of "catering to the needs of ecstasy users," and helped to inspire Congress in 2003 to pass the Illicit Drug Anti-Proliferation Act.

The fallout from this mindset is increasingly apparent, and it's become a popular topic in Latin American countries ravaged by the U.S.-financed War on Drugs. From Mexico to Uruguay, governments are debating liberalizing drug laws and even setting up regulated, legal markets. Strategies like this, Nutt argues, have "been highly successful at reducing harm" in countries like Portugal, where heroin use has dropped dramatically thanks to a policy that pushes users to get treatment rather than fining or imprisoning them. If countries looking to take a similar approach need outside counsel, this British scientist, rejected by his short-sighted government, has written as good a handbook as one is likely to find.

Jacob Silverman is a contributing editor for the Virginia Quarterly Review and a columnist for Jewcy.