Drugs, harm and policy: an interview with David Nutt

Drink yourself to death. Drugs ranked by their overall harm, a combination of their harm to users and to others. Taken from Nutt, 2010, The Lancet.

‘5 Minute Tute’ was a regular feature in The Cherwell, one of Oxford’s student newspapers. Each week, a different academic would be interviewed; the idea being to convey their research to a general readership, channeling the university’s infamous tutorial system.

After hearing David Nutt speak in Oxford, I managed to arrange an interview for the column (first published here). Serving as the UK government’s advisor on drug policy from 2008–2009, he was sacked after publishing an academic paper that ranked alcohol and tobacco ahead of MDMA and cannabis by their harm caused to users and society. He subsequently set up the Independent Scientific Committee on Drugs in 2010 as an impartial body to review the harm of drugs.

Recently, when applying for a competition to attend the Cheltenham Science Festival 2017 for the purposes of science communication, I was reminded of this piece being my first attempt at science journalism. Five years since writing it, there has been no progress towards the UK implementing an evidence-based drug policy and the interview still seems very relevant:

HS: What, if anything, is wrong with this country’s drugs policy?

DN: The current Misuse of Drugs Act 1971 (MDAct1971) was supposed to be evidence based, but politics has since taken over so that about half of the drugs controlled by the Act are in the wrong classes. This completely undermines any confidence in the accuracy of the MDAct1971, the 2010 amendment, and the Drugs Act 2005. The non-evidence based classification of drugs has undermined the value of classification as an educational message for harm reduction, and has led to injustice for drug users, especially young adults.

HS: Is alcohol a drug?

DN: Undoubtedly. Ethanol has very similar pharmacology to other sedatives such as GBL and GBH, which are both Class C illegal drugs. If alcohol was discovered today it would probably be banned. Alcohol is socially acceptable yet causes much more harm overall than drugs like cannabis and ecstasy.

HS: To what extent do you think the corporate world shapes our drug taking, and drug policy?

DN: The alcohol, and to a lesser extent the tobacco, drug industries have had a huge impact on drug use and policy. Firstly, there has been a massive increase in the use of these legal drugs because of active marketing. This has been accompanied by dishonest claims about the health benefits of alcohol use. And secondly, the industries encourage the incorrect belief that illegal drugs, such as cannabis and ecstasy, are more harmful than alcohol so push users towards alcohol. Drugs that are illegal usually come without attractive marketing and are more likely to be taken in secret, making their consumption seem more grubby and shameful. So powerful is the influence of the industries (especially alcohol) that people have been led to believe that ‘illegal’ drugs are far more addictive and dangerous in the short- and long-term than the legal drugs that are so frequently abused.

The non-evidence based classification of drugs has undermined the value of classification as an educational message for harm reduction, and has led to injustice for drug users,

HS: The commonly held view is that cannabis causes schizophrenia. Is this true?

DN: Cannabis does not cause more than a few percent of cases of schizophrenia. It does, however, mimic some aspects of psychosis, especially paranoia, which can be mistaken for schizophrenia by non-experts. The main harm of cannabis is dependence, leading to daily use. Regular users experience a loss of motivation and become less productive, which is particularly problematic for those in full time study.

HS: Do we know the long term effects of using novel synthetic drugs like MDMA and mephedrone?

DN: We know that ecstasy has been used for some 40 years with little evidence of long-term problems. We have less experience of mephedrone, but as it is chemically similar to amphetamine, which has been around for 70 years and doesn’t cause major health problems provided usage is not excessive, we can be fairly certain that the associated long-term problems are minimal. Cocaine deaths have been increasing by ten year-on-year, and have not been curtailed by any government measures. In 2009, however, there was a 30% decrease in cocaine deaths due to users switching to the safer mephedrone. Mephedrone was used by thousands of young Israelis between 2007 and 2008 with no reported fatalities. Shoddy reporting by the media is to blame for the view that mephedrone has caused numerous fatalities. In fact, the high profile fatalities showed no presence of mephedrone in toxicology reports. The two teenagers who died in Scunthorpe had mistakenly taken the heroin substitute methadone after heavy drinking, not mephedrone.