Science and substances

The case of Professor Nutt, lately chair of the Advisory Council on the Misuse of Drugs, has been the subject of much recent debate. He has by overly focusing on what he sees as the science, and by failing to take into account wider social and moral issues, gained the notoriety he was probably seeking and the opprobrium he deserved.  I don’t claim for a second to be an expert but I will comment on what I do know.

His claim that alcohol and tobacco are more harmful than many illegal drugs, including LSD, ecstasy and cannabis, is bizarre, his methodology suspect.  They are so radically different in their effects, they cannot be compared.

He claims that ecstasy is no more dangerous than horse-riding. As the Home Secretary wrote to the Guardian:  ‘There are not many kids in my constituency in danger of falling off a horse – there are thousands at risk of being sucked into a world of hopeless despair through drug addiction.’

Death is but a small, albeit more permanent, part of the damage ecstasy can do. Ecstasy may be safe is small doses and the short term for most, but for some it has an immediate and very damaging psychological impact, which can last for months or years. Longer term the effects on those who have no short-term effects from the drug are unknown. It is irresponsible to make a public judgement about a drug on the basis of one headline-catching fact, and downplay its other consequences.

Likewise, cannabis, about the reclassification of which Prof Nut went public, in my own experience (which goes back many years but is significant) impacts perception in a way quite different and more insidious than moderate doses of alcohol.

Prof Nutt when challenged agreed that a Royal Commission on the subject of the decriminalisation of drugs would be a good idea. I part company with him sharply here too. It may be that decriminalisation would spare a multitude of minor offenders a criminal record, and make treatment more accessible, but more than balancing that is the damage that freely available drugs would do. If all were as harmless as alcohol in moderate quantities then we’d have little to worry about. But a multitude of drugs with the capacity to do a multitude of harms, and freely available, is a recipe for social licence and social disaster.

If you dictate a note of moralising in my tone you are right to do so. We’re talking here not only about social consequences broadly defined but of the deeply personal consequences for all those who suffer as a result of drug  misuse and for all those who would be more likely to do so if an abundance of routes to recreational escape and ecstasy were available.

I leave to last the very dubious nature of the classification chart that Prof Nott used to make his case. He claims that ‘alcohol ranks as the fifth most harmful drug after heroin, cocaine, barbiturates and methadone. Tobacco is ranked ninth. Cannabis, LSD and ecstasy, while harmful, are ranked lower at 11, 14 and 18 respectively’.

Nutt and colleagues used three factors to determine the harm associated with any drug: the physical harm to the user, the drug’s potential for addiction and the impact on society of drug use. The researchers then asked two groups of experts to assign scores to twenty different drugs. Each category is given the same weighting, which is enough in itself to invalidate the process.

The categories themselves are deeply suspect and to a layman look to be an inappropriate basis for scientific analysis. Psychological harm, arguably the most insidious and damaging factor of all, comes under the heading physical harm, when it has to be considered in its own right. Addiction is an extension of psychological harm, with its own specific social consequences. Countless people suffer lonhg-term psychological harm without becoming addicted, or indeed suffering from schizophrenia , another of the extreme conditions (death – see earlier – is another) which Prof Nutt uses to over-simplify the argument.

Sadly it seems much may be explained by Prof Nutt’s role as a psychopharmacologist, with links to the drug industry, and a pro-drug (anti-depressants) and anti-psychotherapy (an oversimplification, but broadly true) stance. In other words he is parti pris, on one side of an old argument, to many the wrong side, and an inappropriate person to be heading up a government body. I have to wonder why he was appointed to chair the Advisory Council in the first place.

Prof Nutt’s categories are a poor basis for research. Scientists have responsibilities to society but also to their own science. Prof Nutt has failed on both counts. If by their actions they discredit science they do great damage, and an over-focus on the supposed verities of their own specific disciplines, combined in this case with a suspect methodology, has just that effect.

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