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Rationality and Drugs

We like to think we live in an age of reason, so why is our attitude to drugs plagued by irrationality?

David Nutt

We like to think we live in an age of reason, so why is our attitude to drugs plagued by irrationality? Why have successive governments refused to act, and what are the implications for science and for society?

Leading pharmacologist David Nutt speaks to the IAI about the irrationality at the heart of current drug policy, why it matters, and what an evidence-based approach to drugs policy would actually look like.

Nutt is a fierce proponent of rational, science-based drugs policy. He worked as an advisor to the Ministry of Defence, Department of Health and the Home Office under the last Labour government, but repeatedly clashed with ministers over issues of drug harm and classification. In 2009, Nutt published a paper in which he compared the dangers of taking ecstasy with those of horse riding. Shortly after, he was infamously sacked by Home Secretary Alan Johnson, prompting a host of resignations.

Nutt is now chair of the Independent Scientific Committee on Drugs, which he founded in 2010. His book, Drugs without the Hot Air, won the Transmission Prize for Communicating Science in 2014.

 

Tobias Phibbs: What do you see as the major consequences of our current drug policy of prohibition?

The policy has completely destroyed 50 years of research on a whole range of important drugs, particularly cannabis. It’s some of the greatest censorship of research in the history of humankind.

TP: You advocate an evidence-based approach to drug policy. What would that look like?

Anything less harmful than alcohol would be available from pharmacists, but alcohol would be controlled more severely and only sold in licensed premises, not in supermarkets. It would also include rapidly increasingly the availability of tobacco alternatives.

TP: There are all kinds of factors relating to the effects of drug intake on culture, on interpersonal relationships and so on, that seem very hard to quantify. How do we avoid a crude utilitarianism when discussing the impact of drugs, and the drug policy we consequently advocate?

This is a very good question. The key thing is that we cannot let the odd individual reaction dictate policy on one drug, like ecstasy. For example, under the last government, Tony Blair said ecstasy killed Leah Betts, which it didn’t, but he said it to appease the family and to appease the right-wing press. No politician is going to say that 20,000 people a year die prematurely because of alcohol, even though it’s the leading cause of death in men under the age of 50. They never say anything about that because there’s a smokescreen, a conspiracy of silence around the harms of alcohol. We’ve got to talk about these drugs in the same way, analyse their harms the same way. We’ve got to take the personal out of it and focus on the population as a whole.

TP: Do you think things are moving in the right direction in terms of drugs legislation?

No, we’re going backwards. The UN are planning to ban Ketamine completely now. Ketamine is the only non-sedative opiate in the world, and they want to ban it because it’s now used recreationally. Against the advice of the World Health Organisation, they’re going to make Ketamine a Schedule 1 drug of the UN Convention – that will stop all research and all treatment worldwide.

TP: You’ve recently written about the deaths of clubbers taking PMA and other MDMA substitutes, and it seems to show very clearly the dangers of illegal drug production and distribution without regulation or clear labelling of the risks. Why do you think the gap is so wide between sensible drug policy and real drug policy?

The question is: why are we so scared of drugs? Or, why are we scared of some drugs and not other drugs?  Why aren’t we scared of alcohol and tobacco for the real drugs they are? It’s a complicated answer: it’s because there’s a hugely powerful lobby base for the drinks industry and the tobacco industry to keep classing them as foodstuffs rather than drugs. But there’s no lobby base for recreational drugs. Some recreational drugs like heroin are very harmful, so there are some reasons to be scared. But there’s massive misinformation around drugs for political purposes. I personally believe there’s a hysteria that the last government and this government have directed against psychoactive substances that has nothing to do with the harm they cause, but simply to do with giving a pretence of action, a pretence of activity against a non-threat in order to avoid confronting the really difficult challenge – which is alcohol.

TP: How should we confront that challenge?

Minimum pricing would have a major impact. It would actually make people better off too – particularly the people who spend money on alcohol – and it would reduce the tax burden that alcohol currently puts on people. But there is no open debate on that: the media and the drinks industry are in collusion to pretend that minimum pricing will actually cost people money, when actually it won’t. It would save the average taxpayer money, because the average taxpayer pays £1,000 a year simply to service drinking as we do today – intensive and excessive drinking by young people and alcoholics. That costs us £3.5 billion a year in terms of healthcare costs, and would be significantly reduced by minimum pricing, thereby reducing the tax burden.

TP: For decades, research on mental health problems like schizophrenia has focused on replicating psychotic states through psychedelics. Is there something specific to psychedelics that make them such a rich field of research?

There’s no question that some of the experiences of psychedelics are similar to those people have when they’re psychotic. That makes them of interest, because we don’t have very good anti-psychotic drugs at present, and we don’t have any easy ways of screening new drugs for anti-psychotic potential. What we have to do is put them through clinical trials. So one of our research goals at present is to see if we can use, for instance, the psychotic-like effects of psilocybin. Cannabis and Ketamine could also be used to simulate slightly different sorts of schizophrenia. My argument is that we should be able to test all three of them and see which is the best, and maybe utilise them. But that is very difficult to do with the current legislation.

TP: What kind of legal obstacles prevent the serious study of illegal drugs?

The legal obstacles are that you need to have a license. In real terms this costs about £6,000 – £3000 for the license itself plus various extra costs such as CRB checks. Very few places in the country can actually afford that license. In addition, it takes a year to process, so that is also a setback. All the drug suppliers also need the same license, so everything is massively more difficult. This means that almost no one does the research, because it’s almost impossible. It has taken us two years to get to our present stage, and we still haven’t started the trials of psilocybin for depression, even through we had the drug two years ago. We couldn’t begin the research because of all the extra rules in terms of clinical trials. These are measures for governments to pretend that they are doing something, when all they’re doing is preventing research.

Such restrictions are even more harshly enforced in the USA. In the fifty years since LSD has been banned, there hasn’t been a study in it. The authorities say that they’re not stopping scientists from studying it but they just make it impossible to study. About 20 years ago, for example, Rick Strassman got through the US regulations to study DMT because he thought it might be an endogenous cause of schizophrenia. He studied it with about six people, but that cost him £100,000 in order to source it from the Amazon Rainforest, and he just couldn’t afford to continue the trial because every single stage in his supply chain had to have these official licenses. These take years to get, so the whole project was stymied by regulation.

TP: Do you see DMT as a particularly exciting avenue of research?

I’d love to study DMT, but I haven’t got any funding for it yet. Getting funding for this kind of research is almost impossible. The standard funders don’t want to be involved; they’re scared of being seen as somehow complicit in breaking the law. This idea that these substances are illegal pervades science and people think you shouldn’t study them. MPs say “why is Professor Nutt allowed to study an illegal drug?” People think just because they’re illegal you shouldn’t study them. So I don’t know how I would get funding to study the effect of DMT on the brain – certainly not from the standard research funders.

In addition, it’s hard to study DMT because it’s very short-acting, and there are all sorts of complications around what it is, what’s in the mixture etc. But it certainly should be studied – it’s a really interesting molecule.

We recently published our paper of the first human trial of LSD in fifty years. It came out last November in Psychopharmocology – it was a pilot study showing the effects of LSD on creativity.  Now we’re analysing the main brain-imaging studies, which are going to take a few more months – it’s a massive data set. We hope it should be a total landmark paper – the first ever brain-imaging study of LSD in the world.

 

Image credit: Aurelio Asiain

 

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