Yesterday’s launch

November 2, 2010

Yesterday, we launched the Independent Scientific Committee on Drugs’ first piece of research – Drug harms in the UK: a multi-criteria decision analysis – at a summit held in association with the Lancet, Drug science and drug policy: Building a consensus.

The event was held under Chatham House Rule to enable participants to speak their minds freely, however, we will be publishing outputs from the event as soon as possible. In the meantime, the full paper is available to read for free on the Lancet website. I welcome your feedback.

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32 Responses to “Yesterday’s launch”

  1. Addy Says:

    I was very interested to hear about your report on alcohol being more harmful than heroin. My story (outlined in my blog) is if anything more grist to your mill.

  2. Alex Young Says:

    I found the paper enlightening and informative. However, I’m not sure if the overall scoring method is the best way to do things. For societal rules, shouldn’t only the social harms be considered? It is the individual user’s responsibility if he wants to take the risk of using metamfetamine, for example, whereas we all have to deal with the costs of alcohol use. Is the social economic cost not incredibly contingent on what degree of socialised healthcare we have? In a country without socialised healthcare, would the societal costs go down and the individual harms go up?

    I’m also curious as to how much you believe these scores would change if drugs were legalised, regulated and taxed. For example, would the economic cost score for cannabis significantly reduce once we stopped arresting and locking people up for it?

  3. Adam Says:

    I have some serious issues with the paper and the conclusions that have been presented.

    I think there’s a confused message about what this study is actually for. Is it to reclassify drugs based on their dangers? If so, as so many have pointed out, it’s not appropriate to use alcohol’s prevalence against it. Most comments have dismissed the whole study because many of your harms don’t account for the rate of use. If the point is to find which drugs are society’s biggest issues – correctly pointing the finger at alcohol – many of the medical points shouldn’t be included and the whole thing would be better expressed simply in terms of pounds lost.

    Three limitations that you point out at the end of the paper are also particularly important:
    1) Benefits (a counterstudy?): economic, pleasure/fun, new experiences, medical uses, stimulants…
    2) Many of the harms listed are caused by prohibition. That makes classifying drugs based on your rankings even less appropriate as stronger prohibition would only make them worse.
    3) Different levels of use. One study should perhaps rank both low doses of each drug (e.g. 2 units of alcohol) and larger, problematic use.

    There are a lot of interesting data, which should be able to show that the current classifications are a joke. And I know that comparing harms and benefits is a nightmare. But I have to say that I’m sympathetic of those who dismiss this paper. You’ve succeeded in generating ‘alcohol worse than heroin’ headlines but a complete rethink is needed. Is this advice on which drugs individuals should most avoid or advice on which problems the Govt needs to prioritise? Combining the two is deeply confusing and results in having all the results ignored.

  4. Adam Says:

    Also, it would be great if you could publish the weighted (or unweighted) scores – essentially the data used in Figure 4. A good thing about the 2007 paper was the ability to look at all the scores and compare them as one likes.

  5. James Conroy Says:

    Again great stuff from the professor. I do though agree with Adam, there should be more study dedicated to the possible benefits of each, and maybe that taken into account when producing a score.

    One thing I do not understand though is how cannabis has been given a score of twenty, seven points of that coming from ‘harm’ to society, thirteen coming from harm to the individual. This is a drug that has never killed anybody and is not toxic especially when vapourised, yet a drug that does kill (MDMA for example) has been a score of less than ten overall.

    Could you please explain why this is so?

  6. Ross Says:

    I have only read the Guardian Newspaper report, I have not registered with the Lancet to get the whole report, free or not, so I may have miss-understood. The Guardian report indicates that Cannabis gets a score of 20 which puts it into class B. I thought that David had resigned over the Labour government’s decision to move it from class C back to B?
    Are the classes in this report newly defined and so different from the current ones or does the report find that cannabis is correctly classified as being in the current class B?

  7. Andrew Says:

    I have just learned of you from this article. But in reading your previous blog post about marijuana I have some concerns. For one you complain about people not understanding how alcohol is more destructive than marijuana but who are you complaining to. In one day the whole world is privy to your new drug study and it is on every news channel. You are the person with the power to change misguided information on drugs. Im tired of hearing misinformation about marijuana from my classroom and my politicians. It’s up to you to inform the people. Ive been trying but the total number of people that listen to me are well below a hundred, you can reach millions in a single day. I think that some of the problems you’re having are the results of the research itself.
    Now for one there is not much detail in the data listed about how you got the results for your findings. Please look at Adam’s post for the three limitations. To further that and to be specific how can marijuana, tobacco, and cocaine all have about the same score for “harm to others”? Now if I sit there and analyze everything from the report I think the similar scores are because of the “social” aspect. But come on, marijuana is more harmful to others than cocaine? Only in your research paper. The only way I can think to how you came up with that was that from 2000- 2007 in the US about 40% of of drug arrests were from marijuana possession. From that you can score low in your crime, family adversities, international damage, community, and economic cost catagories. But if that is the case then your weighting is flat out wrong. Is it more that marijuana is causing harm to others, or is the Government the one doing the harming. Lets say tomorrow the Government made cheese illegal, would all of a sudden cheese start harming people. Cause according to your study it would.( And it would probably score high too, due to cholesterol and how many people eat cheese and would presumably get arrested for it) Is the marijuana itself harming other people, not really. Are drug laws hurting other people more than the drug itself. Yes. But there is no telling the difference in your research, everything is mashed all together. Example: Is there a difference regarding a drugs harm in a country that has strict drug laws and one that doesn’t? Wouldn’t not including this be detrimental to the accuracy of your results. What if it was found that a drug like marijuana when legal actually has a positive affect on others due to jobs created, tax money, and money saved from not policing it. Your study would worthless because it doesn’t actually tell a person how harmful a specific drug is, only which drugs are illegal in most places and getting the most arrests.
    Ill help save you money though by exploring marijuana as legal and see if your study changes, lets go through it. Marijuana- does not cause violence, making it legal would erase crime since it would be legal, the environmental impact would probably lesson if legit farms actually grew it. If it was legal fewer families would be torn apart by drug arrests, and if it was legal that would mean it was socially acceptable in our communities. The economy would make huge gains with legalization, thanks to taxes, jobs, and law enforcement saving money.
    So there it is for everyone, if cannabis was legal it would be even lower on the list and have very few if any harmful affects on other people.
    So simply to to sum up my point and this is just one example, but your data doesn’t do a good job telling the REAL story of a drug’s harm. It’s too clouded with variables that have more to do with how hard government or society is on a certain drug, and less with a drugs actual effects.

    • Chris Says:

      Andrew – marijuana turns some people into psychos, mutilates their brain & personality, and destroys the life of everyone around them for the rest of their time alive. And that’s just one of it’s many undesirable dangers. This is a drug that needs fewer people using it. Congratulations to everyone working to keep it’s destructive effects away from society.

      • cannabisforautism Says:

        What about the people who are psychos when they do not take any drug at all, do not respond well to any legal medicine, but are ‘perfectly sane and normal’ when using cannabis?

        Everybody is different.

      • James Conroy Says:

        Chris – Marijuana does not turn anybody into a psycho. The research that suggests this does not take into account the fact that whilst marijuana use has gone up dramatically in the last 30 years, the reported incidents of psychosis hasn’t increased at all in real terms. It’s mis-informed people like you who are making civil liberty in this country so hard to achieve. If the millions of people that go drinking at weekends smoked marijuana instead the country would be a better place to live in. Vastly reduced violence, massive saving from not treating all the health issues related with alcohol and massive savings in police resources from not arresting (and criminalising) non-violent marijuana users.

      • hannah Says:

        Marijuana may bring on the effects of schizophrenia in some (although this is not many and in any case is not a proven link). However alcohol kills, is more addictive than most other drugs and can make ordinarily pleasant people aggressive, violent, destructive and stupid. Your views are limited and ignorant.

      • jimb0b Says:

        Ughh im no scientist but Chris’ interpretation of cannabis use causing problems seems to be false and uninformed.

        My opinion is this…,

        When will people realise that this “drug” is safe. Cannabis quite simply…..

        ***ONLY ENHANCES WHAT YOU FEEL.***

        If you have any underlying problem with mental health … heavy cannabis use WILL OUT THE PROBLEM, NOT CAUSE IT.
        If you have problems with laziness.., you’ll become increasingly lazy etc etc etc.

        After years of use ( and yes sometimes abuse ) This is the conclusion i have come to. It may be worth nothing but its a conclusion based on a LOT of experience and lifestyle.

        Since i have controlled my usage to responsible levels i can contest to this wholeheartedly.

        Problems with psychosis seem to be a result of mixing cannabis with tobacco as a recent study showed that heavy nicotine use can bring on psychosis. Hell AFAIK even heavy coffee intake has problems with psychosis!!! I honestly also believe that the psychosis and paranoia that arises in some people could be a result of prohibition. There’s a funny pic flying around the net with the stat of something like ” every 3 seconds a cannabis user is busted… and you wonder why we are paranoid?”
        This sums it up perfectly for me.

        Although as i said im no scientist, i base this on lots of various studies and my own personal “anecdotal” evidence along with knowing MANY other cannabis users some who have had problems and lots who don’t have any issues at all.

        BTW the link to schizophrenia is tenuous at best as the figures clearly show no increase in schizophrenia when put alongside the stats showing the rise of cannabis use.

        Im open to discussion on this theory as ive been proved wrong before and no doubt will be again.

      • Chris Says:

        I’m describing the destruction to my own family from of what this drug did to one of us.

        This is an undisputed medical fact – extremely well studied, documented, and proven.

        Vent your anger elsewhere – lying about the effect of cannabis is going to put the gullible curious at serious risk.

        If you have to lie to support your case – I suggest you take a closer look at your *real* motivation for doing that.

      • jimb0b Says:

        Your suggesting that i am lying?
        Everyone has a horror story about cannabis they instantly blame something that’s relatively safe instead of looking at their own short comings, transference i believe its called in psychological terms.

        If you think my experience is a lie then fair enough you have the right to say that no matter how wrong i think you may be.

        Id suggest cannabis didn’t do anything to your family, the problem was already there and cannabis outed the problem that would’ve come sooner or later anyway.

      • James Conroy Says:

        Chris said “This is an undisputed medical fact – extremely well studied, documented, and proven.”

        Really??????????

        Where is this study?

        Where are all the articles talking about this ‘proven’ link?

        Chris you obviously know nothing about this subject.

        I agree with jimbob, if you had some problems in your family, try looking a little closer to home as to why it happened instead of blaming a substance that they happened to be taking.

  8. Mari Lewis Says:

    While it would be useful to see more research on poly drug use, as that is a serious issue within the field of substance-related harms, I really applaud Professor Nutt’s level-headed and thought-provoking classification system. Thank you for you tenacity and commitment to addressing the issue of substance misuse as it actually is over multiple domains, rather than its 1-dimensional and short-sighted media depiction.

  9. cerebus Says:

    Hi David, this might not be the place to mention it but your new blog has no RSS feed. It would be great if you could add one!

    Also: http://www.owen.org/wp-content/uploads/after-peer-review.jpg

  10. Stan Says:

    Please keep up the good work, Professor Nutt.

    Could you also include other seemingly harmful edible substances like sugar and refined carbs as discussed in Gary Taubes’ book “The Diet Delusion” (USA Title: “Good Calories, Bad Calories”) in your future research?

    For most people, sugary soda and cookies would be more relevant than riding horses, so if you do risk comparisons, it would be more beneficial if such comparisons were included. People like Robert Lustig says sugar is poison and should be treated like heroin:

    Sugar: The Bitter Truth

    I’m looking forward to your future research on “any substance we put in our mouth that impacts our health”, including drugs.

  11. Chris Says:

    I wish you could add “petrol sniffing” to your study.

  12. zindicaf1 Says:

    what we want to see is a prohibition model vs a regulation model from the same enviroment . for some reason i cant view the paper from this computer ,but i guess its based on government information gatherd from the current prohibition model, as some of the substances as we know are more harmfull because of laxed or no proper regulation , fact based education age restrictions and improvement of product purity ,not to mention been controlled by criminal gangs , but all in all it is sparking overdue public debate, if alcohol was controlled by criminals it would be even worse , dispite funded media reports

  13. Simon Bailey Says:

    I don’t think we should be criticising the weightings, and therefore the outcome of this study. As a cannabis user I was saddened to see it score so high(i’m sure theres a pun there somewhere), but as a believer in science, I am willing to accept it. It doesn’t really matter what the outcome is as long as it’s scientidic fact. I am sure that this study is just the second of many in this field and I am sure that using these methods, more studies will be conducted that look at other aspects.

    I for one would welcome studies that lookaed at the positives of using drugs. Also a study investigating the fully legal situation would be interesting too.

    As far as anecdotal evidence, whatever is being argued acan be countered by an anecdote that is delivered with passion and belief. It isn’t very scientific though. for all the stories i have read about peoples lives being ruined through drug use, I have heard the same number or more stories of how drug use has enriched peoples lives( I’m not talking about selling drugs here).

    Personally, I hold the view that all substances should be made legally available, subject to individual levels of control. It’s not everybody’s favourite view, but let’s face it, prohibition isn’t really working here.


  14. Once again Government ‘policy’ positions (too frequently based on a biased values judgement unsupported by evidence) is shown to have been wrong by independent and well grounded research. Alas Prof. Nutt you’ve paid a price for daring speak the truth – I do hope you get an apology in the mail from Alan Johnson.

    I’ve experienced a number of the sides of the coin and have up close and personal evidence of alcohol’s bitter pill in social and personal settings. There’s one other anecdotal piece of evidence regarding marijuana usage – I never saw a single marijuana user assault another person – unlike alcohol users.

    I wonder what the sports bodies are thinking regarding their close alignment to alcohol sponsorship – or if indeed they are thinking at all

  15. Matthew Roberts Says:

    I whole-heartedly support the spirit of the report, but it leaves me deeply frustrated. The shock-horror headlines were that alcohol was found to be ‘more harmful’ than heroin. But the real shock is that heroin remains listed as one of the most harmful drugs. Surely this is nonsense. Surely all of the medical evidence is that heroin in itself is essentially harmless.

    If the point of the exercise was (as I believe it was) to illustrate which drugs should be regulated, and how strictly, it appears to have failed miserably. An uninformed reader would conclude that heroin is quite rightly outlawed. But the truth is that heroin should be made available and taxed in a similar way that alcohol & tobacco currently are. In that case the vast majority of the ‘harm’ associated with it would go away.

    Hasn’t your report just confused the issue?

  16. jw Says:

    i think what the paper highlights is the need for the truth ,so drugs cannot be used as an excuse for other problems ,thus keeping them in the hands of the problem areas, criminal control and child access , its an open secrete that if you claim to be a cannabis addict you can get off lightly from more sinister crimes ,only the removal of prohibition and the implementation of a regulated system where full control is in the hands of the goody’s will do the things prohibition claims it will do , i find it funny when people claim their family was ruined by cannabis without questioning the policy that created the black market that has no rules nor age limit that suppress fact based information and encourages folk to blame it while failing to keep it from the hands of their fast growing teenage kids , hats of to the professor for highlighting the importance of science based regulation and science advised policy making ………………..

    step back and look at what prohibition does compared to what is claimed it will do and who’s making them claims and what are them claims based on!

  17. jw Says:

    and one more thing ,i think alen johnson ,jaque smith and gordon brown should apoligise to the professor then whole of the uk

    • coker Says:

      Hi JW,

      Your posting has prompted me to post my response to the reply I recently received from the Home Office.

      My query to them was:-

      Dear Sir or Madam,

      Could you please explain to me whether I can obtain a UK or European doctors prescription for any of the wide varieties of cannabis for the treatment my illness/medical condition, or for any other purpose and the current legal position regarding this?

      To which the Home Office replied:-

      ————————————————-
      Dear Mr Coker,

      Thank you for your e-mail of 21/10/2010 enquiring about the importation and possession of herbal cannabis in the UK prescribed abroad, specifically Holland. I am sorry for the delay in replying.

      I understand that you are referring to the issue that has arisen in the context of the UK’s obligations under Article 75 of the Schengen Agreement which took effect in 2005. This provision allows for the free movement of travellers within the Schengen member states with their prescribed narcotic and psychotropic substances that are necessary for their medical treatment provided they have a certificate – “a Schengen certificate” – issued or authenticated by a competent authority of their state of residence.

      Pursuant to Article 75, the UK recognises that a patient who is resident in another member state can travel to the UK with their narcotic and psychotropic medication, provided that they are resident in a country where that drug is legally prescribed; it has been prescribed by their doctor; it is for necessary medical treatment for a maximum of 30 days and is for personal use only; and they have the appropriate certification from their relevant health authority. Of course, this is a reciprocal arrangement enabling UK residents to travel with their personal medication. The Department of Health is the UK’s competent authority.

      In respect of herbal cannabis I understand that health authorities in The Netherlands and Belgium allow herbal cannabis products to be prescribed by doctors and dispensed to patients for a number of indications. In the limited circumstances described above, a Dutch or Belgian resident will be allowed to travel to the UK with herbal cannabis products prescribed in these countries.

      However, a UK resident cannot rely on the Schengen Agreement to bring prescribed herbal cannabis into the UK from The Netherlands or Belgium. This activity would be in breach of UK law, amounting to the unlawful importation and possession of a controlled drug, and the UK resident would be liable to arrest and prosecution under the Misuse of Drugs Act 1971. The Government is committed to maintaining UK drugs laws and is seeking assurance from European authorities that checks in this system, including the checks that member states make before issuing a Schengen certificate to an applicant, are as robust as possible.

      In the UK, cannabis is controlled as a Class B drug under the Misuse of Drugs Act 1971 and is listed in Schedule 1 to The Misuse of Drugs Regulations 2001 as the UK does not recognise that it has a medicinal use. The Government recognises that there are people with chronic pain and debilitating illnesses who are looking to alleviate their symptoms and who may not find adequate relief from existing medication. For them, the UK does recognise the medicinal value of a cannabis-based medicine ‘Sativex’, which based on an assessment of its safety and efficacy by the UK regulatory authorities, the Medicines and Healthcare products Regulatory Agency, has recently been granted a Marketing Authorisation.

      However, the Government has no intention of altering our position on cannabis in its raw form. Cannabis is a drug that has a number of acute and chronic health effects and prolonged use can induce dependence. Most cannabis is smoked and smoking, in any form, is dangerous. Even the occasional use of the drug can pose significant dangers for people with mental health problems, such as schizophrenia, and particular efforts need to be made to encourage abstinence in such individuals.

      Yours sincerely,

      Matt Donovan

      Drug Strategy Unit
      ————————————————

      My response to this, which I earlier sent to the Home Office via email, is as follows:-

      ————————————————
      Thank you for your reply:
      Reference : My Inquiry?

      I wish to draw to your immediate attention the following information at:-

      http://www.421flavors.com/468/cannabis-oil-succesfully-used-to-cure-skin-cancer-video/

      Where, it is claimed, along with some supporting documetary/video evidence,
      as follows:-

      ‘Here’s a fully documented case of cannabis curing skin cancer.
      What’s sickening about this is that it has been known for years.’

      Are these claims, in any way true or false?

      Yours sincerely,

      coker
      ———————————————-

      I was wondering, particularly in light of your post, if the people to whom you refer would actually be able to give any more concise or more helpful or truthful answers than the Home Office has, or capable of giving any really worthwhile apology to Prof. Nutt?

  18. Bob Says:

    Hello Professor Nutt.

    Firsly many thanks for your efforts in rationalising the UK’s disproportionate and absurd drug laws. Its a shame Alan Johnson is so spineless.

    This is probably slightly off subject, but I’ve got a query about your harm ratings for Cannabis, firstly does your report assume its smoked? thus the extra harm factor? or does the report look at the harm ingesting cannabis does? Dutch GP’s seem to recommend Vapourising or ingesting it.

    This leads me to make next query, Sativex has recently been given Marketing Authorisation (A letter I’ve had from the Home office confirms this, although its a standard letter they have prepared for Schengen queries), as far I’m aware Sativex is effectively cannabis oil. The Home office suggest Herbal Cannabis provides NO medicinal benefit, surely if Sativex is just cannabis oil surely they have missed the point? And are contradicting themselves?

    Do you intend to assess Sativex in the same way as you’ve assessed cannabis as they are pretty much the same thing?

    • coker Says:

      My rather limited understanding [Please correct me if I am wrong?] is that ‘Sativex’, according to the claims of the manufacturers GW Pharmaceuticals in their promotional video, is a solution of cannabis-oil in alcohol/ethanol.

      The cannabis-oil is first obtained from the dried cannabis plant by means of solvent-extraction using alcohol/ethanol, this ethanol is then boiled-off/evaporated leaving a thick brown oil,,, to which alcohol/ethanol is then added to give ‘Sativex’, the finished ‘drug’ product.

      Is it this alcohol alone that the Home Office claims or implies gives Sativex it’s ‘medicinal’ properties?

      If it is, then why bother putting ‘medicinally’ useless [as claimed implied by the Home Office] cannabis oil, in ‘Sativex’ and possibly contaminating this medicine by this inclusion?

      How much does a bottle of this ‘Sativex’ alcohol solution cost?

      Why would GW Pharmaceuticals evaporate all of the solvent alcohol to produce cannabis-oil and then add alcohol to this oil,, there must be a reason for this, could anyone please explain?

      Is ‘Sativex’ similar or the same to the medicinal ‘fluid extract CANNABIS U.S.P.’ manufactured by ‘Parke-Davis & Co’ in the U.S.A; apparently dating from the year 1928?

      http://www.bonkersinstitute.org/medshow/pdcannabis.html

      Could anyone explain what ‘Tincture of Cannabis’ is or was – what is a ‘tincture’ …is ‘Sativex’ a ‘tincture of cannabis’?

  19. Michael Says:

    Greetings Professor Nutt

    First of all, thank you for your new study about the real dangers of recreational drugs. It’s interesting and sad at the same time that drug prohibition doesn’t use scientific facts.

    Since I’m from Switzerland, I’m wondering how you would classify the legal heroin/diacetylmorphine which is given to hardcore addicts in the swiss heroin programme? In my opinion, street heroin and medical grade diacetylmorphine just cannot be ranked the same, as the latter one is made for human consumption ande therefore sterile and of known dosage without the cuts and impurities street heroin has. What is your opinion about this?

    Regards
    Michael

  20. coker Says:

    Hi Professor Nutt,

    Thank you for allowing, perhaps even initiating this imperative and long-overdue ‘real’ debate.

    Personally, in all of the circumstances as I am aware, I think you should now obviously receive immediate reinstatement to your former position. I’m fairly sure I am not alone in this view.

    Might I suggest an appropriate title or heading for any follow-up to your very interesting paper on ‘Equasy’ might possibly be…

    ‘The Emperor’s New Clothes-Horse’

    with an abvious acknowledgment to Alan Johnson’s outstanding contribution in this particular field?

  21. Wheels5894 Says:

    the latest study into passive smoking was published today – at least for the general public – and suggests many deaths and illness are caused by second-hand tobacco smoke. Will this study affect the chart of harms?


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