Drug laws should be grounded in factual information

A respected scientist set out to determine which drugs are actually the most dangerous — and discovered that the answers are, well, awkward…

By Mark Pothier | December 13, 2009

Overall, alcohol is far worse than many illegal drugs. So is tobacco. Smoking pot is less harmful than drinking, and LSD is less damaging yet.

(Source)  In the long and tortured debate over drug policy, one of the strangest episodes has been playing out this fall in the United Kingdom, where the country’s top drug adviser was recently fired for publicly criticizing his own government’s drug laws.

The adviser, Dr. David Nutt, said in a lecture that alcohol is more hazardous than many outlawed substances, and that the United Kingdom might be making a mistake in throwing marijuana smokers in jail. His comments were published in a press release in October, and the next day he was dismissed. The buzz over his sacking has yet to subside: Nutt has become the talk of pubs and Parliament, as well as the subject of tabloid headlines like: “Drug advisor on wacky baccy?”

But behind Nutt’s words lay something perhaps more surprising, and harder to grapple with. His comments weren’t the idle musings of a reality-insulated professor in a policy job. They were based on a list – a scientifically compiled ranking of drugs, assembled by specialists in chemistry, health, and enforcement, published in a prestigious medical journal two years earlier.

The list, printed as a chart with the unassuming title “Mean Harm Scores for 20 Substances,” ranked a set of common drugs, both legal and illegal, in order of their harmfulness – how addictive they were, how physically damaging, and how much they threatened society. Many drug specialists now consider it one of the most objective sources available on the actual harmfulness of different substances.

That ranking showed, with numbers, what Nutt was fired for saying out loud: Overall, alcohol is far worse than many illegal drugs. So is tobacco. Smoking pot is less harmful than drinking, and LSD is less damaging yet.

Nutt says he didn’t see himself as promoting drug use or trying to subvert the government. He was pressing the point that a government policy, especially a health-related one like a drug law, should be grounded in factual information. In doing so, he found himself caught in a crossfire that cost him the advisory post he had held for a decade.

The same issue is becoming a hot one in America – this fall the Obama administration took a baby step toward easing federal scrutiny of medical marijuana use, and a policy report due early next year is expected to emphasize addiction prevention and treatment over criminal enforcement. Opponents are already attacking the administration for its laxity, but Thomas McLellan, a newly installed White House drug official, has begun loudly pushing for policy that incorporates more science.

“We must increase the use of evidence-based tools at our disposal,” McLellan said in an interview last week.

But as Nutt’s case illustrates, that is tough to do. The more data we accumulate about drug harmfulness, the more it seems like the classification systems used by the United States, the United Kingdom, and other governments need to be dismantled – and the more it becomes clear that societies can’t, or won’t, take that step. Drug laws are rooted in history and politics as much as science. Our own culture embraces one intoxicant – alcohol – that Nutt’s ranking deemed far more dangerous than 15 other harmful substances. And even if it were possible to divorce drug politics from drug-use facts, some policy specialists say, letting science call the shots would be a bad idea.

Intoxication has been part of human culture since before recorded history. So have its consequences. A drug can cause all sorts of harms, some devastating, some minor: It can ravage the body of an addict, or simply make a user late for a meeting with the boss. Drugs can impoverish families, trigger deadly violence, cause cancer. In modern society, drugs drive crime and increase health costs for everyone.

To Nutt, a professor of neuropsychopharmacology at London’s Imperial College who chaired the government’s Advisory Council on the Misuse of Drugs, it made sense that laws and policies should take into account the harmfulness of the drugs themselves. But when he considered ways to improve the system, he discovered a problem.

“It became clear that [the government] didn’t have any systematic, transparent way of assessing drugs at all,” he said. “If you say drug laws are based on reducing harm, you have to actually know what kind of harm they cause.”

So about a decade ago, he and some colleagues set about to gauge the dangers of 20 substances as objectively as possible. This would not be a measurement with calipers and a scale – drug risks are inevitably subjective, depending on factors like an individual user’s tolerance, the amount used, and the duration of use. But Nutt also knew he could create better data than anything the government was currently employing.

He and his colleagues assembled a range of independent experts and asked them to score each drug in three categories – its physical effects on the user, the likelihood of addiction, and its impact on society. The group included addiction specialists registered with the Royal College of Psychiatrists, as well as people with expertise in chemistry, forensic science, and police work.

They gave the specialists a detailed list of parameters to consider. In assessing the addictiveness of, say, cocaine, they would separately rate its pleasure, psychological dependence, and physical dependence, and the ratings would be combined to create an overall risk factor. After a series of meetings and discussions, the rankings were determined by averaging scores across all the categories. The result was a paper published in the public-health journal The Lancet in March 2007.

Number one on the experts’ list was an easy call: heroin. It’s extremely addictive and, by any measure, destructive to the user and the society around him. Cocaine came in second, followed by barbiturates and street methadone.

Then the list got interesting. Alcohol, which has always been legal in England and was only briefly outlawed in the United States, took the fifth position, above tobacco (9), marijuana (11), LSD (14), and ecstasy (18). The least harmful drug in all respects was khat, a stimulant derived from the leaves of an African shrub.

Included in the Lancet paper was the authors’ recommendation that the government should reclassify drugs to reflect the harms they cause. “We saw no clear distinction between socially acceptable and illicit substances,” they wrote, suggesting “a more rational debate” on drug policy, based on “scientific evidence.”

The ranking – nicknamed the “drug league table,” after the British term for sports standings – lay quietly, more or less ignored by the public and politicians, until King’s College issued a press release in October based on a lecture Nutt had given in July. Nutt thought he was making much the same point he made in the medical journal two years earlier: If we looked at harm objectively, we would engineer a drastically different set of drug policies than the ones we now use.

He was swiftly booted from his government position. Home Secretary Alan Johnson said Nutt had crossed a line. He “cannot be both a government adviser and a campaigner against government policy,” Johnson told The Guardian newspaper.

“It was a funny, kind of petulant reaction,” Nutt told the Globe, “all about machismo and politics. We’re harder on drugs than you, we’re tougher.”

Suddenly, Nutt was everywhere – the papers, the BBC, YouTube, a Facebook page started by his backers. Critics accused him of sending England’s youth a mixed message about drug use. Supporters charged the government with stripping the professor of his right to speak freely.

Amid the charges and countercharges, others wondered whether, beneath all the controversy, the government shouldn’t just start paying more attention to that list.

If Nutt’s list is accurate – if we really do know which drugs are really bad and which are relatively benign – the next step is figuring out how to make use of that information.

It might seem obvious that the most harmful drugs should receive the most attention from the government, with beefed-up prevention and treatment programs, and tougher punishments for producers and distributors. And to conserve their limited resources, it might make sense for drug officials to stop worrying about the least harmful substances, even decriminalizing or legalizing them.

But real-world drug policy is not like that. To a certain extent, say analysts,

legal drugs are acceptable and illegal ones are dangerous because, well, because they’re already illegal.

“There’s a crazy kind of logic that argues, about some currently illegal drug, ‘Look how dangerous it is! You couldn’t possibly legalize a drug as dangerous as that!’ ” said Mark A.R. Kleiman, a professor of public policy at UCLA. The fact that a drug is against the law makes people overestimate its risks, he said, while legal status causes them to underestimate dangers.

Politicians tend to follow that same line of thinking, leaving socially acceptable legal drugs alone, while making easy prey of would-be liberalizers. In the United States, for instance, it would be politically insane to call for the legalization of the least harmful drugs on Nutt’s list – khat, GHB, and steroids – while campaigning to outlaw tobacco.

One indisputable fact that emerged from Nutt’s study is this:

We have assigned a high social value to booze. Alcohol causes many of the harms associated with “harder” drugs – lots of people die or become deeply dysfunctional because of drinking – yet it has been entrenched in society for so long that scientific evidence of its hazards relative to other intoxicants doesn’t get much of a public hearing.

Kleiman and other experts – including Nutt – are not suggesting that either Britain or the United States should ban alcohol. America tried that once, and even during Prohibition, people didn’t stop drinking – they simply built a system of illegal manufacturing and distribution big enough to satisfy their thirst. Instead, Kleiman believes a good strategy on alcohol should include increased taxes to discourage drinking – young people and heavy drinkers are price-sensitive – and an outright ban on sales to people who have been convicted of drunken driving or other alcohol-fueled crimes.

Of course, that would require new laws, and more political wrangling. How many convictions? How long of a ban? If the science is complicated, the politics would be more so. The fight would last more than a few rounds.

Nutt, for one, seems ready to go the distance. “The majority of people in [Britain] are more damaged by alcohol than any other drug,” he said. “Let’s get the scaling of harm right.”

For drugs that are currently illegal, he said, that means having prevention efforts and laws that are proportionate to their dangers. For instance, British law allows up to five years imprisonment for marijuana possession, a penalty Nutt called “infantile and embarrassing.” McLellan, the White House drug adviser, echoed him, saying jailing pot smokers “is idiocy, a really bad use of resources.”

But drug law will never be as simple as making a list, and even experts say it shouldn’t be. At a certain point, scientists should excuse themselves from the discourse, Kleiman said. Intoxicants are part of our culture in ways that a list can’t sort out for us.

“Science gives you facts about the world,” he said, “and you have to assign values to those facts. It doesn’t tell you what’s worth having and what’s not worth having.”

Mark Pothier is the Globe’s senior assistant business editor. He can be reached at mpothier@globe.com


Lies About Marijuana Drive People to a Much More Harmful Drug — Booze

By Steve Fox, AlterNet – Monday, November 9 2009

Anti-pot propaganda drives most people to drink alcohol instead. But booze is far more dangerous than marijuana.

He made a big mistake at the end of last month. In a lecture at King’s College in London, he spoke honestly – and truthfully – about the fact that cannabis is less harmful than alcohol and urged the government to factor the relative harms of substances into their policy-making.  Moreover, he accused the British government of ignoring the evidence about the true harms of cannabis in order to reclassify the drug and increase penalties for possession.Professor David Nutt didn’t play the game. As the chief drug policy advisor in the British Government, an unspoken part of his job description was to help maintain a public fiction about marijuana – or cannabis, as it is known in the U.K. and other parts of the world.  Specifically, he was expected to further the misperception of cannabis as a substance worthy of being classified and prohibited in a manner similar to more dangerous drugs like heroin and cocaine.

Reacting with the logic and reason of pub patron after last call, Home Secretary Alan Johnson immediately demanded that Prof. Nutt resign as the head of the Advisory Council on the Misuse of Drugs. He said Prof Nutt had “crossed the line between offering advice and … campaigning against the government on political decisions.”

More accurately, Prof. Nutt crossed the line between deceiving citizens and being honest with them.  The home secretary, a former member of Parliament, is no doubt comfortable with a little verbal jousting over public policy decisions. What he could not abide by was a top ranking official threatening the anti-cannabis mythology embraced at the very top level of government. Based on Nutt’s fateful bout of truthfulness, Johnson said he had “lost confidence” in Nutt as an advisor.

In a letter to Professor Nutt, Mr. Johnson explained how the system is supposed to work. He said: “As Home Secretary it is for me to make decisions, having received advice from the [Council] … It is important that the Government’s messages on drugs are clear and as an adviser you do nothing to undermine the public understanding of them … I am afraid the manner in which you have acted runs contrary to your responsibilities.”

The Home Secretary’s chief medical officer Sir Liam Donaldson put a similar spin on this hostile reaction to fact-based statements to the public.  “These things are best sorted out behind the scenes,” he said, “so that the government and their advisers can go to the public with a united front.”

In the real world, what this means is that advisors are free to provide research or reports based on an honest assessment of the scientific evidence, but when this research is completely ignored in setting policy, they are expected to keep their mouths shut and move on as if nothing ever happened.

This is all part of the game the government plays in order to maintain marijuana prohibition.  In the United States, there are many examples of significant advisory opinions related to marijuana being completely ignored – even where the opinions were part of a decision-making process that should have led to action by the federal government.

In 1970, Congress established the National Commission on Marijuana and Drug Abuse to study marijuana and make recommendations about how to control its use.  The Commission’s final report suggested removal of criminal penalties, noting, “The actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior.”  President Nixon ignored the Commission’s findings and launched and all-out war on marijuana users.

In 1988, Francis Young, an administrative law judge at the Drug Enforcement Administration (DEA), following hearings to determine whether marijuana should be placed into a less restrictive category under the Controlled Substances Act, wrote that marijuana should be moved from Schedule I (the most restrictive category) to Schedule II and it would be “unreasonable, arbitrary and capricious” to conclude otherwise.  More than 20 years later, marijuana remains a Schedule I drug.

A recently as February 2007, an administrative law judge at the DEA issued an opinion concluding that it would be in the public interest for the agency to grant a license to the University of Massachusetts to grow a limited amount of marijuana to be used to study its potential therapeutic benefits.  Faced with this seemingly rational opinion, the political powers at the DEA sat on it for nearly two years and then rejected it by formally denying the University the license in the very last days of the Bush administration.

Of course, ignoring fact- and evidence-based advice about marijuana is just one part of the game our government has played over the past four decades.  It has also gone out of its way to promote and spread myths about the drug – from the “gateway” theory to marijuana’s supposed connection to cancer to the notion that “potent pot” is somehow more dangerous than “your father’s marijuana.” Each one has been debunked or proven wrong or misleading, but there is no doubt that they have helped keep marijuana illegal.

Yet there is one myth more insidious than the rest.  And it is one that is as devastating as it is subtle.

You see, whether intentional or not, the government’s greatest achievement when it comes to keeping marijuana illegal has been its ability to convince a majority of Americans that marijuana is as harmful as, if not more harmful than, alcohol.  By doing so, it has secured alcohol’s place as the recreational substance of choice for the vast majority of the public.

Influenced by the government’s anti-marijuana propaganda, a large segment of our population is comfortable with a system that bans the use of marijuana but allows – and even celebrates – the use of alcohol, despite the fact that alcohol is objectively far more harmful.

Let’s consider just a few facts about the two substances.  For starters, alcohol is far more toxic than marijuana.  Just ten times the effective dose of alcohol can be fatal.  Yet there has never been a recorded marijuana overdose death in history.  The highly toxic nature of alcohol is also what leads to the all-too-frequent occurrences of nausea and vomiting from over-indulgence.

Over the long-term, alcohol consumption is also far more likely to lead to the death of the user.  According to the U.S. Centers for Disease Control, between 33,000 and 35,000 Americans die annually from the effects of alcohol.  The comparable number for marijuana?  Zero.  The supposed cancer-causing properties of marijuana?  Non-existent.

Perhaps most disturbingly, as almost anyone who has been exposed to the two substances could tell you, alcohol is far more likely to produce dangerous and socially destructive behavior.  It is cited as a contributing factor in 25-30 percent of violent crimes in this country and in about 100,000 sexual assaults on college campuses annually.  These kinds of negative associations simply don’t exist with marijuana.

As mentioned at the beginning, facts like this were quite familiar to Professor Nutt.  Even after his firing, he endeavored to spread the truth about the relative harms of marijuana and alcohol and urged parents to be especially wary of the one that posed the greatest potential for damage.

“The greatest concern to parents,” he said, “should be that their children do not get completely off their heads with alcohol because it can kill them … and it leads them to do things which are very dangerous, such as to kill themselves or others in cars, get into fights, get raped, and engage in other activities which they regret subsequently. My view is that, if you want to reduce the harm to society from drugs, alcohol is the drug to target at present.”

Our nation’s leaders might think this is a game, but it isn’t.  There are children and adults seriously suffering and even dying because of alcohol, and it is time our leaders started being honest and realistic about how it compares to marijuana – both in terms of public education and public policies.  Neither propaganda nor policy should be used to steer adults – or teens, for that matter – toward alcohol instead of marijuana.  This does not mean that marijuana is harmless; it simply means, and all of the evidence indicates, that it is less harmful than alcohol.

And no one should be fired for saying that.

See Also “Smoking Pot is Safer than drinking Alcohol… Period.