The Lancet, Volume 374, Issue 9703, Pages 1731 - 1733, 21 November 2009
Government vs science over drug and alcohol policy
David Nutt
My statement in October1 that alcohol was more dangerous than many illegal drugs, including cannabis, ecstasy, and LSD, referred back to a paper I published in The Lancet 2 years ago.2 It would be an understatement, given the political, media, and academic interest, to say that I stirred up a hornets' nest in the UK Parliament and elsewhere. The Home Secretary, Alan Johnson, sacked me from my role as chair of the ACMD (the government's Advisory Council on the Misuse of Drugs, on which I had served with distinction for 10 years), and the Conservative shadow minister said it should have happened earlier this year when I published a paper comparing the harms of ecstasy and another addiction (which I had termed “equasy”—ie, horse riding).3
There are several important aspects of what has happened, which some are calling the Nutt-gate affair. The first is the overwhelming public support I received, with tens of thousands sending emails, signing up to protest websites, and a petition to the government to reinstate me. Many academic groups have come out in support and there is an online petition in the academic world. A protest march was held on Nov 7, organised by a group called “Students for sensible drugs policy”, whose name represents exactly what I am saying—drugs policy should be based on evidence and common sense, the two factors that should drive interventions to reduce drug-related harm.
There is one major benefit of my sacking in that it has given huge publicity to the issue of drugs and their harms, and this public debate is welcome. It now seems that most people accept alcohol is a drug, and that there is no apparent dissent from my statement that alcohol is one of the most harmful drugs in use today. Sadly the attempt4 earlier this year by the government's Chief Medical Officer to persuade government to act on this danger through the only intervention of proven efficacy—pricing—was summarily rejected in a similar fashion to the way the ACMD's recommendations on the classifications of cannabis and ecstasy were also dismissed by this government.5, 6
The scientific community has been almost totally behind me, although the issue of cannabis and schizophrenia has been resurrected7 by my assertions on the basis of the evidence accumulated by the ACMD that cannabis harms only a small percentage of users. I have repeatedly stated the drug is not safe, but that the idea that you can reduce use through raising the classification in the Misuse of Drugs Act from class C to class B—where it had previously been placed, but thus now increasing the maximum penalty for possession for personal use to 5 years in prison—is implausible. Use of cannabis clearly makes psychotic symptoms worse and stopping use is a major element in the treatment of such users. The drug probably does cause some cases of schizophrenia and other psychotic illnesses, but the ACMD estimate5 was that, to stop a single case of schizophrenia, we would have to stop 5000 young men (and more for women) ever using the drug, which does not seem a viable public health approach. The association between cannabis and schizophrenia is clearly complex and Frisher and colleagues, using the UK General Practice Research Database from 1996 to 2005, found that there was no increase in the number of cases of schizophrenia despite the big increase in self-reported cannabis use over the period before and during the analysis.8 Those who claimed that there was a link had suggested that there had been an increase in schizophrenia after greater cannabis use. However, more detailed investigation by Frisher and colleagues did not find any evidence to support this idea. Thus there is not even any increase in the incidence of schizophrenia to explain.
Clearly more work is necessary. We need to understand why so many people with schizophrenia take cannabis, and whether such use helps them in some way. We also need to know why so many smoke and drink. We also need to know if the absence of cannabidiol in skunk makes it more psychotomimetic.5 The demise of cannabis-receptor antagonists, such as rimonabant, removes a potential new approach to the treatment of cannabis abuse modelled on that of naltrexone for heroin addiction, and attempts to reinstigate such compounds for this indication would be warranted. The control of cannabis use through regulation rather than criminalisation has proved safe and effective in the Netherlands, and was indeed suggested in The Lancet as far back as 1963.9
The major downside of my dismissal has been the loss of confidence of the scientific community in the UK Government's acceptance of the scientific process. The idea that we are serfs to government ministers to be instantly discarded if we dare to challenge their political machinations with evidence is not one that will encourage others to engage in the advisory process. The ultimate paradox is that only in July this government10 published their paper, Putting science and engineering at the heart of government policy—clearly that is for only when the evidence suits their political aims
.
I have received funding from the UK's Medical Research Council for brain research into alcohol and opioids, and from the Beckley Foundation for research into cannabis and psilocybin.
References
1 Nutt D. Estimating drug harms: a risk busines. http://www.crimeandjustice.org.uk/opus1714/Estimating_drug_harms.pdf. (accessed Nov 6, 2009).
2 Nutt DJ, King LA, Saulsbury W, Blakemore C. Developing a rational scale for assessing the risks of drugs of potential misuse. Lancet 2007; 369: 1047-1053. Summary | Full Text | PDF(124KB) | CrossRef | PubMed
3 Nutt DJ. Equasy—an overlooked addiction with implications for the current debate on drug harms. J Psychopharmacol 2009; 23: 3-5. CrossRef | PubMed
4 Hencke D. Government to reject proposals to set minimum prices for alcohol. Guardian. http://www.guardian.co.uk/society/2009/mar/16/alcohol-minimum-prices-government-proposals. (accessed Nov 6, 2009).
5 Advisory Council on the Misuse of Drugs. Cannabis; classification and public health. http://drugs.homeoffice.gov.uk/publication-search/acmd/acmd-cannabis-report-2008?view=Binary. (accessed Nov 6, 2009).
6 Advisory Council on the Misuse of Drugs. MDMA (‘ecstasy’): a review of its harms and classification under Misuse of Drugs Act 1971. http://drugs.homeoffice.gov.uk/publication-search/acmd/mdma-report?view=Binary. (accessed Nov 6, 2009).
7 Murray R. Cannabis risks must not be underplayed. Times. http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article6900001.ece. (accessed Nov 3, 2009).
8 Frisher M, Crome I, Martino O, Croft P. Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophrenia Res 2009; 113: 123-138. PubMed
9 Anon. Pop “pot”. Lancet 1963; 282: 989-990. CrossRef | PubMed
10 Innovation, Universities, Science & Skills Committee. Putting science and engineering at the heart of government policy: eighth report of session 2008—09. Vol 1. http://www.publications.parliament.uk/pa/cm200809/cmselect/cmdius/168/168i.pdf. (accessed Nov 6, 2009).
