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Book cover, Drugs Without Th Hot Air, by David Nutt

Many will remember me as ‘the government scientist who got sacked’. In many ways my departure from the UK government’s Advisory Council on the Misuse of Drugs (ACMD) was my reason for writing this book, so it makes sense to start the story there. I was earlier head of the clinical research ward at the National Institute of Alcohol Abuse and Alcoholism NIH Bethesda, Maryland, where I acquired the deep knowledge of the harms of alcohol that eventually got me sacked.

     In October 2009 a lecture I’d given a few months before was released as a pamphlet on the internet. This got picked up by the media and I was interviewed on BBC Radio 4. This generated more interest and several more interviews. A few days later I received an email from the then Home Secretary Alan Johnson asking me to resign from my position as chair of the ACMD. When I refused he released a statement saying that I had been sacked. 

     The lecture that sparked off this chain of events had covered a number of topics, but all the media wanted to talk about were my views on cannabis. Cannabis was downgraded to Class C in 2004, but in January 2009 it was re-upgraded to Class B, indicating increased harmfulness; the change was made against the recommendation of the ACMD. The Home Secretary at the time justified ignoring the recommendations of our report because, the ‘decision takes into account issues such as public perception and the needs and consequences for policing priorities. ... Where there is ... doubt about the potential harm that will be caused, we must err on the side of caution and protect the public.’ In the lecture, I discussed whether this was a rational approach, and particularly whether putting a drug in a higher legal Class in order to ‘err on the side of caution’ would actually protect the public and reduce harm. And why did she not act on a drug where there was proof of harms—alcohol?

I’d entitled my lecture Estimating Drug Harms: A Risky Business? because I knew from experience that talking about the harm done by drugs in relative terms was considered politically sensitive. This had been made very clear to me when a scientific editorial I’d written, comparing the harms of ecstasy with those of horse riding, provoked questions in Parliament and an unhappy personal call from the Home Secretary.

     There had been a similar reaction to another paper, which tried to rank 20 drugs in order of harmfulness, taking into account 9 different sorts of harm, including physical, psychological and social factors. What was remarkable about this paper was our finding that alcohol was the fourth most harmful drug in the UK, below heroin and crack cocaine but above tobacco, cannabis and psychedelics. Since alcohol was legal this challenged the logic underpinning the drug regulations which were supposed to be based on harms.

     Politicians didn’t like the idea of some drugs being openly acknowledged as ‘less harmful’ than others (or even worse, less harmful than legal drugs such as alcohol), because it might be seen as encouraging more people to use them, or make the politicians seem less ‘tough’ in the eyes of the tabloid newspapers. This is despite the fact that the purpose of having different Classes of drugs built into the Misuse of Drugs Act—or the US controlled drug regulations—is to communicate to the public a degree of relative harm. Class B drugs should be less harmful than Class As, and Class C drugs less harmful than Class Bs. Incidentally, many drugs that have medical uses are both covered by the Misuse of Drugs Act, and regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Medicines Act. In the US the situation is similar but the classification system uses Schedules rather than Classes and has more of them.

     Which brings us back to cannabis—the only drug in the history of the UK Misuse of Drugs Act 1971 ever to be downgraded, following recommendations made by the Runciman report in 2000. After the downgrading of cannabis, however, the media, along with some politicians and medical professionals, became concerned that stronger forms of the drug (known as ‘skunk’) were causing serious mental illnesses such as schizophrenia.

     There was certainly a legitimate question as to whether new breeds of cannabis were more harmful than the sort that had been considered by Runciman and the ACMD in the past. As the government’s advisory council, this is exactly the sort of issue that our research was supposed to address, and we undertook a very thorough study—one of the most comprehensive ever. Our conclusion was that, although there probably was a causal link between smoking cannabis and some cases of schizophrenia, this link was weak and didn’t justify moving the drug up to the next Class. Yes, there was a risk of developing a serious mental illness after using the drug, but it was smaller than the risks posed by other Class Bs such as amphetamines, which can also cause psychosis. This was the message that we wanted to send to the public by keeping cannabis in Class C. 

David Nutt

Certainly, nobody was calling cannabis safe. However, as my 2007 Lancet report had shown, across a range of different sorts of harm, cannabis was by no means as damaging as many other drugs, particularly alcohol. This was a point I made in my lecture, and which got picked up in the radio interview: ‘surely you can’t be saying alcohol is more harmful than cannabis?’ I replied yes, that’s exactly what I’m saying, it’s in the Lancet, on the front page of the Independent and the Guardian—so it was hardly a secret. But this question was repeated in the other interviews that week—everybody wanted the quote that alcohol was more harmful than cannabis. It was an entirely defensible thing to say, as it was based on my own scientific work, and backed up by a similar study from Holland which agreed that alcohol deserved to be ranked among the most harmful of drugs. In these interviews I also observed that the government had asked the ACMD to determine which Class cannabis belonged in, but then hadn’t followed our advice. 

     In a letter to the Guardian a few days after he sacked me, Alan Johnson explained that I ‘was asked to go because he cannot be both a government adviser and a campaigner against government policy.’ I responded that I didn’t understand what he meant when he said I had crossed the line from science to policy, and that I did not know where this line was. The ACMD was supposed to advise on policy, and indeed it was set up by the Misuse of Drugs Act because the legal Class of a drug is supposed to inform the public about relative harm, and those who designed the act recognized this was best determined by a group of independent experts. By acting against our recommendations, the government had themselves blurred the line between science and policy. 

The subtitle of this book refers to making sense about drugs and the harm done by drugs whether legal or illegal. This has always been my primary concern as a psychiatrist, and what I always hoped the advisory body (the ACMD) and the UN were working towards. The upgrading of cannabis to Class B was the third time we had been ignored. (The other two were when magic mushrooms were made Class A without consulting us, and when the government refused to downgrade ecstasy to Class B despite our recommendation.) The longer the government persisted in creating policies that conflicted with the scientific evidence, the more harm those policies would do, not least because they undermined our ability to give a consistent public-health message, especially around the dangers of alcohol.

     The more hysterical and exaggerated any government was about the harms of cannabis, the less credibility they would have in the eyes of the teenagers binge drinking themselves into comas every day. If we’re going to minimize harm, we have to have a way of measuring it, and a policy framework that can respond to this evidence. Comparing the dangers of cannabis and alcohol was considered a ‘political’ act that overstepped my remit as a scientist and physician. 

     I am not the only scientist to have suffered the displeasure of governments. The UK Chief Medical Officer (CMO) Sir Liam Donaldson warned of the rapidly growing medical costs of alcohol use and recommended a policy of increasing the price of the cheapest drinks. His report was dismissed by the government, leading to his leaving the post early. The past-president of the Royal College of Physicians of the UK Sir Ian Gilmore was also ridiculed by the press and government when he shared his view that the current drug laws were not working, and that the personal use of drugs should be decriminalized as in Portugal. 

     The day after I was sacked, I received an email from Toby Jackson, a man with a keen interest in science, who was rather wealthy. He offered to fund an alternative independent expert committee that could carry out drugs research free from political interference. Together, we founded the Independent Scientific Committee on Drugs (since renamed DrugScience), and most of the scientific experts who resigned from the ACMD over my sacking  joined the new group. (A few members have also worked with both councils simultaneously.) 

     Being outside government has in many ways been a blessing, as it has allowed us to be far more outspoken in our criticism of government policies, notably during the mephedrone debacle and the recent ‘spice’ legislation, which you will learn more of in later chapters. My hope is that this book can put some of DrugScience’s work in context, and help contribute to a debate grounded in objective evidence about drugs—including alcohol and tobacco ... 

Book cover, Drugs Without Th Hot Air, by David Nutt

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