A review of drug harms?

Mankind has had getting on for 5 thousand years of recorded experience of cannabis. OK, maybe not here in the UK, but certainly in many cultures around the world. There is, or was before prohibition was imposed on these cultures and did its best to eradicate it, a wealth of social knowledge about its effects and how to accommodate its use in a social context. Just take a look at the cannabis timeline we have on UKCIA if you don’t believe that, cannabis is not a new drug by any means.

The reason to mention that is the news this week that Sir Micheal Rawlins has ended his tenancy as the chairman of the ACMD (the advisory body the government appointed to advise on drugs classification which it ignores) and is to be replaced by Professor David Nutt. Prof Nutt is expected to bring with him an agenda to review the classification system at the heart of the despised Misuse of Drugs Act, the act of parliament which has created the drugs policy mess we have today.

The Transform blog covers the reaction his call to reclassify Ecstasy is likely to get from the tabloid press and politicians (Ecstasy reclassification meltdown; it begins again), if you thought the lack of evidence based decision making over the issue of cannabis was bad, wait till you see the coverage of the ecstasy debate..

A while back – in March 2007 actually – Prof Nutt was involved in a review of “drugs harms” which ranked drugs in order of the harms they cause to society and to the users. It produced this by now famous graph published originally in the lancet:

Click for a larger image

These results confirm what most people other than politicians or Daily Mail readers already knew by placing alcohol and tobacco way above cannabis in terms of the harm they cause. Of course, the comparison is flawed because it compares illegal cannabis supplied by the mob with legal, regulated alcohol. If it were to compare illegal moonshine with other illegal drugs it’s a fair bet alcohol would be somewhat further up the harm scale than it is now, likewise, of course legal, regulated cannabis would be somewhat lower for much the same reason.

But the thing that caught the attention of the hacks of the gutter press like the Independent on Sunday was the claim that, as the IoS put it:

New research being published in this week’s Lancet will show how cannabis is more dangerous than LSD and ecstasy.

Now, don’t get me wrong. The classification system which underpins the Misuse of Drugs Act is barmy – and that’s being nice about it. The rankings proposed by Prof Nutt are several orders of magnitude more intelligent than we have now. But is LSD really safer than cannabis? It’s not difficult to raise an eyebrow or two at such a claim. What this means basically, is perhaps there’s something very wrong with Prof Nutts rankings, and that “something” is probably an over reliance on knowledge gained over recent years, all of which has been under the regime of prohibition which by it’s nature makes reliable data collection impossible. In short, there’s a problem with how we can measure the harm caused by illegal drugs and this glaring error of ranking LSD below cannabis provides an interesting example of how it can happen.

LSD does seem to be a very safe drug, certainly it’s not addictive or anything like that and it simply isn’t associated with anything much in the way of social harms as far as we can tell. Take, for example the apparent fact that LSD is not associated at all with road accidents:

According to the Transport Research Laboratory

LSD was tested for, but not detected in any of the casualties.

Note the choice of words there. Odd? You bet. There’s really only two conclusions to draw from this, either tripping people never get behind the wheel of a car (and that has been claimed believe it or not), or you can’t test for acid. The truth is, of course, you can’t test for acid. Well, ok there is a theoretical test but in practice there isn’t. To all intents and purposes LSD is impossible to test for, which isn’t really surprising given the tiny doses it’s taken in, a 250 micro gram dose is a mind-melting trip which lasts for around 12 hours, the usual drug war instrument of enforcement, drug testing, simply doesn’t work.

LSD is an interesting, some would say amazing drug, but it can easily take the user somewhere cannabis simply can’t go, to a world where dangers are misunderstood and accidents can and do happen. But because of the way we measure these things LSD is never blamed, it truly is a Macavity cat of drugs, never there when you look for it.

The psychological effects of LSD are also no real secret, the legend of the 60’s acid burn out are well known and even sadly well documented. For any respected scientist to rank a substance like that lower in terms of harms than cannabis shows there’s something wrong. No-one doubts Prof Nutt and colleagues ability to examine the data, but we should perhaps query their acceptance of the validity of that data without question.

Now of course, this contrasts greatly with cannabis which is easy to detect weeks after last use. Cannabis is the one drug against which detection does work without fail, which means that if cannabis was there it will turn up. Because cannabis use is so easy to detect, it always gets counted even if use was some time before the incident and the effects have long since worn off. To be fair, the TRL tudy accepts that by saying

In the current study, cannabis was the drug most frequently
found, constituting nearly half of single drug use. There has
been a substantial increase in the incidence of cannabis in
fatal road casualties from 2.6% to 11.9% over the period
between the studies. However, cannabis remains traceable in
the blood stream for up to 4 weeks, after it is taken by regular
users, whereas its effect on driving is probably limited to a
few hours at most after it is taken (Sexton et al., 2000).

But it still presents the cannabis figures as being high

So, in conclusion yes please, do review the classification rankings of drugs including alcohol, but lets be aware of the way we collect the data. To compare the harms drugs can do when illegal with those which are legal is flawed and to rely on the measuring regime imposed by prohibition is equally so. Likewise, to pretend the legal regime drugs exist in has no effect on the harms they can cause is also deceptive.

Better surely to look at the measures which are effective in reducing harms, rather than tinkering with a system that can’t work.