Drugs Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs


in Books and literature, Economics, Geek stuff, Law, Politics, Psychology, Science, Writing

Psychologically active drugs may be the least rationally regulated part of our society, with one dangerous and addictive drug advertised and available everywhere (alcohol) and only nudges to disocurage the use of another that kills five million people a year globally (tobacco). Meanwhile, police forces and court systems around the world tie themselves up with investigating, processing, and incarcerating people who own or sell small quantities of much less dangerous substances.

David Nutt was appointed as chairman of the British Advisory Council on the Misuse of Drugs in 2008: an expert panel intended to provide non-partisan advice on drugs to the government. He was fired in 2009 after pointing out that the chances of getting hurt from an hour of horseback riding are about 30 times greater than the odds of dying from taking a pill of MDMA (ecstasy). His book Drugs Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs covers some extremely interesting ground in a convincing and well-argued way.

Nutt describes how policy-making in the area of drugs is often driven by a combination of media-enhanced hysteria and an effort on the part of politicians to seem ‘tough’ on the issue. He categorizes many of the harms that result from this, ranging from criminal records acquired by youth (which harm their lives much more than drugs) to harsh restrictions on the availability of painkillers around the world, leaving many with terminal illnesses to die in a great deal of pain.

Nutt also provides a nuanced and interesting description of the nature of addiction, distinguishing between people who rely on steady access to a drug to control and underlying condition (as diabetics use insulin) and those whose use of a drug has been sufficient to give them harsh withdrawal symptoms when they stop using it, which in turn drives them into a cycle of continuous use. Nutt argues that treating addicts as criminals causes a great deal of harm to the addicts themselves and to society at large, through mechanisms including the suppression of scientific research, the discrediting of the law through its obviously unjust application, the enrichment of criminal gangs, increasing the spread of infectious disease, diverting attention from controlling alcohol and tobacco, and the indirect encouragement of more harmful drug-taking practices because safer alternatives are not available.

My copy of the book is sprinkled with a few typographic errors which I am told have already been corrected in the newest printing. It’s also a bit challenging to square a few of the claims about the relative dangerousness of drugs. Early in the book, Nutt describes a complex exercise in which multi-criteria decision analysis was used to evaluate the relative harmfulness of a variety of legal and illegal drugs across sixteen dimensions, encompassing both harm to the individual and harm to society. The ranking found alcohol to be the most destructive drug overall, followed by heroin and crack cocaine. Methamphetamine, powder cocaine, and tobacco follow. Lower in the list are amphetamine, cannabis, GHB, and benzodiazepines. At the bottom of the scale are ecstasy, LSD, and psilocybin mushrooms. Between ecstasy and benzodiazepines – about 1/3 of the way up the harmfulness scale – Nutt lists ‘butane’ – an inhalant. Later in the book, however, he characterizes butane as extremely dangerous and capable of killing people on the first use if misused. Perhaps the scale is based on the proper administration of the drug. Still, it seems like a drug that carries a significant risk of accidental fatal overdose should probably be rated as more harmful than drugs like cannabis which carry no such risk.

Regardless of the exact ranking of harmfulness that is most appropriate, the book contains a great deal of interesting information, as well as an informative chapter on what parents should tell their children about drugs. Nutt argues convincingly that treating drug addicts as people with a serious medical problem makes more sense than treating them as criminals, and lays out a good case for why the supposed ‘War on Drugs’ has failed. He also provides some interesting information on the functioning of the brain and makes some suggestions about how drugs of all sorts could be regulated to reduce harm. He does a good job of pointing out the hypocrisy in our treatment of tobacco and alcohol and makes some sensible suggestions for how states could effectively discourage the use of the latter.

All told, Nutt’s book provides a scientist’s take on the various substances people consume with the desire to change their thinking, as well as the consequences of the production and use of those substances for individuals and society. By repeatedly pointing out the many areas where policies are poorly informed by reality and counterproductive, he makes a strong case for the need for drug law reform. Both for individuals who wish to educate themselves about drugs and for policy-makers who aspire to regulate them more appropriately, this book could be a very useful reference.

Nutt is now associated with the Independent Scientific Committee on Drugs which has a great deal of useful information about drugs and harm reduction on their website.

{ 17 comments… read them below or add one }

Byron Smith September 13, 2012 at 9:20 pm

“the least rationally regulated part of our society”
Sorry, I couldn’t get past your opening sentence. You’ve written tens (hundreds?) of thousands of words on climate change, are starting a PhD on environmental politics, and you think that drugs are the least rationally regulated part of our society? ;-)

Milan September 14, 2012 at 10:20 am

On climate change, many of our policies are harshly unjust to future generations, but reasonably rational if you only care about the short term.

On drugs, I think our policies are even more pointlessly destructive – though failure in that arena is ultimately less serious than failure in maintaining climate stability.

. September 20, 2012 at 10:10 am

A real fMRI high: My ecstasy brain scan

And then I start to feel it. A tingle of energy, like pins and needles, starts in the pit of my stomach and rises slowly, not unpleasant but not exactly pleasurable either. It builds in intensity, then breaks into a wave of bliss. The placebo effect can be powerful but when it happens again, I’m in no doubt. I’m coming up.

I’m taking part in a groundbreaking study on MDMA, the drug commonly known as ecstasy. The research is run by David Nutt of Imperial College London, a former government adviser and one of the few UK researchers licensed to study class-A drugs.

His main aim is to discover what MDMA does to the human brain, something that, remarkably, has never been done before. A second goal is to study MDMA as a therapy for post-traumatic stress disorder. The experiment is also being filmed for a Channel 4 documentary called Drugs Live: The Ecstasy Trial, which will be broadcast in the UK next week.

. September 25, 2012 at 11:07 am

Drugs – without the hot air

Now published in the USA and the UK, in paperback and in ebook (Kindle and ePub editions).

DAVID NUTT is Edmond J Safra Professor of Neuropsychopharmacology at Imperial College, London, but is best known as “the scientist who
was sacked” by the UK’s Home Secretary because he compared the harms of horse-riding with taking ecstasy or cannabis.

The science of what drugs are and how they work lets us quantify and compare the harms caused by different drugs. With this information we can radically transform drugs law, and hugely reduce crime and all the other social, economic and health harms currently caused by drugs. The book is written in plain English. It is intended for people who take drugs, and those dealing with the harms drugs cause: parents, teachers, doctors, politicians, social workers and law enforcement agencies.

* Explains what drugs are, how they work, and how people become addicted.
* How harmful are alcohol and tobacco compared to illegal drugs?
* Does the “War on Drugs” cause more harm than good? How does it affectlegitimate scientific research into potentially valuable therapies?
* What should you tell your children about drugs, and at what age?

. April 23, 2013 at 10:22 pm

Their cup runneth over
Britain’s drinking culture is deeply unhealthy. So is the politics of drink

Budget pubs are thriving in austerity Britain, masking a decline in pricier traditional watering-holes. J D Wetherspoon has opened cheap boozers in a former bank, post office and cinema. But none offers so pithy a comment on modern Britain as The High Cross. Its fine brick-and-stone building was constructed in the late 19th century by a temperance outfit, the Leicester Coffee and Cocoa House Company, which sought to wean working people off the demon drink by providing pleasant surroundings in which to drink tea, coffee and cocoa for a penny a pint. “Is that right?” chuckled Clare, a tattooed reveller at The High Cross. “Didn’t work then, did it?”

Indeed not. Britain has a big drink problem. Like most chilly north European countries, it has an ancient tradition of getting blotto. But Britons manage to combine Scandinavian bingeing with liver-pickling Mediterranean levels of consumption. After a three-decade-long surge in drinking, over 60% of British adults drink alcohol in any given week and one in six get drunk at least once. The health implications are catastrophic: alcohol-linked deaths have risen by 20% over the past decade. Noisy binge-drinkers also cause some crime and a lot of disruption—over which Britain’s popular newspapers have an almost obsessive concern. “Twenty Thirsteen: Boozy revellers go bonkers”, splashed the Sun this week. No wonder two-thirds of Britons believe the national drink habit is out of control.

anon June 15, 2013 at 2:18 pm

Former UK drug czar David Nutt (and author of the amazing and indispensable Drugs Without the Hot Air) has published a paper in the journal Nature Reviews Neuroscience called “Effects of Schedule I drug laws on neuroscience research and treatment innovation” where he, and his co-authors (Leslie A. King and David E. Nichols) call modern drug policy “the worst case of scientific censorship since the Catholic Church banned the works of Copernicus and Galileo.”

anon June 15, 2013 at 2:18 pm

Effects of Schedule I drug laws on neuroscience research and treatment innovation

Many psychoactive drugs are used recreationally, particularly by young people. This use and its perceived dangers have led to many different classes of drugs being banned under national laws and international conventions. Indeed, the possession of cannabis, 3,4-methylenedioxy-N-methylamphetamine (MDMA; also known as ecstasy) and psychedelics is stringently regulated. An important and unfortunate outcome of the controls placed on these and other psychoactive drugs is that they make research into their mechanisms of action and potential therapeutic uses — for example, in depression and post-traumatic stress disorder — difficult and in many cases almost impossible.

. July 2, 2013 at 2:27 pm
. November 12, 2013 at 10:41 am
. July 8, 2015 at 12:26 am
. November 5, 2015 at 6:47 pm

This video, which was released last year, was produced by the city of Amsterdam to warn tourists that heroin was being sold by street dealers as cocaine. The city set up signs and offered inexpensive drug test kits so people could test the street drugs they’d purchased and find out if it contained heroin. The video ends with the promise that drug users will not be arrested for using drugs or for reporting the discovery of white heroin, or for seeking medical help in an emergency. Could you imagine something this sensible happening in the U.S.?

. July 26, 2016 at 11:10 pm

Drug-testing at music festivals

Revellers get the chance to see if their drugs are what they claim to be

Concrete posing as ecstasy, brown sugar as MDMA crystals: illegal drugs often are not what they seem

. July 26, 2016 at 11:11 pm

As police turned a blind eye, technicians analysed nearly 250 drug samples, mostly of ecstasy, cocaine and ketamine.

Or at least, that was what they claimed to be: in reality the bags of “MDMA crystal” being sold for £50 ($66) per gram turned out to be brown sugar; some suspiciously hard, grey pills were made of concrete; and several samples of “cocaine” and “ketamine” were in fact ground-up anti-malaria tablets. Even the real drugs varied dangerously in potency: the strongest ecstasy pills were five times as potent as the weakest.

. August 12, 2017 at 5:16 pm

One in eight American adults is an alcoholic, study says

A new study published in JAMA Psychiatry this month finds that the rate of alcohol use disorder, or what’s colloquially known as “alcoholism,” rose by a shocking 49 percent in the first decade of the 2000s. One in eight American adults, or 12.7 percent of the U.S. population, now meets diagnostic criteria for alcohol use disorder, according to the study.

The study’s authors characterize the findings as a serious and overlooked public health crisis, noting that alcoholism is a significant driver of mortality from a cornucopia of ailments: “fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.”

Indeed, the study’s findings are bolstered by the fact that deaths from a number of these conditions, particularly alcohol-related cirrhosis and hypertension, have risen concurrently over the study period. The Centers for Disease Control and Prevention estimates that 88,000 people a year die of alcohol-related causes, more than twice the annual death toll of opiate overdose.

. August 12, 2017 at 5:24 pm

“Stunningly, nearly 1 in 4 adults under age 30 (23.4 percent) met the diagnostic criteria for alcoholism.

“I think the increases are due to stress and despair and the use of alcohol as a coping mechanism,” said the study’s lead author, Bridget Grant, a researcher at the National Institutes of Health. The study notes that the increases in alcohol use disorder were “much greater among minorities than among white individuals,” likely reflecting widening social inequalities after the 2008 recession.”

. September 6, 2019 at 10:48 am

Vaping causes ‘havoc’ in the lungs, study with mice finds

Scientists point finger at solvents used in e-cigarettes

. February 10, 2020 at 3:44 pm

Tide Pods more dangerous to public health than THC-infused edibles, frustrated Canadian doc says

In over a decade of work in the country’s emergency rooms, Dr. Ian Mitchell said he has treated more patients suffering from the effects of ingesting Tide Pods than from THC-infused treats. The cannabis cases that Dr. Mitchell has seen have involved potent products from the unregulated market.

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