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Science and non-science in drug policy

Science and non-science in drug policy. David Nutt FMedSci Prof of Neuropsychopharmacology Imperial College London d.nutt@imperial.ac.uk Hon Consultant psychiatrist CNWL Chair – Independent Scientific Committee on Drugs drugscience.org.uk profdavidnutt@twitter.com. Who am I ?.

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Science and non-science in drug policy

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  1. Science and non-science in drug policy David Nutt FMedSci Prof of Neuropsychopharmacology Imperial College London d.nutt@imperial.ac.uk Hon Consultant psychiatrist CNWL Chair – Independent Scientific Committee on Drugs drugscience.org.uk profdavidnutt@twitter.com

  2. Who am I ? • A Cambridge graduate (Downing 69-72) • Apsychiatrist with > 30 years experience • A researcher for about 30 years • Mostly into effects of drugs and the brain • Over 500 publications • Worked in USA and Australia but mostly in UK • A parent of 4 (post)teenage children • An (ex) government drugs advisor • Worked for ACMD for ten years • 9 as chair of scientific committee • 1 as chair of Council - then sacked

  3. Oct 30th 2009 Sacked… …but not gagged

  4. Media divided Broadsheets and BBC critical of government Independent & Guardian Very supportive

  5. The rags/redtops • The Sun = Professor Poison • The Mail Melanie Phillips • Fatuous, dangerous, utterly irresponsible - the Nutty professor who's distorting the truth about drugs • He is part of a manipulative, subversive and lethally dangerous clique that want to overturn the UN conventions on drug use Peter Hitchens that ninny-brained menace to the nation’s young people

  6. The rags/redtops What they did next…. The Sun hacked into 3 of my children’s Facebook pages • 2 page spread claiming cannabis use and under-age drinking + picture of one son naked (in snow at Swedish sauna) Repeated by Mail and News of the World • Press Complaints Procedure = PCC • Sun took down web page • Mail didn’t • Because Editor Paul Dacre is chair of the PCC?

  7. Public response • > 30,000 supporters on facebook • > 2000 scientists signed petition to PM demanding reinstatement • Students for a Sensible Drug Policy protest at Downing St

  8. Why was I sacked? Its not clear “getting involved in policy” I said - current policy not evidence based “ giving mixed messages” I said = alcohol would be banned if newly invented cf GHB/GBL “loss of confidence” = in my ability to toe the line “didn’t inform Home Office of release of text of an academic lecture I gave” = Eve Saville lecture - http://www.crimeandjustice.org.uk/opus1714/Estimating_drug_harms.pdf - why should I have?

  9. Conspiracy or cock-up? Lord Drayson – Science Minister • 'If I had been asked by the Home Secretary before he took that decision I would have said that a decision to dismiss Professor Nutt would have caused serious concern,'' he told The Times. • ''It's very important that in future the chief scientific adviser and the Science Minister are consulted before ministers take decisions to sack independent scientific advisers.''

  10. Conspiracy or cock-up? Lord Drayson – Science Minister • 'If I had been asked by the Home Secretary before he took that decision I would have said that a decision to dismiss Professor Nutt would have caused serious concern,'' he told The Times. • ''It's very important that in future the chief scientific adviser and the Science Minister are consulted before ministers take decisions to sack independent scientific advisers.'' Unfortunately he was in Japan racing his classic car that week

  11. Government Chief Scientist Professor John Beddington, the Government's chief scientist has backedProfessor David Nutt, the sacked drugs adviser, over his claims that alcohol and cigarettes are more harmful than cannabis“of course he’s right” Unfortunately he was in Khazakstan and out of phone contact that weekend

  12. The science-v-policy conundrum Scientists do science - Politicians do policy …. and ne’er the twain shall meet But when it suits them politicians “do science” - e.g. “skunk is lethal” - Gordon Brown (ex)PM 2008 - e.g.ACMD got it wrong on ecstasy and brain damage - Jacqui Smith (ex)Home secretary 2009 - e.g. ACMD wrong on cannabis and schizophrenia – Alan Johnson (ex)Home Sec 2009 But if scientists “do policy” e.g. point out that a focus on alcohol rather than cannabis would have more health benefits – they get sacked!

  13. What is a drug? And who says? Back to the science ….

  14. What is a drug? “something given to a rat that results in a scientific paper” Anon

  15. What is a drug? “something a politician once used but now regrets” Jaqui Smith “I smoked but didn’t enjoy” David Cameron “I did things when young that II shouldn’t have – we all did” etc etc Release

  16. Some are honest “something a politician once used but now regrets” Jaqui Smith David Cameron etc etc I used cannabis – and I liked it Tim Yeo Conservative MP Release

  17. Some make a joke about it This an outrageous slur – of course I have taken drugs!

  18. Sometimes inadvertently “I wouldn’t answer the marijuana question. You now why? Because I don’t want some little kid doing what I tried”

  19. The drinks industry?

  20. Some media agree Metro 2008 Note – 2 years before sacking

  21. Broadsheets get it right

  22. What I say a drug is “a chemical which when taken produces physiological changes” Which in relation to controlled drugs relates to pleasurable/desirable effects in the brain Or damaging ones……..

  23. Death from drugs? SORTED? Gavin Britton Leah Betts alcohol poisoning MDMA  water poisoning (drinking game after Exeter University golf match)

  24. Amy Winehouse's death due to acute alcohol poisoning Blood alcohol 450mg/% = 5.5 x legal driving limit Imperial College student also this year

  25. Alcohol – bingeing deaths BBC news 29 September 2010 Last updated at 13:58 Teesside man dies after downing pint of vodka A man died after downing a pint of vodka in four seconds, an inquest heard. Richard Davies, 29, from Thornaby, near Stockton, had been drinking with friends before the alcohol knocked him unconscious in January. Mr Davies was found not breathing in a pool of his own blood, and died hours later. Recording a verdict of misadventure, Teesside coroner Tony Eastwood said the alcohol in his system had killed him.

  26. Drug-related harm About 3 people a week dies of alcohol overdose 10 + of accidents due to intoxication - often on highly significant days (can’t overdose on cannabis) + most common factor in date rape by far (ACMD date-rape drug review 2004)

  27. Rising drinking  Falling deaths Son of ex-Asda chief dies in drunken ski resort prank leaping between chalet rooftops in the upmarket French ski resort of Courchevel More people die each year from falling from windows and roofs and piers drunk than have ever died from trying to fly under influence of psychedelics 1 death each week in summer season in Majorca Each “a tragic accident’ = coroner

  28. Alcohol main cause of global disability in 15-24 yr olds Males Females

  29. And in Europe – new data from the European Brain Council Males: Total neuropsychiatric: 23.4% Mental dis. Neurological other Other disease groups Females: Total neuropsychiatric: 30.1% Mental dis. Neurological other Other disease groups DALY Rate per 10.000 persons

  30. Health costs of alcohol Hospital admissions 2006/7 = 208,000 1995/96 = 93,500 2009 = 1million hospital episodes -13,000 under 18s MDMA /ecstasy ~ 2000 Cannabis ~700

  31. Social damage from alcohol Exxon Valdez = largest environmental disaster before the Gulf Spill - 1989 Captain drunk

  32. Political destruction In UK many MPs careers ruined including George Brown and Charles Kennedy

  33. Alcohol induced violenceEven Royal Ascot not immune Royal Ascot June 16th 2011 Metro

  34. In the last 40 years alcohol consumption has doubled - as the real cost has halved Superstrength lagers and ciders + “alcopops” 200000 Hospital admissions doubled in last decade 100000 Sources: BBPA Statistical Handbook 2008; Institute of Alcohol Studies Factsheet ‘Trends in the affordability of alcohol in the UK’

  35. The rise and rise of liver deaths British Liver Trust analysis of Office for National Statistics mortality statistics covering all deaths related to liver dysfunction covering ICD K70–76 and other codes including C22–24 (liver cancer), and B15–B19 (viral hepatitis), January 2009

  36. Massive increase in alcohol health harms Chronic liver disease and cirrhosis mortality rates per 100,000 population, 1950-2006 Scotland – highest binge drinking as well Leon & MacCambridge, Lancet 2006

  37. What about cannabis?

  38. 20x increase in cannabis users over last 40 years Ever use Period prevalence Incident Cannabis < 18 Rise in incidence and prevalence of cannabis use since 1970 in England and Wales (Hickman et al 2007, Addiction 102, 597-606)

  39. Drug related deaths Source: Smoking and drinking among adults, 2009. Office for National Statistics Drug Misuse Declared: Findings from the 2010/11 British Crime Survey England and Wales. Home Office Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2009/10: Sweep 6 report. The Centre for Drug Misuse Research

  40. If anything schizophrenia is declining Frisher et al (2009) Weissenborn and (Nutt 2011)

  41. If anything schizophrenia is declining To prevent one case of schizophrenia one would have to prevent 5000 young men from ever smoking cannabis ACMD 3rd cannabis report 2009 Therefore no need to reclassify from Class C

  42. Why was cannabis made class B? But the desire to appease the Redtops was so intense it was made Class B based on … possible risk…. public perception and policing priorities… Jacqui Smith Home Sec Did Gordon Brown do a deal with the Mail? – agreeing to Class B in exchange for their support in the (aborted) election

  43. Drugs ranked according to total harm Alcohol Tobacco Cannabis Nutt King & Phillips Lancet Nov 2010

  44. As The Telegraph saw it

  45. But its not a joke! • Clean needles + pharmaceutical heroin • Little harm and low mortality

  46. The Misuse of Drugs Act 1971 The original intention of the MDAct was to have a system of relative based harm against which penalties would be applied (penalty fits the crime). The Act states that: ‘Her Majesty may […] make such amendments in Schedule 2 to this Act as may be requisite for the purpose of adding any substance or product to, or removing any substance or product from …’ i.e. changes can be made as the evidence of relative harm becomes clearer ACMD charged with providing this evidence Government must consult

  47. Margaret Thatcher – a PM who did listen to the ACMD Agreed to needle-exchange to reduce the incidence of HIV despite it conflicting with Tory philosophy

  48. Where did the war on drugs come from? Flushed with victory(?) in Iraq in 2004 Tony fires up the War on Drugs – starting with the mushrooms

  49. Collateral damage The first casualty of war is the truth Mushrooms are highly dangerous Once at war, all reason is treason Which is why I was sacked 2005 Victory(?) in Iraq – then the War on Drugs

  50. “Justifications” for the war on drugs To reduce the harms of drugs to society to the user (we’ll criminalise, and even imprison you, to protect you from the possibleharms of drug use)

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