Society’s inconsistent moral judgements of potentially harmful activities

What do horse riding, motorsports, base jumping, mountain climbing, storm chasing, and drug use have in common? They are of all course all potentially dangerous activities pursued for a thrill, a rush, and often a great deal of enjoyment. But in our modern-day prohibitionist culture, one of those things is not seen as being like the others.

 

Professor Nutt and the Advisory Council on the Misuse of Drugs

After serving as the chair of the Advisory Council on the Misuse of Drugs (ACMD) technical committee for seven years, Professor David Nutt was finally promoted to chairman of the ACMD in 2008 by the Labour Government. Yet that same government would force him to resign the following year. In 2008, Prof David Nutt was appointed as head of the ACMD – the Advisory Council on the Misuse of Drugs – hired by the government to examine the potential harms of various substances and make recommendations about how they should be treated under the law. By 2009, he was sacked.

The controversy revolved primarily around a paper Nutt published in the Journal of Psychopharmacology entitled “Equasy – An overlooked addiction with implications for the current debate on drug harms.”

The paper focuses on directly comparing the dangers of horse riding and use of ecstasy, a common street name for MDMA and the third most popular illicit substance in the UK (behind cocaine and cannabis, respectively).

It comes to the conclusion that the likelihood of death from using MDMA is far lower than death from riding horses and encourages the government to reclassify MDMA to reflect this – or at the very least open a discussion comparing drug harms to harms from other risky yet socially acceptable activities.

This comparison was not arbitrary. As Nutt later explained in a 2012 parliamentary hearing:

It was not an arbitrary choice of horse-riding as a comparator, it came from a patient I had seen who had suffered irreversible brain damage from falling off her horse, and she came to me for treatment. In fact I did treat her; I treated her with amphetamine. It did not help greatly but it controlled some of her impulsivity. But it got me thinking, “How dangerous is horse-riding?” I discovered, remarkably, that it was considerably more dangerous than I had thought. Then I thought that it was an interesting comparison because it is something that people do – young people do – and it is popular but dangerous. It is probably addictive as well; many riders find it difficult not to ride. I thought it would be an interesting experiment to compare this pseudo-drug, equasy (equine addiction syndrome), which a lot of people think is a drug now.”

In that same hearing he also elaborated on his views regarding the place drugs have in society:

I think people have a very exaggerated perception of the harms of drugs and they tend to minimise the harms of other activities that particularly young people engage in that are potentially as harmful or more harmful. I thought it is important if we are going to debate drugs and make laws about whether people should or shouldn’t use drugs and if these are going to be based on harms, we should know about proportionate harms. We cannot see drugs in a bubble; they are part of life, and they are part of the world.”

When Professor Nutt was sacked, five more ACMD members resigned in protest as many wondered why the government would hire an expert in drugs science to conduct research if they weren’t interested in the results of that research. They certainly seemed more interested in the party line than any actual science. When explaining the reason for dismissal the then Home Secretary, Alan Johnson, stated in no uncertain terms: “He cannot be both a government adviser and a campaigner against government policy.”

With the support of many of his peers, Professor Nutt went on to publish his most well-known paper in 2010 titled – ‘Drug harms in the UK: a multicriteria decision analysis

Around the time of this publication, a group of scientists formed the Independent Scientific Committee on Drugs to provide evidence-based drug policy recommendations without political or commercial interference (since renamed simply Drug Science).

 

Drug harms in the UK: a multicriteria decision analysis

This paper was published in The Lancet medical journal – one of the most well-respected journals in the British medical community.

It has been widely reported throughout the media upon release and referred to many times since, drawing particular controversy due to its finding that when all factors are considered – 16 variables were studied and broadly categorised as either harm to users and society – alcohol is more dangerous overall than any illicit substance including heroin or crack cocaine.

Additionally, among the least harmful substances are the classic psychedelics and empathogens: Psilocybin, LSD, and MDMA all rank right at the bottom as much safer than alcohol, “hard drugs” like heroin and crack cocaine, and even prescription drugs such as benzodiazepines. Also of note is that cocaine and nicotine were considered to be equally dangerous.

What’s more, an almost identical study was conducted by a different group of scientists in 2015, except this time they looked throughout the EU rather than just the UK. It came to virtually an identical conclusion:

The outcome of this study shows that the previous national rankings based on the relative harms of different drugs are endorsed throughout the EU. The results indicate that EU and national drug policy measures should focus on drugs with the highest overall harm, including alcohol and tobacco, whereas drugs such as cannabis and ecstasy should be given lower priority including a lower legal classification.

This was further replicated in an Australian study in 2019 which showed some nuanced differences to Europe and the UK, but overall, alcohol was still considered to be the most harmful.

 

Socially acceptable intoxicants 

It has of course been pointed out – not least by alcohol trade groups and lobbyists – that the dangers of alcohol may be exaggerated simply because it is legal and socially acceptable while the other drugs it’s being compared against are not. Of course, the more widely used substance will have more deaths related to it. However, alcohol is responsible for 5.3% of all deaths worldwide every year according to the World Health Organisation, with a death toll of over three million a year attributed to alcohol use. That makes it the second most deadly drug on the planet (the first of course being tobacco, another legal substance).

A question which this raises is – would 5.3% of all the world’s deaths be caused by cannabis if it were to replace alcohol as the socially acceptable intoxicant?

Opponents of cannabis legalisation might argue that this only looks at the harms to the individual, not society at large. In England alone, alcohol also causes over 1.2 million violent incidents every year and around the world is universally linked to many forms of violence from fights on the street to domestic abuse. Alcohol is a major factor in violence across society, in the home, on the streets, at social events. It would be interesting to study the likelihood of violence for people who use cannabis compared to those who use alcohol in a population which uses both of these substances in similar quantities.

 

Is MDMA dangerous?

The real controversy, however, comes not over cannabis but MDMA. This is largely an area where harm reduction is key. MDMA is neurotoxic if used to excess. Of course it should be no surprise something is harmful if used to excess – that’s precisely what excess means. The problem is that in a prohibitionist society, it is much more difficult to tell end users what responsible use is, and literally impossible to regulate the purity and dose of the drugs on the market. In recent years, far from concerns of impure cuts, MDMA purity has actually been going up for quite a while and we now have very clean cheap MDMA in the UK.

The biggest concern for those taking MDMA is actually taking too much high purity MDMA as the pills are often dosed highly, commonly ranging around 250mg but sometimes as high as 300mg. In the Netherlands, where a lot of the MDMA supply is imported to the UK, users tend to know they should break a pill in half. In the UK this is, unfortunately, less common despite the high doses. But then how many people even know what a “safe” dose of MDMA is supposed to be? Generally, we expect one pill to be one dose. The fact is, our pills today are two or three doses in one. This is once again a fault of the black market and prohibition.

With alcohol we have the units system, we print on the bottle what the recommended limits are and how many units of alcohol are in that drink, and most importantly you know exactly how much alcohol you are consuming. We cannot do this with other substances if they’re illicit. MDMA users rely on the honesty of their drug dealer who may be ill-informed or negligent. Nowadays, amazing services such as The Loop and WEDINOS are testing substances such as MDMA and other festival drugs, however, these tests have their limitations. We must first have a legally regulated market to accurately inform MDMA users of what they are consuming.

MDMA has been around for quite a while and was originally used to facilitate therapy. The non-profit organisation MAPS – the Multidisciplinary Association for Psychedelic Studies – is running clinical trials to get MDMA approved as a prescription drug by the FDA in the US by 2022. Their US trials are already at phase III, while their European trials are at phase II. The idea is to use it for its original purpose: assisting in psychotherapy, initially for PTSD but research is ongoing for a number of other conditions ranging from anxiety to autism.

 

Most drug harms are consequences of prohibition

Let’s go back to horse riding. That’s a dangerous activity. But we put measures in place, such as helmets, to reduce any potential harm that could result. We also offer information and education to those wishing to ride so they know the safest way to ride a horse with minimal risk of injury. Now imagine if tomorrow the government banned horse riding. There would be no open exchange of information on the safest way to do it. The entire process would be unregulated with unqualified people giving advice to those wanting to try horseriding. Suddenly something that already carries risk now carries a lot more risk for no other reason than the state has decided they don’t want you doing it.

If you turn absolutely anything over to the black market it will become more dangerous because instead of being run by legitimate regulated companies it is instead run by criminal operations with no oversight from anyone. It doesn’t take a genius to work out how taking something and putting it in the hands of criminal gangs is going to cause negative repercussions.

Indeed it wasn’t too long ago, historically speaking, that the USA attempted to prohibit the sale and consumption of alcohol. As anyone who watched Bugsy Malone will tell you, that didn’t go very well. Alcohol was still readily available at speakeasies but it was of unknown purity and strength and peddled by violent gangs. When prohibition was reversed, the black market did not linger – instead, you had legitimate breweries making a regulated product of controlled strength and huge reductions in gang-related violence.

The efficacy of prohibition hasn’t changed and nor have its negative consequences. Today the biggest danger in the world of drugs is fentanyl and its analogues. Fentanyl is a drug that is roughly 50x stronger than heroin while an analogue of it, carfentanyl, is estimated to be 1000x stronger than heroin. Fentanyl is used medically, but only in tiny microgram doses, while carfentanyl is used only as an elephant tranquilliser and occasionally as a chemical weapon. What is happening on the street is dealers are buying these things in bulk from China and cutting heroin with it in unknown doses. This is an especially big problem in the USA where many fatal overdoses have ensued.

 

You cannot fight human nature

There is an evidence-based line of thought among many in the medical community that humans simply have a natural predisposition to mess around with their heads to experience altered states of consciousness.

Certainly, this appears to be a difficult position to argue against. There has never in the history of humanity been a completely sober society. The drugs that happen to be socially acceptable change over time – for many years in Asian cultures, opium was the socially acceptable drug of choice – but the fact is every human society provides some type of outlet for this instinct – and if one is not provided legally, the black market swoops in to fill the gap.

Indeed, we also know – thanks to the UK government no less – that strict drug laws have absolutely no correlation with reduced drug use. I can’t help but be reminded of attitudes towards sexuality in the Victorian Era. Attempting to create a society of the sexually repressed was quite a failure. What they succeeded in doing, however, was creating a society where people went underground to indulge in their desires. The same thing is happening with drugs right now.

 

This article was kindly contributed anonymously by P.M, you can read the full article here!