Public Health

The British Labor government has created a firestorm of controversy with its firing of Professor David Nutt, head of the Advisory Committee on the Misuse of Drugs (ACMD) last Friday. Nutt was canned by Home Secretary Alan Johnson after the psychopharmacologist again went public with his criticism of the government for refusing to follow a science- and evidence-based drug policy. As of today, after a weekend of furious back and forth in dozens of newspaper articles, two more members of the ACMD have resigned in protest over the firing, and a mass resignation of the 31-member body may come after a meeting next Monday. Johnson told parliament Monday that he had agreed to a request from the ACMD for an urgent meeting, but he also told parliament he had ordered a review of the ACMD to satisfy ministers that the panel is "discharging its functions" and that it still represents a value to the public. The ACMD's charge is to "make recommendations to government on the control of dangerous or otherwise harmful drugs, including classification and scheduling under the Misuse of Drugs Act 1971 and its regulations," its web page explains. "It considers any substance which is being or appears to be misused and of which is having or appears to be capable of having harmful effects sufficient to cause a social problem. It also carries out in-depth inquiries into aspects of drug use that are causing particular concern in the UK, with the aim of producing considered reports that will be helpful to policy makers and practitioners." Tensions between the ACMD and the Labor government began rising after the government up-scheduled marijuana from a Class C drug (least harmful) back to Class B, where it had been prior to being down-scheduled in 2004. The Labor government ignored the ACMD's recommendation that marijuana remain Class C. Things only got worse when the ACMD recommended that Ecstasy be down-scheduled from Class A (most harmful) to Class B, and the government promptly ignored that advice. At that point, Nutt went public with his criticisms of then Home Secretary Jacqui Smith. He also famously compared the dangers of Ecstasy to those of horse-riding, deeply offending both the horsey set and the Labor government. Smith told Nutt to shut up, and he managed to do so until last week. Last week, in a lecture and briefing paper at the Center for Crime and Justice Studies at King's College London, Nutt accused Smith of "distorting and devaluing" scientific evidence when she decided to reclassify marijuana. He also said that Ecstasy and LSD are less dangerous than alcohol and tobacco. "We have to accept young people like to experiment – with drugs and other potentially harmful activities – and what we should be doing in all of this is to protect them from harm at this stage of their lives," he said. "We therefore have to provide more accurate and credible information. If you think that scaring kids will stop them using, you are probably wrong.” Nutt's briefing paper included a ranking of various licit and illicit drugs by comparative harm. Heroin and cocaine were ranked the most harmful in Nutt's scheme, with alcohol fifth, marijuana ninth, LSD fourteenth, and Ecstasy eighteenth. "We need a full and open discussion of the evidence and a mature debate about what the drug laws are for — and whether they are doing their job," Nutt said. That was too much for Home Minister Alan Johnson. He told parliament Monday that Smith had warned Nutt not to publicly disagree with ministry decisions again. "Well, it has happened again," said Johnson. "On Thursday October 29 Professor Nutt chose, without prior notification to my department, to initiate a debate on drug policy in the national media, returning to the February decisions, and accusing my predecessor or distorting and devaluing scientific research. As a result, I have lost confidence in Professor Nutt's ability to be my principal adviser on drugs." Prime Minister Gordon Brown is standing behind Johnson. An official spokesman said the firing was based on the "important principle" that advisers should present advice to ministers but not speak out against their policy decisions. "It would be regrettable if there were other resignations, but this is an important point of principle," the spokesman added. "The government is absolutely committed to the importance of having independent advice and evidence presented by advisory bodies." Nutt defended himself and attacked the government in a London Sunday times opinion piece. "My sacking has cast a huge shadow over the relationship of science to policy," he wrote. "Several of the science experts from the Advisory Council on the Misuse of Drugs (ACMD) have resigned in protest and it seems likely that many others will follow suit. This means the Home Office no longer has a functioning advisory group, which is very unfortunate given the ever-increasing problems of drugs and the emergence of new ones. Also it seems unlikely that any 'true' scientist — one who can only speak the truth — will be able to work for this, or future, Home Secretaries. One of the ACMD members who resigned, chemist Les King, said ministers were putting inappropriate pressure on scientists to make drug policy decisions based on political—not scientific—reasons. "It's being asked to rubber stamp a predetermined position," he said, warning that others could leave the council over the brouhaha. "If sufficient members do resign, the committee will no longer be able to operate," King said. Scientist and Labor MP Robert Winston said Nutt had a "very reasonable" point about the relative dangers of legal and illegal drugs, and that he was disappointed by the firing. "I think that if governments appoint expert advice they shouldn't dismiss it so lightly," he said. "I think it shows a rather poor understanding of the value of science." Reuters reported Saturday that the firing is causing consternation in scientific circles. Scientists told the news agency the decision could undermine the integrity of science in policy-making, including critical areas like health, the environment, education, and defense. "Scientific data and their independent interpretation underpin evidence-based policy making -- and nobody rational could possibly want a government based on any other type of policy making," said Chris Higgins, chair of an advisory committee on spongiform encephalopathy, or "mad cow" disease. Maurice Elphick, a professor of animal physiology and neuroscience at Queen Mary, University of London, said politicians should look elsewhere if they wanted data to back social policies and allow science to maintain objectivity. "If, however, politicians really do want to have an objective assessment of the relative risks to health of different recreational drugs, then they should listen to what the medical scientist has to say, not sack him." he said. The Labor government has picked a fight with science. It's unclear how this will all play out, but Labor doesn't seem to be doing itself any favors so far.

At last, a solution to the problem of not being able to get high during a brain scan:

Smoking during a brain scan is not easy. Why would you want to? Because functional magnetic resonance imaging (fMRI) allows researchers to observe activity in the brain, and doing so while smoking tobacco or pot could enhance our understanding of addiction and how to treat it.
…

Displaying skills that would put MacGyver to shame, Frederick constructed a makeshift water pipe inside of a picnic cooler, then ran 2.4 meters of tubing to a plastic facemask that rests inside of the scanner. Since the mask is made from materials that are not magnetic, it will not interfere with the imaging. [Wired]

In college, my friend Derek conducted some remarkably similar research. Lacking an MRI scanner, he simply conducted informal interviews to see how the device affected participants.

To be sure that the contraption can get people high, Lindsey and her associates asked nine volunteers to inhale smoke from a marijuana cigarette with exactly 3.51 percent THC, then checked to see how much of the drug made it into their blood. Using the mask, the subjects got almost as high as if they had puffed on a joint directly. The researchers suggested using stronger weed to achieve more realistic effects.

These people are geniuses. Next they need to build a device to administer nachos during a brain scan. Hypothesis: Scott Morgan will experience feelings of contentment.

Mark Kleiman is one of a relatively small number of US academics who thinks and writes about drug policy. I don't always agree with him—especially his proposals for licensing drug users, higher alcohol taxes, and "coerced abstinence"—but his work is thoughtful, and, after listening to what passes for drug policy discourse among the political class, a veritable breath of fresh air. Kleiman is at it again this week, with a lengthy article, "Dopey, Boozy, Smoky—And Stupid," in the magazine The American Interest. After noting that 35 years into the war on drugs, the country still has a massive drug problem, as well as a massive police and prison apparatus aimed at drug users and sellers, Kleiman observes that no policy is going to eradicate drug use and what is needed is "radical reform." But real reform requires a better understanding of drugs and drug use, and that is where reality confronts mythology. As Kleiman notes, "most drug use is harmless," but drug abuse is not. That's quite different from "just say no." Similarly, he goes up against another drug policy mantra, this one popular with some reformers, that "drug abuse is a chronic, relapsing condition." That is true for only a minority of a minority of drug users, he correctly notes. After discussing some of the basics, Kleiman gets to the fun and thought-provoking part of his article—general policy recommendations:

These facts having now been set out, five principles might reasonably guide our policy choices. First, the overarching goal of policy should be to minimize the damage done to drug users and to others from the risks of the drugs themselves (toxicity, intoxicated behavior and addiction) and from control measures and efforts to evade them. That implies a second principle: No harm, no foul. Mere use of an abusable drug does not constitute a problem demanding public intervention. “Drug users” are not the enemy, and a achieving a “drug-free society” is not only impossible but unnecessary to achieve the purposes for which the drug laws were enacted. Third, one size does not fit all: Drugs, users, markets and dealers all differ, and policies need to be as differentiated as the situations they address. Fourth, all drug control policies, including enforcement, should be subjected to cost-benefit tests: We should act only when we can do more good than harm, not merely to express our righteousness. Since lawbreakers and their families are human beings, their suffering counts, too: Arrests and prison terms are costs, not benefits, of policy. Policymakers should learn from their mistakes and abandon unsuccessful efforts, which means that organizational learning must be built into organizational design. In drug policy as in most other policy arenas, feedback is the breakfast of champions. Fifth, in discussing programmatic innovations we should focus on programs that can be scaled up sufficiently to put a substantial dent in major problems. With drug abusers numbered in the millions, programs that affect only thousands are barely worth thinking about unless they show growth potential.

Hmmm, sounds pretty reasonable. Now, here is where Kleiman gets creative. Below are his general policy recommendations. I will leave the comments for others, but there is plenty to chew on here: