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What is our government on?

In October 2009, Professor David Nutt of Imperial College London, chairman of the Advisory Council on the Misuse of Drugs (ACMD), was sacked by home secretary Alan Johnson. Professor Nutt had long been outspoken in his criticism of the government's approach to drugs, famously criticising the decision to re-classify cannabis back to class B from class C, against the ACMD's advice. Nutt was sacked ostensibly because he had caused “confusion between scientific advice and policy”. Controversy ensued, with many in the scientific community pointing out that the comments were made in professional arenas, separate from the Professor's advisory role. The situation raises questions about the influence of scientific advice on government drug policy. How exactly does the government make decisions regarding drug safety and classification in the UK? To what extent is scientific advice heeded?

The UK's current 'ABC' drug classification system is based on the Misuse of Drugs Act (1971) , which also established the ACMD. The act was intended to “make it possible to control particular drugs according to their comparative harmfulness either to individuals or to society at large when they were misused”. Accordingly, the penalties for those caught using class A drugs are more severe than for class C. Despite this, the only rationale for classification was that it was “the order in which we think they should be classified of harmfulness and danger”, and supporting evidence has never been provided. In fact, the implicit justification for classification itself, that higher penalties act as a greater deterrent, leading to less damage to individuals and society, is itself unproven.

Given the arbitrary nature of the initial classification, has subsequent scientific input been employed to improve the system? The degree to which the government heeded the ACMD's advice is highlighted in a 2006 report by the Commons' Science and Technology Committee (Drug Classification: Making a Hash of it?). Firstly, the much debated cannabis. Following years of recommendations by the ACMD, the government decided in 2004 to downgrade cannabis to class C, based on comparisons with the generally more harmful drugs in class B (e.g. amphetamines). The change resulted in reported savings of 199,000 police hours in the following year. Meanwhile, continuing research had suggested links between schizophrenia and perceived increases in the potency of some cannabis products. The ACMD was consulted again in 2005 but concluded that “the consumption of cannabis is neither a necessary, nor a sufficient, cause for the development of schizophrenia”. It was against this backdrop that a decision was made in 2008 to move cannabis back to its present class B position; the then home secretary Jaqui Smith said she was 'playing it safe'. In a less publicised action, fresh 'magic mushrooms' were placed in the class A category in 2005, alongside their dried and prepared counterparts. The government did not consult the ACMD in this clarification, leaving a relatively innocuous fungus, responsible for a single death between 1993 and 2000, in the same class as heroin, which was responsible for 5,737. Similarly, no consultation was made prior to assigning ecstasy to class A in 1977, where it has remained ever since, despite its death toll being less than 3% that of heroin in 2004.

What about the ABC system itself: are there better systems available? There are certainly more rational approaches. The US classifies drugs based on five 'schedules' related to potential for abuse and known medical uses, supervised by the Drug Enforcement Agency. The Netherlands has a simple two-part system based solely on the potential for damage to individuals and society; schedule I contains heroin, schedule II, cannabis. Professor Nutt, along with his colleagues, proposed a scale himself in The Lancet in 2007 that ranks substances by physical harm, dependence, and damage to society. Of 20 drugs, heroin is public enemy number 1, alcohol comes in at 5, with ecstasy coming close to the bottom of the pile at 18. A ranking such as this, tightly associated with potential damage, is a much more rational way to apportion the finite resources available for controlling drug use.

Inevitably government policy is heavily influenced by public opinion, leading to actions designed to win votes more than solve problems. When such actions fly in the face of reason, attention and resources are diverted away from the true problems, with the result that we all lose out. Professor Nutt will continue to provide a focus for this debate through his new Independent Scientific Committee on Drugs. In January 2010 his less strident successor, retired Oxford Professor Les Iversen took up his post as chair of the ACMD. The knowledge and experience of these two men could be invaluable to government - provided someone is listening.

Jon Manning is a postdoc in the Centre for Cardiovascular Science


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