Drug Laws vs. Drug Harms

Although science is not in the business of ordaining moral or social values, it can inform moral and social decisions. For example, people who take a moral stance in support of stem cell research usually do so as a consequence of their understanding of elementary principles of biology. Similar moral and social decisions that should be informed by scientific evidence are those that pertain to our drug laws. Statements of concern regarding the health of citizens, or relating to their productivity, appear to serve as distraction manoeuvres within drug law debates—the legality of both alcohol and tobacco attest to this fact. 

Here in the UK, illegal drugs are placed into one of three classes, A (most harmful), B or C (least harmful). This classification system allows politicians and police officers to determine an appropriate jail sentence for an individual caught possessing or supplying a banned substance. Now then, if you clicked the preceding link you will have found that cannabis was reclassified from Class C to Class B in January of 2009, that move was made by Gordon Brown’s government, in spite of the scientific evidence. Simply declaring by fiat that “cannabis should be in Class B because it is lethal in the form of skunk” in the face of enormous bodies of evidence that demonstrate the relative safety of cannabis makes a mockery of the government, the police, and far more importantly—science. Ignoring expert scientific advice in this manner will inevitably lead to the disillusionment of the general public and serves only to undermine any genuine future advice regarding drug misuse. In the appendix to the Challenger shuttle disaster report, Richard Feynman famously wrote:

For a successful technology, reality must take precedence over public relations, for nature cannot be fooled. 

The exact same can be said of The Misuse of Drugs Act, in order for it to be successful; politicians must accept and value the opinions of those who best understand the character of nature—the scientific experts. In their paper ‘Development of a rational scale to assess the harm of drugs of potential misuse’ Prof David Nutt, Dr Leslie A King, William Saulsbury and Prof Colin Blakemore made some very interesting comments relating to the current UK drug classification system:

The current classification system has evolved in an unsystematic way from somewhat arbitrary foundations with seemingly little scientific basis.

In their paper they set out to provide a,

new system for assessing the potential harms of individual drugs on the basis of fact and scientific knowledge. This system is able to respond to evolving evidence about the potential harm of current drugs and to rank the threat presented by any new street drug.

Some of the facts laid out in the paper's introduction were enlightening:

• Tobacco and alcohol together account for about 90% of all drug-related deaths in the UK.
• Estimates suggest that smoked tobacco is the most addictive commonly used drug, with heroin and alcohol somewhat less so; psychedelics have a low addictive propensity.
• Tobacco is estimated to cause up to 40% of all hospital illness and 60% of drug-related fatalities. 
• Alcohol is involved in over half of all visits to accident and emergency departments and orthopaedic admissions.

The results of the study are even more interesting; Figure 1 (pictured below) displays the mean harm scores for 20 substances. Classification under the Misuse of Drugs Act, where appropriate, is shown by the colour of each bar:

http://www.thelancet.com/journals/lancet/article/PIIS0140673607604644/images?imageId=gr1&sectionType=green

Figure 2 (posted below) shows the correlation between the mean scores from the independent experts and the specialist addiction psychiatrists: 

[1=heroin. 2=cocaine. 3=alcohol. 4=barbiturates. 5=amphetamine. 6=methadone. 7=benzodiazepines. 8=solvents. 9=buprenorphine. 10=tobacco. 11=ecstasy. 12=cannabis. 13=LSD. 14=steroids.]

http://www.thelancet.com/journals/lancet/article/PIIS0140673607604644/images?imageId=gr2&sectionType=green

The following table, published in the results section, gives a comprehensive overview of the data obtained (click to enlarge):

http://www.thelancet.com/journals/lancet/article/PIIS0140673607604644/table?tableid=tbl3&tableidtype=table_id&sectionType=green

During the analysis of the data, the following comment was made:

Interestingly, alcohol and tobacco are both in the top ten, higher-harm group. There is a rapidly accelerating harm value from alcohol upwards. So, if a three-category classification were to be retained, one possible interpretation of our findings is that drugs with harm scores equal to that of alcohol and above might be class A, cannabis and those below might be class C, and drugs in between might be class B. In that case, it is salutary to see that alcohol and tobacco—the most widely used unclassified substances—would have harm ratings comparable with class A and B illegal drugs, respectively.

Unfortunately, as is the case with almost every paper ever written, some of the data is not completely independent:

Participants were asked to assess the harm of drugs administered in the form that they are normally used. In a few cases, the harms caused by a particular drug could not be completely isolated from interfering factors associated with the particular style of use. For example, cannabis is commonly smoked as a mixture with tobacco, which might have raised its scores for physical harm and dependence [my emphasis], among other factors.

Even with a possible bias towards higher harm scores for cannabis, the table of results above illustrates that alcohol is, in every respect measured during this particular study, a more harmful drug. In truth, this is not surprising. Alcohol has been known to be addictive for decades; it is also common knowledge that alcohol’s lethal dose is achieved relatively easily. Moreover, the role alcohol plays in car crashes, violence, injury, unplanned pregnancy and the spared of STD’s is beyond dispute. When consumed over many years it can lead to cirrhosis of the liver and severe neurological impairments, and, eventually, to death. Alcohol is also devastatingly toxic to a developing fetus (it appears that “crack babies” have actually been suffering from fetal-alcohol syndrome). Few, or arguably none, of the above charges can be levelled at cannabis. In fact, cannabis has several medical applications and has no known lethal dosage. In the US alone, drugs like ibuprofen and aspirin cause approximately 76,000 hospitalisations and 7,600 deaths per year, while cannabis kills no-one.

A further point of contention that usually arises in these debates is the apparent role that cannabis plays as a “gateway drug”. The “gateway” effect has by no means been conclusively demonstrated and alternative explanations appear to be more plausible. Moreover, almost everything human beings do – driving  cars, playing contact sports, riding bicycles – is more dangerous than smoking cannabis in the privacy of one’s home. Professor David Nutt articulated this point nicely in his paper ‘Equasy – An overlooked addiction with implications for the current debate on drug harms’:

There are many risky activities such as base jumping, climbing, bungee jumping, hang-gliding, motorcycling which have harms or risks equal to or worse than many illicit drugs. Of course, some people engage in so called ‘extreme’ sports specifically because they are dangerous[…] So why are harmful sports activities allowed, whereas relatively less harmful drugs are not? I believe this reflects a societal approach which does not adequately balance the relative risks of drugs against their harms.

Society’s distorted perception of drug harms can be, at least in part, attributed to poor media coverage. A study of a decade of media reporting of drug deaths in Scotland illustrates the media’s warped perception on this matter. During the decade studied, the likelihood of a newspaper reporting a death for each drug named is as follows:

• Paracetamol: 1 in every 250 associated deaths reported in newspaper. 
• Diazepam: 1 in every 50 associated deaths reported in newspaper.
• Amphetamine 1 in every 3 associated deaths reported in newspaper 
• Ecstasy: every associated death reported in newspaper.

Clearly, the media’s quasi-pornographic obsession with deaths that are associated with illegal drugs does not help the situation. I’m sure many of the same people who were appalled after reading those newspaper articles about ecstasy will have lit a cigarette or poured themselves a glass of wine in order to calm down, probably not realising that alcohol and tobacco cause more physical harm and higher dependence than the drug they just read about! A further example of poor media coverage of drug harms can be found in the video below. Note that the interviewer has not even bothered to read the paper that she is trying to criticise:



The fact that people are being imprisoned for using cannabis, while alcohol and tobacco remain readily and legally available, is without doubt the reductio ad absurdum of any belief that drug laws are implemented in order to lessen the damage people do to themselves and others. Laws that prevent healthcare institutions from providing addicts with fresh needles must surely have an adverse effect on the rates of transmission of blood-borne diseases such as hepatitis C and AIDS. Also, since the dosage, concentration and purity of illegal drugs remains a matter of guesswork for most addicts, the rates of overdose and poisoning remain needlessly high (as they were for alcohol during prohibition). Furthermore, laws that limit the availability of opiate painkillers intended for medical use achieve little more than to keep terminally ill patients suffering unnecessarily in their final weeks of life. The prohibition of drugs ultimately leads to the imprisonment and vilification of thousands of otherwise productive and law-abiding citizens. Sometimes violent criminals—murders, rapists, and child molesters—are paroled to make room for such people. The total cost of US drug laws—when one factors in the expense to state and local governments and the tax revenue lost by the US’s failure to regulate the sale of drugs—could, according to some sources, be in excess of $20 billion dollars each year . To say nothing of police resources that might otherwise be used to fight violent crime and terrorism. 

It is truly tragic that people are being prosecuted and imprisoned for choosing, voluntarily, to use drugs that are scientifically proven to be less harmful than alcohol, tobacco and horse-riding.