The Scientific Activist

Yesterday, the House of Commons Science and Technology Committee released a report entitled Drug Classification: Making a Hash of It?, which challenges the logic behind current drug classifications in the UK, especially when tied to legal penalities. The report discusses specific cases where drugs were misclassified or their classifications were changed for political, rather than scientific, reasons. The report is particularly critical of the Advisory Council on the Misuse of Drugs (ACMD) for not doing enough to push for a more scientifically based drug classification system.

The conclusions of the report were based on findings from extensive observations and oral and written testimony. Of particular interest, though, is one of the sources, which can be found buried in the appendices of the report. The ACMD recently conducted a study on how well drug classification correlates to the actual health risks of those drugs. The findings are, frankly, astonishing and deserve quite a bit more publicity, since they turn current drug dogma on its head. Unfortunately, as far as I can tell, the only place this study has been published is in the back of the larger Science and Technology Committee report (specifically on pages Ev 110-Ev 117 of the pdf, although The Independent also published a nice summary of the rankings).

In the US, drugs are classified primarily by schedules, which divide up drugs into five schedules based on their relative medical utility compared to their potential for abuse and dependence. Drugs in Schedule I have “no currently accepted medical use in treatment” and are considered to be particularly dangerous. Drugs in Schedules II-V have accepted medical uses and decrease in danger as the schedule increases. This system is problematic, because it lumps together very different substances, including heroin, marijuana, ecstasy, LSD, psilocybin, into Schedule I.

The UK also uses drug schedules, but it additionally divides drugs into three classes strictly on their perceived health risks. Drugs in Class A are considered the most dangerous, those in Class C the least. Drug enforcement is carried out in accordance with these classifications, which makes sense, since hard drugs like heroin and cocaine are placed in Class A and treated distinctly from the softer drug marijuana, which was recently downgraded to Class C.

Still, drug classification has hitherto been less than scientific, and the recent ACMD study highlights just how out of whack some of the classifications are. In order to evaluate the current classification scheme, the ACMD had various addiction experts evaluate the danger of different drugs using nine parameters (acute harm, chronic harm, IV harm, intensity of pleasure, psychological dependence, physical dependence, intoxication, other social harms, and healthcare costs). The values from each parameter were combined, giving each drug a single rating. The results are pretty surprising:

i-3b49e3d17204db18b42306fb36d3e154-drug study bbc.gif

Image from the BBC

The Class of a drug appears to have little to no relation to its actual danger. Although heroin and cocaine, both Class A drugs, received the highest harm ratings, other Class A drugs (ecstasy, LSD, and 4-MTA (an amphetamine derivative)) were rated as being less harmful than alcohol or even tobacco. In fact, of the twenty substances surveyed, alcohol was (it pains me to say) ranked the fifth most harmful.

Now, I don’t think anybody is saying we need to outlaw alcohol (come one, we’re not Puritans here), but this is food for thought. The Science and Technology Committee report says it best:

In our view, it would be unfeasible to expect a penalty-linked classification system to include tobacco and alcohol but there would be merit in including them in a more scientific scale, decoupled from penalties, to give the public a better sense of the relative harms involved.

In particular, the onus is now on lawmakers to defend exactly why ecstasy, LSD, and 4-MTA belong in Class A, if experts judge them to be not particularly dangerous.

The good news for the UK’s drug classification system is that the placement of marijuana in Class C appears appropriate. This is in line with the results of another recent study that found that smoking marijuana isn’t as dangerous as once thought. Things aren’t looking so good back in the US, though, where marijuana is still a Schedule I drug, despite potential medical uses. So, even though the UK’s system isn’t perfect, it’s beats what we have in the US, where the war on drugs continues to spin out of control.

This study is a great example of the importance of taking science into account in formulating policy. Clearly, if science superseded politics (ha!), then the UK’s drug classification system would be much different. Although the study at hand is a great start, though, it is still somewhat subjective, since it just relies basically on survey data. If anything, its results indicate the dire need for more studies in this area. That doesn’t mean the results from the current study aren’t compelling, or even conclusive, since, for example, a sample of psychiatrists were surveyed as well, and came up with very similar results to those of the addiction and drug experts, whose data is shown above.

Although magic mushrooms, or their active substance psilocybin, were not evaluated in the ACMD survey, the Science and Technology Committee report explored their classification as a Class A substance and found serious issues here. The government used a roundabout way of placing magic mushrooms in Class A, and did not appear to take scientific evidence into account in doing so. The report, though, places a lot of the blame on the ACMD for not speaking out against this, “despite the striking lack of evidence to suggest that the Class A status of magic mushrooms was merited on the basis of the harm associated with their misuse.” The placement of magic mushrooms in Class A seems particularly absurd, considering that in addition to their relative lack of major side effects, a recent study (with very sound methodology) found that controlled usage of psilocybin can regularly induce intense and positive spiritual experiences.

One of the primary recommendations of the Science and Technology Committee reports is that, due to the inconsistencies in and the ephemeral nature of the classification system, penalties for drug possession should not be tied to a classification scheme. Beyond the fact that the report does not propose an alternative model, I would disagree with this assertion on principle. Especially if one has a scientifically valid classification system, why shouldn’t that be tied to penalties. For example, I would certainly not expect one to have the same penalty for possession of marijuana as one would for heroin, and based on the results of the ACMD study, several other drugs should be downgraded to marijuana’s status as well. When most major drugs are lumped into a single category, as in the US, many more problems can arise. A great example of this is the much higher penalty for possession of crack (a drug used more commonly by minorities and the less wealthy) as opposed to cocaine (a drug of choice for many upper class whites), despite both having the same active ingredient. Clearly, that’s not based on science.

Of course, a good and comprehensive drug policy should rely on education and treatment over punishment, and when penalties come into play, they should be targeted toward dealers over users. Also, the need for legal penalties for the recreational use of soft drugs could also be debated. With that said, it appears that for the most part the UK’s drug policy is heading in the right direction. Before it’s acceptable, though, scientific studies such as the one by the ACMD need to be taken into account in determining drug classifcations. After all, I’d much rather have a drug policy based on fact than on fiction.


Note: Jake Young also gives his two cents on this issue over at Pure Pedantry.

Comments

  1. #1 natural cynic
    August 1, 2006

    I would assume that the amphetamine category is for oral d-amphetamine/methamphetamine. For street durgs in the US, I would guess that smoked crystal meth would be much farther to the left on the graph.

  2. #2 Wade
    August 1, 2006

    How can you describe as “scientifically valid” a study that uses “intensity of pleasure” as an indicator of harm. The core reason for using recreational chemicals is to gain pleasant sensations; the use of this as an indicator of harm just means that drugs will be rated as harmful in direct proportion to their desirability.

    “Intoxication” has similar logic problems.

  3. #3 Nick Anthis
    August 1, 2006

    Although I think “intoxication” might be a more valid indicator (since intoxication can affect motor ability, etc.), I can still see the logic behind using “intensity of pleasure” since a drug becomes more dangerous the more desirable it is. That alone doesn’t make it dangerous, but I don’t see a problem with factoring it in.

  4. #4 daksya
    August 1, 2006

    A great example of this is the much higher penalty for possession of crack (a drug used more commonly by minorities and the less wealthy) as opposed to cocaine (a drug of choice for many upper class whites), despite both having the same active ingredient. Clearly, that’s not based on science.

    Why do you say that?

    It happens to be not based on science, as it was the cheap price of crack that prompted a greater deterrent effect.

    But having the same “active ingredient” doesn’t mean much since the end effect depends critically on dose and method which is where coca, coke powder and crack cocaine differ by leaps and bounds. See reference here (scroll a bit down).

  5. #5 Nick Anthis
    August 1, 2006

    While you raise a good point, I think it’s clear that the shear magnitude of the disparity in legal treatment of these two drugs cannot be justified by pricing alone. For example, by federal law, one would have to be caught selling 100 times more cocaine than crack to to receive a mandatory five year sentence. Also, possession of cocaine is just a misdemeanor, while possession of crack is a felony. This is bad enough, but it should raise a distinct red flag when one looks at the racial demographics affected by this disparity.

  6. #6 daksya
    August 1, 2006

    it’s clear that the shear magnitude of the disparity in legal treatment of these two drugs cannot be justified by pricing alone

    It’s not price alone.

    It’s both

    1)quite greater addictive potential of crack (the UK govt claimed, in a 2003 report, 79% of past-year crack users as dependent, as opposed to 12% of powder cocaine users.
    2)cheaper price.

    You seem to be insinuating that the grossly disproportionate racial
    effect to be an intention of the legislation. I think that ended up being the outcome due to the two factors I mentioned, especially the second. The disparity exists because of the “Stop the apocalypse” typical panic-mode legislation, IMHO, not “let’s screw those n********”.

  7. #7 Nick Anthis
    August 1, 2006

    Whether it’s cause or effect, the result is the same, and it’s deplorable.

  8. #8 Wade
    August 2, 2006

    “A drug becomes more dangerous the more desirable it is” is an astonishing non sequitur. “Desirability” and “dangerousness” are logically unrelated concepts. For example, prussic acid scores as maximally dangerous (consumption of small quantities leads to prompt death) but with zero desirability or intensity of pleasure, whereas consumption of marijuana gives a high intensity of pleasure with negligible health effects, which should give it a very low “dangerousness” score.

  9. #9 Hyperion
    August 2, 2006

    There is one small problem with basing penalties on a drug’s classification, whether current classification or one based on that graph or future studies:

    One of the parameters used to determine the relative danger of these drugs involved their addictive ability (actually, two parameters, since they separated physical and psychological dependence). So if one based penalties based in part on the addictive nature of the drug, the system would be meting out greater punishment in the very situations where the defendants have the least ability to stop using.

    Of course, this only highlights the absurdity of attempting to use criminal penalties to solve a public health problem, but as you said (or meant to say), policymakers rarely pay attention to the science cited by policy analysts.

  10. #10 Nick Anthis
    August 3, 2006

    In response to Wade’s comment, I will repeat what I said before. Desireability alone doesn’t make a drug more dangerous. However, if two drugs are equally harmful, the more desireable one would overall be more dangerous. If nobody has any desire to use a drug, then that drug isn’t something to be as concerned about.

    In response to Hyperion’s comment, I think that’s a good point. Clearly, drug policy should be based primarily on treatment, since addiction is a disease, with penalties reserved primarily for dealers. Either way, I think it makes more sense to base our drug policy on drug classifcation, rather than lumping everything together and relying on inconsistent and more subjective decisions.

  11. #11 Colin
    August 3, 2006

    While interesting this study has some serious holes. As others have mentioned there can be a drastic difference between drugs based on their method of use. Crack and meth are great examples of this where smoking (or injecting) causes a massive rush, which is very different and more addicting than snorting cocaine or amphetimine.

    I’ve seen other studies that show smoked meth to be more addictive than heroin, so this particular chart seems really lacking.

    Additional, aspects of this chart stand out to me too like the rating of LSD verses ecstasy. Granted they are both about the same here, but LSD has a much greater safety record and less of a record for addiction.

    Several of the variables they are using are very opinion based, and I think they face a problem when they try to roll them all up together in one umbrella score.

  12. #12 Chris Hyland
    August 3, 2006

    In some ways the government are tied by public opinion. For example if you want to reduce the number of people who die taking esctacy, the best way to do that is to provide information on how to take it safely. Im assuming that in its current status this would be illegal, and that it would be seen as engouraging use even if it was presented in the form ‘you really shouldnt take it, but if you do …’. The problem is that thousands of people do take it, and it is simply not within the governments power to stop them.

    “Clearly, drug policy should be based primarily on treatment, since addiction is a disease, with penalties reserved primarily for dealers.”

    I completely agree, at the moment it’s the only disease where people refuse to get treatment for fear of going to prison.

  13. #13 Nick Anthis
    August 3, 2006

    I think the Netherlands’ drug policy is in interesting model to take a look at. Despite legalizing soft drugs, drug use is no more rampant there than elsewhere and drug use is generally lower.

    In response to Colin’s comment, I think you’re right that the study has plenty of holes and is still uncomfortably subjective, but it’s a great starting point for future more in depth research. Based on the results of this study, there’s clearly a great need for that.

  14. #14 Wade
    August 3, 2006

    In response to your response to my previous comment, you seem to believe that dangerousness and harmfulness are different things. If drug A produces one fatality per thousand users per year, while drug B produces one fatality per ten thousand users per year, drug A is ten times as harmful and ten times as dangerous as drug B. This is true even if drug B is used by one hundred times as many people and therefore produces ten times the crude fatality rate.

    A ridiculous example of where your thinking leads would be this “Expensive vintage wine is more desirable than cheap plonk; both are equally harmful to your health; therefore expensive vintage wine is more dangerous than cheap plonk.”

  15. #15 Nick Anthis
    August 3, 2006

    Whoa, slow down there, Wade. Clearly we’re not on the same page here. I assumed that it goes without saying that when I’m talking about danger or harm, I’m talking about them in terms of rates. So, to clarify my earlier statement, when I say “if two drugs are equally harmful, the more desirable one would overall be more dangerous”, I mean that if two drugs have the same number of bad effects (incidents of addiction, deaths, etc.) per use, then I think it’s obvious that the more desirable one is more dangerous (and, I’m using “harm” and “danger” interchangeably). Now, please explain what’s wrong with that logic.

  16. #16 Joseph j7uy5
    August 8, 2006

    Expensive vintage wine would be more dangerous than cheap plonk, if they both cost the same, but that obviously is not possible (by definition); you also have to assume that the price reflects the desirability of the product.

    You have to look at the variables one at at time, holding the others constant.

  17. #17 zhongliu
    April 21, 2007
  18. #18 Rachel Smith
    March 29, 2011

    I’m glad i found this, it is so helpful. Thanks for sharing your knowledge and help them to know that alcohol and tobacco are more harmful than marijuana, LSD or ecstasy. Good post

  19. #19 what is molly
    May 13, 2012

    Well, I must say its about time that an official report has surfaced solidifying many of the claims within the “drug scene”. Notice that many previous claims of MDMA deaths are actually “MDMA Related”.

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