Back in August, I reported on an ACMD study buried in the back of a UK government report. The study gave strong evidence that the current drug classification scheme in the UK was fundamentally flawed and was not based on the actual danger of a given drug. The study has now been published in this week's issue of The Lancet (David Nutt, Leslie A. King, William Saulsbury, Colin Blakemore. "Development of a rational scale to assess the harm of drugs of potential misuse" The Lancet 369, 2007 1047-53). The Guardian also has a nice piece on it today. The bottom line is that the current unscientific drug classifcations that the UK (and the US) currently rely on need to change. Now.

Here's what I originally wrote:

(1 August 2006) 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 penalties. 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:

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 classifications. After all, I'd much rather have a drug policy based on fact than on fiction.
 
 

http://scienceblogs.com/scientificactivist/2007/03/study_finds_alcohol_and_tobacc_1.php

Professor David Nutt, a senior member of the drugs panel which recommended the downgrading of cannabis, is calling for the current system of drugs classification to be widened, to reflect the dangers posed by excessive drinking.

The addiction expert says only 10 premature deaths a year in the UK can be blamed on ecstasy, compared with at least 22,000 attributable to drinking. He highlights the fact that alcohol is exempt from an official system of harm rating despite being the cause of 10,000 assaults a year, unlike ecstasy, which is not linked with violence.

Professor Nutt says in the latest edition of the journal Psychopharmacology that the Tory leader, David Cameron, is "correct in his logic" in suggesting that E, currently a class A drug, should be in a lower category than drugs such as heroin and cocaine.

The scientist, who chairs the Advisory Council on the Misuse of Drugs (ACMD) technical committee, writes: "Why is ecstasy illegal when alcohol, a considerably more harmful drug, is not? When we consider that the possession of a drug that is much less dangerous than alcohol can lead to a seven-year prison sentence, whereas alcohol use is actively promoted, perhaps David Cameron did not go far enough."

But Professor Nutt's comments have enraged drugs prevention charities, who say he is wrong to compare the harm caused by drugs such as ecstasy with the effect on health from excessive drinking.

"Ecstasy kills at random and there is a lot of cumulative harm," said David Raynes from the National Drugs Prevention Alliance. "Although there is a lot of harm from alcohol, very few people just die from drinking alcohol, but they do die from taking E. If the Government does downgrade E, then it sends a signal that it's less harmful than it was before."

Alcohol is more harmful and causes more deaths than the drug ecstasy, a leading scientist who advises the Government on drug safety is warning.

Professor David Nutt, a senior member of the drugs panel which recommended the downgrading of cannabis, is calling for the current system of drugs classification to be widened, to reflect the dangers posed by excessive drinking.

The addiction expert says only 10 premature deaths a year in the UK can be blamed on ecstasy, compared with at least 22,000 attributable to drinking. He highlights the fact that alcohol is exempt from an official system of harm rating despite being the cause of 10,000 assaults a year, unlike ecstasy, which is not linked with violence.

Professor Nutt says in the latest edition of the journal Psychopharmacology that the Tory leader, David Cameron, is "correct in his logic" in suggesting that E, currently a class A drug, should be in a lower category than drugs such as heroin and cocaine.
The scientist, who chairs the Advisory Council on the Misuse of Drugs (ACMD) technical committee, writes: "Why is ecstasy illegal when alcohol, a considerably more harmful drug, is not? When we consider that the possession of a drug that is much less dangerous than alcohol can lead to a seven-year prison sentence, whereas alcohol use is actively promoted, perhaps David Cameron did not go far enough."

But Professor Nutt's comments have enraged drugs prevention charities, who say he is wrong to compare the harm caused by drugs such as ecstasy with the effect on health from excessive drinking.

"Ecstasy kills at random and there is a lot of cumulative harm," said David Raynes from the National Drugs Prevention Alliance. "Although there is a lot of harm from alcohol, very few people just die from drinking alcohol, but they do die from taking E. If the Government does downgrade E, then it sends a signal that it's less harmful than it was before."

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