Sunday, 1 November 2009

Nutt's sacking

Much ink has been spilt on the David Nutt saga in the last few days. For the benefit of readers outside the UK, the amusingly named Professor Nutt was the chairman of the Advisory Council on the Misuse of Drugs until the government sacked him because he said that cannabis, LSD and ecstasy are less dangerous than alcohol and tobacco.

Daniel Hannan and Tom Harris, despite being on opposite ends of the political spectrum, are united in siding with the politicians. They say that it is for the government to make the final call on the classification of drugs. I agree up to a point, but do politicians also have to sack any experts who don't give them the advice they want to hear? This looks like a dangerous precedent to me.

I don't want to go over the arguments for and against this decision, but there are a couple of points that have been largely overlooked.

The Pub Curmudgeon's take on it echoes my own thoughts, which is that we shouldn't confuse David Nutt with a liberal.

Prof. Nutt’s message is as much anti-alcohol as pro-drug.

Indeed so, and it is a message that he has been pushing since March 2007 when The Lancet first published the top 20 drugs in order of their supposed harm. This showed cannabis in 11th place and ecstasy at 18th, while tobacco was at 9th and alcohol was at 5th.

I remember this story being in the papers at the time, but there was no backlash from politicians, despite Prof. Nutt saying things like...

"The current system is not fit for purpose. Let's treat people as adults. We should have a much more considered debate how we deal with dangerous drugs."

Nutt didn't say anything this week that he hadn't said back in March 2007. So why were there no sackings then? I think Rod Liddle hits the nail on the head in today's Sunday Times.

Nutt also pointed out the simple fact that cannabis is less dangerous than tobacco or alcohol, pretty much regardless of the strength of the dope; nobody disputes this, and nobody disputed it three years ago when Nutt first made the comparison. 

But at that point the government was busy trying to push through its bill to ban the smoking of tobacco in public places and what is now an unfortunate truth was then a useful propaganda tool.

Nutt's advice could be taken in one of two ways:

(1) Cannabis is less dangerous than tobacco and alcohol so let's ease up on cannabis

(2) Tobacco and alcohol are more dangerous than cannabis so let's clamp down on tobacco and alcohol. 

In 2007, it suited the government's cause du jour to adopt the second position. Today, having since upgraded cannabis to a class B drug - the government can no longer be seen to adopt the first position. But, as the Pub Curmudgeon says, Nutt's liberal attitude towards drugs does not extend to tobacco or alcohol. He has made it clear that if he had his way, cannabis would be a class C drug, but alcohol would be a class B drug. They would both be illegal.

Whatever their differences, David Nutt and the government are united in wanting to see fewer people taking any of the substances in The Lancet's top 20. Nutt's dismissal, and several subsequent resignations, have all been caused by a dispute over whether certain drugs should be in Class B or Class C. What goes unmentioned is that once a drug is criminalised, it makes no difference what class it it put in.

By the government's logic, upgrading cannabis to class B should make fewer people smoke it. But if that is true, we should have seen more people smoking it after 2004, when the Blair government downgraded it from class B to class C. As we can see from this graph [PDF], the opposite happened.

After rising for several years, rates of cannabis use dropped by a third after it was downgraded. I would never suggest that this drop was due to the reclassification itself (I'm always reluctant to use the post hoc proptor hoc logic of the 'heart miracle' cranks) but we can surely agree that cannabis use did not rise after it was downgraded. What, then, is the point of upgrading it? 

Most public health policies are expensive failures (see Ireland for a recent example). Drug classification is only a talking point for academics and the political class. It is, quite simply, irrelevant to the people who use drugs.

I'd be prepared to bet that most cannabis users have no idea which class their drug is in and that they wouldn't alter their intake even if they knew. It is a peculiar vanity of politicians to believe that the public will alter its behaviour as a result of them reclassifying drugs, creating new targets or changing recommended daily limits. 

David Nutt and Alan Johnson are like two bald men fighting over a comb. Resign on principle, by all means, but don't imagine that moving a drug from one class to another is going to make any difference to how many people take it.


Ben said...

Chris, I think there is a typo in the first paragraph. It should rather read:
"cannabis, ecstasy and LSD were less dangerous than alcohol and tobacco"

Christopher Snowdon said...

Cheers Ben. I've corrected it now.

Unknown said...

But moving a drug from one class to another does change the penalties for dealing (from memory up to life for class A?) which would have an impact on enforcement at the supply end.

While I agree that changes in classification system aren't likely to be particularly meaningful to the user, they're useful to the criminal justice system, so carefully considering where to place a drug isn't a completely futile activity.

Unknown said...

Chris, I posted this in Siegal's blog in response to your request there but just in case... The text of the NZ acute effects study he's talking about seems to be here. Full report, page 98 onwards.

The link above is provided as the reference in the published article to the bit that talks about acute effects.

What's my prize?

Christopher Snowdon said...

Thanks Blueblack, your prize is a warm glow and a probable mention in my next blog post! Regarding your other post, I agree that the classifications are there to set levels of punishments but surely the idea is that the greater the punishment, the lower the offending rate. Between 2004 and 2008 there was effectively no punishment, just a warning, so cannabis use should have soared. It did the opposite. So what's the point?

Unknown said...

I've spent some time looking at the original paper and I'm certainly not convinced by it. Apart from anything else the paper explicitly states:

direct comparison of the scores for tobacco and alcohol with those of the other drugs is not possible since the fact that they are legal could affect their harms in various
ways, especially through easier availability.

It also takes averages of scores of various harms that I think is not a very useful way to proceed. I've written about this in more detail here.