Pubdate: Wed, 01 Jun 2016
Source: Guardian, The (UK)
Copyright: 2016 Guardian News and Media Limited
Author: David Nutt
Note: David Nutt was chair of the advisory committee on the misuse of 
drugs until 2009 and is author of Drugs: Without the Hot Air


This Act Drives Users Back Towards Illegal Drugs and Alcohol, the 
Most Dangerous Substance of Them All

With the Psychoactive Substances Act 2016, ministers last week banned 
the sale or procurement of any substance that has psychoactive 
activity, regardless of whether it is harmless or even useful. The 
sole exceptions are alcohol, nicotine products and caffeine.

The main justification for this draconian piece of legislation is to 
make it easy for the police and local authorities to close down "head 
shops", or at least to stop them selling so-called legal highs: drugs 
such as nitrous oxide; some synthetic cannabinoids, salvia, and some 
weak stimulants known as bubbles or sparkle. The act is based on the 
false premise that legal highs are responsible for up to 100 deaths a 
year, when in fact the true number is fewer than 10. Media hysteria 
about the use of nitrous oxide by a few footballers and a dislike of 
young people doing something different from their parents has also 
played a part.

My own view is that this new act is part of a systematic campaign by 
successive governments to pretend to be doing something about drugs, 
so enabling them to ignore the most harmful ones: tobacco, alcohol 
and heroin. Legal highs have become a new moral panic in the same 
vein as those created previously for cannabis, cocaine  and most 
recently mephedrone.

As tobacco is responsible for more than 80,000 premature deaths a 
year, alcohol for more than 25,000 and heroin and other opioids for 
about 1,500, one might imagine that these would be the main targets 
for drug policy interventions. But they are not, because this 
government and the last Labour administration have continued with a 
policy whose primary measure of outcome is the number of users, 
rather than the harms of drug or alcohol use. I sometimes suspect 
that the instigators of this policy feel that the number of dead 
users aids their target, since death stops them being counted.

This measure - use as opposed to harm - has distorted not only the 
approach to new drugs but also the way drug dependence is tackled in 
the UK. Instead of using approaches to minimise deaths, current 
policy promotes abstinence above other interventions.

Undoubtedly, abstinence can work. But most people with drug and 
alcohol dependence who stop using relapse at least once before 
becoming stably abstinent, and many relapse multiple times. In each 
of these relapses they are particularly vulnerable to the effects of 
the drugs they start using again, since they have lost the tolerance 
that they had acquired. This loss of tolerance means a significant 
proportion die in their relapses, examples being the singer Amy 
Winehouse, who died from alcohol poisoning when she resumed drinking, 
and the actor Philip Seymour Hoffman, who died from a heroin relapse.

A proven way to reduce deaths from relapse is to use medicines that 
substitute the dependent drug but which are safer. For heroin, these 
are methadone and buprenorphine; for alcohol, sodium oxybate or 
baclofen. Safer medical alternatives also exist for nicotine, such as 
varenicline; and for cocaine, such as amphetamine or modafinil.

Given the principle that safer substitutes can work when used 
medically, it makes sense to encourage the use of safer alternatives 
to illegal drugs. An excellent instance of this was when mephedrone 
(also known as cat or meow meow) hit the UK in the latter half of the 
2000s. This is a moderate stimulant with actions similar to cocaine 
and amphetamine but with less power-per-unit dose.

When it was first sold, mephedrone was legal, and rapidly became very 
popular, with hundreds of thousands of users in the UK. The resultant 
media and police panic led to its being banned within a couple of 
years, despite few, if any, deaths. However, during the period of 
legal mephedrone popularity, deaths from cocaine  which over the 
preceding decade had risen inexorably year on year - fell 
precipitously. Amphetamine deaths also fell by a similar percentage. 
The most plausible explanation is that people switched to mephedrone 
because it was legal, pure and less toxic.

I have estimated, based on the ONS statistics, that mephedrone 
probably saved more than 300 deaths from cocaine and amphetamine 
while it was legal. Since it has been banned the fall in cocaine 
deaths has reversed, and last year reached a new UK record of nearly 
250. Amphetamine deaths have also risen, and there has been a 
resurgence in MDMA use.

Many young people, including professional footballers, have used 
legal highs such as nitrous oxide in order to avoid more dangerous 
intoxicants. Now the only intoxicant they are allowed to use legally 
is alcohol, which research by me and others - published in the Lancet 
in 2010  showed was the most harmful drug in the UK.

The new act means that safer and less dependence-producing 
alternatives to alcohol would now be illegal, as would safer 
alternatives to nicotine. Thus innovative approaches to health 
improvement have been snuffed out for a purely symbolic, politically 
motivated gesture to close head shops and appease elements of the media.

I predict that in a few years' time, the data on the impact of this 
act will reveal the same results as the Irish ban of six years ago 
did - that is, more use from the black market and internet supplies, 
and more drug-related deaths. But will anyone in government care?
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MAP posted-by: Jay Bergstrom