HTTP/1.0 200 OK Content-Type: text/html Alcohol 'Is More Dangerous Than Ecstacy'
Pubdate: Fri, 23 Mar 2007
Source: Daily Telegraph (UK)
Copyright: 2007 Telegraph Group Limited
Note: This figure from The Lancet was printed with the article
Referenced: The Lancet report


Alcohol is ranked much more harmful than the Class A drug ecstasy in a
controversial new classification system proposed by a team of leading

The table, published today in The Lancet medical journal, was drawn up
by a team of highly respected experts led by Professor David Nutt,
from the University of Bristol, and Professor Colin Blakemore, chief
executive of the Medical Research Council. advertisement

The authors proposes that drugs should be classified by the amount of
harm that they do, rather than the sharp A, B, and C divisions in the
UK Misuse of Drugs Act.

They say the basis of the Act is ill-defined, opaque, and seemingly
arbitrary and overestimates the risks of ecstasy, which kills around
ten people annually of the half a million people who use it every
weekend, while neglecting those of alcohol, a legal substance which
kills more than 300 annually by acute poisoning, and many tens of
thousands by road traffic accidents, cirrhosis, gut and heart disease.

In the paper, the team argues that it would make much more sense for
drugs to be reclassified on a rational basis that can be updated as
new evidence emerges, and more easily than the current rigid category
system now in use.

Prof Blakemore added that policies of the past four decades "clearly
have not worked", given the ubiquity and low price of illegal drugs,
and that fresh thinking is now required.

Today's call to overhaul the UK drug classification system, which will
be examined by the forthcoming UK Drug Policy Commission, is likely to
receive popular public support, according to research into attitudes
to drugs by the Academy of Medical Sciences' DrugsFutures project.

Harmful drugs are currently regulated according to classification
systems that purport to relate to the harms and risks of each drug.

However, "these are generally neither specified nor transparent, which
reduces confidence in their accuracy and undermines health education
messages," said Prof Blakemore.

"The most striking observation is that there is no statistical
correlation between this ranking of harm of drugs and the ABC

In the new system legal drugs, such as alcohol and nicotine, are
ranked alongside illegal drugs.

The new ranking places alcohol and tobacco in the upper half of the
league table. These socially accepted drugs were judged more harmful
than cannabis, and substantially more dangerous than the Class A drugs
LSD, 4-methylthioamphetamine and ecstasy.

"Alcohol is not far behind demonised terrors of the street such as
heroin and cocaine," said Prof Blakemore.

But the conclusions are likely to be ignored, according to coauthor
Prof David Nutt from the University of Bristol, who has worked with
the Advisory Council for the Misuse of Drugs.

Because some individuals with a particularly genetic make-up are at
greater risk, as has been seen with rare deaths connected with
ecstasy, ministers have been reluctant to change classifications
despite the relative safety for the rest of the population.

Several millennia of human experience with alcohol, its pervasiveness
in industrialised cultures, and the US experience with alcohol
prohibition (1920 32) make it unlikely that any industrialised society
will criminalise alcohol use, he said.

But that still leaves taxation and regulation as methods of control.
"Alcohol is a drug we should take very seriously."

The team identified three main factors that together determine the
harm associated with any drug of potential abuse: the physical harm to
the individual user caused by the drug; the tendency of the drug to
induce dependence and addiction; the effect of drug use on families,
communities, and society

Within each of these categories, they recognized three components,
leading to a comprehensive "matrix of harm".

Expert panels gave scores, from zero to three, for each category of
harm for 20 different drugs.

All the scores for each drug were combined to produce an overall
estimate of its harm. In order to provide familiar benchmarks, for
comparison with illicit drugs, five legal drugs of potential misuse
(alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that
has since been classified (ketamine) were included in the assessment.
The process proved simple, and yielded roughly similar scores for drug
harm when used by two separate groups of experts, one of consultant
psychiatrists who were on the Royal College of Psychiatrists' register
as specialists in addiction and the second including a range of
expertise, from police chief constables to scientists. "The two show
very good agreement," said Prof Nutt.

Cannabis, the subject of much recent debate, was ranked below tobacco,
despite the evidence for a link with psychotic episodes in about 7% of
schizophrenics. Since the expert panels were asked to assess the harm
of drugs in the form that they are currently used, this ranking took
account of the widespread use of skunk, which is about twice as potent
than traditional cannabis resin.

Other experts still doubt there is a cause and effect relationship
between cannabis and psychosis, while a study that claimed genes place
some people at particular risk requires confirmation.

Prof Nutt said that young people believe that the establishment lies
and distorts the dangers posed by drugs and the only way to restore
their confidence is to rely on hard evidence, not arbitrary

"It is a landmark paper, a real step towards evidence based
classification," commented Prof Leslie Iversen of the University of
Oxford, a member of a working group of the Academy of Medical
Sciences, though he added that there is still more to be done to take
on board new understanding of addiction arising from

The Academy has been asked by the Government to undertake an
independent review of the issues raised in the Foresight report
'DrugsFutures 2025?' The review will take on board the opinions of
many hundreds of people from across the UK who have taken part in face
to face discussions and an online debate at,
which is open until end of this month.

Participants are clear that the current classification of drugs is
"confusing and inconsistent". A majority of participants support a
health-based approach to drug use and treatment, rather than a law
enforcement approach. Many also point out that alcohol is one of the
most harmful drugs in common use, to both individuals and wider society.

There appears to be little support for decriminalising drugs however.
Professor Sir Gabriel Horn, Chair of the Academy of Medical Sciences
group considering the findings of the DrugsFutures project said "The
UK Government have asked us to explore the likely future impact of
recent developments in science on addiction, drug use and treatments
for mental health. We have heard views from both members of the
scientific community and of the public which indicate that the current
classification system is in need of review.

"Such a review must be underpinned by evidence on the harms of drug
use to the individual user, to families and to society, and be
considered in the light of the latest evidence from the brain sciences."

Drug misuse is one of the major social, legal, and public-health
challenges in the modern world.

In the UK, the total burden of drug misuse, in terms of health,
social, and crime-related costs, has been estimated to be between
UKP10 billion and UKP16 billion per year. 
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