Psilocybin for anxiety and depression in cancer care? Lessons from the past and prospects for the future

This special issue of the Journal of Psychopharmacology contains two landmark studies – the most rigorous controlled trials to date using the psychedelic drug psilocybin, the active ingredient of magic mushrooms (Griffiths et al., 2016; Ross et al., 2016). These were conducted in patients with anxiety and depression and existential distress in the context of having a diagnosis of cancer, and they showed that a single psychedelic experience could produce profound and enduring mental health benefits.

To many people brought up in the Reagan drug war era with the ‘drugs fry your brain’ message, psilocybin may seem a strange and possibly even a dangerous drug treatment of serious mental illness. For this reason, we have asked a number of significant figures in relevant research areas to provide commentaries on the two studies. These experts in the fields of psychiatry, trial design and end-of-life care provide their perspective on the research and its implications for clinical practice. The fact that everyone we approached agreed to provide a commentary, despite short notice, is a testimony to the interest that these two studies have sparked.

The honours list of the commentators reads like a ‘who’s who’ of American and European psychiatry, and should reassure any waverers that this use of psilocybin is well within the accepted scope of modern psychiatry. They include two past presidents of the American Psychiatric Association (Lieberman and Summergrad) and the past-president of the European College of Neuropsychopharmacology (Goodwin), a previous deputy director of the Office of USA National Drug Control Policy (Kleber) and a previous head of the UK Medicines and Healthcare Regulatory Authority (Breckenridge). In addition, we have input from experienced psychiatric clinical trialists, leading pharmacologists and cancer-care specialists. They all essentially say the same thing: it’s time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950s and 1960s, which means we need to go back to the future. As the commentaries point out, much more research needs to be done into optimising this approach, evaluating the breadth of possible target disorders and exploring the underpinning mechanisms. But the key point is that all agree we are now in an exciting new phase of psychedelic psychopharmacology that needs to be encouraged not impeded.

When Albert Hofmann discovered the remarkable mind-altering properties of lysergic acid diethylamide (LSD) in 1943, he didn’t have much trouble persuading his bosses at the pharmaceutical company Sandoz (now part of Novartis) that this drug would play a very important role in understanding the nature of mental illness and potentially providing a very novel approach to their treatment. Through the 1950s and 1960s, Sandoz supplied medical LSD in the form of Delysid that was studied in hundreds of trials in thousands of patients. The US government via the National Institutes of Health funded more than 130 grants in this field. Results were generally reported as positive and encouraging in disorders including anxiety, depression and addiction (Krebs and Johansen, 2012). One of the founders of Alcoholics Anonymous, Bill Wilson, was so impressed by the power of LSD to change alcoholics’ defeatist focus on alcohol and to give them insights into powers beyond themselves that he encouraged treatment research with it.

Having set off this burst of innovation with LSD, Hofmann continued to research psychedelics derived from plant products, and this led to his discovering the chemical structure of active ingredient of ayahuasca (DMT) and magic mushrooms (psilocybin). The kinetics of psilocybin made it a particularly interesting agent to study therapeutically. When given orally, the effects come on in 20–40 minutes and last around three to four hours, a time course much easier to use in the clinic than that of LSD, which can produce effects that last for 12 hours, or DMT, which isn’t orally active and which given intravenously lasts for just 10–20 minutes. Psilocybin also shows a clear dose–effect relationship, and rarely seems to produce ‘bad’ trips. In many ways, it is the ideal psychedelic for treatment trials, which is what Sandoz tried to do when Hofmann characterised it.

Unfortunately, psilocybin got caught up in the backlash against LSD occasioned by the protests against the Vietnam War and the Haight–Ashbury social revolution. So when LSD was banned on the basis of some very dubious so-called research findings of harm, psilocybin and all other known psychedelic drugs became illegal too. There was no evidence of psilocybin being harmful enough to be controlled when it was banned, and since then, it has continued to be used safely by millions of young people worldwide with a very low incidence of problems. In a number of countries, it has remained legal, for example in Mexico where all plant products are legal, and in Holland where the underground bodies of the mushrooms (so-called truffles) were exempted from control.

It is the safety and ease of practical use of psilocybin that has led to it being resurrected in a series of psychological (Griffiths et al., 2006, 2008, 2011), psychopharmacological (Kometer et al., 2012; Pokorny et al., 2016; Vollenweider et al., 1998), imaging (Carhart-Harris, Erritzoe, et al., 2012a; Carhart-Harris, Leech, et al., 2012b; Carhart-Harris et al., 2013) and small pilot clinical studies (Bogenschutz et al., 2015; Carhart-Harris et al., 2016; Grob et al., 2011; Johnson et al., 2014; Moreno et al., 2006). These have provided the intellectual and safety data underpinning the two current studies that are special in that they are the most rigorous double-blind placebo-controlled trials of a psychedelic drug in the past 50 years. Hopefully, the positive findings that they report will act to spur on other researchers in the field of psychopharmacology, particularly in relation to depression, anxiety and addiction – disorders of enormous personal and social costs, and with many patients who still fail to respond adequately to current treatments, as well as to patients with existential distress

For the original article, including bibliography, please click here

How one patch of grass became the UK's first ever decriminalised drugs space

By Fiona Measham and Henry Fisher. A version of this article was published at

Inside a previously unremarkable circle of grass about 10 metres in diameter, a bold new precedent for drugs policy was set in the UK. Pitched on the grass at the Secret Garden Party 2016 festival in Cambridgeshire, was a tent run by The Loop, a not for profit drug and alcohol service. For those few days it was the first ever de facto decriminalised space for possession of drugs in the UK.

Attendees of the festival could come to the tent and hand over to Loop staff a pill or small scoop of powder where it would be tested for content, purity and strength by a team of chemists without any police interference.

A series of up to three different methods of forensic testing typically took 5-15 minutes to analyse a sample. When those using the service came back to collect their results, they were given individually tailored, free and confidential advice by experienced drugs workers. The risks of their drug and alcohol use were discussed and they could raise any concerns they might have. After being given the results, they were then given the choice to dispose of their drugs. It is important to note that their drug use was neither condoned nor encouraged. This was not 'drug checking' to ensure safer consumption, but harm minimisation. And yes, it was legal. No drugs were returned to users and all drugs were destroyed in the testing process, with police collecting any remnants.

The importance of this development cannot be overstated.While national drug policy is still locked in the deep freeze, the Loop's initiative is the boldest example yet of a progressive evidence-based initiative taking place at a local level. While some police forces have de-prioritised arresting users for cannabis possession or small scale growing, this is the first time any area of the UK, albeit a very small area, has decriminalised possession of all drugs for all users.

This was not an easy battle to win. Alongside the support of the festival management itself, it required the support of the local police, public health and council at all levels, a multifaceted feat of persuasion that The Loop Director and Co-Founder Fiona Measham has been working on behind the scenes for several years. Unsurprisingly there have been several near-misses when trying to implement similar schemes at previous events, each time foiled by unconvinced councillors or truculent public health officials with half an eye on potential reputational damage. "What if someone dies after having their drugs tested on site?" was a regular question posed by opponents. Of course, "what if there are multiple deaths if people can't get their drugs tested on site" was the unasked question left hanging in the air.

Notably, all police forces approached by Measham have been exceptionally supportive of this model of drug testing for public safety - a combination of evidence-based policing and reduced resources means that policing of public events increasingly prioritises harm reduction over criminalisation of possession. This at the same time as national drug policy and local drug services are moving away from harm reduction and increasingly embrace an abstinence-based recovery model of drug prevention and drug treatment. This shift in UK drug policy in recent years has meant that front of house drug testing can sit uneasily with public health officials and councils publicly wedded to zero tolerance festival drug policies.

Clearly the stars aligned for Secret Garden Party and consent was given across the board for it to be the first festival to introduce front of house drug testing to the UK.

The faith of Cambridgeshire police, public health and the enthusiastic organiser of Secret Garden Party, Freddie Fellowes, has seemingly paid off. In total nearly 250 different samples were analysed, with many samples submitted by groups of friends, meaning the actual number of festival-goers who received drugs advice from The Loop actually far exceeded this number. Not bad for an unadvertised first pilot.

MAST is part of a wider research project by Measham at Durham University and the data collected from Secret Garden Party and the second pilot this coming weekend at Kendal Calling festival in Cumbria will be carefully analysed over the coming months. Initial impressions are that the pilot was a resounding success not just for drug users but also for emergency services on site. The value of the service was evident in that nearly a quarter of those who took part, handed their drugs to The Loop to dispose of after finding out that the contents - adulterants or inactive ingredients - were not what they expected. Furthermore they were able to spread the word on site about mis-selling of substances such as anti-malaria tablets as cocaine. While it hasn't yet been quantified, anecdotal reports from paramedics and welfare services on site indicate that they experienced a reduced pressure on their services this year compared with previous years. This then allowed the police to deal with other concerns, such as an influx of organised crime gangs selling nitrous oxide, and paramedics to spend more time on serious casualties.

That small patch of grass also witnessed another small revolution - in people's thinking. Initially sceptical police and paramedics and incredulous partiers saw a different, sensible way of approaching the risks of drug use, and most came away with a different perspective. If such schemes catch on and proliferate, it could be our public and social consciousness that finds itself in an altered state.

Fiona Measham is Director and Co-Founder of The Loop and Professor of Criminology at Durham University. Henry Fisher is Policy Director of VolteFace and testing volunteer at The Loop

I blame Fabric’s closure on this country’s backward drugs policy

A version of this post was published in The Guardian

It seems the London club Fabric has had its licence revoked on the grounds that its management is inadequately controlling drug use in the venue. The immediate incidents that led to this decision were the tragic deaths this year of two young men at the club.

Though it will be months before the coroner’s court tells us the causes of these deaths, it is widely anticipated that drugs will be implicated. And, if so, these are likely to be ecstasy-type stimulants.

The decision to close Fabric has been challenged by Sadiq Khan, the mayor of London, as a blow to the city’s vital nighttime economy, which has lost a lot of venues in recent years. While the death of any young person is a cause of great sadness, I question whether the council and the Metropolitan police’s response is fair and proportionate.

This raises three important questions: did it deserve to be closed; will the closure make young people less likely to come to harm; and how can we minimise future deaths and yet encourage the nighttime clubbing economy?

The first question is one of proportionality. Young people do risky things that often result in harm to themselves and sometimes others, but this doesn’t usually result in the closing of the sites of these accidents. Five young men drowned in the sea at Camber Sands last month but there haven’t been calls to ban swimming at British beaches.

As I detailed several years ago, horse riding (particularly eventing) is statistically riskier than taking ecstasy, but stables are still open, even though one of the UK’s leading eventers, William Fox-Pitt, suffered a significant head injury and was in a coma for two weeks from a fall last year.

The lack of proportionality in the debate appears to be based on the stereotyping of clubbers by the police and public as being too young to make sensible decisions about risks to their health. There is also the added prejudice that the ambience of the clubs they frequent is far too different from that of Badminton or Burghley to be an acceptable source of pleasure.

Will the closure reduce risks? This seems unlikely as it will encourage more “illegal” raves, where security and drug monitoring will be much reduced. Indeed, some such events could even be in part funded by drug suppliers, so the possibility of harm may rise. Evidence for many drugs, such as alcohol, heroin and cannabis, reveals their use in underground markets is much more harmful than when use is properly regulated.

Young people die frequently from acute alcohol poisoning. We don’t stop supermarkets selling alcohol but we do try to reduce harm by checking they are over 18 when they purchase it. Can we apply similar harm-reduction principles to dance venues?

In fact, we already do. Regulations require clubs to have chill-out areas and free water, rules that were brought in to minimise ecstasy–related hyperthermia deaths in the 1980s, and have proved very successful.

In contrast, supply-side attempts to stop ecstasy production, for example through seizures, have increased harm, as these have led to the emergence of more toxic “pseudo” ecstasy tablets containing PMA and PMMA. With these substances, a slower onset of effects often leads to the user “topping up” – and, in the worst cases, to accidental overdose deaths.

Other countries have embraced harm-reduction approaches in clubs with a great deal of success. The most notable example is the Drug Information and Monitoring System (DIMS) system in the Netherlands that allows safe, legal testing of drugs for anyone. It has the added advantage of letting the authorities know when new dangerous variants arrive, such as the Superman ecstasy pills that killed several people in the UK but not in the Netherlands, because there officials were able to warn the public.

In Vienna, a club-based testing system has proved very successful and has inspired a similar model currently being tested on a small scale in the UK.

Fiona Measham, a professor of criminology at Durham University who is behind the scheme, is championing harm reduction through a new charity that has conducted safety testing at the Warehouse Project in Manchester and also at two UK festivals this year. Multi-agency safety testing, as its name suggests, is supported by several groups including, most importantly, the local police in Manchester, who have a forward-looking and responsible attitude to young people’s drug use, in contrast to the regressive, backward looking attitude of the Met.

If we really care about deaths in clubs, we should keep them open and make them safe, using a range of proven approaches such as this, not drive them underground.

The poppers ban is a veiled attack on pleasure

A version of this post was published in The Guardian

The new psychoactive substances bill, when it comes into force in the UK in April, will ban the acquisition and sale of all psychoactive substances, whether existing now or to be discovered in the future, except for alcohol, tobacco/nicotine and caffeine. The driver for this draconian piece of legislation is supposedly to reduce the harms of so-called legal highs and to shut down the “head shops” that sell them. The fact that two exempted substances, alcohol and tobacco, each cause much more harm than all the legal psychoactive substances put together is ignored.

Most of the drugs referred to as legal highs by the proponents of the bill are in fact already illegal. The only legal drugs that will be banned by the new act are some new synthetic cannabinoids, weak amphetamine-type stimulants, nitrous oxide, and alkyl nitrite preparations colloquially called “poppers”.

These last two are some of the safest drugs we know. Nitrous oxide has been used for nearly 200 years for pain control and some alkyl nitrites have been a medicine for angina for around a century. Their safety means that the health impact of their ban will be negligible. The Home Office has said it expects the ban will save around 12 lives a year from drugs, so why are they putting so much parliamentary resource into this bill? If deaths were the concern they would ban the gas helium, which is associated with far more deaths each year than nitrous oxide.

The truth is that this bill is a veiled attack on pleasure. In fact the term “psychoactivity” has become a proxy for the term “pleasure”, and the ban of poppers gives the lie to this.

Poppers are not psychoactive – unless you take the perverse view that the headaches they produce are pleasurable. The Advisory Council on the Misuse of Drugs confirmed this, stating that poppers should be exempt from the bill. Its assessment of poppers has consistently been that although they can cause health harms, the frequency and severity of these are too low to warrant control under the Misuse of Drugs Act 1971. This is presumably why the Home Office is pushing for them to be controlled under the new act.

The science behind poppers is that their active ingredient leads to the production of nitric oxide in the body, which dilates blood vessels and relaxes smooth muscles. Poppers are most widely used in male gay sex where the muscle-relaxing properties facilitate anal intercourse.

Why is the government so anti-pleasure, particularly for gay men? Much of the drive to ban legal highs has come from the Centre for Social Justice (CSJ), a rightwing thinktank that has consistently misled the public and government about the harms of legal highs. These claims have been refuted by DrugScience.

One of CSJ’s main attacks is on what it calls the “loosening” of laws on moral values in the past decades, leading to the erosion of the family. The acceptance of homosexuality is one of its main concerns. It is hard not to conclude that the government shares this opinion and that the poppers ban is in fact an attempt to deter – or even punish – men who enjoy having sex with men.

This is the conspiracy theory explanation, but we must also consider that the government is confused. It may think nitric oxide is the same as nitrous oxide. Confidence in its reasoning is not encouraged by the fact that at the first reading of the psychoactive substances bill, government spokespeople several times referred to a ban on nitrates, which are fertilisers, not nitrites.

Whatever the reasoning behind the popper ban, it is fundamentally flawed. Poppers should be removed from the psychoactive substances bill, though it would be much more honest to scrap the whole legislation as it is so lacking in justification and logic.

The UK needs common sense about ketamine

A version of this post was published in The Guardian

Ketamine is a unique anaesthetic and analgesic that has unfortunately become a popular and harmful recreational drug. Last year, in an attempt to reduce recreational use, and on the recommendation of its Advisory Council on the Misuse of Drugs (ACMD), the UK government decided to ban all ketamine-like drugs (analogues) and also put ketamine itself under greater controls.

These changes were opposed by many scientists who saw the analogue ban as anti-scientific, and by many doctors and vets who feared that the greater controls would reduce ketamine use with consequent increase in patients suffering. Our fears turned out to be true. For example, the Glastonbury festival medical team who use ketamine for emergency anaesthesia (eg for burns) were last year denied supplies.

The increased restrictions also failed to take account of the advances in prescribing options provided by the Patient Group Directive legislation, which improves access to vital medicines by allowing trained nurses and other practitioners to prescribe. On Tuesday, the Home Office was told by the ACMD of this oversight, and hopefully the regulations will soon be changed to allow ketamine to be used optimally.

These issues highlight the perverse damage that can occur with the current simplistic legal-based approaches against recreational drug use. They damage research and harm patients, yet have little if any effect on recreational use. Now the misuse of ketamine in some other countries could lead to an even more outrageous decision: the banning of ketamine as a medicine world-wide. The UN Commission on Narcotic Drugs (UNCND) is proposing this at its next meeting in March. This recommendation is being pursued despite opposition from the World Health Organisation that argues ketamine is a vital medicine. Ketamine is the only anaesthetic that does not cause respiratory depression and one that has proven utility in emergency situations, war zones and in surgery for children. This is not the first time that the faceless “war on drugs” bureaucrats in the UN are trying to get a drug banned to justify their existence – but surely it must be the last?

The prospect of denying the long-proven therapeutic benefits of ketamine to people, particularly children in pain, is one I am sure we would all find abhorrent. We need to remember that because many countries blindly follow UN guidance to ban all strong opioids under UN conventions, 80% of the world’s population doesn’t have access to adequate opioid analgesia, one of the great socio-medical scandals of the past century.

Ketamine also has a major and growing role to play in the control of patients with chronic pain. Moreover ketamine is probably the most significant innovation in the treatment of resistant depression in the past 40 years. It can produce rapid remission of symptoms in suicidal patients and is also being tested in treatment-resistant PTSD.

To stop the clinical and research use of ketamine would be madness but this is what would happen if the UK approves and implements the UNCND recommendation. This would mean that every doctor and hospital that wished to use ketamine would need their own special licence to do so. We know that only four hospitals in the country have such a licence and to get one costs about £6,000 and takes a year or more.

The idea that banning ketamine will stop recreational use is ludicrous, given that similar bans on heroin and cocaine have not impacted misuse. Unless our scientific and medical leaders stand up to the UNCND, researchers and patients will suffer. We need to remember that the UK medical community successfully lobbied the government to reject the 1961 UN recommendation to ban heroin when many other countries went along with it and so eliminated it as a medicine. UK patients have benefited from this powerful painkiller whereas patients in other countries have suffered. We can insist that common sense over ketamine prevails and that our medical leaders demand a similar exemption be applied to ketamine in the UK if the UN proposal is endorsed.

But we should do more. It is time to stop the UNCND pursuing its failed “war on drugs”. This serves its goals of maintaining its significant international profile and job security, but it has been a costly failure in terms of the rest of humanity, particularly because of the perverse effects to deny proven pain-control treatments to much of the world’s population. Surely it is now time for the UK, one of the founders of the World Health Organisation and a leader in international health policy, to rectify this cruelty: stopping it worsening by opposing the ketamine ban would be the first step.

The Superman pill deaths are the result of our illogical drugs policy

A version of this post was published in The Guardian

The past week has seen a number of drug disasters in the UK, one of which is the unexpected deaths of three men, two from Ipswich and one from Telford. They all appear to have taken a drug called PMA (para-Methoxyamphetamine). We presume that they did not know this was what was in the pills bearing the Superman logo that they bought – it seems likely they thought it was ecstasy (MDMA). PMA and its close relative PMMA are not new drugs; they were made in the 1950s and tested for beneficial mood effects then. However, they didn’t provide a clear positive effect so were discarded, though were made illegal under the UN conventions.

They have in the past few years re-emerged as a toxic surrogate for ecstasy. In this period they have been responsible for more than 100 deaths in the UK, and now the majority of deaths that the media report as being due to “ecstasy” are, in fact, caused by PMA and PMMA.

Their re-emergence is directly due to the international community’s attempts, via UN conventions, to stop the use of MDMA by prohibiting its production and sale. As the earlier UN drug control conventions were clearly not working, in 1988 a further attempt to limit drug use by impairing production was made by banning a number of precursor chemicals. One of these is safrole, the precursor of MDMA. In 2010 there was a massive seizure of 50 tonnes of safrole in Thailand. This did significantly dent availability for MDMA production, so chemists looked for an alternative source of a suitable precursor. Aniseed oil seemed the ideal alternative, as it is chemically very similar to safrole, so this was used. Unfortunately the product that results from using the MDMA production process with aniseed oil is PMA or PMMA. Hence these substances only exist because of the blockade of MDMA production. That in itself wouldn’t particularly matter if they were not more toxic than MDMA.

PMA/PMMA are significantly more toxic than MDMA for three reasons. First they are more potent, up to 10 times so. This means that a user who is typically safely using MDMA at a dose of 80mg per session will be taking the equivalent of 800mg of MDMA if they take 80mg of PMA. Secondly, PMA works more slowly than MDMA so when users don’t get the expected effects of MDMA about 30 minutes after taking the drug they think they have been sold a weak lot and may take another dose to make up for this. Then, when the effects of PMA kick in at around two hours, they have taken far too much. Thirdly PMA and PMMA are not pharmacological equivalents of MDMA. They have very different actions, which is why they were discarded after first testing. Their major problem is that they block the actions of the brain enzymes that offset the desired effects of serotonin and dopamine release that PMA/PMMA produce. This then massively accentuates their toxicity as the brain can’t compensate for the increase in serotonin so users can develop serotonin syndrome. This is a toxic reaction that elevates body temperature to a dangerous, and in some cases lethal, level.

The emergence of the more toxic PMA following the so-called “success” in reducing MDMA production is just one of many examples of how prohibition of one drug leads to greater harm from an alternative that is developed to overcome the block. This first became obvious when the US pursued alcohol prohibition in the 1920s and many switched to hootch, which was illicitly distilled ethanol, and some even to methanol, both of which are more poisonous than regulated alcohol. The banning of smoking opium led to the increased production and injecting of a more potent and dangerous opiate, heroin.

There are several proven ways we can we stop this rising tide of PMA/PMMA deaths. One, well established in the Netherlands, is to make testing facilities available to the public without fear of prosecution. This serves not only to warn the users when they have purchased something that wasn’t what they were expecting but also allows the state to monitor the emergence of new, possibly more toxic recreational drugs and put out warnings. A more radical approach as explained by Transform would be to make safe doses of pure MDMA (eg 80mg/day) available to registered users in a regulated fashion, for example, via pharmacists.

In the meantime we should accelerate the testing of seized tablets and make public their contents and strengths on internet databases, so that all users can check what they might be taking. This kind of testing to provide knowledge of drugs in use locally has been pioneered at some clubs and festivals by Professor Fiona Measham of Durham University, and should now be rolled out nationally. Visible public information about tablets, their contents and dosage is used to reduce harm in Ibiza. Finally, let’s stop pretending that these PMA deaths are unexpected effects of rogue “ecstasy” and tell the truth: they are a consequence of our current illogical and punitive drug policy.

“Ravaged by drugs”? Let’s spread facts, not fear; science, not stigma

Today the MailTelegraph and others have been featuring the vile and dehumanising "More than Meth" campaign, which invites us to gasp and be disgusted by the faces of Americans arrested for drug related offenses. The campaign shows mugshots of individuals chronologically as their appearance changes.

Unsurprisingly, the ghoulish coverage of this stigmatising campaign omits small-print disclaimer used by its creators that "The deterioration seen in consecutive photos is not necessarily the result of drugs or addiction..." and that "All persons are considered innocent of the crimes they were arrested for until proven guilty".

The uncritical comments below the coverage of this ‘story’ on the Mail Online and elsewhere are pretty depressing, including low points such as “Ewwwww...” and “... it's not [sad], it's their own bloody fault”. The number of people arrested for drug offenses in America per year is not that far off the total circulation of the Daily Mail; out of a pool of one and a half million people, you can presumably select a dozen mugshots that tells any story you want;- that methamphetamine is an elixir of youth, that heroin use leads to steadily curlier hair. Similarly, someone with a different agenda could cherry-pick Mail Online comments from individual readers to form chronological time-series that appeared to show that exposure to Mail articles leads to increasingly reactionary and ignorant views... but that would be equally meaningless.

It is true, and let’s be absolutely clear, that use of methamphetamine, heroin and cocaine (and much more commonly alcohol) can become problematic from the beginning or after years of use, that a significant minority of users can find their control slipping despite seeing damage occurring, and that chaotic drug-centred lives, (especially when eating, sleeping and self-care get neglected) can lead to abnormally fast ageing, collapsing health and death. In fact, crack cocaine, heroin and methamphetamine, followed by alcohol, ranked as the four drugs with the greatest associated harm to the typical user (alcohol leaps ahead in terms of total harm caused due to its vastly higher prevalence) in the ISCD’s famous objective assessment of Drug Harms in the UK.

However, an individual's deteriorating health cannot simply be put down to the illicit substances they use, and separated from context, including the purity of what they use, the way they use it (are they addicted? Do they inject?), their individual biology, their life history, their social environment and the political environment. If it was as simple as these drugs being fundamentally highly toxic substances that automatically make your teeth drop out and your skin break down, amphetamines and opiates would not be widely used and valued as medicines.

Heroin and methamphetamine molecules have fixed physical properties like mass and solubility, and they have intrinsic pharmacological properties, i.e. they cause predictable effects on heartbeat and brain activity according to the dose. But neither they nor any other drugs have a predetermined property that they always take over and wreck the lives and health of everyone who tries them. In reality only a minority of drug users become addicted to drugs, doing so despite their best efforts to cut back and stop using. Addiction is not a failure of moral fibre. Put another way, drug use is neither necessary nor sufficient to tell the story of how any one of the people featured in this campaign reached such a low ebb in their lives. 

The most obvious contextual factors this campaign chooses to gloss over are social and political ones. These photos are not, say, a random sample of people who have used illicit drugs in the past year, which I don’t imagine would be easy to distinguish from a sample matched by age and background. All the photos are mugshots of people getting arrested for drugs offenses; by definition people undergoing harm. Being in and out of prison and having a permanent criminal record does not make it any easier for people with drug use problems to get a steady job and a stable lifestyle, get their problems in hand and look after themselves. Users of methamphetamine and other drugs are very often at the bottom end of America’s ever-more unequal income distribution, and numerous factors exclude them from accessing addiction treatment and health and welfare services.

Alleged drug use by the subjects of these photos seems to have become a convenient excuse to sidestep the question of why the richest country ever allows millions of its citizens to live precarious existences without a decent safetynet. Rather than questioning this, it seems that the campaign is instead telling us “Don’t make yourself worthless like these people have!” If the individuals pictured were considered to be real people with families and futures who could be helped and supported to help themselves, it might be harder for this campaign’s creators to morally justify these stigmatising, humiliating photos which themselves must negatively affect the life-chances of the subjects.

None of this criticism should detract from legitimacy and importance of running campaigns that inform people that by minimising or better still avoiding use of these particularly risky drugs, they can minimise or avoid the risks of collapsing health and death. In the opinion of the ISCD, the success of drug information campaigns should be judged not by their ability to shock or to go viral as ‘clickbait’ in newspapers and blogs looking for a free way to generate traffic, but by their honesty and their effectiveness in reducing the total burden of harm associated with drug use, including the harms of criminalisation and stigmatisation.

The ISCD is a volunteer-led organisation, (neither I nor anyone else in our scientific committee get any money for our time) and funding is tight. Since methamphetamine isn’t widely used in the UK, we’ve so far not published one of our evidence-based information pages on it. But we’ll try to get one up on the website within a month, and you can help us by donating, which pays for office costs and supports our mission to get objective, harm-reducing information out there. 

In the meantime, if you want to find out more on the science and mythology of methamphetamine, you can read a deeper evidence-based critique of meth hysteria from Prof Cart Hart and colleagues here.

Michael Le Vell – double standards over the ‘use’ and ‘abuse’ of drugs

ISCD volunteer Richard Clifton takes a look at drugs in the news.

In recent years, it seems that Coronation Street is never very far away from a drug scandal, and now Michael Le Vell has become the latest in a long line of actors to be suspended from the soap after admitting to snorting cocaine. Craig Charles, Simon Gregson and Jimmi Harkishin have all been written out of the show in the past after being caught with drugs (all the actors have subsequently returned). 

Newspaper headlines talked of Le Vell’s cocaine ‘abuse’ and his suspension was a direct result of hisadmission to the Sunday Mirror on 1st March. However, the actor has claimed to have only used cocaine on two occasions. At the time he was still on trial and under considerable pressure and media scrutiny. These circumstances are not meant to condone his drug use, but the term ‘abuse’ seems to leap to judgement, and the word ‘addiction’ used in the Independent seems simply incorrect. The ISCD always refers to drug ‘use’, rather than ‘abuse’ or ‘misuse’ on principle, because the latter terms are subjective labels, not objective assessments that can be put to any scientific test, like ‘harm’. 

An interesting contrast is apparent in the portrayal of Le Vell’s use of another drug. The actor has also admitted to being an alcoholic for the past thirty years. Le Vell would, he said while on trial, drink up to twelve pints a night and has sought out Alcoholics Anonymous in the past. Using any metric, this level of excessive drinking for prolonged periods of time is likely to have a greater potential to damage and disrupt the lives of Le Vell and the people around him than infrequent cocaine use. Yet upon his acquittal from charges of sex offenses, newspapers pictured him ‘celebrating’ with a pint with neither the judgement or pity that accompany stories of celebs using or addicted to other drugs.

Statements from both Le Vell and his family indicate that he will stop taking cocaine but: “He still likes spending time in the pub with his friends but he’s not doing that as much,” in spite of his alcoholism. The double-standard is striking. The obvious distinction between the substances is their legality, but Le Vell was suspended for medical rather than criminal reasons (it is possessing not taking cocaine that is an offence in any case) and in terms of risks to health cocaine and alcohol are not worlds apart.

The ISCD’s 2010 study in the Lancet, comparing the relative harms of 20 different drugs, ranked alcohol as the most harmful drug tested (scored 72) whereas cocaine was ranked fifth with a score of 27. Alcohol’s higher score is mainly due to the large impact that it has on people other than the user (lost productivity, drink driving, violence) but alcohol and cocaine remain similarly harmful overall even if we just consider metrics that impact the user. Cocaine was found to have a greater addictive potential than alcohol (2.39 vs. 1.93), but alcohol edges ahead on some other factors including bodily damage.

Society would benefit from a more consistent, proportionate, informed attitude to the relative dangers of different drugs.

Figures for UK deaths from legal highs cannot be trusted

A version of this post was published in The Guardian

At the last G8 summit, the prime minister said legal highs are a serious concern and claimed that the UK would lead the world in research into them. But at the same time David Cameron's government has introduced temporary banning orders on several legal highs, thus making this research very difficult. The new drugs minister, Norman Baker, has since rejected the idea of the UK joining in the more balanced approach being proposed by the EU and has set up a working group to explore local options to this so-called "growing threat".

The latest figures on these new psychoactive substances, for 2012, were published as two separate datasets: one from the National Programme on Substance Abuse Deaths claiming 68 deaths, and the other, from the Office for National Statistics, claiming 52. These numbers are tiny when compared, in both relative and absolute terms, with the 80,000 deaths per year from tobacco, the 8,000 from alcohol or even the 1,200 from opioids, but still the media have revelled in the seemingly large increase from the previous year.

DrugScience has looked into these data in some detail, and as explained in our letter published on Friday in the Lancet, on closer examination they look very suspect. For instance, most of the drugs identified as being "legal highs" are not in fact legal. Only 11 of the 68 are currently "legal highs".

Twenty deaths reported by the National Programme on Substance Abuse Deaths are associated with the PMA/PMMA types of amphetamines that have been illegal for over 30 years. These drugs are considerably more toxic than MDMA (ecstasy)and emerged as a direct consequence of MDMA production being restricted by the clampdown on sassafras oil and other precursors. PMA/PMMA drugs are intrinsically more toxic than MDMA, but are sold as ecstasy.

They also have slower onsets of action than MDMA, which can lead users to believe after the first dose that they haven't taken enough; they then take another dose which means that later when absorption is complete they have accidentally overdosed. This is one of many examples of the perverse effects of prohibition: limiting availability of a relatively low-harm drug can lead to greater harms from alternatives. We have advice on the ISCD website for anyone who might come across PMA. These drugs have caused deaths in other countries, particularly Canada, leading to calls from senior health officials to legalise MDMA to obviate the threat of these counterfeits.

The most frequent drug deaths reported by the Office for National Statistics were attributed to GHB (13 of the 52), which was made illegal in 2003 when we were part of the group reviewing its harms for the Advisory Council on the Misuse of Drugs. Among the drugs labelled "legal highs" were anabolic steroids and DNP (a weight-reducing agent), which are not even psychoactive. Intriguingly, according to the Office for National Statistics, there were only four deaths solely frommephedrone, despite it being the most popular stimulant in 2008/9.

The poor quality of the data currently being discussed in the media raises the question of whether this is just sloppy science or whether there has been some attempt to massage the figures to justify the current political focus on legal highs. It is also questionable whether we need two sets of drug-related mortality statistics.

The government and media attention on legal highs distracts from the much more important health issues of tobacco, alcohol and heroin deaths. What is certain is that if the current government review of legal highs is to be taken seriously and lead to health improvements then there must be a proper definition of terms and improved data collection. Moreover the data must be independently audited so the effects of any change in the law can be properly evaluated.

Death by cannabis?

(UPDATE 04/02/2014 - The Metro brought balance to their coverage by publishing letters today from Prof. David Nutt (see picture below) and other readers on the subject of the risks of cannabis. The ISCD will continue to make such media interventions where a scientific perspective is needed, but we rely on your continued support to do so. Thanks for your donations; the more we receive the more resources we will be able to dedicate to this aspect of our work.)

Today, the front page headline on the Metro newspaper read “The tragic proof that cannabis can kill”. Perhaps this splash might lead to some family conversations about drugs. If so, it would be useful now to consider what the sad case of one young mother who died after smoking cannabis can tell us about the dangers of cannabis. I think the answer is nothing. If this upsetting story does at least prod parents into talking to their kids about drugs I hope they might discuss just how to sceptically evaluate and make use of the information we read in the papers.

With scant formal drugs education and negligible public information, our national conversation about drugs is built around the telling of tragic stories like that of Gemma Moss, Leah Betts and Amy Winehouse. Although the facts may be at least part true, these stereotyped stories subtract from rather than adding to the public understanding of drugs. They erode rather than bolster the potential of individuals and the State to rationally recognise and minimise the real harm drugs can cause. These stories misinform even when the facts are ostensibly ‘true’, because the real names, places and dates are slotted into misleading old fairytales about the essential moral evil of drugs, (which are made animate by the stories), and the essential vulnerability and innocence of those (particularly attractive young women) who passively fall prey to them. The types of drugs, people and harm in these stories are not representative of the real burden drugs cause in society. 

I cannot begin to understand the pathologist’s certainty that cannabis killed Gemma Moss, but neither do I wish to contradict him outright. Taking any amount of cannabis, like all drugs, like so many activities, puts some stresses on the body. Cannabis usually makes the heart work a little harder and subtly affects its rate and rhythm. Any minor stress on the body can be the straw that breaks the camel’s back, the butterfly’s wingbeat that triggers the storm. Ms Moss had suffered with depression, which itself increases the risk of sudden cardiac death. It is quite plausible that the additional small stress caused by that cannabis joint triggered a one-in-a-million cardiac event, just as has been more frequently recorded from sportsexsaunas and evenstraining on the toilet

There are good reasons that most of us choose not to use cannabis, and that most of the rest do so infrequently. You can get arrested, some become dependent on it to relax, it can make you cough and wheeze, feel less sharp than you could be, or more anxious, and a cannabis habit can be a barrier to achievement. The risk of sudden cardiac death has no place on the list of sensible reasons to avoid or cut down cannabis use. As with cannabis, there is a long list of reasons someone might want to avoid or cut down on visits to McDonalds for example, but a single freak fatality caused by such a visit is not one of them.

The question of whether cannabis killed one individual may be significant for the family concerned but it is not useful for exploring the essential scientific, political and personal questions about each drug’s capacity to injure and kill. To answer that, you need data from thousands of people, to distinguish harm from freak events. Coincidentally, buried on page 20 of the same edition of the Metro, three lines of text allude to a new study on alcohol that provides a striking example from a study of 151,000 people. It found that one in four Russian men are dead before they reach 55, most of them killed by alcohol.

Scheduling clash: revisiting ketamine (and legislation) harms

It was announced today that ketamine will be reclassified to Class B, up from C. But that's not the whole story.

Drug classification, which determines the penalties for illicit recreational use, makes the headlines. Drug scheduling, which determines the regulations for licensed use by doctors, vets and researchers is the hidden issue here. The proposal is to tighten the regulations on legitimate use of ketamine to the very toughest level, the level used for diamorphine, more commonly known as heroin.
Heroin is a valuable painkiller for dying patients, but needs the tightest controls on secure storage and documenting its movements to prevent supplies going missing, or worse, as the Shipman murders demonstrate. The risks of ketamine misuse or theft is simply notcomparable so this move is disproportionate and unnecessary. Current regulations on ketamine are sufficient. Sensible NHS guidelines already stipulate that where practical, ketamine is to be treated the same as heroin anyway, so the proposed change is not needed. But vets, especially small local and agricultural vets operating out of buildings without purpose-built drug storage rooms may be hit hard by overzealous restrictions. 
The consequences of burdensome or totally obstructive rules on the legitimate use of ketamine will of course not only inconvenience vets, but may cause harm and suffering to animals when vets are less able or willing to make use of ketamine, or to afford to upgrade their drug storage facilities to stock it. Vets rely on the unique properties of ketamine as safe anaesthetic for many species. Also, research projects on wild animal populations (such as the badgers of Wytham Wood) sometimes utilise ketamine as a low-risk way to allow measurements to be taken while causing minimal stress to the animal. Such research has proved essential for understanding and protecting British wildlife, for example by collecting evidence on the impacts of climate change, and the feasibility of TB vaccination. It is very important for conservation efforts that misguided regulations do not put such vital work in peril.
The proposal to reschedule ketamine seems simply to be an automatic move to match the reclassification, rather than a considered decision to reduce harm. Before ketamine became a popular recreational drug, diversion of legitimate supplies may have been a significant source to the illegal market. However, ketamine is now manufactured and imported in large quantities for the illicit market, and diverted legitimate supplies play no meaningful role.

Help me in my ambition to be uncontroversial

I’m very grateful for having been awarded the John Maddox prize. The award has caused me to reflect on the role of science in the public discourse, and evidence in politics, to ask what Standing up for Science means.

When I am invited to talk on the radio or in a debate, sometimes it seems as if I am there to represent one pole of a dichotomised debate. This isn’t always a comfortable position for a scientist to be.  There are a few topics where I am happy to be contentious, but more typically I find that there is no relation between the statements I think are radical and those that actually provoke controversy. I can’t complain if people disagree with a moral or political stance, but I worry when it is factual statements about the harms of drugs or the efficacy of policy that are received as controversial by interviewers and listeners. It’s controversial to point out that the risks of some Class A drugs, such as LSD and ecstasy, are simply not comparable to those of heroin or methamphetamine. It’s controversial to suggest that “sending messages” by toughening classification has no pronounced or predictable effects on the prevalence of drugs like cannabis or ketamine. It is controversial to think that interventions that result in a fall in the numbers using a particular drug cannot be assumed to be successful in reducing net harm. This phenomenon, where truth is taboo, is the hallmark of topics where progress is needed in improving public understanding.   

Drug science happens to be the field in which I do most of my work, but the change I’m hopeful of seeing would necessarily be wider-reaching. Improved public literacy in critical and scientific thinking is a desirable end in itself, but I think that the benefits could be quite profound, as any rewards attached to mythmaking by politicians and journalists recede, and the costs of misrepresenting science grow. Those who stand up for science risk being misconstrued as advocating for something akin to a scientific dictatorship, where their advice is never challenged. Actually, my vision for the role of evidence in the political debate is quite different; what I would like is a shared understanding about when any views or feelings have an equal claim to be considered, in contrast to questions of fact, things that can be framed and tested as scientific hypotheses. How much more productive might these discussion be if we could start from a consensus reality, and a shared assumption that any intervention we should make should have real-world effects? This was summed up by Dr Ben Goldacre on a science comedy programme this year (18.40). He said “It would have been nice to see politicians say ‘Look, I understand [what the evidence shows about the relative dangers of drugs], … but I just think, regardless of the real world impact, I just want drugs to be illegal. I just feel, morally, it’s just nice that the country sends out a message, just says this stuff is wrong, and actually I don’t care if the impact of that is to increase the total amount of harm.”

For better or worse, science and society are interconnected. It is up to scientists to step out of the lab and stand to say that using – or at least considering - evidence in public policy shouldn’t be controversial. It's something that we at the ISCD have worked tirelessly to correct. The only way we can continue to be independent and speak out for science is with your help. Please donate today.



Sense About Science: The John Maddox Standing up for Science Award

Why David won the John Maddox Standing up for Science Award

Our cultural imagination features some odd and rather unflattering stereotypes of scientists; the socially awkward oddballs out of touch with reality, or the maniacs in blood-stained lab coats you may have encountered this Halloween. Thankfully for the ISCD, with its mission of promoting an evidence-based public discussion around drugs, Professor Nutt defies these stereotypes rather more than his name would suggest. David is in his element in his laboratory and in his clinical work, but equally stellar when speaking to young festival-goers at the Secret Garden Party festival and giving evidence to the Home Affairs Select Committee. He demonstrates on a daily basis that evidence is not irrelevant or threatening, rather, that knowledge is for everyone, that engaging with evidence benefits society. That is standing up for science. David has been at the forefront of his academic field, and improving his patients’ wellbeing for decades, but to understand just how fitting this accolade is, we need to consider the last four years.

Exactly four years ago, Jon Gaunt wrote the following in Britain’s most popular newspaper after David had commented on the relative dangers of illegal drugs such as cannabis and ecstasy compared to alcohol and tobacco. “He wants to reclassify all drugs on a “harm” basis and in an academic sense he might be correct. But we are not talking about a society that is only confined to the lofty intellectual towers of a university campus… It's perfectly acceptable for Nutt to have these discussions in the cosseted world of academia but it is totally irresponsible for him to pontificate in public and in his position as Drug Tsar. He must be sacked immediately.”

David had, it seems, broken an unwritten rule stating that the public are vulnerable to reality and must be protected from the dangers of scientific evidence around drugs. If this quote sounded silly then, it is staggering now. David was indeed sacked, but instead of being humiliated into silence, he founded the ISCD and has redoubled his efforts to stand up for science, to bring the discussion of drugs out of that “cosseted world of academia” and into the public domain.

Perhaps not many people realise that when he was sacked, David did not lose a government salary and pension; members of the Advisory Council on the Misuse of Drugs are unpaid public servants. The ISCD follows the same model;- he and the other 20 Committee members contribute their time for the public good without financial reward. The ISCD is a lean machine, with only two part-time staff on the payroll. All donations go straight to our day to day operation and pursuing our projects. With a huge support-base in and outside the scientific world, and plenty of plans ready to be put into action, funding is the only limit to what we can achieve. If, like us, you admire David’s generosity in dedicating his time to standing up for science, please stand with him by donating to the ISCD. Together, we can make the evidence matter.

Sophie Macken
Director, ISCD

“Think cannabis is harmless?” No. Does anyone? But what about propagating drug hysteria? Is that harmless?

A week ago, the Daily Mail published a story entitled “Think cannabis is harmless? It drove this grammar school boy insane – then killed him”. This is not the first time that the Mail and other newspapers have used personal tragedies to generate panic about cannabis, particularly related to psychosis, and particularly aimed at concerned parents. In the past, the ISCD and other voices who challenge drug misinformation have hesitated from getting involved, as it seems rather distasteful to engage in a debate about evidence over the body of a young man. However, this has allowed the Mail and others to go unchallenged in their willingness to exploit their readers, grieving families and the deceased themselves. They sell wild speculation and morbid sensationalism dressed up as a heroic crusade against enemies in our midst. The headline alone takes aim at two insidious foes for readers to fear and hate; the army of straw men who think that cannabis is harmless, and the drug itself, which becomes personified as a killer. 

You do not need telling that newspapers are not scientific journals, nor that many journalists are talented in creating eye-popping nonsense. That’s not news. What we want to point out is that these stories are not just a diversion from the real issues; they may themselves be harmful. Whilst posing righteously as exposing the threat of cannabis-induced psychosis, the Mail may in fact be contributing to the problem, through their effects on public understanding and political tides. To explain how, we need to explore the evidence of links between cannabis and psychosis. 

Cannabis is associated with psychosis (a symptom) and schizophrenia (an illness where this symptom is persistent) in complex, contradictory and mysterious ways. The evidence does demonstrate various links that we all should all be aware of, especially cannabis users and parents. However, the evidence doesnot support anything like the level of fear propagated in the media.

Whilst someone is actually ‘stoned’, the principal psychoactive component of cannabis, THC, can sometimes have unwanted psychosis-like effects, such as anxiety and paranoid delusions. This is a reason that many people try the drug and don’t like it; but transient paranoia isn’t the same as schizophrenia. Persistent drug use of any kind may seriously complicate and worsen pre-existing mental health problems, and the use of cannabis seems able to exacerbate symptoms in a person with an illness like schizophrenia, or latent vulnerabilities.

On the other hand, the second key component in cannabis, cannabidiol (CBD), has powerful antipsychotic and anti-anxiety properties, so people with schizophrenia, or teens predisposed to psychotic symptoms may feel relief from consuming cannabis. Paradoxically, this self-medication is very likely to be counterproductive in the long-run because of the THC content, and so vulnerable young cannabis users should be given this explanation, and positive support to minimise or stop their use. The paradox of short-term relief versus long-term exacerbation shows the need for great sensitivity to the experiences of young cannabis users with mental health problems; they may not be being delusional and selfish by using the drug as the Mail implies, but simply doing what, in their experience, helps. 

Several studies have suggested that regular, long-term cannabis use is one of a number of environmental factors that, in combination with certain genetic predisposing factors, may significantly increase a young individual’s chance of experiencing psychosis and developing schizophrenia. However, numbers of people being diagnosed with schizophrenia remained stable over time during which the number of cannabis users increased and average strength rose significantly. There are clearly nuances that remain to be understood, but despite this uncertainty, we can entirely rule out the possibility that cannabis causes a level of risk of schizophrenia that would warrant the media coverage of the issue.

Cannabis use is fairly common (around 1 in 3 have tried it), and use typically begins in teenage years and young adulthood. Schizophrenia is fairly rare, (about 1 in 200 will be diagnosed at some point in their lives) and also typically begins in teenage years and young adulthood. It should be noted that when a condition is rare, less concern is warranted by an increase in risk, compared to if a condition is common. For example, a doubling in the risk of cancer or heart disease, very common conditions, should really worry us. A doubling of the risk of being struck by lightning shouldn’t really scare us at all. 

A doubling in the risk of psychosis, Robin Murray’s rough estimate for the maximum increased risk of heavy cannabis smoking, lies somewhere in between; far from meaningless, but certainly not a major public health catastrophe. Based on a similar estimate of risk, it has been calculated that very roughly, the chance of a 20 to 24 year old man (the group at the very highest risk) developing schizophrenia this year will be raised from about 1 in 3,100 to 1 in 1,900 if he is a heavy cannabis smoker. This is not, in our view, even the most serious risk of cannabis. Roughly one in ten cannabis users are addicted; they have lost some degree of control over their use. Heavy cannabis use before adulthood can interfere with education and intellectual development, impacting on learning and employment opportunities. 

The other major negative impact of cannabis use is that of getting a criminal conviction for possession or other minor cannabis offences. These have a profound impact on future employment and travel opportunities, disproportionately affect the UK minority ethnic population, particularly black young men, and may preclude them from serving as police officers, teachers, nurses and politicians. Those, in our view, are far far more significant problems, but perhaps they are less suited to creating sensation than the fear of one’s children becoming “insane”.

In comparison with this uncertain 2-fold increase in psychosis risk from heavy persistent cannabis use, the risk of lung cancer from heavy and persistent cigarette smoking is increased by about 25 times. Now that is a public health catastrophe. Cannabis smoke can irritate lungs, but is not definitively linked to lung cancer. Cigarettes are moreover a particular catastrophe for people with schizophrenia, who smoke at vastly higher rates than the general population, a major reason they live shorter lives on average. But the association between legal tobacco and psychotic illnesses, or indeed suicide, is not of much interest to the media. 

If cannabis use does increase the risk of schizophrenia, this means that cannabis use is causing some ‘extra’ cases that wouldn’t occur if cannabis didn’t exist. However, unless cannabis turned out to be causing a much higher risk increase than the most alarming scientific estimates, it remains true that the majority of the young people who smoked cannabis and developed schizophrenia would have developed the illness in any case. By analogy, consuming even low amounts of alcohol is causally linked to an increased risk of breast cancer, but most women who develop the cancer and also drink alcohol would have developed the cancer anyway. The implication of this key fact is that when any particular case of schizophrenia is definitively blamed on the cannabis use of that individual, such as in the Mail’s article, this is always misleading speculation (and thus, on the face of it, always in breach of the codes of press standards to which the Mail is committed).

A cannabis-using young person experiencing psychotic symptoms, or diagnosed with schizophrenia, should be told that cannabis is likely to worsen their condition, may have been a factor in causing it, and be strongly encouraged and supported to give up the drug. To instead dishonestly affirm that their choice to use cannabis brought about their own illness is cruel victim-blaming. The Mail has a long history of promoting the health benefits of daily alcohol consumption; but we are unaware of any article published by the Mail that categorically blames a woman’s daily drinking for her death from breast cancer.

So is this myth-making about cannabis and psychosis a harmless form of tabloid titillation? We think not. When parents and even doctors become hysterical about a vulnerable individual using cannabis, attribute blame and have lots of arguments with them, for all their good intentions it may be making the situation worse. As we have seen, cannabis use is at worst one risk factor amongst many, and that cannabis containing CBD may in the short-term offer relief from psychotic symptoms and anxiety, even whilst it might make things worse in the long-term.

We are not saying that parents should just ‘chill out’ about their children using cannabis and especially not if they have a pre-disposition to mental health problems. However, people with schizophrenia struggle with a gap between their reality and the consensus reality, and often don’t know who to trust. So to treat as delusional that person’s valid experiences that cannabis helps ease their symptoms is not going to help. Research shows that the stress of criticism and stigma within the family and in the wider social environment worsens the course of schizophrenia, and can lead to suicide, whereas a stable, warm environment can improve the prognosis and protect against suicide.  

Secondly, the media frenzy over cannabis and psychosis has had harmful and counterproductive political consequences. When he was Home Secretary, David Blunkett was brave enough to listen to what experts had been saying for decades, ignore hostility in the press, and downgrade cannabis to Class C. Following this move, cannabis use continued to decline steadily, (legal classification having no significant impact on cannabis use), the Home Office celebrated saving 199,000 hours of police time,  whilst fewer people suffered the harms of criminalisation. However, from the announcement of reclassification onwards, the Mail and several other newspapers produced a stream of spurious articles about skunk cannabis and schizophrenia, alleging that Blunkett’s move to “soften the law” was putting young people’s mental health at risk. Predictably, the pressure was too much and in 2008 Jacqui Smith announced that she would put cannabis up to Class B again, a decision she now regrets

Since then, the Mail has persisted in misleading their readership, even in 2011 asserting in a headline that “Just ONE cannabis joint can bring on schizophrenia”. To once again stress the gulf between this claim and reality, based on estimates discussed above it has been estimated that to prevent one case of schizophrenia in men aged 20 to 24, about 5,000 men would have to be prevented from ever smoking cannabis. 

This year, a fascinating analysis was published of hospital admissions recorded for ‘cannabis psychosis’ over the brief period when cannabis was in Class C. Admissions fell when cannabis was made Class C and rose again when it became Class B. The lead author of this research, Ian Hamilton, points out that a causal link cannot be definitively made. Even so, after this finding, how can the Mail and others maintain their position that it is their heartfelt concern for the mental health of our children that justifies tough penalties for cannabis possession, and that those who argue against criminalisation recklessly endanger young people’s minds? Whilst they dedicate pages to emotive anecdotes of cannabis victims, wildly misrepresent research on mice and report unpublished research when it can be distorted to fit their view, they unsurprisingly did not cover this peer-reviewed analysis.

It is bitterly ironic that those who set themselves up as a bastion against insanity-inducing cannabis may have some responsibility for the current situation, where vulnerable cannabis users only have access to the types of cannabis which pose the highest risks to mental health. The UK cannabis market has evolved under the pressures of tough enforcement. Instead of importing hashish and outdoor-grown cannabis, products high in cannabidiol (CBD), most is now grown indoors here, and contains far less CBD and much more of the psychosis-promoting THC. If the Mail wishes to crusade in the interests of families impacted by schizophrenia, they could instead support research into the potential use of CBD as an antipsychotic, one with none of the nasty side-effects of currently available options.

Tragically, it seems likely that the harmful consequences of promoting criminalisation, instead of education, to ‘send messages’ on drugs fall disproportionately on the very same people most vulnerable to any increased risk of psychosis that cannabis may produce. They are not the demographic of cannabis victims which the Mail focuses their sympathies on. A cannabis-using young person who is black, male, an immigrant or child of immigrants, lives in an urban area, and has an unstable home life has many of the risk factors for psychosis, and is precisely the demographic most likely to be arrested for cannabis possession. The disproportionate laws for which the Mail has lobbied, supposedly to reduce the harms of cannabis, just compound the harm falling on the most vulnerable.

The ISCD will critique, debunk and praise more drug-related stories in the media. We hope you will come back and read, and perhaps we’ll see fewer nonsensical drug-related articles like this being published, and journalists using their talents to inform rather than mislead.

The Government’s proposal to curb drug-driving is a car-crash

A short version of this blog post was published in the Guardian

I don’t know about you, but I find that the old “Would You Rather?” game helps liven up long motorway journeys. Here we go…

Would You Rather that the car ahead of you was driven by Paul, who just knocked back the hair of the dog at the motorway services pub before merging back into your lane from the slip road…

Or Would You Rather be behind Rob, who is alert, has his eyes on the road, but shared a cannabis joint earlier on in the day?

Now when I tried this question out earlier, the first answer I got was “That’s a plainly leading question, not a balanced dilemma. You clearly don’t know how Would You Rather works”.

The correct answer I’m looking for to set up this article is “I’d definitely rather drive behind Rob. He’s probably as clear-headed as I am if a few hours have passed since the joint. Half-drunk Paul might be dangerous though. And what’s a motorway services pub? No-one would allow that”.

The Government see things differently and have plans afoot.  Regulations preventing alcohol sales on Highway Agency sites, they believe, are stifling the development of motorway branches of Wetherspoon and similar big pub corporations and should probably be removed. If Paul can stay just south of our generous legal drink-driving limit, (not that anyone will be breathalysing people as they leave the pub) his drug use is an essential part of the economic recovery. This Government prides itself on cutting regulatory red tape. I just hope that less red tape at the roadside doesn’t mean more of the fluttering blue and white kind bearing the word ‘POLICE’.

What about Rob? Under Government proposals, if a microgram of THC (from cannabis) can be found in a pint and a bit of his blood, (enough to be sure he hasn’t simply walked too slowly past a cannabis smoker), then he should be prosecuted as a drug-driver. Whether or not Rob is in possession of cannabis, actually intoxicated, or in any way a danger to road users, is immaterial. The Government have announced that they want a “zero-tolerance approach” to drivers whose bodies contain definitive traces of any one of a blacklist of 8 controlled drugs.  They openly state that they don’t want to take a consistent "risk-based" approach to drivers using drugs; an approach that aims to discourage and punish those who drive when their blood contents suggests they are unfit to do so; they would prefer to use the Road Traffic act to get “tough” on people who test positive for an arbitrary selection of the wrong drugs, and so “send a message” to us all about the unacceptability of drug use. Some drug use. The “risk-based approach” as recommended by their scientific advisors is fine for alcohol, sleeping pills, morphine, just not for cannabis, cocaine, MDMA and 5 others. This is, they say, to avoid sending “mixed messages”.

I probably don’t need to tell you that “sending messages” of any kind isn’t really what the Road Traffic Act is supposed to be for. Evidence abounds that messages of toughness or liberality expressed by drug laws have no clear effect on levels of drug use. Disproportionate toughness will not prevent car wrecks, but lives and careers will be wrecked through criminalisation. Yes, driving when properly ‘stoned’ is one of the only ways cannabis can kill, and needs to be tackled. A risk-based cannabis-limit can do that. Zero tolerance to drivers who ever use cannabis is more likely to make things worse. In US those states where medical cannabis has been legalised, there are fewer deaths on the road, probably because people switch to cannabis from alcohol. Both drugs dangerously impair driving, but they are strikingly unequal in their relative risks. In a dataset (France 2001-2003) where an equal proportion of drivers have alcohol in their system as cannabis, the drinkers cause more than ten times as many fatal crashes.

Changes to the Road Traffic Act should be directed at maximising its fairness and functionality; “messages” are best sent through education not legislation. The extra enforcement costs of pursuing not just intoxicated drivers, (the ones who put us all at risk), but any drivers who test positive for traces of the blacklisted substances, will be a big drain on resources. On the other hand, following the evidence-based approach instead, by the government’s own estimates is much more favourable, with the value of preventing casualties more than outweighing the costs of enforcement.

Once again, the Government commissioned a team of scientists to set out the facts and make evidence-based recommendations, and then resolved to stick with their own prejudices. The Government’s plan, and two alternatives (one being to accept the expert recommendations in full), was set out in a Government Consultation which has now closed, but you can still have your say in this “would you rather” game that actually matters by contacting your MP. Their assent is needed for this amendment to the Road Traffic Act to be adopted. You’ll find more details in the ISCD's submission to the consultation here

Of course the Government decided that its arbitrary zero-tolerance drug blacklist would be incomplete without including a drug unparalleled in its fearful symbolic potency; LSD. What can be deduced from their choice to ignore the experts and add LSD to the list? It seems they could have picked any number of other drugs with equal or greater justification; the more prevalent, less notorious drug psilocybin (magic mushrooms), or the even more popular and legal drug salvia. As the Expert Panel’s leader Dr Wolff notes, neither LSD nor psilocybin have ever been detected in anyone apprehended in the UK for drug driving, nor in any driver involved in a smash. The Expert Panel sagely noted that tripping on mushrooms or LSD “is not likely to be compatible with the skills required for driving”, (perhaps after consulting with Jon Snow), and recommended that forensic evidence from drivers and crashes be monitored so that evidence-based LSD or psilocybin or indeed salvia limits might be proposed in future. 

But the Government doesn’t intend to wait to get tough on the LSD “menace” (yes that word was really used). Could it possibly be that the ‘message’ – a Government standing strong against the drug scourge – has priority over actual evidence of any serious preventable threat? Are LSD-addled drivers top of the list of traffic safety worries? I previously pointed out that vehement anti-cat posturing by the Government would be rather more proportionate than their drug policies. Apologies for revisiting a theme, but Road Minister Stephen Hammond should take note that when British drivers see airborne cats zoom past their windscreens, that’s less likely to be an LSD-induced hallucination than the result of the 40% of pet-owners who, with no legal requirement to do so, don’t restrain their pets in the car. Why not institute zero tolerance on that? Whilst battling the as-yet undetected scourge of drivers on LSD or mushrooms, Hammond seems blithely unconcerned that bloody cats are wreaking destruction on our roads in ways both obvious and terrifyingly discreet

To conclude on a serious note, there’s a danger that people imagine that “totemic toughness” on drugs is cost-free, a good way of demonstrating to ourselves that we care about the tragedies caused by intoxicated drivers. Don’t be fooled. Policymakers who block out inconvenient evidence to pursue “totemic toughness” are rarely vindictive, indeed many see themselves as holding the moral high ground against cold scientific rationalists. They could hardly be more wrong. The moral basis is clear for criminalising intoxicated drivers. Testing a driver’s blood against an evidence-based limit, as recommended by the experts, provides a fair and objective legal standard for punishing a reckless behaviour that the public largely agree to be wrong. However, with the zero tolerance approach, the blood test is being put to an alarming new purpose, and gains a whole new meaning. Rather than being merely a tool that helps implement our existing values (that driving when impaired is wrong), the test itself becomes the moral arbiter that identifies if drivers are criminals. We are surrendering our measure of right and wrong to a forensic test.

Will new drug driving law reduce minimise harm?

By Nicholas Lay

Earlier this month the government chose to ignore the recommendations of its own Advisory Council on the Misuse of Drugs (ACMD) regarding the legal status of the herbal stimulant khat, proposing instead that it be banned. Hot on the heels of this decision, the government has once again ignored evidence-based guidance, this time when drawing up its recently announced new drug driving laws. At the behest of the government, a panel of experts produced a report carefully calculating the threshold amounts of illegal and prescription drugs which would produce impairment comparable with the drink driving limit. It was published in March of this year. Despite the scientific rigour of the report (or because of it?), the government has chosen to disregard the thresholds advised for illegal drugs, instead opting for a ‘zero tolerance’ approach where the question of whether the driver is impaired is discounted.

Under these new laws, roadside tests and/or blood samples will see drivers prosecuted for drug driving if they are found to have any detectable amount of any one of eight specified illegal drugs (includingcannabisMDMA and cocaine) in their system, regardless of whether it is biologically possible that this amount is causing impairment. While the reduction of drug driving is of course a noble aim, and the law is in need of clarification in this area, this zero tolerance approach once again raises questions concerning the government’s attitude to evidence and reason. Then there is the issue of the policy itself, as it is debatable as to whether any benefits will outweigh the harms.

While the government has proposed that any trace of these eight illegal drugs that is enough to rule out passive consumption will warrant prosecution, it will adopt the limits recommended by the expert panel for eight controlled prescription drugs (including morphine, methadone and variousbenzodiazepines, such as diazepam). This inconsistency gives the impression that the effect of banned drugs on driving is a categorically darker threat than the effects of prescription drugs or alcohol. Of course in reality, someone just under the drink-drive limit, or indeed someone who is tired or has a headache will be more impaired than someone who took cannabis the day before. The official press release  lists the eight illegal drugs, but leaves the prescription drugs embedded in its report, perhaps suggesting the ‘zero tolerance’ rhetoric in relation to certain infamous illegal drugs is the factor of most importance in terms of posturing to the media.

The same can be said for the specific addition by the government of the hallucinogen LSD (acid) on the list of eight drugs. LSD was not even recommended for inclusion in the law in the experts’ report. Discouraging people from driving on LSD is a good thing, but its insertion into these laws appears to be unnecessary, even ridiculous. As the lead expert on the report, Dr Kim Wolff, points out; to date LSD has “not been detected in drivers apprehended for drug driving or involvement in road traffic collisions in this country”. Indeed, if LSD needs to be strictly controlled when it comes to drug driving, why did the government not include psilocybin (the main active ingredient in magic mushrooms) or the legal hallucinogen salvia, both of which have similarly dramatic effects, and are more popular and easier to obtain? Without any conceivable scientific justification, it seems likely that LSD was included solely because of its notoriety in comparison to the others, a gesture to the press.

The civil liberties implications of this law are serious. For good reasons, drug use itself is not illegal (actual crimes include possession and supply) so this law is worrying in the way it resembles a back door approach to the criminalisation of people for having drugs in their system. This new level of powers has the potential to cause harm without preventing greater harms. A young, sober driver pulled over by the police for a broken taillight could have no cannabis in their vehicle or on their person, but may have trace amounts in their system. Even if they have not been stoned for a day or two, they might be prosecuted, despite posing no driving-related threat to either themselves or other road users. On top of the yearlong ban, they will face all of the harms consistent with a drug conviction. These include a criminal record, a potential fine or even jail time, difficulty getting or keeping a job or a place at university and travel restrictions abroad, particularly to the United States.

The current, contrasting drink drive limit supports this theory of back door criminalisation. Under the current law, drink drive limits are in place which punish people for driving whilst impaired, rather than for their drug use itself. The expert panel presented thresholds based on extending this system, yet the government has deemed such a method to be inappropriate. Hypocritical is the only way to describe this action. If driving with illegal drugs in your system cannot be tolerated in the slightest, the same should apply to alcohol. After all, it causes far more injuries and deaths on the roads.

Quite simply, these new laws give the impression of an attempt by the government to appear tough on drugs and to crack down on drug users, rather than to merely curb drug driving, the actual issue at hand. The benefits of a law designed to deter drug driving and save lives could still be achieved without causing the unnecessary harms discussed above. Putting appropriate laws in place, i.e. the ones outlined in the government-commissioned report produced by a panel of experts, would do this. The government should be consistent with its laws rather than posturing as tough. Most importantly of all, it should take heed of the scientific evidence available to it. That way, everyone wins.

Uruguay is set to legalise cannabis. Should we celebrate?

Assuming this law will pass though the country’s Senate, Uruguay is set to become the first country to legalise cannabis. Might this reduce the level of harm cannabis causes there to individuals and society?

To get closer to an answer, it is essential to move beyond the binary of legal and illegal, and to think more about the controls and regulations in place. Legality can look very different depending on the details of how a product is controlled. Compare an uncontrolled ‘legal high’, a legal and aggressively marketed drug like alcohol and a legal drug like paracetamol. The obsession with legal vs. illegal disguises the complexities and subtleties of how policy can produce positive or negative outcomes. Markets for legal drugs can be dangerously unregulated just as illegal markets are. It is clear that neither legalisation nor prohibition are themselves solutions to drug harm.

The good news is that the government of Uruguay are not so naive to believe that drug harms can be tacked simply through the legalisation or prohibition of drugs. They have been consulting in depth with many international experts to develop detailed plans to reduce the harms of cannabis. They are even setting up a unit which will evaluate and monitor evidence in how the law is performing so it can continue to be optimised. We will need to wait to see how these plans are implemented, but at this very early stage, Uruguay are making all the right signals that they intend their policy to work to reduce harm, not just to signify a particular posture on drug use. This looks like truly evidence-led policymaking.

Uruguay have had a policy of depenalisation for a while, where cannabis is prohibited, but possession of small quantities for personal use is tolerated. So their public and politicians know that the sky does not fall in when cannabis users go unpunished. That knowledge is not quite so widely accepted here, but international evidence shows that the wide variation and many local readjustments in ‘toughness’ of cannabis policy have no clear connection to how popular the drug is. And if use rises somewhat in Uruguay, is that itself a disaster if the overall burden of harm can be reduced? If we consider the harms of scuba-diving, is it better for this to be a popular and licensed activity with some risks or an illicit and dangerous habit of fewer people? We will have to look beyond the raw figure of cannabis prevalence to evaluate this law. Drops in crime and the use of more dangerous drugs are other vital measures of success.

Those who are close-minded to options beyond criminalisation frequently point to alcohol and cigarettes, which despite their legality causes more harm than any other drugs. As stated above, they are right, in the sense that legality itself is no magic bullet. But Uruguay intends to have a state monopoly over the production and sale of cannabis. Whilst kids’ sporting heroes are sponsored by booze companies here, all promotion of cannabis in Uruguay will be illegal, no companies will be seeking to maximise their sales. For our government, where a man who earns money from Big Tobacco has a job in the heart of the system, it proved a step too far to regulate tobacco packets so that they are not designed to appeal to new users. In Uruguay, to buy cannabis a user will have to be over 18, will need to register, and will buy the drug from pharmacies, unless they want to grow a personal supply themselves. Scrutiny of this state monopoly will still be essential to ensure that policy is never skewed by any vested interests that conflict with harm minimisation.

Alcohol provides a useful comparison in other ways. Illegal alcohol often contains a high amount of methanol, which blinds and kills drinkers. Legal alcohol has quality control. Like alcohol, the chemistry of cannabis affects the risks. Cannabis in this country has changed, 24 hour lighting in growhouses have produced a product with less or no CBD in it, which now dominates the market. CBD is a chemical which offers some protection from both the more unpleasant and more harmful effects that THC in cannabis can have. Uruguay has a great opportunity to offer their cannabis users access to a better, less harmful product. It is worth noting that illegal alcohol still exists and kills; a regulated market can only aim to outcompete and minimise the illegal market. Legalisation should slash the harms drug crime and illegal markets do to society, but will not eliminate them. Uruguay must follow the evidence of outcomes to find the optimum between over-regulation (for example a very weak product), which will push users back to unregulated illicit sources, and under-regulation, which I would argue is what we have for tobacco and alcohol, where opportunities to reduce harm, such as plain packaging, are rejected.

This article has focussed on the ways politicians can influence drug harm, but the Uruguayan proposals show understanding that top-down State action is not enough, and users’ decisions determine outcomes too. They propose education that equips citizens to make these judgements over their drug use, and healthcare and support for people needing help with cannabis problems. 

Cannabis is not harmless, for example it can worsen the mental health of some heavy users, especially the young. But the mental health impact of prison, unemployment and illegal drug gangs is considerable, legalisation reduces this burden of criminalisation. When deciding a drug's legal status, the question of whether it is harmful is less important than the question of how the legal status might reduce or increase those harms.

The world must watch what happens in Uruguay closely. If their approach works, this evidence should provoke reform elsewhere.

Khat - the claims vs. the evidence

Proponents of a ban on khat, however well-intentioned, are using a range of arguments which do not stand up well against the facts, or survive the application of reason.

Argument 1: the drug chemistry justifies a ban

The Claim;-

Khat is a natural form of mephedrone (or amphetamine/speed) which is banned, therefore it is logical that khat must be banned too. Khat is like cocaine, khat is like ecstasy....


Mark Lancaster MP – “The main component, cathinone, is found in meow meow” ...“I was shocked to learn that cathinone and cathine, are members of the same group of drugs as methadone(sic) ... Cathinone and cathine are illegal as is mephedrone yet contradicting all common sense, khat containing these same substances is legal. How can we continue to promote this hypocritical message?”

The Reality;-

Mark is muddled over his molecules. Cathinone isn’t mephedrone, although they are indeed related. However that tells us very little that is useful about its risks of khat leaves, which are lower than the risks of either cathinone in a pure form, or mephedrone. Whilst mephedrone is a powder that can be easily binged on, or even injected to produce an instant rush, cathinone is found in low concentrations in khat leaves, and released slowly by chewing over the course of an hour or so. Fatal overdose with khat is impossible, with mephedrone overdose is rare, with alcohol it’s common. Extracted cathinone is already illegal. Pure caffeine (not illegal) is pretty harmful, but that says little about the dangers of coffee.

Media guidance;-

Comparisons with other drugs such as amphetamine, caffeine, mephedrone etc, are of limited validity and should be used with care.

Argument 2: the drug effects justify a ban

The Claim;-

Khat is extremely dangerous and potently intoxicating, with various noxious effects on physical and mental health, so a ban is needed.

Mark Lancaster MP,
Baroness Warsi... “It can trigger paranoia and hallucinations. It is carcinogenic”. 

The Reality;-
The ACMD review found; “In summary, the evidence shows that khat has no direct causal link to adverse medical effects, other than a small number of reports of an association between khat use and significant liver toxicity.”

This is corroborated by DrugScience's review. Having said that, khat, like any drug, and indeed like anything, can cause harm if used inappropriately. As with alcohol or fast food, it is usual to make a distinction between problematic excessive use and ordinary use. This distinction is abandoned by the critics of khat.

Khat is not a hallucinogen like LSD, nor does it alter consciousness in the way that cannabis or alcohol are. It is a stimulant, and after a moderate amount of it, there is no evidence that a user would be incapacitated to think or even drive (although it’s best never to combine drugs with driving). As an aside, there is NO connection between the degree of intoxication a drug causes and its dangers, so implications that a drug are mind-bending and therefore need banning are usually rooted in morality rather than science. Cigarettes cause no intoxication and kill up to half of their persistent users. LSD is one of the most mind-altering drugs, but poses comparatively minimal risks to physical health.

It is likely that khat could play a role in mental health crises in which hallucinations, paranoia and aggression may occur. For example, if someone with a history of trauma from war in Somalia has a breakdown and chews khat without sleeping for days, they may suffer psychosis. Once again, alcohol is associated with mental health issues like this, but few call hallucinations an effect of wine. Hallucination should not be mistaken for an effect that khat causes in normal use.

There is no conclusive evidence that khat is carcinogenic. If khat does prove to cause a risk of cancer so slight that it hasn’t been picked up in some studies asking this very question, this does not make it uniquely dangerous. You can go through the alphabet (Alcohol, Bacon, Coal...) listing objects linked to cancer to some degree. The important factor is the level of risk. Tobacco poses a huge cancer risk to khat users.

Media guidance;-

Care should be taken to distinguish claims and facts about the effects of khat. Claims of its dangers should not go unchallenged, and could be set against the evidence reviewed by the ACMD.

Argument 3: the will, the cri de coeur, of the affected communities justifies a ban

The Claim;-

Communities affected want a ban, it’s racist not to ban it, banning it is a caring, kind act towards the user communities. 


Political proponents,

Abukar Awale (self-proclaimed Somali representative)  

The Reality;-

It is true that significant numbers of the Somali community express support for a ban, enough to rally small crowds that have protested in Downing Street. However, one cannot claim to have a democratic mandate by looking only at those who vigorously support the plan. Opinions on khat are diverse. In the UK, there are other communities aside from the Somali community (Ethiopian, Yemeni communities) in which regular khat use is also very common, but who seem to suffer hardly any of the harms that khat allegedly causes in the Somali community.  The opinions of these communities are never mentioned. For various cultural and religious reasons, people are less willing to shout about their right to use khat than they are to shout about how evil it is.

Opposition to khat is driven by a small handful of highly motivated individuals such as Awale Akubar, equipped with emotive anecdotes about the devastation khat causes. The ACMD’s review examined the diversity of views and found that the idea that khat is a food, not a drug, and that it has beneficial properties, also has very considerable support in the user communities. If policy is to be justified by anecdotal evidence without concern for establishing the facts, we would like an explanation why the first type of anecdotal belief is considered more valid than the second. Is it any more rational to impose a blanket ban because of anecdotes of harm than to impose universal provision of khat on the NHS because of anecdotes of health benefits?

When such conflicting personal perspectives exist, the need to examine the peer-reviewed scientific evidence is all the more vital. This is not to say that anecdotes about khat are useless, or to say that those who hate khat should pipe down until they have doctorates in drug science. As the ACMD’s review points out, anecdotal evidence is indispensable in guiding research to the right questions. Avoiding khat and warning against its use based on personal opinion is entirely legitimate. However it is another question whether the government should step in to coercively enforce anti-khat values on other adults without objective evidence of exceptional harms.

Psychologists know that collecting reliable evidence of people’s opinions is much harder than it appears. It has been suggested for example that evidence from surveys of considerable support for the proposition that khat should be banned is complicated by the possibility that the question is understood as shorthand for “Do you think khat use is a good or bad thing?” or “would you prefer if khat didn’t exist?” It is also likely that, similar to other drugs, big chunks of the Somali community and the public overestimate the deterrent effect of drug bans and underestimate the unintended consequences, genuinely believing that it is in the government’s power to make problematic drug use go away with the stroke of a pen. 

One can imagine a very different result if the question was phrased differently, for example “do you think that people who chew khat should be arrested?” A more sophisticated survey, capable of better separating people’s personal liking /disliking of khat from the practical question of effective policy responses might ask participants to choose between 3 options for the government;-

 1) Do nothing

 2) Control khat under the Misuse of Drugs act so that criminal sanctions are attached to its possession (with description of potential costs and benefits)

 3) Implement ACMD’s recommendations in full, review in 7 years (with description of potential costs and benefits)

The Misuse of Drugs Act 1971 is designed to classify and control drugs on the objective basis of their harm. Experts have shown that khat is not harmful enough to qualify for the Misuse of Drugs Act so if Theresa May wants a khat ban on a moral basis, she should put before Parliament for their consideration a new Act which does so transparently, rather than misusing the Misuse of Drugs Act. 

Media Guidance;-

It is essential to include Somali people’s opinions when reporting on this issue but no single individual, however forthright, can claim to speak for the Somali community, and this should be made clear. Opinions on drug use based in subjective values or religion are of course important, but a distinction needs to be maintained between such moral claims against khat, which cannot be measured as true or false, and objective claims against it, which need to be evaluated against the evidence.

Argument 4: international prohibition, even in the Netherlands, justifies a ban

The Claim;-

Look internationally, even the Netherlands, home of wacky drug liberalism, have banned khat! We’ve become ‘out of step’.


Mark Lancaster MP

Home Office

Sections of press.

The Reality;-

The Netherlands currently have a fragile centre-right government, in which anti-Islam politicians have gained prominence. They are not a bunch of stoned hippie lefties. When they banned khat, they also did so in spite of evidence collected by scientific advisors (Trimbos). 

The Dutch scientific advisers of course made a similar assessment as the ACMD have, as the facts are the facts. Co-author Clary van der Veen said, "We made very different recommendations based on our study. The large group of social users is not a problem. You may need to inform them better and point out the long-term effect, just like with smoking and drinking,"  "In countries where khat has been banned, the integration of Somalis is not faring better," she said. 

By following the example of the Netherlands we are following a policy of denial of the evidence.

As we are seeing here, calls to ban khat were mixed up with anti-immigrant sentiment and plain racism. Khat was the excuse for the then Immigration Minister Gerd Leers (now resigned in disgrace) to say that 10% of Somali men were "lethargic and refuse to co-operate with the government or take responsibility for themselves or their families". The 10% figure for problematic khat use appears to be a novel invention, but the image of the lazy, black man who breeds without looking after his offspring and doesn't heed white authority figures is certainly not novel. It barely needs stating that ACMD found no evidence to support a causal link between khat use and social problems like these. They found that for an unemployed person, excessive khat use could indeed be a barrier to getting employment, but cited research for the Home Office by Patel (2005) that found that a smaller proportion of unemployed Somali men use khat than employed Somali men. The ACMD pointed out that "the majority of users moderate their consumption to fit in with work patterns".

The Dutch Government also cited antisocial behaviour such as littering as a justification to ban khat. The ACMD points out that such problems have already been effectively tackled in the UK through "community-level action working in partnership with police and local authorities".

Whilst the evidence clearly challenges the notion that khat is to blame, in a straightforward way for family breakdown, unemployment etc, there IS irrefutable evidence that criminal records for drug offences cause family breakdown, unemployment and the rest.

The ACMD looked at the international situation, and noted that the bans internationally either were imposed without a scientific assessment, or in the face of the scientific evidence. Where bans have been imposed, the problems of the Somali diaspora have not vanished. Neither has khat. But the price has risen sharply.

In the UK, it is clear that perceptions around khat are highly influenced by anti-immigration (or more plainly racist) sentiment. On the 4th July 2013, the ‘best rated’ comment on the story that a ‘Defiant’ Home Secretary was outlawing khat was simply "ban the drug and deport the users".

Media Guidance;-

The Misuse of Drugs Act 1971 is designed to classify drugs on the basis of their harmfulness.

Argument 5: terrorist links justify a ban

The Claim;-

Khat is “linked to al-Qaeda”, or the trade funds al-Shabaab, or the khat cafes breed radicalisation, so we need a ban. 


Awale Akubar,

Daily Mail, Sun


It is notable that Abukar Awale, the self-proclaimed Lead Campaigner for a khat ban, appeared to admit to a journalist that he likes to feed fears about terrorism as that is the key which forces political action.

"This is the tool for me," Awale said. "I will put this on the table and say, 'Now you must act'. And they will act. When this country hears terrorism, they will act."

Awale deserves a well-paid job as a phenomenally talented political lobbyist. Baroness Warsi cited him in the Conservatives first calls to ban khat in 2008, this year he told the Mail on Sunday that Lee Rigby’s murder was linked to khat.

After the ACMD had reviewed the evidence for the link between khat and terrorism, the chair of the ACMD called this a ‘nasty little rumour’. Whilst Somali use of khat is often integrated into the local Muslim tradition, so that it is used in celebrations and to fuel nights of Koranic study, most Muslim authorities from other traditions internationally consider khat-use to be at best undesirable and at worst forbidden. In fact, radicals spreading a fundamentalist interpretation of Islam into East Africa have been a major force behind the prohibition of khat there.

There is no reason to believe that khat cafes are linked to radicalisation, and the narrative is indicative of a general suspicion of Muslims, or indeed any people who are not white British. The Sun’s article making these lurid claims has the following comments below it;- ‘scouseviking’ says “Maybe if U turn Osborne put VAT on it, the Somalians  might all want to protest then you can round em all up and ship em home.....simples” 

Once drugs are illegal, the trade goes underground, becomes massively more profitable, and the illegal trade in heroin certainly has been a major source of funds for the Taliban and other fanatics. The sheer injustice of a ban like this targeted on an already marginalised population within a country that celebrates the legal use and abuse of our own socially lubricating drug, alcohol, would, if anything, foster the alienation and ostracision which radicalisers feed upon. 

Perhaps Theresa May has in the back of her mind a hope of some favourable headlines in certain tabloids that gave her a hard time over her struggles with Abu Hamza and Abu Qatada. But it is very ironic that a khat ban seems to appeal to the very same anti-immigration demographic as a way of taking a tough stance regarding Muslims in the UK, since Abu Hamza would likely have been very much in favour of Sharia law banning khat in the UK. Since May can’t justify banning khat on public health grounds, she’d be better off taking a Sharia-like approach and banning it on grounds of morality!

There's more than one way to skin a cat

A version of this post was published by The Guardian

Now this is embarrassing. I'm expected to have something to say about Theresa May's intention to ban the plant-drug khat, but due to a texting error by a new intern, I'd been preparing my thoughts on the Tory plan to ban cats, a plan which I now learn may not exist. Fortunately for her, I find that many of the same arguments apply, so I'm not quite back at square one.

The proponents of a ban on cats khat may be well intentioned, but rely on a mixture of exaggerated, selective, anecdotal, prejudiced and most frequently erroneous and illogical arguments. Cats are Khat is indeed associated with harm, which can be very serious at times, but it is unwise to generalise from the most extreme cases, or assume that cats are khat is solely to blame for complex problems of owners users.

Advocates for a ban are sometimes prone to demonise cats khat and, cynically or credulously, to fuel unfounded fears against owners users.Historically, cat owners were persecuted as witches. Khat users find themselves linked spuriously to terrorists, the ultimate folk-devils of our era.

Despite all the rhetoric, when detailed studies are made that explore the actual empirical evidence, suspicions about the dangers of cats khatare revealed time after time to have little basis in reality. A balanced assessment also exposes the prejudices of those campaigning for a ban on cats khat. Theresa May, who wants to disregard expert advisers and label as criminals any people who possess cats khat, has disregarded the evidence before, personally undermining her own government's promise to reduce the far greater harms caused by dogs alcohol.

By nearly every possible objective measure, dogs cause alcohol causes far greater danger to health, life and society at large than cats khat, or indeed any other pet drug. People rightly worry about the harm caused to society when people are irresponsible with dogs alcohol: the thousands of hospital admissions; the mess and intimidation we encounter on our city streets. However, insight and experience show that these harms to society can best be minimised through education, co-operation and maybe regulation, not by criminalisation and ostracism. Bans offer an opportunity for governments to posture and express their toughness to the electorate, but our legislative agenda should be driven not by the naive assumption that simple bans solve complex problems, but by evidence of what might actually best serve the interests of the public.

Those wanting a ban on cats khat might do well to consider the historical precedent. Driven by tabloid hysteria, the UK government introduced The Dangerous Dogs Act 1991, banning four breeds of dog. Since then, hospitalisations for dog bites have more than quadrupled , with experts highlighting the absurdity of criminalising possession of particular types of dog instead of addressing issues of owner behaviour and responsibility . Driven by a moral agenda, alcohol was banned in the US in the 1920s, successfully handing the trade to organised crime networks. While prohibition probably reduced consumption, overall harm rose as the people most harmed by alcohol were denied the help they needed and were instead branded criminals. Now in the UK, the freedom of individuals to lawfully own a dog drink is respected, and we recognise even that pets alcohol might have some social value too.

Those who don't like going near dogs alcohol, who think that dog owners drinkers are wasting good money on dog food alcohol and valuable family time going on walkies to the pub have a valid opinion, but we don't think their values should be imposed on others through the criminal justice system. The same is true of cats khat: no one should mistake their inalienable right to find cats khat disgusting with a right to interfere with the personal choices and pleasures of others.

The risks associated with dogs and cats alcohol and khat are not something we should take lightly, but bans are an excuse to do nothing productive to address a problem, which the government has been doing very well already. Twice they have asked the Advisory Council on the Misuse of Drugs (ACMD) to review the harms of khat, (they are obliged to get expert advice before they ban it), and twice the ACMD has said that a ban would be inappropriate and disproportionate, while making a series of considered recommendations for awareness-raising and community engagement, access to treatment services and improving health standards of khat cafes. While the government has no problems collecting millions in tax on khat imports, it seems reluctant to consider any investment in looking after khat users, except if they are in prison cells.

All right, I think we've chewed over the khat/cat analogy long enough, but there is a serious point to be made here. I got into a little trouble for comparing the risks of death and serious injury from horse-riding and ecstasy, so I should be sure to say that whilst horse-riding really is comparably risky to the class A drug, in terms of acute harm, I expect that khat use is more often seriously problematic than cat-ownership. However, we should be comfortable with the idea of comparing the risks of drug use with other risks we might face: cooking, trampolining, sunbathing or pet ownership. Our drug laws are purportedly there to protect individuals and society from harm – they are not meant to be there to uphold any specific moral values and punish deviance from them. If politicians wish to argue for drug prohibitions on a moral basis, because they think it is obnoxious and dissolute to sit around getting high from leaves or intoxicated by drink, that's fine, let them make the case, and see whether parliament or the electorate have an interest in policing people's personal habits. What they must not be allowed to do is to push a moral agenda against an already marginalised group through laws intended to regulate drugs on the basis of evidence of their harmfulness.

Let’s get the War on Drugs out of our hospitals and laboratories

There are politicians in every major party who hold sensible attitudes to drugs, and a few of them even have the integrity to air these attitudes in public, rather than just acknowledging them in private, or when they have left office. Unfortunately, while they serve in government and have a chance to tinker with the creaking old banger of our drug policy, they only ever pick up the hammer or wrench to toughen and tighten the rules. They never reach for the oil or the fuel that might ease the rusted up axles and make our policy actually work.

Beneath the rust, our drug policy does have the mechanisms in place to operate (whether an entirely different mechanism might work better is quite another question). There are twin engines under the bonnet, the familiar Misuse of Drugs Act (MDA 1971), which details how different drugs are controlled to prevent ‘misuse’, and the lesser known Misuse of Drugs Regulations (MDR 2001), which details how different drugs are controlled to allow legitimate use for research and medicine. If our drug policy ‘worked’, we’d see the harms associated with drugs driven down through MDA 1971, and the benefits associated with medical advances and scientific progress driven forward by MDR 2001. Sadly, these engines seem to have seized up.

Today, with Les King and David Nichols I’m publishing a paper in Nature Reviews Neuroscience which with your support will kick-start a debate on one of the principal failings of our drug policy, one that could be mended tomorrow if politicians knew that most voters want their drug policy to work, rather than to sit there symbolising something about the tough values of its engineers. I am highlighting the fact that here and internationally, the Regulations on using controlled drugs in research are so illogical and obstructive that they amount to the greatest act of censorship on scientists since Galileo was tried before the Inquisition, and texts advocating the sun being the centre of the universe were banned.

The Regulations classify drugs into several ‘Schedules’, with different degrees of control. Schedule 2 for example contains drugs with significant dangers, but also medical uses, like morphine. They are regulated to allow legitimate use in hospitals and laboratories whilst minimising the risk of the drugs getting into the wrong hands. Schedule 1 is for the most tightly controlled of all, it contains drugs that, at the time of writing the laws, were deemed not to have any proper medical value. Therefore, in theory, those drugs could be stringently restricted with no compromise to future human welfare. With political motivations often trumping evidence, into the bottomless pit of Schedule 1 went LSDmagic mushroomscannabis, and ecstasy, each of which actually have considerable therapeutic potential. More recently, our government has tipped into this black hole barrowloads of totally un-researched new chemicals (e.g. cannabinoids, cathinones, arlycyclohexamines) because they are chemically related to banned drugs. All these drugs are caught in purgatory, stuck in a paradox; without an established medical use they can’t be freely researched, but without this research, any medical potential they may have will never be uncovered.

Drugs get sucked into the black hole of Schedule 1 all too easily, but no evidence of medical value seems enough to get them out. We need to resist the scary fairy-tale that removing drugs such as cannabis from Schedule 1, or reforming the Regulations, will open a Pandora’s box. There’s much more reason to believe that we’ll unleash a Neuroscientific Enlightenment, making new discoveries about the brain and consciousness, developing new treatments for debilitating disorders like PTSD, depression and chronic pain, and giving a boost to our economy along the way.

LSD was used as a therapeutic tool, and research thrived before UN Conventions and domestic laws controlled it as if it were akin to smallpox. The controls on Schedule 1 drugs like LSD, magic mushrooms and MDMA are purported to counter the threat of diversion, yet far more harmful drugs including heroin, (categorised as Schedule 2), are safely researched and used therapeutically in UK hospitals under more proportionate controls. Research on Schedule 1 drugs is technically still permitted under licence, and indeed some goes ahead, allowing the authorities to deny that scientific progress is being stifled, yet the figures tell their own story. Since this censorship began, there have been just one or two studies published on the therapeutic potential of LSD in human subjects, compared to the hundreds of studies before. With Schedule 1 licences costing thousands of pounds, and with endless bureaucratic obstacles, it is remarkable that any research on these drugs is done at all.

I’m not calling for scientists and doctors to be let off from the rules on drugs that apply to other citizens. I’m calling for the regulations on controlled drugs to be proportionate to the risks they pose. One simple gesture that could be introduced tomorrow would be to introduce minimum quantity thresholds below which a lower tier of regulations apply. It’s hard to argue that a 50mg reference sample of MDMA in a locked cabinet,- less than a single dose- poses a greater threat to public health than the cleaning products and medications in our bathroom cupboards. Another progressive change would be to make Schedule 1 licences free, which would be cost-effective considering how the economic powerhouse of biosciences in the UK would be invigorated. Moreover, it is essential that new compounds, with no known dangers and unknown therapeutic potential, are not lost into the black hole of Schedule 1.

I hope for regulations that support scientists and the biosciences industry to uncover new knowledge and treatments, rather than holding them back. If you agree, why not write to your MP?