21 Jan 2014

Reducing the harm of drugs

8:10 am on 21 January 2014

Professor David Nutt is a British psychiatrist who has spent his career researching drugs and the brain. He is the Edmond J Safra Professor of Neuropsychopharmacology at Imperial College London and one of the world’s top experts on drugs and addiction.

In 2008, Professor Nutt was named chairman of the UK Government’s Advisory Council on the Misuse of Drugs (ACMD. His role was to make scientific recommendations to government ministers on the classification of illegal drugs. He was dismissed from this role in 2009 after challenging the evidence base of the government’s drug policies.

He’s outspoken about drug policy, the role of science in policy, and the media’s culpability in creating hysteria around illicit drugs, while ignoring the harm of others.

In a presentation in Wellington hosted by the New Zealand Drug Foundation, Professor Nutt pointed to the case of Amy Winehouse, asking of she died from a drug overdose, an alcohol overdose or “both the above”. In fact, it was alcohol that caused the singer’s death – her blood alcohol was 5.5 times the British legal driving limit, and CNN reported above the level considered fatal. Professor Nutt says her death being widely reported as happening “despite being in recovery” was an opportunity to educate the public on the harms of alcohol that was missed.

The science around the brain and drugs is complicated, and still much debated. But Professor Nutt says that fundamentally, the brain is a bag of chemicals. “Clearly, there are some chemical changes in the brain which we think cause addiction. We think some individuals have chemical differences in their brain that pre-dispose them to become addicted to drugs, or gambling.”

It’s an illness that has been foisted on them by governments that get a lot of tax revenue from selling alcohol, and turn a blind eye.

“But also there are psychological factors as well,” he says. We know that one of the major factors which discriminates between people who use drugs and become addicted and those who don’t, are things like economic advantage, the poor, people who have been psychologically or physically damaged, child abuse.”

Professor Nutt says that’s a mixture of the psychological sense of not being empowered to live one’s life, but there are also long term chemical changes in the brain which result from poverty and childhood adversity.

He says stigmatising people with addiction, either by jailing them or media coverage like that of Amy Winehouse’s death, is absurd. “In some people, a trigger in the brain that controls behaviour gets switched off. Often, you will have alcoholics say “I didn’t even want to drink. I woke up drunk, I didn’t even want to drink. But it was compulsive in me”

“It’s an illness that has been foisted on them by governments that get a lot of tax revenue from selling alcohol, and turn a blind eye.” He points to a saying: “a drug is something a politician once used, but now regrets.” In his presentation, Professor Nutt said the worst example of the British government's “deliberate blindness” towards the effects of alcohol is that it has ignored the fact that for 15 ways of dying there is a strong relationship between alcohol consumption and risk of dying.

“In fact the only area of human death that isn't similarly affected is ischemic heart disease ... there is some protective effect of alcohol of middle aged men. And that effect was considered sufficient evidence, by the Blair government, to refuse to countenance any change in change in alcohol policy. So all the other deaths are irrelevant. In fact, the drinks industry has been so effective at highlighting that possible benefit, that many people now think they should drink in order to get the benefit. They think that what used to be our recommneded maximum intake, they've now been re-framed as desired target.”

Professor Nutt says there are social policy ways to control some of the harms of alcohol, but not every country is doing them. “The reason we tax vodka more than we tax beer is because it’s more dangerous to drink a pint of vodka than a pint of beer. So basically, we know that you can regulate consumption by price.”

He says the more the consumption is reduced, the more harm is reduced, but it’s not linear. “One of the remarkable things about alcohol is that there is a progressive rise in harm the more you drink. So going from one standard drink a day to five a day increases your chance of dying as a result of drink by about three times.”

He says going from five standard drinks a day to ten – which seems a lot but something Professor Nutt says is within the realms of possibility, for alcoholics – then the chance of dying goes from three times to eighteen times. “That exponential rise is one of the reasons that alcohol is dangerous, but it also shows that even if you make small impact on high-end consumption, you actually reduce deaths. You can make those small impacts just by sensible pricing, by reducing availability, shutting shops at midnight.”

Julia Louis Dreyfuss smoking an e-cigarette at an awards ceremony.

David Nutt says he believes e-cigarettes are the biggest health advance since vaccines. Photo: Unknown

“The other point to make is that most of the harm from alcohol in society comes from people who are not alcoholic,” he says. “Most harm comes from violence: young people crashing their cars; breaking their necks; being permanently brain damaged as a result of getting their head kicked in by drunken enemies. Most of the harm comes from drinking below the level of addiction. That’s why anything we can do to reduce consumption is massively beneficial to society.”

Professor Nutt says there are proven ways to deal with addiction, like methadone programmes and needle exchanges for heroin addiction – which reduce harms to both the user and to society. But he says the weakness of those programmes is that people haven’t thought beyond substitution therapy. “Most people don’t want to be on methadone all their life – they’d like a period of stabilisation on methadone, and then to become clean.”

“What we need is much more research into how to keep people clean,” he says. “I’m interested in drugs which are not psychoactive drugs to help people stay clean, which work in the brain.”

The most addictive drug – and the one that kills the most people worldwide – is nicotine. Currently, about 6 million people die each year of tobacco-related illnesses. One approach to stopping that is abstinence – people quitting, either cold turkey or with gum or patches. Another is to have a safe form of nicotine, like the drug Champix, which stops people going into withdrawal.

We have to have a much more rational debate about drugs, because we can’t let hysterical media stop health advances.

Professor Nutt says the newest development is “electronic delivery systems” or e-cigarettes. “I actually think e-cigarettes are the greatest health advance since vaccines. This is going to revolutionise health in the world.”

“More people die of tobacco, than die of aids, malaria, TB and meningitis combined,” he says. “Imagine wiping out those four diseases. We can’t do that, but we could, by everyone switching to electronic cigarettes, wipe out deaths from cigarettes.”

Professor Nutt would like to do the same thing for alcohol, which he says doesn’t kill as many people, but is more harmful than any other drug.

There are already treatments to encourage alcoholics into abstinence – which work about 15 to 20 per cent of the time. There is a relatively new treatment for binge drinking, to help people have control over their drinking.

“Far too many people now see alcohol as a means of intoxication,” says Professor Nutt. “Over the years, I’ve learned a lot about alcohol. About 10 years ago, I thought ‘we will never find an antidote to alcohol. It’s far too complex, it interacts with far too many things. Maybe we’ve got it the wrong way round, why don’t we make a safe alcohol?’”

He says he wanted use scientists’ knowledge of alcohol, and what it does in the brain, all the good points – to make people happy, relaxed, sociable, and interested in other people – without all the bad parts.

So he developed a cocktail, saying he wants to allow people to enjoy the taste, smell, and look of a nice drink, in a nice bar with their friends. “I want to re-establish the ability of people to drink as part of social engagement, rather than to drink alcohol as a drug. What I am trying to provide is an alternative to the drug of alcohol.”

But he says it is hard, because investors are worried that the cocktail will be seen as a drug, and that it will be banned. “And of course, you can’t say they won’t. The history of irrationality about drugs is so deeply entrenched.”

“And the big fear is of course that one newspaper will start saying “this is a drug”, and someone will start lying about it and say this drug caused my child to kill themselves,” he says. “That’s why we have to have a much more rational debate about drugs, because we can’t let hysterical media stop health advances like that."