Originally published in 2012 ‘Drugs Without the Hot Air: Minimising The Harms of Legal and Illegal Drugs’ is written by David Nutt. Nutt is the Edmond J Safra Professor of Neuropsychopharmacology at Imperial College, London and the chairman of the Independent Scientific Committee on Drugs. This book is a broad exploration of drugs, looking at their harmfulness and the medico-legal positions they are currently judged within, arguing against the current classification methods of government.
David Nutt was formerly the head of the Advisory Council on the Misuse of Drugs (ACMD), the U.K. government body for reviewing and making recommendations on drug classification and policy, but was sacked amid some controversy in 2009. He was sacked by the then Home Secretary, Alan Johnson, for criticizing the classification of cannabis. Indeed, he had already been in trouble after a small remark he made in a scientific editorial was picked up by the media. The comment? That horse riding was more dangerous than taking ecstasy. The first couple of chapters of Drugs Without the Hot Air are concerned with justifying this claim and laying the foundations for his position on drugs; harm reduction.
When it comes to U.K. public drug policy, an invention that has its roots in the Victorian era, there has always been somewhat of a battle between legal and medical professionals for defining its functions. Sometimes it leans a little to the medical, as it did in Britain for much of the first half of the twentieth century, sometimes a little to the legal, as anyone currently in jail for possession of a controlled substance will tell you. Currently, the popular paradigm for understanding drug policy is harm reduction. Although subsequent governments have tended toward moral (i.e. election-driven) policy making, as opposed evidence-based, harm reduction is currently gaining momentum, led, in part, by David Nutt. But what is harm reduction?
In 2007, David Nutt co-authored a paper that ranked twenty drugs in order of their harmfulness. This meant taking into consideration physical, psychological and social harms and the results, for those majority of individuals who have little or no experience of drugs, were surprising. Heroin, of course, ranked highly but it did so along with tobacco and alcohol, while traditionally demonised substances like MDMA, LSD and cannabis, ranked a lot lower. The implication of this paper, when applying its findings to UK drug classification was that the current system is hopelessly outdated, driven by moral panic and completely inadequate for reflecting the ‘real’ dangers of drugs. Of course, in combination with Nutt’s media-hyped comments, this meant he was as loggerheads with the current policy paradigm and this book can be read as his peace on the matter.
Drugs Without the Hot Air is written for the electorate, for parents, for the drug novice and as a vindication of Nutt’s position. In it, with easy-read short sections, Nutt discusses the difference between recreational use and medicinal use, outlining the chemical reasons we may enjoy a drug, become addicted to a drug, or be healed by a drug. He explores both licit and illicit drugs, pointing out that alcohol and tobacco should be understood as drugs along with LSD and the opiates, and addresses hot topics like the smoking ban, prescription drugs, and mephedrone. He also gives some advice to parents in What should I tell my kids about drugs? and outlines his hopes for the future in The future of drugs.
There is a wonderfully anti-government, (and to a degree institutional,) tone to the book. The power of such lobbying organisations as the drinks industry comes under scrutiny: “[T]he Labour government’s 2004 Alcohol Harm Reduction Strategy shows clear evidence of the influence of the drinks industry, because it focused on the measures the industry recommended… and ignored the measures recommended by the Chief Medical Officer” (Nutt 2012, 93). The government itself is accused of banning mephedrone due to it being election time i.e. to win favour with the public as opposed to reducing harm based on evidence. And the media and police are lambasted: “[T]he police shouldn’t make public statements or hold press conferences on the basis of hearsay and presumption, and the media should apply some traditional journalistic principles to their coverage of issues around drugs” (Nutt 2012, 124). The current problems of approaching drugs, in this sense, revolve around the manipulation and articulation of public opinion.
However, although the book is a good balance, so far as it tips the scales away from the political and media-driven misinformation and moral panic and into the realm of scientific evidence, it still addresses the same audience. Similar moral tactics are used in order to push the reader within a certain understanding. For example, in a section entitled Freedom and choice, Nutt tackles the smoking ban for public places and the argument that we should be free to choose. He begins by making a line of connections: This belief makes the individual a libertarian; being a libertarian means they are economically right-wing; the UK Independence Party is a libertarian right-wing party; ergo, those who believe in the freedom to smoke are in fact in league with an unpopular (pushing)-far-rightwing party. Instant demonisation, especially under our current political climate.
The fact that individuals are not so easily pigeon-holed, to believe in the freedom to smoke does not make one economically right-wing for example, seems to have passed Nutt by. Secondly, if he is going to seriously tackle the philosophical argument then he should have extended the breadth of the argument. It is not simply a question of smokers and their liberties; but the choice of landlords and ladies to choose as well, perhaps? The choice of individuals to work in a smoky environment, or not? The freedom to be not dictated to by any blanket law applied by central government? Regardless of one’s position on the smoking ban, it is a shame for Nutt to be employing this kind of tactic, using cherry-picked political-philosophical positions to push his own position, when he chooses to attack governments and institutions over their cherry-picked scientific ones. Moreover, his pop at Ayn Rand’s hypocrisy for being anti-state, but then using Medicare for her own smoking ailments in later life, smacks of politicising his own position.
The medico-legal paradigm, whether it be edged one way or another, remains a medico-legal conjunction. And, as such, both sides share an important number of problems. Like the above, as much as one wishes for a purely scientific, evidence-based approach, one can never leave one’s political bias at the door, as Nutt has perfectly demonstrated with his book. Furthermore, one system of control is as good as another when they both have the potential to lead people into a more dictatorial state-of-society. Whether the original intentions are good or bad, they are working for a system based on exercising undue power over individuals. For example:
Within twenty years, it’s likely that every child born in the UK will have their DNA sequenced at birth, perhaps with the data stored on a microchip under their skin. The primary purpose of this, from a therapeutic point of view, is to avoid many of the thousands of deaths a year that occur when people have allergic reactions to the medication they’re given in hospital. When someone is brought into an accident and emergency (A&E) department in 2030, they will have their microchip scanned and cross-referenced with a database of genetic variants that are known to predict problems with common medicines. This will save many lives (Nutt 2012, 293)
But at what cost will these lives be saved when these chips could be used to govern the nation in so many, perhaps more sinister, ways? Nutt himself points out some problems with the government, police and media, baying to perceived public beliefs, electioneering and unfair criminalisation. In conjunction with the knowledge that drugs are often used as a way victimise people based on religion, colour, and even wealth, do we need more centralised control like this? If a mother refuses to allow a chip to be put in her baby, will they take her child away from her, for instance? It would be a shame if a naïve medical perspective were to give rise to such events.
Furthermore, the problems of harm can be more clearly articulated under the term Establishment ethics, as Nutt, unwittingly no doubt, outlines in his book. The poverty, misinformation, lobbying powers and alike, which according to Nutt contribute to the nation’s drugs problems, are, arguably, the result of the very system he wishes to empower, albeit medically to begin with. The establishment ethics are bound up with the medico-legal paradigm for drugs and while this reviewer believes it is important for evidence-based knowledge to be disseminated, he feels its more important to recognise the problem as being bound up with the existence of our whole State politics. Treating the symptoms of these problems, perceived clearly by Nutt through the drugs lens, will not tackle the cause.