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Alcohol is ranked much more harmful than the Class A drug ecstasy in a controversial new classification system proposed by a team of leading scientists.
The table, published today in The Lancet medical journal, was drawn up by a team of highly respected experts led by Professor David Nutt, from the University of Bristol, and Professor Colin Blakemore, chief executive of the Medical Research Council.
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The authors proposes that drugs should be classified by the amount of harm that they do, rather than the sharp A, B, and C divisions in the UK Misuse of Drugs Act.
They say the basis of the Act is ill-defined, opaque, and seemingly arbitrary and overestimates the risks of ecstasy, which kills around ten people annually of the half a million people who use it every weekend, while neglecting those of alcohol, a legal substance which kills more than 300 annually by acute poisoning, and many tens of thousands by road traffic accidents, cirrhosis, gut and heart disease.
In the paper, the team argues that it would make much more sense for drugs to be reclassified on a rational basis that can be updated as new evidence emerges, and more easily than the current rigid category system now in use.
Prof Blakemore added that policies of the past four decades “clearly have not worked”, given the ubiquity and low price of illegal drugs, and that fresh thinking is now required.
Today’s call to overhaul the UK drug classification system, which will be examined by the forthcoming UK Drug Policy Commission, is likely to receive popular public support, according to research into attitudes to drugs by the Academy of Medical Sciences’ DrugsFutures project.
Harmful drugs are currently regulated according to classification systems that purport to relate to the harms and risks of each drug.
However, “these are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages,” said Prof Blakemore.
“The most striking observation is that there is no statistical correlation between this ranking of harm of drugs and the ABC classification.”
In the new system legal drugs, such as alcohol and nicotine, are ranked alongside illegal drugs.
The new ranking places alcohol and tobacco in the upper half of the league table. These socially accepted drugs were judged more harmful than cannabis, and substantially more dangerous than the Class A drugs LSD, 4-methylthioamphetamine and ecstasy.
“Alcohol is not far behind demonised terrors of the street such as heroin and cocaine,” said Prof Blakemore.
But the conclusions are likely to be ignored, according to coauthor Prof David Nutt from the University of Bristol, who has worked with the Advisory Council for the Misuse of Drugs.
Because some individuals with a particularly genetic make-up are at greater risk, as has been seen with rare deaths connected with ecstasy, ministers have been reluctant to change classifications despite the relative safety for the rest of the population.
Several millennia of human experience with alcohol, its pervasiveness in industrialised cultures, and the US experience with alcohol prohibition (1920–32) make it unlikely that any industrialised society will criminalise alcohol use, he said.
But that still leaves taxation and regulation as methods of control. “Alcohol is a drug we should take very seriously.”
The team identified three main factors that together determine the harm associated with any drug of potential abuse: the physical harm to the individual user caused by the drug; the tendency of the drug to induce dependence and addiction; the effect of drug use on families, communities, and society
Within each of these categories, they recognized three components, leading to a comprehensive “matrix of harm”.
Expert panels gave scores, from zero to three, for each category of harm for 20 different drugs.
All the scores for each drug were combined to produce an overall estimate of its harm. In order to provide familiar benchmarks, for comparison with illicit drugs, five legal drugs of potential misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) were included in the assessment. The process proved simple, and yielded roughly similar scores for drug harm when used by two separate groups of experts, one of consultant psychiatrists who were on the Royal College of Psychiatrists’ register as specialists in addiction and the second including a range of expertise, from police chief constables to scientists. “The two show very good agreement,” said Prof Nutt.
Cannabis, the subject of much recent debate, was ranked below tobacco, despite the evidence for a link with psychotic episodes in about 7% of schizophrenics. Since the expert panels were asked to assess the harm of drugs in the form that they are currently used, this ranking took account of the widespread use of skunk, which is about twice as potent than traditional cannabis resin.
Other experts still doubt there is a cause and effect relationship between cannabis and psychosis, while a study that claimed genes place some people at particular risk requires confirmation.
Prof Nutt said that young people believe that the establishment lies and distorts the dangers posed by drugs and the only way to restore their confidence is to rely on hard evidence, not arbitrary classifications.
“It is a landmark paper, a real step towards evidence based classification,” commented Prof Leslie Iversen of the University of Oxford, a member of a working group of the Academy of Medical Sciences, though he added that there is still more to be done to take on board new understanding of addiction arising from neuroscience.
The Academy has been asked by the Government to undertake an independent review of the issues raised in the Foresight report ‘DrugsFutures 2025?’ The review will take on board the opinions of many hundreds of people from across the UK who have taken part in face to face discussions and an online debate at www.drugsfutures.org.uk, which is open until end of this month.
Participants are clear that the current classification of drugs is “confusing and inconsistent”. A majority of participants support a health-based approach to drug use and treatment, rather than a law enforcement approach. Many also point out that alcohol is one of the most harmful drugs in common use, to both individuals and wider society.
There appears to be little support for decriminalising drugs however. Professor Sir Gabriel Horn, Chair of the Academy of Medical Sciences group considering the findings of the DrugsFutures project said “The UK Government have asked us to explore the likely future impact of recent developments in science on addiction, drug use and treatments for mental health. We have heard views from both members of the scientific community and of the public which indicate that the current classification system is in need of review.
“Such a review must be underpinned by evidence on the harms of drug use to the individual user, to families and to society, and be considered in the light of the latest evidence from the brain sciences.”
Drug misuse is one of the major social, legal, and public-health challenges in the modern world.
In the UK, the total burden of drug misuse, in terms of health, social, and crime-related costs, has been estimated to be between £10 billion and £16 billion per year.
http://www.telegraph.co.uk/connected/main.jhtml?xml=/connected/2007/03/23/nalcohol123.xml
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