I understand his frustration, but picking a public fight with the government was going to result only one outcome, and that wasn't going to be a rational change in policy.
I guess we differ in perspective here. I personally don't really see conducting independent research, unconnected from his duties within the ACMD, as "picking a fight with the government."
The issue here seems to be with how the government acts and expected him to act rather than anything else. They hire experts - and Nutt is extremely well qualified in his field - but expect those experts to only tell them what they want to hear and sack them if they say anything that deviates from the party line.
In other words the government doesn't actually want scientific recommendations, which is ostensibly the function of the ACMD. All they really want is their existing views to be echoed back to them by scientists to lend more credibility to their current policies.
If an expert they hire dares to contradict government policy, even on their own time and separately to their government work, they will be removed.
I can only ask again - how will any change happen if even scientists are not allowed to contradict existing government policy when advising the government?
I think we all aspire to a rational policy about drugs, but what if the public wants an irrational policy? Do scientists get to overrule them. I believe the answer is no. We can only present information and try to change minds. The moment we go beyond that into activism is the moment we get sucked into the political vortex and get accused of bias.
I'm curious, in what way do you believe Nutt was attempting to overrule the politicians?
He did not start his own party, or a political movement, or become an activist, or anything of the sort. He did his job as a scientist, which is to review and conduct research and report his findings.
Further, much of what the government took issue with was research he conducted independently of his governmental duties. It had nothing (or very little) to do with how he conducted his actual job as chair of the ACMD.
I simply do not see how anything he did was attempting to remove control of policy from politicians.
As for your point about the public - this is valid of course, and understandably political parties have to take public opinion into account if they are to be reelected, but why does this mean an expert government advisor who presents alternate views on the matter has to be sacked? The government are not bound by ACMD recommendations, and again most of what the government took issue with was independent research to begin with.
Perhaps if Nutt was able to stick around and have a voice in government, the public would be more likely to become exposed to rational views. At the moment, unless someone happens to take a particular interest in the issue of drug use, all most of the public hears is the same lines trotted out again and again in the mainstream media. Minds don't change if they're never presented with new information.
Thankfully public opinion is slowly changing on a generational basis. Young adults view cannabis as safer than alcohol - which is factually correct. But the government had to be pushed by a very public PR nightmare to even admit cannabis has medical benefits, despite much research already proving this for years and years prior. They simply do not want things to change.
To quote a great philosopher:
“One lied, mendaciously inventing reasons for these laws, simply to avoid admitting that one had become used to these laws and no longer wanted things to be different.”
I was invited to a debate by the Mayor of Oporto to discuss this when it was being proposed. I got the distinct impression that we scientists were being managed by the politicians (and possibly other interests). No questions from journalists were allowed after my talk, which emphasised the structural and functional changes in the nervous system after taking drugs. We were given no free time at all from 7AM until 10PM and we were assigned a handler that followed us everywhere. There's politics on all sides of this issue.
Absolutely there are. But don't you think that's rather absurd? Politics trumps science every time. I'm simply arguing this isn't how things
should be. It is irrational and illogical to put political point scoring above scientific evidence.
On my part I would like to see recreational drugs decriminalized but regulated. I really would like to see governments institute a drug user's license (including for nicotine and alcohol). That means you get to choose whatever drug you want once you are of age, but risk losing your license if you engage in drug-fueled violence, criminality, reckless behaviour that endangers others, or if you have a health problem that would be complicated by drug-taking. I find it appalling that people caught driving while drunk often get banned from driving, which often entails impacts on employment and family life, but are still allowed access to alcohol. It makes no sense whatsoever.
I would be fully on board with this policy, sounds very sensible to me. Nutt effectively suggested a similar type of system (many years after he got sacked) whereby most drugs (aside from "light" ones like cannabis) would only be available from a pharmacy, people would only be able to buy limited amounts, there would be plain packaging and a ban on advertising, and there would be a database to keep track of use.
In case you're curious:
This is how the United Kingdom would be taking drugs if the law had anything to do with how harmful they actually are.
www.vice.com
Clearly neither of these proposed systems (yours or Nutt's) would stop a motivated addict from obtaining their drug of choice by other means, but they'd keep the majority of the public within safe limits.
The way I see it, if the public can be trusted with open access to a drug as dangerous and addictive as alcohol, and most of them end up not dying or becoming alcoholics, they can be trusted with controlled supplies of most other substances.
The body gets used to this and down regulates naturally occurring neurotransmitters and/or receptors to try and get back to homeostasis. When someone with addiction/dependence stops taking the opioids regularly (or any other abusable drug), it takes time for the the body to re-regulate itself. So this is why I say even if someone didn’t have conditions like anxiety and depression going into their drug use, between the brain learning drugs are a coping mechanism and the withdrawal effects, people usually end up with at least temporary psych issues when coming off.
Of course, this is why tolerance builds for basically any substance and withdrawals happen for drugs that develop physical dependence. No argument here. This is also why rushed tapers or cold turkey detox is a bad idea. You need to wean the person off the drug slowly to avoid (or at least reduce) severe withdrawals, rebound symptoms, and so on.
Particularly if you consider alcohol and benzos. Rapid withdrawal from those can easily lead to seizures in cases of severe abuse.
Long term opioid use can suppress the endocrine system, including testosterone, which can effect males and can be psychologically detrimental directly and indirectly, though this tends to reverse itself.
Yep opiates absolutely lower testosterone levels. But typically once you begin to taper off you notice the sex drive come roaring back.
Marijuana is generally considered not very addictive, though I believe the numbers are quite underestimated. THC, especially used during adolescence and teenage years, may have a long term effect on learning/memory and potentially other cognitive factors. It can also induce psychosis in the predisposed (which may or may not have happened otherwise naturally) and worsen psychotic disorders in those already with them.
Again I am in full agreement. I don't think cannabis should be used by teenagers with developing brains - a very good argument for legalisation and regulation - and yes if someone is already predisposed to or is experiencing psychosis cannabis may well trigger it or make it worse.
It does also seem quite possible that in many cases people with psychotic illness are using cannabis to self-medicate however. The high number of schizophrenic patients who smoke tobacco is also very interesting. I'm not saying either is a good idea, but rather that in many cases it is very possible the psychosis came first and cannabis (as well as tobacco) was then used as self-medication.
Benzodiazepines, again not considered the most addictive drugs, even at therapeutic levels there is some evidence they may cause long term memory issues. Abuse levels would likely lead to worse effects.
Benzodiazepines certainly are very addictive if abused. If used therapeutically under medical supervision the risk of a psychological addiction is greatly reduced (although unless used prn you of course always get physical dependence as with any psych med). But when people abuse benzos they commonly increase their doses as tolerance develops and the withdrawal symptoms are notoriously severe.
However based on the research I've read, therapeutic dose ranges of benzos do not cause permanent brain damage, only excessive doses do. The research I looked at was on diazepam though and it may well be the more potent benzos such as alprazolam pose more of a risk. There's no conclusive link to therapeutic benzo use and reduced cognitive function even after the medication has been discontinued as far as I'm aware.
Even if such a link was proved, as you'd be talking about therapeutic use, the question would be is symptom relief worth the tradeoff? For many the answer could well be yes. For others it'd be no. Depends on if alternate treatments work for that specific patient and how severe their condition is to begin with.
Personally I find comfort just in knowing I have a small amount of benzos I can use if they're needed. But I don't use them daily and instead use cannabis whenever possible. Often cannabis provides comparable anxiety relief if it's the right strain for the job. But if the anxiety is more severe, a benzo is the only option for me personally.
Stimulants like cocaine and meth like THC can induce/exacerbate psychotic disorders. They can also affect longterm cognitive skills. they can induce seizure disorders. Really long term use can cause Parkinson-like symptoms from burning out dopamine receptors. The profound cardiovascular effects can result in brain hemorrhages, heart attacks, and stroke which of course can cause a myriad of forms of neurological damage.
Absolutely. But on the flipside of this, we have almost a century of data showing that therapeutic levels of pharmaceutical amphetamine or methylphenidate do not carry these risks to nearly the same degree. Not only due to the lower doses, but also because amphetamine is fundamentally a safer drug than meth (which is neurotoxic) or cocaine (which is cardiotoxic).
Abusing pharma stims can still cause psychosis, psychological addiction, and a host of other bad things, but if used correctly there's very little risk even in long-term use.
So as with most substances really, it comes down less to is the drug itself inherently harmful and more to is it being abused in a way likely to cause harm?
MDMA is related to stimulants and has similar effects, so I would imagine it would fall into the category above. MDMA is rarely pure (at least in the US) and often contains other stimulants and sometimes opioids as it is. Some claim it is not addictive, but think that’s willful ignorance unsupported by research- and I’ve seen many cases of MDMA addiction.
MDMA is a substituted amphetamine indeed. I cannot speak for the US, but in the UK and Europe in general MDMA is highly pure. The Dutch labs pump out virtually 100% pure MDMA and it is dirt cheap. I can get a gram of pure MDMA for £10. I know it's pure because I can get it lab tested using GC/MS. It's very rare for MDMA to be cut with anything here because there's simply no point.
When droughts have occurred, caused by law enforcement interfering with supply as happened in 2009-2010 for instance, this is the only time MDMA purity became an issue here. But then precisely for that reason we (in the UK) stopped using MDMA and started using mephedrone (4-MMC) instead. By the time mephedrone was made illegal the MDMA supply began to return and purity has only been climbing ever since.
As for its addictive potential, the research is quite clear that it is low. I can dig up sources if you wish. The big thing with MDMA is it's not a drug you wake up the next morning wanting another hit of, as you might do with heroin, but rather it's a drug with a comedown you have to ride out for about a week, while the next morning the positive feelings associated with the experience stick with you if it's good stuff. You don't really feel like doing more. And if you do take it too frequently, it simply stops getting you high and you only get the negative effects - after all, your brain can only produce so much serotonin. It's really quite a difficult drug to become addicted to.
Mephedrone on the other hand was far more addictive than MDMA. It was very moreish in a way that MDMA simply isn't and the comedown far less severe and far more short lived compared to MDMA too.
Just to make one last point here, the only reason the MDMA in the US is impure is quite obviously due to the black market nature of its supply. Were it to be legal and regulated, it would of course be pure. If MAPS is successful in getting it FDA approved in a couple of years you will have legally prescribed pharma grade MDMA. It'll be used to assist in psychotherapy, which is exactly what Shulgin promoted it for in the first place when he synthesised it.
LSD, DMT, Peyote, and most hallucinogens are generally not considered addictive, but can have damaging effects on the psyche long term depending on how well individuals tolerate their trips. They do risk inducing/exacerbating psychosis. In heavy users, there is also the risk of persistent hallucinations (“flashbacks”), though there isn’t a ton of data on this condition and it’s prevalence estimates vary widely. Chronic use of such drugs isn’t particularly common though.
Classic psychedelics are overall very safe drugs. As you correctly point out, the primary risk for an already healthy individual comes from the lingering psychological effects of bad trips. This is where the importance of set and setting comes into play.
Other than that, yes, the only real dangers are to people already predisposed to or suffering from psychosis.
Chronic HPPD is extremely rare to the point where there's so little data on it, it's debatable whether or not it's real. Even temporary HPPD is very rare except perhaps for the next day after a strong trip.
The fact so little data can be gathered on it speaks volumes to how small of a risk it is considering how long psychedelics have been in use by humans (in the case of mushrooms, pretty much since we have existed).
And they're certainly not prone to addiction. For one thing tolerance to most psychedelics builds instantly and takes a couple weeks to reset. And for another, as with MDMA, you simply do not wake up the next morning desiring more. A trip is an intense experience. You typically want time to chill and mentally recover while you process everything and regain your energy.
I did some 2C-B with a few friends in a park last night, topped off with a couple bumps of ketamine and a joint being passed around. Had a great time. As 2C-B is short lasting and not very intense mentally (it's a primarily visual experience) I got up this morning and began work as usual.
If I had been drinking all night instead I'm quite certain the resulting hangover would have rendered me much less functional. I'm also quite sure I'd have done much more damage to my brain and body.
Let's not forget that mainstream medicine is finally catching up to the therapeutic benefits as well. Two pharma companies are running clinical trials on ketamine products for depression treatment hoping to beat the other to market. MAPS is set to get MDMA approved by the FDA as early as 2023. Ongoing research into LSD and mushrooms is yielding very promising results. It's my belief psychedelics are the future of mental health treatment. Clearly I'm not the only one who holds this view.
I would be careful not to discount how dangerous all opioids are even without other benzos or alcohol. Many of people die from pharmaceutical opioids alone every year.
Certainly. I'm not downplaying the dangers of opioids in other aspects at all. The primary danger, in my opinion, is the severe psychological addiction. There's a reason I kicked oxy and decided I'm better off smoking weed and tripping/rolling instead. Far better for my mental health, in fact I would argue I've had trips and rolls that have been outright therapeutically beneficial to my mental health, more so than any prescription psych meds.
In short, long term effects on the brain by drugs are not just related to neurotoxicity (damaging neurons directly). Any drug that has an effect in the brain (intended or not) can potentially have long lasting effects. For example, old people given anesthesia can wreak havoc and take months to recover if ever. Even Benadryl given to an old person, especially with dementia, can cause anticholinergic toxicity (incl. delirium) and potentially have longterm consequences.
Anything that alters brain function can have effects on the mind especially if used chronically and especially in vulnerable groups, for sure.
The questions though are about balancing risk and reward. For instance, are these harms likely to occur in the majority of the public? Are they less than the harms of already legal and socially acceptable intoxicants and medications such as alcohol and opioids? Are there risk factors we can look at to determine who is most likely to be at risk of harm?
It seems to me the answers there are quite clear cut and show no reason that many drugs such as cannabis and psychedelics should not be legal for recreational and medical use. Certainly, to use a very relevant real world example in the US right now, cannabis for pain relief is proving to be a lot safer than the use of opioids. No one has ever in the history of the universe overdosed on cannabis.
The idea that people can go to detox +/- rehab (or simply outpatient programs) and then magically be cured is insane. Going back to the same environment, with the same people, with the stress of everything that existed beforehand is a recipe for disaster, yet this is what nearly all insurances expect to happen. Not surprisingly the long term success rate of these short stints are very, very low.
I agree with this and everything else you wrote in this particular comment 100%.
You'd be correct regulating prescribing would be more effective than limiting production, but the government also has pretty limited ability to restrict doctor's prescribing.
Does the DEA not have that power? I was under the impression that the DEA is being very strict in regulating opioid prescriptions in recent years for instance.
The same is true pretty much everywhere. Psych funding is generally the last concern of most healthcare systems, particularly addiction.
Sadly very true.