Agony and Ecstasy

How about A Lovely Horse?
How about A Lovely Horse?

David Nutt (former chair of the Advisory Council on the Misuse of Drugs, and lonely voice of reason in drug policy) has just published a book called Drugs Without the Hot Air. You may remember him from the avante-garde Channel 4 ecstasy experiment in which celebrities such as Keith Allen and Lionel Shriver got high for shits and, most importantly, for ratings (and who knows, perhaps even for science too). So I thought I’d publish this article I wrote several months ago now on the topic of drugs policy, folklore, history and potential benefits to society.

Judging by the reception of David Nutt’s recent publication in which he compares ecstasy to horse-riding (here is a decent summary from the BBC), one might be tempted to call the man naïve. The comparison is rather an inflammatory one, given the idolatry of horses in British society. Beyond face value, however, the point about this statement was entirely missed, with Jacqui Smith, the Telegraph and the Sun accusing him of trivialising a serious issue. Smith’s refusal to allow the fair comparison of a legal activity with one that is at present illegal demonstrates the Chinese finger trap in which drug research is caught: the very basis upon which drugs are made illegal at present is heuristically, anecdotally, socially, politically and even economically driven; there is not yet any decent empirical evidence to wisely classify drugs (although Nutt made a fairly good attempt), and until there is, they cannot be properly categorised in the legal sense. This research is made almost impossible because of the illegality of drugs.

Of course Nutt was not suggesting that horse riding falls into the same category of recreational activities as ecstasy. Neither is he saying that by this comparative analysis of risk that horse riding should be made illegal. The very basis upon which many drugs have been assigned their legal status in the past is unknown, and conversely the risk profile of other, legal recreation activities are well known – yet the riskiest are still legal. Free diving, horse riding, hang gliding…perhaps saying that you cannot compare something legal and illegal because one of them is illegal is an argument that reveals a paradox, and implies two very terrible beliefs that belie the apathy of a nation: that the law is infallible and should never be questioned, and that there is no reason why the law should be empirically formulated.

In a society that protects people from doing themselves in, inadvertently or not, metrics of potential harm with both social and physical dimensions, such as dependence or active dose versus lethal dose, need to be considered. They currently aren’t, and this reveals something else about human nature: we are very easily convinced that we are logical creatures, but in truth we approach the law as primarily a social issue that relies on folk understanding as opposed to risk analysis. Of course, both social elements and physical elements are important, and risk can incorporate both, yet it must be calculated nevertheless in order to dispel the social beliefs that turn out to be wrong. A great examples of the guiding hand of prevailing social principles was made plain in the debunking of the link between cannabis and schizophrenia. The ongoing discussions of alcohol in pregnancy are perhaps further evidence of one of society’s panic buttons interfering with results.

The therapeutic benefits of different drugs have been posited upon their discovery before entering the public consciousness. However there has, until recently, been little true empirical basis to either sides of the drug prohibition argument. The so-called War on Drugs has made it very difficult for research into the potential therapeutic benefits of certain illegal drugs to come to fruition. Their very illegality, this being based on historical, religious, or anecdotal precedence, cannot be questioned and their actual harm cannot be quantified because it is so difficult to get funding and ethical approval, let alone to source such materials, for these studies. All of this is in the face of reasonable probability that illegal drugs may have some benefits in the clinical environment, given that there are many existing close analogies already in use in conventional medicine. Ritalin is a close analogy to amphetamine, morphine is a close analogy to heroin. Obviously, there are many pharmacological facts that we know about that led medicine to choose morphine over heroin as an therapeutic opiate. But other drugs – psychedelic and psychotropic drugs such as psylocybin, mescaline and MDMA, are less understood in the clinical context, especially with regard to prospective therapies for conditions such as depression and PTSD.

The greatest problem, as Nutt sees it, with drug reclassification or legalisation, is the dangers of purely hedonistic use and all of the associated problems of reduced productivity (Soma, anyone?), thinking in general, and burden on the health services through rising addiction: I realise that I prematurely postulate these dangers in the absence of proper epidemiological study, but in the UK, the health service deals with a significant number of alcohol-related problems. Would the legalisation of some drugs (cannabis, for example) lead to an overall increase in the health burden, or simply a reorganisation of it? Overuse of any drugs, be it alcohol, caffeine, tobacco, can lead to different serious health problems, and moderation is not possible for some addiction-prone individuals. Actually, Nutt gives a very good summary of the effects of drug law reforms that have taken place in other countries.

Drugs ordered by their overall harm scores, showing the separate contributions to the overall scores of harms to users and harm to othersThe weights after normalisation (0–100) are shown in the key (cumulative in the sense of the sum of all the normalised weights for all the criteria to users, 46; and for all the criteria to others, 54). CW=cumulative weight. GHB=γ hydroxybutyric acid. LSD=lysergic acid diethylamide. The Lancet. Volume 376, Issue 9752, 6–12 November 2010, Pages 1558–1565.
Drugs ordered by their overall harm scores, showing the separate contributions to the overall scores of harms to users and harm to others. The weights after normalisation (0–100) are shown in the key (cumulative in the sense of the sum of all the normalised weights for all the criteria to users, 46; and for all the criteria to others, 54). CW=cumulative weight. GHB=γ hydroxybutyric acid. LSD=lysergic acid diethylamide. The Lancet Volume 376, Issue 9752, 6–12 November 2010, Pages 1558–1565.

The different between moderate, hedonistic use and addiction is not always clear. In fact, there may be certain advantages to using drugs to adapt thought patterns to the task at hand – different drugs may facilitate organisation, creativity, logical reasoning. To give you an anecdotal example, Paul Erdos, Hungarian Mathematician, claimed that his giving up stimulants for a month set back the world of mathematics by a month. Erdos had a brilliant mind, being able to calculate by age three the number of seconds a person had been alive, so stimulants were perhaps simply facilitating his abilities rather than creating them. Drugs have also lead whole societies to make rather more spurious connections: it was a common belief that cocaine was the fuel of social unrest amongst African Americans at the turn of the century; this was probably thought to be a reasonable notion at the time, although it a laughable idea now.

The problems with hedonism are manifold. Hedonism is largely perceived to be a bad thing, it being a self-satisfying act. The word itself is unsatisfactory and vague, given its evolution over the centuries. Indeed, ‘hedonism’ itself is at the mercy of societal goals, which differ over time. To be productive in one’s work, to contribute to the greater good of society, is certainly a great achievement. Seeking out power for oneself often coincides with being rich and successful – something that would be considered simultaneously hedonistic and productive from an economic and political perspective.

The hedonistic element of drug taking can have benefits from the creative and productivity perspective. But it can also be responsible in part for drug addiction, and this distinction is too often drawn in black and white: you either become addicted (an underproductive burden to society) or you do not, in which case you are productive. Drugs can work as an adjunct to the productive individual, but no drug can create an artist; however, an addict may also be incredibly productive. Perhaps the most famous example of this contradiction in recent history is that of Christopher Hitchens (William Burroughs, Ernest Hemmingway, Lewis Carroll…mmm, all of my favourites!), who proposed that much of his understanding would not have developed without the social fuel of his continuing intellectual development: alcohol and cigarettes (although in true contrarian fashion he also censures the use of drugs for hedonistic purposes). This anecdotal claim – giving credit to mind-altering substances – appears again and again in great thinkers, with a variety of different drug types of different classes of legality and abuse potentials. Of course, we can never know whether or not their productivity would be equal in magnitude if they did not take drugs at all (although, due to mind-altering properties of drugs we can probably assume that the output would be different in many ways), and so we cannot accept it as anything more than anecdote. But the notion that it offers some benefit to members of society aside from medicinal or indeed intellectual uses is an interesting one that cannot be ignored.

The question of hedonism is not an easy one to confront. Most of us busy people hooked on drinking coffee from dusk till dawn and beyond would swear blind that they wouldn’t function as productively without it, and they may be right. Most of us could even go some way to justify drinking regularly in order to loosen up, to disinhibit ourselves, to step outside of our skins and forget the day job… although this is probably not something you hear very often, given the stigma of alcohol (largely arising from its addictive nature, perhaps we perceive it better to be a secret drinker than an ambassador of alcoholism). Even the medical community proposed the theory of self medication, to explain why, for example, depressed people drink – or why drunkards are often depressed. This comorbidity is seen in manic depression (with use of cocaine during manic phases and alcohol during depression).

The idea that puts hedonism at odds with asceticism is the notion of self satisfaction as being counterproductive for the spirit, a kind of poison for the soul, and this is perhaps an outdated notion today. That drugs have a plethora of effects and outcomes depending upon the individual, their environment and experience, means that blanket classification will never be adequate – indeed the same can be said for many aspects of the legal system. We are very quick to forget the past and to forget that not all of our steps into the future are steps of progress; we are in a strange time in history, where we risk complacency because we think we have arrived truly in the age of empiricism.

The chequered past of drug legality brings up some odd surprises, notably coffee: from its Muslim ceremonial origins, to it being banned for religious reasons in Christian Europe, its overturning by the pope at the time due to it being “so delicious that it would be a pity to let the infidels have exclusive use of it”, to its prohibition in Germany for political and economic reasons (to encourage Germans to drink more beer, of all reasons) – coffee is a great example of blind faith in place of straightforward reasoning in drug policy. Prohibition amounts to nothing more than an accident when taken out of sociopolitical historical context, and the current legislation not only hinders the application of drugs for therapeutic benefit, but it also criminalises addiction whilst filling the pockets of the underworld – while a canny and progressive government might use it to fill it’s vacant coffers.


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