Been through the desert on a horse with no brain?

The affair of David Nutt’s sacking has prompted widespread debate. The injustice of the dismissal is, therefore, balanced by the opportunities it has provided to push the boundaries of the conversation that UK society is having with itself about the direction of drug policy and the factors driving it. The new Release blog launches itself onto an unsuspecting world in a week in which discussions about drugs are going on beyond the usual circle of policy nerds, journalists and evasive politicians. One topic of interest lies in an area that is customarily held to be somewhat arcane: the relation between drug policy and evidence.

A couple of times now I’ve had the pleasure of watching Professor David Nutt, erstwhile Chair of the Advisory Council on the Misuse of Drugs, deliver his famous or infamous lecture on Equasy—“Equine Addiction Syndrome” to give it its full title. As widely reported, the presentation takes for its theme the relative hazards of Ecstasy and horse-riding, with that time-honoured and quintessentially English pursuit of the nobility—and lest there be any confusion, I am referring here to equestrianism—standing condemned as the more dangerous of the two. This scholarly but provocative conclusion caused considerable unease amongst the ranks of our elected representatives.

To its credit, the BBC News magazine has just attempted to look further into the facts of the horse-riding plague that is spreading amongst pockets of our youth, even though they remain the better-lined ones. Lucy Higginson, editor of a publication entitled “Horse and Hound” and evidently an apologist for equestrianism, commented: “There have been quite a few fatalities in Britain over the years. Most people accept riding is a risk sport. The reward and the thrills more than make up for it.” Interestingly, the risks are acknowledged but the pleasures afforded are judged to make them worthwhile. Every weekend millions of UK citizens perform the same kind of cost-benefit calculation in relation to their drug use. “Doing an E tonight? Yes, there are risks, but the reward and the thrills more than make up for it.” But because the drugs are illegal, and those who stand guard over the moral well-being of our society are anxious about the “messages” sent to the young and the vulnerable, such considerations are frowned upon when made in the context of drugs. Professor Nutt has begun to make them, and therein lies his sin.

Approached by the BBC, Dr John Silver, a prominent consultant on spinal injuries, observed that the accidents associated with horse-riding generally result from a “mismatch between the skills of the participant and the task attempted”. Again, this is a point that is highly relevant, yet is, explicitly at least, denied entry to the policy considerations of government, and for the same sort of reasons. But the fact stubbornly remains: many, perhaps most, of those who come to grief with illegal drugs, who overdose and who unwisely mix substances—lack the skills and knowledge necessary to make their drug use relatively safe. Drugs and horses have this in common. So do cars and mountain-climbing.

This introduces another set of considerations into the equation, which do not invalidate Professor Nutt’s position, but they do problematize it. How do you make a “scientific” scale of drug harms when the harmfulness of drugs, like horses, is in part a function of the skills sets of those in the saddle? The harmfulness of a drug, like its effects, does not just reside in the molecular structure of its chemical constituents or their impact on the body’s neurological and physiological systems. Things are more complex than that: the emotional and psychological frame of reference of the consumer plays an important part, as does the social setting and its associated expectations, myths and fantasies.

The truth is that, despite its claims to be “evidence-based”, the classification system for illegal drugs functions mainly as a vehicle for the government’s beloved “messages” about the dangerousness of drugs. Professor Nutt is surely right to stand up and say so. But the notion of a purely scientific system of drug classification is itself something of an illusion, built on the reductive model of drug-effects as matters of chemistry and biology. Of course, they are matters of chemistry and biology, but they are also much, much more.