Jane McCredie: A rational drug debate

A COUPLE of years ago, British psychiatrist Professor David Nutt landed in hot water after he wrote in the Journal of Psychopharmacology about an addictive behaviour that caused injury once in every 350 uses.

He cited traffic accidents, neurological damage and deaths. He found that the risks of the behaviour compared unfavourably with those associated with the party drug ecstasy, which leads to acute injury only once in every 10 000 uses.

What is this dangerous practice that puts those who indulge in it at such serious risk of harm?

The answer is horseriding, an addiction Nutt jokingly referred to as “equasy”.

When it comes to debating drug policy, such levity is not appreciated — as Professor Nutt soon found out.

Australian journalist Lisa Pryor documents what happened next in her new book, A small book about drugs. She explains that Nutt was forced to apologise and eventually sacked from his position as chair of the UK government’s Advisory Council on the Misuse of Drugs after questioning official policy on cannabis.

But there was a serious point behind Professor Nutt’s perhaps provocative analogy.

When it comes to the various mind-altering substances available in contemporary society, it seems very hard for us to have a rational debate.

We more or less tolerate the devastating toll of alcohol misuse, but brand a teenager who brings a bag of pills to a dance party with her friends a criminal.

NSW police, for example, recently proudly announced that they had searched 550 people at a music festival in outer Sydney, charging 81 with possession of drugs, in most cases ecstasy or cocaine.

Are such operations really the best way for us to tackle the undeniable harms caused by recreational drugs?

Pryor, who has been inspired to study medicine by her experiences researching her book, argues such crackdowns may actually increase risk, encouraging users to take drugs in locations with less access to medical care or to take larger quantities at once to avoid detection.

In fact, she makes a reasoned case for a harm minimisation approach that would see drugs at least decriminalised or, preferably, legalised.

Legalisation would, she argues, ensure standardisation of ingredients, encourage safer practices by users, provide tax revenue that could be used for drug rehabilitation and — perhaps most importantly — break the nexus between the drug trade and organised crime.

That doesn’t mean Pryor is advocating open slather: “Those who fear it would be disastrous to allow free and easy access to all drugs are absolutely right. Thankfully, this is not what decriminalisation and even legalisation would mean. Moving towards more rational and effective drug policies should be nuanced and gradual, reflecting the particular nature and extent of the dangers of each drug, the way it is taken, and by whom.”

We don’t have evidence on the results of legalisation, since no jurisdiction has yet gone down that path, but Pryor draws upon the experience of Portugal, which decriminalised personal use of all drugs in 2001.

The British Journal of Criminology last year reported the controversial move had not led to major increases in drug use.

In fact, the researchers, from the National Drug and Alcohol Research Centre at the University of NSW, said Portugal had experienced a decline in problematic drug use and in drug-related harms in the wake of decriminalisation.

Drugs can ruin lives — but that statement should not be the end the discussion.

Whether it’s cocaine or pinot, no policy is ever going to eliminate the potential damage of mind-altering substances.

The real question is which policy model delivers the least harm. Our answer to that should be based on evidence, not emotion.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 10 October 2011

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