[e-drug] Tobacco and alcohol should be classified as more dangerous than LSD

["E-Drug" <e-drug@healthnet.org>]

E-DRUG: Tobacco and alcohol should be classified as more dangerous than LSD
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[Interesting view on the classification of "drugs" in the UK. Copied as fair use; thanks to Andy for spotting. WB]

http://bmj.bmjjournals.com/cgi/content/full/333/7562/275/DC1
Tobacco and alcohol should be classified as more dangerous than LSD 
London 
Adrian O'Dowd 

Tobacco and alcohol should be rated as potentially more harmful drugs than illegal substances such as ecstasy and lysergide (LSD), says an influential report from MPs. 

The parliamentary science and technology committee has called for a major overhaul in the United Kingdom's ABC classification system for categorising drugs. 

The committee, which published its report into the classification of drugs last week, said that the current classification system was not useful because it lacks consistency in the way some drugs are classified. 

MPs argue that there should be a "decoupling of the penalties and the harm ranking of drugs" because the classification system is seen by police as being of minor importance, so it is not making criminal penalties proportional to the harm that drugs do. 

Alcohol and tobacco should be included in a more scientific approach to a scale, says the report, as this would give the public a better sense of the relative harms involved. 

Together, tobacco and alcohol cause about 40 times the total number of deaths from all illegal drugs combined. 

A new league table of drugs and the harm they do has been developed by Professor David Nutt of the Advisory Council on the Misuse of Drugs, the government's scientific advisory body on drugs policy, and Colin Blakemore, the chief executive of the Medical Research Council. 

Professor Blakemore said that under the alternative system for categorising drugs he had worked on, alcohol would probably be listed as a class A drug and tobacco as a class B drug. 

"We included tobacco and alcohol because the public is very familiar with the harm associated with them. We felt it was good for the public to get a handle on the harm of other drugs if they were set side by side." 

The new league table, which has not yet been published but has been submitted to the Home Office for consideration, is outlined in the MPs' report and places alcohol as the fifth and tobacco as the ninth most harmful of drugs, both higher than class A drugs ecstasy and LSD. 

The MPs' committee also criticised the Advisory Council on the Misuse of Drugs, calling its failure to alert the home secretary to serious flaws in the classification system a "dereliction of its duty." 

The chairman of the committee and a Liberal Democrat MP, Phil Willis, said, "The current classification system is riddled with anomalies and clearly not fit for purpose. The only way to get an accurate and up to date classification system is to remove the link with penalties and just focus on harm." 

Former home secretary Charles Clarke announced that a review was to be carried out into drug classification in January and the new report from the MPs will now be taken into consideration as part of that review. 

Alex Paton, a retired consultant physician with a particular interest in alcohol related problems, welcomed the proposal for a new system, saying, "Alcohol and tobacco should have the highest profile in terms of the damage they can do. There should be more of a focus given to them as dangerous substances." 

A Department of Health spokesperson said that tobacco and alcohol were legal to purchase, but it was the government's job to discourage people from using them, and it was doing so in many different ways including legislation and campaigns. 

A Home Office spokesperson said, "We will consider closely the science and technology committee's report and give a full response in due course." 

Drug Classification: Making a Hash of it? is available at www.parliament.uk/s&tcom. 

~~~
http://bmj.bmjjournals.com/cgi/content/full/333/7562/272
BMJ  2006;333:272-273 (5 August), doi:10.1136/bmj.38929.578414.80 
Editorial
Classification of illegal and harmful drugs 
The UK's confusing and inadequate ABC system is ready for an urgent overhaul 

This week the House of Commons Select Committee on Science and Technology published the report of its inquiry on the classification of illegal drugs in the United Kingdom.1 The report high-lighted glaring anomalies in the classification of illegal drugs into classes A, B, and C and reflected a broad agreement that the current system is not fit for purpose. The committee also reported considerable confusion over the remit of the Advisory Council on the Misuse of Drugs and serious flaws in the way that the council conducts its business. 

The select committee's report criticises the government for failing to meet its commitments to evidence based policy making. Indeed, the inquiry on illegal drugs was part of a wider investigation into how the UK government handles scientific advice, risk, and evidence. Launching the whole inquiry last November, the committee chairman, Phil Willis MP, said "We keep hearing from government ministers that policy is based on evidence. We want to... (know what that) means in practice." 

The classification system (based on the United Nations Single Convention, 1971, and the Misuse of Drugs Act, 1971) was designed as a way to control the use of illegal drugs according to their relative harmfulness (table).2 The Misuse of Drugs Act created the Advisory Council on the Misuse of Drugs to oversee the system. 

~~
Table: Current classification of harmful drugs in United Kingdom

Data order: Classification - Drugs - Maximum penalties 
 
Class A -  Heroin, lysergide (LSD), ecstasy, amphetamines (prepared for injection), cocaine, crack cocaine, magic mushrooms - For possession: 7 years' imprisonment or a fine (or both); for supply: life imprisonment or a fine (or both) 
 
Class B -  Amphetamines, methamphetamine, barbiturates, codeine - For possession: 5 years' imprisonment or a fine (or both); for supply: 14 years' imprisonment or a fine (or both) 

Class C - Cannabis, temazepam, anabolic steroids, valium, ketamine, methylphenidate (Ritalin), -hydroxy butyrate (GHB) - For possession: 2 years' imprisonment or a fine (or both); for supply: 14 years' imprisonment or a fine (or both) 
~~ 

Although classification is based on the concept of harm, this term is not defined. When the inquiry on illegal drugs began, the then Home Secretary Charles Clarke repeatedly asserted that "clinical, medical harm is the... predominant consideration." But the chairman of the advisory council contradicted this, stating that social and medical harms were given equal weight. 

The government has handled the classification of specific drugs inconsistently. Despite the many harms associated with use of tobacco and misuse of alcohol, these two substances are not covered by the classification system and the committee now recommends that they should be. 

After a long running debate about the classification of cannabis, and at the request of the then Home Secretary David Blunkett, the advisory council recommended in 2002 that cannabis should be reclassified from class B to class C. This recommendation was accepted with effect from January 2004. 

In contrast, in July 2005 the government reclassified magic mushrooms as class A drugs. Sir Michael Rawlins, the chairman of the advisory council, told the committee "I have no idea what was going through the minds of the group who put it in class A."1 The committee thought the council's failure to speak out against the government's placement of magic mushrooms in class A was complacent, damaging to the credibility of the council, and made the council look as though it endorsed the government's decision.1 

The classification of the drug ecstasy is equally controversial. Both the Runciman report in 20003 and the Home Affairs Committee in 2002 suggested that ecstasy should be reclassified from class A to class B. These recommendations were rejected by the then Home Secretary David Blunkett on the grounds that reclassification would be "irresponsible."4 

Ecstasy is used widely, with a reported prevalence in 2001-2 among 16-59 year olds in England and Wales of 6.8%, which made it the second most frequently used illegal drug after cannabis.5 Yet the advisory council has never reviewed the drug's class A status or voluntarily presented recommendations on the drug to the government. The select committee's report this week suggests that the advisory council should be more proactive in providing scientific advice on drugs policy. 

The advisory council has also made inconsistent decisions on methamphetamine. In November 2005 the advisory council told the home secretary that there was no basis for reclassifying methamphetamine from class B to class A.6 In May 2006, after appearing before the Committee on Science and Technology and after a flurry of media reports about the drug's harms, the advisory council revised its position on methamphetamine and recommended moving it to class A. Did the council realise that it had made a mistake or did it succumb to outside pressure? Such an approach to policy making is opaque and could be seen as a knee jerk response to a media storm. 

The select committee expressed surprise that the advisory council had never formally discussed the case for reviewing the classification system, and regarded its failure to alert the home secretary to its serious doubts about the system as a dereliction of duty.1 As well as calling for a less confusing approach to the classification of drugs, the committee's report urges the government to increase considerably its investment in research on addiction to improve the evidence base. Current funding of research on addiction was described by Professor John Strang of the National Addiction Centre (an expert witness to the committee) as "an embarrassment"1 and by the committee itself as "woefully inadequate."1 

One main purpose of classification of illegal drugs is to produce a deterrent effect by linking legal penalties to the harms associated with particular drugs. The committee found no evidence of any such effect. Furthermore, the committee recommends in its report that the government should uncouple classification on the basis of harm from the penalties for possession and trafficking of illegal drugs. 

Other countries that have also signed the UN drug control treaties, such as the Netherlands, United States, and Sweden, have very different policies on drug legislation from those in the UK.7 The select committee concluded that the UN drug control treaties do not pose a major barrier to reform of the UK drug classification system and that the conventions allow more room for manoeuvre than is generally understood. It is clear that it is now time for that reform. 

Michael Gossop, head of research 

National Addiction Centre, Institute of Psychiatry, London SE5 8AF 
(m.gossop@iop.kcl.ac.uk) 

--------------------------------------------------------------------------------
Competing interests: MG was the specialist adviser on drugs to the select committee but was not a member of the committee and did not formulate its recommendations. 

References
1. House of Commons Science and Technology Select Committee, 2006. Drug classification: making a hash of it? 5th report of session 2005-06, HC 1031. 
2. Spear HB. Heroin addiction: care and control. London: DrugScope, 2002. 
3. The Police Foundation. Drugs and the law: report into the Independent Inquiry into the Misuse of Drugs Act 1971. London: Police Foundation (Runciman report), 2000. 
4. Home Affairs Committee. The government reply to the third report from the Home Affairs Committee. The government's drug policy: is it working? London: Home Office, 2002. 
5. Aust R, Sharp C, Goulden C. Prevalence of drug use: key findings from the 2001/2002 British crime survey. London: Research, Development and Statistics Directorate, Home Office, 2003. www.homeoffice.gov.uk/rds/pdfs2/r182.pdf (last accessed 31 July). 
6. Advisory Council on the Misuse of Drugs. Methylamphetamine review, November 2005. London: Advisory Council on the Misuse of Drugs, 2005. 
7. McCoun R, Reuter P. Drug war heresies: learning from other vices, times and places. Cambridge: Cambridge University Press, 2001