Towards a science-based drug policy

Article first published as Moving Towards a Science-Based Drug Policy on Technorati.

The government is responsible for formulating a drug policy that protects both the health of its citizen’s and its delicate societal fabric from harm. The policy is enforced by the police and upheld by the courts via custodial sentences and rehabilitation. It is in the best interests of the government to therefore base the policy on scientific or sociological evidence to ensure consistency and transparency which in turn would be represented by an improvement in the health and well-being of the people. When scientists and medical experts report that  new evidence no longer supports the government’s position, it is expected that the policy should be changed to reflect the facts. Everyone’s a winner; the government can use science to formulate their policies accordingly and have irrefutable statistical and medical evidence to back-up their decisions, whilst citizens are protected from harm and addiction. Representative and democratic. Unfortunately, as with many decisions regarding politically sensitive topics, ideology and the ability to secure votes often trumps the science and this leads to inconsistencies within the policy making it more difficult to defend and police as well as ripe for judicial review and further scientific scrutiny.

Let us postulate that two new drugs have been formulated and they need to be assessed by the Advisory Council on the Misuse of Drugs (ACMD) to decide whether the evidence suggests that they should be legal for use or criminalised. Drug A is a powerful anaesthetic and depressant with damaging side effects and high toxicity, a strong potential for addiction and overdose, as well as a verifiable record of violent, risk taking and socially damaging behaviour. Drug C is a mild hallucinogenic and depressant with no recorded instances of overdose and very low toxicity, little or no propensity towards physical addiction or violent behaviour, as well as several scientifically validated medicinal uses. It seems like a straightforward decision. These two drugs do in fact exist and their appropriate legislative positions are opposite to what may be expected. Drug A is alcohol; legal, popular and often cited as a corner-stone of UK culture, whilst drug C is cannabis; illegal but still popular despite the possibility of a custodial sentence or rehabilitation programme for its possession and cultivation.

Cannabis. It’s a controversial topic, and one seldom addressed by UK politicians despite their individual propensity towards it’s use. It’s the UK’s most popular illegal recreational vice and is currently categorised as a class-B drug, along with amphetamines and other stimulants, and possession of even small quantities of cannabis can result in a 5-year prison sentence or an unlimited fine or both. Based on the severity of the government’s stance towards cannabis, one naturally assumes that it must be a physically, psychologically and societally harmful drug deserving of this level of strict policing and custodial enforcement. Over the last few years however, it is becoming increasingly obvious that this may not necessarily be the case and many claims about the deleterious affects of smoked or ingested cannabis do not hold up to scientific scrutiny. The juxtaposition between the evidence and the current policy suggests that legislation regarding the recreational use of this substance may be dictated not by science, as it should be, but rather by the political machination of successive governments in the UK and abroad.

The cannabis plant and the biochemistry of the psychoactive compounds it produces are well studied. The main psychoactive ingredient in cannabis is delta-9-tetrahydrocannabinol (THC), a secondary metabolite of the cannabis genus of flowering plants, which includes the species cannabis sativa, cannabis indica, and cannabis ruderalis. THC is thought to have evolved as a defence against herbivorous animals, or as a form of protection against harmful UV-B rays from the strong tropical sun throughout its native range of Central and South Asia. The mature flowers of the female plant contain abundant glandular trichomes (see image) that secrete dozens of organic cannabinoids, including THC, and these structures are normally dried and then smoked, vapourised or eaten.

Evidence alluding to the ancient use of smoked cannabis as a sacrament in ritual or religious ceremonies, as well as the use of hemp – a versatile material made from the fibrous stems and stalks of the plants – for clothing and paper, has been found across Asia and the Middle East. The most ancient record of cannabis use is documented by tablets found in Assyria, northern Iraq today, dating to the 7th century BC, but archaeological evidence reveals that it was probably in use for many hundreds of years before. Cannabis remains part of several modern-day religions, including Hinduism, Rastafarianism and contemporary and ancient African religions such as the Ethiopian Zion Coptic Church. ‘Magic’ hallucinogenic psilocybe mushrooms may have also been used as entheogens as far back as 6000 years ago.

THC laden granular trichomes visible on the surface of the flower of the female Cannabis plant.

Regardless of its sacramental use in religion, which could act to further enforce any reservations non-religious people may have on the legalisation of the drug, cannabis is used recreationally by millions of people from many backgrounds, including the sciences. Cannabis’ international fan-base formerly included respected cosmologist Carl Sagan, one of my scientific heroes, who anonymously authored an essay detailing his positive personal experiences of cannabis use. Sagan’s second wife Ann Druyan is a campaigner for the reform of marijuana laws in the US. Renowned evolutionary biologist Stephan Jay Gould was an advocate for the use of medical marijuana and claimed that the drug eased the chemotherapy-induced nausea associated with his 20-year battle against lung cancer.

It would appear that cannabis has a following amongst scientists because when objectively scrutinised it appears to be an extremely safe recreational drug, especially when compared to legal alternatives such as alcohol, tobacco and caffeine. Pharmacologist Professor David Nutt resigned from his position as head of the UK government’s drug advisory panel (ACMD) after instigating a political furore by noting that medical science suggests that LSD, ecstasy and cannabis pose much less of a risk to individual users, and society at large, than alcohol or tobacco. It would appear that his successor is likely to agree with his position. Given the evidence, it is difficult to disagree. It is obvious that inhaling smoke of any kind is likely to cause damage to the lungs, but it should be noted that cannabis smoke is known to contain markedly fewer carcinogens than that of tobacco. Personal experiences of cannabis intoxication may be differ between regular users and occasional smokers with heavy doses possibly resulting in nausea, anxiety and paranoia. It is however physically impossible to overdose on cannabis due to its remarkably low toxicity and there have been no recorded cases of any deaths linked solely to excessive cannabis consumption. There is also a temptation to associate cannabis use with loss of motivation, psychiatric problems and cognitive degeneration, but the science simply doesn’t reflect this perception. An increasing amount of evidence seems to suggest that cannabis has several beneficial properties, from appetite stimulation to sleep modulation, as an analgesic and and for treating glaucoma, amongst others.

Why does alcohol and tobacco remain legal whilst mountains of legitimate, scientific evidence suggests that cannabis, magic mushrooms and ecstasy are almost certainly less harmful. Legalising cannabis, for example, would most likely reduce its use (table 2) and eliminate the possibility of  it acting as a ‘gateway drug’. The key to the gateway is very much in the possession of the supplier as opposed to the buyer. Legalisation severs the supply chain that fosters this association and in so doing serves to board up the gateway and throw away the key, providing the gateway existed in the first place (paragraph 52 and 53). This progressive approach also removes the responsibility of the supply of the drug from the black market, where it is unregulated, its quality variable and toxic adulterants rife, to that of a regulated public or private institution where use can be monitored and its sale regulated, potential addiction addressed whilst also being heavily taxed for additional income.

In choosing to ignore the evidence of experts the government is setting a dangerous precedent. It is important to at all times make rational, informed and objective judgements when navigating the muddy waters of governance; basing your policies on substantial, easily defended evidence is a sure-fire way to ensure that they have added depth and consistency beyond shallow ideology and will stand up well to criticism and analysis. It’s difficult to write about cannabis, or drugs in general, without appearing biased. Although I have used the example of cannabis in this article, the same applies for a number of other recreational drugs that have been proven to be safer than it was initially thought. The subject is very polarising, and the direction of the schism seems to run parallel to the left-right orientation of the traditional political spectrum. It is for this reason that emotive politics should be left by the wayside and the lens of drug policy focussed instead by science.

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