RECALIBRATING DRUG LAWS, BASED ON SCIENCE

In the long and tortured debate over drug policy, one of the
strangest episodes has been playing out in the United Kingdom, where
the country's top drug adviser was recently fired for publicly
criticizing his own government's drug laws.

The adviser, Dr. David Nutt, said in a lecture that alcohol is more
hazardous than many outlawed substances and that the United Kingdom
might be making a mistake in throwing marijuana smokers in jail. His
comments were published in a press release in October, and the next
day he was dismissed. The buzz over his sacking has yet to subside:
Nutt has become the talk of pubs and Parliament, as well as the
subject of tabloid headlines like: "Drug advisor on wacky baccy?"

But behind Nutt's words lay something perhaps more surprising and
harder to grapple with. His comments weren't the idle musings of a
reality-insulated professor in a policy job. They were based on a
list - a scientifically compiled ranking of drugs, assembled by
specialists in chemistry, health and enforcement, published in a
prestigious medical journal two years earlier.

The list, printed as a chart with the unassuming title "Mean Harm
Scores for 20 Substances," ranked a set of common drugs, both legal
and illegal, in order of their harmfulness - how addictive they were,
how physically damaging and how much they threatened society. Many
drug specialists now consider it one of the most objective sources
available on the actual harmfulness of different substances.

That ranking showed, with numbers, what Nutt was fired for saying out
loud: Overall, alcohol is far worse than many illegal drugs. So is
tobacco. Smoking pot is less harmful than drinking, and LSD is less
damaging yet.

Nutt says he didn't see himself as promoting drug use or trying to
subvert the government. He was pressing the point that a government
policy, especially a health-related one like a drug law, should be
grounded in factual information. In doing so, he found himself caught
in a crossfire that cost him the advisory post he had held for a decade.

The same issue is becoming a hot one in America - this fall the Obama
administration took a baby step toward easing federal scrutiny of
medical marijuana use, and a policy report due early this year is
expected to emphasize addiction prevention and treatment over
criminal enforcement. Opponents are already attacking the
administration for its laxity, but Thomas McLellan, a newly installed
White House drug official, has begun loudly pushing for policy that
incorporates more science.

"We must increase the use of evidence-based tools at our disposal,"
McLellan said.

But as Nutt's case illustrates, that is tough to do. The more data we
accumulate about drug harmfulness, the more it seems like the
classification systems used by the United States, the United Kingdom
and other governments need to be dismantled - and the more it becomes
clear that societies can't, or won't, take that step. Drug laws are
rooted in history and politics as much as science. Our own culture
embraces one intoxicant - alcohol - that Nutt's ranking deemed far
more dangerous than 15 other harmful substances. And even if it were
possible to divorce drug politics from drug-use facts, some policy
specialists say, letting science call the shots would be a bad idea.

Intoxication has been part of human culture since before recorded
history. So have its consequences. A drug can cause all sorts of
harms, some devastating, some minor: It can ravage the body of an
addict or simply make a user late for a meeting with the boss. Drugs
can impoverish families, trigger deadly violence, cause cancer. In
modern society, drugs drive crime and increase health costs for everyone.

To Nutt, a professor of neuropsychopharmacology at London's Imperial
College who chaired the government's Advisory Council on the Misuse
of Drugs, it made sense that laws and policies should take into
account the harmfulness of the drugs themselves. But when he
considered ways to improve the system, he discovered a problem.

"It became clear that [the government] didn't have any systematic,
transparent way of assessing drugs at all," he said. "If you say drug
laws are based on reducing harm, you have to actually know what kind
of harm they cause."

So about a decade ago, he and some colleagues set about to gauge the
dangers of 20 substances as objectively as possible. This would not
be a measurement with calipers and a scale - drug risks are
inevitably subjective, depending on factors like an individual user's
tolerance, the amount used and the duration of use. But Nutt also
knew he could create better data than anything the government was
currently employing. He and his colleagues assembled a range of
independent experts and asked them to score each drug in three
categories - its physical effects on the user, the likelihood of
addiction and its impact on society. The group included addiction
specialists registered with the Royal College of Psychiatrists, as
well as people with expertise in chemistry, forensic science, and police work.

They gave the specialists a detailed list of parameters to consider.
In assessing the addictiveness of, say, cocaine, they would
separately rate its pleasure, psychological dependence and physical
dependence, and the ratings would be combined to create an overall
risk factor. After a series of meetings and discussions, the rankings
were determined by averaging scores across all the categories. The
result was a paper published in the public-health journal The Lancet
in March 2007.

No. 1 on the experts' list was an easy call: heroin. It's extremely
addictive and, by any measure, destructive to the user and the
society around him. Cocaine came in second, followed by barbiturates
and street methadone.

Then the list got interesting. Alcohol, which has always been legal
in England and was only briefly outlawed in the United States, took
the fifth position, above tobacco (9), marijuana (11), LSD (14) and
ecstasy (18). The least harmful drug in all respects was khat, a
stimulant derived from the leaves of an African shrub.

Included in the Lancet paper was the authors' recommendation that the
government should reclassify drugs to reflect the harms they cause.
"We saw no clear distinction between socially acceptable and illicit
substances," they wrote, suggesting "a more rational debate" on drug
policy, based on "scientific evidence."

The ranking - nicknamed the "drug league table," after the British
term for sports standings - lay quietly, more or less ignored by the
public and politicians, until King's College issued a press release
in October based on a lecture Nutt had given in July. Nutt thought he
was making much the same point he made in the medical journal two
years earlier: If we looked at harm objectively, we would engineer a
drastically different set of drug policies than the ones we now use.

He was swiftly booted from his government position. Home Secretary
Alan Johnson said Nutt had crossed a line. He "cannot be both a
government adviser and a campaigner against government policy,"
Johnson told The Guardian.

"It was a funny, kind of petulant reaction," Nutt told the Boston
Globe, "all about machismo and politics. We're harder on drugs than
you, we're tougher."

Suddenly, Nutt was everywhere - the papers, the BBC, YouTube, a
Facebook page started by his backers. Critics accused him of sending
England's youth a mixed message about drug use. Supporters charged
the government with stripping the professor of his right to speak freely.

Amid the charges and countercharges, others wondered whether, beneath
all the controversy, the government shouldn't just start paying more
attention to that list.

If Nutt's list is accurate - if we really do know which drugs are
really bad and which are relatively benign - the next step is
figuring out how to make use of that information.

It might seem obvious that the most harmful drugs should receive the
most attention from the government, with beefed-up prevention and
treatment programs and tougher punishments for producers and
distributors. And to conserve their limited resources, it might make
sense for drug officials to stop worrying about the least harmful
substances, even decriminalizing or legalizing them.

But real-world drug policy is not like that. To a certain extent, say
analysts, legal drugs are acceptable and illegal ones are dangerous
because, well, because they're already illegal.

"There's a crazy kind of logic that argues, about some currently
illegal drug: 'Look how dangerous it is! You couldn't possibly
legalize a drug as dangerous as that!' " said Mark A.R. Kleiman, a
professor of public policy at UCLA. The fact that a drug is against
the law makes people overestimate its risks, he said, while legal
status causes them to underestimate dangers.

Politicians tend to follow that same thinking, leaving socially
acceptable legal drugs alone, while making easy prey of would-be
liberalizers. In the U.S., for instance, it would be politically
insane to call for the legalization of the least harmful drugs on
Nutt's list - khat, GHB and steroids - while campaigning to outlaw tobacco.

One indisputable fact that emerged from Nutt's study is this: We have
assigned a high social value to booze. Alcohol causes many of the
harms associated with "harder" drugs - lots of people die or become
deeply dysfunctional because of drinking - yet it has been entrenched
in society for so long that scientific evidence of its hazards
relative to other intoxicants doesn't get much of a public hearing.

Kleiman and other experts - including Nutt - are not suggesting that
either Britain or the United States should ban alcohol. America tried
that once, and even during Prohibition, people didn't stop drinking -
they simply built a system of illegal manufacturing and distribution
big enough to satisfy their thirst. Instead, Kleiman believes a good
strategy on alcohol should include increased taxes to discourage
drinking - young people and heavy drinkers are price-sensitive - and
an outright ban on sales to people who have been convicted of drunken
driving or other alcohol-fueled crimes.

Of course, that would require new laws, and more political wrangling.
How many convictions? How long of a ban? If the science is
complicated, the politics would be more so. The fight would last more
than a few rounds.

Nutt, for one, seems ready to go the distance. "The majority of
people in [Britain] are more damaged by alcohol than any other drug,"
he said. "Let's get the scaling of harm right."

For drugs that are currently illegal, he said, that means having
prevention efforts and laws that are proportionate to their dangers.
For instance, British law allows up to five years imprisonment for
marijuana possession, a penalty Nutt called "infantile and
embarrassing." McLellan, the White House drug adviser, echoed him,
saying jailing pot smokers "is idiocy, a really bad use of resources."

But drug law will never be as simple as making a list, and even
experts say it shouldn't be. At a certain point, scientists should
excuse themselves from the discourse, Kleiman said. Intoxicants are
part of our culture in ways that a list can't sort out for us.

"Science gives you facts about the world," he said, "and you have to
assign values to those facts. It doesn't tell you what's worth having
and what's not worth having."