Drugs - Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs

369 Pages·2016·32.26 MB·English

by  David Nutt

Drugs - without the hot air
Drugs - without the hot air
Minimising the harms
of legal and illegal drugs
David Nutt
UIT
CAMBRIDGE, ENGLAND
Published by
UIT Cambridge Ltd.
PO Box 145
Cambridge
CB4 1GQ
England
Tel: [phone]
Web: www.uit.co.uk
ISBN 9781906860165
Copyright © 2012 UIT Cambridge Ltd.
All rights reserved.
Without the hot air® is a registered trademark of UIT Cambridge Ltd.
The right of David Nutt to be identified as the author of this work
has been asserted by him in accordance with the Copyright, Designs
and Patents Act 1988.
The information and instructions in this book have been included
for their instructional value. Neither the publisher nor the author
offers any warranties or representations in respect of their fitness for
a particular purpose, nor do they accept any liability for any loss or
damage arising from their use. Neither the publisher nor the author
makes any representation, express or implied, with regard to the
accuracy of information contained in this book, nor do they accept
any legal responsibility or liability for any errors or omissions that
may be made. This work is supplied with the understanding that
UIT Cambridge Ltd and its authors are supplying information, but
are not attempting to render professional or other services.
The publishers have endeavoured to contact all copyright holders,
but will be glad to correct in future editions any inadvertent
omissions brought to their notice.
Many of the designations used by manufacturers and sellers to
distinguish their products are claimed as trade-marks. UIT
Cambridge Ltd acknowledges trademarks as the property of their
respective owners.
Contents at a glance
1 Why I had to write this book 1
2 Is ecstasy more dangerous than horse riding? 9
3 How can we measure the harms done by drugs? 30
4 Why do people take drugs? 51
5 Cannabis, and why did Queen Victoria take it? 72
6 If alcohol were discovered today, would it be legal? 91
7 "Meow meow" - should mephedrone have been banned? 114
8 What is addiction? Is there an "addictive personality"? 132
9 Can addiction be cured? 155
10 Cocaine - from chewing to crack 177
11 Why was smoking banned in public places? 192
12 Prescription drugs 216
13 Can drugs improve performance? 232
14 Psychedelics - should scientists try LSD? 247
15 The War on Drugs, and drugs in war 264
16 The future of drugs 292
17 What should I tell my kids about drugs? 307
URLs 317
Index 326
Contents
1 Why I had to write this book 1
Who this book is for....................................................................................6
2 Is ecstasy more dangerous than horse riding? 9
Go compare .................................................................................................10
Equasy..........................................................................................................13
What is ecstasy?..........................................................................................14
Does ecstasy kill? .......................................................................................15
What are the other harms of ecstasy?...................................................16
Ecstasy in the media...................................................................................17
Ecstasy: a moral issue................................................................................20
Why measuring drug harms frightens politicians............................22
Ecstasy and post-traumatic stress disorder.........................................24
3 How can we measure the harms done by drugs? 30
Why measure?.............................................................................................30
Sixteen different sorts of harm................................................................32
Multi-criteria decision analysis................................................................35
The expert panel..........................................................................................36
Which drugs did the expert panel consider?......................................38
Rating the drugs..........................................................................................39
Weighting the scores...................................................................................41
Results ..........................................................................................................43
Limitations of the m odel..................................................................... 45
Critical reception..................................................................................... 45
Conclusion............................................................................................... 46
Reviewing a drug's Class? The case of ketamine.......................... 47
4 Why do people take drugs? 51
How drugs evolved.............................................................................. 51
Chemicals in the human brain........................................................... 51
A typical day without drugs.............................................................. 52
What is a drug? ..................................................................................... 54
1. Opioids - opium, heroin, methadone,.......................................... 55
2. Stimulants or "uppers" - cocaine, amphetamine,...................... 56
3. Depressants or "downers" - alcohol, benzodiazepines, GHB 57
4. Psychedelics - LSD, mushrooms,................................................... 57
Less easily-classified drugs................................................................. 58
A typical day on drugs........................................................................ 60
A brief history of drug u se................................................................. 61
Why do people take drugs?................................................................. 65
Why this matters..................................................................................... 68
5 Cannabis, and why did Queen Victoria take it? 72
Cannabis as hemp.................................................................................. 72
Cannabis as a drug .............................................................................. 73
What are the benefits?........................................................................... 74
What are the harms?.............................................................................. 75
Cannabis routes of use ........................................................................ 76
Is skunk more harmful than hash?.................................................... 78
Why did cannabis stop being seen as a medicine?....................... 79
Medicinal cannabis use in the UK today ....................................... 82
Conclusion............................................................................................... 84
Does cannabis cause schizophrenia?................................................. 85
6 If alcohol were discovered today, would it be legal? 91
How the drinks industry influences alcohol policy....................... 93
How can we reduce the harm done by alcohol? .......................... 104
Conclusion............................................................................................... 109
7 “Meow meow” - should mephedrone have been banned? 114
"Meow meow" ..................................................................................... 114
What is mephedrone and why is it called plant food?................ 116
The harms and benefits of taking mephedrone............................. 117
Why was mephedrone banned?........................................................ 118
The designer drug problem................................................................. 120
Alternative approaches........................................................................ 121
The very least we ought to know........................................................ 123
Conclusion............................................................................................... 124
The original cathinone: khat.............................................................. 126
8 What is addiction? Is there an “addictive personality”? 132
Addiction in history.............................................................................. 133
The brain mechanisms of addiction................................................. 135
What is tolerance and why does it occur?....................................... 139
Withdrawal and craving ..................................................................... 141
Diagnosing addiction........................................................................... 143
Is there an "addictive personality"?................................................. 145
Protective factors - why some people don't get addicted to drugs 148
Conclusion............................................................................................... 149
How does neuroimaging work?........................................................ 150
9 Can addiction be cured? 155
Introduction............................................................................................ 155
Case study 1: Tony Adams and alcohol.......................................... 155
Case study 2: Pete Doherty, heroin and crack............................. 156
Case study 3: Amy Winehouse........................................................... 156
Psychological treatments..................................................................... 157
Pharmacological substitutes .............................................................. 159
Other pharmacological treatments.................................................... 160
What is heroin? ..................................................................................... 161
Why do people take heroin, and why can't they stop?................ 162
Using heroin to treat heroin addicts................................................. 164
Advantages and disadvantages of methadone treatment . . . . 164
Buprenorphine - a better solution? ................................................. 166
Evaluating treatments........................................................................... 167
The Portuguese experiment................................................................. 170
Preventing addiction ........................................................................... 172
Conclusion............................................................................................... 173
10 Cocaine - from chewing to crack 177
Routes of use and main associated harms .....................................177
Why are drugs used in different forms?...........................................179
Kinetics and dynamics of addiction..................................................179
From chewing to crack: the history of cocaine..............................181
Why is crack twice as addictive as cocaine?.....................................186
Conclusion................................................................................................187
The international damage done by cocaine......................................188
11 Why was smoking banned in public places? 192
The 2007 ban on smoking in public places in the UK......................192
What is tobacco?.......................................................................................193
What are tobacco's harms and benefits?............................................194
How do we know that smoking causes lung cancer? ..................197
Why is smoking so addictive?.............................................................199
Public-health responses and industry resistance..........................202
Consequences of the UK smoking ban................................................204
Freedom and choice................................................................................206
Conclusion...............................................................................................208
12 Prescription drugs 216
What are benzodiazepines and how do they work?....................217
What are the benefits and harms of benzodiazepines?................217
Antidepressants and SSRIs.................................................................221
Painkillers .................................................................................................224
The pharmaceutical industry and science.........................................225
The mental-health epidemic..............................................................227
Informed consent ....................................................................................229
Conclusion...............................................................................................230
13 Can drugs improve performance? 232
Muscle and power.....................................................................................232
Other drugs in sport.................................................................................237
Improving mental performance - cognition enhancers .............238
Conclusion..................................................................................................244
14 Psychedelics - should scientists try LSD? 247
How do psychedelics work?..............................................................247
The discovery of LSD..............................................................................248
LSD and psychiatry.................................................................................250
Set and setting..........................................................................................251
LSD leaves the laboratory.......................................................................252
What are the harms of LSD and psychedelics?.............................254
What are the benefits of psychedelics?..............................................255
Should scientists take LSD?...................................................................256
Mushrooms and other psychedelics...................................................258
Why were magic mushrooms banned in the UK? .......................260
Conclusion.................................................................................................261
15 The War on Drugs, and drugs in war 264
The other "war on drugs".......................................................................264
Amphetamines and war .......................................................................265
The aims of the War on Drugs.............................................................267
A. Has the War on Drugs reduced supply?....................................269
B. Has the War on Drugs reduced demand? .................................271
C. Has the War on Drugs minimised harm?....................................273
Why are we still at war? .......................................................................280
What are the alternatives? ...................................................................282
Comparing the harms of cannabis and prison.............................283
16 The future of drugs 292
Genetic sequencing................................................................................292
What are the risks of genetic sequencing?.......................................295
Treating addiction....................................................................................296
Learning and unlearning.......................................................................297