This week, we were interviewed for the excellent Mushroom Hour, in an episode that will be released in a few weeks. We’ve spoken to Darren at Mushroom Hour before, and take great inspiration from his infectious love for fungi of all types, as well as his dedication for getting information out to his listeners.
In our chat with him, we talked a little about the issues facing medical research into psychedelics (as well as our views of whether the medical model really serves all users of psychedelics), and one thing that came up in conversation was the ‘unknown harm’ excuses made by those who would restrict access to psilocybin. We spoke of our frustrations that some people working on access to psilocybin for therapeutic purposes—which is a noble goal—nevertheless seem determined to throw recreational users under the bus, by stating at the end of their papers that there are ‘unknown harms’ facing those who take mushrooms outside of a therapeutic setting. We are frustrated with this because we have so much evidence that the harms facing those who take mushrooms are vastly overstated, compared to other substances that we permit or even encourage in our society.
So on this week’s post, we thought we’d talk a little bit about David Nutt, and his Drug Harm analysis, for those of you who haven’t heard of this before.
If you’ve read our first book, The Psilocybin Mushroom Bible, you’ll have read the name David Nutt; if you live in the UK you’re likely to have heard of him too, even if you aren’t deep into the specifics of current psychedelic research. For a brief period around the end of 2009, Nutt became infamous for being dismissed as chairman of the Advisory Council on the Misuse of Drugs, a non governmental body set up in the 1970s to steer the UK government’s drug policy. The dismissal of someone on this council isn’t the sort of thing that usually makes the news. This time, it did.
Nutt took over as Chairman of the group in January 2008, having served on its technical committee for seven years. The intention of the ACMD, on paper at least, is to feed science-backed advice to the government, which is made up primarily of non doctors and non scientists; such advisory committees are meant to inform and shape how the government deals with the issue of drugs. In January 2009, the UK government upgraded cannabis from “Class C” to “Class B”, citing a supposed increased harmfulness, against the explicit advice of the ACMD. The Home Secretary Jacqui Smith, in justification of ignoring this advice, said that the government must err on the side of caution when there is doubt about the potential harms of a drug. This, clearly, enraged David Nutt—especially given that the committee had been ignored before, when the government made psilocybin-containing mushrooms “Class A”, equivalent to Schedule 1 in the US, without consulting the ACMD at all.
Nutt had been writing on the measurable harms of drugs for years, at this point, but his methodology was about to get a lot of attention. Just as the UK government was upgrading cannabis against scientific advice, he published an editorial in the Journal of Psychopharmacology called "Equasy – An overlooked addiction with implications for the current debate on drug harms”. Equasy was Nutt’s term for an invented addiction to horse riding, the harms of which he had become aware of after treating a patient who had brain damage after falling from a horse.
In his tongue-in-cheek paper, Nutt compared the instances of serious harm from horse riding (one instance in every 350 exposures) to the instances of serious harm from taking ecstasy (a.k.a MDMA - one instance per every 10,000 exposures). His intention was to show that we can’t consider the harms of drugs outside of the context of everything else we do in life, which may be much more harmful than currently illegal drugs. If we trust people to make informed choices about horse riding when it is, demonstrably, more dangerous than MDMA, then why we can not trust people to make informed choices about something that is relatively safe in comparison? The laws around drugs, he was saying, have to take this into account.
This paper did not originally get much attention. But later that year Nutt gave a lecture on the same topic, and in October that lecture was released as a pamphlet, and days later he was sacked from the ACMD, having refused to resign.
But what was it about David Nutt’s methodology that was so controversial? Well, let’s take a look.
Since 2007, David Nutt had been trying to make the point that the relationship between real-world harm and the scheduling of drugs into “classes”, determining their level of illegality and the resulting criminal charges against users, was broken—primarily because the government was not interested in assessing the actual harms of drugs in the context of people’s lives. They were illegal, so they must be harmful: this was the way the UK government saw it. Nutt and his colleagues saw it differently.
In 2007, Nutt and colleagues (some on the ACMD, some elsewhere) had developed a method of measuring drug harms that took in nine different types of harm; by 2010, this has been adapted to consider 16 different types. (This list is taken from Nutt’s excellent book Drugs Without the Hot Air).
Harms to user:
Drug-specific mortality (death from poisoning)
Drug-related mortality (inc. death from chronic illnesses caused by drug-taking)
Drug-specific harm (physical damage short of death caused specifically by a drug)
Dependence
Drug-related harm (inc. viruses, infections, traffic accidents from driving while impaired)
Drug-specific impairment of mental functioning
Drug-related impairment of mental functioning (the psychological impacts of drug-taking)
Loss of tangibles (losing job, income, home etc.)
Loss of relationships
Harms to others:
Injury (harming someone else while on drugs due to the effect of the drug)
Crime (outside of the Misuse of Drugs Act—things like burglary to fund a habit)
Economic cost (for e.g. to the NHS, via injury caused while on drugs)
Impact on family life
International damage (harms via drug trafficking)
Environmental damage (both of drug production and via usage)
Decline in reputation of the community (social stigma via use of drugs)
In the final analysis, these harms were given different weightings, to account for their impact. A panel was then brought together to consider these harms; those on the panel included chemists, addiction experts, GPs (family doctors), forensic scientists, psychologists, journalists, criminologists, and those working in the criminal justice system.
The panel considered not only illegal drugs, but many which are legal, as you will see below. They assigned a final score out of 100 for each drug, and posted these as a graph. We won’t list the whole graph here, but will list the top 6 most harmful drugs, according to their analysis:
Alcohol
Heroin
Crack
Methylamphetamine (meth)
Cocaine
Tobacco
That’s correct: two of the six most harmful drugs, according to this expert panel, are not only not Class A drugs, they’re completely legal. The other four—heroin, crack, meth and cocaine—were Class A drugs. But this highlighted, scientifically, that the UK’s approach to drug legality was not at all based on the real-world harms we can measure.
Ecstasy (MDMA) was fifth from the bottom of the list, below anabolic steroids, butane and ketamine. At the very bottom of the list, the least harmful drug according to this analysis, scoring a tiny 6 out of 100? Magic mushrooms.
Nutt has gone on to write extensively about the use of psilocybin as a therapeutic substance, and has been involved in some of the most exciting research into its effectiveness for conditions such as OCD, treatment-resistant depression and alcoholism. But he has also maintained what he wrote in 2010: that magic mushrooms are one of the safest drugs available, safer even than alcohol—and horse riding. He has gone on to say, even, that it is basically “anti-addictive”, and maintains that criminalising the use of a basically harmless drug is anti-science and anti-social.
At the time this paper was written, mushrooms were considered Class A drugs in the UK. Today, the situation is still the same.
What David Nutt shows is that you can write and research on the therapeutic possibilities of psilocybin, and advocate for its medical use, while also refusing to throw recreational users under the bus. Any true medical analysis of a drug cannot buy into the anti-scientific idea of nebulous ‘harms’ that are based more in government ideology than any real-world analysis—and we have to be more critical about those who are willing to do this.
As the possibility of psychedelic legalisation moves closer, the commercial possibilities of psychedelic substances also increase. Those with a canny financial mindset can see the dollar signs advancing over the horizon—and what they can see is that if a product becomes legal in one setting but remains illegal in another, there is a lot of money to be made from that one legal setting. For those wanting to earn the maximum money from partial legalisation of mushrooms, keeping them illegal for recreational users is the best way forward.
But we have to resist this. A basically harmless substance should not only be accessible for those whose struggles are pathologised or medicalised; it should be accessible for all. Even the experts agree.
Following his dismissal from the ACMD, Nutt got funding to set up an independent body, DrugScience, and he also runs the DrugScience podcast.