Ecstasy reclassification meltdown; it begins again

Thought the reclassification ridiculousness was over? WRONG. It's only just starting. The miserable cannabis reclassification saga (as chronicled on this blog over the last couple of years) may be done and dusted for the time being but the next installment is about to begin with the imminent ACMD review of ecstasy's classification status. And if it was possible to find a drug that works tabloids and politicians into more of a irrational lather than cannabis, then that drug is ecstasy.

buckle up folks, its about to begin again. And it'll be even worse this time.

The first trickle has begun with the media reporting the fact that Sir Micheal Rawlins has resigned (more accurately stepped down at the end of his tenure) as chair of the ACMD, to be replaced by Professor David Nutt, the coverage leading with the hook that Nutt wants to reclassify ecstasy downwards to class B.

The Telegraph for example, reports that 'The Home Office Considers Reclassification of Ecstasy' . For a start it is the nominally independent ACMD, not the Home Office per se, that has decided to review the drug's classification. We can be certain that the Home Office would be delighted if the committee would leave the whole question well alone; they are painfully aware the review will once again highlight the absurdities and injustices of the classification system and the crumbling edifice of the Misuse of Drugs Act in which it sits. Secondly, the 'news' of this 'admission' is actually neither. The ACMD have been very open and clear since 2006, yes that's over two years, that the ecstasy review would be undertaken. Indeed it has already begun, with a review of the literature already commissioned and underway. All made fully public. The Telegraph are either guilty of lazy journalism or, surely not, whipping up some non-news into a sexy headline.

Almost the exact same story ran in the Sun (which informed us that ' BRITAIN’S new drug Czar wants to DOWNGRADE mind-bending ecstasy and LSD, it was revealed last night.') , and minus a few gory details but using much of the same (presumably agency supplied) text, on Politics.co.uk . Nutt, it should be made clear is not the new Drugs Czar - that absurdly titled post (it was actually on the job application form) was created and inhabited by Keith Hellawell in 1998, until he was rather ungraciously shunted into retirement and the post quietly dropped into to the stupid-populist-ideas-bin in 2002.

Anyway, the ACMD ecstasy review will report later this year and will almost certainly call for ecstasy to be reclassified as a class B drug. Just as happened with the cannabis saga, opponents of the move, or the Government, or both, will say repeatedly and entirely incorrectly that this is 'sending out the message' that 'ecstasy is harmless/safe'. Now, as has been explored in detail by Transform for a number of years, the classification system is riddled with conceptual and intellectual holes rendering it almost completely devoid of public health or criminal justice utility. None the less it is at least nominally based on ranking drug harms and Nutt and his brainy academic colleagues have recently, if rather belatedly (a mere 35 years late) made it clear how they think this ranking should work. Moving ecstasy to B will no more be saying 'it is safe' than moving cannabis to C did. It will merely indicate, correctly as far as it goes, that the risks (addictiveness, toxicity, mortality, social harms etc) are relatively less than other drugs in A, such as cocaine and heroin, just as the cannabis move to C described it as less harmful than class B drugs such as amphetamines. Nutt has also suggested that LSD be moved to B, and moving ecstasy and LSD out of the 'most risky' category has been supported by the Police Foundation report back in 2000 and the Home Affairs Select Committee drugs inquiry back in 2002. Its far from hot news this.

We can fully expect to see all the same confused, emotive and partisan nonsense from the cannabis debate regurgitated once again as ecstasy classification rears its head over the toilet bowl. The ghost of the Leah Betts tragedy will no doubt return to haunt and misinform us, lazy journalists will trawl scientific papers for ecstasy-shock statistics to cherry pick and mis-report, meaningless monkey brain-scans and unclever headlines about 'The agony and the ecstasy' will make a unwelcome return to our newspapers, and the David Davis sending-out-the-wrong-message-ometer will light up like a Christmas tree.

Now before I conclude by pointing and laughing at the anti-science political posturing of drugs minister Vernon Coaker (that has a particular bearing on this story) I would like to say a couple of words to the ACMD on the off chance that any of them are reading this; Reviewing the safety of ecstasy is a very tricky business. Not only is the literature painfully thin (I wrote my undergraduate thesis on the subject in 1992 and was able to read everything ever published) but the drug's effects on individuals, or on populations, is nigh on impossible to ascertain for a number of reasons:

• Ecstasy is rarely used in isolation - poly-drug use with alcohol, cannabis, cocaine, ketamine and / or amphetamines is very much the norm amongst ecstasy users and teasing out which negative effects can be pinned on ecstasy alone is highly problematic. The ABC classification system is woefully inadequate for describing or tackling such complex interactions of variables and behaviours.
  
  
• Ecstasy death statistics are an epidemiological minefield. What is recorded on death certificates does not imply direct causality with ecstasy use as raw death stats suggest. As the Leah Betts case demonstrated, related behaviours can cause or contribute to deaths, as can poly-drug use or other individual predispositions. 60% of recorded 'ecstasy deaths' are of people 'known to drug services'. Think about the significance of that.
  
  
• What is taken as 'ecstasy' is not always MDMA, indeed testing suggests it rarely is. I have done pill-testing at parties (using the maquis reagent) when none of the pills tested contained any ecstasy at all. Are you examining the risks of MDMA or the 'pills' containing a range of different unknown substances that are now sold as ecstasy? (I have discussed this briefly with Prof Nutt and I'm glad to say he acknowledges the difficulties)
  
  
• The nature of the ecstasy pills, and patterns of use has changed dramatically in the last 20 years - they have become far cheaper and (generally) weaker (consequently used in much greater volume) as well as less often containing MDMA - is the research you are looking at still relevant to today's patterns of use? (probably not)
  
  
• There is also a split in the market between cheap ecstasy 'pills' and more upmarket crystal MDMA powder (I predict this to be the new ecstasy version of super-potent 'lethal skunkabis' around which the imminent media ecstasy panic will, er, crystallize). Again, patterns of use are very different and generalised conclusions about harms are not useful for making policy decisions.
  

• As the above points suggest, drug harms are directly impacted by legal status. Pills and powders of unknown strength, purity and often containing unknown drugs are (unless they contain no drugs at all, which is not uncommon) intrinsically more risky than pharmaceutical grade drugs from legally regulated sources with dose, purity and safety information on the packaging. Comparing the safety of pharmaceutical ecstasy (and there is some literature on this) with the safety of illicit use and related behaviors would not only be scientifically sensible but also very illuminating for policy considerations. This point highlights the significant missed opportunity from the 2007 Nutt et al Lancet study on drug harm rankings, discussed in more detail here.

Also, please remember that translating rankings of rather vague population wide harms of a certain drug into criminal penalties for individuals is neither scientific nor ethical and there is no evidence that such and approach, even if the rankings made more sense, delivers any useful policy outcomes. The classification system is long overdue a major review and overhaul, that goes a long way beyond an occasional alphabetical re-jig. The ACMD supported the call of the Science and Technology Select Committee classification inquiry for such a review in 2006, as promised by a previous Home Secretary to the House of Commons in January of the same year. In line with the responsibilities of the committee, the appointment of the new chair provides an apposite moment to repeat this call.

And while you wrestle with all the above remember that whatever the review determines regards ecstasy, the cannabis classification debacle demonstrates with absolute clarity that the government do not give a stuff about science and rational policy making when it does not fit their political prerogatives or pre-ordained 'beliefs'. For those in any doubt let us revisit the follow up oral evidence session to the publication of the Science and Technology Select Committee’s devastating 2006 critique of the classification system, when the the committee re-interviewed then ACMD chair Sir Micheal Rawlins, soon to be chair Prof Nutt (who both acquit themselves very well) and drugs minister Vernon Coaker MP (less well).

By any stretch it is a truly remarkable interrogation, with the Minister not having a leg to stand on when he is repeatedly challenged on the lack of evidence base for the classification system's effectiveness, or the justification for certain howling anomalies within the system. He falls back on evasion, changing the subject or the excuse of decisions being ‘political judgements’ , or worse, merely that it is his ‘belief’ that the system works. There is not even the pretence that the system is evidence based. So here you go folks, just so you know what you're up against.

First is a section about the reclassification of ecstasy:

Q109 Mr Newmark: If the ACMD discovered new evidence when it undertook the review, would you consider reclassifying ecstasy?

Mr Coaker: We would consider their evidence. As I say, we have no plans to reclassify ecstasy. The ACMD is independent of government, we obviously respect what they say, and they will bring their report forward, but the Government has no plans and no intention of reclassifying ecstasy.

Q110 Dr Harris: You say that you do not propose to move ecstasy and it will remain a Class A drug. Is that an evidence-based policy?

Mr Coaker: That is a judgment the Government makes on the basis of what we believe to be something that is in the interests of the public at large to keep ecstasy as a Class A drug.

Q111 Dr Harris: Is it an evidence-based view?

Mr Coaker: It is a judgment that we make based on all the evidence we have had no recommendation from anybody to reclassify ecstasy from an A to a B. We think it is a drug which is harmful. There is no safe dose of it. We were talking about alcohol earlier on and one of the problems you have with alcohol is there probably is a safe dose. Like many here, I have a drink now and again, but there is no safe dose of ecstasy, we think it would send out totally the wrong messages and, as I say, we have no intention of reclassifying ecstasy.

Q112 Mr Newmark: Because it kills unpredictably?

Mr Coaker: As I say, there is no safe dose. This is the point, just half a minute—

Q113 Dr Harris: There is no safe dose of tobacco.

Mr Coaker: It just does make the point very well, the exchange that we have just had between two members of the Committee, quite rightly, about the difficulties that there are in this area and the different views and opinions that people have. I think what we all wrestle with is using evidence and using science and also trying to think about it from a non-scientific point of view in the social judgments and the individual judgments and the community judgments that we make. We wrestle with that and, as I say, as a Government we have no intention of doing anything with respect to ecstasy because we do not believe there is a safe dose, it is harmful, it kills unpredictably, as Brooks has said, and we just think that it is a very important way to use the classification system.

Q114 Dr Harris: If the ACMD reviewed the evidence and that review made recommendations to you, are you saying now it is not worth them doing it because your decision on this will not be evidence based, it will just be a reassertion of your "no intention to reclassify ecstasy"? Even if they said there will be fewer deaths, for whatever reason, if it is reclassified, are you saying that you will never consider an evidence-based decision on this drug?

Mr Coaker: I am not saying that at all. What I am saying is the ACMD, of course, can conduct research and look at whatever they wish to with respect to drugs and make recommendations to the Government. What I am saying quite clearly is that we have no intention of reclassifying ecstasy.

Q115 Dr Harris: I am keen to pursue this one. I understand you have no intention and I assume that is current because I do not think you could bind your successors if the evidence changed. Is it your view that all drugs for which there is no safe dose should be in Class A or is there something special about ecstasy which means it is one of the drugs for which you say there is no safe dose which means it must be in A?

Mr Coaker: In talking about ecstasy, it kills unpredictably, we do not believe that there is a safe dose; we will not reclassify ecstasy.

Q116 Dr Harris: Does that apply to all drugs that meet those criteria?

Mr Coaker: What we try to do where we have evidence and where people come to us with recommendations is make individual judgments, as we will do whenever people come to us. All I am saying with respect to ecstasy is that we have no plans and no intention of doing so.

Q117 Dr Harris: So do you think you are wasting your time, Professor Rawlins, if you end up doing a review in this area?

Professor Sir Michael Rawlins: No, I think we will give advice on whatever we feel is appropriate but perhaps in a way more importantly we will also be able to, I hope, give better advice on harm reduction, which is actually rather important, and on what further research is needed in order to understand the dangers of it.

Q118 Dr Harris: Will the fact that the Minister has said quite categorically that he is not going to change the classification have any bearing on whether you follow through and do a report?

Professor Sir Michael Rawlins: None at all because we are going to do it*.

*please take note, James Kirkup, Political Correspondent at the Daily Telegraph

Now here is a second section from slightly earlier in the session. Creationism gets a mention in reference to the Minister's scientific discourse; it seems an appropriate analogy:

Q45 Chairman: Vernon, in response to us, you said that the Government "fundamentally believes that illegality is an important factor when people are considering engaging in risk-taking behaviour . . . It believes that the illegality of certain drugs, and by association their classification, will impact on drug-use choices". Where is the evidence for that?

Mr Coaker: That is the belief and the judgment that the Government have.

Q46 Chairman: I did not ask you that. People believe in creationism and they are entitled to do that, though I do not agree with that, but I am asking you, where is the evidence?

Mr Coaker: To be fair to the response that we tried to make in response to the Committee where the Committee has challenged us, we have ourselves said that we need to do more research into the deterrent effect, that we need to establish a better evidence and research base for that, so we have accepted the point of the need to actually do something about it, but we do believe, and strongly believe, that the classification of drugs in the current system, A, B and C, with respect to Class A does act as a deterrent system. That is a judgment we make, it is a belief that we have and we have accepted that there is more to do with respect to that.

Q47 Adam Afriyie: If when you carry out and conduct this research the evidence shows that you are completely mistaken in that view, will change your view?

Mr Coaker: I cannot prejudge what any research is going to tell us. Clearly you make judgments about the research that you receive and that is obviously the point.

Q48 Chairman: Vernon, you have not commissioned any research and nor have the ACMD.

Mr Coaker: No, but what we have said in response to where the Committee challenged us and said, "Where is your evidence base for that?", as we have done with a number of other things, we said that we understand that point, we accept that point and we need to look at establishing a better evidence base for that, but it does not alter the fact or change the fact that the Government believes that the tripartite system, the classification system, does send out a strong message and does impact on, and affect, behaviour.

Coaker's speaking in political tongues couldn't help but remind me of this: