Wednesday, May 21, 2008

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:



14 comments:

Frank said...

Great update again Steve. I can see this blowing up even more than cannabis did. The British public, it would seem, have a relatively comfortable grip on the notion of cannabis: to the mainstream it's a plant with a 'soft' high that has a history of media coverage and familiarity - Mr and Mrs average know where they stand. Ecstasy, however, is difficult for middle Britain to get to grips with - with the exception of the tragic but tiresome Leah Betts case, the drug itself and its related culture have not been significantly covered in the media since the pre-nightclub rave days and remains on the fringes of the public's understanding.

But I think this new ecstasy classification 'meltdown' will open a can of worms for journalists and middle Britain. The ACMD will no doubt produce a sterling synthesis of the shape and nature of ecstasy and its use in the UK and this will receive a good deal of high-level media coverage. Although the government reaction will be a farce and continue to 'send out messages', the voices calling for evidence-based policy will become increasingly more audible, as they have done over the last couple of years. In this sense I think the coming ecstasy saga could help the drugs debate turn a corner as the ridiculous blunders of prohibition, which are especially pronounced in the case of ecstasy, are brought to public attention through media discourse. It would seem every time the government publicly ignore the evidence and the experts, the public prick their ears up a little more. We just need to keep hammering away - so keep up the good work at Transform! I'm hoping this coming 'meltdown' will be just one more of the last shambling footfalls of a government tripping over its backward drug policies.

jdc325 said...

That Coaker stuff about the Govt holding the belief that drug policy works drives me absolutely nuts.

Still trying to work out what this means: 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
Does that mean they are going to look for evidence that supports their belief or does it mean they are going to look at whether or not the evidence supports their belief?

mj said...

Aye, this is just another example of how little real drugs education we recieve, in general. :(

It'll be interesting to see how this plays out in the media if this coincides with the end of the long awaited MAPS MDMA/PSTD study (due to end later this year, results very promising).

ps agreed, great update, well worth the wait. :)

mj said...

Don't get your hopes up jdc325, as far as I can make out, this is standard UK drug policy spin. The way I read it is : "We dont have an "evidence base" for our policy, but we recognise that and accept that we should get some evidence. However, we wont, (because its not politically expedient) but we recognise that we should"

See the infamous "why would we commision research into that if we're not going to change it" quote for more fun evidence dodging.

john-boi said...

Steve do you know if the classification of Magic Mushroom as class "A" is also being looked at. I hear about ecstasy and you mention LSD in your article (brilliant as usual) but no mention of Mushrooms which plainly shouldn't be in there with heroin and cocaine.

Derek said...

Oh dear, light blue touch paper and stand well back!

I'm afraid as far as this government goes, we are indeed dealing with people of faith and not science on this issue as Coaker's replies so depressingly demonstrate.

But I would sound a word of caution aimed at Prof Nutt as well. There's something wrong with his methodology that's shown by his opinion of acid, LSD.

Because of the way these things are measured, acid shows itself to be a pretty safe substance. It doesn't kill, it's never involved in accidents, never involved in anything really, it's benign to all intents and purposes.

Believe that and you might as well believe in the tooth fairy, little green men or prohibition.

Acid has a property seldom acknowledged by drug warriors or even respected scientists. The main weapon in the prohibition arsenal - drug testing - simply isn't available against LSD. Acid is undetectable in or after use.

This is mostly due to the amazingly low doses acid is taken in - 250 MICRO grams is a hell of a strong trip - apparently within 15 mins or so of consumption, well before it kicks in, it's as good as gone as far as detection goes.

Hence after car crashes or other accidents or incidents when they test for illegal drugs, acid just isn't there. It really is the mccaffrey's cat of drugs.

Now of course, this contrasts with cannabis which is detectable weeks after the last use of course ensuring it always shows up.

So sure we need to review the whole ranking of drugs, and include alcohol and tobacco, but we also need to think a bit about how we actually measure things. Any review of drug harms which puts LSD lower than cannabis is so obviously flawed as to be laughable.

Oh - and the law is not a deterrent against the use of drugs. Unlike the government, I don't say that as a matter of belief - I know it isn't from, er lets say “direct observation”, if I can put it like that.

Steve R said...

Thanks for the comments - regards classification of mushrooms - I don't know, although the committee have said they will go through all the drugs systematically. That presumably includes mushrooms and would presumably result in a recommendation to move them to B or more likely C, but Im not aware its on the immediate agenda.

I hope that ecstasy thing provokes some sensible debate. On balance the cannabis debate may have moved some issues forward with the government move being widely perceived as cynical posturing over science. On the other hand the skunk panic has had a huge impact on the popular consciousness and its hard to gauge on balance. The outcome has certainly been bad, But at least ecstasy can only go down or stay put.

Nowhere Girl said...

It seems curious that LSD is also proposed for reclassification, but everyone seems mostly concerned about ecstasy. Has LSD really become such an "unmedial" drug? ;) Or do they have a lack-of-evidence problem?

)SoFoS( said...

I remember when I was taught about Leah Betts in Biology while at secondary school. Surprisingly the impression that I had was that her death was due to her lack of drugs education, rather than the drug itself. We were told that she drank herself to death on water, while she was trying to avoid dehydration. Dehydration being hard to monitor when under the influence of the drug. My description may well be inaccurate, due to my not so envious memory and possible oversimplification of the matter. Please correct my stupidity where necessary.

I have never taken Ecstasy, being pretty indifferent about the matter. However science being ignored is a big concern of mine.

Thanks again Steve for another interesting read.

chrisbx515 said...

When Leah Betts died and the press told us that the pill she had taken was called an ‘apple’ the sale of these pills went crazy because everyone on the scene new that the pills were strong. Everyone knew from the reports that she had died from drinking to much and not a dodgy pill. While the government convince themselves that they are sending messages that are listened to the rest of the drug taking population continue to ignore the propaganda and get on with what they do. Prohibition encourages rebellion.

Anonymous said...

nowhere girl, I think it's just because ecstasy is a much more controversial drug than LSD is, probably due to the well-publicised tragedies involving ecstasy, so the media and government focus more on it. Somehow it's more at the forefront of people's minds and is seen as more relevant to today's world, rather than LSD which is mostly perceived as a 60s hippie drug. Also a lot more people use ecstasy than LSD.

Anonymous said...

As a sister of someone who died as a result of taking ecstacy, i am appauled with this move. I totally disagree with you and agree that if ecstacy was reclassified to B this would send out a dangerous message to young people. My 24 year old brother was not one of the 60% people known to drug services but a normal healthy fun-loving individual who had taken ecstacy a handful of times. I have been made aware of 2 other instances of death of young men in my town as the result of taking ecstacy also. These boys similar to my brother were not drunks, addicts or popping every drug going as your report suggests ectasy users do. They were young men that met their tragic ends as a result of taking ecstacy in a culture that says its okay to do so. My brothers death certificate did indicate that he had died of pulmonary odema but this was a RESULT of talking the ecstacy tablet and if he had not done so he would still be here today! I will be one of the people backing the 'unwelcome return'by the media of promoting ' the agony and the ecstacy' because living through it it is something I would never want any family to have to go through again. I think your article is completely insensitive to the families who have lost sons/daughters as a result of taking ecstacy. Your research lacks essential information about the effects of ecstacy and the devasting consequences that can prevail. Many of the 'lazy journalists' you talk about are not as misinformed as you believe but tell the true story about young people and their needless deaths as a result of taking ecstacy.

Steve R said...

anon - I think you have misunderstood the thrust of this piece which you have seen through the prism of your own terrible personal tragedy. this blog is neither condoning ecstasy use nor claiming it is safe, but highlighting the political and media driven culture that shapes policy in ways that maximise harm and make tragedies more likely, rather than being based on evidence of effectiveness at achieving the opposite

Take a look at the Transform briefing on the classification system.

bob said...

Anon:

Really sorry you had to experience this and hope you get through it eventually. Unfortunately I must disagree with a couple of your points. I haven't taken anything for many years and have had some bad experiences as a result of drugs. I've also had some great experiences and met some wonderful people who've had a very positive influence on my life.

I've looked after countless people on all sorts of drugs, and would have almost definitely just looked down my nose at them if I hadn't had experience of the same thing with close friends being stupid. I've got myself in some silly states/situations through being a bit over-zealous myself and always thought of the individual, not the drug when I see anyone in difficulty.

I'm an accountant with numerous qualifications, not a junkie. I spent my 'honeymoon' with pills in absolute heaven. I was in the unenviable position of having severe clinical depression for most of my life (from the age of 4 as far as several experts told me eventually) and the only things that could result in a production of serotonin in my brain were things like near-death experiences, drug-taking, and great sex. Sorry to lower the tone, if that's what you think I'm doing - it's not my intention!

I had a truly wonderful time and still wish things could be like they used to be.

I woke up one morning and didn't take anything any more. Just that simple. I've tried a few times since, and each time the drop in quality is palpable. If there was a standard, taxable, regulated drug this problem would be completely eradicated. As it currently stands, towards the end of my experiences, I used to spend time with friends debating the exact mix of extras/substitutes in the pills we'd had to the level that we almost became statisticians, since we'd all had other experiences as well (whether personal or third party) with other substances.

This was whilst we were experiencing the 'wonderful highs' of the drug itself, which, a couple of years, or even months, earlier, would have meant this was the furthest thing from our minds - merely the wonderfullness (I know it's not a word when you're straight, but it bloody is when you're not!) would have been the topic of any conversation whilst we weren't engaged in hugging people or dancing. Surely the latter is one of the best ways to operate in this uncaring, disgracefully antisocial world we live in..? As the late, great, legend who is Bill Hicks once said, "If you're at a ball game and somebody's causing trouble, is he drunk, or is he high? Drunk! He's not fighting because he's high because it's fu(£ing impossible!"

The fact that the quality/purity of pills was so bad stopped me and almost all of my friends from taking anything any more (we'd all refused to take anything else apart from blow long before) kind of explains a lot to me. I hung about with these guys whilst they were still dropping for a long time afterwards and still class some of them as my closest friends. I don't think REAL MDMA-based pills are a problem at all, merely the crap that is peddled as them in clubs up and down the country every day. The amount of Ket in most was horrifying (we tested them through a couple of pharmacologist friends...)

If you want statistics, then look at the numbers. Millions of pills are taken each weekend and we've only had an average of 2-5 deaths a year in the UK from ecstasy. You truly have my sympathy for being connected to these - I wouldn't wish it on anyone. The number of deaths from Aspirin far outweighs this, though. Does this mean Aspirin should be an A class drug? Of course not. It serves a legitimate, and very successful, purpose. This could also be the case of ecstasy if it was controlled. The numbers lost to nicotine or alcohol each year are terrifying, and cost each of the tax payers an absolute fortune, despite the taxes levied on these products, yet are still legal. Think of it like this - If the whole of the UK gave up smoking, the NHS would collapse as soon as the budget came 'round. Think what could be achieved, medically, if pills were properly regulated and taxed...

This is not meant as a rebuttal of your points, but merely an alternative viewpoint.