DOCSLIB.ORG

Using Multi Criteria Decision Analysis to Estimate Relative Drug Risks and Harms

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Using Multi Criteria Decision Analysis to Estimate Relative Drug Risks and Harms Using multi criteria decision analysis to estimate relative drug risks and harms Prof. David Nutt FMedSci Edmond J Safra Prof of Neuropsychopharmacology Imperial College London Chair ISCD drugscience.org.uk [email protected] Drugs are controlled because … They are harmful They might be harmful The media wants it? … as do the majority of politicians … and some of the public So getting the best estimate of harms is vital But difficult • Poor data on existing controlled drugs because illegality covert use • And less for new entrants to the field, “legal highs” 4 key issues 1. Relative harms of drugs - and comparisons with alcohol and tobacco 2. Comparative harms –v- other risky activities 1. Proportionality of penalties cf health harms 2. Benefit-harm equation of the law? 5 A short history of what we have done First - the 9 point scale 2000 Runciman report: develop the 9 point harm assessment scale Drugs and the Law: Report of the Independent Inquiry into the Misuse of Drugs Act 1971. Members of Inquiry: Viscountess Runciman (Chairman), A Chesney, R Fortson, J Hamilton PQPM, S Jenkins, A Maynard, L G Murray, DJ Nutt, D O’Connor QPM, G Pearson, I Wardle, B Williams, A Zera. Report published in 2000. 2001-2006 – Home Office ACMD group systematically reviews a range of drugs using this scale Nutt, DJ; King, LA; Saulsbury, W; Blakemore, C [2007] Developing a rational scale for assessing the risks of drugs of potential misuse Lancet 369:1047-1053 PMID: 17382831 The nine point scale Drug harm ranking Nutt et al 2007 Lancet 8 A short history of what we have done First - the 9 point scale Two2000 Runciman problems: report: develop- the 9 point harm assessment scale Drugs and the Law: Report of the Independent Inquiry into the Misuse of Drugs Act 1971. – Membersno weightings of Inquiry: Viscountess Runciman of (Chairman),different A Chesney, harms….R Fortson, J Hamilton PQPM, S Jenkins, A Maynard, L G Murray, DJ Nutt, D O’Connor QPM, G Pearson, I Wardle, B Williams, A Zera. Report published in 2000. - and were these the right harms? 2001-2006 – Home Office ACMD group systematically reviews a range of drugs using this scale Nutt, DJ; King, LA; Saulsbury, W; Blakemore, C [2007] Developing a rational scale for assessing the risks of drugs of potential misuse Lancet 369:1047-1053 PMID: 17382831 9 March & June 2009 ▫ Medical Research Council and Home Office co-sponsor research project ▫ Advisory Council on the Misuse of Drugs, (ACMD), David Nutt as Chair, meets to develop an MCDA model and to test its potential for evaluating drug harms July 2010 ▫ ACMD publishes the MCDA framework developed in 2009 ▫ http://www.homeoffice.gov.uk/publications/drugs/acm d1/ACMD-multi-criteria-report The 16 criteria of harm Harm to self Harm to others Drug specific mortality Index of toxicity = deaths per million users heroin >>>cocaine > amph - MDMA - Cannabis 20,000 - 170 - 70 - 50 - 5 1 in 50 heroin users die of drug King L ACMD report 2008 Amy Winehouse's death due to acute alcohol poisoning = drug SPECIFIC mortality Blood alcohol 450mg/% = 5.5 x legal driving limit + Imperial College student last year Despite being in “recovery” Drug RELATED mortality Tobacco – lung disease Alcohol - liver disease Drug related mortality 90,000 1,400 80,000 1,200 70,000 1,000 60,000 800 50,000 600 40,000 400 30,000 200 20,000 0 10,000 0 Tobacco Alcohol Opiates Source: Smoking and drinking among adults, 2009. Office for National Statistics Drug Misuse Declared: Findings from the 2010/11 British Crime Survey England and Wales. Home Office 14 Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2009/10: Sweep 6 report. The Centre for Drug Misuse Research Drug related mortality 80% ALCOHOL 20% HEPATITIS Liver disease Deaths for people under age 65 from major diseases compared with 1970 – UK Nick Sheron More than 20% of all male deaths 16-44 yrs due to alcohol Male deaths from alcohol by age band 2,500 30% 25% 2,000 20% s 20% h 1,500 t s a p h t u e a o d r e f g d o 15% l l e r a g e f a b o y m b u 1,000 % N 10% 500 5% 0 0% 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age group Wholly attributable conditions Partially attributable chronic conditions Partially attributable acute consequences % of all deaths by age group Figure 1. Number (% of all deaths in each age group) of male deaths attributable to alcohol consumption by age and type of condition (2005) Alcohol the most common reason for death in men under 50 1,000 16% 900 14% http://www.nwph.net/nwpho/publications/alcoholattributablefractions.pdf800 12% 700 10% s h 600 t a s e p d h t u f a o o r e 500 8% r g d e l l e b a g m f a u o y 400 N b 6% % 300 4% 200 2% 100 0 0% 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age group Wholly attributable conditions Partially attributable chronic conditions Partially attributable acute consequences % of all deaths by age group Figure 2. Number (% of all deaths in each age group) of female deaths attributable to alcohol consumption by age and type of condition (2005) 14 Drug related morbidity Heroin AIDS Hep B and C Skin infections Anthrax Clostridia Drug specific morbidity – alcohol brain damage Normal Alcohol addiction Drug SPECIFIC mental impairment Keith Campbell – one of the creators of Dolly the Sheep hanged himself in a drunken rage Professor Campbell was a "regular" drinker who suffered from hypertension, high blood pressure and a heart condition Alcohol - Harms to others Even Ascot not immune! Royal Ascot June 16th 2011 Metro MP arrested after brawl in commons bar 22/Feb/2012 Ed Joyce Labour member For Falkirk - no longer! Environmental damage from alcohol Exxon Valdez = largest environmental disaster before the Gulf Spill - 1989 Captain drunk Community damage In UK many MPs careers ruined including George Brown and Charles Kennedy 24 THE ISCD DRUG HARMS MODEL (Independent Scientific Committee on Drugs) Nutt DJ King LA Phillips LD (2010) Drug harms in the UK: a multicriteria decision analysis Lancet 376: 1558-66 DOI: 10.1016/S0140-6736(10)61462-6 25 The 20 drugs Heroin Crack Cocaine Alcohol Tobacco Amphetamine Mephedrone Buprenorphine Benzodiazepines Cannabis Anabolic Steroids Ecstasy Methylamphet- Ketamine LSD Mushrooms amine Khat Butane Methadone GHB 26 Scoring the drugs • The most harmful drug on 100 ┬ Most harm each criterion was scored at ┤ 100. 80 ┤ • All other drugs were scored ┤ relative to that drug. 60 ┤ • E.g., a drug considered half as ┤ harmful was given a score of 40 ┤ 50. ┤ 20 ┤ • This creates a unique ratio ┤ scale for each criterion. 0 ┴ No harm 27 28 Weighting the criteria • Some criteria represent more harm 100 ┬ Most harm than others. ┤ • Swing-weights equate the units of 80 ┤ harm on all the criteria: the swing in harm from the ‘no harm’ drug on a ┤ criterion to the ‘most harmful’. 60 ┤ • The group considered this question to ┤ compare the levels of ‘most harm’ on 40 ┤ the criteria: ┤ – “How big is the difference in harm and 20 ┤ how much do you care about that difference?” ┤ 0 ┴ No harm Weighting Harms to Others 29 30 The resulting criteria weights Drugs ranked according to total harm Alcohol Tobacco Cannabis Nutt King & Phillips Lancet Nov 2010 32 Why is alcohol so harmful? Half the harm from these four 33 Correlations of ISCD scores with... ...van Amsterdam population ...van Amsterdam individual 3 3 2 2 1 linear r = 0.84 1 linear r = 0.83 VA population results population VA VA individual results individual VA exponential r = 0.88 exponential r = 0.91 0 0 20 40 60 80 0 ISCD results 0 20 40 60 80 ISCD results Reference: van Amsterdam, J. G. C., Opperhuizen, A., Koeter, M., & van den Brink, W. (2010). Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. European Addiction Research, 16, 202-207. 34 ISCD input scores vs published studies Study ISCD criterion vs study criterion N r Gable 2004 Drug specific mortality vs log10 safety ratio 12 0.66 King & Corkery Drug specific mortality vs fatality statistics 5 0.98 2010 (other substances mentioned on death cert.) Drug specific mortality vs fatality statistics 5 0.99 (sole mentions on death certificates) Anthony et al Dependence vs lifetime dependence 5 0.95 1994 35 No correlation of UK Drugs Act classification with ISCD results 5 4U 3C linear r = 0.04 2B 1A UK Drugs Act classification UK Drugs 0 0 20 40 60 80 ISCD results Main Implications 1. The UK MDAct1971 is fundamentally incorrect in many of its drug rankings the law is unjust 2. The International Conventions are likely similarly wrong 3. Alcohol should be the major target for harm reduction in the UK What about other countries? EU funded European study 30 experts from 20 countries – May 2013 MCDA on same 20 drugs as UK experts New European data – 2013 ISCD European study FP7 2013 Looking at different formulations of the same drug Nicotine – tobacco –v- other delivery systems e.g. electronic cigarettes and gum/patches • International Expert panel • July 2013 Nicotine products Thanks, questions & further reading Follow us on www.drugscience.org.uk [email protected] All proceeds to ISCD Publisher: UIT Cambridge Published: 30 April 2012 Format: Paperback 320 pages See: Full bibliographic data ISBN 13: 9781906860165 ISBN 10: 1906860165 .
Load more

Recommended publications
  • Neurobiology of Addiction and Implications for Treatment
    BRITISH JOURNAL OF PSYCHIATRY (2003), 182, 97^100 EDITORIAL partial agonist, this drug stimulates the D Neurobiology of addiction and implications 33 receptor enough to keep withdrawal at for treatment bay, but not enough to cause a ‘high’ or to be rewarding. It is currently in phase 1 trials. One drug that affects the dopaminergic ANNE LINGFORD-HUGHES and DAVID NUTT system and has proven efficacy in the treat- ment of nicotine addiction is bupropion (Jorenby(Jorenby et aletal, 1999). The exact mechanism underlying this effect still has to be fully characterised; however, it has been shown that bupropion increases dopamine and noradrenaline levels by acting as an uptake Drug and alcohol misuse result in immense withdrawal as well. In an elegant series of inhibitor (Ascher et aletal, 1995).,1995). harm at both individual and societal level. experiments, Schultz (2001) found that in Our understanding of the neuropharma- primates trained to associate a cue with a cology of these disorders is increasing pleasurable experience (food), increased Related systems involved in reward through the use of approaches such as dopaminergic activity was seen in response Our understanding of other neurotrans- neuroimaging and gene targeting and the to the cue and not to the food. If the food mitter systems that are involved in reward availability of specific receptor agonists was not then presented, dopaminergic and that may modulate dopaminergic and antagonists. Our aim here is to describe function dropped. Reduced dopaminergic activity provides further targets for some interesting new findings that are function is thought to be associated with pharmacotherapy. likely to inform advances in treatment.
    [Show full text]
  • Why Medical Cannabis Is Still out of Patients' Reach—An Essay by David
    BMJ 2019;365:l1903 doi: 10.1136/bmj.l1903 (Published 1 May 2019) Page 1 of 3 Feature FEATURE BMJ: first published as 10.1136/bmj.l1903 on 1 May 2019. Downloaded from ESSAY Why medical cannabis is still out of patients’ reach—an essay by David Nutt Cannabis has been used as a medicine for millennia, writes David Nutt, who charts its relatively recent prohibition, the effect on patients such as Billy Caldwell, and the failure of legal reform to make much difference David Nutt Edmond J Safra professor of neuropsychopharmacology Imperial College London, London W12 0NN, UK Cannabis is arguably the world’s oldest medicine, with evidence This report was relied on to control cannabis under the 1961 of such use from 3000 year old tombs in Egypt and Siberia. It United Nations Single Convention on Narcotic Drugs and had a place in Indian and Chinese medical writing from nearly amazingly persisted as the international medical guidance on as long ago. It didn’t enter the UK until the late 1600s, but by cannabis until 2018, being used as the justification by the World the 1800s it was widely used, sold over the counter as an Health Organization for keeping cannabis a schedule 1 http://www.bmj.com/ alcoholic tincture for problems such as tetanus and seizures. Its controlled drug till then. Even more absurdly, the 1934 report efficacy more broadly became apparent, and the definitive has been lost, so we can’t explore its evidential base or overview was published in the Lancet in 1890 by John Russell reasoning.3 1 Reynolds.
    [Show full text]
  • Professor David J Nutt
    2016 BAP LIFETIME ACHIEVEMENT AWARD Professor David J Nutt David Nutt received the BAP Lifetime Achievement Award at the 2016 summer meeting in Brighton. It gives me much pleasure to write about his long and very productive career in both preclinical and clinical psychopharmacology. I am primarily emphasizing his scientific achievements, both internationally and domestic, and his role in making the public aware of the need for evidence-based clinical science. It is scarcely necessary to detail his commitment to the BAP both as a former President and also editor of the Journal of Psychopharmacology for over 25 years. I have known David for nearly 35 years ever since he joined the MRC Clinical Pharmacology Unit in Oxford and undertook preclinical research for his MD. His enormous enthusiasm for both basic and clinical pharmacology and his impressive abilities were apparent from the outset, and in just 3 years we published together 11 papers and a book chapter, all in major journals (he also published work with other colleagues). A particular interest of David was the translation of basic research to clinical studies in psychiatry, something both David Grahame-Smith, the Unit Director, and I were already enthusiastic about. He then undertook clinical research in psychiatry in Oxford before appointments at the National Institutes of Health, Bethesda, Maryland, the University of Bristol and now Imperial College, London. David’s commitment to communicating clinical pharmacology research to the public is, of course, known to many people, and he has been tireless in demonstrating the need for evidence-based decision making when discussing the risks and benefits of drugs, particularly recreational drugs.
    [Show full text]
  • UIT CAMBRIDGE Rights Catalogue the Physics of Everyday Life Extraordinary Insights Into Everyday Physics Professor Jo Hermans
    UIT CAMBRIDGE rights catalogue The Physics of Everyday Life Extraordinary insights into everyday physics Professor Jo Hermans Description: This book brings the magic of physics to everyday life. With a glass of water, a few drops of milk and a torch, readers will be able to demonstrate why the sky looks blue during the day, but seems to turn red at sunset – and astound their friends by telling them how fast one can cycle on the moon. It will appeal to teenagers and their parents alike. 198 mm x 129 mm, 1 September 2018, Paperback The Author Prof. Jo Hermans is Emeritus Professor of Physics at Leiden University in the Key Selling Points: Netherlands. In addition to his academic research and teaching career he is active in • A best-seller in the Netherlands promoting and explaining science for the general public. He writes a books on everyday where it was originally published science which have been translated worldwide. He was appointed Knight in the Order of • A popular science book focusing Oranje-Nassau by Queen Beatrix in 2010. on the physics ruling everyday phenomena Contents: • Full of theoretical explanations OUTDOOR LIFE 8. Why is the sky blue (and the setting sun red)? and practical experiments 1. GPS navigation, how does it work? (With a tip SOUND AND HEARING of the hat to Einstein) 9. What do our ears hear? BICYCLE AND CAR 10. Why is there not more noise pollution? 2. The human engine when idling IN AND AROUND THE HOUSE 3. Me? A vacuum cleaner? 11. The lid on the pan 4.
    [Show full text]
  • Nutt Dismissal in Britain Highlights Diverging Drug Views
    NEWS Testy debate: Looking ahead: 2009 in review: Biomarkers for Warwick Anderson We take a look prostate cancer discusses funding back at the past stir controversy in Australia year’s headlines 1339 1346 1348 Nutt dismissal in Britain highlights diverging drug views At a time when the US government has Jacqui Smith over a paper Nutt published in signaled a softer stance on medical marijuana, January on perceptions of risk that compared the dismissal of an independent drug advisor 3,4-methylenedioxymethamphetamine in Britain has highlighted the UK’s hard-line (MDMA, or ‘ecstasy’) use to horse riding (J. stance on illegal substances. Psychopharmacol. 23, 3–5; 2009). David Nutt, until recently chair of the Advisory Council on the Misuse of Drugs Public dispute (ACMD), was fired by UK Home Secretary In a statement, Johnson claimed that Nutt’s Alan Johnson on 30 October. The sacking comments “damage efforts to give the public followed the issuing of a press release relating clear messages about the dangers of drugs.” to a lecture on drug risk and classification that Nutt, however, has hit back in a series of Nutt gave in July at King’s College London. interviews attacking the Labour government’s In his lecture, Nutt criticized the lack of approach to the issue of drugs. evidence for the current classification of drugs As Nature Medicine went to press, no less in the UK and claimed that this undermined than five members of the ACMD had resigned the credibility of the official message on drugs. in protest of Nutt’s dismissal.
    [Show full text]
  • 10 Facts About MDMA
    10 Facts About MDMA August 2015 1. What is MDMA? and a desire to intensify these feelings by dancing, talking and touching. MDMA, often referred to as “ecstasy” or “molly”, is short for 3,4 methylenedioxymethamphetamine, a A typical dose of 80 - 125 mg lasts three to six hours. psychoactive drug derived from safrole oil. MDMA Some people experience nausea at the outset, but produces effects that resemble both stimulants and after about 45 minutes, report feelings of relaxation psychedelics, as well as its signature effect: a feeling and clarity. MDMA also causes dilation of the pupils of connectedness. It impacts brain function primarily and, often, sensitivity to light, as well as possible jaw- releasing the neurotransmitter serotonin, and also clenching, tooth-grinding, muscle tension, faintness, temporarily inhibits its reuptake. MDMA is usually and chills or sweating. taken orally, whether in pressed pill form, powder or crystal; or sometimes snorted. After the drug wears off, the theory from preclinical studies is that brain levels of serotonin (a chemical MDMA was originally synthesized in 1912 by the drug responsible for maintaining mood balance) are company Merck.1 However, its psychoactive effects depleted, which can lead in some cases to sadness, weren’t widely discovered until 1976 when Alexander anxiety, depression and sleep problems.4 If they occur, Shulgin developed a new synthesis method, tested the these symptoms arise in the several days that follow. drug on himself, and shared it with a few friendly Generally, they abate within a week, though frequency psychotherapists.2 Because of the drug’s effects of of use and higher doses can slow or stop this increasing empathy and reducing fear, it started to be process.5 used in psychotherapy practices in the 1970s and early 80s, as well as recreationally.
    [Show full text]
  • Drug Harms in the UK: a Multicriteria Decision Analysis
    Articles Drug harms in the UK: a multicriteria decision analysis David J Nutt, Leslie A King, Lawrence D Phillips, on behalf of the Independent Scientifi c Committee on Drugs Summary Background Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, Published Online policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug November 1, 2010 DOI:10.1016/S0140- harms in the UK. 6736(10)61462-6 See Online/Comment Method Members of the Independent Scientifi c Committee on Drugs, including two invited specialists, met in a DOI:10.1016/S0140- 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the 6736(10)62000-4 individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to Neuropsychopharmacology indicate their relative importance. Unit, Imperial College, London, UK (Prof D J Nutt FMedSci); UK Expert Adviser to the European Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to Monitoring Centre for Drugs individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful and Drug Addiction (EMCDDA), to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with Lisbon, Portugal (L A King PhD); heroin (55) and crack cocaine (54) in second and third places. and Department of Management, London School of Economics and Political Interpretation These fi ndings lend support to previous work assessing drug harms, and show how the improved scoring Science, London, UK and weighting approach of MCDA increases the diff erentiation between the most and least harmful drugs.
    [Show full text]
  • MDMA ('Ecstasy'): a Review of Its Harms and Classification Under the Misuse of Drugs Act 1971
    MDMA (‘ecstasy’): A REVIEW OF ITS HARMS AND CLASSIFICATION UNDER THE MISUSE OF DRUGS ACT 1971 Advisory Council on the Misuse of Drugs ACMD Advisory Council on the Misuse of Drugs 3rd Floor (SW), Seacole Building 2 Marsham Street London SW1P 4DF February 2008 Rt Hon Jacqui Smith MP Home Office 2 Marsham Street London SW1P 4DF Dear Home Secretary, The Advisory Council on the Misuse of Drugs (ACMD) recently considered that a review of MDMA (‘ecstasy’) would be timely as there is a much greater body of evidence regarding the harms and misuse of MDMA since the Council last provided its advice to Ministers in 1996. I have pleasure in enclosing the Council’s report. The use of MDMA is undoubtedly harmful. I would therefore like to emphasise that the Council continues to be concerned about the widespread use of MDMA; particularly among young people. Due to its prevalence of use, MDMA is a significant public health issue and we believe that criminal justice measures will only have limited effect. You will wish to note that the Council strongly advises the promulgation of public health messages. It is of vital importance that issues of classification do not detract from messages concerning public health. Forensic evidence shows that MDMA is by far the most commonly seized of the ‘ecstasy-like’ drugs. MDMA is presently generically classified in Class A under the Misuse of Drugs Act with other ‘ecstasy-like’ drugs. The ACMD has not extended this review to other compounds within the generic classification since their use is considerably less than that of MDMA.
    [Show full text]
  • Mind Medicine Australia’S Submission to the Royal Commission Into Victoria’S Mental Health System
    SUB.0002.0029.0347 Mind Medicine Australia’s Submission to The Royal Commission into Victoria’s Mental Health System 5th July 2019 “...My hope is that we will engage in mature, evidence-based discussions about how best to fund and deploy psychedelic-assisted psychotherapies to augment existing approaches to the treatment of mental illness. I hope that governments will have the courage to put the welfare of their citizens ahead of their fear of controversy ‒ and that our politicians will deploy their considerable skills and positions of influence to nurture a balanced and objective understanding amongst the public.” ‒ Dr Simon Longstaff AO, Leading Australian Ethicist and Executive Director of The Ethics Centre Royal Commission into Victoria’s Mental Health System | Mind Medicine Australia SUB.0002.0029.0347_0002 Level 1, 10 Dorcas St Southbank, VIC 3006 Australia 5th July 2019 The Commissioners The Royal Commission into Victoria’s Mental Health System Dear Commissioners We live in one of the wealthiest countries and we have one of the best medical systems in the world. Yet despite the high calibre of our medical practitioners and institutions, and the enormous associated system costs, we also have one of the highest rates of mental illness in the world, and the situation appears to be getting worse. Simply doing more of the same, or making only incremental changes to the current system, is not going to solve this problem and relieve the suffering of so many Victorians. To create positive change, we have to broaden the tools available to our medical practitioners and qualified therapists in this area.
    [Show full text]
  • Psychoactive Drugs of Misuse: Rationalising the Irrational
    Comment Psychoactive drugs of misuse: rationalising the irrational Ideally, policy responses to psychoactive drugs of misuse (1920–32) make it unlikely that any industrialised society would take into account the variations in harm that each will criminalise alcohol use. But that still leaves plenty of kind causes to users and the community. In today’s Lancet, room for more effective use of taxation and regulatory David Nutt and colleagues1 show that the UK classification controls to reduce alcohol-related harm. of psychoactive drugs into three categories of harm (A, Populism favours tough policies towards illicit drugs such B, and C) is only modestly correlated with expert ratings as cannabis. Psychoactive drugs (other than alcohol and of the harms caused. They also point out the obvious: the tobacco) remain the last holdout of the most restrictive classification excludes the psychoactive drugs whose use form of regulation—criminal prohibition—despite the causes the greatest harm—ie, alcohol and tobacco.2 enthusiastic embrace of market deregulation almost Science Photo Library Nutt and colleagues asked UK experts in psychiatry, everywhere else. This situation could change if the USA See Health Policy page 1047 pharmacology, and addiction to rate drugs on three major embraced a free market regime for all psychoactive drugs. dimensions of harm: physical health effects, potential But as attractive as this approach may be to libertarians, for dependence, and social harms. The experts showed it would not be good public-health policy. Allowing a free reasonable levels of agreement in their rankings. By market for all currently illicit drugs would add substantially contrast, their ratings were not well correlated with the UK to the harms now caused by alcohol and tobacco.
    [Show full text]
  • The Rise and Decline of Cannabis Prohibition the History of Cannabis in the UN Drug Control System and Options for Reform
    TRANSNATIONAL I N S T I T U T E THE RISE AND DECLINE OF CANNABIS PROHIBITION THE HISTORY OF CANNABIS IN THE UN DruG CONTROL SYSTEM AND OPTIONS FOR REFORM 3 The Rise and Decline of Cannabis Prohibition Authors Dave Bewley-Taylor Tom Blickman Martin Jelsma Copy editor David Aronson Design Guido Jelsma www.guidojelsma.nl Photo credits Hash Marihuana & Hemp Museum, Amsterdam/ Barcelona Floris Leeuwenberg Pien Metaal UNOG Library/League of Nations Archives UN Photo Printing Jubels, Amsterdam Contact Transnational Institute (TNI) De Wittenstraat 25 1052 AK Amsterdam Netherlands Tel: +31-(0)20-6626608 Fax: +31-(0)20-6757176 [email protected] www.tni.org/drugs www.undrugcontrol.info www.druglawreform.info Global Drug Policy Observatory (GDPO) Research Institute for Arts and Humanities Rooms 201-202 James Callaghan Building Swansea University Financial contributions Singleton Park, Swansea SA2 8PP Tel: +44-(0)1792-604293 This report has been produced with the financial www.swansea.ac.uk/gdpo assistance of the Hash Marihuana & Hemp Museum, twitter: @gdpo_swan Amsterdam/Barcelona, the Open Society Foundations and the Drug Prevention and Information Programme This is an Open Access publication distributed under (DPIP) of the European Union. the terms of the Creative Commons Attribution License The contents of this publication are the sole responsibility (http://creativecommons.org/licenses/by/2.0), which of TNI and GDPO and can under no circumstances be permits unrestricted use, distribution, and reproduction regarded as reflecting the position of the donors. in any medium, provided the original work is properly cited. TNI would appreciate receiving a copy of the text in which this document is used or cited.
    [Show full text]
  • Charlie Hughes (A Minor) by His Mother and Litigation Friend Alison Hughes
    IN THE HIGH COURT OF JUSTICE CLAIM NO: CO/620/2020 ADMINISTRATIVE COURT BETWEEN: THE QUEEN (on the application of) Charlie Hughes (a minor) by his mother and litigation friend Alison Hughes Claimant - and - (1) CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST (2) THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Defendants - and - (1) SECRETARY OF STATE FOR HEALTH AND SOCIAL CARE (2) NHS ENGLAND Interested Parties WITNESS STATEMENT OF PROFESSOR DAVID NUTT I, Professor David Nutt of Drug Science UK will say as follows: 1. I am a psychiatrist and professor at Imperial College London. I have prior training in neurology at Guys and St Mary’s hospitals. My doctorate from Oxford University was on the neuropsychopharmacology of seizures. Since then I have worked for almost all my professional life on the effects, both beneficial and harmful, of drugs on the brain and have extensive clinical and research experience in this field. I am a Fellow of the Royal Colleges of Physicians, of Psychiatrists and of the Academy of Medical Sciences of the UK. I was a member of the Adviory Council on the Misuse of Drugs for 10 years and chair of the Council for one. My expertise has been recognised with a number of prestigious appointments including Presidencies of the European Brain Council, the European College of Neuropsychopharmacology, the British Association of Psychopharmacology and the British Neuroscience Association. I have also served on the MRC Neuroscience board. 2. I have conducted scientific research on the brain actions in humans of a wide range of legal and illegal drugs including alcohol, tobacco, heroin, amfetamines, cocaine, GHB, buprenorphine, antidepressants, benzodiazepines, antipsychotics, methadone, LSD, psilocybin, DMT, cannabis, cannabidiol, ketamine, paracetamol, ibuprofen and caffeine.
    [Show full text]