I'm Professor David Nutt, sacked for telling the truth about drugs and founder of DrugScience, AMA!

First of all I'd like to say thank you for your work in creating a fair and objective analysis of the harms of illegal and legal drugs. The way you stood up to the government and supported the rights of the ACMD as an independent scientific body was truly commendable.

I have 2 questions for you: 1) Which party should I trust when it comes to drug policy?

2) What do you personally think is the biggest obstacle to drug policy reform? How do you think this obstacle can be overcome?

Keep up the good work!

Thanks for your support. Presume you mean UK? Lib Dems and Greens are only parties that have taken any interest in addressing drug harms. Julian Huppert has done everything possible to stop the pointless khat ban going thru. The debate is worth watching http://www.parliamentlive.tv/main/Player.aspx?meetingId=15241

Biggest obstacle to reform - prejudice, ignorance and irrational fear fuelled by parts of media.

Any thoughts on how to counteract the negative effects of the media?

Thanks for your answer!

Our approach is just to keep banging on about the evidence. The more people counter misinformation thru comments on article etc, the better

Your post seems to have been removed - better contact the subreddit mods.

can you explain? Not familiar with the site

Have to head off - I've found this very enjoyable. It's encouraging that there are people out there that understand the issues and are engaging in the debate. I may pop back some time if you'll have me.

We very much need your support to carry on our work so please donate http://www.drugscience.org.uk/donate/donate/

Thanks all, D

Dr Nutt,

I cannot begin to thank you enough for your efforts to drag UK drug policy, kicking and screaming, into the 21st century. I expect that someday your work will keep harmless people like me out of jail and, much more importantly, will get help to people who are currently being denied it due to legislation that has no scientific basis whatsoever. The thought of, for example, veterans with PTSD suffering needlessly while politicians 'umm' and 'err' makes me sick to my stomach.

As for my question, many users of psychedelic drugs report feeling markedly different for a long time after just one experience. Do you think there is any legitimacy to the notion that psychedelics can change or awaken you or squeeze a lot of emotional development into a few hours? Or would you say such people have opened their minds so far that their brains have fallen out?

Thank you again. If you ever feel like having your ego stroked, please swing by /r/Drugs where you'll find you're something of a folk hero :)

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Edit: Hijacking my own comment to link this excellent talk by Professor Nutt and remind you to donate to DrugScience to assist their important research.

Thanks for your kind comments. I wholeheartedly agree about PTSD, and the tragic events in Fort Hood hint at more selfish reasons to treat PTSD effectively, though of course when people with PTSD kill, the victim is almost always themselves. (I don't want to give the idea that we should fear traumatised people). There is no question that psychedelics can sometimes change people, or rather allow for them to undergo change, usually in ways they perceive as beneficial, this has been established in research;- the Johns Hopkins psilocybin work has shown this, http://jop.sagepub.com/content/25/11/1453.short. LSD studies have shown that it can allow people to make the radical change of escaping alcoholism. It is important to understand that psychedelics do not change people in the way that stimulants change blood-pressure; the person's intentions, setting etc have an effect. e.g. in the Johns Hopkins study, the change in personality was not determined by the dose, but by whether they had a profound mystical experience. Maybe I will drop by /r/Drugs!

Would you like to speak at an even organised by Students for Sensible Drug Policy Ireland?

We are holding out first national conference this month and will be looking to book speakers to give talks in colleges in Ireland in the next year.

We would be delighted to host you.

Thanks for the offer, will depend on my diary. Best to speak to my team

Hi David, thanks for doing this.

What I want to know is, do the political elite truly believe in the policies they are upholding, especially relating to cannabis? Do they really think it should be illegal? I mean, most of these people are reasonably well educated individuals, and it doesn't take much to realise that many of our drug laws simply do not make rational and logical sense when viewed in light of the scientific evidence. Is it that it's simply political suicide to voice an opinion that doesn't conform with the prohibitionist consensus?

Cheers, and keep up all the good work

We all often wonder this! I think it is difficult to generalise. But many politicians have changed their position dramatically when they gain and lose office, suggesting they are to some degree denying what they really believe. Cameron used to have a very rational view when he was a backbencher on the Home Affairs Committee. Public opinion is shifting, so it is gradually becoming more damaging for politicians to pursue policies clearly in contravention of the facts, and less risky to do what makes sense. For example, the next generation of voters are less likely to support the criminalisation of cannabis users. Thanks for the support!

Here's a David Cameron you may not recognise. http://www.independent.co.uk/news/uk/politics/tory-contender-calls-for-more-liberal-drug-laws-6143525.html

Hi Professor Nutt, before I get to my question I'd just like to commend you for standing your ground in the wake of a swathe of political and journalistic pressures and dragoons. I'm sure that many others alongside myself have found the attitude that you have towards harm reduction and treating people very inspiring, so thanks always for your contributions and representations.

My question is in regards to depersonalisation disorder, from which I've suffered for about 8 years now. I've personally and carefully been self-medicating using MDMA to consistent, albiet temporary, success for about two years now. So far, it is the only method of many I've employed that has shown any success at all. I was wondering if cases of depersonalization or derealization disorder remission had come up during your research or if there were considerations to study the effect of MDMA on sufferers? I'd slide into an fMRI under the influence in a heartbeat if it could shed some light on how DPD remission functions.

These are difficult symptoms to treat, with no established therapies. I agree it would be worth pursuing more research in this field with drugs such as MDMA, but this is very difficult to do whilst they are illegal. I'm glad that you are having success with MDMA, but would caution others that in general self-medication comes with significant risks.

Our MDMA info: http://www.drugscience.org.uk/drugs-info/mdma/

Also, advice re PMA: http://www.drugscience.org.uk/drugs-info/pma-warning-ecstasy-users/

If we re ran your Lancet drug harm rankings analysis again, but this time imagining all drugs under a theoretical legally regulated model (something like Transform's 2009 'Blueprint for regulation' perhaps) wouldn't the results be very different, and doesn't this have huge implications for future policy? This point is perhaps most obvious with something like heroin where we have hugely different harms associated with the same drug when used illegally (associated with crime, unhygenic needle sharing, HIV, HepC, infection, overdose, etc) or in the context of a supervised Swiss-style heroin clinic (where such risks are reduced to zero).

Good Q - yes results undoubtedly would change. Re heroin related morbidity and mortality would decrease eg from AIDS however if use went up a lot, harms from accidental overdose and addiction would rise. A properly regulated market would inevitably see net harms decrease. You can try your own modeling using the Lancet paper.

Thank you for your excellent work, Prof. Nutt. As a neuroscience student and advocate of drug law reform, I'm constantly impressed by your efforts to inject some perspective and rationality into a debate that is too often governed by polarised views and faulty evidence.

My question is on a slight tangent from recreational drugs - what're your opinions on pharmaceutical cognitive enhancement, i.e. "smart drugs" such as modafinil (provigil) and methylphenidate (ritalin)? Do you think that people should have easier legal access to them than they do currently? Do you think a relaxation in the regulatory authorities' proscription of cognitive enhancers and similar "lifestyle" drugs might result in development of safer and more efficacious non-medical pharmaceuticals?

I can see some circumstances where these drugs can be very useful, such as doctors performing surgery in the middle of the night. Their ability to boost learning in students is less clear, and there may be downsides, for instance, they may increase attention, but reduce creativity. I certainly cannot recommend them. However, the key issue is not whether the use of these drugs will be harmful (unless they get arrested!), but what the societal response to this should be. Drugscience has published in this area. http://www.ncbi.nlm.nih.gov/pubmed/22732441

What is your own experience of recreational drug use?

Almost all of my drug use is caffeine and alcohol! I've also been administered a broad range of psychoactive drugs in the context of medical research. Today's news about Nigella (http://www.theguardian.com/lifeandstyle/2014/apr/03/nigella-lawson-stopped-boarding-flight-us-cocaine-confession) is a reminder that there are real policy-related harms to taking drugs when they are illegal, and to admitting to it! I only use drugs in jurisdictions where it is allowed, and am flying out to Denver soon! haha.

Do you ever think Britain will see the same legalisation of cannabis that is happening some US states?

I'm hopeful that UK will adopt a more rational drug policy with focus on in not too distant future. Harm reduction is not best served through free market availability - Uruguay may be a better model.

I'm a pharmacology student in Bristol and your name keeps on cropping up in lectures. I'd say that we are taught to support your viewpoint on drugs, which I personally support. However when the debates start, it's clear that many people still see drugs with as a completely dangerous area and will automatically write off any argument you pitch with a simple 'drugs are bad'. How do you propose we safely educate people about the dangers of drugs and do you think that it's possible that we will ever have a country where people have realistic views on individual drug dangers?

Also I read a paper a few days ago that involved the testing of LSD for therapeutic effects for the first time in years. I think it was as Swiss paper and is due to be published at some point this year. How close is the UK in joining in research using recreational drugs or are there any studies going on at the moment? If not, how and when can this happen?

Schools have a part to play, but everyone can champion the evidence and challenge unreasonable beliefs. But opinions are shifting in the right direction. A similar process was seen with sex education;- it used to be very common for moralising to get in the way of actually informing people, but over time people saw that inadequate education based on a 'just say no' attitude increased rather than reducing harm. In sex education, it is now mainstream to take a 'harm reduction' approach, e.g. that it is better that young people know about and can access contraception, even if underage sex is not endorsed by teachers. We're hopefully gradually moving towards a similar situation with drugs, where phobias about talking frankly will melt away.

The LSD study is exciting, although the conclusions we can make are limited by its small size. So we need more research! Actually there is loads of great drugs research going on in general, especially in the UK. the problem is more specifically in researching Schedule 1 drugs (like LSD and cannabis), it's easier ironically to research heroin because it has a medical use. Several Drugscience scientists, including myself are actively conducting research into drug use, drug related harm, how drugs work, and what untapped medical potential they have. For example look into the work of Val Curran, John Ramsey, Fiona Measham and the rest http://www.drugscience.org.uk/about/committee-members/

For the research to be freed up, the laws on Schedule 1 drugs need changing. http://www.theguardian.com/science/2013/nov/04/drugs-legislation-david-nutt-john-maddox

Hi David, I was wondering what your views are on the Warehouse Project implementing a Home Office supported pill testing facility

A step in the right direction or walking the wrong path?

Anything that increases evidence to reduce harms is a good thing so yes. Fiona Measham who is involved with that is a DrugScience Member

Important to note drug testing isn't a panacea - home testing is not reliable especially at showing mixtures/adulterations. More info also doesn't eliminate risky behaviour completely - people still horseride!

Good morning Professor,

I've followed your career in the public eye for the last few years and as with most young "open minded" people my age I was wowed by our politicians utter lack of common sense and general ignorance, especially in regards to their lack of willing to improve outdated policies (not just regarding drugs for personal use).

That aside, what is your opinion on the 'Darknetmarkets' that have sprung up in the last few years?

Also, what would your advice be for someone experimenting with drugs as an 'intermediate' e.g they use legitimate test kits to know what they're taking and take standard precautionary measures beforehand.

The 'dark net' sites such as Silk Road are an inevitable reaction to the current situation. It's impossible to say if they are 'good' or 'bad' in general; they have the advantage of delivering decent quality (allegedly, based on a couple of analyses of samples, and anecdotal research http://www.sciencedirect.com/science/article/pii/S0955395913000066) However, the user discussed in the academic paper linked above described being a "child in a sweetshop", and for some people, this easy access will lead to problems controlling level of use. Drugscience is now accepting Bitcoin donations! Any Silk Road users who want to maximise the availability of info that will reduce the chance of Silk Road customers coming to harm might wish to donate!

As for advice to users;- Actually I'd caution against reliance on home testing kits. The theory is tempting, they sound empowering, but actually they can give a false sense of security, potentially increasing harm. See this video featuring Drugscience Committee Member John Ramsey. https://www.youtube.com/watch?v=0MbNJYoHDz8

Further guidance is on our website, and advice particularly aimed at more experimental 'psychonaut' users is coming soon.

http://www.drugscience.org.uk/donate/donate/ Here's the link for Bitcoin donations.

Do you feel that drugs policy in the British government is being driven by the leader writers in newspapers like the Daily Mail?

Yes, often, but that doesn't necessarily represent the views of the public. For example, there isn't public support for actually enacting the harsh sentences that go with Class B status of cannabis. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/119174/acmd-cannabis-report-2008.pdf

Progress is currently in the right direction.

1. How would you respond to people that point out the problems with people abusing mephedrone as a argument against drug legalisation or decriminalisation. I know the issue was massively overblown in the paper, however I certainly knew lots of people who abused it quite heavily and I know it wasn't something that happened just where I lived. As the abuse basically died when it was made illegal. Following on from this do you think it's hurt any chances of decriminalisation in the country?

2. Several sources on the Internet will either argue that you need to wait 1 month or 3 months between using MDMA, and I've never really seen any convincing scientific information one way or the other. What would you recommend, and again, do you see this posing a problem if the drug was to ever be legalised (I can see quite a few people not wanting to wait very long)

1. Problem mephedrone use certainly hasn't gone away - injection has increased massively. It's also remained a popular drug for recreational use unlike any other NPS/legal high. Deaths are at around 4 per year now. Undoubtedly mephedrone has harms (we have info http://drugscience.org.uk/drugs-info/mephedrone/) but there was evidence of a correlating reduction in cocaine deaths. I don't think it's had a particular effect re decrim. Wedinos who test drugs in Wales have found that samples of mephedrone are v adulterated eg with crystal meth so are have fallen prey to usual criminal market harms.

2. A break between using MDMA would make it more likely to feel the effects fully. In our clinical trial it was given two weeks apart for that reason. Remarkably MDMA and similar drugs do not generally cause the same moreish/compulsive behaviour as with stimulants prob cos serotonin system is anti-addictive. Our info http://drugscience.org.uk/drugs-info/mdma/

What do you see as being the best way to help the public see past the stereotype and be able to have an objective view on drugs and be able to understand the damage the current drugs police is having?

Ha, they should read my book! and follow the Drugscience newsletter http://drugscience.org.uk/newsletter/

But really, a key part of the answer is for people like you to stimulate the public debate, challenge misinformation (e.g. by commenting on articles, and demanding sources, corrections and retractions when nonsense is published.)

Hey David,

Thanks so much for doing this AMA, I've just finished your book and I'm just amazed how ignornant I was when I was younger! I'm obsessed with researching drugs and drug policies now!

My questions are

ԭ Which countries have the best drug policies besides Portugal?

ԭ What drug will be the focus of the next channel four episode?

ԭ In "Drug harms in the UK: A Multicriteria decision Analysis" you compared the harms to users, but is that the total harm to all the users or to the individual user?

ԭ Whats the most common misconception people have about drugs?

Can you die from heroin withdrawal?

Thanks for your support and for reading my book! All the profits are being donated to Drugscience, so it supports our mission both financially and directly by spreading info. http://www.waterstones.com/waterstonesweb/products/david+nutt/drugs+-+without+the+hot+air/8823593/

1) There's not too many countries who are well down the road to implementing rational drug policy! Uruguay has been extremely thoughtful with their new cannabis policy, and I'd say they have a better chance at getting close to minimum harm compared to Colorado and Washington, where we're concerned by the appealingly marketed cannabis candies for example.

2) The next Channel 4 programme will be about cannabis!

3)It is harm to a typical user, not total harm. This makes it possible to compare very prevalent drugs to less prevalent ones. The Social harm bit is a total though, so that is related to prevalence. So alcohol for example is the most socially damaging drug, partly due to its high prevalence, but it is the 4th most harmful to the user, irrespective of prevalence.

4) It's hard to pick one most common misconception! One would be that illegality is a reflection of harm, that illegal drugs are automatically 'worse'. Another massive one is that any generalisations can be made about 'drugs', that there could be a single successful approach to 'drugs' in general. The book hopefully shows just how different drugs are from each other in effects and risks.

5) As KnMn says below, no, heroin withdrawal can be horrible, but it is not fatal on its own. Relapse afterwards is often fatal though, as tolerance drops rapidly. The other drug not mentioned by KnMn which can kill from withdrawals alone is GBL/GHB. Benzo withdrawal deaths are extremely unusual.

Can you die from heroin withdrawal?

I'm not the professor but afaik it's not likely unless you have a weak heart or something. The main recreational drugs that can kill you from withdrawal alone are alcohol, benzos and barbituates. Bonus fact: pure heroin is relatively non-toxic.

Depends on definition of 'toxicity'! Stopping people breathing could be given as a toxic effect. Thanks for your helpful answer.

I would like to thank you for your contribution toward objective scientific study free of political and economic bias.

What is your take on the relationship between cannabis use (be it smoked, vapourised, or eaten) and risk of cancer development? There are oft quoted "facts" about cannabis having four times the carcinogens of tobacco, but I am yet to see reliable evidence of this being relevant to observable data regarding cancer development.

Cheers! Cannabis has several interesting associations with cancer, there is not a simple story, and you're right to be suspicious of those 'facts' you mention. smoking tobacco is, as you know, hugely carcinogenic, and the habit of putting tobacco in cannabis joints is an indirect way that cannabis users get initiated into nicotine addiction. There are indications that smoking cannabis with tobacco gives a greater risk of cancer than tobacco alone. However, the evidence is inconclusive as to whether there is any increased risk from cannabis alone. You'd think there would be, since smoke contains chemicals that are carcinogenic, but the best studies don't find a link, although to be clear, smoking cannabis heavily isn't good for the lungs. Read more here;- http://drugscience.org.uk/blog/2012/06/11/smoke-without-fire-scaremongering-by-the-british-lung-foundation-over-cannabis-vs-tobacco/

The reason that cannabis smoking doesn't seem to cause cancer may be that some cannabinoids might have some anti-cancer effects. The internet is full of hype about this, and unfortunately the excitement has run way ahead of the facts, to a degree that people are at risk of dying from rejecting evidence-based chemo in favour of eating high doses of cannabis oil. Cannabis is not a "cure for cancer", although it, or some extracts from it, might in the future have some chemotherapeutic role in some types of cancer. There is research into this. http://www.gwpharm.com/GW%20Pharmaceuticals%20Commences%20Phase%201b2a%20Clinical%20Trial%20%20for%20the%20Treatment%20of%20Glioblastoma%20Multiforme%20GBM.aspx

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1st;- Politicians and the media so often do not tell the truth, through prejudice or ignorance. As the current khat ban demonstrates, the truth doesn't automatically 'win out' when knowledgeable politicians like Dr Julian Huppert speak out. Here's a little article where I explained some if the misguided logic behind the khat ban. http://www.theguardian.com/commentisfree/2013/jul/03/ban-qat-theresa-may-ban-cats

1. Surprisingly lots of people seem to want to volunteer their time and brains to this research! We're not looking for volunteers for this at present.

2. We have thought about crowdfunding for projects that Drugscience have in the pipeline, e.g. school drugs education, but the alcohol substitute is not ideal for crowdfunding as the process of getting it done will not be as quick as most crowdfunded projects.

2 yrs ago you publish together with Dr. J Chick an interesting article: "Substitution therapy for alcoholism: time for a reappraisal? After that, are you sure that your new "benzo-drink" is a real solution for alcoholism? Why Drs don't start to use the tools available today? Why not Baclofen or Topiramate or Ondasentron? 7000 deaths a day worldwide for alcohol related problems. You, Drs, have to make something! Urgently.

My alcohol substitute is designed to reduce the numbers of people who will develop problems of alcoholism, not to treat it! Treatment is a separate issues, and I continue to endorse rational approaches to treating alcoholism. I'm glad you've read that article, I wish more practitioners did and started taking up these models of treatment! Here's a more recent article on a similar theme http://jop.sagepub.com/content/28/1/3.full.pdf+html?ijkey=ovy5Z2c4m0d96&keytype=ref&siteid=spjop

What is your opinion on regulating drugs and specifically NPS in order to maintain some kind of standard for people using them? The government blanket banning is simply making the chemists more creative but putting users in danger for example the APB's had been fairly well tried and tested and people knew the risks associated with them could we take out of New Zealand's book and regulate certain chemicals?

I agree with you, the current response to NPS is failing. Options like the New Zealand model need to be considered, because people need to be able to look at the packet and know what they are taking, and roughly the risks they are accepting. It is yet to be seen if the New Zealand model will adequately deal with the problem though. One important point though;- The current harm caused by NPS is pretty small in comparison with established legal and illegal drugs, and we should remember these are the areas where the biggest benefits from a new approach will be felt in the short term.

Mr Nutt, looking back do you think the mephedrone ban in the UK was justified?

At the time I recall you said that there was not enough scientific evidence to support a ban but what about the wealth of anecdotal evidence? As someone that used mephedrone from Jan 2010 until the ban in April 2010 I was VERY relieved when it was banned because my social circle and I were in no doubt that it was dangerous and destructive.

I have yet to see evidence that banning it has had a net benefit, although in your individual case, I'm glad that the ban was able to help you stop your use. That is not the case for everybody. Mephedrone users now are using a product which is as adulterated and unreliable as other illegal drugs. It's popular in Wales, where samples have turned out to be methamphetamine. http://www.wedinos.org/db/samples

The way mephedrone was available up to the ban, in a completely unregulated way was not what I would advocate as sensible. There are options between the two extremes of unregulated supply, which caused problems for you and your friends, and prohibition, which is now causing problems for other people. Whilst mephedrone may have stopped being available at a click of a mouse, these bans provoke the proliferation of new alternatives, so an apparent drop in harm is not evidence that the ban reduced total net harm. Other people may have returned to cocaine and other more harmful drugs.

The other issue is the process of how bans are enacted in response to political and press pressure, rather than evidence.