Drugs Without the Hot Air: the most sensible book about drugs you'll read this year

Cambridge's UIT Press has established a well-deserved reputation for publishing clear, engaging, evidence-based books on controversial subjects. Titles like Sustainable Energy Without the Hot Air and Sustainable Materials - with Both Eyes Open remain two of the best books I've read on the relationship between environmental responsibility, climate, material wealth, science and engineering -- books that profoundly changed the way I understood these subjects.

The latest in this series is Drugs: Without the Hot Air (UK), by David Nutt. If Nutt's name rings a bell, it's because he was fired from his job as UK drugs czar because he refused to support the government's science-free position on the dangers of marijuana, and because he wouldn't repudiate a paper he wrote that compared the harms of taking Ecstasy to the harms of horseback riding (or "equasy").

Like the other writers in the series, Nutt is both committed to rigorous, evidence-based policy and to clear, no-nonsense prose that makes complex subjects comprehensible. He begins and ends the book with a look at the irrationality of our present drug policy, recounting a call he had with then-Home Secretary Jacqui Smith, who was furious that he'd compared horseback riding harms to the harms from taking MDMA. Smith says that "you can't compare harms from a legal activity with an illegal activity." When Nutt asks why not, she says, "because one is illegal." When he asks why it is illegal, she says, "Because it is harmful." So he asks, "Don't we need to compare harms to determine if it should be illegal?" And Smith reiterates, "you can't compare harms from a legal activity with an illegal activity." Lather, rinse, repeat, and you'll get our current drugs-policy disaster.

Nutt has been talking about harm reduction and evidence-based policy for drugs policy for years, and he often frames the question by pointing out that alcohol is a terrible killer of addicts and the people around them, and a disaster for society. But if he was to synthesize a drug that produced an identical high to alcohol, without producing any of the harms, it would almost certainly be banned and those involved in producing, selling and taking it would be criminalised. We ban drugs because they are harmful and we know they are harmful because they are banned. Drugs that we don't ban -- tobacco, alcohol -- are "harmful" too, but not in the same way as the drugs that are banned, and we can tell that they are different because they haven't been banned.

Nutt has choice words for the alcohol and tobacco industries, who often frame their activity as being supported by responsible choice, and claim that they only want to promote that sort of responsibility. But as Nutt points out, if Britain's drinkers hewed to the recommended drinking levels, total industry revenue would fall by 40% -- and the industry has shown no willingness to regulate super-cheap, high-alcohol booze, nor alcopops aimed at (and advertised to) children and teenagers.

Nutt compares the alcohol industry's self-regulated responsible drinking campaigns to a campaign that exposed students in East Sussex to factual information about the industry's corruption of public health messages, its ferocious lobbying efforts, and the cost of drinking to wider society. It turns out that exposing alcohol industry sleaze is vastly more effective at discouraging student drinking than anything sponsored by the industry itself.

From his discussion of legal drugs, Nutt moves on to factual accounts of the impact of illegal/controlled drugs, from "legal highs" like "meow meow" to opioids to cocaine to prescription painkillers and steroids to psychedelics. Each chapter is a bracing, brisk, no-nonsense inventory of what harms and benefits arise from each substance, the history of their regulation, and the ways in which changes to the means of taking the drugs changes the outcome. Laid out like this, it's easy to see that prohibition isn't ever the right answer -- not for science, not for society, not for justice, and not for health.

There's also a sense of the awful, tragic loss to society arising from the criminalization of promising drugs. A chapter called "Should Scientists Take LSD?" surveys the literature preceding the evidence-free banning of LSD, and the astounding therapeutic benefits hinted at in the literature.

The book closes with the War on Drugs, and the worlds' governments own frank assessments of the unmitigated disaster created by Richard Nixon's idiotic decision 40 years ago. Nutt analyzes the fact that policymakers know that the War on Drugs is worse than the drugs themselves (by a long shot), but are politically incapable of doing anything about it, not least because politicians on all sides stand poised to condemn their opponents for being "soft on drugs."

After this, there is a frank chapter on talking with your children about drugs. Nutt is a parent and has some regrets about how he approached the subject with his own children (one of his sons was stalked by a British tabloid journalist, who tricked him into friending him on Facebook, which gave the journalist the opportunity to gank photos of the young man smoking marijuana). As a parent, this stuff really resonated with me -- sensible advice that focuses on establishing and maintaining trust.

Drugs: Without the Hot Air



          1. what incentive do publishers have if they get no return? e-book should be easier and have larger margin than all the effort&cost of printing and distribution of a physical object made of materials… but no, amazon suck them dry. Delaying e-book at least give them an opportunity to get a bit of return

        1. Maybe it’s just me, but my head had turned straight to “what tool would I need to turn a piece of 2 x 2 into a wooden screw?”

        2. I don’t see that as reason to delay e-book. I want to read it on my Kindle but I don’t care where I get it from. O’Reilly are a fantastic example of doing perfectly well selling their own e-books themselves with free updates and no staggered release in formats.

          I know if selling through Amazon they take a large cut, although I know some of the cost of e-books is going to be tax (at least in my region) which doesn’t apply to printed books.

          1. This. Just release a PDF. They’re standard, look pretty much like the printed version, don’t have OCR or formatting errors, don’t rely on crappy Amazon software, and a 500 page book with diagrams can be reduced to about 10 MB (5 MB without diagrams) — and device memory is getting larger and larger every year.

          2. @darkmobius:disqus Yeah, but why does it take so long? I’m converting my physical library to PDFs. I slice off the spine, feed the pages through something like a Fujitsu ScanSnap, run the result through Adobe using ClearScan, and I get a nice compact PDF that looks great. It takes about an hour — maybe 15 minutes of scanning, and then 45 minutes of Adobe crunching away.

            There is no reason to delay for technical reasons. This is purely a contractual and financial thing — the sort of things that pirates route around.

    1. David MacKay’s book Sustainable  Energy without the hot air is available as a mobi file.  I sent a mobi version to David MacKay converted from epub to mobi using Kovid Goyal’s brilliant Calibre; it should be usable on a Kindle.  You can get it from http://www.withouthotair.com/Electronic.html.  The others might be tougher, as far as I know sustainable materials is only available as pdf; but remember, Calibre can convert that too. I read the mobi version of Sustainable Energy on my Nokia N73 using MobiPocket from http://www.mobipocket.com/en/DownloadSoft/default.asp?Language=EN

    2. Only reason e-books will take a while is that we’ve just completed the agreements with distributors.  (We didn’t  delay ebook publication deliberately to boost paper sales or anything like that — it’s hard enough trying to get the content to be as good as it can be, without having to be devious as well :-)  Anyway, there are free PDFs of “Sustainable Energy” and “Sustainable Materials” on their respective websites.

  1. I’m a big fan of Nutt — we need more scientists like him and we need to inform public policy and debate better with the aid of those scientists. 

    About the only “Huh?” moment I get from him is his call for mandatory alcohol locks on all cars. I mean, I understand his arguments, but philosophically speaking that just seems way too controlling and intrusive. Part of what we’ve learned from the so-called War on Drugs is that sometimes you have to step back from control — even if it is appealing on some levels — and deal with things from a different perspective.

    1. It’s funny how excited I get whenever Nutt pops up and says/writes something publicly.  It’s a really overwhelming experience to see someone discussing this topic in a manner that’s actually intellectually honest and coherent. 

      I can even get with that idea on restricting driving.  I see it as simply disallowing people from doing something (using their vehicle on public roads while intoxicated) which they can’t reasonably expect to have a right to do.

  2. I remember the Schaefer Report as though it were just presented yesterday. I disagree with Nutt on Nixon’s decision, however. I think insane is a more fitting descriptive term for Nixon’s policy than is idiotic.

    Legalize, regulate, tax. End the prohibition.

      1.  The last time I recall hearing about tainted pot was when the US had mexico spraying paraquat for them.

  3. I haven’t read the book, but I went to David Nutt’s talk at the Cheltenham science festival last week, where he covered a lot of the same topics and mentioned the Jacqui Smith equasty anecdote. If the book is anything like the talk, it would be a good read.

    One thing he mentioned was that Gordon Brown may have pushed through the reclassification of cannabis because of a deal with a newspaper for an election; Brown told the Leveson Inquiry a week ago that he had not been influenced by the papers in that decision, and said it was a personal position which he forced upon the rest of the cabinet. Either way, it’s depressing that those in power can and regularly do ignore scientific evidence and the public don’t seem to care.

    It may be of interest that when asked what the public could do to support the message of his talk, Nutt said to vote Lib Dem because they have an enlightened drugs policy, and to support the Independent Scientific Committee on Drugs, which he chairs.

    1. LibDems have “enlightened policies” on many subjects… up to the point when they actually get in power. Then they tend to revert to the mean.

        1. Free what ? The UK is still a monarchy, fyi. 

          (oh I see, you’re accusing me of being a conservative troll, which is really funny — the most right-wing party I’ve ever voted for is a member of the Party of European Socialists.)

          The truth is that the LibDem are a party of opportunists who are too right-wing for Labour or too left-wing for the rabid Tories, but are  internally split on basically every single policy. If all our hopes for a sane drug policy in Britain rely on LibDems coming through with their promises, we’re well and truly fucked.

  4. then-Home Secretary Jacqui Smith, who was furious that he’d compared horseback riding harms to the harms from taking MDMA. Smith says that “you can’t compare harms from a legal activity with an illegal activity.” When Nutt asks why not, she says, “because one is illegal.” When he asks why it is illegal, she says, “Because it is harmful.” So he asks, “Don’t we need to compare harms to determine if it should be illegal?” And Smith reiterates, “you can’t compare harms from a legal activity with an illegal activity.” Lather, rinse, repeat

    When people exhibit circular reasoning like this, I give up at that point.  It’s hard-wired into their brains from birth to form thoughts this way, I believe.  My only plan is to remove them from power for everyone’s good because you really cannot reason with many of these people.  Their brains are dense, brick walls.

    1. I can’t accept that she actually believed that line of “reasoning”.  She did read PPE at Oxford after all.  So I assume she simply had to talk that way because that’s what was required of her position.  Whether being a liar is worse than being obstinately stupid is a matter for another debate…

      1. It is possible that when she said, “You can’t compare…” she did not mean “in a clinical sense,” but, “You cannot honestly expect government to go out and publicly compare…”

        On the other hand, a lot of people went to Oxford whose judgment I would not trust.

        1.  Yes, fair enough :)  But I think being able to sensibly discuss this sort of drugs policy question is exactly the sort of thing you might expect even in an interview for the PPE course.  But it seems our PPE graduate overlords take their skills and turn to the dark side.

          The job description for Home Secretary likely includes a section on drugs policy that says “Our voters are scared of drugs.  You must not yield on one single point that suggests illegal drugs are anything other than bad.  Pretending to show compassion by mentioning ‘counselling for users’ is acceptable”.

          1. Well, the job of a politician is to win elections. Everything else, including (and especially) running the country, is a means to that end.

            That’s actually not bad; it’s like saying that the job of an employee is to keep collecting their salary, and everything they do is a means to that end.

            But until “having a sane drug policy” is viewed as an election winner, the question is going to remain: “Drugs: Meance or Threat?”

          2. Sensibly discuss drug policy? That would be a luxury. In the US, it is literally a violation of the oath of office for certain positions in the US government to discuss legalization or conduct studies related to legalization, and these same positions are legally obligated, for the duration of their term of office and possibly afterward, to oppose all attempts to legalize drugs or any individual drug even for medical use.


            Section 704, paragraph 12: discussing the responsibilities of the “drug czar”.

            There’s nothing sensible about the war on drugs or its supporters.

    2. That is the point in a conversation where you begin ruthlessly insulting the person’s level of intelligence to their face.

        1. I accepted long ago that I don’t have the patience or composure to become a politician.

          e.g. I keyed a cop car at lunch because I got a ticket this morning.

          1. I accepted long ago that I don’t have the patience or composure to become a politician.

            Finding a Home Secretary actually involves a blood circle, cremains and a grimoire made from orphan skins.

    1. I’m not sure about Nutt’s reasoning with this comparison.  An inevitablility in gun control arguments is how cars kill more people than guns do, or that kitchen knives are designed to do only one thing (cut flesh) people dismiss these statements, and those who make them as straw mans arguments.  

      Isn’t the comparison of the dangers of riding a horse to the dangers of illicit drugs basically the same thing?

      1. The common use of a car (getting around), or a knife (chopping food that’s already dead), is very different to that of a gun (causing damage at range).

        The common use of horseriding is the same as that of drugs — they’re enjoyable ways to pass the time.

        I think that’s the distinction.

        1. I can see that viewpoint, but it can be countered with while horseback riding damage to your body is a possibility.  With drug use it is an inevitability.
          i.e. You could horseback ride every day for the next 50 years and never get hurt.  If you do the same with cocaine, heroin, or even weed an organ will fail/become diseased.  (smoking is known to cause cancer)

          1. Sorry, MachaGoGo, that’s not how statistics, or drugs, work.

            Your use of smoking is a perfect example of how you are wrong – smokers significantly increase their likilihood of various chronic diseases, roughly in proportion to the amount they smoke. Just as there is no realistic amount of horse riding that will make the likelihood of chronic back problems or traumatic injury reach 100%, so there is no realistic amount of smoking that will make the likelihood of emphysema or lung cancer reach 100%.

            You are demonstrating the same misunderstanding of statistics as the people who say, “Smoking can’t cause lung cancer – my aunt Thora who smoked a pack a day ever since she was twelve lived to 91! And even then it wasn’t lung problems that got her, she had a fall.”

          2. He was talking about ecstacy use, not cocaine or heroin. You can also vapourise or eat cannabis and never or rarely smoke, as many do. I guess diabetes is a risk if you always bake triple chocolate edibles.

    2. I don’t know about that.  Stealing a horse hurts the person you stole it from whereas purchasing ecstasy benefits the dealer.

      Maybe a comparison of using stolen ecstasy and riding a stolen horse is better?

      1. And chasing Jacqui Smith on a stolen horse while high on ecstasy is the best of all.

        1. chasing Jacqui Smith on a stolen horse while high on ecstasy

          [cow catches up with Jacqui Smith on horse and turns self in to her for being a drug abusing horse hustler]

  5. I’ve never heard of “alcopops aimed at (and advertised to) children and teenagers.”  Can anyone point me to a good example of this?  I’m afraid I’m not really in touch with popular culture.

    1. I don’t think they’re explicitly marketed in that way, but a consequence of the “pop” aspect of many of these kind of premixed soda/candy style drinks is that “amateurs” i.e. underage drinkers, and newly legal drinkers are drawn to them.

          1. If we could get past this stupid war on drugs, we could have really cool things like opioid NECCO wafers.
            “Is the black one licorice?”
            “No, oxycodone!”

        1. Which celebrity would the head of the dispenser be modeled on? The unsavory possibilities are endless.

    2. I’ve never heard of “alcopops aimed at (and advertised to) children and teenagers.” 
      Can anyone point me to a good example of this?

      I’m not really in touch with popular culture, either, but I do know that some alcopop adverts have been banned for ‘using youth culture to appeal to minors’.

    1.  Just started reading, seems promising, thanks for shamelessly promoting your book.

  6. legalization has gone about  it all wrong from the beginning.   They should have just collected money and out-bid the bribes to politicians that the mafia, cops , prison owners and other scum-bags that profit from prohibition have been using for decades.

    It has NEVER been about science and reason and evidence.

  7. Prohibition is clearly the worst possible form of control as it gives control to organized crime. We should be asking ourselves the simple but fundamental question: “Are organized societies capable and willing to manage and control psychoactive substances, instead of leaving it to organized crime?” This, really, is placing the bar extremely low when you think about it. After all, the vast majority of psychoactive substances – alcohol, tobacco and pharmaceutical drugs – are already legal and more or less efficiently controlled.

    I highly recommend “World War D
    – The Case against prohibitionism, roadmap to controlled re-legalization” http://www.world-war-d.com/

    1. No, the worst form of control is the control of information and ideas, which is the real point of this book and is practiced everywhere. This is most insidious because when done well everyone except the censored lives with the illusion of freedom. Those in control just keep repeating the lie and censoring dissent until only believers dominate and take over the dissemination of the lie. Those who dissent publicly are eventually seen as discontents or delusional conspiracy nuts, and dismissed out of hand. Their treatment serving to instill fear and silence the few who may question the cognitive dissonance inherent in these lies.

      Take religion for example, religion is bar none the best at this control and suppression. Manufacturing and maintaining consent for the drug war and fear of illicit drugs and contempt for those who use illicit drugs is no different.

      Even otherwise reasonable people balk at the legalization of all drugs, though there really is no other solution.

  8. Alcohol controls in the UK mostly go back to the First World War. The taxes are much older, and high taxes were enough for organised crime to develop. Smuggled tobacco and illicit distilling are still thriving.

  9. I have to disagree with both Nutt and Phil: Nixon’s war on drugs was neither idiotic nor insane. It was careful, logical, fiendishly clever, and profoundly evil: its effect has been to leverage differential enforcement of laws according to race, into differential access to suffrage and public benefits, without any explicit legal recognition of race. Michelle Alexander makes a very good case for this: you should check out her work, if you haven’t heard of it.

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