Drugs: Without the Hot Air, now in the USA!

I wrote last June about Drugs: Without the Hot Air, the best book on drug policy I've read, written by David Nutt, the UK drug czar who was fired because he refused to bow to political pressure to repudiate his own research on the relative harms from illegal drugs and legal activities. Nutt's book has now been published in the USA. As I said in June, this is a book that everyone should read. From my review:

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 opiods 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."

Drugs: Without the Hot Air



  1. On a slightly related note, the book I believe is the other in the burgeoning series, “Sustainable Energy – without the hot air” by David MacKay is available free on the web and is easily found with a simple search.

  2. The US illegal drug policy is nothing like irrational. It’s just that its rationality has virtually nothing to do with the health and safety of drug users. Rather it is a post-60s political radicalism policy which is pretty systematically designed to permit the policing and incarceration of the poor, those with brown skin and the young. Dan Baum, who wrote Smoke and Mirrors: The War on Drugs and the Politics of Failure interviewed every US Drug Czar through the Clinton administration and reported that they were more or less explicit about the war on drugs intentions in targeting the young, brown and poor.

    Remember that that the liberal canard ‘the system doesn’t work,’ is not true: the system works as intended by the ruling classes.

  3. David Nutt is a propagandist, not a scientist, and his ‘research’ shouldn’t be cited or taken seriously by anyone. If you actually look at his most famous ‘study':


    You’ll see that it’s designed to produce the results he wanted, rather than to be actual science. Some issues:
    – The full methodology isn’t actually published anywhere.- The rankings are creating by combining a lot of different factors that don’t have anything to do with each other, e.g. by combining harm to the user with harm to society. This means that drugs like coffee end up being more dangerous than drugs like heroin, simply because more people use coffee than heroin so the total social costs are greater.
    – The harms for drugs are measured as they are typically used, rather than correcting for things like differences in demographic and route of administration. This leads to drugs like heroin looking more dangerous than they are, because people who have drug abuse problems tend to gravitate toward drugs like heroin. (Whereas people who use, say, Khat tend not to be the worst of the worst as drug abusers go.)
    – The harms of the drugs caused by prohibition are not accounted for. (E.g. they are counting people using dirty needles and impure/unknown/fake drugs as being a harm that stems from heroin, but they aren’t counting using dirty needles and fake Starbucks as being a harm that stems from drinking coffee.)
    – They’re not accounting for the benefits of drug use, only the harms.
    – I believe he is using surveys of health professionals (who often know little or nothing about these illicit drugs) rather than academic literature and actual science as a basis for these ratings. I’m not sure if that’s true for this specific study, but for much of his research he does this.In short Nutt’s research is complete bullshit. I haven’t read this book, but I’d trust it about as far as I could throw it. And we shouldn’t prop Nutt up just because he supports drug reform, otherwise we are just setting the movement up for attack down the line. If you want a good book on drug policy, check out Marijuana Is Safer by Fox, Armentano, and Tvert.

      1. “I always love it when someone criticises someone’s scientific methodology and then says ‘I haven’t read this book'”

        I haven’t read A Million Little Pieces either, nor have I read Jonah Lehrer’s books.

        It’s always wrong to criticize the methodology of a study that you haven’t actually read. 

        But if you’ve read the research the book is based on, and if that research is flawed, then why the hell would you read the book? 

    1.  I skimmed the Lancet article you link, and I’m not seeing much cause for outrage. Among the problems you list, many of the scientists’ choices seem like common sense (why count dirty needles as a risk that stems from drinking coffee?). Is there some other reason for your concern? Maybe you’re really Jacqui Smith?

      1. “why count dirty needles as a risk that stems from drinking coffee?”

        Because if caffeine were illegal then it would be astronomically expensive, so people would inject it to save money like they do with heroin and other drugs. And because only the most hardcore addicts would be doing this, they would also be trying to get the biggest rush possible.

        Before opiates were illegal everyone used to just eat them, injecting them was all but unheard of. And if they were, they were doing it safely, at least by the standards of the day. So harms caused by injection are caused by prohibition, not by the substance itself. So it’s completely fraudulent to claim that, say, heroin is more dangerous than coffee based on looking at the problems caused by injections, unless you’re also going to attribute those same harms to drugs that are currently legal.

        1. Not going to get into a pissing match about this, but no one is talking about making caffeine illegal. The question at hand is, might opiates be safer if they were legal? The answer, using the kind of evidence that has been chosen for the argument in this case, seems to be yes. Perhaps you could make an argument that opiates would be less safe if they were legal?

          1. “The question at hand is, might opiates be safer if they were legal?”

            Yes, which is what I am saying. Nutt’s study makes them look more dangerous than they actually are, because it does not take into account that many of the harms that current opiate users experience are the result of prohibition. 

            That is why the results make zero sense. If you actually believe that huffing butane is safer that using marijuana, which is what Nutt says, then you’re probably well on your way to winning a Darwin award. 

          2. OK, alex, after reading your most recent comment I think I understand your point. If you don’t mind my saying so, you could have made this an easier process if your original comment had been more carefully constructed, didn’t start off resembling an ad hom argument, and didn’t refer to problems that have nothing to do with the paper you cited (the paper doesn’t mention caffeine, for example).

          3. I believe his point is that people wouldn’t be injecting if they were legal, so the dangers associated with injection aren’t relevant.

        2. Are you so sure that “if caffeine were illegal then it would be astronomically expensive”? Expense often doesn’t matter (though it may increase crime rates) – addiction is addiction no matter your socioeconomic status. Addicts find ways to get their drug. Look at powder cocaine and crack – Cocaine was considered a rich white people’s drug and crack was seen as a poor black people’s drug and was “marketed” as such – rich or poor, powder or rock,  it’s still cocaine. The form of the drug is usually altered so that suppliers can make more money (ie. cutting the purity of their product) or to get around a law (synthetic weed) . I’ve always found it irritating that a rich addict is seen as a “different” kind of addict than a poor addict.

          1. Crack wasn’t a marketing thing. The reason people turn cocaine into crack is that it lasts longer, so you get much more value out of the same dollar amount . That’s the same reason why now adays most people inject heroin instead of eating it, like they used to with morphine. 

    2. Since I can’t reply to your threaded comment “If you actually believe that huffing butane is safer that using marijuana, which is what Nutt says”

      That’s not what he is saying, at all. If you read the book you’d realise that their concept of “harm” encompasses 16 different types of harm including injury, economic, social and environmental harms. So marijuana is ranked higher than butane not because it is more dangerous to any particular person’s health (it isn’t), but because it “scored highest on drug-related damage and drug-related impairment of mental functioning, mostly because of the harms associated with smoking” (often with tobacco).

      Similarly, alcohol is ranked by far the most harmful drug, mainly due to how its used on society, not because of its direct physical effects. The fact that Nutt and the ISCD consider other factors besides the direct damage is one reason why this book makes so much common sense.

      1. “If you read the book you’d realise that their concept of “harm” encompasses 16 different types of harm including injury, economic, social and environmental harms.”

        I realize that, but what does it mean to lump harm to users together with dependence potential and harm to society? Nothing, because it’s an absolutely meaningless ‘measure’. 

        What Nutt proposes is placing drugs into different schedules based on his harm rankings. Does that really make sense though, to restrict marijuana more than benzodiazipines because some group of psychiatrists (who get paid to prescribe benzos) think they are less dangerous in some way or another?

        There is absolutely nothing you can do with these rankings, because they don’t actually tell you anything useful. As far as I can tell Nutt only created them to get media publicity for himself. 

    3. Statistics can be used to support ANY viewpoint. What is essential is that we think for ourselves and base it on things other than statistics. Thinking for ourselves involves looking at all sides and choosing which viewpoint makes sense to you, your experiences, and your values. It’s not enough to say “I believe this” if you don’t investigate all options. You don’t have to buy into all possibilities, but you should be aware of them. I appreciate other viewpoints, but because I can think for myself, I rarely can be swayed by them.  

    4. David Nutt is a propagandist, not a scientist, and his ‘research’ shouldn’t be cited or taken seriously by anyone.

      You know, his raw data are available — feel free to come up with a wieghting of your choice that has a modicum of sanity and shows anything else.

      Until you do that your criticism is just, well, hot air.

  4. In a rational world, governments might trial policy in random areas and stick with what worked… oh, wait, they did that with the badger cull trial and then moved the goalposts and changed the game for political reasons.  As a friend describes it: “Policy-based evidence-making.”  

    1.  Sort of like in a Federal system?  Maybe it would be better if the courts didn’t extend the Federal government’s power to control interstate trade in drugs to also control intrastate use.

      1. So state-based bad policy is better than federal-based bad policy… because federal anything is badder because it’s federal. Ah, a libertarian…

        I’d rather argue that NEITHER state-level nor federal-level law-makers have any mandate to regulate brain-chemistry and NEVER had mandate to regulate brain-chemistry, but fear-based political discourse has muddied the water so much that this simple element of policy remains ignored. 

    2. In America, there’s a similar “tail wags the dog” problem with the re-introduction of wolves into the wilds of Montana and Wyoming: cattle ranchers are terrified of potential losses due to wolf kills on cows, but can’t cite any actual incidences of losses directly attributed to the wolves that also can’t be attributed to other predator species; such as coyotes and/or wild dogs, but politicians are more likely to listen to ranchers than scientists, facts be-dammed.

      Or to put it another way: it’s politically safer to ignore what a scientist says versus a rancher …especially in an election year.

  5. If there were a sensible drug policy, then what pretext would there be for the government to build more prisons, buy all these roadside license plate scanners and military grade law enforcement equipment?  

  6. Any word of this book being available electronically? The previous article had a commenter mention they had contacted the publisher who said they were going to be rolled out in around 3 months. Very interested in reading this, but as much as a paper book is nice, I want this on my iPad :)

  7. Just a few simple facts: Marijuana, opium and its derivatives, and cocaine are agricultural commodities. There is a demand for them. Therefore, there WILL be a supply. The only question remaining is the price. Prohibition does one thing to the price – it adds a contraband premium, and makes industrial conglomerates out of people who would otherwise be small-time thugs. This is then compounded by the creation of enormous (and enormously expensive) enforcement bureaucracies dedicated to the eradication of these organizations. These bureaucracies then have an ongoing vested interest in perpetuating the status quo. Vast amounts of manpower and treasure are expended with no hope AT ALL of actually achieving the stated objective of the destruction (or even meaningful reduction) of the industry. Prohibition of a thing with proven demand has never, and will never, work as intended. Study after study has shown that treatment is more effective (and cheaper) than interdiction and incarceration, yet we continue down that sad, sad path.

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