There will always be an England

A commentary by Tony Delamothe in the new BMJ led me to an interesting editorial from earlier this year in the Journal of Psychopharmacology, by DJ Nutt. Alas, this is all closed access, which annoys me no end. Anyway, Nutt is concerned with the relative harms of various drugs of abuse. He writes:

The dangers of equasy were revealed to me as a result of a recent clinical referral of a woman in her early 30’s who had suffered permanent brain damage as a result of equasy-induced brain damage. She had undergone severe personality change that made her more irritable and impulsive, with anxiety and loss of the ability to experience pleasure. There was also a degree of hypofrontality and behavioural disinhibition that had lead to many bad decisions in relationships with poor choice of partners and an unwanted pregnancy. She is unable to work and is unlikely ever to do so again, so the social costs of her brain damage are also very high.

So what was her addiction – what is equasy? It is an addiction that produces the release of adrenaline and endorphins and which is used by many millions of people in the UK including children and young people. The harmful consequences are well
established – about 10 people a year die of it and many more suffer permanent neurological damage as had my patient. It has been estimated that there is a serious adverse event every 350 exposures and these are unpredictable, though more likely in
experienced users who take more risks with equasy. It is also associated with over 100 road traffic accidents per year – often with deaths. Equasy leads to gatherings of users that often are associated with these groups engaging in violent conduct. Dependence, as defined by the need to continue to use, has been accepted by the courts in divorce settlements. Based on these harms, it seems likely that the ACMD would recommend control under the MDAct perhaps as a class A drug given it appears more harmful than ecstasy.

Equasy is, a you may already have guessed, the practice of riding horses. Ecstasy (MDMA) is associated with acute adverse events in 1 out of 10,000 exposures, in other words horseback riding is almost 30 times more dangerous.

Professor Nutt, unfortunately, made a serious mistake. While his analysis is factually correct, it turned out to be politically incorrect. He was summarily dismissed as Chair of the British government's Advisory Council on the Misuse of Drugs, as the Home Secretary was "profoundly disappointed" by the editorial. Nutt responded that "Politicians believe that if they think something, it is true." You can read about the brouhaha here.

The fact is, we just cannot have a rational debate about "drug" policy, either here or in the UK, because ideology consistently trumps truth in this field. Our jails are bursting with people, mostly poor African American and Hispanic men, who are non-violent drug offenders. White people use "drugs" at higher rates, but don't go to jail for it. And believe me, a whole lot of perfectly legal activities are considerably more harmful than use of most illicit drugs. It makes absolutely no sense, in fact it is eroding the fabric of our society.