Your Drug of Choice?

The alternative rankings for drugs of abuse (some legal and some illegal) appears to raise several issues. There is little doubt that the current A,B,C system is inadequate and has been much influenced by subjective assumptions. The new proposed system by Professor Nutt's team (http://www.guardian.co.uk/drugs/Story/0,,2040886,00.html) was based on the rankings of 20 substances (in terms of physical harm, likelihood of addiction and social harm) by 29 consultant psychiatrists specialising in addiction. There was additional input from 16 experts in areas such as Chemistry, Pharmacology, Psychiatry, Forensics, Police and Legal Services). The system placed Heroin, Cocaine and Barbiturates top and Ecstasy, Alkyl Nitrates and Khat bottom. Alcohol was 5th, Tobacco 9th and Cannabis 11th. Although this new ranking is an improvement, there are a number of questions that one might raise. Firstly, although Alcohol and Tobacco are legal 'drugs', they do seem a little different from many of the other substances listed. Alcohol is very widely used and, although it is not a defence in law, there has been a tendency for people to over-report its use as a defence for inappropriate behaviour. Further, its actions (mainly expressed by altering the fluidity of nerve cell membranes) are not much like the actions of other drugs that mainly have their effects by interfering with chemical transmission across synapses (the spaces between nerve cells). Tobacco does have an active chemical Nicotine that is addictive but most of this substance's other health problems seem to be related to other constituents such as tars and particulates. Most users of Cannabis appear to combine it with Tobacco, a fact that makes establishing 'blame' difficult. There are other factors that make objectively ranking legal and illegal drugs problematic. Most legal drugs are generally pretty pure (with some notable exceptions) and people are likely to be more open in admitting their use. Illegal drugs can be 'cut' with all sorts of substances that might well have intrinsic actions of their own and people are less likely to be open above their use. Some of the items listed also appear to be particularly employed by people of particular ages or ethnic origins, again perhaps making general comparisons about the harm-causing properties more difficult. I suspect that this one will "run and run" as they say.