March 10th 2014 saw Professor David Nutt, Edmond J Safra Chair in Neuropsychopharmacology at Imperial College London, deliver the annual Raymond and Beverly Sackler Distinguished Lecture in Neuroscience at the Julian Hodge Lecture Theatre. The lecture was titled ‘Beyond Prohibition: time to put science at the heart of drug and alcohol policy?’, and drew an admirably mixed crowd of students, university staff and the general public.
For those not in the know, Professor Nutt’s CV highlights include medical training at Guy’s Hospital in London, training in psychiatry at Oxford, establishing the Psychopharmacology Unit at Bristol University, and Chairing the Advisory Council on the Misuse of Drugs, which advises the UK government on drug-related issues. Professor Nutt rose to public prominence when he was sacked from the latter position by the then Home Secretary Alan Johnson, for publicly disagreeing with government policy on illegal drug classification.
The lecture focused on the public perception of drugs (including alcohol) and their harmfulness, the potential therapeutic usefulness of certain illegal drugs, and the effect of drug legislation on scientific research.
On the first issue, Professor Nutt marshalled the cases of Amy Winehouse, Gavin Britton and Leah Betts in service of his point: that the public’s perception of the inherent dangers of drugs is out of sync with their actual dangers, and that such misconceptions can be hazardous. When one thinks of Amy Winehouse, drugs, heroin and crack cocaine probably leap to mind, but it was actually an alcohol overdose that took her life.
Gavin Britton and Leah Betts, two young people who both died at the age of 18, were juxtaposed to show how the media, and thus the general public as a result, can be hyper-aware of deaths tangentially related to illegal drugs, but less mindful of the impact legal and commercially available drugs can have.
Leah Betts was something of a household name in the mid-1990s, when she sadly died after taking ecstasy at her 18th birthday party. It wasn’t the ecstasy that killed her, instead, in keeping with the advice at the time to stay well-hydrated if taking ecstasy, she drank roughly seven litres of water in ninety minutes. This ultimately caused hyponatraemia (a low level of sodium in the blood) and brain damage. She fell into a coma, and her life-support machine was later switched off. By way of contrast, Gavin Britton was one of the many people who die each year as a result of excessive alcohol consumption after taking part in a pub golf game at university in 2006. He is a name much less well-known.
Today, alcohol is a much more harmful drug than ecstasy, whether looking at harm done to the user or harm done to others. This is shown by Professor Nutt’s 2010 paper in The Lancet, ‘Drug harms in the UK: a multicriteria decision analysis’. In terms of total harm, alcohol was the most harmful of all the drugs studied, while ecstasy was 17th (out of 20).
Turning towards psychedelics in science, Professor Nutt highlighted two prominent scientists who used this type of drug, Francis Crick and Kary Mullis, both Nobel prize winners. Francis Crick co-identified the double helical structure of DNA with James Watson in 1953 gaining a Nobel prize in 1962, and Kary Mullis discovered the PCR (polymerase chain reaction), an important technique which earned him a Nobel prize in 1993. Both men used LSD recreationally, and Kary Mullis doubted that he would have pioneered the PCR if he had not taken LSD. “These are the two most important Nobel prizes in Medicine, ever,” Professor Nutt said.
The emphasis of the rest of the lecture was on Professor Nutt’s research on psychedelics. Psychedelics, the audience were told, work through a particular subtype of serotonin receptor in the brain, the 5HT2A receptor, which is densely expressed in an area of the brain called the cortex, the full purpose of which is something of a mystery. It has been implicated in mood and pessimism, and Professor Nutt speculated that it may be involved with people getting locked into a habitually negative mindset.
His work has found that psilocybin, the active agent in magic mushrooms, switches off an area of the brain called the subgenual anterior cingulate cortex, which is overactive in depression, and is also switched off by conventional antidepressants. This may be linked to the sense of well-being which volunteers report feeling when given psilocybin.
His research also found that MDMA reduces the negativity of unpleasant memories, which could explain its utility in treating Post-traumatic stress disorder. His team have been awarded a grant to study psilocybin use in resistant depression, and while ethical approval and supply of the drug were eventually obtained, regulatory approval is still proving an obstacle.
Which brings us to the impasse where we currently stand. A wide range of illegal drugs have a largely unexplored therapeutic potential: cannabis in pain, spasticity, and cancer; MDMA in Parkinson’s disease and PTSD; psilocybin in depression, OCD and cluster headaches; LSD in terminal illnesses and addiction. But because of the current regulations, it is almost impossible to do the much-needed research into these, Professor Nutt says, and the cost per patient is more than ten times that of working with legal drugs.
Other highlights of the lecture included Professor Nutt’s proposal for the creation of a safer ‘synthetic’ alcohol along with an antidote which would cause users to sober up, and a question and answer session in which Nutt cited places like the Netherlands, New Zealand, Uruguay and certain US states as doing better in terms of a rational drugs policy.
His parting words included, “We have to stop this current ridiculous hysteria that the media generate around drugs; and try to have a rational debate, how to use science to improve the health of people.” While billed in some quarters as a controversial figure, judging by the applause he received, the Cardiff audience found little in his lecture to be worthy of objection.