Thursday, 16 January 2020

Drug policy and scientific morality

David Nutt is in the news again, talking about the dangers of alcohol (and incidentally promoting his book).  He was on Radio 5 this morning, I think, but this piece in The Guardian offers a good summary of his current position.

I’ve written before about the idea of single ‘harmful’ scores for individual substances and how I find them unhelpful – not just because they’re simplistic, but because they perpetuate a particular approach to drug regulation that I think is naïve and therefore gets ignored.

But I just want to highlight a particularly odd position David Nutt takes in this article.  He suggests that people should share a pint of beer, as just 5g a day is the ‘optimal’ dose.  This is less than a UK ‘unit’, and works out (apparently), as about 40ml of wine – less than a fifth of a large glass you’d be served in a pub or a restaurant.

Even though it's been suggested focusing on this is misleading, as it's likely to have been a throwaway comment used as an illustration, the article has been endorsed by David Nutt - and more importantly it's a revealing, and inconsistent comment.  But at least it’s consistently inconsistent.

As a campaigner for drug policy reform, David Nutt acknowledges the desire to take ‘drugs’ – indeed he proposes that rather than seeking a world in which people don’t use alcohol, we actively create and regulate an alcohol-like intoxicant that is less harmful, and allow people to use this.

Apart from the fact that this proposed ‘alcosynth’ relies on an assumption that we can create and adopt a genuinely new substance to take the place of something that has been part of society since before we were human, the rationale for trying sounds like pragmatic harm reduction: acknowledge an impulse to get intoxicated, and rather than ignoring it or pretending it can be legislated out of existence, provide a safer way that it can be satisfied.

Yet suggesting an ‘optimal’ dose of 5g doesn’t do this.  This is only ‘optimal’ if you don’t want to be intoxicated.  And here we get to the nub of so much alcohol policy discussion: we bring our own preferences and prejudices.  An ‘optimal’ dose can only be judged by the person using it, even if we know ‘objectively’ its effects, whether in terms of intoxication or harm.  I might value my long-term health less than other people, and I might value intoxication more highly.  In which case 5g isn’t so much an ‘optimal’ dose as distinctly ‘sub-optimal’.

This is a strange position for a drug reformer to take.  The whole basis of David Nutt’s campaign against the current drug laws is that they have imposed some kind of moral, philosophical or political priority (intoxication is bad) rather than listening to ‘objective’ science.  But of course there is no universal, objective cost-benefit analysis of drugs, so the language around ‘optimal’ immediately raises the spectre of one set of personal judgements – those of ‘experts’, speaking as an oracle* – simply replacing another.

Previously, I’ve thought of this ‘rational’ approach to drug reform as simply naïve about not only policymaking, but the reality of social existence.

To summarise, the naivety about policymaking is first that telling politicians they’re behaving irrationally isn’t a great lobbying technique, and second imagining that ‘harm’ is the only thing drug policy could ever be about is misguided.  Not only can we not define ‘harm’ in any practical way that acts as a guide for policymakers, but there are plenty of other (legitimate) influences on policy other than reducing ‘harm’.  Balancing freedom, economy and morality is no mean feat.

And the naivety about social existence is simply that even if we’d like to start from some kind of ‘year zero’ in regards to drug policy, we’re dealing with substances that have a social history.  Whether we like it or not, the fact that alcohol has been legal and available in Britain for thousands of years makes a difference, when it’s compared with the substances that are currently illegal.

But looking at this again, I realise there’s something else that has troubled me about this approach, at a more emotional level.  I’ve been chatting about PSHE this week at work, and a couple of us were reminiscing about how, when we were at school, drugs education consisted of handing out booklets that contained key information on all the major drugs – where they tended to be available, how much they were likely to cost, what the effects were and how long these were likely to last.  Whether you ended up taking them or not, most people looked at that booklet and did a quick cost-benefit analysis to see which would be their preferred drug.  Perhaps not the intended response, but it illustrates a key point for drug policy: we didn’t all agree.

I think my problem, fundamentally, with the Delphi model is that someone else has done this cost-benefit analysis for me, and I don’t agree.  (Or perhaps more accurately, they’ve listed the costs, but not the pleasures that might balance them.)  What I’ve previously thought is naivety about policymaking or reality is, I think, arrogance.  A belief not that government making decisions about personal pleasures is wrong, but simply that they’re making the wrong decisions.

Back in the first few months I was writing this blog, I said that the most powerful and fundamental argument the alcohol industry could make in relation to alcohol policy would be based on liberalism, not on the technical details of research and modelling.  I understand why it might help to undermine or muddy the waters of ‘public health’ evidence, but that’s not really the fundamentals of this debate.

The same applies to drug policy reformers.  The debate is fundamentally about freedom: why should one person’s preferred drug (alcohol) be legal, while another’s (cannabis, or MDMA) is illegal?  Harm helps frame this debate, but it can’t drive it.  That’s not a question of naivety or pragmatism, but ethics.  Drug policy really can’t just be about science.

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