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Comment by swombat | Hacker News Reader

Here's some background. Nutt initially released this scale in 2009 and was sacked by the government over it:

http://www.timesonline.co.uk/tol/news/uk/health/article68947...

Several other members of the drugs advisory board resigned in protest. It's a typical case of the government asking scientists to come up with evidence and then refusing to see the evidence when it is presented. "You got us the wrong evidence! Get us another truth!"

At the bottom of this article, you can find the suggested classifcation by harm:

http://news.bbc.co.uk/1/hi/6474053.stm

Of course, the point is not to ban alcohol, but to have a more mature debate about drugs (and possibly to unban relatively harmless drugs such as LSD, Ecstasy, Cannabis...)

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It's important to note that this scale took into account number of active users. In other words, ranking weight and popularity of use are correlated.

Prof Nutt told the BBC: "Overall, alcohol is the most harmful drug because it's so widely used.

I have no idea what this means when using the chart to back up statements about the relative harm of legalization of various substances. I'm personally still a fan of it purely through considering the volume of crime and harm sustained by the black markets. I just want to caution conclusions being drawn without analysis of the methods that produced the table.

Given the amount of misinformation that exists about drugs, the chart is probably totally justified. To make claims on it without understanding the methods is to add even more misinformation, though.

(Disclaimer, I haven't read his papers either yet)

With that in mind, it's impressive that crack and heroin are on the same order of magnitude as alcohol given the relative number of users.

Prof Nutt told the BBC: "Overall, alcohol is the most harmful drug because it's so widely used.

You could then make a driving speed chart like this.

Driving 35-75 MPH would get a very big bar for both harm to others and harm to drivers, due to the volume of accidents that occur at those speeds.

Driving 76-100 MPH would have a smaller bar, because fewer drivers drive that fast.

Driving 101-130 MPH would have an even smaller bar, as you're getting into a small subset of reckless drivers.

At the bottom of the chart, you might have speeds that can only be achieved with high-performance sports cars. 160-200 MPH would have a tiny bar for both harm to others and to the driver, as barely anyone possesses both the recklessness and equipment to drive at these speeds.

So, then, that chart can get a headline reading "Driving at 35 MPH 'more harmful' than driving at 200 MPH."

How is that an argument against the article?

Most accidents do happen between 35 and 75 mph. So most of the energy of the road safety agencies should be directed at making roads where people travel at those speeds safer.

This is what the study is intended to demonstrate: that the harm caused by alcohol is so much greater than the harm caused by Ecstasy, that alcohol should get a whole lot more attention than Ecstasy.

How stupid would it be to focus all our energies on regulating race tracks where people are allowed to drive above 130mph, "which are so much more dangerous than 35mph"? This is what our drug policy is doing... focusing on the 180mph roads even though most of the accidents are happening on the "safe" 30mph roads.

1) It's an argument against the article because the chart is presented with little consideration to the methods used to generate the chart, which are arbitrary and are homomorphic to a specific (yet unspecified) definition of harm.

2) It's easy to interpret the chart to mean that, in the driving metaphor, driving at 200 mph is safe so let's just eliminate speed limits. Again a deficiency in the definition of harm (total harm, harm per capita, economic harm, social harm, initial harm, expected lifetime harm, average harm, what does harm even mean) leading to conclusions not supported by evidence.

A more specific chart and methodology would help people to do informed reasoning. If your presentation of evidence isn't actually helping people to make more informed conclusions, what is it doing?

This is the first time I see LSD and Ecstasy put together in a harmless group together with marijuana. Am I brainwashed or are you wrong? I mean, I've smoked dope and nothing bad ever happened. But a friend of mine took ecstasy once and blew his kidneys (he's waiting for a donor now).

The problem with this is that if you are to buy illegal drugs such as exstacy, you cannot verify its purity. This is another argument for legalization - quality control. I am saddened by what your friend is going through. There is no way to know what he was actually sold. The scientists are rating the actual drug. What you get on the street is a coin toss.

I'm not a user, but have friends who do. If you do as well, encourage them to play safe, and test the material: http://dancesafe.org/health-and-safety/adulterant-screening-...

this is a good idea, but it makes it attractive to buy larger amounts of a known safe pill... which makes you much more vulnerable to a dealer rap if you get caught. Just another example of the insanity of our current policy.

You cannot obviously test for the presence of adulterants, but you can easily test in your own home for the relative presence of different common drugs in pills: http://www.eztest.com/

I'm not sure I would say Marijuana is a completely safe and harmless drug. The effects of the use are a lot less drastic than with other drugs, but regular and heavy users, in particular if they are young, are known get sluggish to the point where it becomes a huge problem for them. Some also develop mental illnesses.

That is probably a lot less drastic than the effects of e.g. getting completely drunk every day. But one of the problems is that there is no public evidence based knowledge about the effects of drugs like Marijuana. People either believe it's completely harmless, or they think it's the devil. There is also no good social canon on the use of such drugs. Getting drunk every day has obvious social stigma in all circles, but smoking hash every day can be accepted behaviour in certain circles.

That is actually the nice thing about this study, they try to correct this and give facts.

known get sluggish to the point where it becomes a huge problem for them... Some also develop mental illnesses.

Citations, please.

A phrase to remember when citing anecdotes about mentally ill people taking Drug X is self-medication. This is a technical term in counseling psychology; it refers to a very common phenomenon where a person who is suffering a mental health issue -- which can be anything from a mild acute depression to full-blown schizophrenia -- figures out, by trial and error, that taking a certain drug seems to alleviate their symptoms, or make those symptoms more tolerable. This often causes the patient to end up with two health problems, which can be difficult to sort out from each other and which generally must be treated together.

So even if you uncover evidence that mental illness and taking drugs are correlated, you can't simply assume that the drugs cause the mental illness. It could just as easily be the other way around.

I don't have proper sources, nor am I an expert on the subject. I just remember this being the result of a study I read about some years ago, and it fits my personal experience with several friends.

Some Googling finds this: Pope HG, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58(10):909–915, 2001.

Your caveat about correlation and self-medication could be right. It might also be wrong - you don't give a good citation either. My point was that I think we have a lot less knowledge about the effects of these drugs than e.g. alcohol which we're (ab-)using since millenia, so the UK analysis is certainly an improvement.

"Longitudinal studies indicate that, in long-term, the higher use of cannabis is associated with an increased risk of developing bipolar disorder, and probably, major depression in subjects initially without affective disorder, but was not found increased risk of cannabis use among those initially only with mania or depression." http://www.ncbi.nlm.nih.gov/pubmed/20658056

the source is not very reliable(some obscure journal in portugese),

This is why I will never vote for the legalization of MJ. Proponents will never admit that there are negative effects of the drug and when someone tries to mention it, they are immediately attacked and silenced.

A very small percentage of people are smoking it for health effects. The rest just want to forget about whatever is going on in their lives and get high. Why can't people just admit the truth?

"The rest just want to forget about whatever is going on in their lives and get high. Why can't people just admit the truth?"

Many people consuming alcohol are doing so for similar reasons.

I know this. Alcoholics also aren't trying to tell the world that it cleanses your kidneys.

I'm not a user of THC, but it doesn't help the debate when opponents spread huge amounts of misinformation and propaganda on the opposing side of the topic either, often citing debunked toxicity studies, and claiming false links to mental illness, none of which have been shown to be causative. Many of the dangers claimed are observations made from animal necroscopies after LD50 doses or doses non-representative of recreational or medical usage. Not joking, the LD50 of cannabis leaf for humans is roughly 3/4 of a ton, or something like 17lbs of pure THC.

I'm just curious, your opposition seems largely centered on people being high and not the medical effects, are you a prohibitionist too? What about self-induced altered states of mind, hypnosis, etc? Neurochemically active foods (chocolate->dopamine link)? What's the reasoning?

I don't see how mechanical_fish was attacking Nitramp, and he most certainly did nothing to silence him. Could you explain what mechanical_fish did that was inappropriate?

I thought a glass of red wine a day was recommended by doctors and this advice was widely followed by the middle class?

It's generally not recommended by doctors, though it's though to be good for your physical health.

There is a difference between a glass of wine a day and getting drunk.

What's interesting there is that a glass of wine a day (which might be healthy, though such claims get regularly debunked) is socially accepted. I think our societies just have better knowledge of acceptable use of drugs that we're more familiar with, as a whole.

You're largely brainwashed. I know a fair number of people who have taken and/or continue to take Ecstasy, LSD, Mushrooms and even Cocaine, some of them on a very regular basis. None of them have ever "blown their kidneys" or, in fact, had any severe negative reaction. As non-anecdotal evidence, about a million people take ecstasy every weekend in the UK - that's not the same million people each time, so that amounts to millions of active users in the UK. If Ecstasy was so dangerous, you would see it on newspaper headlines every day.

Possible causes of your friend's unfortunate disaster include:

1) It wasn't MDMA/MDA (typical Ecstasy components), as binarymax suggested. Until drugs are legal, who the hell knows what you're actually taking. Could be anything, including washing powder. Unlikely to be actually poisonous stuff, since dealers like repeat customers too, but really, it could be anything.

2) Your friend took an exceptional amount, was not used to intoxicating substances, and had very fragile kidneys. Perhaps his kidneys were about to give up anyway, and Ecstasy just pushed him over the edge. Maybe a good drunken night would have done the same thing.

3) It was just a coincidence.

I suspect a combination of 1 and 2... probably it wasn't Ecstasy, and your friend was already in danger of blowing his kidneys anyway.

I actually did a research paper on rave culture a few years back. Pretty eye-opening; a fairly significant amount more people had died from drinking too much Red Bull than from taking ecstasy, even including where it was laced with cyanide / something equally bad to consume. It's literally one of the safest street drugs around.

----

Some fun numbers from http://thedea.org/technicalFAQ.html:

>"MDMA-present" drug deaths occur at a rate of aproximately 2-3 users per 100,000 users/year. ... cigarettes ... on the order of 400 deaths per 100,000 users/year

With only "a handful" US-annually where it was the only drug, out of less than a hundred. Think alcohol can claim that?

That's some pretty interesting research, although that's looking at per user rather than per-use - I'm guessing that there's a difference if you adjusted for number of hits (I'm assuming the average smoker smokes a lot more cigarettes than the average ecstasy user pops pills).

It can really vary depending on how far you want to go with it. At the peak of usage in my youth we were all taking in excess of 30 a week, some even 30 in one evening (dropping 4 each time)! Interesting things start to happen when you get that deep, such "mid-week blues". Where you just get really upset half-way through the week (the other side of the weekends), teary and somewhat irrational. Typically this is around the point where people give it up due to the side-effects. We knew we were taking too many when we uttered the words: "its tuesday, so we'll only have 6".

Thankfully it isn't at all addictive so it's not hard to stop. :)

There's validity to that... but if so, what does this imply about the two drugs? Apparently that ecstasy users are far less likely to increase their use to unsafe levels - ie, less addictive. And if not, it's even safer than it appears to be, because I'd imagine most people make the same assumption.

Either way, it falls solidly on the side favoring ecstasy over tobacco.

How would you define a "hit" anyway? Doses don't really compare, and even if it's 1-cigarette/1-pill, it's all societal how much is in each "dose"...

It does seem like a pretty tough problem to define, and the issue of addictiveness really clouds the issue.

If you try to say, what is more dangerous - taking one ecstasy tab or one cigarette - even if the ecstasy is more dangerous in the short term, the possibility of addiction could make the cigarette much worse.

I guess maybe you could work the other way - start with say, 1 cigarette, and then try to calculate what amount of ecstasy is an equivalent dose? However I would guess that it fluctuates largely on how much you have at the same time?

It sounds like you're running with the assumption that there is a consistency in the dosage. I admit there would be for cigarettes. Despite different brands offering different amounts of tar and nicotine most people stick to a particular brand and smoke a particular amount in a day. However for ecstasy the dosages may well fluctuate wildly. Obviously to start with it isn't habitual so frequency isn't usually consistent. Even with a consistent "every Saturday night" (probably the most common dosage) due to the struggles of supply and demand in a black market you will take different quantities of different stock.

I.E. One day you'll have rubbish "Roles Royces" and you'll have 6 of em, another you'll have some nice "Mitsis" and just take 3 and on other days you'll have an insane "Red Tulip" that was incredibly more potent than all the others so you only needed one. Of course the name never really means anything as you can have both good "mitsis" and bad "mitsis".

Then there is also the case where the pill is actually cut with something else (pretty common I believe), perhaps a bit of ketamine or god knows. The issue perhaps is that an "ecstasy" in its black market form may be very different from its medical definition making it very difficult to compare like for like.

By that logic, I can quote you thousands of people who die or "blow their kidneys" thinking they are drinking ethanol (vodka), but instead get methanol, ethylene glycol, or similar poisonous additives in their conterfeit alcohol.

(That's exactly the same problem actually - buying black-market alcohol. Which is still pretty big in Russia and neighbouring countries.)

Not railing totally on your comment, because the idea is on track, but black market booze is silly. Alcohol is just ridiculously easy to create. If you have a source of sugar, or starches and source of amalyse enzymes (your saliva has them if you're desperate) and yeast (open air is sufficient), you have alcohol. It takes a moderately equipped kitchen and a little bit of storage room and ingenuity, but it's an amazingly simple task.

Anyone with internet access should be able to sidestep this problem altogether. Manufacturing MDMA or Meth at least requires acquiring lab equipment and some fairly dangerous chemicals, plus some knowledge of chemistry, which is understandably above the abilities of some people. But any idiot can make booze.

MDMA is one of the safest drugs you can take. There are long term effects of taking high dosages regularly (to do with mood regulation), but a person using what they have verified to be actually MDMA in responsible doses faces the grave danger of loving everyone and everything for about 4 hours.

That reminds me of a quip I heard from one drug policy researcher (paraphrased because I can't find the original)

"Evidence-based policymaking would be ideal, but I would be happy with just a lack of policy-based evidence making."

Nutt initially released this scale in 2009 and was sacked by the government over it

... and this in a moment of brilliance was dubbed the "Nutt Sack" by the UK press.

(I would have felt guilty making this the first comment in the thread last night, but now that there's lots of serious discussion surely someone ought to sneak it in.)

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