Anmeldelse af David Nutt's Drugs without the hot air (2012)

Indledningsvis skal det lige siges, at David Nutt er ganske utilfreds med at jeg gør hans bog tilgængeligt på nettet. Manden forstår sig på stoffer, men ikke på at sælge bøger på nettet. Jeg sagde til at ham, at hvis han ville tjene flest mulig penge på salg af bogen, så skulle man lave et pay-what-you-want system med en ebog uden DRM. Det mente han ikke. Da jeg derfor ikke kunne købe bogen online (bortset fra en DRM version til kindle, hvilket er ubrugeligt), så købte jeg en papirudgave, som jeg fik scannet med hjælp fra 1dollarscan.com. Denne har jeg lagt ud på min side, her:

Det er rigtig skidt for sit eget foretagende når DN både ikke sælger ebogen i et ordentligt format uden DRM og til optimale priser. Man kunne også bare have sat prisen til fx 5-10 dollars, hvilket også ville have givet et pænt salg. I stedet forsøgte han at bekæmpe piratkopiering. Fail, fail fail. Især når man nu skriver en bog hvis formål er at oplyse befolkningen. I det tilfælde er man naturligvis interesseret i at flest mulig mennesker læser den. Dette skal naturligvis opvejes mod det faktum, at bogen også blev skrevet for at samle penge ind til hans uafhængige forskningscenter, Independent Scientific Committee on Drugs.

Overordnet anmeldelse

Hvis man interesserer sig for stoffer, og ønsker et hurtigt indblik i forskningen, så er dette et fint sted at starte, især fordi at der er fokus på skadereducering.

Længere anmeldelse

Da jeg læste bogen var der et række tekststeder som gav anledning til eftertanke. Disse er citeret her og mine tanker følger hvert citat.

 While everything in this book is grounded in scientific evidence, drugs also have social and cultural aspects. We can't talk about reducing the harms drugs cause without examining how they are used, how freely available they are, and their legal status. So this is also a book about poli­ cies - the ones that reduce harms (like the smoking ban), and the ones that increase them (like allowing cut-price alcohol in supermarkets). In­ evitably, the book is critical of the "War on Drugs" (chapter 15), not just because this set of policies has caused enormous damage to millions of people around the world, but also because the evidence of the harm it has been causing hasn't led to a change of approach. Politicians must often make decisions with imperfect knowledge, and sometimes those decisions don't work or have unintended negative consequences. The War on Drugs wasn't so obviously the wrong thing to try in the 1970s, but today it is clearly doing more harm than good, and the "drugs prob­ lem" needs radical rethinking as a public-health crisis rather than a moral crusade.

 When I first started working with the government, I thought that our drugs policies were broadly going in the right direction. As time went by and I realised the extent of the perverse consequences the policies were causing, I came to the conclusion that the Misuse of Drugs Act is no longer fit for purpose and needed to be thoroughly revised. The crucial point is that I changed my mind. Being willing to change our minds in the light of new evidence is essential to rational policy-making. As long as our politicians refuse to consider any framework other than prohibi­ tion and criminalisation, then science and evidence will be considered dangerous, and those who champion them will be sidelined and even sacked. I hope that this book will contribute to a new understanding of the issues around drugs that is rational, scientific and humane.

Jeg vil nu mene at det var ret åbenlyst. Antallet af narkomaner havde været konstant gennem flere årtier, og forbuddet mod alkohol som man tidligere prøvede gav ufatteligt dårlige resultater. Derudover, så kunne man godt forsøge resultatet af en krig mod stoffer. Efterspørgslen på stofferne kan man ikke fjerne. Forbud gør sjældent handel umuligt, slet ikke med noget som er svært at kontrollere. Det er også ret nemt at producere mange af rusmidlerne, især cannabis. Følgelig er det indlydende at et forbud mod noget der er svært at kontrollere, som der er efterspørgsel på, og som er relativt let at producere... Ja, det vil aldrig virke.

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I then looked for data on ecstasy and road traffic accidents. There didn't seem to be much information on this, perhaps because the police don't test for it very regularly, but I did find some laboratory studies where people simulated driving while under the influence of ecstasy alone, and after taking ecstasy and alcohol together. These showed that although the drug impairs some aspects of driving performance, it actu­ ally improves things like attention and concentration, and this was par­ ticularly marked when combined with alcohol. Given the lack of clear data either way, I decided to omit ecstasy-related traffic accidents.

Spændende. Det er relevant når man skal fastsætte grænseværdier mht. færdselssikkerheden, noget jeg har skrevet om før, se Færdselsloven og euforiserende stoffer.

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The first widely-publicised deaths involving ecstasy were mostly young men, who died of dehydration and hyperthermia (abnormally high body temperature) after dancing for hours in badly ventilated clubs without drinking enough water. Alongside a certain amount of media hysteria, some very sensible public-health advice went out in response to this, and clubs began providing free water and chill-out rooms to help dancers cool down. Deaths from dehydration fell once this was understood by venues and clubbers.

Unfortunately, this advice didn't make it clear that drinking water was an antidote to the health risks of extreme physical exertion and sweating, not an antidote to the drug itself. As a result, the second wave of ecstasy- related deaths were mostly young women suffering from water intox­ ication, which happens when a person drinks so much water that the sodium level in their blood plasma drops dangerously low. (The lower ratio of body water to body mass in women compared with men prob­ ably explains why women are particularly at risk.) The most famous case was Leah Betts, who died just after her 18th birthday after taking two ec­ stasy pills; when she began to feel ill she repeatedly drank large amounts of water, until her plasma sodium level was so low that this water was sucked into her brain cells by osmosis, causing her brain to swell. The increased pressure on her brain stem put her into a coma from which she never woke up. Again, a public health campaign about how much to drink (one pint an hour), how to drink it (sipping rather than gulping), and what to drink (sports drinks, or water with added salt), helped to reduce the number of deaths from this condition.

Illustrerer vigtigheden af korrekt information om stofferne. Information som er svær at finde når stofferne er ulovlige og sundhedsmyndighederne insisterer på at køre skræmmekampagner. Når sundhedsmyndighederne insisterer på at køre skræmmekampagner, så får det det åbenlyse resultat, at folk stopper med at stole på sundhedsmyndighederne (analogt til når politikerne laver dumme love, så mister folk respekten for love generelt).

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When Jacqui Smith called me to ask me to apologise for my equasy editorial (page 13), we had the following exchange:

Jacqui Smith: You can't compare harms from a legal activity with an illegal one.

Me: Why not?

Jacqui Smith: Because one's illegal.

Me: Why is it illegal?

Jacqui Smith: Because it's harmful.

Me: Don't we need to compare harms to determine if it should be illegal?

Jacqui Smith: You can't compare harms from a legal activity with an illegal one.

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I started to think about the whole purpose of classification. Clearly, some drugs are more harmful than others, and people should have a broad understanding of the risks if they choose to take them. Politicians sometimes invoke the precautionary principle to argue that, if we're not completely sure if something might do harm, we should put it in as high a Class as possible. However, this may be unwise as it can have perverse consequences. There was a very sad tale a few years ago of a fyoung girl in the Shetland Islands who wanted to try cannabis, but could only get hold of heroin and died of an overdose; if cannabis and heroin are in the same Class, indicating that they pose the same sorts of risks, this kind of tragedy may happen more often. More generally, people aren't stupid, and have access to other sources of information about drugs apart from the government. If the other evidence and the government response don't seem to add up, it undermines public confidence in what the gov­ ernment is doing and makes giving a credible educational message im­ possible.

Illustrerer vigtigheden af ikke bare at forbyde ting når man er lidt usikker på deres effekter (fx e-cigaretter). Og Nutt laver samme pointe som jeg lavede ovenfor mht. fejlinformation fra myndighederne af.

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Brugbar oversigt.

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Smoking cannabis with tobacco in cigarettes puts the smokers at risk of the same problems that smoking tobacco alone does;smoking cannabis pure reduces these risks, but it doesn't remove them completely. Spliffs are usually passed around a group rather than smoked by an individual, but users usually inhale more deeply than they do with tobacco alone, and often hold the smoke for 10-15 seconds as they believe this makes them more "stoned". (+Tests have shown that this doesn't actually increase THC levels in the brain, so it is probably just oxygen deprivation that causes the bigger effect.)

Det anede jeg ikke! Kilden er angivet til en bog: The Science of Marijuana, Leslie I. Iverson, Oxford University Press, 2000, så det er lidt svært lige at verificere.

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Meanwhile, some British governors in India were becoming worried that cannabis might be causing widespread psychological problems in the colony. This led to the Indian Hemp Drugs Commission report in 1894, which assembled seven volumes' worth of evidence on the medici­ nal and social uses of cannabis in the subcontinent. The report concluded that the drug was not harmful, and should not be controlled. Yet the re­ port was largely ignored in the UK, despite having been commissioned by the British Parliament and having collected a huge variety of testi­ mony and evidence, and it was not even mentioned in Parliament until 1967. The legal status of cannabis, and its possible harms and benefits, were seen as a foreign issue unrelated to everyday British concerns.

Dengang, som nu, var politikerne glade for at bestille rapporter som de kunne ignorere, eller bruge hvis de tilfældigvis var enige med rapporterne.

Wikipedia har en artikel med uddrag fra rapporten, den er jo ude af copyright nu. Rapporten i sig selv har kun 13 citationer på Google Scholar (14 hvis man ligger denne bog til).

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The criminalisation of cannabis (Figure 5.4) for recreational use has re­ sulted in a great deal of harm from imprisonment, as we'll discuss in chapter 15. However, the most inhumane result of the legal status of can­ nabis has been the criminalisation of very sick and disabled people who rely on the drug as a medicine. A middle-aged ex-teacher with MS wrote to me recently detailing how the police have broken down her front door in dawn raids on three occasions in the last six years to combat her use of cannabis for medical purposes. This kind of aggressive law enforcement is devastating for the patients and their families and distasteful for the courts - many magistrates will privately admit their extreme dislike of having to criminalise users. And that's not to mention its being a com­ plete waste of public money.

Det er svært at finde ord på et sådant misbrug af det offentliges penge.

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The negative effects of this situation are felt far and wide. A lot of young people ignore the genuine warnings that health professionals give them about the dangers of cannabis, because so many of these warnings are exaggerated. Rather than protecting people, exaggerated warnings increase the risks of harm and addiction. Criminalising recreational use leads to thousands of young people getting a criminal record each year for using a drug which is considerably less harmful than alcohol. While these consequences cause a lot of suffering, the negative effects of crimi­ nalising the medicinal use of cannabis are even worse. As a result of laws which had almost nothing to do with the risks or benefits of the drug, thousands of sick and disabled people are denied access to a medicine with unique properties for treating their illnesses, or are forced to break the law and risk prosecution to obtain it. This nonsensical and inhumane situation cannot continue, and our trust in politicians is eroded when they make statements that draw a false distinction between "raw canna­ bis" and the cannabis-based medicines they have licensed. We must base our laws on a realistic assessment of harm, not on irrelevant historical factors, nor on political cowardice about changing the status quo.

Amen.

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In the 1950s, alcohol was three times the price relative to income as it is now, and we drank half as much. Evidence from across the world shows that the +price of alcohol determines use for almost everyone, with the possible exception of severely-dependent drinkers. The government should triple the cost of alcohol progressively over five years, through a minimum price per unit, or through increased taxation. I prefer the second option because it delivers more money back to the public purse, helping to offset the costs of the harm caused by the drug. If we did go down the minimum pricing route, a simple way to calculate it would be to charge the same amount in a shop as the average price in a pub.

We already tax different classes of alcohol differently, but with the in­ vention of super-strength lagers and ciders we need to extend this prin­ ciple and start taxing drinks according to their alcohol content. It makes no sense for an 8% alcohol-content cider to be taxed at a quarter of the rate of a 12% wine; a can of 8% lager should cost twice as much as a 4% can, and four times as much as a 2% can. Discounted alcohol in Happy Hours and "all you can drink for £20" offers should be banned, and sub­ sidies removed for bars in government-supported organisations, such as universities.

Some people might argue that increasing the price of alcohol will un­ fairly affect the poor - but many of the poor are poor because they're addicted to alcohol and tobacco. Increasing the price of cigarettes has sig­ nificantly reduced demand, and there is every reason to think this would be the case for alcohol as well. Since alcohol-related damage already costs each taxpayer £1,000 a year, tripling the price and reducing the harm by two thirds would save everyone £666, making up for the price increase over the bar. Anyone that would be financially worse off under this plan is drinking at a dangerous level anyway. It's possible that this could lead to higher levels of smuggling, although with tobacco there is +no clear relationship between levels of taxation and levels of smuggling (in fact, countries with the lowest levels of taxation have historically had the most smuggling). Effective border controls have substantially reduced the amount of contraband tobacco coming into the UK, even as the price has been rising, and there's no reason to think that this couldn't work just as effectively for alcohol.

Disse løsninger kan ikke bruges i Danmark pga. Schengen-aftalen (åbne grænser indenfor EU) og nærheden til Tyskland.

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To stop binge drinking we need a cultural change. It's very difficult to achieve this through regulation, but we could start by banning com­ panies who run events at which reckless levels of drinking routinely occur, such as the student event promoter, Carnage UK. The dangers of these events are well-recognised by public services; as the National Union of Students' vice-president for Welfare said, +"Any organised bar crawl that has an ambulance following behind it clearly has something deeply wrong." While it would be hard to regulate private groups, drink­ ing games and pub crawls should be banned in government-supported organisations like university sports and social clubs, and financial sup­ port removed if they continue to host them.

There are other simple steps we can take. Wine should be sold in 125ml glasses again, rather than the 175ml or even 250ml ones which have crept in. This is especially important for women, who often drink wine; women's higher proportion of body fat means they experience about twice the effect per unit of alcohol compared with men. The mea­ sures suggested above to reduce cheap alcohol sales from supermarkets are likely to reduce "pre-loading" (drinking large amounts before going out to pubs or bars). We should enforce the law that makes serving drunk customers illegal, and have breathalysers available to back up the judge­ ment of bar staff. If someone's blood alcohol concentration is over 150 mg/lOOml they shouldn't be served until they've sobered up a bit.

Man skal huske på at David Nutt er læge, og læger har et træls forhold til personlig frihed. Altid skal de finde på forslag til hvordan folk kan blive sundere og leve længere. Tænker man på Danmark, og de danske sundhedsfascister (som de kaldes), så tænker jeg på fx Vibeke Manniche.

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Make it law that all alcohol outlets have to sell non-alcoholic beers and lagers as well, so that people who like the taste of these drinks can ex­ perience it without the risk of intoxication. The quality of these is im­ proving, and although some seasoned drinkers say they prefer the taste of alcoholic versions, this is mostly the result of repeated conditioning to the alcohol which is exactly the effect we need to reverse. Non-alcoholic drinks should be cheaper than their alcoholic equivalent, and made ob­ viously available in shops and in all bars.

Another route to explore (which has formed part of my academic re­ search), is investigating less dangerous alternatives to alcohol, to provide some of the pleasurable effects of mild to moderate inebriation without the harms. The active ingredient would probably be a benzodiazepine (there are thousands) which could be produced as a liquid and added to other sorts of flavoured drinks. Ideally, it would be impossible to get drunk on, just producing a moderate buzz with no increase in effects at higher doses. It would also come with an antidote - a "sober pill" that could be popped at the end of the night to reverse the effect of the drug, so that people could get home safely, even if they were driving.

Den anden ide her er meget bedre, da den ikke involverer at man fritager borgere eller virksomheder deres frihed.

Jeg har nogle gange fået kommentarer om, at man ikke bør forske i nye rusmidler. Big pharma, tjener rigeligt, siger folk. Men det er en dum holdning. Selvfølgelig skal man forske i alternative stoffer af den årsag, at hvis vi kan bytte et stof vi tager p.t. ud med et som er mindre skadeligt, så er det godt for folkesundheden.

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Another thing we could do to learn more about new drugs as they appear is to set up a Drugs Information and Monitoring System (DIMS) like the one they have in the Netherlands, which is a fascinating example of applying common sense to drug use. Across the Netherlands there are a number of hospitals where drugs can be tested. Users take their drugs to the centre knowing that they will not be arrested. After the tests they are given information on what the drug is, health and safety advice to help them decide whether to take it or not, and what to do if they get adverse effects. Not only does this offer an opportunity for harm prevention, but also the Dutch authorities get to know exactly what drugs are in circulation and where, and they can catch "bad batches" before they do too much damage. We should set up a similar system in the UK.

Det er en god ide. Det foreslår jeg for Piratpartiet.

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Some of these negative behaviours are the result of heroin and crack being illegal, and can be reduced by administering the drug (or pharma­ cological substitutes) in medical settings. If they didn't need to steal to fund their habits, for example, heroin and crack addicts would be less likely to have their lives ruined by being sent to prison.

Og når man giver dem rusmidlerne, så ser man det medierne skrev om forleden, nemlig at narkomanerne keder sig. De behøver jo ikke gå ud og stjæle hvis man bare giver dem rusmidlerne gratis. En stor samfundsforbedring af disse rusmidler er billige at producere og det er dyrt at opklare 100vis af indbrud, derefter dømme narkomaner, have dem i fængsel, osv.

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Pseudo-antagonists. Whereas antagonists just block the positive ef­ fects of drugs, pseudo-antagonists actually produce negative ef­ fects. For example, Antabuse mimics the oriental flushing reac­ tion to alcohol, by blocking the person's ability to break down the acetaldehyde that alcohol is converted into. When people drink after taking Antabuse they feel quite unwell and so get put off drinking any more. As we learn more about the biological factors which are protective against addiction, we will be able to develop more of these sorts of treatments.

Nutt lader ikke til at vide, at antabus faktisk virker ret dårligt til at få folk ud af alkoholisme. Jeg henviser til Lilienfeld, Scott O., Steven Jay Lynn, and Jeffrey M. Lohr, eds. Science and pseudoscience in clinical psychology. Guilford Press, 2004.

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Dried coca leaves are mixed with lime to form a "quid" which is placed between the cheek and gum, and sucked. The lime helps extract the co­ caine from the leaves, but the process is very slow, and peak concentra­ tions in the brain are only reached after about two hours. Because the effect happens so slowly, users rarely experience psychological cravings if they stop, although if they rely on it to deal with physical hardship they will, of course, feel worse if they don't chew it any more. Coca chewers are not addicted to cocaine.

When the Spanish conquistadors encountered coca in the 1500s, it fas­ cinated and quite alarmed them. The Catholic Church disapproved of its use in Shamanic rituals, and in 1569 they declared that it had S a ­ tanic powers and that all plantings should be destroyed. The colonists soon discovered, however, that the indigenous people were much less productive when they didn't have coca's stimulating effects, particularly in the silver and gold mines where they often refused to work without their coca rations. In the end, the Spanish accepted the importance of the practice, and began profiting from the trade by levying a 10% tax on coca sales.

Hvis det er rigtigt, så lyder det som et stof man burde se nærmere på i forbindelse med akademisk arbejde. Fx i forbindelse med en 24 timers eksamen. Kilden er angivet til: Laserna, Roberto. "Misconceptions on Coca and Cocaine." (1998). Bogen har kun 2 citationer på Googel scholar og det var ikke lige til at finde en online udgave. Så det er svært at sige om det er rigtigt. Jeg ledte en smule videre og fandt: Zapata-Ortiz, Vicente. "The chewing of coca leaves in Peru." Substance Use & Misuse 5.2 (1970): 287-294, som mere eller mindre bekræfter Nutt's påstande.

Mht. at bruge coca-blade som mental doping, så se fx: Evenden, J. L., et al. "Caffeine and nicotine improve visual tracking by rats: a comparison with amphetamine, cocaine and apomorphine." Psychopharmacology 110.1 (1993): 169-176.

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Secondly, you can't make a free choice if you're an addict. This is not to say that addicts can't get "clean", but that addiction changes our brains and impairs our judgement, so an addict's choice of whether or not to smoke a cigarette is completely different to the choice a non-addict makes. Your first 100 cigarettes might be freely chosen, but once your brain has adapted to the drug, your desire to have your 101st is mostly driven by the unpleasantness of nicotine withdrawal. Protecting people's freedom to choose must include taking steps to avoid addiction.

And thirdly, while libertarians emphasise their right to live without being influenced by others, drug-taking isn't an isolated, personal mat­ter. Your freedom to have a drink and get in your car directly affects other people's freedom to be safe on the road, just as your freedom to have a cigarette where you like affects other people's freedom to choose whether or not to be exposed to your smoke. An important part of this impact on other people is the costs that are covered by public services. I believe, as the majority of people in the UK do, that free public health­ care (ie the NHS) benefits everybody, and that nobody should remain un­ treated even if their illness is partly self-inflicted. Tobacco addicts are also taxpayers, and while banning smoking in public places restricts them as smokers, it increases their freedom as taxpayers by releasing money from treating tobacco-related illnesses.

Nutt viser igen at han er læge. Når man snakker om frit valg, så mener man ganske enkelt mangel af tvang. Dvs. at der ikke er nogen som står bag ved dig med en pistol og truer dig, eller nogen som afpresser dig, og lign. Det handler ikke om nogen anden, filosofisk/metafysisk ide om fri vilje.

Det er korrekt, at det ikke er ligetil hvordan man skal kombinere klassisk liberal argumentation om frihed sålænge at det ikke går udover andre med at have et offentligt sundhedssystem. Mange som er liberale mht. rusmidler vælger den simple løsning, at ville afskaffe det offentlige sundhedssystem. En anden ide er at selvforårsagede sygdomme ikke dækkes, men det fører det praktiske problemer da det ikke er så nemt at afgøre i praksis. Den sidste mulighed, og den som jeg er fan af, er at beskatte rusmidlerne således at disse skatter dækker ekstraudgifterne som samfundet får pga. brugen af rusmidlerne. Det kan give problemer hvis man har nabolande som sælger rusmidlerne billigt, såsom situationen med Danmark og Tyskland (men også Sverige/Norge og Danmark). Det er stadig den bedste løsning mht. det danske samfund jeg kender til.

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Most new medications are produced by a handful of pharmaceuticals companies, known colloquially as "big Pharma". The pharmaceutical industry comes under a lot of criticism, and many people worry about the sort of drugs it produces. The main concern seems to be that the medications sold are ineffective, unnecessary or will have unpleasant side-effects. While there are certainly examples of harmful drugs having been approved in the past (for example, when thalidomide was given to pregnant women and the children were bom with birth defects), today the pharmaceutical industry is one of the most heavily-regulated in the world and the process for getting a drug approved is extremely rigorous.

Nutt's holdning til medicinalindustrien er vist lige positiv nok. Måske han ikke kender til det store problem med publication bias?

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Like benzodiazepines, anabolic steroids are in Class C of the Misuse of Drugs Act, and Schedule 4 of the Medicines Act. This means it is not illegal to buy or possess amounts for personal use, although it is illegal to import with intent to supply. One important but simple harm-reduction measure would be to provide better information about the legal status of the drugs, as many users believe that possession is illegal and therefore don't seek help or treatment.

Vidste ikke at de var lovlige i små mængder i Storbritannien. Men det andet viser problemet med at have stoffer ulovlige - det får folk til at undlade at søge hjælp da de er bange for at blive straffet, hvilket fører til skader som måske kunne have været undgået eller reduceret.

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The discovery of the psychedelic properties of LSD coincided with sev­ eral other breakthroughs in neuroscience that completely revolutionised our understanding of the brain and mental illness. Until then, the princi­ pal framework for understanding mental illness was the one provided by psychoanalysis: people went mad because of repressed traumatic experi­ ences which needed to be exposed through the "talking cure" pioneered by Freud. Although this approach had undoubtedly been beneficial to many people, it had been largely ineffective for those with more severe disorders such as schizophrenia.

The discovery that LSD could create symptoms similar to psychosis co­ incided with the identification of serotonin and its presence in the brain. Together, these discoveries helped develop a new understanding, based on brain chemistry, of psychotic disturbances. This is one of the reasons why drug-control laws that limit research on psychoactive substances are so damaging to neuroscience: so much of what we know about brain chemistry, neurotransmitters, receptors, and how to treat the most severe types of mental illness, has been learned from studying the changes in­ duced by (now-illegal) drugs that change the way we see the world.

Hofmann immediately recognised that his new compound could be beneficial to psychiatry. The first thing he did was inform several of his pharmacologist colleagues, who repeated his experiment with similar re­ sults. The drug was then taken by a group of psychiatrists in Canada, including Humphrey Osmond, Abram Hoffer and Duncan Blewett, all working at the Saskatchewan hospital in North Battleford. An immedi­ ate result was they changed how they personally approached their pa­ tients - +they recorded that they found themselves taking their schizo­ phrenic patients' accounts of their illness more seriously after being put in their shoes for a while. They then began doing experiments on pa­ tients, paying great attention to the "set" and "setting" of the experience.

Forbuddet besværliggør forskningen og sløver derfor videnskaben. Meget dårlig ide.

Psilocybin is found in psychedelic "magic" mushrooms. It's inert itself, but breaks down in the body to psilocin, which is a potent pyschoactive substance. Psilocybin is found in mushrooms all over the world: we know most about their history in religious ceremonies in South and Central America, but the Sami in Siberia have a long history of using fly agaric mushrooms in shamanic rituals, and it seems likely that magic mushrooms were used by the ancient Greeks in the Elysian fields. Psilo­cybin's effects are very similar to LSD, but psilocybin is much shorter-acting, lasting 20 to 30 minutes, so it's much more practical than LSD for use in brain imaging when we study the effects of psychedelics.

Jeg blev overrasket da jeg læste dette. Det må næsten være en sjuskefejl, jeg har svært ved at tro på, at Nutt mener at svampetrip kun varer 20-30 minutter. Han har måske blandet psilocybinsvampe og salvia divinorum sammen?

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In the early 2000s, the British government started to become concerned about magic mushrooms. Some companies had started importing them freeze-dried from the Netherlands and selling them in shops in the Cam­ den area of London, and this was generating bad press in the tabloids. Rather than simply banning their sale, the government decided to act "tough on drugs" and ban their possession altogether. They made a rushed decision to place them in Class A, even though they were clearly much less harmful than other Class A drugs like crack and heroin. (The government argument for categorising them this way was that pure psilo­ cybin was Class A, so the source of the chemical should be as well - al­ though there was little justification for psilocybin being in this Class in the first place.) If they had consulted with us on the ACMD we could have told them that this classification was inappropriate, but in their hurry to be seen to take action they produced a badly-thought-out piece of legislation without seeking our advice at all. (Arguably this was ille­gal, since consulting with the ACMD is required by law). This was the beginning of the Labour government starting to ignore the ACMD when passing drugs legislation - and the beginning of the end for me.

We now have the ridiculous situation that if you find magic mush­ rooms in the wild you can sit in the field and munch them to your heart's content, but if you take them home you could go to prison for up to seven years, and if you give them to a friend you'll be supplying a Class A drug and you could spend 14 years in jail. This silliness weakens respect for the law, and makes people distrust the classification system as an objec­ tive indicator of the relative harm of different drugs.

Man burde helt klart hive regeringen i retten for det. Alt for at få stoppet stofkrigen.

Det med at finde svampe som gror vildt, der gælder noget lign. i Danmark, omend straffen måske er anderledes.

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We may be able to make better recreational drugs as well. As discussed in chapter 6, I've done some research on replacing ethanol in "alcoholic" drinks with a safer alternative such as a reversible GABA-enhancer, and it may be that by 2030 that's what we'll all be drinking in the pub. An alternative approach is to modify alcohol itself to make it safer and more pleasant. We now know that alcohol works on a set of GABA recep­ tors with different functions, and we have started to identify the differ­ ent mechanisms involved. Receptors called Alpha-1 seem to control the sedative effect of alcohol, making you unsteady; +Alpha-5 receptors make you lose your memory; and we think Alpha-2 or Alpha-3 recep­ tors make you feel relaxed and happy. In some very interesting studies, participants were given alcohol with an +inverse agonist that counters alcohol's effects on the Alpha-5 receptor. These participants performed much better on memory tests than those who had had alcohol on its own, showing it is possible to reverse at least one of the effects of alcohol with a drug. In principle, we could make alcohol safer by combining it with a range of inverse agonists that counter its negative effects on the other sorts of GABA receptors, too. It's likely, for example, that if we could find an inverse agonist for Alpha-1 you would be able to drink without becoming unsteady on your feet. Ideally, we would develop a version of alcohol which targets just Alpha-2 or 3, giving us all the sensation of relaxation and enjoyment without the negative effects.

Mere om samme pointe som nævnt tidligere.