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Nutt DJ. 
“Equasy-- an overlooked addiction with implications for the current debate on drug harms”. 
J Psychopharmacol. 2009 Jan 22;23(1):3-5.
The regulation of illicit drugs in the UK is via the 1971 Misuse of Drugs Act [MDAct]. That of legal drugs is via the Medicines Act if they have clinical utility or via trade regulations in the case of tobacco, alcohol, food supplements and vitamins. When a new drug comes along and concerns are expressed about potential harm, its status is reviewed in the UK by the Advisory Council on the Misuse of Drugs [ACMD] which has a statutory duty to advise the UK government on the harms and risks so that appropriate policy can be generated. Typically this leads to a decision to classify it or not under the MDAct.

In recent years, following a systematic review by the ACMD, ketamine (Nutt and Williams, 2004) has been brought under the act into class C whilst khat (Williams and Nutt, 2005) was considered not to require regulation. Recently benzylpiperazine and related stimulant drugs have been reviewed and recommended for a class C status in agreement with the EMCDDA risk analysis (EMCDDA, 2007). Similarly cannabis classification was reviewed in 2002 (ACMD, 2002) and downgraded to class C, a decision subsequently endorsed by two further reviews (Rawlins, et al., 2005, 2008). Ecstasy is currently in class A, a position challenged by the House of Commons Committee on Science and Technology (2006) which has lead to an ongoing review of its status.

The UK MDAct classifies drugs into three classes, A, B, C on the basis of their harmfulness: Class A (the most harmful) includes cocaine, diamorphine (heroin), 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) lysergic acid diethylamide (LSD) and methamphetamine. Class B (an intermediate category) includes amphetamine, barbiturates, codeine and methylphenidate. Class C (less harmful) includes benzodiazepines, anabolic steroids, gamma-hydroxybutyrate (GHB) and cannabis. This system of classification serves to determine the penalties for the possession and supply of controlled substances. The current maximum penalties are as follows: Class A drugs: for possession – 7-year imprisonment and/or an unlimited fine; for supply – life imprisonment and/or fine; Class B drugs: for possession – 5-year imprisonment and/or an unlimited fine; for supply – 14-year imprisonment and/or fine; Class C drugs: For possession – 2-year imprisonment and/or an unlimited fine; For supply – 14-year imprisonment and/or fine.

How best to assess the classification of a drug is an issue that is and has always been problematic. A potential method for exploring harms has been developed that assesses harms across nine domains; three relate to the personal harms of the drug [acute harms e.g., from overdose, chronic harms and harms due to intravenous use], three relate to its propensity to cause dependence [liking, physical dependence and psychological dependence] and three cover social harms [harms from intoxication, (including anti-social behaviour), harms from supply/dealing, associated acquisitive crime and health care costs]. Each can be scored on a 0–3 scale and a value for each drug derived from which a rank order of harm may be produced (Nutt, et al., 2007). In this study, we also assessed alcohol, tobacco and some other misused substances to provide anchor points that would allow non-experts and the general public to better understand the harms of drugs with which they might not have familiarity. This study produced a degree of public debate and considerable media coverage. This taken together with the subsequent coverage of the classification of cannabis (ACMD, 2008) and the ongoing review of ‘ecstasy’/ MDMA has shown that the arguments about relative drug harms are occurring in an arcane manner, at times taking a quasi-religious character reminiscent of medieval debates about angels and the heads of pins!
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Dec 21, 2015 16:13
Sarcastic Science as Policy Critique #

The author sarcastically examines the clinical risks of "equasy", or "Equine Addiction Syndrome," and analyzes how best to regulate horse riding in the light of our current drug control policies.
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