This is my column. This is my column on drugs. Any questions?

June 12th, 2009 by Ben Goldacre Tags:
in bad science, drurrrgs, evidence based policy, politics | 67 Comments »

Ben Goldacre
Saturday 13 June 2009
The Guardian

In areas of moral and political conflict people will always behave badly with evidence, so the war on drugs is a consistent source of entertainment. We have already seen how cannabis being “25 times stronger” was a fantasy, how drugs-related deaths were quietly dropped from the outcome measures for drugs policy, and how a trivial pile of poppies was presented by the government as a serious dent in the Taleban’s heroin revenue

The Home Affairs Select Committee is now looking at the best way way to deal with cocaine. You may wonder why they’re bothering. When the Advisory Council for the Misuse of Drugs Act looked at the evidence on the reclassification of cannabis, they were simply ignored. When Professor David Nutt, the new head of the advisory council, wrote a scientific paper on the relatively modest risks of MDMA, he was personally attacked by the Home Secretary.

In the case of cocaine, there is an even more striking precedent for evidence being ignored: during the early 1990s the World Health Organisation conducted what is probably the largest ever study of global cocaine use. In March 1995 they released a briefing kit which summarised their conclusions, with some tantalising bullet points.

“Health problems from the use of legal substances, particularly alcohol and tobacco, are greater than health problems from cocaine use,” they said. “Few experts describe cocaine as invariably harmful to health. Cocaine-related problems are widely perceived to be more common and more severe for intensive, high-dosage users and very rare and much less severe for occasional, low-dosage users.”

The full report – which has never been published – went on to challenge several of the key principles driving prohibition, and was extremely critical of most US policies. It suggested that supply reduction and law enforcement strategies have failed, and that alternative strategies such as decriminalisation might be explored, flagging up such programmes in Australia, Bolivia, Canada and Colombia.

“Current national and local approaches which over-emphasize punitive drug control measures may actually contribute to the development of heath-related problems,” it said, before committing heresy by recommending research into the unintended adverse consequences of prohibition, and discussing “harm reduction” strategies. “An increase in the adoption of more humane, compassionate responses such as education, treatment and rehabilitation programmes,” it said, “is seen as a desirable counterbalance to the overreliance on law enforcement measures.”

It specifically singled out anti-drug adverts which sought to modify behaviour through fear. “Despite a broad range of educational and prevention approaches, most programmes do not prevent myths, but perpetuate stereotypes and misinform the general public. Such programmes rely on sensationalized, exaggerated statements about cocaine which misinform about patterns of use, stigmatize users, and destroy the educator’s credibility. This has given most education campaigns a naïve image and has reduced confidence in the quality and accuracy of these campaigns.”

It also dared to challenge the prevailing policy view – still enduring – that all drug use is harmful misuse. “An enormous variety was found in the types of people who use cocaine, the amount of drug used, the frequency of use, the duration and intensity of use, the reasons for using and any associated problems they experience.” Experimental and occasional use are by far the most common types of use, it said, and compulsive or dysfunctional use, though clearly worthy of close attention, are much less common.

It then descended into outright heresy. “Occasional cocaine use does not typically lead to severe or even minor physical or social problems … a minority of people start using cocaine or related products, use casually for a short or long period, and suffer little or no negative consequences, even after years of use.” And finally: “use of coca leaves appears to have no negative health effects and has positive, therapeutic, sacred and social functions for indigenous Andean populations.”

At the point where mild cocaine use was described in positive tones, the Americans presumably blew some kind of outrage fuse. This report was never published, because just two months after the press briefing was released, at the 48th World Health Assembly, the US representative to WHO threatened to withdraw US funding for all their research projects and interventions unless the organisation “dissociated itself from the conclusions of the study” and cancelled the publication. According to WHO, even today, this document does not exist, (although you can read a leaked copy in full on the website of the drugs policy think tank Transform at ).

Drugs instantiate the classic problem for evidence based social policy. It may well be that prohibition, and the inevitable distribution of drugs by criminals, gives worse results for all the outcomes we think are important, like harm to the user, harm to our communities through crime, and so on. But equally, it may well be that we will tolerate these worse outcomes, because we decide it is somehow more important that we publicly declare ourselves, as a culture, to be disapproving of drug use, and enshrine that principle in law. It’s okay to do that. You can have policies that go against your stated outcomes, for moral or political reasons: but that doesn’t mean you can hide the evidence, it simply means you must be clear that you don’t care about it.

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67 Responses

  1. Skimmer said,

    June 18, 2009 at 8:52 am

    Thanks, I’ll take a listen when I get home.

    I’d love to know the reason why drug use was reduced. Likely to be a combination of effective treatment, and a reduction in the ‘glamour’ of it all, but that’s just a guess.

    However, by criminalising supply you’re still leaving the trade in the hands of the Al Capone’s, and skewing the incentives towards strong concentrated drugs that can be easily smuggled. Strong bathtub spirits where the product available during alcohol prohibition because they were so much easier to move than gallons of beer.

  2. timboson said,

    June 18, 2009 at 10:26 am

    Great stuff Ben, as always very informative.

    Personally I believe we should legalise it, tax it and use the proceeds for educating people so they can make an informed decision, and healthcare for the percentage of people who always become addicted to a substance.

    Very interesting about Portugal, BKrapcha #48, I never knew.

  3. dslick said,

    June 18, 2009 at 6:00 pm

    speedkermit – sorry, but I don’t want my government lying to me about anything by exaggeration, omission, or in any other way shape or form. I’d prefer to have the unadulterated facts — which on important issues, should be actively sought out on my behalf by the government, rather than actively suppressed — and make up my own mind. You want to trust other people whose interests might not be consistent with yours to decide for you that something is a problem (e.g., Iraq) and then start lying to you about it for “your own good”?

  4. John Stevenson said,

    June 21, 2009 at 5:16 am


    You already are – by far the biggest source of street violence is alcohol.

    Because it involves selective allocation of limited resources to target the bogey-man of the moment, prohibition often makes the situation worse.

    The classic example is the ‘success’ of Australia’s attempts to limit the supply of heroin, a drug that has very few negative side-effects if administered in pure form (overdoses and other health issues from heroin arise from the erratic quality of an illegal supply – addicts prescribed heroin in the UK before its super-criminalisation lived balanced and productive lives).

    The limiting of the supply of heroin led to an explosion in the use of crystal meth, a drug far likelier to set its users off on violent rampages than heroin.

    The paradox is that those calling for severe drug prohibition are often also the same stripe as those demanding free markets in everything. Yet if people who want to get off their races had true free choice the evidence suggests they would pick far ‘nicer’ highs than alcohol and crystal meth.

    Give me a world where those who can’t handle reality (or want a temporary holiday from it) escape using cannabis or heroin any day.


    Heroin is dirt cheap to produce and opium poppies not hard to grow. Tasmania supplies a large proportion of the world’s opium and has a climate similar to France.

    The market for cigarettes is seriously unbalanced by taxation, which massively inflates the street price of legal tobacco products and has the unpleasant side-effect of addicting governments to a revenue stream based on letting a handful of drug barons slowly kill a proportion of its population. The USA, for example, earned almost $15,000 million from tobacco taxes in 2006; yet the previous year all the states spent $541 million on anti-smoking measures while the tobacco industry spent around $13,000 million on marketing.

    The elephant in the room is the reported increase in street violence and disorder since pub opening hours were deregulated in the UK, and the problems that the police say center around late-opening very large pubs in Sydney. This should give pause to those of us who’d legalise everything, because it indicates that some groups of people really can’t be trusted to behave responsibly in a free market: allow the suppliers of substances with socially harmful side-effects open slather and they will find ways to exploit the weak-willed.

  5. JustCurious said,

    June 22, 2009 at 8:47 pm

    Hi Ben,

    I’m guessing you didn’t want to extend this discussion into legal, prescription drugs, but what the hell, I’m burning with curiosity about this, so will go ahead and ask about it here, anyway. (And besides, drugs is drugs, right? They all make you happy, after all).

    It’s just I came across this report recently, suggesting that SSRI’s are damaging to motor neurones in the brain, and that this needs to be investigated further:

    I’d be interested to know how seriously you think this ought to be taken? Looks like the authors did concede that the experiments in rats were not directly equivalent to human physiology, but it does look quite dramatic, all the same.

    If you could use a few seconds to offer your feelings about this, I’d be very grateful indeed. Cheers.

  6. JustCurious said,

    June 22, 2009 at 8:52 pm

    Oh yeah, sorry, another link:

  7. heavens said,

    June 23, 2009 at 11:10 pm

    I wonder:

    If you legalized (not just decriminalized) addictive psychotropic drugs — sold like cigarettes, for example — could we force the manufacturer of the “dangerous product” to pay for drug rehab for all their customers? If someone is high as a kite, or tripping on a hallucinogen, and gets into a car wreck, can we make the drug maker to cover the full costs?

  8. DrJG said,

    June 24, 2009 at 10:25 pm

    Hmmm. I don’t want to seem to be supporting UK or US drug policy, but a lot of the arguments used by their critics don’t, to my mind, stand up very well either.

    Yes, I see more harm from alcohol and tobacco than from drugs. But then again, a lot more of my patients drink or smoke than use illegal drugs. I see little sense in smoking, but, just like the suppressed WHO report claims for cocaine, most alcohol “users” suffer little harm. And I say that as someone whose father’s alcoholism was probably the biggest single influence on their childhood. Ultimately, though, I would say that the arguments for stricter controls on alcohol and tobacco are stronger than those for relaxing controls on other substances.
    Nor am I convinced by arguments based on the negative consequences of Prohibition in the US. I do not accept that experiences gained from banning a drug which had been widely and legally used for many generations can be safely applied to a situation where there has been no prolonged or widespread legal use, if any. Yet, should legalization be tried and turn out to have severe negative consequences, it could prove a very difficult cat to re-bag.
    I have read many earnest and well-meaning articles blaming all the harm from opiate use on its restriction. They almost make it sound as if the times of the London Opium dens were some forgotten halcyon days, which is patent tosh. Opium and its relatives were brought under legal controls for very good medico-social reasons.
    I will agree that poverty and drug use made, in Victorian times, and continue to make a very damaging cocktail, but the world of the rich and famous is littered with examples which prove that great damage can still be caused to those wealthy enough
    a) not to need to turn to crime to fund their habit, and
    b) with far better social networks to afford some protection from the consequences of their use. Amongst my own patients, some have continued to hold down steady jobs to “pay their way” but if anything they are more likely to report the harm their habits cause them than those who fund it through crime and show more obvious outward signs.

    Finally, Ben recently commented on spurious figures for the “costs” of illegal downloads. If read many equally dubious figures for how much money is “wasted” on fighting the illicit drug industry and the organized crime which lies behind so much of it. These figures only make sense if one is going to claim that the criminals are in it largely due to a commitment to maintaining the supply of drugs as a service, rather than committed to getting money from whatever crime pays best. Lets be a bit more realistic about this, take away one source of illicit profit, and few criminals are going to go straight, most will find some other niche, so the potential savings in law enforcement do not actually materialize, they just get diverted to another department.

    No, I don’t like the deliberate suppression of information and evidence, but I’m not ready to accept that evidence as the last word on the subject.

  9. mikey2gorgeous said,

    June 29, 2009 at 9:48 am

    @Justcurious: the study you describe is IN VITRO – it’s done using chemicals directly onto cells in dishes. Also it is using other SSRIs than cocaine.

    It may have a bearing on cocaine use in humans but we cannot derive any conclusions from it because it is so unrelated. There are hundreds (thousands?) of systems in the body that balance & keep us going. Replacing dead cells, replenishing fluids & chemicals. The study you mention cannot take these into account.

  10. hatter said,

    June 29, 2009 at 11:07 am

    @heavens the producers, retailers and users would all be contributing taxes that would then go towards the costs of drug use.

    @DrJG the cat’s already well out of the bag. Has been for decades. Anyone who wants drugs can get them. The dealers don’t even ask for proof of age. Those criminals are not just going to go away, but prohibition has dramatically expanded high return criminal employment.

    @NeilHoskins I’m wondering where you do live? On a remote island perhaps? Maybe a very strict Muslim country? You won’t really find any western country that does not have druggies walking around. Especially when there’s a game on.

    I’ve been attacked by someone completely sober. I blame the lack of drugs. I don’t want to live in a country with sober people walking around.

  11. Helen said,

    June 29, 2009 at 7:09 pm

    #41 In reply to Speedkermit, as a member of the public myself, I strongly object to the general public being lied to, even if it is supposedly for our own benefit.

    It’s a slippery slope. If we give politicians a mandate to lie to us whenever they believe it is for our own good, then who are they accountable to? Who watches the watchers?

  12. JustCurious said,

    July 1, 2009 at 10:53 am

    Sorry Ben, that was very anti-social of me to post off-topic like that, it’s just that I’m a bit new to the site, so got carried away with the prospect of being able to ask you a question about the research.

    However, tell you what, here’s a more interesting and relevant question:

    How do you think the overall safety record of street drugs like heroin and Cocaine, might compares with SSRI’s?

    For starters I guess you can say that street drugs don’t usually cause movement disorders – or do they? George Monbiot was quoting your article the other day, and seemed to agree that the health risks from heroine/cocaine were pretty minimal.

    What are your thoughts on this. Regards.

  13. prescott said,

    July 3, 2009 at 7:11 pm

    Nobody is free of cancer, I hope soon find a cure and to fight this disease now, because it is tedious to go to therapy all the time and drugs to treat the disease are very strong opioids such as hydrocodone, Lortab, vicodin medicines of very high content of acetaminophen and codeine considered hallucinogenic drugs, then imagine how much pain, really hope there will be a solution as quickly as possible for this …..

  14. Chenneth said,

    July 16, 2009 at 10:59 pm

    Fantastic article. I teach at a college and I teach the ‘truth’ about drugs… this is completely against what the establishment would like but I just don’t tell them. Sad though that I should have to resort to this kind of subterfuge just to get a point across. I also use the ‘Should drugs be legalised’ debate to highlight the importance of critical thinking and using evidence to back up arguments.
    Is this the right way forward?

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  16. Pharmwizard said,

    December 28, 2009 at 1:46 pm

    A rather wise man said: “Not all drugs are bad…in fact, some of them are damned good.”

  17. toasterpop said,

    July 27, 2014 at 8:57 pm

    Thank you for the lively banter here. The truth is that in many of these cases, it has been poor government policy attempting to cure an age old social problem forcing individuals to do what they clearly do not wish to do. With Europe and the States having developed along isolated paths, one of harm reduction and one in pursuit of abstinence, it has been fascinating to watch different clinical models emerge at the polar fringes and now seek to meet back toward a center. Reviving my own thoughts on this and other recovery topics after a bit of a pause on my blog and can’t thank you enough for the insights. More to come in terms on non-12 Step Recovery and Treatment options for addiction and alcoholism.