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Scotland’s Futures Forum

Scotland’s Futures Forum. Devising a scale of harm – and then what?. Dr Laurence Gruer OBE. Current system. Most powerful psychoactive drugs covered by Misuse of Drugs Act (1971) Rough ABC classification of harm: A Heroin, Cocaine, Ecstasy B Amphetamine, Barbiturates C

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Scotland’s Futures Forum

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  1. Scotland’s Futures Forum

  2. Devising a scale of harm – and then what? Dr Laurence Gruer OBE

  3. Current system • Most powerful psychoactive drugs covered by Misuse of Drugs Act (1971) • Rough ABC classification of harm: • A • Heroin, Cocaine, Ecstasy • B • Amphetamine, Barbiturates • C • Cannabis, Benzodiazepines • Not covered • Tobacco, Alcohol

  4. Nutt, Blakemore and colleagues • Ranking of psychoactive drugs based on: • Physical Harm • Dependence • Social harm

  5. Physical harm • Acute • Chronic • Intravenous harm eg HIV, Hepatitis, overdose

  6. Dependence • Intensity of pleasure • Psychological dependence • Physical dependence

  7. Social harms • Intoxication • Other social harms • Health-care costs

  8. Assessment by panels of experts • Score of 0-4 for each of nine variables • Overall average score is index of harm • Panel of addiction psychiatrists • Panel of other experts • Independent scoring • Close agreement

  9. Scale of harm: top ten • Heroin 2.8 A • Cocaine 2.3 A • Barbiturates 2.1 B • Street methadone 1.9 A • Alcohol 1.8 O • Ketamine 1.7 C • Benzodiazepines 1.7 C • Amphetamine 1.6 B • Tobacco 1.6 O • Buprenorphine 1.6 C

  10. Scale of harm: 10-20 • Cannabis 1.4 C • Solvents 1.4 O • 4-MTA 1.4 A • LSD 1.3 A • Methylphenidate 1.2 B • Anabolic steroids 1.2 C • GHB 1.2 C • Ecstasy 1.1 A • Alkyl nitrates 0.9 O • Khat 0.8 O

  11. Scale of harm • Conclusions • Present system is irrational • New system is more rational and consistent • What are its implications for reducing harm?

  12. Volume of harm • Tobacco 26% of adults addicted to nicotine 24% of all deaths in Scotland • Alcohol 2/3rds of assaults 1 in 3 prisoners Rapidly rising rates of alcohol related disease • Heroin Most property crime Most fatal overdoses Most bloodborne viruses • Cannabis Most popular illegal drug Declining use after reclassification Rising proportion of drug service cases

  13. Reducing harm • Legislation, taxation and regulation • Moral codes (oppression of women?) • Public information • Professional training • Health/social care interventions • Safety measures

  14. What works? • Tobacco – increase price, market restrictions, public information • Alcohol – increase price, market restrictions, drink driving laws, public information • Heroin – needle exchange, methadone, rehab, public information

  15. What doesn’t work • Prohibition • Free markets

  16. Where do we go from here? • More, less or different legislation and controls? • More public information? • Cultural evolution/ revolution? • More professional training? • More health/social care interventions?

  17. Where do we go from here? • Is there a less harmful middle way than at present? • If so, what will it take to get us there? • What role can public information play?

  18. Futures Forum

  19. Futures Forum

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