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 Heroin2.8A Cocaine2.3A Barbiturates2.1B Street methadone1.9A Alcohol1.8O Ketamine1.7C Benzodiazepines1.7C Amphetamine1.6B Tobacco1.6O Buprenorphine1.6C

10. Scale of harm: 10-20 Cannabis1.4C Solvents1.4O 4-MTA1.4A LSD1.3A Methylphenidate1.2B Anabolic steroids1.2C GHB1.2C Ecstasy1.1A Alkyl nitrates0.9O Khat0.8O

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 Tobacco26% of adults addicted to nicotine 24% of all deaths in Scotland Alcohol2/3rds of assaults 1 in 3 prisoners Rapidly rising rates of alcohol related disease HeroinMost 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