The principal aim of these guidelines is to put in place a sound methodological and procedural basis for carrying out each risk assessment. The risk assessment has regard to the health and social risks of the use of, manufacture of, and traffic in the new psychoactive substance, the involvement of organised crime and the possible consequences of control measures. The guidelines were finalised and adopted by the EMCDDA’s Scientific Committee in November 2008.
J.G.C. van Amsterdam, A. Opperhuizen, M.W.J. Koeter, L.A.G.J.M. van Aerts, W. van den Brink
30 June 2009
In its report Ranking of drugs: A comparison of the harmful effects of drugs, the National Institute for Public Health and the Environment (RIVM) has performed a risk assessment on the harmful effects of 17 drugs plus that of tobacco and alcohol. These 19 items were ranked according to their degree of harm.
David Nutt, Leslie A King, William Saulsbury, Colin Blakemore
24 March 2007
Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages.
This article explains the international context of regulation to control addicting substances that gave rise to schedules. It discusses the impact of scheduling decisions on subsequent national drug control legislation and international drug control negotiations, highlighting how the creation of schedules introduced new incentives and rewards into calculations about the national/international commerce in drugs.
No one is suggesting that drugs are not harmful. The critical question is one of scale and degree. We need a full and open discussion of the evidence and a mature debate about what the drug laws are for - and whether they doing their job? In `Estimating drug harms: a risky business', Professor David Nutt, of Imperial College London argues that the relative harms of legal drugs such as alcohol and tobacco are greater than those of a number of illegal drugs, including cannabis, LSD and ecstasy.
The 1961 UN Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances, entrust the Expert Committee on Drug Dependence of the World Health Organization (WHO) with the responsibility of assessing substances for abuse liability in order to make recommendations on their control under the two aforementioned Conventions.
The 196l Single Convention did not include so-called "psychotropic substances" such as amphetamines and barbiturates among the drugs controlled. The discussions on the scope of control were focused on plant-based drugs, such as cannabis, poppy cultivation, poppy straw, coca bush and coca leaves This document describes the development of an international instrument for the control of psychotropic substances.
The Advisory Council on the Misuse of Drugs reviewed the classification of cannabis in the light of real public concern about the potential mental health effects of cannabis use and, in particular, the use of stronger strains of the drug.
Due to its prevalence of use, MDMA is a significant public health issue. The Council believes that criminal justice measures will only have limited effect and strongly advises the promulgation of public health messages. It is of vital importance that issues of classification do not detract from messages concerning public health.
The UK system of classifying drugs according to their harmfulness has been in place since the introduction of the Misuse of Drugs Act in 1971. Over the past 35 years patterns of drug use have changed quite significantly, and recent debates about the classification of certain drugs, especially cannabis, have led to questions about the clarity of the current system and whether it remains fit for purpose.
David J Nutt, Leslie A King, Lawrence D Phillips, on behalf of the Independent Scientific Committee on Drugs
01 November 2010
To provide better guidance to policy makers in health, policing, and social care, the harms that drugs cause need to be properly assessed. This task is not easy because of the wide range of ways in which drugs can cause harm. This study undertook a review of drug harms with the multicriteria decision analysis (MCDA) approach. This technology has been used successfully to lend support to decision makers facing complex issues characterised by many, conflicting objectives.
In my view, perceived harms associated with drugs are vulnerable to so many restrictions on reliability and validity that, for the time being, a serious estimate of drug harm per drug is impossible. In my view, it is even invalid to associate harms to drugs alone. Drugs are used by humans, under individual, social and legal conditions, in certain purities and dosages. Whatever the 'effects' of drugs, harmful or not, they cannot be estimated or even discussed without associating the drug with a particular user or user culture. Drugs per se do not meaningfully exist.
There is a long history of psychoactive substances being regarded as dangerous and subsequently being banned or forbidden. Often the bans were introduced on substances new and unfamiliar to a society, which were viewed as more dangerous than substances which were well known and enculturated. With industrialisation and the globalisation brought by European empires, the growing availability of psychoactive substances was increasingly seen as a problem in the 1800s, setting off social and policy reactions – what we know as the temperance movement against alcohol,
and initial UK legislation limiting the sale of ‘poisons’.
The classification of drugs has a profound impact on the lives and well-being of individuals across the world and where the classification is incorrect, people suffer unnecessarily. This is an issue that deserves greater public awareness and greater engagement with citizenry and that where such public awareness is in place it should be galvanised in order to work towards a new democratic answer to this difficult situation.
E.J.M. Pennings, A. Opperhuizen, J.G.C. van Amsterdam
22 August 2008
In preparing a decision about the legal status of khat in the Netherlands, the Dutch Minister of Health requested CAM (Coordination point Assessment and Monitoring new drugs) to assess the overall risk of khat in the Netherlands. The present paper is a redraft of a report which formed the scientific basis of the risk evaluation procedure (October 2007). This report reviews the scientific data about khat available in the international literature. In addition, the report contains some information specific for the Netherlands (prevalence, availability of khat and public order aspects).
Ketamine is an essential medicine used for anaesthesia. It is the only available anaesthetic for essential surgery in most rural areas of developing countries, home to more than 2 billion of the world’s people. Scheduling ketamine will leave these populations with no alternative anaesthesia for essential surgery, and will further deepen the already acute crisis of global surgery.
The UN Commission considers to bring ketamine under the control of the 1971 Convention on Psychotropic Substances contrary to WHO recommendations. The 58th Session of the UN Commission on Narcotic Drugs (CND) in March 2015 has been asked to consider a Chinese proposal to place ketamine – an essential medicine used for anaesthesia – in Schedule I of the 1971 Convention (E/CN.7/2015/7 and E/CN.7/2015/81). Ketamine is the only available anaesthetic for essential surgery in most rural areas of developing countries, home to more than 2 billion of the world’s people. Scheduling ketamine under any of the 1971 treaty schedules will reduce its availability and further deepen the already acute crisis of global surgery.
The Commission on Narcotic Drugs (CND) in Vienna will decide next week between two opposite proposals by China and the WHO about international control of ketamine, an essential anaesthetic in human and veterinary medicine. China originally proposed bringing ketamine under the 1971 Convention’s most severe control regime of Schedule I, which would dramatically affect its availability for surgery in poor rural settings and emergency situations. The WHO Expert Committee reviewed all the evidence and advised against any international control of ketamine, arguing it would trigger a public health disaster.
Scheduling ketamine would restrict its availability worldwide, which would lead to harmful impact on animal health and welfare, as well on public health. The World Medical Association is urging its 111 member associations to lobby their governments to oppose scheduling the anaesthetic agent Ketamine as a controlled drug.