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5/7 Scheduling - How could we better classify drugs?

  • Benjamin-Alexandre Jeanroy
  • May 2, 2016
  • 5 min read

Since the ratification of the International Drug Control Regime (IDCR) conventions, science has made substantial progress while it could be argued that the overall legal control framework has not. There is indeed a profound lack of scientific and empirical evidence in the current way we schedule at the global level what we consider to be a drug. Perhaps, one of the most detrimental topic being the lack of universal standard evidence based ‘harm’ index showing how much damages different drugs do and therefore how tightly regulation should be applied to them (1).

As noted by several researchers, “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.” (Nutt & al., 2010) Indeed, negative consequences of drug consumption are not all alike. For example, if your attention is primarily concerned with cancer, heart, lung, mouth diseases, then tobacco and combustion should be your number one concern. If you are more worried about the lives took by drugs and their external consequences, then alcohol should get most of your attention, followed second by potent stimulant such as cocaine and methamphetamines. If you are most worried about fatal overdose, heroin is the winner; and so on.

In 2010, the U.K. based Independent Scientific Committee on Drugs attempted to classify 20 substances (2) by indexing them in regard to their potential harms. These harms were classified on 16 different criteria in a scheduling model called the Multi-Criteria Decision Analysis (MCDA). These criteria included “nine on the substance’s danger to the user and seven gauging the substance’s associated harm on others." (Nutt & al., 2010) These harms were classified into five sub-groups, dividing physical, psychological and social (3) effects as shown in Figure 1

Figure 1 Source: (Nutt & al., 2010)

Unsurprisingly, the results differed widely from the current international scheduling and subsequent political perceptions (4). Alcohol notably, was “found to be the most harmful drug studied when taking into account physical, psychological, and social problems, scoring a total of 72 out of 100. Although crack cocaine, heroin, and methamphetamines were assessed to be more dangerous to the user (…), alcohol was recognized to be the mo st harmful drug to other people.” (Nutt & al., 2010) (See also Figure 2) Tobacco was also considered to be one of the most harmful product, whereas several substances currently under international scheduling were reported much less harmful for individual users and for others than these two pre-excluded substances. (See figure 3). “The study “ultimately pointed out that most global drug scales bear no relation between evidence of harm and legality.” (Nutt & al., 2010)

Figure 2 Source: (Nutt & al., 2010).

Figure 3 Source: (Nutt & al., 2010).

What we probably ought to understand here is that although, “the MCDA process provides a powerful means to deal with complex issues that drug misuse presents” (Nutt & al., 2010), the limitations of such system are numerous and other ways to classify drug exist (5). First and foremost, only harms are taken into account. Benefits and pleasure, as we will see in further articles, could arguably also be components worthy of attention, otherwise it may remain quite difficult to understand why drugs are still consumed. Additionally, “some drugs such as alcohol and tobacco have commercial benefits to society in terms of providing work and tax, which to some extent offset the harms and, although less easy to measure, is also true of production and dealing in illegal drugs.” (Loyd & McKeganey, 2010) Similarly, the potentiality to regulate currently illicit drugs and its impacts are not considered.

Criteria 5, “Addiction” is also debatable as it has nowadays been shown, as we will see in further articles, that such state is heavily influenced by social factors and the environment of consumption. “Thus the socio-cultural context to attitudes to both drugs and harm means that any determination of the relative risks, or benefits, of drugs is fundamentally a subjective and political enterprise.” (Rolles & Measham, 2011) Furthermore, and this is fundamental for harm related approaches, it does not distinguish different ways of substances consumption, some being more harmful than others, nor does it include different patterns of use, and specific context (with the exception of crack cocaine and cocaine).

Finally, it does not take into account, the micro-dosage use which amounts to take about a tenth of a ‘normal’ dose and which allow to alleviate “a bevy of disorders, including depression, migraines and chronic-fatigue syndrome, while increasing outside-the-box thinking.” (Leonard, 2015) Nor is it concerned with the poly-drug use phenomenon that defines contemporary recreational consumption (that is the absorption of several drugs simultaneously, especially popular among youth (Coomber, 1999)). In light of these limitations and the probability that these gaps cannot be resolved, another questions need to be laid out. Does the very concept of drug scheduling really possible, and even necessary? This will be the topic of the next article.

 

(1) It is notably for this reason that harm reduction responses to substances abuse is fundamentally important as it can help patients not able to comply with the abstinence-based treatment objectives. Indeed, “to apply the acquired understanding about problematic patterns of drug use effectively within the context of prevention, treatment, and harm reduction interventions requires making clear distinctions between different patterns of use and between the harmfulness and risks associated with the different substances available on the illicit and licit markets.” (OAS, 2012)

(2) The 20 substances ranked by the UK ISCD include Alcohol, Amphetamine, Anabolic steroids, Benzodiazepines, Buprenorphine, Butane, Cannabis, Cocaine, Crack cocaine, Ecstasy, GHB, Heroin, Ketamine, Khat, LSD, Mephedrone, Methadone, Methamphetamines, Mushrooms, and Tobacco.

(3) “Social harms are harder to ascertain, although estimates based on road traffic and other accidents at home, drug-related violence, and costs to economies in provider countries (eg, Colombia, Afghanistan, and Mexico) have been estimated.” (Nutt & al., 2010)

(4) As noted by the researchers, “the results were eye-opening. The study assessed that the harmfulness of many drugs does not correlate scientifically with global classification systems, including the drug scales used by the United States, the United Kingdom, and the 1961 Convention.” (Nutt & al., 2010) Specifically, the “MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places” (Nutt & al., 2010).

(5) To see another way of scheduling drugs: UK Strategy Unit, 2003.


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