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Equivalence in death

Mark Easton | 08:55 UK time, Tuesday, 10 February 2009

Having read the latest instalment of the "ecstasy classification" row, I wonder whether anyone is tempted to "lash out at the home secretary" for "trivialising" the dangers of riding horses and showing "insensitivity to the families of victims" of horse-riding accidents.

I ask after Jacqui Smith publicly rebuked the head of the Advisory Council on the Misuse of Drugs for suggesting that the risks from horse riding were significantly greater than the risks from taking ecstasy.

The Press Association describes how the home secretary "lashed out at the government's top drug adviser for suggesting taking ecstasy was no worse than riding a horse".

"For me, that makes light of a serious problem, trivialises the dangers of drugs, shows insensitivity to the families of victims of ecstasy and sends the wrong message to young people about the dangers of drugs," the home secretary told the Commons.

So what of the loved ones of the 10 people who die in horse-riding accidents each year in Britain and the many more who must live with the permanent neurological and physical damage from such incidents? Ms Smith told MPs that "there is absolutely no equivalence" between those who are killed or injured in "the legal activity of horse riding and the illegal activity of drug taking".

Some might argue, however, that the "equivalence" is very great between the parent of a young person who dies taking drugs or dies falling from a horse. The sense of loss and the grief may well be remarkably similar. If there is a significant difference, it is that people are much more likely to be harmed from riding a horse than taking ecstasy. It might be handy for people to know that.

And that was Professor David Nutt's point; once again, we are witness to the spectacle of a scientific point being obscured by a political one.

As head of the Advisory Council on the Misuse of Drugs, Professor Nutt's job is to assess the harms and risks associated with illicit drugs. He has developed a nine-point "harm matrix" to bring the best science to the process.

However, there is obvious frustration that having asked him and his committee to use their scientific expertise to make rational judgements about the relative risks and harms associated with different illicit drugs, politicians then ignore their advice.

It is probable that, on Wednesday, the ACMD will advise ministers that ecstasy be downgraded from Class A to Class B, and that ministers will take no notice.

In his provocative article, Professor Nutt complains that "the drug debate takes place without reference to other causes of harm in society, which tends to give drugs a different, more worrying status".

So he invents an addiction called "equasy" to make his point. He reveals how the harmful consequences are well established - "about 10 people a year die of it and many more suffer neurological damage". He adds that "it is also associated with over 100 road traffic accidents per year - often with deaths".

Equasy, he then reveals, is Equine Addiction Syndrome, "a condition characterised by gaining pleasure from horses and being prepared to countenance the consequences, especially the harms from falling off / under the horse".

Using the same nine-point scale that his committee employs for drugs, he compares 'Equasy" and "Ecstasy". In terms of "acute harm", riding a horse is proportionately 28 times more dangerous than taking ecstasy.

Chart comparing the risks of ecstasy and equasy - apologies to users with screen readers; a problem with stylesheets is preventing us displaying tabled text

Now, this is clearly an absurd comparison, but Professor Nutt is employing satire. "Making riding illegal would completely prevent all these harms and would be, in practice, very easy to do", he writes. He acknowledges that there would be "little public or government support for such an option".

"This attitude", he continues, "raises the critical question of why society tolerates - indeed encourages - certain forms of potentially harmful behaviour but not others, such as drug abuse."

"Is there a lesson from these relative comparisons of harms and risk that regulatory authorities could use to make better drug harm assessments and thus better laws?", he asks. "The use of rational evidence for the assessment of the harms of drugs will be one step forward to the development of a credible drugs strategy."

There will be a few people, perhaps, reading this post who will have been directly affected by the damage that ecstasy can do. There are, however, likely to be many more directly affected by the harm from pain killers.

A study in Scotland in 2001 titled "Distorted? A quantitative exploration of drug fatality reports in the popular press" reviewed 10 years of media reporting of drug deaths.

It found that the likelihood of a newspaper reporting a death from paracetamol (unclassified) was one in 250 deaths. For diazepam (Class C), it was one in 50. For amphetamine (Class B), it was one in three.

For ecstasy (Class A), every associated death was reported. And I very rarely read reports in the national press about those deaths from horse-riding accidents.


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