On 9 June the United Kingdom’s House of Lords will have its first opportunity to debate a new set of drugs laws. The Psychoactive Substances Bill, proposed by Conservative peer Lord Bates, reflects the new government’s manifesto commitment to deal with legal highs. At present, legal highs (or “novel psychoactive substances”) are identified and banned on a case-by-case basis, which means that the police and the courts must constantly react to new drugs, and a delay is added to the control of these substances.
The new bill’s provisions mainly clarify a rather confusing and haphazard approach to legal highs, which were not anticipated when drugs laws were created in the 1970s. However I believe that there is one situation where the use of psychoactive drugs is currently illegal, and I argue that an amendment to this bill gives us an opportunity to create some good in the world: this is the case of research use of drugs in universities and clinical institutes.
Most illegal psychoactive drugs are controlled by the Misuse of Drugs Act. To study the effects of a drug on a human participant in a UK lab requires a huge amount of work. According to Imperial College’s Dr Robin Carhart-Harris, a researcher into the effects of drugs on the brain, “The current laws impede our research due to the requirement for a Schedule 1 drug license, which is expensive, takes a while to set-up and requires maintenance fees and check-ups. This puts scientists and manufacturers off getting involved. It also massively hikes up the price of the drugs and this is perhaps the biggest impediment.” Dr Carhart-Harris points out that defining a drug as illegal creates a stigma that puts off investment from pharmaceutical manufacturers, which inhibits research. Psychiatrist Dr James Rucker agrees: “Say that a substance that falls under the remit of the Psychoactive Substances law is actually a great antidepressant, or a great antipsychotic, or even an effective anti-dementia medication. How will we know if we can’t do the research?”
Most researchers, and most politicians, are not interested in using drugs in the lab. How can researchers study the effects of drugs in real-world settings? Typically a researcher team will go to a nightclub and hand out questionnaires to people, asking if they have taken a specific drug that evening, and inviting them to come to the lab the next morning for testing. This method raises several practical and ethical difficulties. First, there is the practical problem that people rarely take a single type of drug in an evening. So studying, say, the effect of ecstasy on mood is made more difficult if ecstasy users have also taken other mood-altering substances like cannabis or alcohol during the evening. Prof. Cathy Montgomery from Liverpool John Moores University, whose research on drug use is affected by this problem, explains: “Most of the research in this area has to rely on users of various drugs retrospectively. A major problem with this approach is drug purity. We are unable to assess the effects of a precise quantity of the intended psychoactive chemical, and it is difficult to control for external factors.”
The second problem relates to research ethics. The most statistically powerful type of experiment is a randomised control trial (RCT). In a typical RCT, participants are accepted into the trial if they meet certain criteria, and then randomly assigned either to a placebo group or to a group who take the active form of a drug. Current laws make this possible only with extreme difficulty.
Can researchers be trusted with a cabinet full of drugs? One medical and recreational psychoactive substance that is currently used in research is ketamine. Ketamine is well known as an anaesthetic, and is also used recreationally for its dissociative properties. If it weren’t already a controlled substance, albeit a less restricted substance than some other recreational drugs, ketamine would fall under the remit of the new bill since, as it is worded in Section 2, it “affects the person’s mental functioning or emotional state” and changes a person’s “mood or empathy with others”. Yet some excellent scientific work has resulted from the use of ketamine in labs. Ketamine may act as a fast-acting antidepressant, and seems to reduce suicidal thoughts in severely depressed people. However ketamine use is also associated with serious side effects, including urinary tract and bladder damage. Ketamine also impairs memory, and affects other cognitive functions. We would know far less about the potential risks and benefits of ketamine of it were not available for careful lab-based studies.
Research with human participants, particularly in experiments that involve modulating brain function, is never taken lightly in the United Kingdom. Each proposed experiment is scrutinised by an institutional review board, which reviews the safety of the research and which protects the participant’s rights. These rights include the right to be fully informed of the nature of the research before giving consent, and the right to withdraw from the research at any time. The structure and ethos of good, safe, science is ingrained into UK research culture. With appropriate monitoring of people’s safety, research with psychoactive drugs is no more risky than many other research procedures in neuroscience and medicine.
What would be the benefit of a research exemption? We have already seen that research use of ketamine has led to scientifically important findings, and may lead to treatments for depression and other mood disorders. However there is another benefit to well-conducted research, which is that many drugs initiatives are based on flimsy evidence. Understanding the risks and benefits of the use of a substance can help us to understand where public resources should be spent in either eradicating the supply of a drug, or in developing the drug for pharmaceutical use.
On 9 June the Psychoactive Substances Bill will have its Second Reading in the Lords. This is the first opportunity for the Lords to discuss the bill (the First Reading, on 28 May, simply entered the bill into the Lords’ timetable). The main part of the bill deals with the powers of the police to investigate and prosecute people involved in the supply and use of legal highs and related psychoactive substances. I believe this bill provides an opportunity to clarify the position of researchers at British universities and clinical institutes who wish to develop these substances for the benefit of all.
By Nick Davis - The Guardian/June 8, 2015