 Hello, and welcome to Downstream, the Navarra Media interview series that cracks open big ideas like it's a lovely tropical coconut, fills it with lime, a dash of rum, and serves up with a cocktail umbrella and a straw. And I am delighted to be talking to Professor David Nutt, Professor of Neuropsychopharmacology. Can you tell I've been practicing saying that all morning? At Imperial, thank you so much for joining us, David. It's a pleasure. Thank you for that. Are you a David or a Dave? Well, it depends. If there's other Davids in the room, I call myself Dave, but you can call me whatever. Dave or David, I don't mind. So not to cast dispersions on the celebrity status of neuropsychopharmacologists, but a lot of our viewers might be familiar with you because of your work on drugs in particular. So for those who are unfamiliar, David is the author of Drugs Without the Hot Air, Minimising the Harms of Legal and Illegal Drugs. You sat on the government's advisory council on the misuse of drugs until you were dismissed by the then Home Secretary, Alan Johnson, after arguing in a paper that alcohol, tobacco, and horse riding are more dangerous than some illegal drugs like LSD and ecstasy. I'm not sure what you've got to say about horse riding while on LSD, but maybe we could save that question for the end. I never recommend anyone riding a horse, it's far too dangerous for the rider and for the horse. I don't stick with LSD myself. So for those who might not know your work, what is your position on illegal drugs and how does it differ from the government's? Well, my position is that the concept of illegality is a very charged one. At a very simple level, my research and that of hundreds of other people who've been in this field for longer than me, it's clearly shown that the legal illegal status of a drug has got nothing to do with it, whether it's harmful or not. But it's largely driven by political expediency at the time it gets discovered. So what does a harm reduction approach to drugs even mean? How do you quantify harm across different substances? Well, that's where we have made a significant advance. About 10 years ago, we decided to develop what you might call a transparent, systematic way of assessing drug harms. And we did it through a group of experts and we use a technique called multi-criteria decision analysis. And that is an extremely powerful way of comparing anything you like. But certainly in the case of comparing drug harms, it allows us to compare harms from the drug, like are you going to die if you take fentanyl? With the harms that come from, say, producing the drug, like the war in Afghanistan or the deforestation in Peru relating to cocoa production. It turns out that there are 16 harms of drugs. There are nine harms to the user and there are seven harms to society. And this MCDA approach allows us to collate all of them and come up with a single figure of harm. And we did that. We published it in the Lancet in 2010. And it turns out alcohol is the most harmful drug in the UK, which is why I was sacked because I was saying drugs like LSD and MDMA are way less harmful than alcohol. And the government didn't want to know that because the drinks industry didn't want them to know that. And the many newspapers didn't want them to know that. In fact, most people don't want to know that because most people drink. I mean, when I was growing up, it was the Lea Betts era. So there was a VHS and a teacher would pop it on. And what I learned about ecstasy was from the case of Lea Betts, who took ecstasy at a party. And I think a friend of hers was convicted of drug dealing, who was a teenager as well. So I grew up thinking that all drugs are equally dangerous to the user. So you've said that alcohol, according to this matrix of criteria that you guys put together is the most dangerous in the UK. The most harmful to the UK, but not the most harmful to the user. The most harmful to the user is crack cocaine crystal meth heroin. The reason alcohol is the most harmful in the UK is because so many people use it. I would estimate probably every family in Britain has been damaged from alcohol, either because someone's become dependent or harmed by it or because someone who's been drinking has damaged them. So thinking about the difference between harm and danger, I think, is the really important point here. And so you've made the point about the drinks industry, but how is it that relatively new drugs like ecstasy or synthetic drugs accrue this sense of danger. They very quickly get placed in that category of this is dangerous and no one should use them. How does that happen? Well, the newspapers lie about them and politicians lie about them. And the organisations, Puritan based organisations, they want to eliminate all drugs. Actually, they quite like to eliminate alcohol use too. If once you scrape the surface, you realise that actually their prohibition is through and through and they'd like to get rid of all drug use. But they know they can do alcohol. It was tried and it failed in America and Sweden and Norway in the 1920s. So basically they attack new drugs because there's not such a vested interest in maintaining their availability. So when you're putting together a model for assessing the harm of drugs, how do you separate the harm of the substance from the harm of criminalisation? Yeah, excellent question. And the answer is we with difficulty is the answer, but we have tried to subsequently to look into that. We've done that in two ways. So after our landmark Lancet paper, we then went and looked at different classes of drug and did some analysis on those. So for instance, we took opiates and we looked at opiates, whether they use legally or illegally. And it is clear that illegal use of opiates contributes greater. They're more harmful when you use them illegally than when you use them legally, which makes sense for two reasons. One is, of course, if you're injecting in a gutter or the back door of a shop somewhere, you're not going to get sterile sterility in needles, etc. And also you don't know the source. The illegal source can produce contaminated drugs. And now a particular problem with opiates is that you might be thinking you're buying heroin but you're getting fentanyl and it can kill you. So yeah, so we've done that. We've also done that to some extent with tobacco products showing that vaping is way, way less harmful than tobacco smoking. So we can dissect a part of the harms of drugs in terms of how they're used and how they're assessed. But the other thing we've done more recently, which people know so much about, is we've looked at modeling different regulatory systems. That's even more complicated than looking at the harms of drugs. So as I said, there were 16 harms of drugs, but if you look at the number of variables, you'll have to consider when you're looking at different regulatory systems. It turns out there are 27. So there's issues around crime, there's issues around policing, there's issues around... Well, the most interesting one of all, to some extent, is the issue around to what extent there's a policy, corrupt politicians. And then there's also the health costs and the education costs and et cetera. So there are 27 separate kind of costs you have to look at in order to work out which policy might give the best overall outcome in terms of minimizing damage and maximizing benefit. And we were able to do that for three drugs. We did it for alcohol as a sort of prototypical kind of... That's our control and cannabis. Interestingly, for both of those drugs, state control came out on top. So state control is better for alcohol and better for cannabis. And that's interesting, isn't it? Because state control of alcohol is what they do in Sweden and state control of cannabis is what they do in Uruguay. So those two countries have got it right according to this very detailed analysis we've done. I mean, so one of the things that you've written about is the way in which currently the system we have pulls problematic users, people who suffer from problems with addiction that you phrased it as they get pulled into the dragnet of the criminal justice system. And I thought that was really wonderful evocative phrasing. Could you expand on that a little bit and perhaps tell us what your views are on the decriminalization of all psychoactive substances? Well, personal use, personal position of all drugs should be decriminalized, absolutely. That's hardly anyone's going to argue against that because criminalization just makes things worse. As you pointed out, once people get a criminal record they get sucked into an underclass where they find it very difficult. Even if you've got a criminal record of cannabis possession you can be denied access to teaching, to becoming a teacher, to becoming a policeman. If you want to join the RME you can only join at the level of a private, you can't join at the level of an officer. So there's enormous deterrious effects on people's career from these criminalizations. And of course it's an extraordinary racist policy because we know that four to five times greater likelihood of you having a criminal record if you're a black or a minority than if you're white. We know that you've got very little chance of being convicted if you're a conservative minister. And like Michael Gove, even if you admit to cocaine you still become the most second most powerful man in the British government. But Boris Johnson, who when I have I got news for you and both still live of doing cocaine. Well, yes, he's now denied it. He said he would probably cast a sugar. But you know anyway. He paid 100 pound a gram for cast a sugar. My God. Well, he's very rich. And anyway, but let's put the policies. The reality is it's a racist policy. It's a policy designed basically to disadvantage people who don't vote to encourage or to appease the bloodlust of right-wing newspapers who like to see people punished for doing things that their readers would like to do but haven't got the courage to do. And it creates an underclass. And when you're in an underclass, what do you do? Well, about the only thing you can do. This is really, really absolutely the case in the state is deal drugs because it's the only job you've got. So you know the drug markets are created by people who've been punished for using drugs and it's become self-fulfilling. I mean, one of the things that I'm interested in is the way in which proponents of decriminalization, there's a consensus around decriminalizing possession for personal use. And then it starts to fall apart when you start talking about possession with intent to supply. And when you look at convictions for dealing, black people are 1.4 times more likely to receive an immediate custodial sentence for the same crimes as a white person. So that itself is racialized. So how do you deal with the inequalities you see in convictions for dealing without saying, well, we'd have to decriminalize or indeed legalize and regulate that too? We just give better guidance to judges. I mean, that's pretty straightforward. Yeah, I mean, you know, because the judges make, convictions are done by juries, but the judge decides on the penalties. And if there are inequalities, which as you pointed out, there are, there are worse inequalities, by the way. The inequalities relate to the type of drug, they're even worse than relating to ethnicity or your color. The long, you know, which drug gives you the longest prison sentence for dealing? I would guess crack, but... Yeah, everyone would, but it's MDMA. Why is it MDMA? Because judges hate young people having fun. They can accept that a crack dealer might be doing a purpose because he might be helping people who are addicted to crack. But if you're selling MDMA, all you're doing is giving young people a chance to have fun. And that's a really bad thing. You mustn't let young people have fun because they might enjoy it. I mean, one of the things I'm really interesting is how different drugs accrue different narratives around them. This is something which Dr. Carl Hart, who's very open about his own psychoactive substance use, he admits to taking amphetamines, cane, even heroin. He's quite keen to bust some of these myths. But for instance, taking MDMA and the kind of social circles I'm moving is very, you know, is commonplace and it's not stigmatized at all. But when you talk to people about other drugs, perhaps cocaine or even heroin, the moral tone of the conversation changes. And to what extent are people who, you know, are in favor of decriminalization, maintaining these quite racialized and classed distinctions about which drugs are the good ones and which ones are the evil, irredeemable ones? Yeah, it's hard for me to come into that because you're talking about his anecdote. And one of the things I've often said, if you want to change drug policy, the most powerful tool in the whole of the armory of tools to change drug policy is fashion. Fashion is infinitely more powerful than legislation or education or exhortation. Some drugs are fashionable in some groups and some are unfashionable. And a lot of the change in drug use that we see on a regular basis is driven by fashion. I don't know if you've got brothers and sisters, but your younger brothers and sisters probably would not want to do what you do simply because you do it. You know, and they certainly don't want to do what their parents do because so fashion isn't really important, sir. And that's a factor. But in terms of general messaging, I mean, there's only one... Well, there are two key rules I say about drugs. Absolutely two ways to minimize harm. Never inject and never get caught. But I mean, on the never get caught part, we effectively have a two-tier justice system. If you're of my social class, you are unlikely to be stopped and searched, even if you are a person of color like me, right? I can go through Notting Hill Carnival and nobody's bothering me. You're sure it's not because you're a woman? Well, I think that's the element of it as well. But it's also the fact that the kind of parties I go to, police aren't raiding that and it gives a crap. Whereas you walk through Notting Hill Carnival and you see the same group of young black lads getting stopped and searched again and again. You've got a two-tier system. Effectively, it's decriminalized for people who are well off enough or insulated by virtue of their race or their gender. And you're policed, harassed and surveilled if you're not. Well, actually, it's not to do with... We've seen in terms of the stuff in search of successful black sports people. Even if you're rich and black, you're deemed to be a drug dealer just because you're rich and black. I mean, the drug laws were conceived. They started in about 1910. They've always been conceived to find the other, to identify the other. A group that you can vilify so that you can pretend that you're doing something to protect this country, the white middle classes from them. And you find a group that can't protest so that you can abuse them as much as you'd like and get away with it. So it starts off with the Chinese. So we start creating hysteria about Chinese opium dens. And young women and white women are going and smoking opium and having sex with Chinese men in and or so sailors and that. You know, it's racist completely. What happens? So you ban opium and then people strangely start injecting morphine, which is considerably worse. But the policy then goes on and America has prohibition, which failed. But when prohibition is restored, when alcohol is restored to America, the Drug Enforcement Agency, as it's now become, under Harry Anslinger has to have something else to keep it. It's a business, so they have to have employment. So they turn against Mexicans and they start to associate Mexicans with cannabis and they start to attack them. And and so it goes on. And of course, the ultimate sort of pinnacle of the deceit is the 1968 Nixon election. When he's going for reelection, the war on the war in war in Vietnam is failing. He's going to lose because everyone hates the war in Vietnam. So he creates an internal scare. He creates scare about drugs. He creates the war on drugs. So people forget the war in Vietnam. And his what we would now call his mind or his thought agent, his Cummings says, John Ehrlichman says, OK, what are we going to do? Well, we've got to scare the American people. So we've got two opponents. We've got the anti-war left. And then really left, they're just sensible people. And we've got black people. So we're going to vilify them because we're going to tell the world or tell America that the anti-war left are taking cannabis and black people are taking heroin. And we're going to scare Americans that these people are going to take over America. So we've got to fight the drugs and we're going to fight the people. And as he said, it's so graphic. He said, by accusing them of drug-taking, illegal drug-taking, we could vilify them. We could break up their meetings. We could abuse them night after night on the evening news, completely throw attention away from Vietnam onto these underclasses. And then win the election. It was an absolutely brilliant campaign. He went from losing the election to winning every state except Maine. And as Ehrlichman said afterwards, did we know we were lying about the drugs? Of course we did. Everyone knows they're lying. All politicians know they're lying about drugs, but they just choose to lie because it's an easy way of getting political victory. But at the point that Rick Lines makes, and I really like his work on drugs, one of the things that he says is that the UN 1961 Treaty on Drugs is the only UN treaty to use the word evil. The word evil doesn't appear in the treaty on apartheid, the treaty on slavery or genocide or rape as a weapon of war. It's only drugs. And so thinking about how that developed, I think, as you said, out of identifying an internal other, Chinese people, OPM, that's something which has now been entrenched in international law. So if you want to start shifting that point of view, where do you start? Do you start with saying we're going to decriminalize at a local level? Do you start by trying to build social movements, change in culture? How do you deal with the fact that we have embedded in our political imagination the idea that drugs are evil? Well, you tell the truth. You have programs like this which educate people about the history and a lot of people don't realise it. Most doctors, when I say I'm working with Silo Simon for depression, they say, well, that's a very dangerous drug. It's a Schedule 1 drug and it must be addictive. And I say, no, it's not addictive and it's not dangerous. And they say, well, it must be. It's in Schedule 1. And I say it's in Schedule 1 for political reasons because of the Vietnam War and people protesting the Vietnam War under LSD. But the lies that have been told have been told for so long and with such vigor that even educated people believe them. So you're quite right. And the change has to come through education but also in emphasising and this is where we're currently working hard emphasising the fact that illegality has had almost no impact on use. For some drugs like Silo Simon and LSD it has had no impact on harm. For some drugs like opiates it's actually worsened the harm. But the really compelling argument to my mind is that it has denied access of proven therapies to people who need them. And that's the really criminal thing. And most people can eventually understand that it makes no sense to deny medical access to a drug even if it was to reduce recreational use, which it isn't. Are the cases you're talking about, there's been studies done on the use of ketamine to treat alcoholism, Silo Simon for depression but also for Crohn's disease and issues to do with inflammation that was one study I was reading about and obviously cannabis for chronic pain and other issues as well. So in terms of the kind of research you do what for you are the areas where if you go you know what, if we decriminalise drugs use there are these health issues which could really be dealt with. What for you were the most urgent ones? Addiction, addiction. This is the ultimate paradox. People say we cannot make these drugs legal because they're addictive and I say they're not addictive they've never been addictive they're anti-addictive and they say no they must be addictive because they're illegal drugs and this this illegality paradox actually oh I don't want to talk about my history but it does go back to a conversation I had with the Home Secretary Jackie Smith in 2009 when she insisted that illegality was the defining feature of a drug rather than harm. I mean it was completely surreal but I'll just tell you I just actually just as an aside on Saturday night on the Radio 5 Live on the Steve Nolan show I had the most surreal conversation with an ex-MP with Edwina Curry about the whole issue about drug testing in prisons a completely failed policy a policy that so so failed it's led to hundreds and hundreds of deaths in prisons because people switched from cannabis to spice and she could not accept that it was viable or allowable to actually to evaluate the policy. Her view is well we've got to test prisoners to stop them taking drugs and I said well but they're still taking drugs and taking worse drugs so it hasn't your policy failed? No. And I said what evidence what actually evidence could it ever convince you your policies failed? And she said effectively none because it's a policy. So that's gone off the track a little bit but it just emphasizes that there's still this enormous conflict between politicians who say policies are what matter and and sane people who say actually outcomes are what matter. So what am I doing? I let me answer your question what I'm like what the most important area is addiction. Well the most important actually the most important so we've got to go let's go back to the very beginnings of the psychedelic era let's go back to to a man called Bill Wilson. Bill Wilson founded alcoholics anonymous. He cracked his alcoholism he freed himself as he describes it from the chains of alcoholism having had a psychedelic trip and he realized it's once he took LSD subsequently and he was a guy that actually gave LSD to Huxley he realized that LSD could be used to break the shackles of alcoholism in many people and he's got the US government just to conduct six trials usually one or two doses of LSD in people with alcoholism and the effect the effect size as we see it the clinical effect was twice as big as anything we have ever had to treat alcoholism since but when LSD got banned because of the Vietnam War so all research on LSD and alcoholism stopped and there's never been a trial since but if you look at those six trials and you look at that effect size and you think well what could have happened if we carried on using LSD and I've estimated that in the 50-odd year since it was banned probably over 100 million people worldwide have died prematurely from alcoholism and let's say LSD saved 10% of them it would probably do better but let's just say it was 10% well that'd be 10 million lives saved now look at the other side of the equation how many people's lives have been saved by the ban of LSD well I mean probably none but let's be generous let's say well maybe maybe if you know a few people have been deterred from using it so maybe a thousand lives have been saved so you've got a thousand lives here and you've got 10 million lives on the other side that equation is so imbalanced no one in their right mind except a politician could possibly argue that it was irrational to ban LSD there are people who will say looking at Scotland for instance which has got the highest rate of drugs deaths in western Europe saying well look facilitating the sale of drugs in that context obviously it's worsened by deprivation, economic inequalities lack of opportunities but facilitating the distribution or possession of drugs in that context would be wildly irresponsible what would your response be to that? I don't know what they're talking about what are they talking about you're talking about decriminalising personal possession well you that's utterly responsible that is what you need to do what you need to do Portugal's done it Portugal decriminalised possession in the 15 years of decriminalisation of heroin possession people with heroin get treatment they get basically free heroin or methadone or some other treatment and they start dying and in those 15 years deaths from opiates in Portugal have decreased to one third of what they were before in Scotland and in Britain we've carried on prohibiting people criminalising them for using heroin and deaths from opiates have gone up by two thirds so the answer is we know the answer everyone you know I mean it's not even this you know you can't don't need to debate it you just got to have systems in place which allow people access to treatment rather than prison Do you think that when it comes to a drug like fentanyl which has been partially responsible for many of the opiate deaths that we've seen in the United States has been making its way over here is there a way to safely control access to something like fentanyl or is the only way to shift people off of it is in some way to facilitate them accessing safer opiates and essentially closing down the market for fentanyl in the first place Yeah I mean I'm sounding like a kind of you know I'm just a bent record aren't I but when you look back over over 150 years of drug policy you see the same mistakes being made over and over and over again in the face of people like me with some knowledge and expertise pointing out that what these mistakes are being made and fentanyl is of course you know this is in some ways one of the worst examples of all so maybe your you know your listeners don't fully understand what's gone on in America so in America in the rather turn of just about the turn of the century there was a big increase in the prescription of morphine derivatives for pain particularly in the public health system over there the Medicaid system people in pain were getting treatment and that's kind of partly a good thing some but a lot of that treatment was being given out rather a bit excessively and people in the families of those who were getting these painkillers like oxycodone taking them and using them so there was a rise in opiate misuse amongst that population usually poor whites living outside of cities the government said we've got a problem we've got an opiate crisis because some of the kids teenagers you know were taking that and dying so they then put a massive clamp down on the prescribing of these opiates like oxycodone but they didn't put into place anything to help people stop using so they went if you stop prescribing opiate would you get cold turkey people don't like cold turkey what did they do they went out on the streets and they bought opiates the first drug they could get because that was the one that was available was heroin now heroin has never been a medicine in America or was it a band in 48 so when you see 20,000 heroin deaths you know that's black market there's no way that's coming from the health system so there's this surge of heroin deaths so then they decide to clamp down on heroin to stop them dying and unfortunately at that point the Mexican cartels who were supplying the heroin realized and it's quite interesting it took them a long time so in 20 years to realize that there were alternatives to heroin called fentanyls and fentanyls are for the black market a fantastic drug because fentanyl itself which is one of the weakest fentanyls is is twice as it's 50 times as potent as heroin and half the price so then you can increase your profit margin about about 100 folds so they switched to fentanyls and then they went on to over 100 different fentanyls now are have been detected on the black market as opioids and now they've got 70,000 or 100,000 going up each year deaths in America from fentanyls so we've created not only the problem of people needing the black market by stopping prescribing to them but also we've created a worse black market and fentanyls are in Britain we've had I think 70 deaths last year and we have to do something about it so your question really was what can we do about it and the answer is well let's not make it worse so the first thing is anyone wants treatment anyone's using an opiate should be allowed to walk into a clinic any time pretty well certainly any time in the day time and get access to treatment instantly that's the first thing and secondly obviously we've got to roll out a lot more than the loxones are the people that who are dying of fentanyl and who actually think they're getting heroin but they're getting fentanyl mixed with it can be treated so we've got to roll out in the loxone the antidote and much much more effectively and you know I had an email last week from someone saying I'm desperate I'm desperate desperate to get in the loxone but my doctor won't prescribe it and my pharmacy won't give it to me and I mean that's it's actually completely moronic we should have no loxone on the side of the streets like we have defibrillator so that's the next thing to do and then the other thing we've got to do is try to try to in Britain there is some diversion of fentanyl from medical use into recreation use so we need to try to minimize that but overall we must learn the lesson that banning something almost always leads to the development of something that is more toxic more potent and lower mass so it's more profitable for the black market I think I might know what you might think of this question which is it's silly to frame things as consumer choices but I'm going to ask the stupid question anyway considering what we know about the violence in supply chains when you're talking about drugs like cocaine can you consider it ethically neutral to purchase illegal drugs when you trace it back and there's a chain of violence exploitation dispossession and misery yeah but it's also for many people the only viable source of income so the farmers in Peru and Brazil and Colombia they sell cocoa because they can't you know the price of their coffee has dropped to the point where it's unsustainable I mean opium was growing you know in Afghanistan because it was the certainly way more profitable than anything else they could grow so it's not as simple as that sure you know there's a suffering but it's not unnecessarily the case that actually eliminating those markets would actually be beneficial to the people out there but it could be I mean actually here was an interesting policy that was so I think 2004 Tony Blair was offered a solution to the Afghan opium problem and it was suggested to him that we or the international community buy the crop it's about four billion pounds a year buy the afghan afghan opium crop and never was happy we buy it we destroy it doesn't get you know into the west and the growers have catch and he agreed and then just before he signed the check or signed the contract or whatever the year he he said but then it's gone for good and he said no no they'll plant them next year and he decided then it wasn't worth it and that's an interesting economic question I mean I suspect it was worth it but we spent a trillion trillion dollars now in the war on drugs so a few billion each year take a long time to build up to a trillion but anyway he decided not to but that would be an economically sensible thing to do to to give people money not to grow open do you think that people in this country when talking about drugs are scared to admit the obvious which is that one there is such a thing as safe recreational use because people do it all the time and two that drugs are kind of fun do you feel that there's a puritanism which goes you know far beyond the Vietnam War and is a fear of admitting no well there's a puritanism absolutely but it's it's complicated puritanism so yeah the temperance movement started in the 1880s it tried to get rid of alcohol it tried to get rid of in the 1880s you go into a pharmacy you could buy tincture of cannabis tincture of cocaine tincture of heroin tincture of morphine and you go down the off-license and you know a pub and you could buy alcohol and the temperance movement tried to destroy everything and it succeeded in getting rid of all the drugs and it succeeded in the 1920s as I say in America and Sweden and Norway to get rid of alcohol a lot of people don't know this but in I think it's in 2023 there was an election a general election and in Dundee Winston Churchill stood against the temperance candidate in Dundee and the temperance candidate beat him by 14 000 votes so there was an enormous public antipathy to all drugs and which led to in America as I say the complete prohibition so there's always been a strong puritanical temperance movement and eventually of course that was turned over with alcohol but it and then as I explained earlier Anselinger turned it on to other drugs so yes so you've got the puritanical temperance movement which of course had you know it had two elements it had a moral element which is drugs are bad in the only way you get to heaven if you don't take any but it also was clever because it it actually hid that behind the veneer of kids are dying mothers are giving Lord and them to their kids open to their kids to shut them up and they're dying and and that was the kind of the public hysteria these I mean there probably were some deaths accidental deaths but that was enough to to get these drugs banned but behind it also I think they also the alcohol industry particularly after prohibition the alcohol industry decided it wasn't ever going to get on that route again so I think it systematically tried to put out disinformation about the the harms of alcohol and magnify the harms of other drugs and we see that now in American states where and they're rolling out aren't they I think what we've got now 13 American states with legal legal cannabis we see that that when the elections are coming up to vote for legality of cannabis we see the alcohol industries are always supporting the anti-legalization group because it's a threat to their to their market in fact I sometimes say I'll say it now that I think the industry has been remarkably successful in 100 years it's destroyed all opposition in this country the only intoxicant now which is legal is actually alcohol so it's Puritan morality it's lobbying alcohol lobbying and it's non-political expediency as well so last week Keir Starmer ruled out the legalization of cannabis saying that no I think he didn't rule out decriminalization decriminalization sorry he ruled out the decriminalization of cannabis because he sees drugs as sitting behind an array of social ills including knife crime criminal gangs I don't think he's a Navarro media subscriber but on the off chance that he's watching what would you want to say back to him? I'd say Keir it's time you realize you're no longer head of public prosecutions and you have to escape from the carapace of being someone who puts people in prison it's the old adage if you're a hammer everything's a nail if you're a policeman you punish people if you're a public prosecutor you punish people the drug policy we've tried for a hundred years trying to police it trying to punish people out of it it doesn't work they're proven it's not as if we're asking you to go into a field where there's not massive evidence there are proven policies and if you ever want me to advise you I'm on the end of the phone I wanted to ask you about your work on synthetic alcohol because you've talked about the harms of alcohol abuse the fact that it's so widespread everyone in their family knows somebody who has problematic relationships with alcohol and then even if you don't know someone with an addictive relationship to alcohol all of us have had you know night where you take it too far and you feel absolutely dreadful just the one I think it was many many years ago I also I can name the culprit was Jose Cuervo Tequila and I decided I was maybe 14 and I decided to nick off with a bottle and try and impress a boy by drinking most of it which didn't impress him and my mum has a come pick me up dreadful really dreadful and so you've been doing some research into synthetic alcohol basically the idea that you could have a built-in cut-off for inebriation am I right in saying that that was very good very good that's right we can produce what's a plateau effect so we can what we've done is we've developed molecules or we're developing molecules we have tested some that produce some of the good effects of alcohol but they produce a plateau the reason alcohol is so very dangerous is it what it has multiple reacts with multiple transmitters in the brain and we're targeting just the first one that makes you relaxed and sociable but if you keep drinking alcohol it goes up and up and eventually it kills you because it blocks breathing and you're quite lucky actually I'm in a bottle of of tequila you know that could be very dangerous you could have vomited in your head so by just targeting the receptors it caused the first step in the alcohol effect we can by being very selective we can avoid all the others so that's the plateau effect so how would you if you're designing synthetic alcohol deal with the overlapping interaction between alcohol and other drugs sometimes that can be very dangerous of course combining alcohol which is a depressant with something like valium or ketamine absolutely very dangerous or even methadone in fact almost all methadone deaths are associated with alcohol but carry on yeah you take something like MDMA and alcohol that's two drugs which are commonly combined in use so when you're designing something like a synthetic alcohol do you take into account all of the ways in which people will be using it well the point is if you get something which you can prove is less harmful than alcohol and we're targeting 100 times less harmful than alcohol in terms of safety testing then it's unlikely to have a negative effect on anything and we will test for that of course eventually as well and so in terms of the stage of the development you know where are you I know that there are some barriers one is that you've got the alcohol industry the other is that you've got people thinking I don't want to take something that's synthetic I want all natural I love my all natural botanical gin there's no such thing as an all natural botanical gin or not all natural there are definitely gin analysts there are water waters it's smell of gin a smell of juniper but they're not gin but to answer your question yeah we have just made a botanical spirit a functional botanical spirit it's called sentia spirits and the first production completely sold out there's a lot of demand out there for an active spirit that gives you some of the effects of alcohol the relaxation sociability conviviality and this is all made from natural products it's all made from food standard herbs put together in a special combination so we get the effect we want what's the taste like it tastes beautiful because we have an amazing woman good Vanessa who has spent her whole well not whole life but she's spent the last 10 years of her life making beautifully flavoured teas and now she's moved to making this beautiful flavoured so it tastes a mixture of of interesting floral horrible tastes and most people find the taste rather appealing but it doesn't taste like gin it doesn't taste like alcohol no it tastes it's a it's a complex horrible drink I suppose the nearest would be to to like a complex remove oh really I'm trying to I'm always curious about scientific advances in food and drinks so lab grown meat and I just think what does it taste like I can't picture it I can't imagine the mouth feel or the smell or well it's kind of it's actually having once recently had a synthetic handbrake it is kind of disconcertingly like meat I mean the last question that I wanted to ask you is in a completely different area because I know that you've also done a lot of work with Alzheimer's and dementia we have an aging population we have a massive gap in terms of the amount of people needing care and the amount of care provision in terms of advances in treatment and early identification where are we if you're a young person and you're worried about what's going to happen with your parents how how pessimistic should we be oh that's a really good question so there's many things I can say about that so the first thing is we know that we can intervene with a number of the known factors which predispose to dementias and so for instance we can reduce our alcohol consumption alcohol is the leading cause the leading known preventable cause of dementia so you could cut your drinking down we can also control your blood pressure and your cholesterol we know that a lot of dementias are due to vascular problems and if you get your blood pressure down and get your cholesterol down you don't you know you can unfur or stop your arteries plotting up so you get more blood flow to the brain so those are two useful things we can do you can also not get not become diabetic because diabetes is has a major negative influence on the brain through a combination of factors not just the high sugar but also the information that goes in the blood so there's three things you can do there but and in fact it seems that those already particularly the big input people are having in terms of controlling their blood pressure with statins and the cholesterol with statins is actually having a having an effect the dementia doesn't seem to be going up it's not the big increase the increase seems to be slowing anyway so we're make I think we are making some progress there but then again we also need to look and try to work out more what's going on and that's where my research is coming I mean we've been developing what we call imaging probes to to scan the brains of people with dementia and other neurodegenerative disorders like Parkinson's and Huntington's to see what's going on and it turns out that when we think of the brain we think of neurons we think of all these neurons firing away allowing us to think and speak and hear and see etc but for every neuron there's about five or six other cells in the brain which are called glial cells and and these are very important for maintaining brain health and it turns out that those change in dementias as well and we've got one of the research has shown you know we've got a probe now we can measure those we can measure measure the changes in them during these dementias so that's a that's a very exciting new development because we can potentially explore how we could make the glial cells more functional make them better at looking after the nerves so that's a big area and then of course I have this particular interest in the in the psych psychedelics because the most remarkable things about the people who first used psychedelics was they live for a very long time so Albert Hoffman who discovered LSD he used it regularly and he lived to 102 the first British psychiatrists to use it was a guy called Joel Elke's professor in Birmingham he lived to 103 so I think we can say that these certainly LSD doesn't fry your brain like the Americans DEA say it does and it may be that maybe the psychedelics could have an effect to prolong brain function it might be that they make neurons work better it might be their anti-inflammatory and that's an area that is being actively researched at present and you might not even have to have a psychedelic dose it might be a lower dose would work I mean it's possible to kind of loop back on what you identified as the illegality paradox it's also possible to conceive of a world where drugs for personal recreational use are still prohibited but for medicine they're allowed the UK is the world's biggest exporter of medical grade cannabis so isn't there also a danger of emphasising a health case at the expense of making one also based on personal liberty and fun and pleasure because you will end up with this two tests yeah look I can't fight every battle I'm a doctor I can fight the medical battles way better than I can I've tried fighting the social battles I've tried fighting the political battles actually I haven't got very far that's your job all right well I'm not doing a great job of it either but professor David Nut thank you so much for joining us today it's been a really illuminating conversation thank you it's been great cheers