Discussion on the role of science in drug policy - Eurad

One of the key questions in drugs policy is the role which science plays. Over the past few weeks this issue has been as pertinent as ever, particularly in the UK. In this blog, I will bring you through some of the discussions I have been involved in and some of the recent political events which have touched on this issue over the last few weeks.

Summary of discussion with EPHA on science in health policies (18th January 2012)

As a small multi-disciplinary group, we had a discussion about our the use of evidence and research in health policies. Most of our discussions revolved around the following questions:

1. Is the research peer-reviewed? By who?

2. Does it consider different points of view or does it appear to be biased towards a "pet theory" the author may have?

3. Is it realistic?

4. Is it legitimate? Who funds the research? Does this have an impact?

5. Is it current? 

6. What are the limitations to the study?

7. What impact does the selected methodology have?

8. Is the evidence contextual? 

9. Does the evidence prove correlation or causation?

Lecture on Science in Drug Policies (25th January 2012)

I travelled to hear a discussion on this topic at a free event hosted by the University of Kent. The debate isn't uploaded yet but it was quite interesting in that it makes me ponder on the points above on how science is used in health policy, for example:

1. The limitations of comparing alcohol and drug related hospital admissions What many researchers/scientists don't give adequate attention to is the fact that hospital admission data is much more difficult to collect than it is for alcohol (this may become a bigger problem with the increase of polydrug use). Often people present at emergency departments with symptoms rather than a name of a substance and this poses a challenge to nursing teams in terms of clinical coding. The next challenge is then identifying the substance the person has used, which many emergency departments are not able to do, particularly with the increase of novel psychoactive substances. I would argue that when making comparisons between alcohol and drugs then we should draw reference to the limitations which exist in the data collection process and to urge governments to better improve their monitoring systems.

2. Is it current? In the presentation, there was an argument made that to stop one instance of schziophrenia caused by cannabis use, you would need to stop 5000 men from smoking cannabis. However, Pscyhiatrist Robin Murray argues that much of the research we have on cannabis is from the older types of cannabis and not the high potency of cannabis which is currently being used across Europe so this is something to bear in mind for the issue of cannabis in particular, in terms with how we keep up with evidence on drugs when their content changes (Skip through to 20mins into this broadcast to hear his counter argument).

3. Correlation and causation: Watch out for causation being applied without significant evidence, or where the author fails to communicate that recommendations are based on correlation, rather than causation. For example, some look at the reduction of cocaine related deaths in the UK since 2009 and apply this "positive" benefit to more people using mephedrone instead of cocaine (then making the argument that mephedrone is safer). However much of this is based on speculation and there is often a failure to prove causation. What we do know is that there had been a peak of cocaine use between 2003-2008, so a documented decreased use of cocaine in from 2009 in some of the highest prevalence countries and changes to reported cocaine purity may well be reason enough for the reductions alone, without even taking into consideration that the public became more aware of the harms caused by cocaine use. Much more research is therefore needed before people can claim causation. The book Freakonomics is a great one for looking at the difference between correlation and causation (no marketing intended!).

UK Home Affairs Committee Inquiry on Drugs (24th January 2012)

Richard Branson gave oral evidence at the UK Home Affairs Committee on Drugs which uou can watch here. Some things Branson said make sense, ensuring good evidence based treatment is in place for example and the role of employers in helping social re-integration but unfortunately these topics were not covered in much depth. In relation to science and drug policy however, there are two things which stand out in his presentation:

1. Is it biased? He opens by stating that drug policies should be based on evidence but then claims that governments should look at the example of Portugal, which you can read more about here and also here. When we are looking at the example of Portugal, it's very important to remember the investment in prevention and treatment which has taken place over the same period.

2. Is it realistic? He exaggerates current use of cannabis amongst his children's generation, when he says that "I would say that 75% of my children's generation have smoked cannabis", whereas actually the best quality data we currently have shows that the percentage of young people (15-24 year olds) who have smoked cannabis in their lifetime is 30% , with a much lower 8% using it in the last month. This is probably just an on the spot question for Branson but we do find overestimates or statements like "widespread use" used quite a lot in the drug policy world. On this issue, it's important to look at your own countries statistics, especially as we have drug data focal points now based across Europe which work with EMCDDA. These give the most up to date prevalence rates and provide a good insight into which groups are using drugs more commonly than the rest of the population.

Undoutedly we could look at every document ever produced under critical lenses such as these but this blog may serve as a useful reminder in a time when we hear so much about evidence based drug policies to actually work out what that means, as the term is thrown around so much without much explanation. So today I will leave you with some useful but relevant science-related quotations to ponder over:

 

Science is always wrong. It never solves a problem without creating ten more ~George Bernard Shaw

A fact is a simple statement that everyone believes. It is innocent, unless found guilty. A hypothesis is a novel suggestion that no one wants to believe. It is guilty, until found effective. ~Edward Teller

Scientists should always state the opinions upon which their facts are based. ~Author Unknown

Research is the process of going up alleys to see if they are blind. ~Marston Bates

Science commits suicide when it adopts a creed. ~Thomas Henry Huxley