Spice ruins lives and costs taxpayers a fortune. It doesn’t have to be this way | David Nutt

Last year I wrote to the health and home secretaries with suggestions on how antidotes for spice could be developed. Their replies revealed a complete lack of appreciation of the magnitude of the synthetic cannabinoid problem and lack of interest in the idea of an antidote.

Spice-induced “zombie” outbreaks in New York and in Manchester have hit the headlines in the past year. Use of these new damaging and powerful forms of synthetic cannabinoids is rife in our prisons and by homeless people, with estimates of up to 50 deaths last year. They can produce extremely strong psychotic states often with very violent behaviour. Sometimes a frozen unconscious state results. Either of these outcomes are health emergencies that consume vast amounts of police, prison officer and health professionals time, and so waste a huge amount of public money.

Spice is a generic term for the hundreds of synthetic versions of cannabis that are used instead of herbal cannabis. The first synthetic cannabinoids were made in the 1970s as potential medicines, but initial human testing found them to be so unpleasant and potent in their actions that none were marketed. Since then they have been sold as legal alternatives to cannabis, and called spice.

The problems with spice are multiple. The first is lack of any quality control: the amount of synthetic cannabinoid in each unit is not known. Second, these substances have little, if any, safety data. Third, many of them are much more potent than traditional cannabis, up to a hundred times more potent in the test tube and have never been tested in animals – let alone humans – so there is no data on real-world safety.

Most are not detectable by current testing processes which is why prisoners prefer them. This high potency means they are very profitable drugs. A spice solution costing a few pounds can be soaked into a single A4 sheet of paper, which, when dried, can be cut up into about 100 units, each of which will give a decent “hit” at £5 each.

The government’s response has been to ban these drugs in a series of amendments to the misuse of drugs act. So now all synthetic cannabinoids are illegal. But, as with other drugs, banning spice doesn’t stop its use. Heroin has been illegal for 50 years yet deaths reached an all-time peak in England and Wales last year.

So what should the government do about spice? First, it must recognise that this problem is not going to be dealt with by simplistic approaches such as more bans or more severe sentencing of users. We should understand that the authorities’ focus on herbal cannabis use is the main reason for spice emerging in the UK. So we should stop testing for cannabis in prisoners and others to encourage a move by users back to herbal cannabis.

The Manchester police commissioner has now publicly wondered if the problem has been exacerbated by the Psychoactive Substances Act which has taken synthetic cannabinoids out of “head shops” and into the underground marketplace. Perhaps we should develop a harm reduction strategy by allowing the sale of safer versions of synthetic cannabinoids, or even cannabis itself, back in head shops?

But to deal with the current epidemic of use we need urgently to develop cannabis antagonists as antidotes to spice for use by health professionals.

The success of naloxone as an antidote for heroin overdose is now well recognised to save lives, and is given to opioid users and their friends for this reason. Several antagonists at the cannabis receptor are known and one, rimonabant, has extensive safety data in humans. It was licensed in Europe a decade ago as a treatment to stop weight gain after people stopped smoking. However post-marketing surveillance found that in some people rimonabant was associated with an increase in depressive reactions, sometimes with suicidal thinking (though not suicides). This led to it being taken off the market for having too low a benefit-risk ratio for this medical indication. But for spice reversal these considerations do not apply – it would only be used once to reverse a bad reaction, and hopefully keep people from harming themselves or others.

The other approach is to develop the herbal antidote THCV. This is made in the cannabis plant alongside d9THC and many other cannabinoids. It has recently been shown to have antagonist actions against the psychosis produced by d9THC and so would almost certainly attenuate spice intoxication. Sadly, just a few months ago, the Advisory Council for the Misuse of Drugs refused to make it available for this purpose on the spurious grounds that a note in a 1974 paper said that when given intravenously in high doses it was a little like d9THC.

Surely it is time for government to push to develop such an antidote to spice if not for humane and health reasons then for economic ones?

Spice ruins lives and costs taxpayers a fortune. It doesn’t have to be this way | David Nutt

Can David Nutt wean us off the demon drink with his alcohol substitute? | Neil Brady

Cancer incidence is set to enhance by 70% globally in between now and 2024, according to the Globe Health Organisation’s Planet Cancer Report published earlier this month. The report states that considerably of the enhance will be down to life style variables – not just smoking, but also bodily inactivity and extreme consumption of sugar (foremost to obesity) and alcohol.

Shifting people’s behaviour is notoriously difficult and costly, but what if it had been attainable to tremendously lessen the toxic effect of 1 of these lifestyle alternatives, alcohol? This is what David Nutt, professor of neuropsychopharmacology at Imperial School London and former chairman of the United kingdom government’s Advisory Council on the Misuse of Medicines hopes to achieve with an alcohol substitute he is working on. The drug would be intoxicating but harmless.

I spoke to Nutt last week about the genesis of his alcohol substitute. “I have spent 20 years making an attempt to decrease the harms of alcohol, and then about 10 years ago – even though operating under the UK’s Foresight initiative – we thought ‘we’ll never ever end alcohol becoming toxic because it really is intrinsically such. It triggers cancer or liver condition, for instance. So why don’t we exchange it with a safe drug?’”

His proposed substitute to alcohol operates by targeting the very same receptors as the neurotransmitter gamma aminobutyric acid, or Gaba, which has a “comforting” result on the central nervous method. These receptors are the target of numerous extensively employed medication, which includes barbiturates, benzodiazepines (such as Valium) – and alcohol.

Nutt’s alcohol substitute is a benzodiazepine derivative, but he is adamant that what he is providing is a lot more than just one more kind of Valium. It targets the same websites in the brain, but he believes the drug will not lead to the identical problems with addiction and withdrawal. “Modern science enables us to target the comforting and intoxicating part, although steering clear of the undesirable parts like addiction and withdrawal,” he explained.

The drug is currently employed in humans for other indications, he adds. “Addiction is a complex procedure. I am assured that the physically addictive properties of this drug are minimum, and that it is a lot less addictive than alcohol. Far more operate will be necessary just before I can conclusively show this, nevertheless.”

For industrial factors, he is not prepared to reveal the drug’s identity for the time getting. But in its present type, it has some crucial limitations. In distinct, it cannot be used in beer or wine due to the fact if affects their flavour, and tweaking the drug’s chemistry to make it much more palatable will need “much more funding, a lot more chemistry muscle”, acknowledges Nutt.

In the meantime, he plans to provide it in the type of a non-alcoholic cocktail. The intoxicating result of the initial three “doses” will be cumulative, he stated, but subsequent shots will have no effect. Remarkably, he has also developed an antidote, or “sober-up pill”.

I asked him what industry he had in mind for his alcohol substitute. Who would buy it?

“I want it to be offered in higher-top quality cocktail bars where folks go and re-understand about the pleasures of drinking in a social surroundings with buddies, consuming sensible amounts,” he said. “Possibly it could be sold alongside alcohol, so that men and women could see the big difference in between it and individuals consuming alcohol and getting into fights.

“It will be an upmarket merchandise for people who want to drink responsibly. You can never ever do that with alcohol since it turns off the parts of the brain that create duty.”

Nutt admitted that individuals are often sceptical when they hear about his perform, but he believes the harms of alcohol demand radical alternatives.

“Alcohol is the foremost result in of death in Britain nowadays in guys in between the ages of sixteen and 50,” he stated. “It has overtaken traffic accidents, suicide and cancer. The overall health fees amount to £3bn a 12 months. Most folks say, ‘my God, what a clever idea, but it could never work. How are you going to license it? Is it going to be a legal higher?’

“At a single degree they’re proper,” explained Nutt. “Alcohol is a drug that has been all around for thousands of years, and western society is immersed in it, so this will be really a revolution.”

The response of drinks firms therefore far has ranged from baffled to sympathetic. One particular of the world’s greatest, Diageo, was sceptical.

“Diageo does not believe a synthetic kind of alcohol that decreases or eliminates the harmful effects of extreme use is on the horizon,” a spokesperson for the firm informed me. “Based on our comprehending, Dr Nutt is seeking to generate a derivative of benzodiazepine. Our business has some of the world’s most iconic brand names, many with hundreds of years of tradition and craft. Buyers about the globe take pleasure in our manufacturers responsibly and we believe they are hunting for the craft and taste associated with our brand names and will carry on to do so.”

Sarah Williams, overall health information officer with Cancer Study Uk, was much less dismissive, describing the alcohol substitute as “an interesting thought”, noting that “the much less alcohol a person drinks, the decrease their chance of cancer”. But she explained more study into Nutt’s drug would be essential.

“We’re keen to see how the analysis develops, particularly to verify that it doesn’t result in a various set of well being hazards. But it’s crucial that this doesn’t distract policymakers from other evidence-based mostly techniques to protect public overall health by decreasing alcohol consumption in the Uk, such as minimum unit pricing.”

Prof Nutt is adamant that the drug is risk-free, and that just as the tobacco business at some point came to accept the worth of electronic cigarettes, the alcohol market will come to accept that an alcohol substitute has a location.

He is presently working with Imperial Innovations, a technological innovation commercialisation business that collaborates with 4 of the UK’s leading universities, to deliver the drug to marketplace. With enough funding, he thinks this could come about as soon as subsequent yr.

“I know the product is secure. And the drinks organizations know that their item kills [almost] 3 million individuals a yr. They would like a safer alcohol, but the industry is expanding in Asia and Africa. That is why we need to have to incentivise them to modify. What we require is for the public to say ‘we need this’, and for governments to inspire it as a well being substitute.”

Can David Nutt wean us off the demon drink with his alcohol substitute? | Neil Brady