commonly used drugs, comparing the physical and social harm they cause and their potential to cause addiction. The work was led by Professor David Nutt of Bristol University and Professor Colin Blakemore of the UK Medical Research Council and its findings were published in 2007 in the leading medical journal The Lancet.
The assessments were made by two panels of independent experts from a range of disciplines, including psychiatrists, chemists, pharmacologists, lawyers and police officers. They drew on the best available scientific and medical evidence. Their analysis took account of three main dimensions, or aspects, of harm: namely, the physical harm caused to the individual user; the broader harm caused to society, including the user’s family and community; and the tendency of the drug to create dependence. Each of these three main dimensions was in turn broken down into a number of sub-dimensions. For example, physical harm was assessed in terms of the drug’s acute effects, its chronic effects and its scope for intravenous use. Some drugs cause mainly acute harm: for instance, cocaine can cause heart attacks and heroin can suppress breathing. Other drugs, notably nicotine, cause most of their harm chronically, through long-term use. Drugs that are taken intravenously tend to be more harmful for several reasons: they produce a bigger ‘rush’, making them more addictive; the user is more likely to overdose; and shared needles spread life-threatening disease such as hepatitis and HIV.
Each of the twenty drugs was assessed on these various dimensions by the experts, who then debated and revised their judgements according to what is known as an expert delphic procedure. The two groups independently arrived at similar scores, adding to confidence about their validity.15 The average of all the scores was then used as an overall index of harm for each drug. The resulting rank ordering, in descending order of overall harmfulness, was as follows:
1 Heroin
2 Cocaine
3 Barbiturates
4 Street methadone
5 Alcohol
6 Ketamine
7 Benzodiazepines
8 Amphetamine
9 Tobacco
10 Buprenorphine
11 Cannabis
12 Solvents
13 4-MTA
14 LSD
15 Methylphenidate (Ritalin)
16 Anabolic steroids
17 GHB
18 Ecstasy
19 Alkyl nitrites
20 Khat
One striking feature of this list is how poorly it correlates with the current legal classification of the same drugs. In fact, statistically speaking, there was no significant correlation at all between the rank ordering according to harmfulness and the classification according to current UK legislation (the Misuse of Drugs Act 1971).
In the UK, illegal drugs are divided into three classes (A, B and C) according to the severity of the penalties incurred for possession or dealing. The highest category, Class A, includes heroin and cocaine, which were also judged by the experts to be the most harmful drugs. However, Class A also includes LSD and ecstasy, which were judged to be among the least harmful. In the UK, you can be sent to prison for up to seven years for possessing a Class A drug and imprisoned for life if convicted of supplying it.
Alcohol and tobacco, which are legal and unclassified, were assessed to be more harmful than several illegal drugs including cannabis, LSD and ecstasy. If recreational drugs were reclassified according to this evidence-based index of harm, then alcohol would be a Class A drug and tobacco would be Class B. I should stress that I am not trying to imply that making alcohol and tobacco illegal would be either desirable or feasible. The point is simply that the current legal framework has little solid basis in scientific evidence or rational analysis. When measured in terms of the harm they cause, there is currently no clear distinction between legal and illegal drugs.
For its part, the UK parliamentary committee concluded that there are serious inconsistencies in the legal system for classifying drugs and in the processes by which governments tackle drug use. The committee found no convincing evidence to support the belief that legal penalties deter people from using recreational drugs. It called for a more objective and evidence-based approach which takes better account of the actual harm caused by drugs and places less emphasis on ‘knee-jerk responses to media storms’.
Similar conclusions were reached by the RSA Commission on Illegal Drugs, following their own two-year study. Their report, which was published in 2007, concluded that ‘the harmless use of illegal drugs is possible, indeed common’. The Commission found that UK drugs laws were driven more by ‘moral panic’ than rational debate. It proposed scrapping the current classification scheme and replacing it with a framework based on harm. The underlying aim should be to regulate the use of drugs in order to prevent harm, rather than trying to prohibit them altogether. The Commission’s chair, Professor Anthony King, called for ‘less foaming at the mouth and more thinking’. I’ll drink to that.
I adore simple pleasures. They are the last refuge of the complex.
OSCAR WILDE, A Woman of No Importance (1894)
As worldly pleasures go, chocolate may seem modest and unassuming in comparison with, say, multiple orgasms or pharma-diving. But the most intense pleasures are not always the best in the long run.
Chocolate has much to say in its favour. Even if it does not stir the strongest passions, except in the most devoted chocophile, it is a dependable source of pleasure which can be dipped into by almost anyone at almost any time. Chocolate is redolent of childhood. It embodies a mild, unthreatening form of hedonism – although in times past its sinful connotations led religious authorities to regard it with suspicion. Few chemical pleasures are cheaper. And, as we shall see, it can be good for your health.
Chocolate clearly has universal appeal, with consumption in the developed world continuing to grow. We eat it ourselves and we present it to others as gifts. The box of chocolates has become the conventional token of gratitude. According to one study, nurses in British hospitals eat an average of five chocolates a day each, courtesy of their grateful patients, with some nurses developing a twenty-a-day habit.
Opinions differ as to which nation eats the most. The British like to think of themselves as the world’s greatest chocolate-eaters. However, credible statistics put Switzerland at the head of the global league table, followed by Austria, Ireland and Germany. A great deal depends, of course, on what is meant by ‘chocolate’. Headline figures are often distorted by the inclusion of ersatz sugary confectioneries masquerading under the name of chocolate. The inhabitants of the UK each consume an average of 10 kilograms of ‘chocolate’ a year, although much of what they eat would not be regarded as proper chocolate in some other countries.
Real chocolate, of the kind that gets the connoisseur’s
