Prof. David Nutt, Imperial College London
Chris - Researchers might struggle to keep up with new legal high compounds being developed, but scientists face a different problem when they're trying to research illegal compounds because David Nutt, professor of Neuropsychopharmacology at Imperial College London, and heís also President of the British Neuroscience Association, had hoped he could investigate the potential of using psilocybin which is the active psychedelic ingredients in magic mushrooms to treat depression. But he and his team then ran into a mountain of red tape when they tried to set up a trial. Kate Lamble spoke to him about these obstacles.
David - Weíve discovered a serious obstacle to doing this research clinically and which is that there are two complex sets of regulation that really make life very difficult when you want to do studies in patients. And those are the fact that psilocybin like many interesting drugs are controlled are under the Misuse of Drugs Act, but theyíre put in a particular Schedule called Schedule 1 which means that they're especially difficult to study because they have especially complex controls. And those controls are arbitrary. They donít relate to the harm of the drugs. So, itís kind of paradoxical. I can study heroin easily because my hospital is allowed to hold heroin, but is not allowed to hold cannabis or psilocybin. This is absurd because heroin is obviously much, much more dangerous. So, the rules are arbitrary. They're old fashioned. Theyíve been stuck in the 1970s and we haven't moved on, so thatís the first thing. The second thing is this recent set of legislation called the European Clinical Trials Network which has really screwed up human psychopharmacology in Europe. And that essentially sets a whole series of extra barriers to do in clinical research. Let me give you an example. I can prescribe a drug for blood pressure. Beta blockers have been around for 50 years. If I want to research with it, I have to go through a bureaucratic process which can take up to a year to get all the permissions. They make it virtually impossible to do trials unless youíve got a company behind you with hundreds of thousands of pounds because it just costs that much to go through these regulations. So, thatís what weíre up against, these two great obstacles of the law and the clinical trial regulations.
Kate - You mentioned itís a Schedule 1 drug which I think means, itís got a high potential for abuse and there's no recognised medical use. How does a drug get classified in that way that seems to restrict it from research?
David - Well, it gets incorrectly classified. Itís kind of painful to have to explain why this happens, but let me take you through it. In 1960 and 1970, United Nations held worldwide convention to do something about illegal drugs on an international scale. They were about looking at drug harms and they decided that they would create a Schedule for drugs which were thought to be harmful and which had no medicinal use. Our British government went along with it and this Schedule 1 was setup, and then they looked at the drugs, they came across psilocybin and they said, ďOh, well that has no medicinal use. Therefore, it must be Schedule 1.Ē The evidence of harm was very limited, but they just thought that all psychedelics were harmful, so they put them all in Schedule 1. They then put cannabis in Schedule 1 even though cannabis was a medicine. It was a medicine until they put it in SSchedule 1 then it stopped being a medicine. So, there was an arbitrariness to it, a perverseness to it. And then in 2005, mushrooms themselves which were legal in 2005, they were put into Schedule 1 Class A and it was an example we see all the time where politicians will goad each other to be harder on drugs. And of course, everyone thinks being hard on drugs is a good thing. By and large, being hard on drugs is not a good thing for research because it completely stifles research.
Kate - Some people would say that putting it under Schedule 1 and restricting it is because weíre worried about protecting patients and these drugs being addictive in some way. Is there any worry with mushrooms or psilocybin that if itís used for depressive patients, it might have an addictive quality?
David - You see, one of the amazing things about psychedelics, they're not addictive. Before LSD was banned in 1964, I think there were 6 trials of LSD to treat alcoholism and there's been a recent meta-analysis of that work and it shows it is as effective as anything else weíve ever had. Itís anti-addictive. A lot of people go overseas, they go to Vietnam and Thailand to have ibogaine treatment for their addiction. There's a whole body of literature about how the mind-changing effects of psychedelics can be useful for addiction as they may well be useful for depression and for dysthymia and all the other things that people get benefits from them with.
Kate - Weíre now seeing a lot more research into how class A drugs, as we see them quite illegal drugs like ecstasy being used for PTSD and things like that, and these drugs having medical implications. Do you think that that legislation is holding us back, or do you think that there is a certain amount of caution that we should be using ecstasy?
David - I mean, most of the drugs in schedule 1 are nothing like as harmful as the drugs in schedule 2. Itís an arbitrary distinction. They're there not because of their harms. They're there simply because someone said that they donít have medicinal use. And it becomes a circular argument. If itís impossible to study them as it is almost impossible, only very cussed people like me can be bothered to pursue the years and years of hassle trying to get licenses. There's no question that if the scheduling was more rational, thereíd be a lot more research and that will be good for neuroscience and that will be good for patients. The worst example is not psilocybin. Itís cannabis. I mean, cannabis was a medicine. It should never have been put in Schedule 1 and exploring that has been terribly slow over the last 40 years because of it. And it probably means that lots of people have suffered unnecessarily because of the use for spasticity, the use for pain. And also, there's a huge interest in cannabis-type drugs for cancer treatments and all these has been really impeded by the scheduling. And of course, it hasnít actually stopped young people using it. When cannabis was put into schedule 1 in 1971, half a million people in this country had ever used cannabis. Forty years on, 10 million people have used it, probably more, probably more like 20 million now. So, it hasnít stopped the use. All itís done is stop scientists using it.
Kate - As weíre discovering more medical consequences from these drugs which weíve previously been restricted of using, do you see a point at which scientists will campaign or win a change in regulation for research purposes?
David - Well, I am pursuing a campaign now to do that. I want scientists to sign up. I've written over to a couple of colleagues quite a powerful piece coming out in Nature Reviews Neuroscience in June that argues the folly of what weíve done for the last 50 years and that strongly challenges the government to change. So, I want scientists behind me because I think when they see the missed opportunities, theyíll realise that neuroscience hasnít expanded, particularly in fields like consciousness and pain research. There are enormous insights to be made from drugs like psilocybin and cannabis.
Kate - Letís say that you finally get the trials under way. What's your foresight of when we could find out whether this can be turned into an effective treatment?
David - The current plan is this, get the trials started as soon as possible. If there is significant benefit, then obviously, we want to find a way of making it available to psychiatrists. And this is why the law must change because I can tell you that under the current law, psychiatrists would need to have a license to use the drug. The license costs 6,000 pounds and takes a year to get. So, they're not going to use it. Hospitals need to have a license to hold the drug. There's only 4 hospitals in the country with that license. So, we must change the law to anticipate benefits of these drugs so that patients can then have access to them.