November 1, 2021

Treatments

#182 – David Nutt: Psychedelics & Recreational Drugs

“It turns out that the drugs that have been most vilified and which we've been taught are the most dangerous, turned out to be the least dangerous.” —David Nutt

Read Time 34 minutes

David Nutt is a psychiatrist, neuroscientist, and the Director of the Neuropsychopharmacology Unit in the Division of Brain Sciences at the Imperial College London. His research focuses on illicit drugs—their harm, classification, and potential for therapeutic use in psychiatry. In this episode, David discusses his framework for assessing the potential harm caused by common recreational drugs and explains how they are regulated, which is often misaligned with actual risk. He describes in detail the neurobiology, mechanisms of action, and addiction potential of alcohol, opiates, cocaine, and methamphetamine and contrasts those with psychedelics, which have been given a similar regulatory classification despite their relatively low risk of harm and their numerous potential therapeutic uses. Additionally, David explains the promise of psychedelics like ketamine, MDMA, and psilocybin for treating drug addiction and depression and discusses how political pressures have created roadblocks to future necessary research.

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We discuss:

  • David’s early interest in the brain and experience in psychiatry [2:45];
  • David’s brief work on government drug policy in the UK [10:15];
  • A scale for rating the relative harm of certain drugs [13:45];
  • The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15];
  • The opiate crisis and rise of fentanyl: the cause and potential solution [25:00];
  • The science of addiction and the potential use of psychedelics for treating drug addiction [35:00];
  • Cocaine: mechanisms of action and risks [41:45];
  • Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15];
  • How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45];
  • The history of MDMA and the bad science and political forces leading to its demonization [1:08:45];
  • History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30];
  • Psilocybin for depression: David’s promising research and the roadblocks to more robust experiments [1:20:15];
  • More.
§

David’s early interest in the brain and experience in psychiatry [2:45]

David’s interest in the brain

  • At age 4 or 5 he realized that thinking comes out of the brain
  • He did his undergrad at Cambridge in brain science
    • He wanted to be a physiologist, like Hodgkin and Huxley, to do physiology
  • He realized that some single cells are interesting, but one has to put the 200 billion together and make sense of them
  • He worked in neurology and found it boring because most people are dying slowly from diseases like amyotrophic lateral sclerosis
  • Next he moved to psychiatry and found it wonderful because one sees “every aspect of the brain in psychiatry
  • Peter’s son (6 years old) asked about the brain and if it was where thoughts come from and how this happens
    • This is difficult to explain on a simple level 
    • The brain is where memories are stored but the deep question of “how does this blob make me think” is difficult to answer
    • Peter was happy his son asked this question because he never contemplated this at such a young age
  • David’s latest book is called Brain and Mind Made Simple; it’s written for the general public to explain as David puts it, how “lots and lots of single nerves can actually turn into all the complexity of the different forms of consciousness and the different experiences humans have

David’s early impressions about the pathology of the mind

  • The first patient he saw as a psychiatrist (during medical school) kept rambling about a smell of fish in the room and didn’t make any sense for the half hour they spent talking
    • David spoke to the consultant who said simply the patient is psychotic and that’s why he doesn’t make any sense
    • He found the relationship between temporal lobe disorders interesting
      • These are the parts of the brain which are intimately involved in aspects of consciousness
      • There is a peculiar overlap between temporal lobe disorders where one can be psychotic and have these olfactory hallucinations
    • He never forgot this bizarre experience of the patient hallucinating in terms of smell
    • This made him realize he had a lot to learn

David’s career in psychiatry and neuroscience 

  • David is a professor of neuropsychopharmacology at Imperial college, London
    • Neuropsychopharmacology is really the use drugs to study the brain and to study the effects of treatments for brain disorders
  • His PhD focused on the GABA system of drugs, and manipulating this system
  • As an undergraduate he was extraordinarily fortunate to be at the University of Cambridge in the early ‘70’s when people are discovering that the brain is a chemical organ
    • Prior, it was thought the brain was an electrical organ similar to a complicated computer or telephone exchange
    • The concept of chemical transmission came along and now it is known that there are at least 80 different chemicals, neuro-transmitters, hormones, neuro-hormones

“And seeing that transformation from electricity to chemistry made me realize the way you study the brain now is through drugs, which affect the chemistry of the brain.” – David Nutt 

  • Drugs can be therapeutic agents: antidepressants, anti-psychotics, anticonvulsants
  • Drugs are also used to change the brain or recreationally: cocaine, crystal meth, psychedelics
    • They are used to deaden pain or gain insights (i.e., psychedelics)

 

David’s brief work on government drug policy in the UK [10:15]

  • David was asked by the British government to help them justify drug policy in the ‘90’s
    • He worked on the Advisory Council on the Misuse of Drugs (ACMD)
    • This is when he realized the drug policy wasn’t evidence-based in any way
    • When he tried to bring evidence to bear on drug policy he was fired
      • Drug policy was based on political decision making not evidence
    • In the ‘90’s he was asked to come up with a policy which would reduce the harms from ecstasy
      • He realized that the harms of ecstasy aren’t from the drug at all, they’re actually from what one does when on the drug
        • Dehydration from dancing all night
        • Hypothermia from being in an environment where one cannot cool down
      • He recommended 2 simple policies; environmental approaches drastically reduced the number of deaths from ecstasy
        • 1) Clubs that serve alcohol should provide free water
          • When people choose between paying for alcohol or water they end up dehydrated from drinking too much alcohol
          • Clubs were making matters worse by turning off the taps in the bathroom so people couldn’t drink water
          • The law changed to allow people access to water
        • 2) Clubs should also provide chill out rooms
          • David notes there have been very few deaths “from ecstacy” since those policies were implemented
      • Now however, a variety of international policies have now made ecstasy considerably more harmful than it used to be
  • UK drug policy follows the United States

“Every single British drug law until 2016 was made at the behest of the Americans. . .they say America sneezes, the world catches cold.” – David Nutt

  • America defined drug policy
    • In 1934 with liberalization of drinking alcohol and attack on cannabis
    • The big inflection came when Nixon decided that the war on drugs war better at gaining votes than the war in Vietnam; he switched people’s attention to drugs

 

A scale for rating the relative harm of certain drugs [13:45]

Peter says: “the goal of frameworks is to have them be as unemotional as possible and to have them, whenever possible, to be objective.”

Peter says drugs can be classified according to…

{end of show notes preview}

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David Nutt, DM, FRCP, FRCPsych, FSB, FMedSci

David Nutt is currently the Edmond J. Safra Professor of Neuropsychopharmacology and director of the Neuropsychopharmacology Unit in the Division of Brain Sciences. He is also the host of The Drug Science Podcast

After 11+ entry to Bristol Grammar School, David was awarded an Open Scholarship to Downing College Cambridge and then completed his medical training at Guy’s Hospital London, continuing in neurology to MRCP.  After completing his psychiatric training in Oxford, he continued there as a lecturer and then later as a Wellcome Senior Fellow in psychiatry. He then spent two years as Chief of the Section of Clinical Science in the National Institute of Alcohol Abuse and Alcoholism in NIH, Bethesda, USA. On returning to England in 1988 he set up the Psychopharmacology Unit in Bristol University, an interdisciplinary research grouping spanning the departments of Psychiatry and Pharmacology before moving to Imperial College London in December 2008 where he leads a similar group with a particular focus on brain imaging especially PET.  In 2010 he founded the non-profit Drug Science to provide evidence-based information on drugs.  

David is currently Chair of Drug Science (formally the Independent Scientific Committee on Drugs (ISCD) and President of the European Brain Council. Previously he has been President of the European College of Neuropsychopharmacology (ECNP), the British Neuroscience Association (BNA) and the British Association of Psychopharmacology (BAP). In addition he is a Fellow of the Royal Colleges of Physicians and of Psychiatrists and a Fellow of the Academy of Medical Sciences. He is also the UK Director of the European Certificate and Masters in Affective Disorders Courses and a member of the International Centre for Science in Drug Policy. He has edited the Journal of Psychopharmacology for over two decades and acts as the psychiatry drugs advisor to the British National Formulary. He has published over 400 original research papers, a similar number of reviews and book chapters, eight government reports on drugs and 27 books. [Imperial College London]

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
  1. Dr. Attia,
    Thank you immensely for this episode. Such an eye opener and perspective shifter. I cannot wait to listen to the upcoming parts of this podcast and continue to understand these concepts better.

  2. There was a comment about cannabis not being social. I believe it is social, but because it has been vilified, it often can not be enjoyed socially, especially publicly. It has been forced out of the limelight. I tend to only enjoy it, socially, or with others, and see it as a social drug. I rarely enjoy it by myself, but rather with others. Just my 2 cents.

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