Neurology Center

Which is more dangerous, taking ecstasy or riding a horse?

This is the question that got Professor David Nutt, a British psychiatrist, into a spot of political bother. Nutt is the Editor of the academic Journal of Psychopharmacology. He recently published a brief and provocative editorial called "Equasy".

Equasy is a fun read with a serious message. (It's open access so you can read the whole thing - I recommend it.) Nutt points out that the way in which we think about the harms of illegal drugs, such as ecstasy, is unlike the way in which we think about other dangerous things such as horseriding - or "equasy" as he dubs it:

The drug debate takes place without reference to other causes of harm in society, which tends to give drugs a different, more worrying, status. In this article, I share experience of another harmful addiction I have called equasy...

He goes on to describe some of the injuries, including brain damage, that you can get from falling off horses. After arguing that horseriding is in some ways comparable to ecstasy in terms of its dangerousness he concludes:

Perhaps this illustrates the need to offer a new approach to considering what underlies society’s tolerance of potentially harmful activities and how this evolves over time (e.g. fox hunting, cigarette smoking). A debate on the wider issues of how harms are tolerated by society and policy makers can only help to generate a broad based and therefore more relevant harm assessment process that could cut through the current ill-informed debate about the drug harms? The use of rational evidence for the assessment of the harms of drugs will be one step forward to the development of a credible drugs strategy.

Or, in other words, we need to ask why we are more concerned about the harms of illicit drugs than we are the harms of, say, sports. No-one ever suggests that the existence of sporting injuries means that we ought to ban sports. Ecstasy is certainly not completely safe. People do die from taking it and it may cause other more subtle harms. But people die and get hurt by falling off horses. Even if it turns out that on an hour-by-hour basis, you're more likely to die riding a horse than dancing on ecstasy (quite possible), no-one would think to ban riding and legalize E. But why not?

This attitude raises the critical question of why society tolerates –indeed encourages – certain forms of potentially harmful behaviour but not others, such as drug use.

Which is an extremely good question. It remains a good question even if it turns out that horse-riding is much safer than ecstasy. These are just the two examples that Nutt happened to pick, presumably because it allowed him to make that cheeky pun. Comparing the harms of such different activities is fraught with pitfalls anyway - are we talking about the harms of pure MDMA, or street ecstasy? Do we include people injured by horses indirectly (e.g. due to road accidents?)

Yet the whole point is that no-one even tries to do this. The dangerousness of drugs is treated as quite different to the dangerousness of sports and other such activies. The media indeed seem to have a particular interest in the harms of ecstasy - at least according to a paper cited by Nutt, Forsyth (2001), which claims that deaths from ecstasy in Scotland were much more likely to get newspaper coverage than deaths from paracetemol, Valium, and even other illegal drugs. It's not clear why this is. Indeed, when you make the point explicitly, as Nutt did, it looks rather silly. Why shouldn't we treat taking ecstasy as a recreational activity like horse-riding? That's something to think about.

Professor Nutt is well known in psychopharmacology circles both for his scientific contributions and for his outspoken views. These cover drug policy as well as other aspects of psychiatry - for one thing, he's strongly pro-antidepressants (see another provocative editorial of his here.)

As recently-appointed Chairman of the Advisory Council on the Misuse of Drugs - "an independent expert body that advises government on drug related issues in the UK" - Nutt might be thought to have some degree of influence. (He wrote the article before he became chairman). Sadly not, it appears, for as soon as the Government realized what he'd written he got a dressing down from British Home Secretary Jacqui Smith - Ooo-er:

For me that makes light of a serious problem, trivialises the dangers of drugs, shows insensitivity to the families of victims of ecstasy and sends the wrong message to young people about the dangers of drugs.

I'm not sure how many "young people" or parents of ecstasy victims read the Journal of Psychopharmacology, but I can't see how anyone could be offended by the Equasy article. Except perhaps people who enjoy hunting foxes while riding horses (Nutt compares this to drug-fuelled violence). Nutt's editorial was intended to point out that discussion over drugs is often irrational, and to call for a serious, evidence-based debate. It is not really about ecstasy, or horses, but about the way in which we conceptualize drugs and their harms. Clearly, that's just a step too far.

[BPSDB]

D. Nutt (2008). Equasy -- An overlooked addiction with implications for the current debate on drug harms Journal of Psychopharmacology, 23 (1), 3-5 DOI: 10.1177/0269881108099672