Is Equasy more dangerous than Ecstasy?

Prof. Dave Nutt was first launched to public fame when he claimed that horse-riding was statistically more dangerous than taking ecstasy, to which the UK Home Secretary Jacqui Smith objected. He wrote this article following his talk at a Beckley Foundation Seminar at The House of Lords on the same subject. The argument caused quite a stir in the media, a precursor to his recent dismissal by the new Home Secretary Alan Johnson, for publicly objecting at the government’s consistent refusal to listen the voice of Science.

The UK MDAct classifies drugs into three classes, A, B, C on the basis of their harmfulness: Class A (the most harmful) includes cocaine, diamorphine (heroin), 3,4-methylene-dioxymethamphetamine (MDMA, ecstasy) lysergic acid diethylamide (LSD) and methamphetamine. Class B (an inter- mediate category) includes amphetamine, barbiturates, codeine and methylphenidate. Class C (less harmful) includes benzodia- zepines, anabolic steroids, gamma-hydroxybutyrate (GHB) and cannabis. This system of classification serves to determine the penalties for the possession and supply of controlled substances.

How best to assess the classification of a drug is an issue that is and has always been problematic. A potential method for exploring harms has been developed that assesses harms across nine domains; three relate to the personal harms of the drug [acute harms e.g., from overdose, chronic harms and harms due to intravenous use], three relate to its propensity to cause dependence [liking, physical dependence and psychological dependence] and three cover social harms [harms from intoxication, (including anti-social behaviour), harms from supply/dealing, associated acquisitive crime and health care costs]. Each can be scored on a 0–3 scale and a value for each drug derived from which a rank order of harm may be produced (Nutt, et al., 2007). In this study, we also assessed alcohol, tobacco and some other misused substances to provide anchor points that would allow non-experts and the general public to better understand the harms of drugs with which they might not have familiarity. This study produced a degree of public debate and considerable media coverage. This taken together with the subsequent coverage of the classification of cannabis (ACMD, 2008) and the ongoing review of ‘ecstasy’/MDMA has shown that the arguments about relative drug harms are occurring in an arcane manner, at times taking a quasi-religious character reminiscent of medieval debates about angels and the heads of pins!

The reasons for this are multiple and complex, but one major element is that 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 to illustrate an approach that might lead to a more rational and broad-based assessment of relative drug harms.

The dangers of equasy were revealed to me as a result of a recent clinical referral of a woman in her early 30’s who had suffered permanent brain damage as a result of equasy-induced brain damage. She had undergone severe personality change that made her more irritable and impulsive, with anxiety and loss of the ability to experience pleasure. There was also a degree of hypofrontality and behavioural disinhibition that had lead to many bad decisions in relationships with poor choice of partners and an unwanted pregnancy. She is unable to work and is unlikely ever to do so again, so the social costs of her brain damage are also very high.

So what was her addiction – what is equasy? It is an addiction that produces the release of adrenaline and endorphins and which is used by many millions of people in the UK including children and young people. The harmful consequences are well established – about 10 people a year die of it and many more suffer permanent neurological damage as had my patient. It has been estimated that there is a serious adverse event every 350 exposures and these are unpredictable, though more likely in experienced users who take more risks with equasy. It is also associated with over 100 road traffic accidents per year – often with deaths. Equasy leads to gatherings of users that often are associated with these groups engaging in violent conduct. Dependence, as defined by the need to continue to use, has been accepted by the courts in divorce settlements. Based on these harms, it seems likely that the ACMD would recommend control under the MDAct perhaps as a class A drug given it appears more harmful than ecstasy (See Table 1).

Have you worked out what equasy is yet? It stands for Equine Addiction Syndrome, a condition characterised by gaining pleasure from horses and being prepared to countenance the consequences especially the harms from falling off/under the horse. I suspect most people will be surprised that riding is such a dangerous activity.

Read Prof. Nutt’s full article here:

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