David King tours the horizon

The Foresight project on Brain Science, Addiction and Drugs reported its findings to government and the wider world in July. The findings themselves are fascinating, and so, I believe, was the way we produced them.

As the project unfolded, it involved the energy of three scientific advisors, experts in psychology, medicine and the sociology of drug use, and over 100 other specialists writing reviews of the state of the art in their field, participating in futures workshops, or advising us as members of the project’s steering group.

Group members ranged from an assistant commissioner of the Metropolitan Police to research council chief executives. Perhaps most significantly, the project involved the general public, whom we consulted about their views on the future prospects for licit and illicit drugs.

Purpose of the project

The motivation for this project was the confluence of our increasing knowledge of the human brain, growing problems with neurodegenerative diseases such as Alzheimer’s, social concern about illicit drug use, and the emergence of new drugs that may help the performance of the healthy brain.

Like any proper research project, this one had a clear question to answer – how could drug use be managed for the good of individuals, communities and society on a 20-year timescale? As Foresight learned long ago, the way to approach such a complex issue is not to produce predictions – we never do – but to see what the main drivers for change might be, whether scientific or social.

Despite our rule about not trying to predict the future, some things about the world of 2025 can be stated with confidence. For example, every society that history has described has used some form of psychoactive substance, be it coffee or aspirin, and it is likely this will continue.

Neuroscience meets genomics

One project finding is that advances in genomics and neuroscience are likely to alter our appreciation of drugs and the brain. We are already discovering the gene variations in animals and human beings that affect how they react to drugs. After all, most people who drink alcohol do not become alcoholics. A few develop an addiction that damages them and the people around them.

Now we are starting to see the differences in brain structure that relate to different drug responses, and the genetic differences that underlie them. Brain imaging is becoming more sophisticated and will allow us to describe the action of drugs on specific centres within the brain more exactly within 20 years.

We do not know how far or how fast this research will progress. As with other advances in genomics, we are sure that it is wise to avoid referring to ‘the gene for’ drug addiction. But it may be possible to counsel some individuals that their genome might predispose them to addiction and that some temptations are best avoided. On the other hand, we certainly want to avoid giving the rest of the population the impression that it is ‘safe’ for them to use drugs.

Addiction

Our increasing knowledge also raises the issue of whether drug addiction might be preventable. Although much has been written about the possibility of ‘vaccination’ against drug use, it will probably never be possible to vaccinate somebody against drugs as one can against measles.

But even if it were possible to do so, the project received a very definite message that it would not be desirable. Our public consultation involved both a sample of the general public and groups with specific knowledge, such as carers for people with Attention Deficit Hyperactivity Disorder, and active users of illicit drugs. The consultation, run by the Office of Public Management, showed that the public want open discussion and choice about these important matters. And they want the choices to be personal ones rather than taken by government.

However, people who treat drug addicts told us that a vaccination that made a drug ineffective, or controlled the craving for it, might be a crucial addition to the therapist’s armoury at a tricky point in recovery from addiction.

Better than well?

The public were also cautious about the promise of ‘cognition enhancers’, drugs which enhance the mental performance of people within the normal behaviour range.

Several such drugs already exist, such as Ritalin, which was originally intended for Attention Deficit Hyperactivity Disorder patients. Ritalin is being used by a small number of students in an attempt to improve exam results and by business people to improve their performance in the board room. In the longer term, the increased focus on neurodegenerative disease could mean a multi-billion pound market for such drugs. Drugs that preserve or enhance brain connections could become big business, and might be especially effective in combination with exercise and other forms of therapy.

However, the public are cautious about the prospects of a society in which abnormal behaviour can be engineered out by behaviour-modifying drugs or by cognition enhancers. They value diversity and like having eccentrics around. After all, some might be the unrecognised geniuses of tomorrow

Industry caution

We also found that the UK pharmaceutical industry, one of the most innovative parts of the British economy, is unwilling to develop drugs for people who are not ill. The costs and risks far outweigh the potential rewards.

However, there is a large potential market in drugs for the elderly, where depression and sleep disorders are priorities alongside Parkinson’s and Alzheimer’s diseases.

Illicit drugs

We also found that advances in science offer much to those with concerns about illicit drug use. For example, drug testing is improving as the equipment becomes smaller and the tests more rapid. Here, the needs of competitive sport as well as criminal justice are driving innovation.

The other side of this coin is that the illicit drug trade, too, includes enthusiastic early adopters of new technology. During the 20th century, synthetic drugs sprang up to rival older plant-based ones. The ability to synthesise and test new drugs rapidly might allow them to spread faster than legislators can make them illegal.

In the same spirit, we noted that the web has already started to transform the way in which drugs are bought internationally. A surprising range of drugs is available online, and by no means all have passed the tests which would allow them to be prescribed by doctors in the UK.

Scenario workshops

We looked at the possible world of 2025 via a number of scenarios, played out over several days by a wide range of participants. One key variable was whether future drug control would be based on evidence of harm, or on traditional views of the acceptability of different drugs. The other was whether drug use would be regarded mainly as a defence against illness, or whether it might become more generally acceptable as a lifestyle accessory.

The scenario workshops threw up a wide range of possible future concerns. For example, if drugs are used routinely for performance enhancement, they might become as common as coffee in the office. Indeed, the public seem to support their use for anyone in a safety-critical job such as driving a train or handling nuclear fuel.

In other scenarios, society’s tolerance for drug use is lower. In yet others, our capacity to invent drugs – and the ageing population that wants them – has outrun our inclination to pay for them. And at another extreme, molecular science might have made such progress that new drugs can be developed, perhaps customised to an individual genome, by tiny open-source companies. So there are business, social, and economic issues to be grasped as well as scientific ones.

Following the launch of the findings, the government has asked the Academy of Medical Sciences to report on the implications. It is important that the evidence we gathered in this project helps to support our long term thinking within and beyond government for years to come.

Sir David King is director of the Office of Science and Technology, and Chief Scientific Adviser to Government.

Details of the Brain Science, Addiction and Drugs project may be found at www.foresight.gov.uk.