All drugs are dangerous, but alcohol and tobacco rank highly

A new study proposes that all drugs should be classified by the amount of harm that they cause users, families and society; and the potential to arouse dependence / addiction. Harmful drugs are currently regulated according to a classification system that purport to relate to the harms and risks of each drug. But this classification is often misleading. 
David Nutt from the University of Bristol and colleagues identified three main factors that together determine the harm associated with any drug of potential abuse:  

  • the physical harm to the individual user caused by the drug
  • the tendency of the drug to induce dependence/addiction
  • the effect of drug use on families, communities, and society  

Within each of these categories, they recognized three components, leading to a 9 classes of harm. Expert panels gave scores, from zero to three, for each category of harm for 20 different drugs. All the scores for each drug were combined to produce an overall estimate of its harm.

Illicit drugs were compared with five legal drugs of potential misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) were included in the assessment. The process proved simple, and yielded roughly similar scores for drug harm when used by two separate groups of experts.

The research rates the most dangerous drugs (starting with the worst) as follows: 

  • 1. Heroin
  • 2. Cocaine
  • 3. Barbiturates
  • 4. Street methadone
  • 5. Alcohol
  • 6. Ketamine
  • 7. Benzodiazepines
  • 8. Amphetamine
  • 9. Tobacco
  • 10. Buprenorphine
  • 11. Cannabis
  • 12. Solvents
  • 13. 4-MTA14. LSD
  • 15. Methylphenidate
  • 16. Anabolic steroids
  • 17. GHB
  • 18. Ecstasy
  • 19. Alkyl nitrates
  • 20. Khat 

David Nutt, lead author on the paper, said: “Drug misuse and abuse are major health problems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.” 

Colin Blakemore added: “Drug policy is primarily aimed at reducing the harm to individual users, their families and society. But at present there is no rational, evidence-based method for assessing the harm of drugs. We have tried to develop such a method. We hope that policy makers will take note of the fact that the resulting ranking of drugs differs substantially from their classification in the Misuse of Drugs Act and that alcohol and tobacco are judged more harmful than many illegal substances.”

Reference: Nutt et al, Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet on 23rd March, 2007. From a press release of the University of Bristol issued 23 March 2007.

Bloggers comments; It should be noted that over the counter medications and prescription drugs were excluded. Many of these have the capacity to induce dependence / addiction i.e. morphine and Temazepam. I wonder why? For example see; Diverted Pharmaceuticals


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