EUCAM - European Centre for Monitoring Alcohol Marketing

Alcohol Is Most Harmful Drug, Followed By Heroin And Crack

1 November 2010

Alcohol Is Most Harmful Drug, Followed By Heroin And Crack Alcohol is the most damaging drug to the drinker and others overall, heroin and crack are the second and third most harmful, Professor David Nutt and colleagues wrote in the medical journal The Lancet today. When all factors related to self harm and harm to others are considered, alcohol comes out top. The authors explain that drugs, including tobacco products and alcohol are major contributors to damage to individuals as well as society as a whole.

Date:1 November 2010
Source:Medical News Today

The harms that are caused by drugs need to be comprehensively assessed so that policy makers can be properly advised regarding health, social care and policing, the authors write; not an easy undertaking because drugs can cause damage in so many different ways.

Professor Nutt and colleagues had previously tried to do this (Lancet 2007) by asking experts to give each drug a score according to nine criteria of harm, which included the drug's intrinsic harms as well as the social and health care burdens. The report triggered widespread debate and interest. However, there were doubts regarding the differential weights of each criterion used.

In this latest report, Nutt and colleagues say they have addressed these concerns by using a multicriteria decision analysis (MCDA) when reviewing drug harms. MCDA technologies have been effectively used to help decision making in areas where factors, features and characteristics are complex and often conflicting, as may be the case when deciding policy on nuclear waste disposal.

Nine criteria related to harm to an individual from a drug, while six looked at harm to others - both in the United Kingdom and other countries. The harms were gathered into five subgroups that covered social, psychological and physical harms. Scoring was done with points up to 100, with 100 being the most damaging and zero no damage. Weighting then compared the impact a score of 100 had on all the other criteria, thus identifying the 100-points-scoring-drugs which were more harmful than other 100-points-scoring-drugs.

The authors wrote (in explanation of their model):

In scaling of the drugs, care is needed to ensure that each successive point on the scale represents equal increments of harm. Thus, if a drug is scored at 50, then it should be half as harmful as the drug that scored 100.



The nine harm-to-self categories of a drug were:

* dependence
* drug-related damage
* drug-related impairment of mental functioning
* drug-related mortality
* drug-specific damage
* drug-specific impairment of mental function
* injury
* loss of relationships
* loss of tangibles

The harm-to-others categories of a drug were:

* crime
* decline in community cohesion
* economic cost
* environmental damage
* family conflict
* international damage

With the MCDA modeling method, alcohol came top as the most harmful drug overall. Below are some highlights of their findings:

* Alcohol, overall harm score 72
* Heroin, overall harm score 55
* Crack, overall harm score 54
* Crystal meth, overall harm score 33
* Cocaine, overall harm score 27
* Tobacco, overall harm score 26
* Speed/amphetamines, overall harm score 23
* Cannabis, overall harm score 20
* GHB, overall harm score 18
* Valium (benzodiazepines), overall harm score 15
* Ketamine, overall harm score 15
* Mephedrone, overall harm score 13
* Butane, overall harm score 10
* Khat, overall harm score 9
* Ecstasy, overall harm score 9
* Anabolic steroids, overall harm score 9
* LSD, overall harm score 7
* Buprenorphine, overall harm score 6
* Mushrooms, overall harm score 5
* The most harmful drugs to the individual are heroin, crack and crystal meth
* The most harmful drugs to others are alcohol, heroin and crack

Not only is alcohol the most harmful drug overall, the authors write, but is nearly three times as harmful as tobacco or cocaine, according to the new ISCD MCDA modeling.

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