The long-running controversy about the harm that drugs cause has gained a new impetus with the findings by a group of scientific experts that alcohol is more damaging than any drug overall and to those around users. It also came fourth in terms of damage to users behind only heroin, crack cocaine and crystal meth.
The paper, co-authored by former government advisor Professor David Nutt, also suggests that tobacco and cocaine were almost equally damaging (one scale point between them), more so than cannabis and many class A substances, such as magic mushrooms, ecstasy and LSD that fell to the bottom of the ranking.
The findings cast doubt on present drug classifications and, in looking at drugs solely through harm they do, the paper has not only challenged common views on damage caused by different substances but also criticized current drug policy.
It also adds fuel to the fire most recently reignited when, late last year, Nutt was sacked as chairman of UK Advisory Council on the Misuse of Drugs by the then Home Secretary Alan Johnson. In a letter to The Guardian, Johnson explained that Nutt could not hold his official role while campaigning against government policies. Outraged by Nutt’s treatment, many other scientific advisors resigned from the council, and subsequently formed the Independent Scientific Committee on Drugs, which the authors describe as “a new organization of drug experts free from government interference”.
Nutt and his colleagues looked at 20 legal and illegal drugs across 16 criteria of harm, which fell broadly under mental, physical and social harm to both users and those around them. Social harm also attempted to gauge the plight of drugs on society as a whole by accounting for economical, international and community damage. An earlier attempt in 2007 by Nutt and colleagues to reclassify drugs by harm sparked much public and media interest, but was criticized for the validity of its ranking. The new paper has attempted to navigate this criticism by using multi-criteria decision analysis.
The largest shortfall in the original paper was the inability to distinguish between the severity of different types of harm. Multi-criteria analysis allowed severity to be taken into account, meaning each criteria contributed proportionately to overall drug ranking. Though the importance of severity placed on different criteria was subjective Nutt and colleagues based these decisions on scientific insight. Once the criteria were ranked the ISDC team went about scoring each of the 20 substances against each criteria using a scale ranging from zero to one-hundred.
Further weight was sought by correlating the papers findings with data routinely collected on drug-related fatalities and criminal damage. The results were promising, showing a strong association between the statistics and Nutt and colleagues’ classification system. Considering this, along with support lent by prior work in the UK and the Netherlands, means the papers reclassification of drugs is hard to dispute.
The multi-criteria ranking of drugs according to harm produced a list that was in stark contrast to UK and other governments’ classification systems. The paper found there was no correlation at all between the ISDC ranking and drug classification based on the UK’s Misuse of Drugs Act 1971.
The paper has given a fresh, outcome focused view on drug severity, which will prove helpful to policy makers prioritizing investment in prevention and intervention to curb substance misuse. It partly breaks down what Nutt has referred to the “artificial separation” of alcohol and tobacco from illegal drugs.
However, the paper does not claim some drugs are not harmful – all cause damage. The ISDC does, however, question if efforts should be focused on criminalizing the use of, and, therefore, users of, less harmful illegal drugs or attempts to prohibit usage of the most harmful substances irrespective of legality.
28 November 2010
Nutt, D, King, L, & Phillips, L. (2010) Drug harms in the UK: a Multicriteria Decision Analysis, Lancet, 378, 1558-65.