March 28, 2007

Which drugs are most harmful? According to this, heroin's worse than cocaine, which is worse than alcohol, which is worse than cannabis, which is worse than LSD. Some results you'd expect, and some surprises. (From The Lancet, free registration required.)

From the study: Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.

  • It's all about control, baby! Once governments start marketing ganja-cola they can outlaw that rascally alcohol, or at least increase the prices. *slurps beer, thinks about hidden stash of pot that Should Not Be Enjoyed In Front Of Children*
  • They require that I have a medical specialty to log in. Did I miss something?
  • Username: ISIRTA Password: reallyrules via
  • Some of these scores are kinda shocking. I knew alcohol was much worse than pot, but I didn't expect it to be so close to the top of the list.
  • Of course, you have to draw a line between "occasional/responsible consumption" and "abuse". Fun with anecdotal evidence follows! There isn't a way to responsibly consume heroin. You can become addicted on the first use. Opiates are sometimes responsibly consumed for brief periods by people with pain problems, or to a larger extent by the terminally ill, when medical professionals decide that addiction isn't an issue. IE, everyone I know who's died of cancer in hospice care was on a lot of morphine towards the end; after I was injured in a car accident a few weeks ago, I was put on a low dose of narcotic painkillers, which I take as directed (or less often, because I don't want to become addicted). Both of these are responsible uses. Alcohol is OK in small amounts: a glass of wine with dinner even has health benefits. It seems to be intoxicating consumption that starts to cause problems. I'm alarmed that I know people in their 30s who still get very drunk every weekend, like to the point of altered behavior and/or blackouts; nice people, but if they haven't stopped by now, I don't think they ever will. Pot seems, to me, to be somewhere around "beer" in the badness realm. If taken in moderation by people who don't operate heavy machinery while under its influences, it's probably not that harmful. But there's a stigma, and no kind of smoking is really good for you. I've never been high, myself (no, really!), but I'd rather be around stoned people than drunk people any day. Better snacks, for one thing. I've never seen someone become angry or violent on marijuana, only happy or sleepy. I've also never done LSD, but anyone I know who ever used it in moderation for a while, then stopped, is fine. I have a few good friends who used to love to trip, and they are currently responsible adults who limit their drug intake to the occasional glass of wine. All the former potheads I know, who may still occasionally indulge, are generally successful and happy. I can't say the same for the alcoholics, who at this point seem OK with their jobs but are mostly single; the junkies have mostly died. So anyway, I'm not surprised by their findings at all, and I don't disagree with the concept that some of the legality or illegality is arbitrary. I think there are only two reasons that tobacco cigarettes are still legal in the US - the fact that so many people are still addicted to them that there would be a major outcry if they were made unavailable, and the fact that the tobacco companies have good lobbyists. (Also, what would you do about Japan? I've heard over and over from multiple sources that the majority of Japanese men are tobacco smokers.)
  • Interesting post (and an interesting comment, verbminx). Up till now, I've been inclined to rate these things according to their apparent naturalness. Alcohol crops up fairly naturally in tiny amounts, and has some slight nutritional value. Fermented drinks have been around for thousands of years, long enough for human beings to get used to them. Distilled drinks are more recent, and harder to deal with, but still pretty well established. Tobacco has only been widespread for a few hundred years, so we're not that well adapted to it; opium about the same (?) and cannabis somewhat less; but in general things you eat, drink, or smoke still seem to have some relationship with natural human experience. Then you get on to stuff that requires advanced chemistry and needs to be injected. But now I see that was just ill-informed, romantic, hopelessly woolly old macrobiotic type of thinking. I still think alcohol tastes best.
  • They talk about the health costs associated with tobacco smoking, but I seem to remember hearing somewhere that smoking actually saves the government money, because many smokers die fairly quickly (if they have lung cancer) at the end of their working lives, before they have received much old age security or had a long term wasting disease. (yes, this all does sound morbid). But something else I remember - I once was in a circle discussion with some alcoholics who were smoking like chimneys, and I couldn't help but think that very few people have lost their jobs, torn their families apart by chain smoking.
  • You're right, jb: smokers not only die through lung cancer, but also have a higher rate of heart disease, which often finishes people off without much healthcare cost. It's also true that in many countries smokers more than pay for their healthcare through taxes on tobacco. IANAS, incidentally.
  • I was at a "clean & sober" party once, and everyone there was chain smoking and sucking down coffee like it was going out of style. ugh. I'll take my chances with booze :D
  • In the U.K., smokers contribute about £8bn in extra taxes, and yes, are less of a burden on the NHS over the course of an average lifetime.
  • I was at a "clean & sober" party once . . . Once!
  • Having just come back from the funeral of a friend who overdosed on heroin, I've been thinking a lot about the relative amounts of harm about different addictive things. My friend became addicted in the mid 90s, when a lot of kids I knew were using heroin because it became a lot cheaper than pot, and often easier to obtain than alcohol. It seems like he was the last of a generation of kids to go, and it's sad. I've always sort of ascribed to the viewpoint of legalizing everything and taxing the heck out of it, and perhaps making the more harmful substances cost more than others. I'm not sure.
  • I believe that some of the currently illegal drugs could be made less dangerous by controlled legalization. I know there will always be abusers, but if I were an average junkie and knew what I needed to fix and could purchase said dose from a standardized and reputable source, I'm convinced that an overwhelming number of overdoses would cease to exist. We could easily have functioning heroin addicts the same way we have functioning alcoholics. Not something to aspire to in either case, but it's better than dieing in a gutter. I am talking about people who, even though they are addicted to a substance, can live a relatively normal life, hold down a job, and not have to rob donut shops or pawn their mother's jewelry to feed their habit. If there ever was a real war on drugs, we lost it a long, long time ago. Time to recognize what we have now isn't working and to look at alternatives to making people with diseases (addictions) criminals. Our current drug law implementation smacks of the same social Darwinism of Victorian England that put the poor and indigent in "work homes". I don't have statistics, but I imagine that a huge percentage of our current prison population is in for drug related "crimes".
  • meredithea, I'm so sorry to hear about your friend. the number of young people who die from illegal drugs each year certainly seems to indicate that present policies are ineffective...maybe it's time for a paradigm shift w/r/t drug policies & laws? or...what squidranch said. and pete, yes, it was once, only once!
  • The other advantage of legalising the harder drugs is you can guarantee their purity, so they're not cut with washing powder, strychnine, and other potentially fatal additives. Very sorry to hear that news, meredithea.
  • We could easily have functioning heroin addicts the same way we have functioning alcoholics. The thing is though that a "functioning" (insert drug problem here) is not, really. It's just a longer arc of an inevitable crash. Sort of like being "a little pregnant". You are or you aren't. But I don't want to derail a "which drug is least harmful" into an addiction-is-this-or-that unless it was already going there.
  • Most of my experience with habitual marijuana users comes from one particular cousin. He does occasionally get mean and violent while. he's using. (NB, I suppose it's possible that he's taking xomething else as a chaser, but if he is he's keeping it more of a secret.) It makes him take stupid chances while operting machinery and vehicles, ignore his wife and children, and basically renders him unable to focus on the basic tasks of taking care of himself. Not to mention raising his cash crop on land belonging to his dying 90-year-old grandmother who doesn't need police knocking on her door.
  • BTW... Monkeyfiltre: Fun with anecdotal evidence
  • We could easily have functioning heroin addicts the same way we have functioning alcoholics. There is no such thing as a "functioning alcoholic." Yeah, I know a guy that works hard at his civil service job and farms hard after work. He's apparently quite the social butterfly, in a boozy sort of way. His ex-wives and children can tell you about the physical and emotional abuse they've had to live with. Some alcoholics can hide it better than others, but they aren't fully functional. Relationships with anything other than the bottle are the first to crash. MonkeyFilter: just ill-informed, romantic, hopelessly woolly old macrobiotic type of thinking
  • Lemmy doesn't like heroin. End of story.
  • You can argue semantics if you wish, but no one can doubt that there are people, even as some can be rather miserable, that are able to exist, contribute and even have small amounts of joy, who are addicted to alcohol or whatever. Not every boozehound beats up his wife and kids and I know of plenty of families who's parent was a drinker who, all in all, were pretty healthy compared to others where alcohol had nothing to do with their fucked up pathology. The AA "all or nothing" school of thought is a falsehood. There are plenty of people who are addicts who can contribute and live semi-normal lives. I know several addicts who have high paying jobs where they can feed their addiction without breaking the law. With the exception of their addiction, they are nice, relatively normal folks and DO contribute to society. My point isn't to define "functioning", it is that there are people are addicted and will do what they have to to get their drug of choice. If they have access to the drug in a clean, standardized form, they won't have to commit other crimes to get the drug and can lead their lives. When you don't have to rob a liquor store to self medicate, believe me it makes choice to go sober a hell of a lot easier. This is the crux of the problem; by enforcing this prohibition, we've done with other drugs the same thing as when we did it with booze. Due to our failed war on drugs we created a multi million dollar black market which funds all sorts of other nefarious criminal activities including terrorism. Almost everyone can agree that prohibition was a huge mistake. What makes us think that this "prohibition" will work any better? If we continue our puritanical trend of treating our addicts as criminals and keep the drugs laws as they are, we will do nothing for their disease, create more criminals, pour more money into the pockets of the dealers, and fill the prisons with even more sick people.
  • What squidranch said.
  • What roryk said.
  • The AA "all or nothing" school of thought is a falsehood. There are plenty of people who are addicts who can contribute and live semi-normal lives. I disagree, but if we define them as addicts, then the point is probably moot. "addiction: compulsive physiological and psychological need for a habit-forming substance" You can argue semantics if you wish, but no one can doubt that there are people . . . that are able to exist . . . who are addicted to alcohol or whatever "Functioning addicts" exist, sure. It's not a great argument for the legalization drugs, but I agree that people can be hooked on and still contribute to society to some extent. I'd argue a lesser extent, but contribute nonetheless as opposed to being, say, dead and not contributing at all. I'm in favor of keeping crack and meth illegal, though. And Rumpleminz. That stuff is wrong.
  • petebest, I knew someone quite a few years ago who was actually addicted to that stuff. *shudders*
  • Not to put too fine a point on it, but what I am arguing is not that being addicted to something is the same as not being addicted or that to be a functioning addict is desirable, it's that addicts exist if we care to admit it or not and they will do what they have to to get their drug. I would much, much rather have addicted people taking their drug in a (relatively) controlled way than have them breaking even more laws to get the money to pay for their habit. It's also easier to get treatment to people who are able to hold down a job when they don't have to pay an arm and a leg for their habit. Furthermore, by decriminalizing the drugs we not only cut dealers and suppliers off at their knees, but we cam drastically reduce law enforcement costs. There are several reasons we haven't gone down the same path as other countries have. One of the major ones is that there is an entire industry based on the criminalization of drugs. From industrial incarceration, to whole sectors of law enforcement, fortunes are being made. I'd be curious to find out what percentage of US prisoners are in for drug offenses...
  • From my experience it is not the object of addiction but the quality of the individual's addiction to the substance that defines it as being a problem. The quality of the problem can be defined by how other people are hurt or protected by the substance abuser. All addicts have their 'back-up', be it tobacco, coffee or diet Pepsi. I mention that as I found so many recovering alcoholics used it to replace the physical demand to drink. Hard drug users are proud when they use only marijuana instead. There are big addicts and little addicts. imo
  • Thanks for your thoughts, everyone. It was an odd funeral, because everyone was very sad to see my friend go, but also strangely happy that he was finally free from his addiction. It's a rather guilty feeling. I tend to agree with what squidranch said. I think that the war on drugs is an expensive, hurtful, losing battle. Why not legalize, standardize, and tax drugs and use the money to fund education and rehab?
  • meredithea you stop with that compassion, rational, sensible approach to the worlds' problems!! what are you, crazy?? ;)
  • There is that, Medusa ;) I do have the crazy, but it's mostly of the "wear hats, eat strawberries, and sing loudly in inappropriate places" variety. I've been working on a paper that was due months ago all day, so right now it's really of the "brain mushy. thinking bad." variety.
  • I'm working on a paper that was due months ago right now. You can see how well it's going. *puts on hat, eats strawberries, sings choruses in public*
  • I think if you legalise drugs, there will be more of them. Lots more. I can't believe that overall that would be a happier world.
  • Decriminalization is better. Theres no sense in putting folks in jail for trying to make themselves feel better.
  • I agree for the most part with the decrimininalilzisation argument. But as with any black-or-white issue, this one isn't. Legalizing gambling has caused problems that don't exist on such a scale when gambling is illegal. People still gamble (and lose their life's savings) when it's illegal, but not on the scale they do when it's legal. The legalization has created a huge problem where there wasn't one before. I think the legalization argument tends to be couched in personal responsibility terms that don't exist as such in the world of addicted drug users. With some drugs, like meth, crack, or heroin, the downside of ready availability seems far worse than the problems we currently face.
  • Should we set our societal standards to the lowest denominator? Some people can't gamble responsibly. Others can't use drugs responsibly. Still others can't drink, operate guns, drive cars, or care for their children responsibly. At what point does the irresponsibilty of the minority interfere with the enjoyment of the majority? You're right. There are no black-and-white solutions.
  • worst.vonnegut.story.evar.
  • It's not that bad, it's just, well, it's just nice, I suppose. But, seriously, there are good ones? People like Vonnegut for the same reasons they like John Waters or Quentin Tarantino; not because he's Hemmingway, but because he's Kilgore Trout.
  • That famous one is really good, I thought. Plus I like him as a speaker and all around ghost-of-Mark-Twain-for-the-postmodern-age
  • Sam Clemens with the shakes, mayhaps?