Drug harms paper: a summary
December 9, 2010
Drug harms in the UK: A multi-criteria decision analysis
The ISCD’s first published work, launched in the Lancet on 1 November 2010, has attracted considerable attention in the media worldwide and from the public. The summary below lays out the basics of what the papers shows and what it cannot. To read the paper in full, download it for free from the Lancet’s website.
Overview of paper
An assessment of the various harms of drugs used recreationally in the UK using multi-criteria decision analysis (MCDA) – a method that uses relevant experts’ knowledge and experience to assess the actual and relative harms.
What is its purpose?
To assess drugs in terms of their known harms to individuals, those around them and more broadly, to domestic and international society. Showing drugs’ harms relative to each other also enables more objective and informed assessment of their harms individually and in relation to their current controls.
What does it show?
The report found heroin, crack cocaine, and methyamphetamine to be the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), with alcohol, heroin, and crack cocaine as the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.
It also found the legal status of most drugs to bear little relation to their harms.
What does it not show?
Because of the many factors that could change, the report does not take the legal status of a drug into account. This will clearly have some impact on its level of harms, for instance alcohol’s regulated availability means that many more people have access to it than most drugs, which will have an effect on its level of harm. Similarly, the controlled status of some drugs will make them more harmful as unsafe production of the drug introduces contaminants and risky practices by users puts them at risk of diseases such as Hepatitis C and HIV.
The rankings of harm to the user would be unlikely to change drastically if all drugs were controlled or, conversely, not controlled, as those harms are intrinsically linked to their effects on the mind and body. However, the harms to society could change if a drug’s legal status changed. There are examples in a number of countries of different levels of control, such as in Brazil, Mexico, Portugal, Spain, the Netherlands, Finland and parts of Australia and the USA, amongst others. However, it is not possible to expect identical results if replicated in the UK, given the wide variety of cultural and historical factors that can influence drug use and especially problem drug use.
Areas of development
This paper represents a step forward in our understanding of drug harms but is by no means the definitive answer. Repetition of the MCDA process with other relevant groups (such as police, teachers, doctors, politicians, users) and in other countries would help to build a fuller picture of the range of harms. Taking into account the various benefits of drugs would also enable better understanding of why people take drugs and how they might positively impact on users and society.