6 ms·

PDF of Nutt's previous 2007 Lancet review here: http://science.iowamedicalmarijuana.org/pdfs/safety/Nutt%20Rational%20Scale%20Drug%20Harms%20Lancet%202007.pdf h

PDF of Nutt's previous 2007 Lancet review here: http://science.iowamedicalmarijuana.org/pdfs/safety/Nutt%20Rational%20Scale%20Drug%20Harms%20Lancet%202007.pdf http://science.iowamedicalmarijuana.org/pdfs/safety/Nutt%20R... The chart with the ranking is on the 4th page. I can't find the most recent Lancet article mentioned in the article. My concern with these rankings is that they don't seem to control for the number of people using the drug. Alcohol kills more people and has higher social costs largely because it's used by more people. However, for an individual user, crack or heroin is far more harmful than alcohol. So saying "alcohol is more harmful than heroin" might confuse some people. Also, if those drugs were legalized, their use might go up, thereby moving them higher up according to Nutt's rubric. I would like to see a ranking that compares the damage these drugs do to an individual person. For instance, is it worse for your health to get intoxicated on a weekly basis with alcohol, or marijuana?

swombat 16y ago
Also, if those drugs were legalized, their use might go up, thereby multiplying their negative impact on society. Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? This may be one of the scales you're looking for, btw: http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_the_harm_of_drugs_(mean_physical_harm_and_mean_dependence).svg http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_t... Also, worth pointing out, with respect to "amount of usage", that drugs like Ecstasy see millions of users every weekend... and yet only a handful of deaths per year (generally involving multiple drugs and/or several-days-long binges). A pretty sterling safety record, I'd say.
- lunchbox 16y ago
  Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? If marijuana were legal I might use it. Conversely, I don't think I know anyone who uses marijuana/heroin but would stop using it if it were legal. I haven't seen the evidence either way; I just made the point in my original post as something to consider.
  - ljf 16y ago
    I /think/ the argument for legalisation lowering heroin use is that if it were legal, certain unscrupulous people would not be pushing it on fragile members of society, and getting them hooked for financial gain. If an addicted prostitute or other user could walk away from a pusher and life of crime and get the heroin on prescription (with an eye to coming off it in the long term), then the thought is that use and dealing would go down. (Why don't users now just go an get methadone/other substitute - I've read that is because they are pretty awful replacements). This is what has happened (to some extent) in Portugal: http://www.time.com/time/health/article/0,8599,1893946,00.html http://www.time.com/time/health/article/0,8599,1893946,00.ht...
    - ahoyhere 16y ago
      Good point. Nobody ever considers the supply-side part of the equation except for drug-related crime.
    - gloob 16y ago
      I /think/ the argument for legalisation lowering heroin use is that if it were legal, certain unscrupulous people would not be pushing it on fragile members of society, and getting them hooked for financial gain. Replace "heroin" with "cigarettes" and you have a one-sentence description of tobacco companies. Legalizing it won't get rid of pushing, so long as pushing is financially beneficial for the pusher.
      - JoachimSchipper 16y ago
        Come on, making heroin "as legal as" tobacco is a straw man. Even the Netherlands, well-known for their liberal drug policy, have rather severe restrictions even on marijuana use.
      - ljf 16y ago
        Yes - if cigarettes were available on prescription, it would massively harm the abilities of cigarette companies to market and advertise (since profits would be hit rather hard!) which in turn would cut out a whole new tranche of smokers.
- bmj 16y ago
  Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? But then why is alcohol and tobacco use so prevalent, since those substances are legal? Did the number of drinkers decrease in the U.S. after Prohibition was lifted? I also wonder if we would see the same sort of safety issues if, say, alcohol was banned but marijuana and cocaine were legalized (driving under the influence, violence--not with pot, I suppose)?
  - Prisen 16y ago
    Hard liquors decreased and beer increased (hard liquors are easier to smuggle). There could be a similar correlation between heroin and lighter drugs.
    - bmj 16y ago
      Hard liquors are also easier to produce.
  - kls 16y ago
    This is just my personal observation so take it for what it is worth, but as a former smoker. When I was a kid it seemed like everyone smoked, over time the stigma of being a smoker and the public awareness campaign has eroded that number. I finally quit when, at a party, I realized that I was the only person going outside to take smoke breaks.
- rfrey 16y ago
  Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? I wouldn't use heroin if legal, but it's possible that the next generation, not being subject to mass anti-drug marketing campaigns, would use it in higher numbers. The question is whether that matters, and that's a debate that's hard to have in an environment of politically motivated and emotionally charged scare campaigns.
  - viraptor 16y ago
    Legalising doesn't mean the end of anti-... campaigns. You can still see a lot of "don't drink too much" / "don't drink and drive" / "drinking kills families" kind of stuff, even though drinking is perfectly legal.
    - lutorm 16y ago
      Yes, but you also see plenty of ads about how cool it is to drink alcohol. Do you think legal heroin would be any different?
      - borism 16y ago
        Yes. I think nobody here argues that heroin should be legalized. But for lighter drugs legalization should clearly include ban on their advertisement (or, in fact, provision that tax revenue from their sale be spent on anti-advertisement)
        jamesbritt 16y ago
        Heroin should be legalized. What I put in my body is my business.
        SoftwareMaven 16y ago
        Until you are breaking into somebody's house to get money to fund the addiction. Unfortunately, heroin is so addictive and so quick to build tolerance, that this is a very possible scenario. The ideal scenario involves legalizing much more research about the drug so we could find a way to "have our cake and eat it, too." I imagine there are some smart scientists who could find a way to create a non-addictive heroin-like substance. As an example, just adding a small bit of naltrexone (an opioid antagonist) to opioids seems to reduce the build up of tolerance. I can't find the company who is doing clinical trials on a drug combining the two right now, but you can see [1] for an overview of combining an antagonist with an opioid. [1] http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf
- zepolen 16y ago
  Let me compare Tobacco and Heroin. I smoke, since I was young, it was silly, but I'd seen others do it and was offered cigarettes from a buddy and got hooked. Thinking about it, the only reason I would never try heroin now, is I've seen what it can do to people, from movies mostly (ironically ones that are not suitable for children to watch). If heroin was legal, I think kids who have no idea what the hell they're getting into would be the ones to be affected. So you're right, most adults wouldn't take up heroin if it suddenly became legal - but I bet a lot of kids would.
  - Someone 16y ago
    only reason I would never try heroin now, is I've seen what it can do to people, from movies mostly Are you seen you have seen that? From what I read, part of the reason heroin addicts look the way they do is that they do not buy enough food because they use all their money on heroin; they use all their money on heroin because it is so expensive, and it is so expensive because it is illegal. Another reason is loss of appetite due to heroin addiction, but that certainly is not the only reason, and looking at programs where the government provides heroin to selected addicts, it does not appear to be the most important one.
    - zepolen 16y ago
      What scares me most is the withdrawal symptoms, nicotine made me appreciate the dangers of addiction.
epo 16y ago
Erm, just look at the green bars, "harm to users". OK it's not ranked that way but its clear enough.
lemming 16y ago
Also, if those drugs were legalized, their use might go up, thereby multiplying their negative impact on society. It's possible that the number of people trying a drug might go up, but there are a number of desirable benefits to drugs being legal: - the quality is controlled, so you know you're not snorting bleach. This reduces user harm immensely right off the bat. - the cost of the drug can be taxed, which would give the government money to invest in treatment programs for problem users. Even if you're generally anti-taxation it's difficult to argue that the profits of the drug trade are better off with the people who currently receive them, who are generally some of the more unpleasant people on the planet. - societies are free to treat problematic drug use as a public health issue rather than a criminal one. US jails have an extremely high number of inmates who are there for relatively minor drug infractions due to e.g. three-strike policies. This is expensive for the state and they probably come out more likely to commit serious crime than when they went in. There's a lot of evidence (apart from just plain common sense) that being able to treat drug abuse with theraputic techniques is much more effective than punishment (see Portugal, for example).

swombat 16y ago

Also, if those drugs were legalized, their use might go up, thereby multiplying their negative impact on society. Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? This may be one of the scales you're looking for, btw: http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_the_harm_of_drugs_(mean_physical_harm_and_mean_dependence).svg http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_t... Also, worth pointing out, with respect to "amount of usage", that drugs like Ecstasy see millions of users every weekend... and yet only a handful of deaths per year (generally involving multiple drugs and/or several-days-long binges). A pretty sterling safety record, I'd say.

lunchbox 16y ago
Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? If marijuana were legal I might use it. Conversely, I don't think I know anyone who uses marijuana/heroin but would stop using it if it were legal. I haven't seen the evidence either way; I just made the point in my original post as something to consider.
- ljf 16y ago
  I /think/ the argument for legalisation lowering heroin use is that if it were legal, certain unscrupulous people would not be pushing it on fragile members of society, and getting them hooked for financial gain. If an addicted prostitute or other user could walk away from a pusher and life of crime and get the heroin on prescription (with an eye to coming off it in the long term), then the thought is that use and dealing would go down. (Why don't users now just go an get methadone/other substitute - I've read that is because they are pretty awful replacements). This is what has happened (to some extent) in Portugal: http://www.time.com/time/health/article/0,8599,1893946,00.html http://www.time.com/time/health/article/0,8599,1893946,00.ht...
  - ahoyhere 16y ago
    Good point. Nobody ever considers the supply-side part of the equation except for drug-related crime.
  - gloob 16y ago
    I /think/ the argument for legalisation lowering heroin use is that if it were legal, certain unscrupulous people would not be pushing it on fragile members of society, and getting them hooked for financial gain. Replace "heroin" with "cigarettes" and you have a one-sentence description of tobacco companies. Legalizing it won't get rid of pushing, so long as pushing is financially beneficial for the pusher.
    - JoachimSchipper 16y ago
      Come on, making heroin "as legal as" tobacco is a straw man. Even the Netherlands, well-known for their liberal drug policy, have rather severe restrictions even on marijuana use.
    - ljf 16y ago
      Yes - if cigarettes were available on prescription, it would massively harm the abilities of cigarette companies to market and advertise (since profits would be hit rather hard!) which in turn would cut out a whole new tranche of smokers.
bmj 16y ago
Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? But then why is alcohol and tobacco use so prevalent, since those substances are legal? Did the number of drinkers decrease in the U.S. after Prohibition was lifted? I also wonder if we would see the same sort of safety issues if, say, alcohol was banned but marijuana and cocaine were legalized (driving under the influence, violence--not with pot, I suppose)?
- Prisen 16y ago
  Hard liquors decreased and beer increased (hard liquors are easier to smuggle). There could be a similar correlation between heroin and lighter drugs.
  - bmj 16y ago
    Hard liquors are also easier to produce.
- kls 16y ago
  This is just my personal observation so take it for what it is worth, but as a former smoker. When I was a kid it seemed like everyone smoked, over time the stigma of being a smoker and the public awareness campaign has eroded that number. I finally quit when, at a party, I realized that I was the only person going outside to take smoke breaks.
rfrey 16y ago
Actually, all available evidence points to the fact that legalising drugs like heroin actually decreases their usage. Would you suddenly take up heroin if it was legal? Do you know anyone who would? I wouldn't use heroin if legal, but it's possible that the next generation, not being subject to mass anti-drug marketing campaigns, would use it in higher numbers. The question is whether that matters, and that's a debate that's hard to have in an environment of politically motivated and emotionally charged scare campaigns.
- viraptor 16y ago
  Legalising doesn't mean the end of anti-... campaigns. You can still see a lot of "don't drink too much" / "don't drink and drive" / "drinking kills families" kind of stuff, even though drinking is perfectly legal.
  - lutorm 16y ago
    Yes, but you also see plenty of ads about how cool it is to drink alcohol. Do you think legal heroin would be any different?
    - borism 16y ago
      Yes. I think nobody here argues that heroin should be legalized. But for lighter drugs legalization should clearly include ban on their advertisement (or, in fact, provision that tax revenue from their sale be spent on anti-advertisement)
      - jamesbritt 16y ago
        Heroin should be legalized. What I put in my body is my business.
        SoftwareMaven 16y ago
        Until you are breaking into somebody's house to get money to fund the addiction. Unfortunately, heroin is so addictive and so quick to build tolerance, that this is a very possible scenario. The ideal scenario involves legalizing much more research about the drug so we could find a way to "have our cake and eat it, too." I imagine there are some smart scientists who could find a way to create a non-addictive heroin-like substance. As an example, just adding a small bit of naltrexone (an opioid antagonist) to opioids seems to reduce the build up of tolerance. I can't find the company who is doing clinical trials on a drug combining the two right now, but you can see [1] for an overview of combining an antagonist with an opioid. [1] http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf
zepolen 16y ago
Let me compare Tobacco and Heroin. I smoke, since I was young, it was silly, but I'd seen others do it and was offered cigarettes from a buddy and got hooked. Thinking about it, the only reason I would never try heroin now, is I've seen what it can do to people, from movies mostly (ironically ones that are not suitable for children to watch). If heroin was legal, I think kids who have no idea what the hell they're getting into would be the ones to be affected. So you're right, most adults wouldn't take up heroin if it suddenly became legal - but I bet a lot of kids would.
- Someone 16y ago
  only reason I would never try heroin now, is I've seen what it can do to people, from movies mostly Are you seen you have seen that? From what I read, part of the reason heroin addicts look the way they do is that they do not buy enough food because they use all their money on heroin; they use all their money on heroin because it is so expensive, and it is so expensive because it is illegal. Another reason is loss of appetite due to heroin addiction, but that certainly is not the only reason, and looking at programs where the government provides heroin to selected addicts, it does not appear to be the most important one.
  - zepolen 16y ago
    What scares me most is the withdrawal symptoms, nicotine made me appreciate the dangers of addiction.

epo 16y ago

Erm, just look at the green bars, "harm to users". OK it's not ranked that way but its clear enough.

lemming 16y ago

Also, if those drugs were legalized, their use might go up, thereby multiplying their negative impact on society. It's possible that the number of people trying a drug might go up, but there are a number of desirable benefits to drugs being legal: - the quality is controlled, so you know you're not snorting bleach. This reduces user harm immensely right off the bat. - the cost of the drug can be taxed, which would give the government money to invest in treatment programs for problem users. Even if you're generally anti-taxation it's difficult to argue that the profits of the drug trade are better off with the people who currently receive them, who are generally some of the more unpleasant people on the planet. - societies are free to treat problematic drug use as a public health issue rather than a criminal one. US jails have an extremely high number of inmates who are there for relatively minor drug infractions due to e.g. three-strike policies. This is expensive for the state and they probably come out more likely to commit serious crime than when they went in. There's a lot of evidence (apart from just plain common sense) that being able to treat drug abuse with theraputic techniques is much more effective than punishment (see Portugal, for example).