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Here's an Economist article which breaks down drug harm, and ranks drugs accordingly. The chart shows that in totality, alcohol does more harm than heroin. [1]

Here's an Economist article which breaks down drug harm, and ranks drugs accordingly. The chart shows that in totality, alcohol does more harm than heroin. [1] [1] https://www.economist.com/graphic-detail/2019/06/25/what-is-the-most-dangerous-drug https://www.economist.com/graphic-detail/2019/06/25/what-is-...

version_five 5y ago
Any study like this takes a very narrow view of good vs bad. Can we even begin to quantify how much good alcohol has done? The amount of fun and sociability it contributes to is staggering. Same with marijuana and no doubt other drugs (i have basically no knowledge of the upside of hard drugs so can't speak to it, but if you google Benzidrine there is an Atlantic article that mentions amphetamine and some upside). I don't disagree that there are vary bad sides to drug use, same as for driving, soda pop, cheese, whatever. But we shouldn't pretend in a vacuum that there are not also positives, and short of severe societal consequences (like with some hard drugs, perhaps) people should generally be able to choose for themselves
- belval 5y ago
  Those studies also often disregard the fact that alcohol consumption is not always (even often) for intoxication, people drink wine and cocktails for the enjoyment of the drink itself, not so much for the effect it has on their behaviour.
  - version_five 5y ago
    Yes, for alcohol in particular (maybe theres also a parallel with cigars) there is the whole other dimension that it's an important part of food, gastronomy or whatever you'd call it. If I get wine pairings with my meal, it has almost nothing to do with intoxication, it's about opening up the senses and adding to what I'm eating. That puts alcohol, as it is normally used, in a very special category compared to ther drugs.
    - arcticbull 5y ago
      I bet an LSD pairing would open up the senses and add to what you're eating too! ;) Granted, the world may fall in on itself and there's a small risk time will stop.
      - renewiltord 5y ago
        Personally, I enjoy sushi on shrooms quite a bit. Especially that feeling of wasabi. Mmmm. Just elevates the experience. Wine is good. The taste sensation changes quite a bit but the texture awareness on psilocybin is unmatched for me. It’s a gastronomic loss that people don’t experience this.
        version_five 5y ago
        I did mushrooms a bit in the 90s and remember either feeling sick of having no appetite (and then being really hungry afterward). Thinking back I really don't remember any instance of eating while on them. Just for the sake of comparison, its interesting. I can picture how one could become caught up in some sensation to do with eating.
        tata71 5y ago
        I smelled pork being cooked near me much differently than I otherwise would have.
        arcticbull 5y ago
        Note token.
        4ggr0 5y ago
        I think shrooms/psilocybin are a loss in general, and I'm really sad that they're so unfairly heavily regulated.
    - lupire 5y ago
      if you just care about pairings, you can use alcohol-free wine/beer/flavorants.
  - Nursie 5y ago
    It's both, even in those situations. By the time someone is doing that, it's likely they've been through years of habituation to alcohol and their brain is wired to respond positively to the stuff because of the effect. To non-drinkers who have never drunk alcohol or have not for a long time, it seems these flavours don't work so well, and all wine is quite nasty (this is anecdotal data from observing such folk). So yes, subjectively I love the taste of a good red, or a well made cocktail, or a fine rum. But the effect of the drug is bound up in my neurological response to it as well as just the flavour.
- zd123 5y ago
  Heres the peer reviewed article upon which the article is based. https://www.ias.org.uk/uploads/pdf/News%20stories/dnutt-lancet-011110.pdf https://www.ias.org.uk/uploads/pdf/News%20stories/dnutt-lanc... I would encourage you to read it before marking it as a “narrow view”. It is literally taking a broad view factoring in societal impacts. It is written by highly respected experts. Alcohol absolutely has severe societal impacts: violence rates are positively correlated to rate of alcohol consumption; clogging up hospitals with self inflicted injuries, driving under the influence, health issues (liver damage), clogging up emergency departments on the weekend etc. I mean I could literally go on. Of all the drugs alcohol really shouldn’t be as easily available as it is. Personally I find the argument that it does “good” pretty wishy washy and more driven by societal bias toward it as an accepted medium for socialistion. Alternatives do exist.
  - pstuart 5y ago
    Most of the harm from heroin stems from it being illegal and unregulated. It obviously would be abused if legal and readily available but even that would be better addressed by spending money on health/prevention vs. police/courts/jails. My brother died of a heroin overdose many years ago. If it had been legal, pure, and known quality that likely wouldn't have happened (he could still have been affected by addiction like our mother with alcohol, but he wouldn't be dead).
    - rectang 5y ago
      I wish that things could have been different for your brother, your mother, and you and all those affected.
      - pstuart 5y ago
        Thank you so much. I do too, as well as for all the others who suffer because of these misguided policies. It so easily could be changed, but we are collectively trapped by the delusion that the only route to safety is to make drugs illegal. You'll see it here on HN, in this thread, about how the "dangerous" drugs should not be readily available because people will get hurt if society lets them have legal access. It's such an easily solvable problem and we collectively support the worst possible way to deal with it -- it's crazy making.
- 14 5y ago
  You sound like these guys from high school I once knew justifying their cocaine use. Saying things like “it makes me way more social” “I am not shy when I do cocaine”. Don’t forget almost all off the feel good drugs once you stop you have to come down and when that dopamine runs out your day feels like shit and all that fun you had is buried with regret and depression. Yes people can have fun but if we added all the fun trips vs bad trips would we as a society see it as a net gain? I have been on a train with a drug user lost out of their mind swearing and threatening people. So if you are counting all the fun drugs have brought you need to count those also.
  - lupire 5y ago
    And also count all the misbehavior of sober depressed / angry people.
- dillondoyle 5y ago
  I have the same argument for all drugs. Including opiates. Which do in fact do a lot of good. For a while. Until they don't. Similar to alcohol. The problem is it's way harder to be a casual opiate user than it is an alcoholic.
- SNosTrAnDbLe 5y ago
  The state of Gujarat in India prohibits the consumption of alcohol. A lot of its cities are considered to the safest for woman in India. While alcohol is available illegally, its consumption is still frowned upon. This relative safety is sometimes correlated with Gujarat being a dry state. I tried to search for any studies but could not find any so it may just be a coincidence. I have lived in Gujarat and the night life is very family friendly and usually involves lots of street food instead of bars and restaurants!
  - bongoman37 5y ago
    The nearby state of Maharashtra has alcohol freely available and Mumbai is considered one of the safest cities for women in India as well. As someone who has lived in both places, I'd say Mumbai is overall better for women in many ways. Also, alcohol in Gujarat is very easily available illegally and the reason for its continued prohibition is largely that politicians derive a _lot_ of money from bootlegging. At this point, the nexus runs so deep that it would take some kind of a massive revolution to upset it.
  - vagrantJin 5y ago
    > A lot of its cities are considered to the safest for woman in India I like how you phrased this as if it were a meaningful metric. Is "safe for women" more useful than safe for everybody including children? Do you have perhaps things relating to brawls, muggings, drunk driving arrests and accidents, drunk pedestrian road fatalities, suicide rates as determinants for a safe city? I'd think they're more reasonable than a vague metric as "safest for women"
  - potamic 5y ago
    By what metric is Gujarat considered safe? It ranks as one of the worst states in India for human trafficking. https://en.wikipedia.org/wiki/Indian_states_ranking_by_incidents_of_human_trafficking https://en.wikipedia.org/wiki/Indian_states_ranking_by_incid...
    - metb 5y ago
      Are we using Wikipedia as a reliable source of hard metric data these days?
jollybean 5y ago
It's worth contemplating the ills of alcohol - but it is available in any quantity to anyone who wants it, and it's socially acceptable. If we sold Opiates/Fentanyl to anyone who wanted it it, in whatever quantities, and there were no social stigma, with 80% of teens doing it 'at least a little bit' before age 21, and 97% of the adult population consuming opiates at least on some occasion again with 'easy access' ... the harm would be orders of magnitude greater than alcohol.
- version_five 5y ago
  Fentanyl, and especially dangerous fentanyl basically only exists because of prohibition. Ignoring that most people wouldn't try hard drugs even if they were more readily available, the current opiate problem is more like if alcohol was unregulated and made in bathtubs everywhere, and every few beers had methanol in it instead of ethanol.
  - com2kid 5y ago
    > Ignoring that most people wouldn't try hard drugs even if they were more readily available, the current opiate problem is more like if alcohol was unregulated and made in bathtubs everywhere, and every few beers had methanol in it instead of ethanol. While I am generally all for harm reduction and even legalization, 19th century history shows what happens when opium becomes readily available to a country with no limitations.
    - Ginden 5y ago
      Arguably, people in XIX century wasn't really aware of opioid addiction. Significant portion of treated troops in US were hooked up on opioids, because physicians weren't aware of issues.
- arcticbull 5y ago
  Potentially, but that's not really what Portugal found when they decriminalized all drugs in 2001 (not legalized, mind you). They saw usage remain roughly constant, but all the negative effects associated with drug use dropped precipitously. [1] [1] https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic...
SapporoChris 5y ago
Based on the chart, it looks like I would benefit by giving up alcohol and switching to heroin. However, I am a little dubious and not quite ready to make the switch. I shopped around, and none of the stores even had heroin.
- arcticbull 5y ago
  Based on the chart it would be better for those around you if you switched to heroin. It would be a bit worse for you. According to the chart it would be better for everyone if you picked up a Bolivian marching powder habit haha.
- exsmelliarmus 5y ago
  Yeah nope. The barrier to entry difference here is staggering. A beer versus a needle in the arm?!?
  - short12 5y ago
    Both can be ordered easily online and delivered to your house. And needles are not even required
  - __float 5y ago
    https://en.wikipedia.org/wiki/Heroin#Routes_of_administration https://en.wikipedia.org/wiki/Heroin#Routes_of_administratio... Wikipedia is surprisingly thorough on most drug articles. But you may even have seen such pipes for sale in stores... it can be smoked. Smoking various substances is pretty well accepted by society, even.
    - sterlind 5y ago
      People smoked in opium dens, after all. Maybe bars succeeded and opium dens failed because alcohol's just been in Western culture longer.
      - boomboomsubban 5y ago
yadaeno 5y ago
What about harm per user? I personally know 3 people that have tried heroin. It quickly has destroyed two of their lives. 0 ability to hold a job, maintain relationships, if not for family they would be homeless. My other friend was able to use it in moderation for a decade but recently going down the same path. The idea that heroin is less harmful then alcohol is absolutely ludicrous. The reason it has done less economic harm is because it's less accessable, extremely taboo, illegal, etc.
- playpause 5y ago
  The harms you describe could also be put down to it being illegal. I am not saying that’s the only difference. I agree heroin is obviously far more powerful a drug, and far more addictive. So I don’t think it should be fully legalised and sold in shops. But making it legal for addicts to use under medical supervision in special licensed places seems a sensible compromise. It would probably scale down the black market (which reduces drug pushing on new users), it would reduce immediate dangers (heroin is pretty safe when administered properly in a clean environment), and it would probably help addicts get off it and build a new life (it would remove a lot of the chaos from their lives and would expose them to drug counsellors).
- adriand 5y ago
  Heroin is a painkiller like the other opiates, and it works on mental pain too, not just on physical pain. Most well-adjusted people without a history of trauma do not want to try heroin or if they do, do not tend to become addicted to it. If we don’t let people have access to pure drugs under conditions that limit the risk of harm, then we should also provide them with the mental health supports they need. People will go to great lengths to kill their pain, including risking death and imprisonment. They shouldn’t be forced into choices like that.
  - jeltz 5y ago
    Yeah, I had to take opiates due to an injury and I hated the feeling (foggy mind and hard to focus). It would be really unlikely for me to become addicted to them. Yes, there is still the physical addiction but I so there is some risk but I wanted to quit taking my opiates as soon as I could when I was on them.
tchalla 5y ago
> Alcohol’s position at the top is partly the result of its widespread use, which causes greater harms to others (crack cocaine is considered the most harmful drug for the user).
arein3 5y ago
leave it to such geniuses to figure out that alcohol does more harm than heroin, put them in charge of society and you get the clown world we have now this is so dumb, I have no words

version_five 5y ago

Any study like this takes a very narrow view of good vs bad. Can we even begin to quantify how much good alcohol has done? The amount of fun and sociability it contributes to is staggering. Same with marijuana and no doubt other drugs (i have basically no knowledge of the upside of hard drugs so can't speak to it, but if you google Benzidrine there is an Atlantic article that mentions amphetamine and some upside). I don't disagree that there are vary bad sides to drug use, same as for driving, soda pop, cheese, whatever. But we shouldn't pretend in a vacuum that there are not also positives, and short of severe societal consequences (like with some hard drugs, perhaps) people should generally be able to choose for themselves

belval 5y ago
Those studies also often disregard the fact that alcohol consumption is not always (even often) for intoxication, people drink wine and cocktails for the enjoyment of the drink itself, not so much for the effect it has on their behaviour.
- version_five 5y ago
  Yes, for alcohol in particular (maybe theres also a parallel with cigars) there is the whole other dimension that it's an important part of food, gastronomy or whatever you'd call it. If I get wine pairings with my meal, it has almost nothing to do with intoxication, it's about opening up the senses and adding to what I'm eating. That puts alcohol, as it is normally used, in a very special category compared to ther drugs.
  - arcticbull 5y ago
    I bet an LSD pairing would open up the senses and add to what you're eating too! ;) Granted, the world may fall in on itself and there's a small risk time will stop.
    - renewiltord 5y ago
      Personally, I enjoy sushi on shrooms quite a bit. Especially that feeling of wasabi. Mmmm. Just elevates the experience. Wine is good. The taste sensation changes quite a bit but the texture awareness on psilocybin is unmatched for me. It’s a gastronomic loss that people don’t experience this.
      - version_five 5y ago
        I did mushrooms a bit in the 90s and remember either feeling sick of having no appetite (and then being really hungry afterward). Thinking back I really don't remember any instance of eating while on them. Just for the sake of comparison, its interesting. I can picture how one could become caught up in some sensation to do with eating.
        tata71 5y ago
        I smelled pork being cooked near me much differently than I otherwise would have.
      - arcticbull 5y ago
        Note token.
      - 4ggr0 5y ago
        I think shrooms/psilocybin are a loss in general, and I'm really sad that they're so unfairly heavily regulated.
  - lupire 5y ago
    if you just care about pairings, you can use alcohol-free wine/beer/flavorants.
- Nursie 5y ago
  It's both, even in those situations. By the time someone is doing that, it's likely they've been through years of habituation to alcohol and their brain is wired to respond positively to the stuff because of the effect. To non-drinkers who have never drunk alcohol or have not for a long time, it seems these flavours don't work so well, and all wine is quite nasty (this is anecdotal data from observing such folk). So yes, subjectively I love the taste of a good red, or a well made cocktail, or a fine rum. But the effect of the drug is bound up in my neurological response to it as well as just the flavour.
zd123 5y ago
Heres the peer reviewed article upon which the article is based. https://www.ias.org.uk/uploads/pdf/News%20stories/dnutt-lancet-011110.pdf https://www.ias.org.uk/uploads/pdf/News%20stories/dnutt-lanc... I would encourage you to read it before marking it as a “narrow view”. It is literally taking a broad view factoring in societal impacts. It is written by highly respected experts. Alcohol absolutely has severe societal impacts: violence rates are positively correlated to rate of alcohol consumption; clogging up hospitals with self inflicted injuries, driving under the influence, health issues (liver damage), clogging up emergency departments on the weekend etc. I mean I could literally go on. Of all the drugs alcohol really shouldn’t be as easily available as it is. Personally I find the argument that it does “good” pretty wishy washy and more driven by societal bias toward it as an accepted medium for socialistion. Alternatives do exist.
- pstuart 5y ago
  Most of the harm from heroin stems from it being illegal and unregulated. It obviously would be abused if legal and readily available but even that would be better addressed by spending money on health/prevention vs. police/courts/jails. My brother died of a heroin overdose many years ago. If it had been legal, pure, and known quality that likely wouldn't have happened (he could still have been affected by addiction like our mother with alcohol, but he wouldn't be dead).
  - rectang 5y ago
    I wish that things could have been different for your brother, your mother, and you and all those affected.
    - pstuart 5y ago
      Thank you so much. I do too, as well as for all the others who suffer because of these misguided policies. It so easily could be changed, but we are collectively trapped by the delusion that the only route to safety is to make drugs illegal. You'll see it here on HN, in this thread, about how the "dangerous" drugs should not be readily available because people will get hurt if society lets them have legal access. It's such an easily solvable problem and we collectively support the worst possible way to deal with it -- it's crazy making.
14 5y ago
You sound like these guys from high school I once knew justifying their cocaine use. Saying things like “it makes me way more social” “I am not shy when I do cocaine”. Don’t forget almost all off the feel good drugs once you stop you have to come down and when that dopamine runs out your day feels like shit and all that fun you had is buried with regret and depression. Yes people can have fun but if we added all the fun trips vs bad trips would we as a society see it as a net gain? I have been on a train with a drug user lost out of their mind swearing and threatening people. So if you are counting all the fun drugs have brought you need to count those also.
- lupire 5y ago
  And also count all the misbehavior of sober depressed / angry people.
dillondoyle 5y ago
I have the same argument for all drugs. Including opiates. Which do in fact do a lot of good. For a while. Until they don't. Similar to alcohol. The problem is it's way harder to be a casual opiate user than it is an alcoholic.
SNosTrAnDbLe 5y ago
The state of Gujarat in India prohibits the consumption of alcohol. A lot of its cities are considered to the safest for woman in India. While alcohol is available illegally, its consumption is still frowned upon. This relative safety is sometimes correlated with Gujarat being a dry state. I tried to search for any studies but could not find any so it may just be a coincidence. I have lived in Gujarat and the night life is very family friendly and usually involves lots of street food instead of bars and restaurants!
- bongoman37 5y ago
  The nearby state of Maharashtra has alcohol freely available and Mumbai is considered one of the safest cities for women in India as well. As someone who has lived in both places, I'd say Mumbai is overall better for women in many ways. Also, alcohol in Gujarat is very easily available illegally and the reason for its continued prohibition is largely that politicians derive a _lot_ of money from bootlegging. At this point, the nexus runs so deep that it would take some kind of a massive revolution to upset it.
- vagrantJin 5y ago
  > A lot of its cities are considered to the safest for woman in India I like how you phrased this as if it were a meaningful metric. Is "safe for women" more useful than safe for everybody including children? Do you have perhaps things relating to brawls, muggings, drunk driving arrests and accidents, drunk pedestrian road fatalities, suicide rates as determinants for a safe city? I'd think they're more reasonable than a vague metric as "safest for women"
- potamic 5y ago
  By what metric is Gujarat considered safe? It ranks as one of the worst states in India for human trafficking. https://en.wikipedia.org/wiki/Indian_states_ranking_by_incidents_of_human_trafficking https://en.wikipedia.org/wiki/Indian_states_ranking_by_incid...
  - metb 5y ago
    Are we using Wikipedia as a reliable source of hard metric data these days?

jollybean 5y ago

It's worth contemplating the ills of alcohol - but it is available in any quantity to anyone who wants it, and it's socially acceptable. If we sold Opiates/Fentanyl to anyone who wanted it it, in whatever quantities, and there were no social stigma, with 80% of teens doing it 'at least a little bit' before age 21, and 97% of the adult population consuming opiates at least on some occasion again with 'easy access' ... the harm would be orders of magnitude greater than alcohol.

version_five 5y ago
Fentanyl, and especially dangerous fentanyl basically only exists because of prohibition. Ignoring that most people wouldn't try hard drugs even if they were more readily available, the current opiate problem is more like if alcohol was unregulated and made in bathtubs everywhere, and every few beers had methanol in it instead of ethanol.
- com2kid 5y ago
  > Ignoring that most people wouldn't try hard drugs even if they were more readily available, the current opiate problem is more like if alcohol was unregulated and made in bathtubs everywhere, and every few beers had methanol in it instead of ethanol. While I am generally all for harm reduction and even legalization, 19th century history shows what happens when opium becomes readily available to a country with no limitations.
  - Ginden 5y ago
    Arguably, people in XIX century wasn't really aware of opioid addiction. Significant portion of treated troops in US were hooked up on opioids, because physicians weren't aware of issues.
arcticbull 5y ago
Potentially, but that's not really what Portugal found when they decriminalized all drugs in 2001 (not legalized, mind you). They saw usage remain roughly constant, but all the negative effects associated with drug use dropped precipitously. [1] [1] https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it https://www.theguardian.com/news/2017/dec/05/portugals-radic...

SapporoChris 5y ago

Based on the chart, it looks like I would benefit by giving up alcohol and switching to heroin. However, I am a little dubious and not quite ready to make the switch. I shopped around, and none of the stores even had heroin.

arcticbull 5y ago
Based on the chart it would be better for those around you if you switched to heroin. It would be a bit worse for you. According to the chart it would be better for everyone if you picked up a Bolivian marching powder habit haha.
exsmelliarmus 5y ago
Yeah nope. The barrier to entry difference here is staggering. A beer versus a needle in the arm?!?
- short12 5y ago
  Both can be ordered easily online and delivered to your house. And needles are not even required
- __float 5y ago
  https://en.wikipedia.org/wiki/Heroin#Routes_of_administration https://en.wikipedia.org/wiki/Heroin#Routes_of_administratio... Wikipedia is surprisingly thorough on most drug articles. But you may even have seen such pipes for sale in stores... it can be smoked. Smoking various substances is pretty well accepted by society, even.
  - sterlind 5y ago
    People smoked in opium dens, after all. Maybe bars succeeded and opium dens failed because alcohol's just been in Western culture longer.
    - boomboomsubban 5y ago

yadaeno 5y ago

What about harm per user? I personally know 3 people that have tried heroin. It quickly has destroyed two of their lives. 0 ability to hold a job, maintain relationships, if not for family they would be homeless. My other friend was able to use it in moderation for a decade but recently going down the same path. The idea that heroin is less harmful then alcohol is absolutely ludicrous. The reason it has done less economic harm is because it's less accessable, extremely taboo, illegal, etc.

playpause 5y ago
The harms you describe could also be put down to it being illegal. I am not saying that’s the only difference. I agree heroin is obviously far more powerful a drug, and far more addictive. So I don’t think it should be fully legalised and sold in shops. But making it legal for addicts to use under medical supervision in special licensed places seems a sensible compromise. It would probably scale down the black market (which reduces drug pushing on new users), it would reduce immediate dangers (heroin is pretty safe when administered properly in a clean environment), and it would probably help addicts get off it and build a new life (it would remove a lot of the chaos from their lives and would expose them to drug counsellors).
adriand 5y ago
Heroin is a painkiller like the other opiates, and it works on mental pain too, not just on physical pain. Most well-adjusted people without a history of trauma do not want to try heroin or if they do, do not tend to become addicted to it. If we don’t let people have access to pure drugs under conditions that limit the risk of harm, then we should also provide them with the mental health supports they need. People will go to great lengths to kill their pain, including risking death and imprisonment. They shouldn’t be forced into choices like that.
- jeltz 5y ago
  Yeah, I had to take opiates due to an injury and I hated the feeling (foggy mind and hard to focus). It would be really unlikely for me to become addicted to them. Yes, there is still the physical addiction but I so there is some risk but I wanted to quit taking my opiates as soon as I could when I was on them.

tchalla 5y ago

> Alcohol’s position at the top is partly the result of its widespread use, which causes greater harms to others (crack cocaine is considered the most harmful drug for the user).

arein3 5y ago

leave it to such geniuses to figure out that alcohol does more harm than heroin, put them in charge of society and you get the clown world we have now this is so dumb, I have no words