Which drugs are most harmful? What a UK expert analysis found
Risky SubstancesKey points
- Alcohol ranked most harmful overall when harm to others was included.
- Heroin, crack cocaine and methamphetamine were most harmful to users themselves.
- Tobacco also ranked high.
- Legal status does not reflect actual harm.
What the study showed
In a multicriteria decision analysis published in The Lancet, members of the UK Independent Scientific Committee on Drugs scored 20 drugs on 16 criteria: 9 related to harm to the user (such as death, dependence and damage to health) and 7 to harm to others (such as crime, family breakdown and economic costs).
Overall, alcohol scored highest, followed by heroin and crack cocaine. Heroin, crack and methamphetamine were most harmful to users, while alcohol, heroin and crack were most harmful to others. Tobacco ranked sixth overall (Nutt et al., 2010).
The Global Burden of Disease study also found alcohol to be a leading risk factor for death and disability worldwide (GBD 2016 Alcohol Collaborators, 2018), and smoking costs more than a decade of life on average (Jha et al., 2013).
Limits
The ranking reflects expert judgment and UK conditions in 2010, before fentanyl transformed the U.S. overdose crisis.
Frequently asked questions
Does this mean heroin is safer than alcohol?
No. Heroin is extremely harmful to the individual. Alcohol ranks highest overall mainly because it is so widely used and harms others.
Would U.S. rankings be different?
Probably in detail, especially with fentanyl, but the main conclusions about alcohol and tobacco are likely similar.
Sources
- Nutt et al. (2010). Drug harms in the UK: a multicriteria decision analysis. The Lancet 376(9752):1558-1565. doi:10.1016/S0140-6736(10)61462-6
- Griswold et al. (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2
- Jha et al. (2013). 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine 368(4):341-350. doi:10.1056/NEJMsa1211128
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