Ranking Drugs From Most to Least Harmful

During a stand-up routine, the American comedian Chris Rock once remarked that the war on drugs failed for a simple reason: “people like to get high.” For many, life is hard, dreary and monotonous; drugs offer an escape. Those who agree with Rock argue for a more realistic approach, one that seeks to educate rather than punish. Instead of simply telling the young that drugs are bad and not to use them, it would be wiser to explain that though no drug is harmless, some are worse than others.

Harmful in What Way?

The word “harmful” is vague. Harmful in what way? First, and most obviously, there is the harm done to one’s body. Alcohol, for example, damages the liver, causes pancreatitis and increases your chances of cancer. Cigarettes are highly carcinogenic, as well as causing COPD and heart disease.

Another major problem is that the user doesn’t always know what is in the drug they are taking. After all, the addict’s health is not one of his dealer’s priorities! Some music festivals in the UK even provide facilities to test people’s drugs. And the results can be shocking. At one such festival, ecstasy tablets had been mixed with concrete and cocaine with rat poison.

Drugs also harm an individual’s mental health. Even cannabis sometimes triggers mental illness, especially among the young. A teenager who thinks it cool to smoke a cannabis joint at 15 may find that by 22 he is a paranoid, socially anxious wreck. Clubbers in the 1990s referred to the depressant effect of ecstasy as “suicide Tuesday,” meaning that after the weekend high there followed a terrible low.

Then there is the effect on friends and family. Again, different drugs have different consequences. An ecstasy user is unlikely to assault his wife while high, but neither is he likely to take good care of his child. Some drugs make people violent and aggressive, others make them paranoid or withdrawn. Used to excess, some weaken your ability to reason or empathize. And as you probably know from experience, the same drug affects people in different ways: one friend becomes chatty and affectionate after a few drinks, a second tearful and maudlin, a third aggressive and argumentative.

And what about the effect on society? During the crack epidemic of the early 1980s, some feared that in parts of the USA the authorities would quite literally lose control. Such fears were nothing new of course. In 18th-century London, cheap, high-strength gin also threatened social breakdown.

Alcohol tends to be a particular problem in deprived areas, or during times of economic stagnation. The actor Nick Frost recalled that as a teenager he was astonished by the effect ecstasy had on the London club scene. Before its arrival, alcohol had been the drug of choice, and that invariably meant violence, especially in the poor area in which Frost lived. Once ecstasy arrived, the traditional Saturday night fight ended.

Drugs undermine society in numerous ways. A normally harmless individual can be transformed into a violent thief by his cravings. Addicts usually struggle to hold down a job, and if they do, they do it badly. Their bodies are damaged, but they have no money for healthcare, meaning the burden falls on the taxpayer. Rarely do they make good or stable parents, which often means psychologically disturbed children who are disruptive at school and unable to hold down a job themselves (though many addicts deeply love their children and many of those children do grow into wonderful young adults).

Problems With Ranking Drugs

First, it’s worth considering what a drug is. The Chambers Concise Dictionary defines it as “something one is intoxicated by.” Most would add the words “harmful” and “addictive.” Ask the average person and they are sure to mention heroin, cocaine, and crack. But how about sugar? The British actor Hugh Laurie once joked that it won’t be terror attacks that bring down the USA but diabetes, adding that terrorists could achieve their aims by opening a chain of donut stores instead of planting bombs.

Sugar is harmful in almost every way. It is certainly addictive (if you doubt this, try going three days without any) and bad for your body. In his recent bestseller The Case Against Sugar, Gary Taubes blames it for everything from cancer to Alzheimer’s. Sugar can even affect your mood. Therapists sometimes advise the depressed or anxious to reduce their consumption since candy and soda trigger a “sugar crash,” which lowers mood still further. Some would add Internet pornography, or even exercise! It is possible to exercise to the point where it causes real harm and yet feel unable to stop. Others become compulsive eaters, using food as a drug.

Any kind of ranking system is going to be controversial. One of the most interesting was produced in 2010 by the British psychiatrist Professor David Nutt and published in The Lancet. Nutt, along with co-authors Les King and Lawrence Philips, added together the negative effect a drug has on the individual and on others. On that basis, they concluded, alcohol comes top, followed by heroin, crack cocaine and methamphetamine. At the very bottom were placed magic mushrooms and MDMA.

Unsurprisingly, this sparked a great deal of anger and controversy. To be fair to Nutt and his colleagues, they acknowledged that heroin, crack and meth are each more harmful to the user than alcohol (though not by much). Still, the idea that overall heroin is less harmful than alcohol seems absurd. Presumably, if it came to a choice between legalizing one and banning the other, the rational decision would be to ban alcohol and legalize heroin. Few would suggest that, of course, but it does reveal how difficult ranking can be. Perhaps the best approach is to rank them under separate headings: first by how addictive they are and second by the harm they do to one’s body.

Addiction

A debate is currently raging over whether or not addiction should be classified as a disease. Some argue that people can even develop addictive personalities. What we do know is that drugs alter the brain’s structure. The brain is plastic, meaning that it constantly rewires in response to new experiences. But there is a difference between physical and psychological addiction. Some people crave a certain drug. Their body demands it. Others become psychologically dependent because the drug eases their fear or blocks some painful memory.

The website “Treatment Center” rank the most popular drugs in the USA according to how addictive they are: heroin at number one, followed by crack cocaine. Surprisingly, nicotine is in number three spot. Like cocaine, nicotine affects dopamine levels. And as every smoker knows, you become addicted to both the drug itself and the ritual of rolling and lighting it. The website then has methadone in fourth, crystal meth in fifth, barbiturates in sixth and alcohol in seventh.

As director of psychopharmacology at Imperial College, London, Professor Nutt asked a panel of addiction experts to rank drugs by how addictive they were. Their list, which took into account physical addiction, psychological addiction and also the pleasure given, ranked heroin at number one, followed by cocaine, nicotine, barbiturates and alcohol.

Physical Harm

Of course, in theory one could become addicted to something that caused them little harm. Equally, there are some drugs that cause immense physical harm but aren’t particularly addictive. Yet again problems arise in compiling such lists. If you take a random nation, Canada, for example, and ask “which drug causes the most physical harm to the Canadian people?” the answer would probably be alcohol, nicotine or sugar. But that is because they are legal and used by more Canadians than, say, heroin.

David Nutt ranks crack cocaine and methamphetamine as the most dangerous to the user, followed by heroin, then alcohol, ordinary cocaine and amphetamine. At the bottom he places mushrooms and, just above them, LSD and ecstasy.

In 2017 a worldwide drug survey was conducted. Over 100,000 people were questioned in 50 different countries. The survey ranked drugs by the number of emergency ward admissions they led to. Methamphetamine came at the top, followed by synthetic cannabis and alcohol. Once again mushrooms appeared at the bottom, just below cannabis, LSD and cocaine. Those who were admitted after using mushrooms had usually gone into the fields themselves and picked the wrong type.

A final point needs to be made about effects on the body. Some drugs, like heroin and alcohol, are very dangerous and cause immense harm. Others, like LSD, do not cause much harm to the body, but they do motivate people to do stupid things, like jump off a balcony believing they can fly. And drugs often harm the body in ways that surprise people. Smoking cannabis, for example, carries an even higher cancer risk than smoking nicotine. Alcohol is also carcinogenic. Spirits, for example, often cause cancer in the throat or mouth.

The current approach to drugs seems irrational. In a country like the UK, an 18-year-old can walk into her local superstore and leave carrying bags loaded with vodka, whisky, cigarettes and sugar. And yet that same 18-year-old would be breaking the law if she ate a “magic” mushroom or took an ecstasy tablet. No drug is harmless of course. Indeed, even the drugs prescribed by a doctor often have nasty side-effects. But if we accept that people will always use something surely the law should reflect how addictive it is, how much harm it does to the body, and how much harm it causes society.

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