Alcohol 'more harmful than heroin'
bbc.co.uk
bbc.co.uk
http://www.timesonline.co.uk/tol/news/uk/health/article68947...
Several other members of the drugs advisory board resigned in protest. It's a typical case of the government asking scientists to come up with evidence and then refusing to see the evidence when it is presented. "You got us the wrong evidence! Get us another truth!"
At the bottom of this article, you can find the suggested classifcation by harm:
http://news.bbc.co.uk/1/hi/6474053.stm
Of course, the point is not to ban alcohol, but to have a more mature debate about drugs (and possibly to unban relatively harmless drugs such as LSD, Ecstasy, Cannabis...)
Prof Nutt told the BBC: "Overall, alcohol is the most harmful drug because it's so widely used.
I have no idea what this means when using the chart to back up statements about the relative harm of legalization of various substances. I'm personally still a fan of it purely through considering the volume of crime and harm sustained by the black markets. I just want to caution conclusions being drawn without analysis of the methods that produced the table.
Given the amount of misinformation that exists about drugs, the chart is probably totally justified. To make claims on it without understanding the methods is to add even more misinformation, though.
(Disclaimer, I haven't read his papers either yet)
You could then make a driving speed chart like this.
Driving 35-75 MPH would get a very big bar for both harm to others and harm to drivers, due to the volume of accidents that occur at those speeds.
Driving 76-100 MPH would have a smaller bar, because fewer drivers drive that fast.
Driving 101-130 MPH would have an even smaller bar, as you're getting into a small subset of reckless drivers.
At the bottom of the chart, you might have speeds that can only be achieved with high-performance sports cars. 160-200 MPH would have a tiny bar for both harm to others and to the driver, as barely anyone possesses both the recklessness and equipment to drive at these speeds.
So, then, that chart can get a headline reading "Driving at 35 MPH 'more harmful' than driving at 200 MPH."
Most accidents do happen between 35 and 75 mph. So most of the energy of the road safety agencies should be directed at making roads where people travel at those speeds safer.
This is what the study is intended to demonstrate: that the harm caused by alcohol is so much greater than the harm caused by Ecstasy, that alcohol should get a whole lot more attention than Ecstasy.
How stupid would it be to focus all our energies on regulating race tracks where people are allowed to drive above 130mph, "which are so much more dangerous than 35mph"? This is what our drug policy is doing... focusing on the 180mph roads even though most of the accidents are happening on the "safe" 30mph roads.
2) It's easy to interpret the chart to mean that, in the driving metaphor, driving at 200 mph is safe so let's just eliminate speed limits. Again a deficiency in the definition of harm (total harm, harm per capita, economic harm, social harm, initial harm, expected lifetime harm, average harm, what does harm even mean) leading to conclusions not supported by evidence.
A more specific chart and methodology would help people to do informed reasoning. If your presentation of evidence isn't actually helping people to make more informed conclusions, what is it doing?
Possible causes of your friend's unfortunate disaster include:
1) It wasn't MDMA/MDA (typical Ecstasy components), as binarymax suggested. Until drugs are legal, who the hell knows what you're actually taking. Could be anything, including washing powder. Unlikely to be actually poisonous stuff, since dealers like repeat customers too, but really, it could be anything.
2) Your friend took an exceptional amount, was not used to intoxicating substances, and had very fragile kidneys. Perhaps his kidneys were about to give up anyway, and Ecstasy just pushed him over the edge. Maybe a good drunken night would have done the same thing.
3) It was just a coincidence.
I suspect a combination of 1 and 2... probably it wasn't Ecstasy, and your friend was already in danger of blowing his kidneys anyway.
----
Some fun numbers from http://thedea.org/technicalFAQ.html:
>"MDMA-present" drug deaths occur at a rate of aproximately 2-3 users per 100,000 users/year. ... cigarettes ... on the order of 400 deaths per 100,000 users/year
With only "a handful" US-annually where it was the only drug, out of less than a hundred. Think alcohol can claim that?
Either way, it falls solidly on the side favoring ecstasy over tobacco.
How would you define a "hit" anyway? Doses don't really compare, and even if it's 1-cigarette/1-pill, it's all societal how much is in each "dose"...
If you try to say, what is more dangerous - taking one ecstasy tab or one cigarette - even if the ecstasy is more dangerous in the short term, the possibility of addiction could make the cigarette much worse.
I guess maybe you could work the other way - start with say, 1 cigarette, and then try to calculate what amount of ecstasy is an equivalent dose? However I would guess that it fluctuates largely on how much you have at the same time?
I.E. One day you'll have rubbish "Roles Royces" and you'll have 6 of em, another you'll have some nice "Mitsis" and just take 3 and on other days you'll have an insane "Red Tulip" that was incredibly more potent than all the others so you only needed one. Of course the name never really means anything as you can have both good "mitsis" and bad "mitsis".
Then there is also the case where the pill is actually cut with something else (pretty common I believe), perhaps a bit of ketamine or god knows. The issue perhaps is that an "ecstasy" in its black market form may be very different from its medical definition making it very difficult to compare like for like.
Thankfully it isn't at all addictive so it's not hard to stop. :)
(That's exactly the same problem actually - buying black-market alcohol. Which is still pretty big in Russia and neighbouring countries.)
Anyone with internet access should be able to sidestep this problem altogether. Manufacturing MDMA or Meth at least requires acquiring lab equipment and some fairly dangerous chemicals, plus some knowledge of chemistry, which is understandably above the abilities of some people. But any idiot can make booze.
That is probably a lot less drastic than the effects of e.g. getting completely drunk every day. But one of the problems is that there is no public evidence based knowledge about the effects of drugs like Marijuana. People either believe it's completely harmless, or they think it's the devil. There is also no good social canon on the use of such drugs. Getting drunk every day has obvious social stigma in all circles, but smoking hash every day can be accepted behaviour in certain circles.
That is actually the nice thing about this study, they try to correct this and give facts.
Citations, please.
A phrase to remember when citing anecdotes about mentally ill people taking Drug X is self-medication. This is a technical term in counseling psychology; it refers to a very common phenomenon where a person who is suffering a mental health issue -- which can be anything from a mild acute depression to full-blown schizophrenia -- figures out, by trial and error, that taking a certain drug seems to alleviate their symptoms, or make those symptoms more tolerable. This often causes the patient to end up with two health problems, which can be difficult to sort out from each other and which generally must be treated together.
So even if you uncover evidence that mental illness and taking drugs are correlated, you can't simply assume that the drugs cause the mental illness. It could just as easily be the other way around.
the source is not very reliable(some obscure journal in portugese),
A very small percentage of people are smoking it for health effects. The rest just want to forget about whatever is going on in their lives and get high. Why can't people just admit the truth?
Many people consuming alcohol are doing so for similar reasons.
I'm just curious, your opposition seems largely centered on people being high and not the medical effects, are you a prohibitionist too? What about self-induced altered states of mind, hypnosis, etc? Neurochemically active foods (chocolate->dopamine link)? What's the reasoning?
Some Googling finds this: Pope HG, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58(10):909–915, 2001.
Your caveat about correlation and self-medication could be right. It might also be wrong - you don't give a good citation either. My point was that I think we have a lot less knowledge about the effects of these drugs than e.g. alcohol which we're (ab-)using since millenia, so the UK analysis is certainly an improvement.
What's interesting there is that a glass of wine a day (which might be healthy, though such claims get regularly debunked) is socially accepted. I think our societies just have better knowledge of acceptable use of drugs that we're more familiar with, as a whole.
"Evidence-based policymaking would be ideal, but I would be happy with just a lack of policy-based evidence making."
... and this in a moment of brilliance was dubbed the "Nutt Sack" by the UK press.
(I would have felt guilty making this the first comment in the thread last night, but now that there's lots of serious discussion surely someone ought to sneak it in.)
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?
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_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.
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.
In a sane world, when drugs are legalized they are also taxed, and a fraction of the revenue goes to treatment and education.
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.
I don't know about the legalization of Heroin, crack and Crystal Meth, I don't know enough about them to form a factual based opinion on their legalization, but I do believe without a doubt that Opium, Marijuana and Coca should be legalized immediately. The possession of a plant being illegal is ridiculous and the fear mongering around these weaker formed was unfounded in the first place.
I think it'd be reasonable to make the penalty for crimes committed under the influence to be equivalent to conciously choosing to commit the crime. This seems to solve that issue to me.
not even this study is arguing that heroin should be legalized, yet you do (and with a nonsensical argument like "it's my business")
it's quite safe to say that you can grow, produce and consume heroin for yourself pretty safely right now. it really is your business! until it's not, which is pretty fast.
(and with a nonsensical argument like "it's my business")
Because if it's not your business, why are you so interested in telling me (and others) what to do?
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)?
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.
This is what has happened (to some extent) in Portugal: http://www.time.com/time/health/article/0,8599,1893946,00.ht...
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.
I know quite a few people that stopped drinking so hard once they turned 21...
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.
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.
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).
Prof Nutt told the BBC: "Overall, alcohol is the most harmful drug because it's so widely used.
"Crack cocaine is more addictive than alcohol but because alcohol is so widely used there are hundreds of thousands of people who crave alcohol every day, and those people will go to extraordinary lengths to get it."
By that logic it's also more harmful to drive a car than to cut open your chest, pull out your heart and eat it?
Alcohol and tobacco do kill tens of thousands of people every year. Ecstasy and LSD and Cannabis kill maybe a dozen people every year all together, and usually in combination with other drugs. Yet there are considerably fewer resources allocated to fighting alcohol and tobacco use than the latter.
just saying
That said, the chemicals themselves are unlikely to cause death. This, obviously, is not the same as "will definitely not have any unpleasant consequence".
excerpt:
"Coroner: Aragon High School student took LSD before falling to death in Canada"
10/23/2010 12:01:00 AM PDT
"A 17-year-old Aragon High School student was under the influence of LSD when he plunged to his death during a trip to Canada in June with teachers and fellow classmates, according to a British Columbia coroner's report.
"Daniel Cho and two friends took the drug while they were on a bus headed from Seattle to Vancouver, British Columbia, according to the coroner. The boys were with more than 100 other Aragon students headed to Canada as part of a musical exchange program.
"When the group made a stop at a popular tourist spot called the Capilano Suspension Bridge on the evening of June 6, Cho climbed over a 4-foot-high fence and fell 100 feet into a ravine below.
"The coroner has ruled his death an accident, and Canadian police won't file any criminal charges in connection with the case."
The substance itself does not cause an "overdose" and the same is true of cannabis (at least for any ingestible amount), but it would be disingenuous to claim they have not caused deaths.
Blame BBC for an ambiguous headline.
The conclusion of the study should be that the government should spend more effort fighting alcoholism than LSD abuse. Most likely, it already does. The conclusion should not be that young people should start experimenting with LSD instead of alcohol.
Deleted comment
Here is the original paper:
http://www.crimeandjustice.org.uk/opus1714/Estimating_drug_h...
http://en.wikipedia.org/wiki/Multi-criteria_decision_analysi...
I have not read the papper, but informing public policy ("decision making") seems to be what this study is trying to do.
If you wanted, I could give you an MCDA showing cocaine is more harmful to society just by tweaking a few criteria a tiny bit. I could add a practicality criteria in that drinking alcohol is a cultural practice in many places, or I can separate two forms of drinking, responsible drinking and irresponsible drinking. There are so many ways to slice it that if you don't have specific decisions you're evaluating against, the whole analysis is useless.
Speaks a lot about the values of this community and the karma system!
The Guardian's coverage ( http://www.guardian.co.uk/society/2010/nov/01/alcohol-more-h... ) knows that this report is likely to be attacked politically (regardless of merit) so it's no surprise they are using adjectives to cut off this attack. Note their use of words like "authoritative" and "respected" early in the article.
http://www.badscience.net/2009/06/this-is-my-column-this-is-...
This describes pretty concisely how governments might choose to use or not use evidence about drug harm and the reasons for doing so:
Drugs instantiate the classic problem for evidence based social policy. It may well be that prohibition, and the inevitable distribution of drugs by criminals, gives worse results for all the outcomes we think are important, like harm to the user, harm to our communities through crime, and so on. But equally, it may well be that we will tolerate these worse outcomes, because we decide it is somehow more important that we publicly declare ourselves, as a culture, to be disapproving of drug use, and enshrine that principle in law. It’s okay to do that. You can have policies that go against your stated outcomes, for moral or political reasons: but that doesn’t mean you can hide the evidence, it simply means you must be clear that you don’t care about it.
Source: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/healt...
For perspective: http://www.meh.ro/wp-content/uploads/2010/09/meh.ro5415.jpg
http://news.ycombinator.com/item?id=1856015
Now how is then smoking less harmful than using some other substance? Or is the evaluation skewed somehow?
"Specifically, alcohol-related fatalities declined significantly in 2004, to 16,694, the second consecutive year in which alcohol-related fatalities declined."
In terms of lethal dose they would be safer. By the author's scale they are safer.
Premature death would be a difficult one to study - as I don't know if there are as many regular users of shrooms/lsd as there are with steroids/tobacco.
More explanation of their methodology would be nice, especially given their use of data from the Netherlands, which has a very progressive drug policy.
Trust me, they will find something else to exploit. Kidnapping in Bogota comes to mind. Crime won't go down.
EDIT: removed fragment: "This is extremely well known". I disagree with the parent, but let's keep the debate as civil as possible. My apologies.
Prohibition didn't work out too well, but anti-smoking campaigns in many countries seem to be somewhat effective. So a gentler approach just may work, if you're willing to accept that it probably takes a century before you can ban the substance.
IIRC here in Canada it's illegal to smoke in a work vehicle, it's illegal to smoke in your own vehicle if you have a passenger under 18. You can't smoke within X-feet of a building entrance. They're trying to make it illegal to smoke in your own home if you have anyone under 18 living there.
I really don't see this as a gentle approach. I'm a non-smoker, I don't give a crap where people smoke and I see this illegalization of smoking to be severely harmful to our society. Given the link between certain genes and smoking, why not make autism illegal? I mean it's harmful to the users and is harmful to society by costing us billions in unearned wages and medical costs.
I'm sick of this nanny state bullshit. At the rate governments are regressing, we will be at full prohibition before we ever see marijuana or LSD legalized.
Contrast prohibition in the US (http://en.wikipedia.org/wiki/Prohibition_in_the_United_State...): the first thing most people noticed was probably a complete ban (1920), although there were already quite a few local bans in place by that point (equally abruptly introduced). Very little effort seems to have been spent on gradual introduction of the law, and it was introduced despite a lack of broad acceptance (contrast the "conditional bans" you complain about.)
It may well be the case that the anti-smokers will, like the "dry" people, eventually achieve a ban on the good in question. However, the anti-tobacco campaign is a lot more gentle than the anti-alcohol campaign, and denying that is just rhetoric.
Two notes: yes, I think an eventual tobacco ban is a good thing; and you may be amused to learn that the nazis were fiercely anti-smoking as well.
People have been sick of smoke for years. It was never sustainable that a minority should be allowed pollute the environment of everyone else. Any politician who campaigned to bring back smoking in these places would fail spectacularly. Get used to it.
Given the link between certain genes and smoking, why not
make autism illegal?
The one that I differ with the anti-smokers on is bars. These are institutions with the explicit purpose of pleasure. I think owner of the establishment should be allowed to decide if his establishment is designated smoking or non. The anti-smokers don't like this because the vote would be a resounding we are a smoking establishment. Because for a good deal of the population, they don't care, they would go to a smoking bar. The non-smokers activist hate this because no one want's to hang out at their non-smoking bar. So they ruin it for the rest. In my state Bars where the last public establishments to fall and they fought hard to resist it because patrons had already voted with their feet and smoking bars where more popular than non.
As I said I am a _non-smoker_. I have been for my entire life. Again as I already said I do not care that people smoke around me and I find it a huge inconvenience on myself that I have to go out of my way to be with my friends when the laws are getting restrictive to the point that you cannot smoke anywhere legally in downtown areas except in the middle of a boulevard.
Yet I can't go downtown on a Saturday night without running into drunks and druggies who get into fights and destroy property. I've seen chairs thrown into oncoming traffic by people refused alcohol, I don't see this from any smokers anywhere?
Please cut the fucking naivety here. Alcohol is more destructive to the users health and to our societal health than tobacco, marijuana or LSD, but we're happy with the former being legal while the latter society wants illegal.
In my opinion with this dataset you can only have conclusions about the experts opinion/experiences.
If you're measuring harm to the communities, shouldn't you be taking polls at the communities?
And you'll need a better argument than "well, that's just their opinion" to sway me.
Dr. Les King is a well-respected chemist; I'll let you dig up your own references. Dr. Phillips is specialized in decision procedures and policy-making.
Yes, it would make sense to have others look over their conclusions, and yes, at least Nutt and Les King are not sociologists. But both have a long service on various boards on the topic of substance abuse - do you really believe they have no idea what they are talking about, medically or sociologically? Do you really think the Lancet wants to get caught publishing highly controversial rubbish ("link bait")?
And all of this is still just a smokescreen - you don't like their conclusions, fine, but then you'll have to point out that they're actually wrong. Calling their authority into question is disingenuous (especially since they have plenty of authority). Their facts may be incorrect, and there is definitely some subjectivity here (how do weigh damage to self in an individualistic welfare state?), but you'll have to offer better arguments than this.
Do you really think the Lancet wants to get caught publishing highly controversial rubbish ("link bait")?
Um, The Lancet frequently publishes controversial articles. They published (and later retracted) a paper that claimed a link between vaccines and autism, they put out one of the highest death-toll estimates of the Iraq War, and they've called for a complete ban on tobacco products in the UK, to name a few.
Yes, but the comment I replied to was questioning their credentials, which is at equally invalid - more so, in this case, since they actually do have quite impressive credentials.
With respect to The Lancet: controversy sells, but you still want to have a credible argument.
You are right, though, that this isn't exactly objective and independent of current policy. Then again, it may be hard to get such data...
But I don't think people sell their mom's furniture to buy marlboro, and haven't seen moms chaining their kids to their beds to stop them from going out smoking.
They aren't really comparable, if you ask me -- I get your point. All I'm saying is that some people can recreationally use all kinds of drugs (alcohol, meth, crack, whatever) and others can't. Smoking will just straight up kill you. So IMO, in terms of 'damage to society' smoking is way further up there than most illegal drugs.