What is the most dangerous drug? (2019) | Hacker News Reader

What is the most dangerous drug? (2019)

economist.com

36 pointsundefined149 comments

The article mentions some of the shortfalls of the scoring system used, but I’m going to repeat an important one in the comments since not everyone reads the whole article.

The scoring system used makes it look like alcohol is about as harmful as crack cocaine or heroin. That’s because they don’t normalize every harm per capita (some are, some aren't). What the scores show is that the total harm of nearly every adult in the UK drinking alcohol is about the same as the much smaller groups of people using crack or heroin. If an individual was choosing a drug to use, alcohol is by far less harmful per user.

I’m not totally disagreeing with the article; it makes good points but it’s a little unfair to compare legal drugs vs illegal drugs on the basis of their total harm. If you want a fair comparison you should come up with a way to compare the harm that crack or heroin would do if they were legalized- I realize this is hard to do because you have to estimate how many more people would use heroin and also estimate whether the supply chain would become safer. My opinion is that an analysis assuming legality would show that crack and heroin would still be pretty harmful but that many recreational drugs like ecstasy and marijuana would be less harmful than alcohol if legalized.

Quick edit: the comparison that I’m talking about is what causal inference in statistics tries to do, but this particular example is an unsolved problem because of issues with transportability and generalizability that arise because we don’t have any data where hard drugs are legal in a population that is comparable to the UK.

You make a good point. Another good point is that alcohol always comes out worst in these types of studies because it is relatively easy to detect. Blood and breath alcohol tests are prevalent, the police uses them all the time, including on people that have been killed by car accidents.

Tests for other drugs are much more difficult, because as opposed to alcohol most other drugs get metabolized very quickly. While there are tests used to determine whether someone has used a certain drug within the last week or month, etc., there are no reliable tests to determine whether someone is under the influence right now.

Thus, a lot of harm caused by other drugs gets ascribed to alcohol.

This is actually a big hurdle for legalization, IMO. I have friends who live in states where recreational marijuana is legal, but they can't smoke because their jobs do random drug tests.

They do safety critical work where being under the influence can cause serious harm (think construction). It makes sense that the employer needs to make sure everyone is sober, but its a huge pain for everyone that the only way to make sure you are sober _right now_ is to make sure you've been sober all month.

As someone who experimented with numerous drugs in college, I always remember being buzzed or drunk when the second drug was introduced. Alcohol lowers inhibitions and puts one in a "party" mode. It's also everywhere, making it easy to consume more than one drink. Plus it's fun to "stack" with other drugs like stimulants, making intoxication more dangerous. Alcohol is THE gateway drug.

Here is the original Lancet article [1] that has been used as the basis for the article.

[1] http://www.ias.org.uk/uploads/pdf/news%20stories/dnutt-lance...

I'm genuinely surprised Sugar is not even in the list.

The headline (and chart) is misleading. The article is about intoxicants.

Also, sugar isn't generally considered a drug.

Is tobacco considered an intoxicant then?

It should be but its not a comprehensive list and in the minds of people crystalline sugar is not something esoteric. Interesting to think about the other modern white powder and how it must affect us.

Sugar is not a drug.

You eat sugar in some form everyday so it’d be pretty hard and pointless to try and ban it. And potentially more harmful too. Used wisely, just like drugs, sugar can be good for you- that’s why our bodies like it.

> You eat sugar in some form everyday so it’d be pretty hard and pointless to try and ban it.

Fruit juice regularly contains a small amount of alcohol, yet I'm sure nobody counts it as a drug. Shouldn't we consider sugar similarly? An apple? Not a drug. A candy bar or a soda? Well, it does give you energy and a good feeling...

Apple juice has as much sugar as soda. Also, what about breakfast cereal? Canned pasta marketed to kids? Etc. All have lots of sugar. Where do you draw the line?

Anything artificially sweetened would be a good start, I suppose. I'm not in the "omg drugs, we can't have those!"-camp, but viewing sugar similar to caffeine makes sense to me. It seems to be addictive, it will change your state and mood, and high-dose and long-term use is bad for you.

Not a drug. But of course very harmful.

It’d be pretty sweet if it was on the list.

Which sugar?

That's a weird chart there by the link. Tobacco can hardly cause any mortality in a direct way and if we consider indirect (via lung cancer) then we should also consider many other carcinogens. And if we swap it for pure nicotine (in form of a proper vape liquid, chewing gum or whatever) we hardly are going to detect any evidence of harm at all.

Ecstasy can indeed cause health damage if used improperly (it can be neurotoxic if you overheat, it can weaken your immune system and let a virus in, it can cause depression-heavy hangover if you use it too often) but they say LSD is even more harmful for your heath and shrooms are comparably harmful! For fuck's sake, how? Needless to say LSD and shrooms have extremely low addiction potential, ecstasy having it slightly higher.

If smoking just caused lung cancer that would be one thing. Most smokers never get lung cancer, they develop and die from cardiovascular disease and chronic obstructive pulmonary disorder.

The most heavily abused drugs are the legal ones. This fact for a long time made me an opponent of drug legalization.

But the destruction of culture and civilization in all the transit and production countries (Mexico, Colombia, central america, southeast asia) made me realize we need to deal with our own problems with drug use in our populace and needed to destroy the economic rewards in shipping and production of narcotics.

The main chart does not seem to include opioids aside from methadone, which are rampant in the US and responsible for the resurgence of heroin abuse.

Title should say "party/recreational drug" or "narcotic" instead of "drug".

Narcotic properly refers to opiates, though law enforcement and uses it to refer to all illegal drugs.

Recreational drugs or drugs of abuse are more accurate.

It easy to gather and drink a bit of alcohol, like in ancient times. I can be social, but the dangers are bigger.

https://archive.md/UqKQG

Sugar should be on the list!

I feel like this graph is far too general to be useful

Social media and 24hr news

If hard drugs were legalized, I doubt they'd stay less dangerous than alcohol.

Prohibition is actually THE biggest driving force behind making drugs more potent for various reasons (one being that potency reduces transport costs for the same effective dose), so it seems implausible that legalization would be worse on this count.

Worse still, inconsistent potency. "I usually do 3 of these" might work OK until one day the stuff is 1.5x as strong and you've done nearly 5.

Some people I knew died of overdoses. The drug using friends of the deceased would then immediately seek out the dead person's drug dealer because they sold the "good stuff."

I don't think there are many people out there who are itching to doing heroin and crack but don't because of legality. On the other hand, there are a whole lot of people out there who already do heroin but are dying because they're getting fentanyl instead, due to a lack of quality control and unscrupulous vendors who care more about a quick buck than the long-term survival of their customers. Not to mention all the violence, which comes from criminals vying for territorial control, rather than users.

I agree with your first sentence, but without data, it's a super hard sell to the folks who think that the laws are the only thing keeping people from descending into hedonism.

I wonder there is way to put some numbers behind it. Typically, this is where natural experiments are valuable, where somewhere legalizes something and another places don't. Then you compare. But it's hard enough to imagine any jurisdiction legalizing crack or heroin, let alone doing so AND systematically capture data to answer these questions.

While decriminalization isn't the same as legalization, places like Portugal and to a lesser extent Switzerland have demonstrated that it doesn't result in an increase in consumption.

You think if heroin and other opioids could be bought in any store as easily as alcohol, there wouldn't be a lot more use than there is today?

I agree with the grandparent that there wouldn't be more informed use. However if the legal purveyors are allowed to market these substances in the same profit-motivated manner in which they currently move products (including dangerous and addictive existing legal products) then I agree we likely would see more use.

Since basic common sense policy that should lead to a safer and freer world is being pragmatically limited by this profit-driven system perhaps it would pay to examine that other problem as well.

Maybe. But if people switched from alcohol as a drug to heroine or morphine, that’d be a net win. They’re substantially less damaging to your body than alcohol.

Why? Many illegal (hard) drugs, especially morphine derivatives have very few actual physical side effects - the most common side effect of morphine is constipation. Morphine is one of the choice painkillers in palliative care because of that

Alcohol on the other hand is an actual toxin that kills cells.

Except that you also become addicted, which does not matter in palliative care. In normal cases, you can't have that

Yes, you can become addicted. It’s a drug. You become addicted to alcohol just as well. Caffeine, too. It doesn’t mean you will in any case. I was given morphine as pain killer in hospital and didn’t become addicted.

The difference is that individuals taking morphine or heroine can function well with little adverse side effect. You shouldn’t drive or operate heavy machinery, but the damaging effect that alcohol has on your body is substantially worse than any morphine derivative you could possibly take.

But the medical use of morphine extends beyond palliative care.

I'm surprised how often I see this argument in a world where Portugal succeeded in doing exactly that.

Oh thank you so much, i search's for the Portugal example through the comments and here it is :)

Limited evidence suggests that might not be the case.

Portugal decriminalised personal use of all drugs some time ago and it’s generally been regarded as pretty successful. [1]

The mortality rate from drugs in Portugal is 3 people per million. [2]

In the US this same measure is 217 per million. [3]

In two US states it is in excess of 400 deaths per million. [4]

[1] https://www.theguardian.com/news/2017/dec/05/portugals-radic...

[2] https://www.independent.co.uk/news/world/europe/portugal-dec...

[3] https://www.bbc.co.uk/news/uk-scotland-48938509

[4] https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mor...

Decriminalization is a far cry from legalization. First is still very much illegal, hard to get, very questionable content, albeit less punishable (what if you have 1kg of material with you?) vs access to clean stuff, dosed in exact amount you want to take, in safest way you prefer.

How would the drug become more dangerous?

The point wasn't made explicit enough - if the drugs became legal, usage would go up and so would overall harm. At least that's the theory.

Statism is the most dangerous drug.

Power

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