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Comment by kasperni | Hacker News Reader

David Nutt (the author of the book that was reviwed) is a professor at Imperial College London. He was famously fired as the UK government's chief drug adviser for saying that alcohol and tobacco are more harmful than many recreational drugs.

I've seen his harm score chart quite a few times here on HN [1]

[1] https://www.economist.com/graphic-detail/2019/06/25/what-is-...

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I could be wrong but is that chart showing total deaths. I think it's an unfair picture: many more people take alcohol than illegal drugs. Also as someone who massively regrets their drug use in their youth, I personally feel alcohol didn't damage me as much as weed and mdma. Those drugs really screw with your head. Personally I find booze not so much.

The chart shows a "harm score", made up of 16 criteria, not total deaths. I haven't pulled the full article for what the 16 criteria were, but a little more detail is in the abstract on the Lancet where it was originally published https://www.thelancet.com/journals/lancet/article/PIIS0140-6... . A contemporaneous article from the BBC describes more of the methodology https://www.bbc.co.uk/news/uk-11660210 A choice quote: "The study involved 16 criteria, including a drug's affects on users' physical and mental health, social harms including crime, "family adversities" and environmental damage, economic costs and "international damage".

Fair enough. Thanks. Thought I might have been wrong about that.

He's also, iirc, working on getting a healthier, synthetic, reversible alternative to alcohol approved in legislation. But I'm not holding my breath

If they don't call it synthehol I will be very disappointed.

It already exists: GHB. The problem is the drug’s reputation and the problem with dosage, which could be alleviated when legalized. It’s also addictive but then again, so is alcohol but alcohol wrecks your health.

I agree but sadly I don't see something so dosage-dependent ever becoming mainstream. Another GABAergic in a similar vein might have a better chance.

Is GHB reversible?

No I didn't get that quite right. Still GHB is a major improvement upon alcohol and I think the dosage problem is mainly an issue of illegality. It's fairly dosable and redosable when you know what exactly you're ingesting. Also GHB doesn't disinhibit aggression as much as alcohol does.

Ghb leads to memory problems, its addictive and indeed, mistakes in dosages can send you right to a heart attack..

Source : addiction happened to people i met and the HR happened in a friends party.

> Ghb leads to memory problems, its addictive and indeed, mistakes in dosages can send you right to a heart attack..

sounds like caffeine (from those criteria)

[0]: https://en.wikipedia.org/wiki/Effect_of_caffeine_on_memory

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777290/

[2]: https://www.webmd.com/heart-disease/news/20060815/coffee-may...

Love the "(from those criteria)".

It's pretty easy to drink 3 cups of coffee and not come anywhere near overdosing on caffeine. And then after that you can drink 3 more. And then after that you are probably sick of coffee, but go ahead and drink 3 more if you really want.

How's the recreational dosing of GHB go?

To be fair, some people have died from caffeine overdose when ingesting pure caffeine, which lead many internet retailers to not carry them any more.

Example: https://www.inquisitr.com/1909754/caffeine-powder-death-teas...

What the hell does fair mean then?

I've never taken GHB and don't plan to, but it looks like a recreational dose is ~1/2 of a dangerous dose, both of which would be (at least somewhat) difficult to obtain.

With caffeine, the typical recreational dose is a beverage that is easily obtained and isn't dangerous. That you could buy caffeine powder doesn't make that a typical way to consume it.

Apparently 500 mg of caffeine is considered potentially dangerous. That would be 5 or 6 cups of coffee (I'm in the habit of drinking that much coffee and have a pretty low resting heart rate during the consumption, so I dunno).

I talked to him about it when I met him 10 years ago and was much more optimistic then. As far as I know this isn't any closer to being on the market now than it was back then.

I think the issue is that drinking is about far far more than simply getting drunk.

Fascinating graph. However, the methamphetamine measures for economic harm and crime seem intuitively off (undercooked). I've seen people on speed and they are often not fun to be around.

It's measuring total harm across society given current usage rates. Alcohol use being 100x more common than methamphetamine use dominates the relative harm comparison.

Exactly, this is disingenuous to say the least. To measure the danger a drug poses it should be comparing the drugs effect per user, not multipied by how popular it is, or at least show both charts together to remove any doubt.

> Exactly, this is disingenuous to say the least.

I think you're both vastly misinterpreting the data. It's not classifying drugs based on how popular they are.

No it's not. Look at the actual study.

I have read the study (DOI:10.1016/S0140-6736(10)61462-6) and, although it's vaguely written, it seems to be estimating total society-wide harm given current usage rates. Statements from Nutt such as "Overall, alcohol is the most harmful drug because it's so widely used" (reported at https://www.bbc.com/news/uk-11660210 regarding this study) seem to confirm this.

This is, in fact, the only sensible way to compare the relative harms of drugs. Otherwise, you can't put a number on how harmful X is without specifying the quantity and frequency of use, and they vary widely. With alcohol we know that lots of people consume small amounts weekly with little harm, and some people consume large amounts daily with major harm. The same is true for all drugs. The only data we have is for the current usage levels in society, so it makes sense to report harms for those levels.

At any rate, the paper boils down to "We asked a panel of experts how harmful are X, Y, Z in various ways on a 100 point scale and we averaged those numbers using some weights that seem vaguely plausible and here are the results!" And somehow the Lancet published it.

Having grown up in an area rife with it, it's one of the most destructive things you can imagine. Once it takes over someone's life I just write them off. The become a totally different husk of a person than you knew before. I'm all for legalizing weed but stuff like meth and crack just destroy people completely. Even if they get off of it somehow, it'll likely their brain is so damaged that life is going to be hell for them.

lol but there is not now, nor has there ever been, any question that alcohol and tobacco are more harmful than other recreational drugs...

Yeah but you'll notice having the facts and convincing everybody of the facts against the grain of industrial propaganda is not a trivial task.

From someone who has tried many drugs and met people who were in the lifestyle.. its not completely true.

Long term use of most substances ALWAYS lead to problems and even the short term there are bad trips, brain zaps that alcohol dont bring. Also even for stuff that do not lead to physical cravings such as mdma, i have seen soo many people falling into an addiction. Its not a game.

Alchol wont be banned ever, but i think is a retarded debate to say "we should decriminalize other stuff be cause alcohl is bad". This is the worse reason possible.

Im quite happy drugs are banned and not mainstream so that my children will stay away from them and maybe try later when they feel more mature.

That doesnt mean i support the american war on drugs or jailing people for 3g of cannabis.. but the decriminalization of weed is stupid to considering two of my friends who have an impaired short term memory after 1 - 2 years periods of abuse.

That's an oversimplification of Butt's position. His main point is that drugs policy should be more evidence based and less political.

Is tho ? Or is it simply is way of bringing a more PC version of "drugs are not that bad" in an anti drugs crowd ?

I dont see any sort of upside in legalizing drugs at the society level considering the effects ive see on people. THATs a simple position.

>brain zaps that alcohol dont bring

Alcohol brings seizures, which are considerably worse (and potentially fatal).

>That doesnt mean i support the american war on drugs or jailing people for 3g of cannabis.

How do you intend to enforce the illegality of substances (and in a manner that will cause your children to fear possessing them) without punitive measures?

> Alcohol brings seizures, which are considerably worse (and potentially fatal).

This is literally the first time ive heard about that. That said i do think alcohol is dangerous.

> How do you intend to enforce the illegality of substances (and in a manner that will cause your children to fear possessing them) without punitive measures?

The status quo in my country is fine to me:

Drugs are easily available, fines are low (i know a ecstasy dealer who got caught in a club woth 60 pills and got 3 month of 'potential' jail time that will apply only if he gets caught again) , its badly seen by society and "forbidden".

That means not a lot of people do drugs. Motivated people can acess them, but you dont have a society of degenerate zombies. All good to me.

>This is literally the first time ive heard about that.

I had hoped it was common knowledge that alcohol withdrawal could lead to fatal seizures. People should be aware that going cold turkey (abruptly stopping heavy drinking) can put them at serious risk.

"All the people who want to do drugs are already using them, but society will crumble into degeneracy if they are legalized"?

What do you anticipate changing if they are legalized?

> What do you anticipate changing if they are legalized?

People will do them thinking "if its decriminalizef they must be fine" which is not a fine mindset at all and its a good thing to fear them.

> Im quite happy drugs are banned and not mainstream so that my children will stay away from them and maybe try later when they feel more mature.

Illegal drugs are much more accessible to teenagers than alcohol is.

What do you mean, weed ?

Alcohol is quite accessible to teenagers outside the US..

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