
Alcohol 'more harmful than heroin' - pierrefar
http://www.bbc.co.uk/news/uk-11660210
======
swombat
Here's some background. Nutt initially released this scale in 2009 and was
sacked by the government over it:

[http://www.timesonline.co.uk/tol/news/uk/health/article68947...](http://www.timesonline.co.uk/tol/news/uk/health/article6894710.ece)

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...)

~~~
CWIZO
This is the first time I see LSD and Ecstasy put together in a harmless group
together with marijuana. Am I brainwashed or are you wrong? I mean, I've
smoked dope and nothing bad ever happened. But a friend of mine took ecstasy
once and blew his kidneys (he's waiting for a donor now).

~~~
binarymax
The problem with this is that if you are to buy illegal drugs such as exstacy,
you cannot verify its purity. This is another argument for legalization -
quality control. I am saddened by what your friend is going through. There is
no way to know what he was actually sold. The scientists are rating the actual
drug. What you get on the street is a coin toss.

~~~
dailyrorschach
I'm not a user, but have friends who do. If you do as well, encourage them to
play safe, and test the material: [http://dancesafe.org/health-and-
safety/adulterant-screening-...](http://dancesafe.org/health-and-
safety/adulterant-screening-kit-instructions)

~~~
bigfudge
this is a good idea, but it makes it attractive to buy larger amounts of a
known safe pill... which makes you much more vulnerable to a dealer rap if you
get caught. Just another example of the insanity of our current policy.

------
lunchbox
PDF of Nutt's previous 2007 Lancet review here:
[http://science.iowamedicalmarijuana.org/pdfs/safety/Nutt%20R...](http://science.iowamedicalmarijuana.org/pdfs/safety/Nutt%20Rational%20Scale%20Drug%20Harms%20Lancet%202007.pdf)

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?

~~~
swombat
_Also, if those drugs were legalized, their use might go up, thereby
multiplying their negative impact on society._

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...](http://en.wikipedia.org/wiki/File:Rational_scale_to_assess_the_harm_of_drugs_\(mean_physical_harm_and_mean_dependence\).svg)

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.

~~~
rfrey
_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?_

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.

~~~
viraptor
Legalising doesn't mean the end of anti-... campaigns. You can still see a lot
of "don't drink too much" / "don't drink and drive" / "drinking kills
families" kind of stuff, even though drinking is perfectly legal.

~~~
lutorm
Yes, but you also see plenty of ads about how cool it is to drink alcohol. Do
you think legal heroin would be any different?

~~~
borism
Yes. I think nobody here argues that heroin should be legalized. But for
lighter drugs legalization should clearly include ban on their advertisement
(or, in fact, provision that tax revenue from their sale be spent on anti-
advertisement)

~~~
jamesbritt
Heroin should be legalized. What I put in my body is my business.

~~~
SoftwareMaven
Until you are breaking into somebody's house to get money to fund the
addiction. Unfortunately, heroin is so addictive and so quick to build
tolerance, that this is a very possible scenario.

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.

[1] <http://pain-topics.org/pdf/OpioidAntagonistsForPain.pdf>

~~~
kls
Addiction and dependency are separate issue when dealing with drugs. I am
physically dependent on opiates. When I was a child I was hit by a truck and
bashed up pretty good. It pretty much ruined my neck. Anyway, in the absence
of my medication I don't jump to the I need to commit a crime to get it nor
would I. Addiction is a psychological phenomenon in which the user becomes
consumed with the drug and will do anything to get it, it is a compulsive
disorder and has nothing to do with the actual drug. If Alcohol where illegal
an therefore prohibitively expensive you would see the same behavior among
addictive personnel with Alcohol. Just because someone is physically dependent
whether an abuser or not does not mean that they exhibit addictive personality
traits.

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.

------
corin_
That ranking is pretty ridiculous.

 _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?

~~~
swombat
The point of the study is the government should address drugs based on the
problems they do represent, not on the problems they might perhaps
theoretically some day represent.

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.

~~~
jakerocheleau
actually LSD and cannabis has never killed anybody ever.

just saying

~~~
epo
Citation needed.

~~~
reyk
The burden of responsibility is on the person claiming that it is responsible
for death. LSD, the substance, has not killed anyone. Someone is welcome to
disprove this.

~~~
rue
The _effects_ of LSD, the substance, certainly have.

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.

------
charlief
Multi-Criteria Decision Analysis (MCDA), which Nutt used, is a tool for
decision making, not something "sophisticated" to generate scientific
evidence! It cannot estimate a drug's harm. Alcohol is wide-spread and
deserves a discussion for that reason alone, but Nutt is not presenting
"evidence" or anything new. MCDA is heavily prone to selection bias in picking
criteria and weights. It is an extremely subjective process and is used when
two or more decisions closely compete to give some _pseudo-quantitative_
separation. When you structure the problem in which one alternative scores
very high, the analysis didn't add a single ounce of value.

Here is the original paper:

[http://www.crimeandjustice.org.uk/opus1714/Estimating_drug_h...](http://www.crimeandjustice.org.uk/opus1714/Estimating_drug_harms.pdf)

[http://en.wikipedia.org/wiki/Multi-
criteria_decision_analysi...](http://en.wikipedia.org/wiki/Multi-
criteria_decision_analysis)

~~~
swombat
_Multi-Criteria Decision Analysis (MCDA), which Nutt used, is a tool for
decision making, not something "sophisticated" to generate scientific
evidence!_

I have not read the papper, but informing public policy ("decision making")
seems to be what this study is trying to do.

~~~
charlief
I'm not sure what you mean by "informing public policy", but if the paper was
to inform, they would provide summary of facts and facts only. The paper says
it is trying to estimate drug harms using some set of arbitrary "harm
parameters". I am saying you can't objectively estimate harms with an MCDA
analysis. You're not going to get anything objective out of this unless you're
framing it against an exact set of decisions you have to make. All you're
going to do is find one group's interpretation. Although MCDA is systematic,
and a lot of it including the ranking is generated automagically once you have
everything set, overlaid with some "sophisticated" (Nutt's words in the
interview) overtones, it is entirely subjective.

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.

------
lemming
Another interesting article from 2009 by the ever excellent Ben Goldacre:

[http://www.badscience.net/2009/06/this-is-my-column-this-
is-...](http://www.badscience.net/2009/06/this-is-my-column-this-is-my-column-
on-drugs-any-questions)

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._

------
pierrefar
Just a heads up: there is a bit of politics with this story. The author was
the head of the government advisory board that suggested changing the ratings
(and thus penalties) of some drugs, but the subject was too dangerous to
tackle politically. He criticised the government and got fired. A year later
he publishes this report.

The Guardian's coverage (
[http://www.guardian.co.uk/society/2010/nov/01/alcohol-
more-h...](http://www.guardian.co.uk/society/2010/nov/01/alcohol-more-harmful-
than-heroin-crack) ) 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.

------
kevin_morrill
Drunk driving kills between 15 to 10 thousand people each year in the U.S.
That's about 3x the lives lost from 911--every single year.

~~~
lunchbox
Tobacco use kills 443,000 Americans each year.

Source:
[http://www.cdc.gov/tobacco/data_statistics/fact_sheets/healt...](http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/)

For perspective: <http://www.meh.ro/wp-content/uploads/2010/09/meh.ro5415.jpg>

~~~
acqq
That's "1 of every 5 deaths in US due to smoking," I've submitted it now:

<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?

~~~
Alex3917
I'm pretty sure that data is about ten years old, but otherwise it's correct.
Overall drug use kills about 1 in 3 Americans.

------
ry0ohki
Shrooms and LSD are safer then steroids and tobacco? Who knew?

~~~
steveklabnik
People who use shrooms and LSD.

~~~
ry0ohki
The "man's" propaganda got to me: <http://www.youtube.com/watch?v=P0zgIzqgxFU>

------
jfager
There is no chance that this chart is accurate for the US. Crack and heroin
are together directly responsible for a ridiculously high percentage of gang
violence and other inner-city problems, and crystal meth has destroyed many
small rural towns throughout the south and midwest.

More explanation of their methodology would be nice, especially given their
use of data from the Netherlands, which has a very progressive drug policy.

~~~
Tuna-Fish
Drug-related gang violence isn't caused by drug use, it's caused by drug
policy. Changing the policy so that it no longer creates ridiculously huge
profit opportunities around the drugs in question does make the problems go
away.

~~~
drndown2008
This argument drives me crazy. You think the drug pushers are gonna say "ah
shucks. no more profit in drugs. guess I better go to college and get a real
job."

Trust me, they will find something else to exploit. Kidnapping in Bogota comes
to mind. Crime won't go down.

~~~
c3o
Probably many would find something else, and that's a problem - but surely it
can't be used as justification for not changing the policies. Legalization
should happen gradually and with some kind of amnesty outreach program. But
even if not: Crime like robbery would likely spike, but unless gangs quickly
find a replacement product that's in similarly high demand (if there was one,
wouldn't they already be serving it?) I imagine cutting off their easiest
source of income would fairly quickly reduce their power to attract new
members, purchase weapons, etc.

~~~
billswift
And even more quickly, since it takes a LOT more money, reduce their ability
to bribe cops and judges.

------
gaius
This was on the news this morning complete with stock footage of adults
drinking socially in the pub - but the problems with alcohol are around ultra-
cheap alcohol bought in supermarkets.

------
russellallen
So is this an argument for legalizing heroin or for bringing back prohibition?

~~~
JoachimSchipper
I haven't followed it, but he seems to be trying to open up the debate.

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.

~~~
electromagnetic
Gentler approach? Anti-smoking _is_ reaching prohibition like levels in most
countries. You're banned from smoking everywhere to the point you're banned
from smoking in your own vehicle if someone else is present regardless of
whether or not the passengers smoke themselves.

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.

~~~
dejb
> I'm sick of this nanny state bullshit.

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.

~~~
swah
OTOH you have to keep in mind these movements are organized by a few people,
and not the entire society suddenly rising against the evils of passive
smoking.

~~~
JoachimSchipper
At least in the Netherlands, in my social circle, anti-smoking laws are _very_
welcome. Like any issue, it's championed by a few people; and yes, there are
people who oppose it. But as far as I can see, there's quite a bit of
acceptance, both by non-smokers and smokers.

------
swah
I never seen a family destroyed by tobacco, but I've seen families destroyed
by cocaine. I don't understand how someone could put those two together.

~~~
thenduks
I think if you look a little you'll find that plenty of families have been
'destroyed' by the effects of tobacco.

~~~
swah
How so? In the sense that the smoker is all messed up in the hospital bringing
pain to his relatives, sure.

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.

~~~
thenduks
I suppose it depends on your definition of 'destroyed', then. Personally, any
kid of mine who I would consider chaining to a bed would be in rehab without a
second thought -- on the other hand, smoking seems so innocuous that before
you know it they're dying of lung cancer and you can't do anything about it...

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.

------
sfall
sure but the ld50 of those drugs are higher than alcohol

~~~
JoachimSchipper
Possibly, and the ld50 of beer is definitely higher than that of vodka. What
are you trying to say? I don't think the amount ingested is very interesting
here...

~~~
sfall
ld50 is for alcohol, be it in beer or vodka or rum

