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The Harm Scale

The classification of 'drugs'

The existing way in which the world looks at substance abuse, from the point of view of legal systems, is to focus on the substance itself and try and put it into a box with other substances of, supposedly, equal status.

The problem with that approach is that it presupposes that a substance has a uniformly predictable effect on its users so that it is possible to state that, say, ecstasy and heroin should be treated equally within the criminal justice system.

Where's the Harm?

More recently, a number of voices have been raised suggesting that the evidence of harm caused is what should determine our approach towards these substances.

In July 2007, The Lancet published a paper by David Nutt, Leslie A King, William Saulsbury and Colin Blakemore entitled 'Development of a rational scale to assess the harm of drugs of potential misuse'. This paper reported the results of asking two groups of experts, one drawn from the national group of consultant psychiatrists who were on the Royal College of Psychiatrists’ register as specialists in addiction and the other made up of experts from a variety of disciplines, such as drug counselling and law enforcement, to rank various substances against a harm scale with nine components.

The findings of the two groups were remarkably similar suggesting that the nine components used are a reproducible way to look at issues of substance abuse.

The nine components were in three groupings of three; physical harm, dependence and social harm.

The results of the paper were widely reported and even formed the basis for a programme in the BBC's 'Horizon' series first broadcast on 5th February 2008. 

What's Top of the Pops?

The Lancet paper looked at a total of 20 substances both legal and illegal and considered them in the context of use outside of proper medical control, i.e. 'on the street'. Not surprisingly it concluded that the top four were heroin, cocaine, barbiturates and methadone. It was No. 5, alcohol, that produced most of the attention as well as ranking tobacco, at No. 9, two places above cannabis at No. 11.

In the opinion of the experts, ecstasy, a Class A substance treated like heroin and cocaine ranks No. 18 out of twenty.

Hurting Me, Hurting You

One possible criticism of The Lancet paper is that it gave equal weight to its three groupings; physical harm, dependence and social harm. The question which should be asked in a free society is how far should the state go to protect an individual from himself? If I chose to sit at home and smoke cannabis every night is that any concern of society? If I get drunk in public every night, that is clearly a very different matter. As is the burden I place on society as a result of the smoking related disease I contract from indulging what may appear to be a harmless pursuit from a 'social harm' viewpoint.

It seems to me that a rational classification of the psychoactive substances must look at the harm done to society in general. And, before anyone suggests that I am proposing a free for all in the use of currently illegal substances, let me stress that I do believe it is very much in society's interests to see that its children mature into healthy, productive adults and controls on the availability of substances to young people are essential.

My Harm Scale

The next few pages of The Poison Garden website look at some of the principal plant based psychoactive substances ranked by my subjective view of the harm caused. The overriding factor in determining that ranking is the number of deaths arising.