All drugs with
potential for abuse share an ability to induce some desired change
in mood or perception. In general, the more desirable and seductive
the change, the greater the potential for abuse and the higher
the risks of physical or psychological dependence in users.
To the Individual
researchers rarely approached evaluating and assessing the relative
hazard potential of a drug to the individual, except in the most
limited sense of possibilities for tissue damage, physical dependence,
or death from overdose.
Such an assessment
involves a series of complex judgments, often based on incomplete
or inadequate information, and it is doubtful that experts would
agree on any rank ordering of drugs or on decision-making priorities
for doing so.
It can be reasonably
attempted, however, by concentrating on objective criteria when
possible and by trusting one's intuitive judgment, based on knowledge
and experience, to subjectively score the individual items.
presented in the table below is an attempt to identify the most
significant variables and arrive at a relative ranking of the
hazards of the major psychoactive drugs.
I've based this
assessment on such criteria as the drug's overall potential to
be used repeatedly or compulsively (or in a self-destructive
manner), to produce physical dependence, impair judgment, predispose
to social deterioration, produce irreversible tissue damage and
disease, and cause accidental death via overdose.
In this ranking,
0 represents the absence of an effect or impairment; varying
degrees of effect are represented from (1) very slight, to (2)
slight, (3) moderate, (4) marked, and (5) extreme. It should
also be noted that not all members of a single class of drugs
are equally dangerous.
of ranking the relative dangers of psychoactive substances is
to review hospital records and medical examiner reports to determine
which substances pose the greatest immediate risks in terms of
accidents and overdoses. The Drug Abuse Warning Network (DAWN)
is a federally-sponsored information-sharing project that tracks
trends in drug-related emergency room treatment and deaths. DAWN
compiles data from 756 hospitals and 75 medical examiner facilities
in 27 major metropolitan areas.
presented in the chart below cover the top eight drugs mentioned
in hospital emergency room incidents and medical examiner reports
for 2002 (the most recent year for which data is available).
Our purpose here
is to begin to examine psychoactive drugs in their broader context
as relative hazards to society. In the process, we may discover
new possibilities in responding to the problems these substances
represent and how to model drug and alcohol prevention, education,
and treatment programs to best address -- and alleviate -- these
The last chart
presents a rank ordering of drugs based on their scores for hazard
potential to society. This order is based largely on the extent
of a drug's probable misuse and subsequent harm to others arising
from social apathy, driving accidents, aggression and crimes
of violence, and so on.
my own assessment with those of 22 representatives of law enforcement
agencies (primarily district attorneys). Since my personal bias
is that alcohol is the most potentially hazardous substance to
society, I assigned a 100 percent rating to alcohol. Not surprisingly,
ratings by law enforcement personnel listed heroin as the highest,
at 100 percent. The estimate of hazard for other drugs was rated
in relation to the values for alcohol and heroin, respectively
(e.g., I rated heroin at a hazard level 68 percent that of alcohol).
As the ratings
reveal, the law enforcement group tended to rate the relative
hazards of the drug group in relation to existing laws and penalties
associated with them. The only exception was marijuana, which
was rated only slightly above alcohol on the scale.
was their low rating of alcohol, which has been listed as the
fourth major public health hazard in the United States. This
was counter to my expectations, particularly considering their
experience in law enforcement, and to data which links alcohol
to more than half of all driving fatalities and to countless
crimes of violence, taking up an estimated 50 percent of their
enforcement time and about one-third of their total budgets.
Most of the pills,
capsules, and powders prepared and sold on the street are marketed
with appalling disregard for human safety. The level of fraud
in the illegal drug market is perhaps its most distinguishing
feature, a situation compounded by the lack of quality control
over composition, dosage, and potential toxicity of most drugs
The main outcome
is that the street user faces dangerously high risks of unexpected
or deadly reactions. And the greater the demand for a particular
drug, the more expensive it becomes--and the greater the risk
of substitution or adulteration.
analysis data collected over the past three decades, up to 50
percent of street drugs do not contain the primary ingredient
they're alleged to contain -- a figure that runs even higher
with specialty drugs, such as opium and mescaline, or tightly-controlled
substances, such as pharmaceutical amphetamine. Similarly, samples
are often found to contain unsafe dosage or to be cut with chemicals
intended to mimic or boost another drug's action. And too often,
these additives carry dangerous side effects all their own.
The hazard scores
in our chart on individual risks were based on the availability
of a drug in pure form, as with alcohol. But there are no guarantees
of the purity of drugs on the street. At the same time, users
of certain drugs, particularly those producing strong physical
or psychological dependence, may be forced to commit crimes to
obtain money to supply a drug habit.
Because of these
conditions, there's clearly a need for reordering hazard potential,
with an eye on the mutual hazards to the individual and society.
Here's one interpretation:
2. stimulants and cocaine
Viewed from this
perspective, the rating provided by the law enforcement panel
comes closest to the ultimate hazard potential of drug use to
A valid, rational
criminal law is one that addresses itself to a real social problem,
deals effectively with that problem, and is enforceable. Many
would argue that at best, these criteria only occasionally describe
current U.S. drug policy.
A main weakness
of our ongoing "war on drugs" strategy has been our
primary emphasis on only one side of the drug abuse equation
-- supply, rather than what must be regarded as the heart of
the problem: demand.
As a result of
"supply-side" enforcement policies, we've seen increased
production of substitute substances, which can pose even greater
risks to the individual and society.
of legal synthetic "designer" analogs of heroin and
other narcotics is a case in point. Milligram for milligram,
these compounds can carry 500 to 2,000 times the potency of heroin.
Some have even been linked with a severe degenerative nervous
system syndrome similar to Parkinson's disease.
So what are we
to do? Learn from our mistakes. And act, if we have the wisdom.
the best available data, the frequency of alcohol or drug abuse
by the population is continually distributed on a log normal
basis. This is simply a complex way of saying what most of us
know intuitively: that in any given using population, there are
many light users, fewer moderate users, and even fewer heavy
users. The curve is continuous, with no clear differentiation
into users and abusers. The drug abuser is thus always a predictably
small fraction of the total population of drug users.
are intriguing. One obvious conclusion is that the only real
way to reduce the actual incidence of drug abuse is by an overall
reduction in the per capita consumption of drugs and alcohol
by the total population and by less tolerance of gross intoxication.
And that moves
us finally into an area that we can do something about.