Drugs of Abuse: Their Actions & Potential Hazards
 Author:   Samuel Irwin, Ph.D.
Publisher:   Do It Now Foundation

 Publication Date:

  September 2003

 Catalog No:


Chapter 6: Measuring Risk

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

Until recently, 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.

The evaluation 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.

Another means 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.

The statistics 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).

To Society

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 problems.

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.

I contrasted 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.

Most remarkable 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.

The Fraud Factor

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 sold.

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.

According to 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:

1. heroin
2. stimulants and cocaine
3. phencyclidine
4. solvents
5. sedative-hypnotics
6. alcohol
7. LSD
8. marijuana

Viewed from this perspective, the rating provided by the law enforcement panel comes closest to the ultimate hazard potential of drug use to society.

Stemming the Tide

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.

The emergence 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.

According to 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.

Implications 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.

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Read On! Chapter 7: Beyond Drugs

This is one in a series of publications on drugs, behavior, and health published by Do It Now Foundation. Check us out online at www.doitnow.org.