Relative drug harm: The comparison of psilocybin with other drugs

“Background: proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. we aimed to apply multicriteria decision analysis (mcda) modelling to a range of drug harms in the uk. method: members of the independent scientific committee on drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. findings: mcda modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. interpretation: these findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of mcda increases the differentiation between the most and least harmful drugs. however, the findings correlate poorly with present uk drug classification, which is not based simply on considerations of harm. funding: centre for crime and justice studies (uk). © 2010 elsevier ltd.”

“© the author(s) 2015. background: the present paper describes the results of a rating study performed by a group of european union (eu) drug experts using the multicriteria decision analysis model for evaluating drug harms. methods: forty drug experts from throughout the eu scored 20 drugs on 16 harm criteria. the expert group also assessed criteria weights that would apply, on average, across the eu. weighted averages of the scores provided a single, overall weighted harm score (range: 0-100) for each drug. results: alcohol, heroin and crack emerged as the most harmful drugs (overall weighted harm score 72, 55 and 50, respectively). the remaining drugs had an overall weighted harm score of 38 or less, making them much less harmful than alcohol. the overall weighted harm scores of the eu experts correlated well with those previously given by the uk panel. conclusion: the outcome of this study shows that the previous national rankings based on the relative harms of different drugs are endorsed throughout the eu. the results indicates that eu and national drug policy measures should focus on drugs with the highest overall harm, including alcohol and tobacco, whereas drugs such as cannabis and ecstasy should be given lower priority including a lower legal classification.”

“Comments on an article, ‘drug harms in the uk: a multicriteria decision analysis’ by david j. nutt et al. (2010). the authors report an article on drug harms in the uk reports a study in which a group of 15 people rated drugs on 16 criteria. the article reports that the group had a ‘facilitator’, and that ‘the group scored each drug on each harm criterion in an open discussion’. in other words, the group, and not independent judges made the ratings. this is unfortunate practice, because it exposes the outcomes to the vagaries, as well as any benefits, of group processes. in this case, we do not have any before-discussion individual means, and so also cannot calculate the group mean before discussion. a better way to do this study would be to record individual ratings, anonymously, before group discussion, and to be aware of the potential effect of group dynamics on such ratings. (psycinfo database record (c) 2015 apa, all rights reserved)”

“What is the drug of choice for condition x? is among the mostrncommonly asked questions in primary care.1rn reflecting therncomplexity of prescribing decisions, answering this questionrnrequires a difficult trade-off between the benefits and harms ofrnmultiple drugs for a given condition.rnthe principles of evidence-based medicine suggest thatrnprescribing decisions should be guided by an objective benchmark,rnnamely scientific evidence.2rn such evidence is particularlyrnimportant when choosing a first-line treatment amongrnmultiple alternatives. unfortunately, existing clinical evidencernon benefits and harms is rarely adequate to inform prescribingrndecisions. a randomized controlled trial comparing all relevantrndrugs would provide such information. however, clinicalrntrials are often designed for regulatory purposes and, therefore,rninclude selective patient populations and do not includernall available comparator drugs.3,4 to obtain insight into therncomparative benefits and harms of multiple drugs, prescribersrnturn to summaries of evidence to discern the most promisingrndrugs from their less effective comparators.”

“Comments on an article, ‘drug harms in the uk: a multicriteria decision analysis’ by david j. nutt et al. (2010). david nutt et al. point out the extent of harm that alcohol does to individuals and to society. the uk coalition government has established morbidity and mortality amenable to treatment as central to its outcomes-based health service reforms. with regard to public health and social policy, the british society of gastroenterology suggests that an outcomes-based policy focused on amenable mortality is especially applicable to alcohol, given its leading contribution to disability and life years lost. the approach to patients who make contact with secondary care with alcohol-related problems is typically nihilistic. nurse-led multi disciplinary teams can have a marked eff ect on successful rehabilitation, with reduced alcohol intake, improvement in liver function tests, and reduced admissions to hospital. the effect of alcohol on health is an international problem, but the uk now has worse statistics for liver disease mortality than other european countries. (psycinfo database record (c) 2012 apa, all rights reserved).”