Drug Harms in the UK: A Multicriteria Decision Analysis – Source: The Lancet, Nov 6, 2010

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) modeling to a range of drug harms in the UK.

Methods: 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 modeling showed that heroin, crack cocaine, and methamphetamine 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.

[Note: a commentary on this report by pain researcher SB Leavitt at PainTopics.org points out that the measures of harm used take into account how addition of alcohol exacerbates the harm done by other drugs, often creating lethal combinations. He also points out that for reasons not explained, over-the-counter drugs for pain were not included in the assessment.]

Source: The Lancet, Nov 6, 2010. PMID:21036393, by Nutt DJ, King LA, Phillips LD. Independent Scientific Committee on Drugs, Neuropsychopharmacology Unit, Imperial College, London, UK. [Email: d.nutt@imperial.ac.uk]

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