Dutch Government study ranks harmfulness of legal and illegal drugs

By Alfa · Jul 3, 2009 · ·
  1. Alfa
    The National Institute for Public Health and the Environment (RIVM) has performed a risk assessment on the harmful effects of 17 drugs plus that of tobacco and alcohol. These 19 items were ranked according to their degree of harm. The assessment was performed by a panel of 19 experts who based their judgement on their own scientific expertise and information derived from the literature. The assessment focussed on the following three categories:

    1. toxicity (acute toxicity and chronic toxicity)
    2. potential for dependency,
    3. social harm at individual and population levels.

    Purple: Physical damage
    Orange: Individual Social damage
    Green: Population social damage
    Dependency is not displayed in the image above.

    The most important conclusions drawn from the assessment are as follows.

    Firstly, alcohol, tobacco, heroin and crack scored relatively high on the scale for Total harm, whereas magic mushrooms, LSD and khat scored relatively low.

    Secondly, the scores of the Dutch expert panel correspond well with
    previous findings from British experts as well as previous advice from the Dutch Coordination point Assessment Monitoring new drugs (CAM).

    Thirdly, classed as legal drugs, alcohol and tobacco have been judged by the experts as more harmful than many of the illegal drugs included in the assessment –with the exception of heroin and crack. This accounts for the Total harm at individual and population levels.

    Finally, regarding Total harm at individual level, cannabis and ecstasy have been assessed by the experts as moderately harmful.

    The study is remarkable, as Dutch drug policy has been making a U-turn in the last 7 years. Magic mushrooms (Paddo's in Dutch) have been banned last December. This study shows magic mushrooms are at the lower end of the risk spectrum, while legal drugs like tobacco(Tabak in Dutch) are much more harmful.

    The study can be found in the Document archive.

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  1. Alfa
    File Archive
    A new entry has been added to The Euphoric body

    The National Institute for Public Health and the Environment (RIVM) has performed a risk assessment on the harmful effects of 17 drugs plus that of tobacco and alcohol. These 19 items were ranked according to their degree of harm. The assessment was performed by a panel of 19 experts who based their judgement on their own scientific expertise and information derived from the literature.

    This file is mostly in Dutch. The abstract is in English.

    To check it out, rate it or add comments, visit Dutch Government study ranks harmfulness of legal and illegal drugs
    The comments you make there will appear in the posts below.
  2. nibble
    Nice addition Alfa. I however fail to see how cannabis can be considered more harmful in any of those aspects than both benzodiazepines and buprenorphine. The problem with such studies is that they don't actually calculate the true harm of each drug itself, large factors are due to their illegality or how users are getting the drug. Methadone for example would not be any less harmful than heroin all things being equal, in fact it's dependance liablity tends to be much worse. It's just the fact that methadone is coming from metahdone clinics or similar and thus avoids the illicit market and the dangers it introduces.
  3. Alfa
    Thats an excellent point. Mind that they measured ecstasy, instead of MDMA.
    I think they measured the toxicity of cannabis in relation to it being smoked, while benzodiazepines are taken orally. The social harms of cannabis are measured as less than benzodiazepines, even while cannabis is illegally produced and wholesaled and benzodiazepines are produced and sold through licensed companies & pharmacies.
  4. podge
    Interesting that Mushrooms, Ketamine and LSD are all equal or lower than Cannabis in danger .... i guess this may be because a larger percentage of of the population smoke cannabis so its percieved as a larger threat to society ?
  5. nibble
    As Alfa said they could have factored smoking into the harm associated with cannabis, where those drugs would be taken orally. Although ketamine has a very poor bioavailability orally and thus is usually insufflated..
  6. Piglet
    Alcohol is SO destructive. I remember a UK researcher called Professor David Nutt who has studied the detrimental effects of drugs for years. He suggested that alcohol be replaced with a benzodiazipine partial-agonist. The idea being that you cannot overdose, it is far, far less toxic and being a partial agonist, would be at the low end of the scale as regards to forming a dependancy.
  7. lloydsLSD
    I don't get it though. 2 or 3 cans of Carling a day wouldn't harm anyone, but 1 spliff a day is bad for you. 1 E a day would be bad for you.

    Population harm is a pointless statistic because much more people are likely to drink alcohol far too much or smoke tobacco far too much, but is this saying that even if you don't drink too much it's still worse for you than smoking cannabis? That's ridiculous isn't it? If SWIM smokes half a spliff his lungs produce gunk and I'm sure cannabis is just as dangerous to take as alcohol when driving a vehicle.
  8. Alfa
    No, it isn't. Driving under the influence of alcohol is more dangerous than under the influence of cannabis. Alcohol makes you reckless, while cannabis does not.
    Alcohol is far more toxic than cannabis. For more people die, get ill, get addicted or cause aggression & incidents from alcohol, than from cannabis. Not just in % of the population, but also in % of users.

    And yes, 1.5 litre of 5.5% alcohol daily does hurt you over the years.

    I agree with you that moderation is the key, but daily use is beyond moderation. The above study put harm nicely into perspective.

    Many people have reacted adversely to this study, because it confronts them with how dangerous alcohol and tobacco really are. Just tell a average tobacco smoker that his hourly cigarette is just as addicting as heroin and physically more harmful than ecstasy. You'll have a riot on your hands there, while its a scientific fact. The same goes for alcohol drinkers.

    The social acceptance of some drugs is not realistic when harm is considered.
  9. Dr.Evil
    The most likely reason the Cannabis is rated so much higher than LSD, Psilocybin (magic mushrooms), Benzodiazepines (BDZ), and is comparable to GHB/Ecstasy, is because of how it is ingested (smoking) just as Alpha stated. The fact of the matter is that Psilocybin, BDZs, LSD, and many of the other drugs low on the scale are very selective to where they bind, and are extremely specific molecules with only one or a few modes of action.

    Cannabis on the other hand is not a moelcule, but a plant with >60 unique compounds and some literature says about 118 carcinogens produced upon combustion (Dale Geirringer et al., this is debatable, and some studies have actually shown THC, not Cannabis, to have an antitumor effect). This, IMHO, is also why ecstasy is rated higher than cannabis. I think the rating for MDMA (what people would refer to as "pure ecstasy" if there is such a thing) would actually be rated lower than some of the drugs mentioned above.

    This is also why acohol, like our intelligent posters have stated, is such a harmful drug and rated so high on the list. I am currently doing research on the effects of chronic adolescent alcohol abuse, and there is a reason that researchers in my lab refer to alcohol as the "dirty drug". This is because, alcohol's effects are so pervasive. Ethanol (the alcohol we consume) affects almost every system in the body by binding to cellular membranes.

    All in all, I believe the main reason these rankings would seem "screwed up" in the eyes of the layman is because, most people don't realize how big of a deal the binding specificty of a drug truly is.

    Sorry for the length. Just had to put my two cents in. GREAT FIND!!:thumbsup:
  10. lloydsLSD
    I'm not saying alcohol or tobacco aren't as bad for you as this study claims, I know they are. I just don't see the difference between abusing alcohol and abusing cannabis. Both are bad for you. I mean how much tobacco do people use in spliffs and how many spliffs do they have a day?

    Alfa, you say cannabis doesn't make people reckless but I know a couple of people who claim they can 'drive better after smoking a spliff', but how can that be when they have such slow reflexes as a result? It's a false sense of driving improvement.

    It's also funny how many cannabis users almost try to make out that cannabis is good for them, like they are paranoid about accepting the damage they are doing to themselves. Eating cannabis might be fine, I don't know, but smoking anything is bad for you.

    Some people reckon that alcohol like red wine in small amounts is good for you, weed is not unless you have MS or something where cannabis might help with the pain.

    EDIT: Alcohol is much worse and will kill someone much faster than cannabis if abused, I understand that, but no amount of smoking anything is good for you. I can see people feeling safer from reading studies like this. We know too much alcohol is bad for us, that's common sense, but how much cannabis is bad for us and how bad? Cannabis is much more likely to be used heavily than Ecstasy or mushrooms.

    Lamb added 37 Minutes and 43 Seconds later...

    We all know very old people who enjoy getting drunk once or twice+ a week, who have done so for many years, but how many really old people are around who have smoked cannabis heavily all their lives?.... None, because they are all DEAD! (LOL I'm kidding)
  11. Dr.Evil
    I completely agree with you Lamb. Its basically a "pick your posion" situation. But, the reason people think cannabis is safer than alcohol is because THC, Cannabidiol, and Cannabinol which are the active compounds in cannabis that give users the subjective "high" feeling have been shown to not be bad for you, and in some cases even have good effects on your health, well-being, etc... and that is what most users assoiciate smoking cannabis with. But in all reality, all of the other chemicals released in cannabis when it is smoked is what makes it comparable to alcohol in terms of damage done. That is why medical marijuana is not legalized, because it is not a legitimate medication. You wouldn't give a person with depression a bottle full of anti-depressants, and just tell them to dump some amount in there hand and take them. It should be medical THC/Cannabidiol/etc... that can be prescribed in smaller known amounts. You already alluded to this point when you said that small amounts of wed rine are good for you, which they are! But I get away from my main point. Alcohol on a population wide scale is worse for a couple of reasons. Way more people abuse alcohol than cannabis, because it is more socailly acceptable. Even though you are right that being intoxicated is being intoxicated, no matter the drug, and one should never operate a vehicle under the influence, the fact is that alcohol depresses the nervous system to a greater degree than cannabis ever could, and because of this there are more alcohol related deaths. Alcohol also causes a great amount of social strife through the form of alcoholism, abuse, and broken families (a family member of mine is a recovering alcoholic and it almost tore our extended family in two). Even though cannabis is physically bad for you, it cannot begin to compare to the long reaching arm and influence alcohol has had on our society.

    Once again I completely agree for you that physically they are both terrible for you, but just trying to show how alcohol's social influence would lead the researchers to place it at the top of the list.
  12. lloydsLSD
    Yes I agree with you, good post. I didn't think about the good ingredients in cannabis that you mentioned and I don't doubt that it would be awesome to get a product that just contained those if possible.

    1 thing I will say is that we all know how alcohol effects us but is it the same for all the different strains of cannabis out there? SWIM has had weed that mashed him so much that he had difficulty just moving his head, and this wasn't even a lot of weed, so driving would have been suicidal! It seems that weed effects SWIM differently to other people sometimes and maybe it does the same thing to other people.
  13. Dr.Evil
    Once again you hit the nail on the head without even knowing it!

    Different strains of cannabis can have anywhere from 2%-20% (don't quote me but I know its somewhere in that range) THC content, and that the average THC content has increased by >10% over the past 20 years or so. SWIM is not smoking SWIM's parents cannabis.

    On how drugs affect people differently you are right about cannabis, and wrong about alcohol. Researcher's have recently begun to realize that genetic polymorphisms (changes in DNA that cause a different amino acid to be placed than the normal one) in your cell's receptors and enzymes cause many different phenotypes (attributes brought by a particular set of genes, or genotype) that make people metabolize and experience drugs completly different from one another.

    For example, the second enzyme in the breakdown of alcohol is called aldehyde dehydrogenase (ALDH) which converts acetaldehyde into acetic acid. ~40% of the Asian population is heterzygous for the active form of ALDH (meaning they have 1 good copy, and 1 bad copy of the gene) and these Asian people get flushed, or red in the face when they drink because of the excess build-up of acetaldehyde. Even more interesting, ~10% of the Asian population is homozygous for the inactive form (2 bad copies) and will have severe flushing, headache, increased heart rate, and even vomitting whenever they drink. Also, this 10% of the Asian population has been shown to have almost zero risk of developing alcoholism.

    There are differences in everyone that affect the experience with drugs. If you have a particular mutation in your GABA receptors (where benzodiazepines, or anxiolytics bind) then BDZs, such as valium, won't be able to bind to your receptors and would have no effect on you.

    There are several examples of mutations like this affecting drug metabolism, and therefor the subjective experience. Hopefully we will learn more as new findings and research is done in this area.
  14. lloydsLSD
    Fascinating stuff, are you a scientist or something dude? So all people are effected differently from alcohol or just different races? Me personally I can drink heavily once or twice a week and not have a hangover or and I can drink heavily for many days and not have withdrawal symptoms if I don't drink again for 1 month. I know that not having hangovers is not a good sign lol but I have always been able to drink a lot and feel fine the next day.

    Anyway I'm off out for a game of football so have a good day mate.
  15. Dr.Evil
    I would qualify myself as a developing scientist. I am currently trying to decide if I want to become a straight scientist (Ph.D) or become a doctor (M.D.)

    Over the majority of the population people generally are affected in about the same way. There are slight differences in genetics and upbringing (nature/nurture) that lead people to react differently to alcohol, and make them more, or less, likely to become alcoholics. There are difference from person to person. Race isn't so much of an issue....I just like to use the Asian example, because a Korean friend of mine gets bright red anytime he drinks :laugh:.....the Asian example just shows how geographically isolated people can lead to new dominant phenotypes in the population (which is how "race" came about)

    Actually the bigger issue in alcohol metabolism is sex......there are ~3 major biological differences between males and females that cause men to be able to hold their liquor better.

    Women have 50-60% less ADH (alcohol dehydrogenase, first enzyme in ethanol breakdown) in their stomach's than males do.

    Ethanol is highly water solube (hydrophilic) and the smaller body size you have (generally females are smaller than males) the higher fat/body water ratio you have....which means the ethanol is less dilute and you will have a higher blood alcohol concentration (BAC)

    The last reason is men have a larger muscle to fat ratio than women, and fat has very little (if any) blood supply. So, this means that overall men have a larger vascular compartment than women (more room for liquid, bc of bigger/more blood vessels) and this makes the alcohol more dilute in their system.
  16. Tony Williams
  17. Dr.Evil
    It's because, if you look at the green bar for meth on the graph it is alot lower than the other hard drugs. The green is population social damage, so I assume that its not number one beause it is (in the course of time) a relatively new drug, and it hasn't had the big social effects of herion, crack, and alcohol...........at least not yet
  18. Alfa
    Although Methamphetamine is destructive and very addictive, it is not as bad as the media scare portrays it to be. The meth epidemic was never there. At least not in the magnitude media and government officals wants people believe. Drug scare propaganda does sells newpapers and attracts funding for government agencies though.
  19. enquirewithin
  20. lloydsLSD
    TBH to me most things in life are common sense and gained from experience and an open mind. I don't need to be told how life ruining alcohol and tobacco are, or at least can be.

    SWIM can smoke crack and take heroin and still take them for what they are and never get addicted. That's why SWIM doesn't rate studies like this, funded and run by rich saps who have no experience of real life at all, just scientific knowledge like the governments have clueless used for decades in order to tell us what's good or bad for us.

    1 girl takes GBL and dies, another take ecstasy and dies. The government tells us something along the lines of "every single one of us is in danger from this horror drug". It's seems like cannabis is being plugged as a wonder drug almost and it's so stupid. "The government could say that cannabis is full of vitamin c and aids strong bones and all pro cannabis users would believe it.

    It makes me sick.
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