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Is alcohol more dangerous than ecstasy?
by Julia Layton

March 27, 2007
Scientists in Britain are proposing a complete revamping of drug classifications in the wake of findings that reveal some major discrepancies between a drug's legality and its safeness. A study surveying health, crime and science professionals regarding the dangers of a set of 20 legal and illegal drugs, published in The Lancet in March 2007, found that alcohol and tobacco, which are legal in Britain and the United States, are considered by experts to be more dangerous than ecstasy and marijuana, which are illegal in both countries.

In Britain, under the Misuse of Drugs Act, illegal drugs (including prescription drugs sold on the street) are classified as A, B or C. Class A is supposed to be the most harmful, and Class C is supposed to be the least harmful. For instance, heroin is a class A drug, and marijuana is a class C drug. The study was intended to achieve harm rankings for 20 drugs, 15 illegal substances and five legal substances that have shown potential for harm, using a systematic, scientific approach. The researchers surveyed two separate groups of experts including medical doctors, mental health professionals, scientists and forensics experts. Each group returned similar ranking results for the 20 drugs based on three primary features:

physical harm to the person using the drug
the drug's potential for abuse and/or dependence
the drug's ill effects on society
The results, shown below, revealed some apparent inconsistencies in Britain's drug-classification system.
Drug Study Ranking Legal Classification
Heroin 1
(most harmful) A
Cocaine 2 A
Barbiturates
(sedatives) 3 B
Methadone
(opioid) 4 A
Alcohol 5 legal
Ketamine
(anesthetic) 6 C
Benzodiazepines
(sedatives) 7 C
Amphetamine
("speed") 8 B
Tobacco 9 legal
Buprenorphine
(opioid) 10 C
Cannabis 11 C
Solvents 12 legal
4-methylthioamphetamine
(amphetamine derivative) 13 A
LSD 14 A
Methylphenidate
(i.e. Ritalin®) 15 B
Anabolic steroids 16 C
Gamma 4-hydroxybutyric acid
(depressant, "date-rape drug") 17 C
Ecstasy 18 A
Alkyl nitrites
(nitrite inhalants, "poppers") 19 legal
Khat
(plant-derived stimulant) 20
(least harmful) legal

Probably the most notable discrepancy is the position of alcohol, a legal drug, at 13 places above ecstasy, an illegal, class A drug. And LSD, also a class A drug, was ranked considerably less harmful than benzodiazepines, a class C group of drugs.

The results seem to call into question exactly which method the British government is using to determine the relative harmfulness of drugs. According to the authors of the study, "Tobacco and alcohol together account for about 90 percent of all drug-related deaths in the U.K." Yet both of those substances are legal. In the United States, a study published in the journal of the American Medical Association in 2000 shows that 95 percent of drug-related deaths in the United States are from alcohol and tobacco use.

With little documentation that attempts to explain the current governmental ranking criteria, the study proposes a method for classifying drugs that uses scientific assessment. The classifications would be based on the three indicators of harm as presented to experts in the study -- personal, physical harm; abuse/dependence potential; and social harm. In the study, the rankings for each of the criterion were combined, with the researchers taking the mean of the three scores, to obtain the overall rankings listed above.

Of course, the legal status of drugs like alcohol and tobacco skews the results. Their legal status makes them far more available, so an accurate side-by-side comparison with a drug like heroin on all three criteria is impossible. Availability will always affect social effects of any given drug. Drugs that are easily available, legal and non-stigmatized logically will result in more widespread use, more adverse reactions and more money spent on police assistance and/or hospital care as a result of those adverse reactions.

Still, availability most likely wouldn't skew the abuse potential or the personal, physical harm associated with a drug. So the study does at least reveal some possible inconsistencies in British (and U.S.) drug law. Ultimately, the researchers believe that the foundations of drug policy need to be more transparent, since those foundations effect everything from public education to criminal sentences to treatment programs to methods of control and enforcement. They point out that without a clear, scientific basis for determining a drug's legal status and harmfulness, it's hard to establish credibility in the policies that dictate how a "drug war" is carried out, and it's hard to determine how effective those policies really are.