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Try out PMC Labs and tell us what you think. Learn More. There have been several recent efforts in the UK and the Netherlands to describe the harms of psychoactive substances based on ratings of either experts or drug users. This study aimed to assess the perceived benefits as well as harms of widely used recreational drugs, both licit and illicit, in an international sample of drug users.
Residents reported their experience of 15 commonly used drugs or drug classes; regular users then rated their harms and benefits. In all, individuals from over 40 countries completed the survey, although the majority were from English speaking countries. Rankings of drugs differed across 10 of perceived benefits. Skunk and herbal cannabis were ranked consistently beneficial, whilst alcohol and tobacco fell below many classified drugs. Prescription analgesics, alcohol and tobacco were ranked within the top 10 most harmful drugs. These findings suggest that neither the UK nor US classification systems act to inform users of the harms of psychoactive substances.
It is hoped the might inform health professionals and educators of what are considered to be both the harms and benefits of psychoactive substances to young people. Worldwide alcohol causes 2. In the USA, the non-medical use of these drugs by 12 million people made them the second most common form of illicit drug use after cannabis in Substance Abuse and Mental Health Services Administration, Deaths from prescription analgesics in the USA are greater than those from heroin and cocaine combined, with rates tripling in the last 10 years Centre for Disease Control and Prevention,which is perhaps unsurprising given their much larger of consumers.
Cannabis has the highest prevalence of use followed by amphetamine, cocaine and heroin. Current approaches aimed at reducing illicit drug use include prohibition of supply, education and treatment. Most countries and international agencies such as the United Nations and World Health Organisationclassify drugs according to how dangerous or harmful they are.
For example, under the UK Misuse of Drugs Actdrugs are segregated into three classes A, B and C which are meant to i reflect their relative harms and ii determine the penalties for possessing and trafficking each drug. It has been argued that these systems have evolved in an unsystematic way according to social, political and historical concerns rather than being based on any scientific evidence.
Nutt et al. Subsequently we used the same harm matrix to survey over UK drug users and found ificant correlations between their harm rankings and those of Nutt et al. These findings were then replicated in the Netherlands, where a two-class classification systems is employed van Amsterdam et al. Once again alcohol and tobacco were rated to be highly harmful whilst cannabis, ecstasy and magic mushrooms were rated as relatively safe.
In response to doubts raised about the differential weighting and choice of criteria used, Nutt et al. Their supported their findings — again, there was no correlation between rated harms and UK ABC classification. A debate has ensued, with some disputing whether it is logically possible to rank drugs on any single dimension of harm Caulkins et al.
It is argued that no model would ever be perfect because ratings of harm to others and harms to self are neither objective nor measureable, as they will always be influenced by expertise and personal biases; indeed, Nutt et al. The latter authors further suggested that even perfect calculation of harm scores cannot determine how a new drug should be scheduled.
Scheduling systems are interrelated with some drugs being precursors to others, and thus it is difficult for them to be considered on a drug-by-drug basis. In addition the consequences of scheduling, changes depend on context of use of the drug; for example, alcohol is highly harmful to use whilst driving. Caulkins et al. However, although this process would be an interesting one to explore, it was deemed too lengthy and complex for an internet survey, and thus we adopted the Nutt et al.
Whilst drug harms may not be sufficient to determine policy Kalant, the belief that policies informed by science are better than those with no scientific basis at all has been expressed by several researchers e. Fischer and Kendall, ; Obot, ; Room and Lubman, The value of informing policy makers of the relative harm of drugs is not opposed even by critics Caulkins et al. As well as harms, however, recreational drugs have perceived benefits, otherwise they would not be used. There are a variety of historical and emerging beneficial uses of various compounds that are illicit substances; for example cannabis, once used as a sedative and anti-convulsant in the UK and US Walton,has recently been explored in its organic form and components as an analgesic, anti-emetic and appetite stimulant.
Renewed efforts have also been made to demonstrate the efficacy of illicit drugs as adjuncts to psychotherapy, either as psycholytics or psychedelics, with promising see Sessa, for a review. For example, in two small studies, MDMA has been found to be effective as an adjunct to exposure therapy for post-traumatic stress disorder PTSD and therapy-resistant anxiety disorders Johansen and Krebs, ; Mithoefer, ; Sessa, In addiction treatment with single dose of LSD, in the context of alcohol treatment programmes in the s and s, is associated with a decrease in alcohol misuse Krebs and Johansen,whilst ketamine has improved rates of abstinence in the treatment of heroin addicts Krupitsky et al.
A wide literature has detailed the benefits of recreational drugs to users e. Griffiths et al. However, only two studies to date have compared the potential benefits of illicit drugs to the harms Carhart-Harris and Nutt, ; Morgan et al. The latter assessed the perceived acute and long-term benefits of 21 substances in over drug users whilst the former compared the benefits of four types of substances in users. The current study aimed to provide a more comprehensive of the perceived benefits as well as harms of 18 psychoactive substances 11 illicit and seven legal.
As surveys have been limited to UK or the Netherlands, it also aimed to obtain an international sample of users with diverse cultural and legal approaches to psychoactive substances. A website was deed using Web II software and was distributed internationally via a link on Erowid in three optional languages English, Spanish and French. Participants were required to provide informed consent and confirm they were over 18 before entering the survey.
Withdrawal from the survey was permitted at any time using a button at the bottom of theand participants were informed that in this instance their data would not be saved. Psychoactive substance use was recorded first to establish which of the 18 drugs each participant would then be able to rate. Dexedrine, Ritalin ; Opiates: heroin, methadone, opium prescription analgesics were kept in their own separate group.
This was an unfortunate practical consideration to limit the length of the survey for respondents. Because of very low s of users less than 0. Poppers were not included in the analyses. Participants were asked to rate the harms associated with each drug on the basis of seven risk factors. Short-term physical risk: Participants were asked to think about how much short-term physical risk they thought was associated with taking a single dose of a drug.
Long-term physical risk: Participants were asked to rate how much long-term physical risk they thought would be associated with regular use each of the drugs. Risk to society: Participants were told that some drugs are seen to have a negative impact on society by damaging family relationships, damage to property, or through the cost of policing.
They were then asked to rate the level of risk to society which they thought each drug posed. Risk of bingeing: Participants were asked to rate the likelihood of bingeing. Bingeing means the tendency to repeatedly dose with a substance, and is an indicator of the dependence-forming properties of a drug, hence it presence as an indicator of harm.
Participants were asked to score each substance on a four-point scale, with 0 no risk, 1 some risk; 2 moderate risk and 3 extreme risk. The scores for these seven factors were averaged to give a mean harm score. Participants rated 10 benefits, defined below. Five benefits comprised multiple items. The of participants who rated a drug as having a particular benefit was calculated as a proportion of the total of participants who rated that drug. The survey was launched on Erowid on the 7 March and all data up until A total of individuals, worldwide, completed the online survey.
Their demographic data are displayed in Table 1. of participants who rated themselves as regular users of a drug and therefore rated their associated harms and benefits are reported in Table 2.
Table 3 presents mean harm ratings of drugs on the seven risk factors. Data for the overall mean harm ratings are presented in Figure 1. Percentages of participants reporting each of the 10 benefits are shown in Table 4 ranked from highest to lowest percentage. The mean percentage of participants rating each drug as a benefit compared with the mean harm rating of that substance is displayed in Figure 2.
C: herbal cannabis; Skunk. C: skunk cannabis; PPK: prescription painkillers prescription analgesics ; Benzo: benzodiazepines; Amphet: amphetamine; Mild stim: mild stimulants; N 2 O: nitrous oxide; Hallucin: hallucinogens. Comparison between mean percentage of participants rating each drug as a benefit and mean harm of drugs. First and second preference profiles for drugs were very different.
Skunk, prescription analgesics and opiates were rated highly as first-preference drugs, but were rated relatively low as second preferences. Alcohol, herbal cannabis and benzodiazepines showed the opposite pattern and were rated highly as second preference drugs but not as first preferences.
Ecstasy showed consistently high ratings across first and second preferences, whilst tobacco, nitrous oxide N 2 Oand hallucinogens were consistently ranked in the bottom 10 drugs. Percentage of participants reporting each drug as a first preference b second preference. Tobacco consistently had the highest percentage of participants who rated themselves as showing likelihood for abuse or dependence on the CAGE-AID Table 5. In terms of harms, there was a lack of any correlation between the rankings of nearly individuals and the rankings of drugs within either the US Schedules or the UK Misuse of Drugs Act.
The findings in terms of UK rankings concur with literature Nutt et al. Under US scheduling, the drugs rated as most harmful were either classed as Schedule II or not classified, whilst several of the drugs rated as least harmful are currently Schedule I. Similarly in the UK, two currently unclassified drugs — alcohol and tobacco — were rated in the top 10 most harmful drugs, whilst ecstasy and hallucinogens both Class A drugs were both rated relatively low on harms.
Both strains of cannabis were rated as the least harmful drugs despite their Class B status. High harm ratings appeared to be driven by perceived long-term physical risks, risk of bingeing and craving. As expected, alcohol was perceived as a particularly high risk to society and had the highest perceived risk of bingeing, whilst risk of injecting was associated predominantly with opiate use, perhaps unsurprisingly.
Although our division is somewhat arbitrary, overall, herbal and skunk cannabis, ecstasy and ketamine were rated as having low harms but high benefits, and tobacco was rated high on harms and low on benefits. Opiates, prescription analgesics and cocaine showed particularly high harms and benefits. In contrast with both UK and USA classification systems, skunk and herbal cannabis were rated as the least harmful drugs whilst ecstasy was rated as sixth least harmful.
These low harm scores were driven by particularly low perceived risk of dependence, risk to society and risk of injecting. Ketamine was ranked eighth overall in terms of harms, higher than the two types of cannabis and ecstasy, which appears to be a result of higher ratings on measures of craving, bingeing and long-term physical risk, concurrent with recent reports of dependence on ketamine Morgan and Curran, Cocaine showed consistently high rankings across all benefits but was rated as the third most harmful drug due to high perceived risk of bingeing, dependence and craving as well as long-term physical risk.
As with cocaine, perceived overall harm of prescription analgesics was also extremely high second most harmful.
Whilst these drugs shared some of the benefits and harms of prescription analgesics, they were less likely to be a drug of choice, which may be due to the higher risk of injecting and craving associated with this group. Benzodiazepines were rated as considerably less harmful than opiates; in this respect, the perceptions of these drugs concurs with their legal status. The high preference for prescription analgesics and benzodiazepines by regular users is a profile that has not been reported in any other study and may indicate a relatively unusual sample, or may reflect the recent trend towards prescription drug use in the US.
Whilst tobacco was ranked seventh in overall harms, this drug was unsurprisingly associated with high long-term physical risk and risk of reliance. Tobacco had the highest proportion of likely dependent users as classified by the CAGE. Amphetamines and alcohol were rated to be of medium benefit.
Alcohol was thought to be highly beneficial for sociability. It was ranked fifth in terms of harms, with particularly high risk to society and risk of bingeing.
Drugs that were rated as having low harms and low benefits were Viagra, hallucinogens, nitrous oxide and mild stimulants. The low beneficial rating of hallucinogens contradicts the findings of our prior UK drug survey Morgan et al. The USA scheduling system is based on the potential for abuse of each substance, hence one might expect it to be mirrored in the proportion of individuals scoring in the abuse range of the CAGE-AID for the different drugs included in this survey.
However, in the present study tobacco had the highest proportion of regular users showing possible abuse or dependence, followed by opiates, prescription analgesics, cocaine and alcohol.
Thus three drugs in the UK and two in the US which are currently unclassified produce the greatest likelihood of abuse or dependence, albeit on a crude scale. Indeed, in the case of prescription analgesics, opiates, cocaine and alcohol, the overall high harm ratings obtained tended to result from high risks of reliance and craving, whilst tobacco scored particularly high in terms of reliance. As an internet survey, it was not possible to verify that each respondent was unique, and the sample was inevitably self-selecting.
Of the nearly individuals who completed the survey, the majority were well educated, white, employed or studying. The survey was only translated into English, Spanish and French, and this may have reduced the of respondents from many countries where other languages predominate. At the same time, this is the first multi-language survey of drug users to date with the largest of respondents who were spread across 61 countries worldwide.
A further limitation of the current study is that the harms and benefits of polysubstance use, which is becoming the norm amongst the vast majority of drug users, were not addressed. This was beyond the scope of this study and it would be have been a complex task for drug users to rate the effects of multiple substances.
Further, research suggests that drug users are aware of the key effects of the drugs they take, even novel compounds such as mephedrone Carhart-Harris,despite being taken in combination with other substances. However, future work should aim to explore this interesting issue. Similarly, the study could not assess the context dependence of the benefits or harms or the benefits of the drug effects versus drug culture, for example the benefits of the sociable dance music culture that can occur around ecstasy use.Fun drugs to try
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