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. 2010 Nov 6;376(9752):1558-65.
doi: 10.1016/S0140-6736(10)61462-6. Epub 2010 Oct 29.

Drug Harms in the UK: A Multicriteria Decision Analysis

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Drug Harms in the UK: A Multicriteria Decision Analysis

David J Nutt et al. Lancet. .

Abstract

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.

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 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).

Comment in

  • Ranking of drugs: a more balanced risk-assessment.
    van Amsterdam J, van den Brink W. van Amsterdam J, et al. Lancet. 2010 Nov 6;376(9752):1524-5. doi: 10.1016/S0140-6736(10)62000-4. Epub 2010 Oct 29. Lancet. 2010. PMID: 21036391 No abstract available.
  • Drugs and harm to society.
    Peto R, Boreham J. Peto R, et al. Lancet. 2011 Feb 12;377(9765):551-2; author reply 555. doi: 10.1016/S0140-6736(11)60193-1. Lancet. 2011. PMID: 21315936 No abstract available.
  • Drugs and harm to society.
    Britton J, McNeill A, Arnott D, West R, Godfrey C. Britton J, et al. Lancet. 2011 Feb 12;377(9765):551; author reply 555. doi: 10.1016/S0140-6736(11)60192-X. Lancet. 2011. PMID: 21315937 No abstract available.
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    Claridge LC. Claridge LC. Lancet. 2011 Feb 12;377(9765):552; author reply 555. doi: 10.1016/S0140-6736(11)60194-3. Lancet. 2011. PMID: 21315938 No abstract available.
  • Drugs and harm to society.
    Bird SM. Bird SM. Lancet. 2011 Feb 12;377(9765):552-3; author reply 555. doi: 10.1016/S0140-6736(11)60195-5. Lancet. 2011. PMID: 21315939 No abstract available.
  • Drugs and harm to society.
    Viskaduraki M, Mamuneas D. Viskaduraki M, et al. Lancet. 2011 Feb 12;377(9765):553-4; author reply 555. doi: 10.1016/S0140-6736(11)60196-7. Lancet. 2011. PMID: 21315940 No abstract available.
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    Hewstone M. Hewstone M. Lancet. 2011 Feb 12;377(9765):554; author reply 555. doi: 10.1016/S0140-6736(11)60197-9. Lancet. 2011. PMID: 21315941 No abstract available.
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    Hawkey C, Rhodes J, Gilmore I, Sheron N. Hawkey C, et al. Lancet. 2011 Feb 12;377(9765):554; author reply 555. doi: 10.1016/S0140-6736(11)60198-0. Lancet. 2011. PMID: 21315942 No abstract available.
  • Questioning the method and utility of ranking drug harms in drug policy.
    Rolles S, Measham F. Rolles S, et al. Int J Drug Policy. 2011 Jul;22(4):243-6. doi: 10.1016/j.drugpo.2011.04.004. Epub 2011 Jun 8. Int J Drug Policy. 2011. PMID: 21652195

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