Experienced drug users assess the relative harms and benefits of drugs: a web-based survey

This survey study (n=93) investigated the subjective harms and benefits of eleven drugs as reported by experienced drug users. Alcohol and tobacco were ranked as the most harmful, MDMA, LSD, and psilocybin as some of the least harmful drugs.

Abstract

“A web-based survey was used to consult the opinions of experienced drug users on matters related to drug harms. We identified a rare sample of 93 drug users with personal experience with 11 different illicit drugs that are widely used in the UK. Asked to assess the relative harms of these drugs, they ranked alcohol and tobacco as the most harmful, and three “Class A” drugs (MDMA, LSD, and psilocybin) and one class B (cannabis) were ranked as the four least harmful drugs. When asked to assess the relative potential for benefit of the 11 drugs, MDMA, LSD, psilocybin, and cannabis were ranked in the top four; and when asked why these drugs are beneficial, rather than simply report hedonic properties, they referred to potential therapeutic applications (e.g., as tools to assist psychotherapy). These results provide a useful insight into the opinions of experienced drug users on a subject about which they have a rare and intimate knowledge.”

Authors: Robin L. Carhart-Harris & David J. Nutt

Summary

Introduction

In 2007, Nutt and colleagues opened a debate on the scientific validity of classification systems of drugs of potential misuse. The results showed that the assessments of two independent groups were similar to those of psychiatrists, but different from those implied by current classification systems.

A recent study in The Netherlands used similar harm parameters to Nutt and colleagues (2010) and rated 19 different drugs. The results correlated significantly with those of Nutt and colleagues (2007).

Nutt et al. (2010) used multicriteria decision analysis to improve their assessment of 2007 and found that their results correlated with those of van Amsterdam and van den Brink (2010).

Morgan et al. (2010) asked drug users to rate the harms of 21 different drugs using the matrix of harm introduced by Nutt et al. (2007). The results showed that drug users’ ratings correlated significantly with those of Nutt et al. (2007).

To develop the approach of consulting drug users, 93 highly experienced drug users were asked to rank the relative benefits and harms of 11 illicit drugs, including alcohol and tobacco, and to express an opinion on how each drug should be classified according to the Misuse of Drugs Act.

Methods

This study was approved by the Imperial College Research Ethics Committee and involved collecting opinions from experienced users of heroin, cocaine, amphetamine, cannabis, GHB, magic mushrooms, ketamine, benzodiazepines, mephedrone, MDMA, and LSD.

Results

Demographic Data

Ninety-three individuals took part in the survey, of which forty-three percent had heard about it through http://www.bluelight. org, 27% had heard about it through http://www.drugs-forum.com, and 30% had either heard about the survey through a friend or through other websites.

Respondents were asked to rank drugs according to their harm/benefit. The mean classification is given in brackets.

Potential Harms

Thirty-two respondents ranked alcohol as having the most potential for harm, fifteen ranked tobacco as having the most potential for harm, and 26 ranked heroin as having the greatest potential for harm.

Potential Benefits

Respondents’ rankings of benefits correlated significantly with those of Morgan et al., both with respect to acute (Rho = .83, p = .002) and chronic benefits. MDMA, cannabis, LSD, magic mushrooms, and benzodiazepines were ranked as having the greatest potential for benefit.

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In addition to assessing the relative harms and benefits of different drugs, respondents also offered opinions on how each drug should be classified. There was no correlation between chosen classification and rankings of harms.

Respondents’ Rankings Correlated Significantly withThose of Previous Assessments

Significant positive correlations were found between the results of the present study and five similar previous analyses, suggesting that there is a developing consensus on the relative harms of drugs among experienced drug users.

Users’ Perceptions of Different Sources of Information on Drugs

Ninety-three percent of respondents ranked their own experiences as the most influential source of information on drugs, followed by their friends’ experiences.

Discussion

This study asked 93 experienced drug users about the relative harms and benefits of 13 different drugs of abuse. The results contrasted with the current legal classifications of these drugs, and provided new information on why drug users regard certain drugs to be harmful and others beneficial.

The survey invited respondents to express their opinions on how each drug should be classified according to the UK’s Misuse of Drugs Act. Although most respondents thought alcohol and tobacco should be classified as illegal, their chosen classifications did not reflect this.

The survey revealed that users prioritize their own experiences and those of their friends over other potential sources of information on drugs.

Limitations

This study has some important limitations. It is worth considering engaging the opinion of drug users on the harms of drugs, and consulting their opinions on what assessment parameters should be included and how they should be weighted.

The sample was dominated by males, and it is possible that some proclaimed “drug experts” are also experienced drug users. It is also impossible to verify the accuracy of respondents’ claims.

In conclusion, this study supports the view that certain drugs pose a low potential for harm, while alcohol and tobacco pose a high potential for harm.