A study published last Friday in the prestigious British medical journal The Lancet has called for drugs -- licit and illicit -- to be classified by the harm they do rather than the artificial divisions embodied in Britain's Misuse of Drugs Act. With the US Controlled Substances Act set up in a very similar fashion, the study speaks to US drug policy as well.

The study, Development of a Rational Scale to Assess the Harms of Drugs of Potential Misuse, also sought to arrive at a science-based assessment of the comparative harms of various substances, both licit and illicit. The results will be surprising only to those who rely on the mass media for their drug knowledge.

The British researchers, led by Dr. David Nutt, professor of psychopharmacology at the University of Bristol, and Dr. Colin Blackmore, professor of physiology, anatomy and genetics at Oxford University, assessed the potential harms of the different drugs on three different scales: the physical harm to the user caused by the drug, the tendency of the drug to induce dependence, and the deleterious effects of drug use on families, community, and society.

When weighed on the basis of harm caused, the researchers found both alcohol and tobacco to be more harmful than marijuana or ecstasy. Heroin and cocaine topped the list as most harmful, followed by barbiturates, street methadone, and alcohol. Of the 20 substances evaluated, marijuana came in 11th, just behind the heroin substitute buprenorphine and just ahead of solvents. Interestingly, LSD and ecstasy both scored very low on the harm scale, coming in at 14th and 18th places, respectively. The mild Middle Eastern stimulant khat was scored as the least harmful of the substances evaluated.

The researchers noted that the rankings by harm had little relation to the way substances were classified in the United Kingdom. While both LSD and ecstasy, for example, were found to be low in harm, they are classified as Class A drugs in Britain -- the most serious classification. Similarly, alcohol and tobacco, while ranking relatively high on the harm scale, remain legal substances.

The situation is similar with the US Controlled Substances Act (CSA). Under the CSA, marijuana, LSD, khat, and ecstasy are all Schedule I drugs, a designation they share with the much more harmful drugs heroin and cocaine. US drug law designates these soft drugs as more dangerous than drugs like barbiturates and amphetamines, which are Schedule II drugs, although the latter rank much higher on the Lancet's harmfulness scale.

Such mis-scheduling is a problem, said the researchers. "Drug policy is primarily aimed at reducing the harm to individual users, their families and society," said Dr. Blakemore in a statement accompanying the release of the study. "But at present there is no rational, evidence-based method for assessing the harm of drugs. We have tried to develop such a method. We hope that policy makers will take note of the fact that the resulting ranking of drugs differs substantially from their classification in the Misuse of Drugs Act and that alcohol and tobacco are judged more harmful than many illegal substances."

"Drug misuse and abuse are major health problems," said Dr. Nutt. "Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse."

While US drug reform activists generally lauded the study and its conclusions, they raised concerns about the ranking of marijuana squarely in the middle in terms of harms.
"It does seem eminently reasonable as we look at marijuana laws that we start from the well-documented fact that marijuana is safer than alcohol and tobacco," said Bruce Mirken, communications director for the Marijuana Policy Project (MPP). "That being the case, our current laws, both in the US and Britain, would appear to make very little sense. The very concept that laws about drugs should bear some relationship to the actual dangers of the drugs is downright enlightening," he told Drug War Chronicle.

Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws (NORML), welcomed the findings, but also raised concern about marijuana's ranking. "They've paved the way toward a better understanding of drug scheduling," he told the Chronicle. "At the very least, this should start the inversion process of pushing cannabis to where it should be on the drug schedules."

And where would that be? "We need to acknowledge that marijuana, alcohol, caffeine, and tobacco are all soft drugs," he said. "Anything above that would need scheduling or some sort of regulation on the substance."

The Lancet study's authors would disagree slightly. In their discussion of science-based drug scheduling, while they note there are no sharp break points on the relative harm scale, they suggest that even a three-tiered system like that now in place in Britain could be more equitably arranged. "If a three-category classification were to be retained," they wrote, "one possible interpretation of our findings is that drugs with harm scores equal to that of alcohol and above might be class A, cannabis and those below might be class C, and drugs in between might be class B. In that case, it is salutary to see that alcohol and tobacco -- the most widely used unclassified substances -- would have harm ratings comparable with class A and B illegal drugs, respectively."

Marijuana's ranking as more harmful than drugs like LSD and ecstasy grated somewhat on the marijuana movement spokesmen. "They ranked it pretty high for dependency, but marijuana dependency tends to be pretty mild," said MPP's Mirken. "You could make the case that dependence on a drug that isn't that harmful isn't as damaging as dependence on one that is more harmful. I don't know that these researchers made that distinction."

"They gave a little too much weight to the social harm they ascribe to cannabis and, more notably, the intoxication level," said NORML's St. Pierre. "They rank it as slightly more intoxicating than LSD, but smoking cannabis in even its most potent form can hardly be compared to a six-hour LSD experience. I suspect that the Lancet editors are giving too much deference to the notion that cannabis is now as powerful as those other drugs."

"I may have some quibbles with their methodology, but this is a reasonable step, and it's more than we're capable of in the US," said Mirken. "When you're crawling and others are walking, you don't criticize them for not running a four-minute mile."