For many Halloween weekend revellers, yesterday's reports that 'alcohol is more dangerous
than crack or heroin' might seem like a farcical hangover from the weekend. Hundreds of thousands of people consumed alcoholic drinks this weekend. Are they more reckless with their lives than crack addicts or heroin users?

Published in The Lancet, Professor David Nutt has provided an apparently uncomplicated system for assessing the harm of various substances. Nutt uses a scale from 1-100, and seven criteria capturing harm to the individual and society, providing what the media presents as a simple ranking of substances. Whilst elegant simplicity is often the mark of scientific genius, there is always a risk of oversimplification.

The ranking that results from Nutt's methodology is insufficiently nuanced and does not jibe with our social and cultural intuitions. It also gives us no guidance in terms of a policy response. 

Alcohol causes such high levels of harm in large part due to its widespread use. However, millions of people have a healthy relationship with alcohol. Alcohol may cause more aggregate harm, but it is not as dangerous as heroin or crack because people are capable of enjoying alcohol in moderation.

It also seems perverse to say that cigarettes are definitively 'more harmful' than cannabis.  It is clear that cigarettes cause staggering levels of harm through diseases like emphysema or lung cancer, which are a significant burden on the public health service. However, these harms often come at the end of one’s life.

Heavy cannabis use in the teenage years, on the other hand, can have a significant adverse impact on brain development. Smoking twenty cigarettes a day is less likely to alter aspirations, for example, going to university, than smoking five cannabis cigarettes a day. Which of these is more harmful is debatable. This is a point recognised by Nutt et al., by arguing that the weighting system for harms is determined through collective discussion and decision-making.

Despite this, the total harm index that places alcohol above heroin and cocaine in terms of harmfulness gives no guidance in terms of a policy response.

As the substance that causes most harm, should Government control alcohol through the Misuse of Drugs Act – effectively banning possession, distribution and supply? Or conversely, should heroin and cocaine now become legally regulated and supplied substances like alcohol? Nutt's classification system obscures and confuses here more than it enlightens.

Despite these flaws, the report does make a significant point. That is, alcohol and cigarettes can be just as harmful as other substances currently controlled by the Misuse of Drugs Act. So, if the act's classification system is meant to convey the relative dangers of substances, failure to include alcohol and cigarettes is a deeply confusing public health message.

If our concern is harm why blatantly ignore substances like alcohol and tobacco?  As one member of the Drug Equality Alliance told me, this is effectively the drug policy equivalent of ‘separate, but equal’ which was used to justify segregation. 

Nutt is right that the Misuse of Drugs Act is past its sell-by date. But his simplified harm index does little to illuminate what is needed to replace it.

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