The Australian drug harms ranking study

Abstract

Background/Aim: The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jurisdictions. Method: A facilitated workshop with 25 experts from across Australia, was held to score 22 drugs on 16 criteria: 9 related to harms that a drug produces in the individual and 7 to harms to others. Participants were guided by facilitators through the methodology and principles of MCDA. In open discussion, each drug was scored on each criterion. The criteria were then weighted using a process of swing weighting. Scoring was captured in MCDA software tool. Results: MCDA modelling showed the most harmful substances to users were fentanyls (part score 50), heroin (part score 45) and crystal methamphetamine (part score 42). The most harmful substances to others were alcohol (part score 41), crystal methamphetamine (part score 24) and cigarettes/tobacco (part score 14). Overall, alcohol was the most harmful drug when harm to users and harm to others was combined. A supplementary analysis took into consideration the prevalence of each substance in Australia. Alcohol was again ranked the most harmful substance overall, followed by cigarettes, crystal methamphetamine, cannabis, heroin and pharmaceutical opioids. Conclusions: The results of this study make an important contribution to the emerging international picture of drug harms. They highlight the persistent and pervasive harms caused by alcohol. Policy implications and recommendations are discussed. Policies to reduce harm from alcohol and methamphetamine should be a priority.

Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others–A Perspective of German Addiction Medicine Experts

“…Our data corroborate the situation in many other countries (5)(6)(7)(8)(9)(10) of discordance between expert harm rankings of popular drugs of abuse and their regulation by narcotic laws, as evidenced most strikingly by the assessment of alcohol-judged to be among the most harmful substances abused in our country. The relatively high prevalence of alcohol use/abuse (compared to that of less-frequently abused but perhaps more dangerous substances) likely contributes to its dimension-specific ratings, e.g., harm to others, as well as to its overall position.…”

“…However, such modus operandi is not unusual for studies of this kind (5). Other limitations, similar to previous studies (5)(6)(7)(8)(9)(10) include the fact that the present work cannot claim to meet strict requirements for representativeness. We aimed to reduce subjectivity biases by recruiting a large and homogeneous study group (all physicians specializing in addiction medicine).…”

“…While this additional step may have increased the likelihood of survey participants' agreement (42), we decided against this course, because consensus-based decisions per se do not eliminate subjectivity (43) and there exists no "one-size-fits-all-method" for benefit-risk assessment (44). Furthermore, prior consensusbased studies utilized smaller samples comprising addiction experts from different professions (5,9,10), whose heterogeneity of experiences in the treatment of SUD more likely needed a consensus-based decision strategy than did our homogeneous group. Similar to the Netherlands (6), the Scottish (7), and the French research groups (8) we performed an "ad-hoc" assessment, using validated health and social dimensions, which have been utilized in previous (5,10) and recent (9) empirical studies.…”

“…Over the past 15 years, the relative health and social harms potential of various addictive substances has been determined in England (5), the Netherlands (6), Scotland (7), France (8), and most recently in Australia (9) by medical and non-medical addiction experts. The average overall harm of various substances is usually reported in relative rankings, based upon multidecision analyses (5,9) or relying on "ad-hoc" assessments (6-8) using validated health and social dimensions (5). These rankings do not necessarily display congruence with legislative and law enforcement priorities in terms of relative regulation and control of substances, with alcohol being a prime example of dissonance between overall harms and control efforts (5)(6)(7)(8)(9).…”

“…The average overall harm of various substances is usually reported in relative rankings, based upon multidecision analyses (5,9) or relying on "ad-hoc" assessments (6-8) using validated health and social dimensions (5). These rankings do not necessarily display congruence with legislative and law enforcement priorities in terms of relative regulation and control of substances, with alcohol being a prime example of dissonance between overall harms and control efforts (5)(6)(7)(8)(9). Nutt et al were the first to demonstrate this incongruity (5).…”