Elsevier

The Lancet

Volume 376, Issue 9752, 6–12 November 2010, Pages 1558-1565
The Lancet

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Drug harms in the UK: a multicriteria decision analysis

https://doi.org/10.1016/S0140-6736(10)61462-6Get rights and content

Summary

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).

Introduction

Drugs including alcohol and tobacco products are a major cause of harms to individuals and society. For this reason, some drugs are scheduled under the United Nations 1961 Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances. These controls are represented in UK domestic legislation by the 1971 Misuse of Drugs Act (as amended). Other drugs, notably alcohol and tobacco, are regulated by taxation, sales, and restrictions on the age of purchase. Newly available drugs such as mephedrone (4-methylmethcathinone) have recently been made illegal in the UK on the basis of concerns about their harms, and the law on other drugs, particularly cannabis, has been toughened because of similar concerns.

To provide better guidance to policy makers in health, policing, and social care, the harms that drugs cause need to be properly assessed. This task is not easy because of the wide range of ways in which drugs can cause harm. An attempt to do this assessment engaged experts to score each drug according to nine criteria of harm, ranging from the intrinsic harms of the drugs to social and health-care costs.1 This analysis provoked major interest and public debate, although it raised concerns about the choice of the nine criteria and the absence of any differential weighting of them.2

To rectify these drawbacks we undertook a review of drug harms with the multicriteria decision analysis (MCDA) approach.3 This technology has been used successfully to lend support to decision makers facing complex issues characterised by many, conflicting objectives—eg, appraisal of policies for disposal of nuclear waste.4 In June, 2010, we developed the multicriteria model during a decision conference,5 which is a facilitated workshop attended by key players, experts, and specialists who work together to create the model and provide the data and judgment inputs.

Section snippets

Study design

The analysis was undertaken in a two-stage process. The choice of harm criteria was made during a special meeting in 2009 of the UK Advisory Council on the Misuse of Drugs (ACMD), which was convened for this purpose. At this meeting, from first principles and with the MCDA approach, members identified 16 harm criteria (figure 1). Nine relate to the harms that a drug produces in the individual and seven to the harms to others both in the UK and overseas. These harms are clustered into five

Results

Figure 1 shows the 16 identified harm criteria. Figure 2 shows the total harm score for all the drugs and the part-score contributions to the total from the subgroups of harms to users and harms to others. The most harmful drugs to users were heroin (part score 34), crack cocaine (37), and metamfetamine (32), whereas the most harmful to others were alcohol (46), crack cocaine (17), and heroin (21). When the two part-scores were combined, alcohol was the most harmful drug followed by heroin and

Discussion

The results from this MCDA analysis show the harms of a range of drugs in the UK. Our findings lend support to the conclusions of the earlier nine-criteria analysis undertaken by UK experts1 and the output of the Dutch addiction medicine expert group.8 The Pearson correlation coefficient between Nutt and colleagues' 2007 study1 and the new analysis presented here for the 15 drugs common to both studies is 0·70. One reason for a less-than-perfect correlation is that the scores from Nutt and

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