How Dangerous Are Drugs, Really?

By Nat Eliason in Health

Junior year of high school I had my first drink of alcohol and realized I’d been lied to for four years.

When you start going through “health” classes in middle school, you eventually learn about alcohol and all of the reasons you shouldn’t drink it.

“You could die!”

“You’ll get in trouble!”

“It destroys your brain!”

These messages had left me wondering, as I imagine they did to most kids, why anyone would drink alcohol in the first place. I’m fairly sure I didn’t miss a powerpoint presentation or poorly acted VHS video explaining that being drunk or tipsy feels awesome and that’s why people drink. The education completely glossed over the “hey this feels good, so be careful” part.

And it wasn’t just alcohol, that messaging was the same for every other form of drug, legal or not. Don’t do it, it’s terrible for you, if you do it you’ll die, etc.

‍Thank you, Pawlings School District, for the helpful graphic

It’s similar to old forms of sex education. Most schools today aren’t so naive as to teach abstinence-only anymore. They realize that sex is going to happen anyway, so they focus on how to have sex safely and not get infected with a virus or baby.

But drugs aren’t there yet. Despite knowing that most kids will at least drink or try marijuana, schools still lump all drugs together and make you believe that they’re all horrible for you, you should never do them, if you do them you’ll wind up strung out and dead on the street, and so on.

It’s not limited to what we hear in school, too. Most people are hilariously uneducated about drugs, treating them all as horrible scary things, mostly basing their opinions on the ridiculous belief that “well, if it’s not legal, it must be bad.”

The recent surge in popular opinion in favor of marijuana shows that the tide is turning a bit, but there’s still confusion on how bad different drugs really are. If we strip away what’s legal and what isn’t and get down to the root of it, how bad are different drugs really?

How Bad Are Drugs

Alright, before we dive in, the disclaimer. I’m not a doctor, I’m not giving you medical advice, and I’m not suggesting you do any of these drugs. Many are illegal in most parts of the world, and whether or not those laws should exist, they do. I am only trying to decomplicate the topic by providing my interpretations of research that I found. If you do anything stupid and die I’ll be very sad, so please don’t do that.

My interest in this topic came up in high school when, in response to my incredulity that he was trying it, my friend told me “Molly (MDMA, Ecstacy, etc.) isn’t that bad for you.”

That statement simply didn’t compute in my brain at the time. I wondered, “How could this “drug,” not be that bad for you? And how could someone so well educated and otherwise intelligent do something so bad for them?”

So, I did some research. A few Google searches later, I stumbled upon a study that sought to create a scale to assess the potential harms of drug misuse. The result of the study was a pretty little chart I’m about to show you, but before I do, I want you to quiz yourself.

Here’s the chart, and I’ve hidden all the drug names except for Heroin, the golden standard for destructive drugs, and Khat, a plant from Africa that you can chew to get high. Now, where do you think Alcohol is? What about Tobacco? And how about drugs like LSD, MDMA, and Cannabis?

Now, that only compares potential harm with potential addiction. What about total harm to yourself and to others? Here’s that graph, pulled from an article on The Economist.

One last one. This compares the dependence potential of different drugs, with how close you get to the “lethal dose” from regular doses. It gives a rough idea of how likely you are to accidentally kill yourself or seriously harm yourself with a drug.

Now, try to keep in your head where you think alcohol, tobacco, LSD, MDMA, and cannabis are before you see the real graphs. Ready?

Here’s the unveiled harmfulness comparisons:

Here’s the unveiled self-harm + other harm:

And here’s the unveiled dependence vs. potential lethal dose:

Does anything stand out to you? Here’s what blew me away the first time I saw these:

Surprise 1: Alcohol is Worse for You Than Tobacco

Comparing unit for unit, (say, one drink for one smoke), alcohol does more physical harm to you, has a higher risk of accidental overdose, and does more harm to other people. If we were going to outlaw drinking or smoking, outlawing drinking would clearly be the bigger boon to society.

The reason you don’t think of people dying from drinking as much as from smoking is that it’s much harder to have 20 drinks a day and still be a functioning member of society. But you can easily smoke 20 cigarettes a day. So while alcohol does more damage, there’s more of a natural resistance to doing it all the time. Also, cigarettes are more addictive, so people feel more compelled to have them more frequently.

Why are we so much more critical of people who smoke, though? Why isn’t casual smoking acceptable?

I think the criticism comes mostly from secondhand smoke since that’s bad for you, but you’re significantly more likely to die from someone drinking than someone smoking. You just don’t feel the little influences of drinking the same way you do with second-hand smoke. You either get killed by a drunk driver late at night, or you don’t.

Surprise 2: LSD and Mushrooms are Two of the Safest Drugs

This one really blew me away. For some reason, I always believed that mushrooms and LSD, especially LSD, were terrible for you. I thought they rotted your brain, were highly addictive, stayed in your body forever, and were much worse for you than alcohol.

That’s clearly not the case, though. Both have extremely low chances of dependence, cause little physical harm, have no chance of overdose, and do no damage to people beyond the user. If, in 30 years, I for some reason had to choose between my daughter having a small dose of LSD every day or a small dose of alcohol, I’d have to go with the LSD.

Now, there’s certainly the potential for a bad trip on both, and that’s not a psychological swamp that anyone wants to end up in, but even that isn’t limited to psychedelics. How many times has one of your friends turned into a depressed mess when they’re drunk? That’s a bad trip too.

Surprise 3: MDMA and Ecstasy Aren’t Particularly Bad Either

The next surprise was that MDMA and Ecstasy (which is made from MDMA), the party drugs that flood your brain with serotonin, aren’t particularly dangerous either. Compared to alcohol and tobacco they do less physical harm and they’re less addictive.

Now that said, there is an indication that continual use of MDMA can lead to serotonin down-regulation and depression, so it’s not harmless. But continual use of alcohol and tobacco have their problems too. It’s clearly not the hard, terrible drug it’s made out to be.

Surprise 4: Cannabis isn’t Perfect

Despite what many pro-cannabis advocates are saying, it’s not some perfect miracle drug with no harms. It still does damage, but clearly less than alcohol and tobacco.

What’s more surprising to me here is that it does seem to do more harm and be more addictive than the psychedelics, which makes me wonder why we aren’t legalizing those first.

Alright, we have a better baseline understanding of how relatively bad each drug is, but I think we can do better.

Creating a Better Assessment of Drug Harm

One issue with the data as it has been presented so far is that we’re comparing based on two different “harm” variables, the long-term harm, and the chance for an accidental overdose.

To understand just how bad each drug is relative to each other, let’s create a new harm measure by combining them. This gives us an idea of how dangerous it is to mess with a given drug, based on the long term damage that it could cause, as well as your chance of overdosing in any particular session. This combination of harm variables is worthwhile since a drug like cocaine isn’t that likely to kill you in a single session, but it’ll definitely fuck you up long term. Conversely, alcohol won’t do as much damage long term, but an overly indulgent night of drinking could land you in the hospital or morgue.

You can follow along with my calculations on my spreadsheet here.

First, I took the lines from the recreated relative harm graph and used their length in pixels as a rough number for relative harm (this is all supposed to be relative, there’s no good objective measure for total harm).

Then I took the Active:Lethal Dose measurements from the chart above, and multiplied them by 1000 to get them on the same scale (note, this doesn’t change their usefulness, since we’re looking for relative rankings here). This gives us two ratings, a relative harm rating, and an active to lethal dose rating.

Then, I used the recreated harm to dependency graph to get a rough number for how high of a dependence rating the different drugs have. If you’re wondering where the Y values came from, it was the distance in pixels up the graph.

Next, I took the relative harm and the active lethal dose, plotted them on an imaginary graph and calculated all of their hypotenuses.

This way, a drug with low long term harm but a high potential for accidental overdose is ranked about the same as one with high long-term harm, but a low potential for overdose.

Now we can plot our dependence and total damage numbers to get a more accurate graph for assessing risk among drugs.

They’re a little messy to plot now, though, since they don’t have any relationship to each other and are just meant to give us relative rankings. So let’s put them back on the 0-3 scale from before. If we assume that Heroin is a perfect “3” for damage and dependence, then we can divide its dependence and damage by 3 to get the number to divide the rest by in order to create a 0-3 scale for both numbers.

This gives us two nice graphs. One where we can compare the stacked dependence and damage:

And another one similar to our first graph, with the bubbles representing their relative placement.

And by using those, we can create a more rational mental model for assessing just bad each drug really is relative to others.

Takeaways

From doing this research and distilling it down to these graphs, I’ve come to a few conclusions.

There’s no relationship between legality and danger

Alcohol and tobacco are squarely in the middle of the graph. There are illegal drugs that are significantly safer and illegal drugs that are significantly less safe. Whether or not a substance is legal for recreational use is not a good indicator of its safety.

There’s a big difference between “doing a drug” and “overdosing”

When people think about the dangers of most drugs, it’s usually the overdosing part. A single session of just about any drug isn’t going to do much long-term damage, if any. An overdose will.

With alcohol, we recognize that there’s a difference between having a drink and going on a bender, but we forget that those distinctions exist for every drug.

You could have a bit of weed to relax after dinner, have a cigarette after sex, take some mushrooms and go hiking, do a bit of cocaine before a party, take amphetamine before working (adderall). These are all essentially the same thing. Some are slightly more damaging than others, but everything can be done at a low dose, except heroin and maybe meth.

We should respect the dangers of alcohol more

I’ve always been scared of overdosing on drugs and winding up in the hospital or dead. But the chances of that happening are higher with alcohol than just about anything else.

Here’s the thing, you’ve probably seen someone overdose on alcohol. In college, I saw at least half a dozen people get carted away to the hospital to have their stomachs pumped, but we don’t think of that as “overdosing” the same way we do with other drugs. Why not?

We have to recalibrate how we think about drugs in one of two ways:

  1. We can say that alcohol is not that dangerous and can be consumed moderately, in which case everything below and to the left of it is just as safe.
  2. Or, we have to say that alcohol is more dangerous than we give it credit for, and if we’re going to treat MDMA and LSD as “dangerous drugs” then we should be concerned about alcohol too.

I fall somewhere in the middle. I think alcohol is more dangerous than we give it credit for, but that we also need to chill out about practically everything else. There’s no reason to react differently to “have a bit of mushrooms,” and “have a couple drinks.” We just need to get the laws changed.

It’s Not Black and White; We Need to Calibrate Rationally

The most important takeaway, though, is that drug risk is not black and white. It’s easy to teach it that way, and most people treat it that way, but aside from the legal/illegal differentiation, there is no good binary measure of what’s safe and what’s dangerous.

Having a dozen Oreos once in a blue moon won’t kill you, but if you do that every day you’re going to kick the bucket early. The same seems to be true for many of the drugs that we talk about being terrible, scary things. But we don’t realize that until we unlearn some of the initial education, and create a more rational assessment of how dangerous everything really is.

Should you do any drug, including alcohol, daily? No. But if you want to indulge every now and then depending on the relative harm of what you’re doing, you’re probably going to be fine.

P.S. Once again, I’m not a doctor, or medical professional, and this is not advice. Be smart.

Sources:

Footnotes

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