File talk:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg

Suggesting to put this tag to the file (whatever obscure wiki politics you have, people have been misrepresenting stuff 'by accident' and that doesn't need to be so):

See wikicommons for more discussions. C0NPAQ (talk) 16:38, 17 February 2014 (UTC)

Here's just a few facts that show how inaccurate this chart is
Heroin, by itself, with no other CNS depressants in the system, is very hard to overdose on and die from - it would take something like 10-50 times the recreational dose to get close to dying.

Benzodiazepines, by themselves, are almost impossible to overdose on and die from - assuming there are no other CNS depressants in the system. It is only when combined with other CNS depressants that drugs like heroin or benzodiazepines become possible to die from.

There have been at least 72 deaths attributed to GHB, yet GHB places behind cannabis on the chart for physical harm -- why??

Amphetamine is physically damaging not only to the cardiovascular system, but the central nervous system as well, so it should place much higher when it comes to "physical harm" than most of the other drugs on the graph.

Solvents are extremely toxic, and damaging to the central nervous system after a single use - and as far as I'm concerned should have a max value on the chart for physical harm.

This chart only reflects the incompetence of whoever created it and the psychiatrists who were polled for its creation. --75.134.138.242 (talk) 01:54, 5 July 2012 (UTC)

The fact that this is still on wikipedia is staggering
Other people have already pointed out that the methodology behind this chart's creation is flawed; values were assigned to the drugs based on arbitrary aspects of the drug (i.e., "is the drug injectable intravenously?"). As such, the graph's creator could sway the outcome of where a drug is placed on the graph simply by including (or discluding) certain criteria for the scoring system. Therefore, this graph fails to be a mathematically proper graph, and is invalidated (this is not to say anything about the subjective nature of the graph's content, but merely the technical inconsistencies of it). It also fails to be a proper graph because subjective values can not be quantified. In light of this, it must be removed from wikipedia.

Now concerning the subjective aspects of the graph, the graph is not only misleading (and poses a potential health risk to anybody who reads it taking it seriously; an adolescent might view it and think that solvents are safe because this chart places them behind alcohol, and then subsequently die from huffing solvents), but is blatantly agenda-driven. The fact that this graph was ever taken seriously by the medical community speaks volumes about how broken the current medical system is in our society. It is both alarming and terrifying. If I may get personal here for a moment with you doctors/psychiatrists defending this graph's validity, I must ask you, did you even pay attention in any of your post-grad classes? Did you retain anything from the textbooks you read? Or do you now just unquestionably agree with the opinions of pop-culture medical journals because they are fashionable? (and not only fashionable, they make your job incredibly easy; I mean lets be honest, you don't actually know what you're doing, do you? You just know how to open up a DSM-IV and match criteria, and then prescribe medications accordingly based on what a medical journal told you was this month's "hot new medication".) --75.134.138.242 (talk) 08:41, 17 March 2012 (UTC)

About the inclusion of various chemicals
This graph is not scientifically reliable. For example. Alcohol causes more deaths than any of the drugs listed, each year there are more alcohol related deaths than deaths from all other illegal drugs combined...yet alcohol is only given "medium" rating under "physical damage". Also, heroin is a form of morphine (it is also prescribed by doctors in the UK as a pain reliever). In the U.S. morphine is prescribed safely every single day by doctors. The most common side effects are constipation and nausea, it also can cause shallow breathing (it's a CNS depressant)...Heroin turns into morphine after passing through the liver- and if morphine were so physically dangerous, than it would not be so widely prescribed by doctors. I suggest changing the name of this chart to "the general public's perception of drugs as influenced by ONDCP and drug war propaganda". This chart is NOT based on science, but rather POLITICS and PROPAGANDA. —Preceding unsigned comment added by 24.188.6.58 (talk) 01:22, 10 February 2009 (UTC)

This graph refers to the effects of various drugs on the human body, that is only one person, and does not consider societal consequences of these drugs. Also, "Tobacco" should probably read "Tobacco (Nicotine)" since that is the active and addictive ingredient in most tobacco products.Nsteinme (talk) 16:14, 26 March 2009 (UTC)
 * This graph does consider societal consequences under the "physical harm" umbrella, according to the paper. psycherhexic (talk) 06:19, 14 July 2009 (UTC)

If this is about the harm done by drugs why is cannabis even listed? Jeff419 (talk) 03:22, 20 January 2009 (UTC) Jeff419
 * This diagram uses data from a cited reliable source. Wikipedia editors are not in the position to evaluate whether any specific chemical "should be included" or similar concerns...that's WP:OR. DMacks (talk) 05:20, 20 January 2009 (UTC)flipchic is cute
 * The source is not entirely reliable. Since its publication in 2007 it has been cited only ten times by other authors and two of these citations seem to be by a man with which the authors collaborate. Simply because the article comes from a scholarly journal does not mean it is a reliable source, even under Wikipedia policy. Other papers have dismissed the methodology. See doi:10.1016/j.drugpo.2009.02.012 psycherhexic (talk) 06:19, 14 July 2009 (UTC)

Alcohol causes more damage because it's sold everywhere and there are a lot of consumers. Alcohol dependants will find it really hard to leave the habit, but becoming an addict requires genetical disposition or very large doses. —Preceding unsigned comment added by 62.57.225.253 (talk) 01:46, 17 February 2009 (UTC)

Tobacco is the number one cause of mortality and morbidity. While deaths from alcohol are often obviously from alcohol, deaths from tobacco use (arising from dependence/habituation) are much more numerous - COPD, coronary heart disease, lung, bladder, oral, throat cancers, stroke, etc. Peruville (talk) 10:01, 8 May 2009 (UTC)

I'm sure that alcohol's position takes into account not only use by alcoholics, but also the moderate or light drinking of countless other people; this would cause the mean harm to be far lower than if measured based on alcoholics alone. —Preceding unsigned comment added by 72.193.59.97 (talk) 01:24, 6 October 2010 (UTC)

Has anyone here actually read the paper this graph is from? There are errors in this generalized graph of all the data for the entire experiment that considered a number of factors that no one has mentioned here. In the discussion section of the Lancet article, they explain many of the anomolies that you are all bitching about. Additionally, anyone who is making these points that people come into the emergency department all the time clearly misses the point of the entire drug policy debate. There are inherent risks to everything in life from drug use to driving. The measure of the harmfulness of a drug should be considered as a ratio of the number of people consuming the drug to the side effects occured. For the most part, ranking system seems very well researched and depicted. Sure there are some contentious areas. But over all, Heroin and Coke are terrible for you they have intense cardiac and respitory effects that can cause death even in relatively small dosages. Alcohol can cause acute death and chronic alcohol use leads to a variety of physiological problems. However Amphetamines should be ranked lower. Anyone every taken Adderrall? This is straight amphetamine and most people dont get addicted and have relatively few serious side effects. Acid and MDMA are similar, extremely high doses are bad, probable brain damage. The same is true though for people who get hammered every day. However, the harmfulness of weekly or monthly use of these substances is minimal particularly if you are taking a moderate dose. The same way that a getting drunk on a Friday night will ahve relatively few consequences. The main dangers with the vast majority of drugs are as follows: doing too much at once, doing them too often, and pushing yourself when you are on the drug. However, these common sense precautions exist everywhere in society. if you aren't feeling well and then do vigorous activity you may have a problem. If you eat high fats foods everyday, you will probablly have problems, If you drive carelessly, you may have problems. Many of the drugs on this list can be used safely with little side effects the same way sports, driving, and eating can be fun and relatively safe if the right precautions are taken. My main disappointments with this thread are as follows: It seems that few people have actually read this paper, few people have analyzed how well it accomplished ITS goals, few people are approaching this in a rational sense that considers the likely method and frequency these drugs are used, many people are jumping to extremes and not realizing that almost every activity in life involves risk the question in this study is is the risk from Class a drugs really greater than class C. This train of thought can then be expanded to compare the danger of drug use to many other recreational activities. When this comparison is made you will find that drugs like LSD and MDMA have less harmful risk associated with them that many other recreational activities like sports, ATVing, and drinking. Every study has flaws but if you examine the numbers this one isn't bad. —Preceding unsigned comment added by 69.136.131.248 (talk) 15:50, 24 November 2010 (UTC)


 * You actually think amphetamines are not addictive? What planet do you live on? And cocaine worse than amphetamine? Cocaine is cardiotoxic true, but less so than procaine. It is however not neurotoxic, but amphetamine IS. Not to mention heroin under controlled dosing is extremely safe, opioids are not toxic in moderate doses. I'm not saying the graph is wrong, but I am saying you're wrong. C6541 (T↔C) 05:01, 19 April 2012 (UTC)

Ecstacy is much more harmful than given credit
I have analyzed Ecstacy health data for a very long time, and I can assure that while the health consequences are not as devastating as some as may believe, there are some very real, very serious consequences not being quantified here. Modification of the serotonin structure and short term brain damage are very noticeable and serious effects of Ecstacy use. Considering this damage is detectable only after a couple uses of Ecstacy, I would certainly say Ecstacy's negative health effects should be described as at least 2 out of 3, not 1 out of 3. —Preceding unsigned comment added by Spudst3r (talk • contribs) 21:35, 20 February 2009 (UTC)

It can be argued the endorphins released from watching your kids baseball game "modify" the seratonin system, which is technically true for short periods, a detrimental long term effect on the seratonin system by mdma alone has never been proven, even with the millions the ONDCP spends trying. But as a warning, in the multitude of studies done it has been shown mdma along with an MAOI can trigger seratonin syndrome. As for this graph people need to remember this is a 2D graph, a Z axis for 'social harms' or 'phsycological harm' does not exist, and since physical harm and dependence are clear enough titles people should stop throwing it under the bus for those reasons and go make a social harm vs. Pshycological harm graph.


 * Your claim about "modification of serotonin structure" makes no sense whatsoever.Enemyunknown (talk) 08:53, 27 June 2009 (UTC)
 * Surely Spudst3r speaks of modification of the serotonin system (the system of neurons in the brain producing serotonin), not the structure of the serotonin molecule itself. Ecstasy has long been known to interfere with the "normal" activity of 5HT. There are many, many papers in the literature concerning this topic. psycherhexic (talk) 04:42, 15 July 2009 (UTC)

seconded, this graph doesn't properly assess anything76.71.15.90 (talk) 03:33, 8 April 2009 (UTC)

Thirded...I'm assuming the "reliable source" used for the chart was the report issued by the UK Advisory Council on the Misuse of Drugs. They claim that MDMA is "safer than horseback riding in terms of risk" and that it only causes around 50 deaths a year which, while not necessarily inaccurate, is misleading. I wish I could find the case study of the man who did MDMA on a daily basis for years and eventually reached the point where he could no longer function and had to be committed. You may say that that's a special case and that most people don't use as much but I consider that irrelevant...I'm a "social smoker," that doesn't make cigarettes any less harmful, and I think it's accepted that an average dose of MDMA is "more damaging" than a joint or even enough drinks to get you good and hammered; especially considering the major secondary risks of MDMA use, hyperthermia and hyponatremia. Regardless, I don't think a chart that tries to condense drugs into a numerical scale of harmfulness and dependency risk has any place in an encyclopedia...even if it's based on reliable data, it violates NPOV as the scale used is based on the opinion of whoever made it, as evidenced by the fact that these complaints exist. Consider that according to the chart, LSD has the same dependency risk as khat, MDMA and "solvents." LSD has no known withdrawal effects and there's no evidence of dependency, while khat and MDMA have mild withdrawal symptoms from occasional use and quite serious ones that occur after discontinuing long-term use. MDMA is also not only a powerful CYP2D6 inhibitor, but a long-lasting one (on the order of days with some research indicating over a week). This enzyme is involved in the metabolism of all tricyclic antidepressants, most SSRIs, chlorpheniramine and dextromethorphan (these being of particular interest IMO, as I'd assume MDMA users are more likely to also use DXM), amphetamine, and some opioids as well. Add to that the fact that CYP2D6 shows the most variation in activity of any cytochrome in the body and you have a host of unintentional ODs that are possible for days after MDMA use. I would consider it one of the most physically harmful drugs you could take. CaptainColon (talk) 00:49, 6 May 2009 (UTC)

Your proof that mdma is bad was a guy took it daily for 50 years and got committed? If I eat copius amounts of nutmeg daily for 50 years and go bat shit crazy can we make that illegal too and create a new war in our own backyards over it? Its not the governments job to tell me what to do with my body if I don't infringe on others, to our founding fathers if you wanted to go home and drink turpintine be their guest, natural selection might come back around, gov should educate and prevent infringment on others.

And a fourth: The chart is bogus in my opinion a student (MA) of biopsychology, and if I may say so, looks to be agenda driven. 68.84.6.98 (talk) 09:14, 11 June 2009 (UTC)

Dude... your a biopsychology student and you summarize the chart as bogus. Stop living in a text book. Over 30 million people do MDMA every year. It was synthesized by a pharmaceutical company for human consumption. How many alcoholics do you know and how many people do you know hooked on MDMA? It does alter seratonin levels... thats the premise. The idea is that you don't do it every weekend. Take your head out of the text and stop speaking from inexperience. You are the equivilent of a blind person that has never driven explaining to someone how to drive a car. —Preceding unsigned comment added by Top performer (talk • contribs) 14:17, 15 December 2009 (UTC)

And as a biophsych major that gives you no credit since this graph obviously does not include phsych harm to the full degree it could, for that a z axis should be added or seperate graphs, as a "biophsych" major I thought you would have been able to notice that.

noone cares what your opinions are. this chart is from a reputable source (a well respected medical journal) and anything else is just hearsay.119.224.40.127 (talk) 23:40, 23 June 2009 (UTC)
 * Many people care about the opinions of others, especially here on Wikipedia, where opinion (during the drafting of a rule set or during the process of deciding whether or not an article or image adheres to the drafted rule sets) surely guides the editing process. psycherhexic (talk) 04:42, 15 July 2009 (UTC)

The chart is fine, if you think you can make a better one then go ahead, once you have it published in a reputable medical journal it may even be included here along with the original. Enemyunknown (talk) 08:53, 27 June 2009 (UTC)
 * Implying that someone should make a better chart themselves to be able to criticize the current one is incredibly illogical. Regardless, I have (under the title "A Joke") stated below that the chart presented in the paper is more acceptable than the one reproduced for Wikipedia. The chart presented here on Wikipedia was never accepted to any medical journal. Perhaps an inferior chart you come up with should be posted alongside the current one before you can tout the current chart's strong points. That sounds reasonable, at least while following your logic. Simply saying the chart "is fine," however, is not much of a defense in any case. The Lancet is a very reputable medical journal, yes, but the article itself is quite flawed. psycherhexic (talk) 04:42, 15 July 2009 (UTC)

The placement of ecstasy in this chart is what brought me to this talk page. It is significantly more harmful than the chart gives it credit for. Perhaps fewer psychiatrists and more ER doctors should have been polled. 68.228.35.75 (talk) 18:18, 26 September 2009 (UTC)
 * The modus operandi here is "Put up or shut up". Find sources because your simple opinion means absolutely nothing, especially when put against medical research papers. 98.207.159.144 (talk) 06:09, 10 June 2010 (UTC)

Simply put: people die from taking Ecstasy (see newspaper files). Who ever died from cannabis? Ampwright (talk) 00:21, 14 June 2010 (UTC)

Marijuana's safety is irrelevant. Ecstacy is not safe because pills bought off the street can contain anything. I agree with where it stands on the chart if it is referring to pure MDMA, but the chart is not specific, so it should be ranked higher. I don't know how much proof there is regarding hospitalizations from using pure MDMA, but I am aware that a great many hospitalizations are from drugs sold as 'Ecstacy' that are not MDMA. —Preceding unsigned comment added by 24.83.165.83 (talk) 04:18, 22 August 2010 (UTC)

Really good chart (kudos)
Like to see it in more articles, especially cocaine, Methamphetamine and heroin. Nice to see tobacco and alcohol listed. Wonder if there's a way to assess the risk with a point scale if U use many different drugs? I plan to add it to my website and do a tineye search to see where else it appears on the internet. A tineye search only showed one source without providing it's URL, not too sure why. Raquel Baranow (talk) 16:44, 2 April 2009 (UTC)
 * Yes, very odd indeed that the search for a flawed chart only showed one source without providing a URL. A striking remark toward its validity, yes? psycherhexic (talk) 04:42, 15 July 2009 (UTC)

This chart is a joke
This does not belong on wikipedia. Even if the data is somehow justified with specific methodology, the way this information is presented it is absolutely atrocious. Cannabis = amphetamines in terms of dependence, solvents less harmful than alcohol? Absolutely ridiculous. The fact that anabolic steroids is even on the thing... —Preceding unsigned comment added by Cmochrie (talk • contribs) 04:31, 8 June 2009 (UTC)
 * Yes, quite interesting, especially when you look at where LSD and ecstasy are placed... I drink regularly but would never consider taking them... --Sigmundur (talk) 13:21, 24 July 2009 (UTC)


 * Yes quite interesting. I use LSD regularly but would never consider drinking. I think the concept of putting drugs into a chart like this itself is flawed since what may be safe for one may kill another. What may be incredibly addictive to one may be a complete turn off for another. Ive seen this chart numerous times and its always bothered me. —Preceding unsigned comment added by 98.219.8.22 (talk) 22:00, 2 March 2010 (UTC)
 * Its funny someone would consider themselves knowledgeable based on the fact that they "drink regularly". But I think a chart like this is perfectly acceptable based on statistical analysis - regardless of the propensity for it to be more or less harmful to different people. 98.207.159.144 (talk) 06:14, 10 June 2010 (UTC)

How can I go about getting this chart removed? It is completely false and very misleading.
 * You can go about getting this chart removed by finding reliable sources that contradict the chart. I saw another chart on the page for LSD that is very similar to this. Are they the same source? 98.207.159.144 (talk) 06:14, 10 June 2010 (UTC)

benzodiazepines
How on earth do benzodiazepines manage to have a higher physical harm score than alcohol? Unlike alcohol, benzodiazepines are practically impossible to overdose on, do not tend to cause liver damage, overdose is easily reversible (fluamezil), and because they're relatively freely available inexpensively, there is very little criminal activity associated with trafficking. And GHB safer than benzodiazepines? That's ridiculous; they're both GABA agonists, although benzos tend to act more on GABA(A), where GHB acts more on GABA(B), the latter of which, tends to cause more respiratory depresson.

71.17.52.50 (talk) 16:03, 9 May 2009 (UTC)


 * The alcohol data is broken. It doesn't include a score for 'intravenous harm' since alcohol is almost never used intravenously. However, for some ridiculous reason it seems to count this as a score of zero, and gets an average of 1.4 out of harm scores of 1.9 and 2.4. It should have a score of 2.15. Frankly, alcohol has massive social costs and pretty serious dependence as well in chronic users, so I think that the scores across the board are a bit low, but the former error is pretty inexcusable. Anyone prepared to fix this? --24.13.150.125 (talk) 21:37, 19 August 2011 (UTC)


 * if you find that alcohol has a "pretty serious dependence" you obvliously dont have any expirence with other drugs listed higher then alcohol. — Preceding unsigned comment added by 217.120.209.121 (talk) 10:05, 29 April 2012 (UTC)

Question
(moved from Cannabis talk page)

The chart comparing depndence with physical harm seems questionable. For example, anabolic steriods are said to have a degree of dependance, and LSD is said to have a degree of physical harm greater than that of extacy. It also shows the level of dependance for Marijuana and Amphetamenes to be roughly equal. This chart does not seem like it was adaquitley researched. 68.161.127.144 (talk) 15:43, 18 May 2009 (UTC)

Just.. no. — Preceding unsigned comment added by 173.78.5.41 (talk) 23:34, 27 October 2011 (UTC)

A Joke
After reading the paper from which this chart was taken, it is obvious that the methodology used to calculate physical harm was incredibly flawed. The authors of the article clearly state that tobacco and alcohol cause 90% of all deaths in the UK and, as such, cause great physical harm. However, many drugs outpace tobacco and alcohol in the eyes of the addiction psychiatrists that participated in the polling. How can this be? Surely it is the failure of the methodology or the understanding of the psychiatrists polled. Also, LSD and alkyl nitrites received "intravenous harm" scores (0.3 for both) comparable to other intravenously-used drugs. This must be a joke on the part of one or more of the polled psychiatrists (there were 29 in all: only 29 out of 77 psychiatrists asked to reply to the polling did... 29 out of 77). LSD also received a 0.3 score for physical addiction. More disturbingly, these are averaged numbers, so, seeing as how many of the psychiatrists surely voted 0 in the above categories, the one or more addiction psychiatrists rating LSD as intravenously harmful or physically addictive must have rated the substance much higher than 0.3 in each category.

The psychiatrists that were polled were simply on a registry at the Royal College of Psychiatrists and labeled themselves as addiction specialists. It only takes 5 years of experience, a few recommendations, and less than $300 to be placed on the list. Not the most discerning qualifications for polling. Even still, only 29 of these psychiatrists, out of 77, decided that the methodology presented in the paper was worthwhile - less than half.

Primary to the above concerns is the fact that the chart on this Wikipedia page is not the chart from the actual paper. It has been reproduced by the submitting user, or perhaps someone else, then submitted by this user. If I were the authors of the paper in question I would not want my work, upon which my career is built, redrawn and subsequently posted for all the world to see. The actual chart presented in the paper is much less offensive in its representation of the horrid data contained in the referenced publication.

This chart is atrocious and offensive to anyone knowledgeable enough to know better. psycherhexic (talk) 06:06, 14 July 2009 (UTC)


 * I would go even farther than the author above stating that this graph has zero scientific validity. First of all, the whole notion of "physical dependence" on a drug is a mess and full of contradictory notions, and alludes any single definition.  Although many drugs do not generate a classic withdrawal syndrome along the lines of alcohol, barbiturates, and benzodiazepines (characterized by autonomic hyperactivity, and delirium), many drugs that are widely regarded as "safe" have significant 'withdrawal' issues.  This includes even serotonin reuptake inhibitors, which can be brutally difficult to get off of, as anyone who's ever tried to withdraw from Paxil or Zoloft will testify.  The problem with this kind of grotesque misrepresentation of neuroscience and pharmacology is that a lot of young and impressionable people come to Wikipedia with the notion that this website has the last word.  This puts an extra burden on Wikipedia to clean up its act in terms of removing misleading and unscientific postings, as already suggested by several other people being basically in the service of politics and have very little to do with pharmacology.  I would certainly agree with the comments below about how morphine and heroin really should be treated as very similar drugs, and it's a joke that tobacco was not listed as extremely addicting and extremely destructive.  the notion that there is some kind of easy axis  "physical harm" and that this is something that can be measured or quantified in relationship to all the substances without making a boatload of misleading assumptions is just a joke.  Could someone please prevail on Wikipedia to remove this graphic?  it has ZERO scientific value.  I doubt very seriously that this was generated by a panel of addiction experts, has no genuine expert on addiction would sign off on this kind of trash.
 * DFW Harvard Medical School.207.180.129.233 (talk) 01:51, 15 July 2009 (UTC)


 * Agreed that this graph does not have strictly scientific validity (polling experts is not science). That said, it is probably more reliable than much of the information that is out there, including the information used to decide drug scheduling (which is the point of the article). The paper does include an independent scoring by an outside panel that showed good correlation. I would say this graph falls under the category of original research, though my understanding is that the WP guidelines for original research are relaxed for graphics. 128.211.166.52 (talk) 16:57, 20 October 2009 (UTC)
 * How can it be OR? It is published in this paper by some of the most experienced drugs researchers in the UK. Smartse (talk) 18:22, 3 November 2009 (UTC)
 * I posted on the commons talk page requesting deletion. If any mods there have even the remotest bit of sense, it'll be gone by tomorrow. -TullFan (talk) 15:40, 3 November 2009 (UTC)
 * As I've said on the commons page this diagram is certainly scientific. Obviously it isn't perfect, but this is the best attempt that has been made to produce anything like this. I think I will trust Professors over people who say that they know better than them for no particular reason. Smartse (talk) 18:33, 3 November 2009 (UTC)
 * I agree with Smartse, the diagram is derived from a reliable source. Hopefully a future study will offer an improvement, or at least a different perspective/presentation for comparison, but for now this is what has been published. Shanata (talk) 10:34, 11 November 2009 (UTC)


 * I'm not sure who has said that they know better than the authors or contributors to this research. I also do not know why someone would say that people disagree with the work for "no particular reason." The reasons are clearly elucidated in the original post above (under the heading "A Joke"). Additionally, simply because I have a problem with the work does not mean that I must think that I know the subject better than the author of the work with which I disagree. That is ludicrous.
 * I find it laughable that defenses of the subject matter include sentiments not dissimilar to "...is probably not as bad as..."
 * While David Nutt looks to be a very accomplished researcher and an intelligent man whom I agree with on many points, he did not create this image. That is, he collected the data wrote the paper. The image is a result of that process but does not necessarily reflect his views on the matter. He is not responsible for the views of the polled psychiatrists.
 * Look again at the criteria for admission to the Royal College of Psychiatrists. One of the criteria is 5 years experience in psychiatry. That's for the highest membership level, Specialist Associateship. Members apparently label themselves as those that treat drug abuse, rather than going through some kind of more rigorous process. While I would put money on the idea that at least a few of the most experienced psychiatrists are members of the Royal College of Psychiatrists, we have no idea who responded to the polling process and the pool, on the whole, of possible responders is less than stellar to say the least.
 * We cannot ignore the fact that this image is a remake of the original image from the paper. psycherhexic (talk) 07:24, 30 December 2009 (UTC)

mean of 'acute harm' and 'chronic harm' when drug isn't administered intravenously

 * I think a quite serious flaw of the chart is, that physical harm is calculated as the average of 'acute harm', 'chronic harm' and 'intravenous harm'. Alcohol, Tobacco, Cannabis, Solvents, 4-MTA, LSD, GHB, Ecstasy, Alkyl nitrites and Khat get zero or very low values in the category 'intravenous harm' (I guess simply because it is not possible at all to use the drug this way or not possible for the drug to have the desired effect this way), but for the average harm over these low values is averaged as usual. So I would say these drugs get a too low rating on the harm scale. I mean, why should a drug be rated more harmless just because it is not administered intravenously? I tried to modify the image in the way that for these drugs I averaged only over 'acute harm', 'chronic harm', and what I got IMHO looks much more sensible. Of course this likely will not fix all the flaws in the methodology, but could be an improvement:

O.mangold (talk) 15:59, 11 November 2010 (UTC)

I agree to O.mangold's opinion. The calculation (acute harm + chronic harm + 0)/3 is really a joke, and his suggested version is much more realistic as the flawed current version. I added similiar thoughts and different solutions under commons:File talk:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg.

Best, --Richard (talk) 22:46, 1 April 2014 (UTC)

circles same size
Shouldn't the circles be different sizes depending on the range of responses related to each substance? &mdash; goethean &#2384; 16:30, 30 December 2009 (UTC)

Methodology disclosure
Stop blaming the graphic! There's no objective reality for this kind of thing. As a point of view of a socially recognized research team, it provides a useful overview of one notable vantage point that would be tragic as a reader to have to extract from acres of text. It would be better if a casual reader—less intelligent, of course, than anyone here—did not mistake this as a broad consensus, or imbue it with an aura of objectivity or scientism it doesn't (and can't) deserve. IMO, this would best accomplished if each use of the image contained a link to the methodology and definitions employed by the research team who pulled it together. Things like how they balanced single-dose toxicity versus accumulated toxicity. I would like to see caffeine added to give many low-grade addicts a personal perspective on the dependency scale. I have a family member who works in probation. That's a community that has a pretty clear ranking among themselves on the prognosis concerning different substance abuse histories, which is probably quite different than a GP or a biologist, but I think all of these would have a correlation over 50% so I take the glass half full approach to the obvious shortcomings. — MaxEnt (talk) 01:38, 13 March 2010 (UTC)

Datura
I'm wondering why Datura is not incluced it's quite powerfull although not addictive i think it belongs here. —Preceding unsigned comment added by 64.231.45.231 (talk) 19:50, 2 April 2010 (UTC)
 * Because this is data extracted from a scientific study. The subjects in the study were not asked to rate datura, and therefore there is no data. Sure, this may be a horribly inaccurate and graph, and sure the methodology of the study is incredibly flawed, but we can't just make up numbers out of thin air, it has to be verifiable data from a recognized academic source. 66.183.161.132 (talk) 08:06, 23 June 2010 (UTC)

Interesting similarity
Theres an interesting similarity between this chart, and the chart on dependence vs lethal dose:

This indicates a pretty strong relation between lethal dose and physical harm (at least according to the source giving physical harm ratings). It also gives some validation to the chart in question.


 * Heroin, cocaine, and pentobarbital (a barbiturate) is near the top right in both
 * Nicotine is in pretty much the same place on both charts
 * Alcohol and MDMA seem to have a bit of a higher lethal does in comparison to their non-lethal physical harm.
 * The charts seem to slightly disagree as to the dependence of ketamine

Fresheneesz (talk) 06:36, 10 June 2010 (UTC)

For Clarification:
I would assume that this chart considers the effects of the drug itself, rather than the use of the drug. For example: though LSD may not directly harm you, it can impair your decision-making skills and thus lead to the possibility of injury or sickness. Would that be accurate? --97.127.67.108 (talk) 15:46, 19 July 2010 (UTC)

Black border
This graph might be better without the black border. Jason Quinn (talk) 10:53, 19 September 2010 (UTC)
 * Agreed. It appears there are many derivatives of this file (and some even have rotated text for the vertical-axis label, another nice touch). Might want to contact author of the image to see about getting it done across-the-board. Also might want to take the discussion to commons since that's where the images are hosted. DMacks (talk) 11:43, 19 September 2010 (UTC)


 * I thought I was on Commons at the time I posted this. I quickly realized not and also posted there. Your comments are welcome over there too. Jason Quinn (talk) 12:08, 19 September 2010 (UTC)
 * See you there. DMacks (talk) 12:18, 19 September 2010 (UTC)

New study
See this BBC News report about a new paper in The Lancet, I can't find it online yet but it should appear soon. SmartSE (talk) 10:22, 1 November 2010 (UTC)

Solvents...
The fact that solvents aren't listed as causing the most physical harm of all these substances pretty much invalidates the whole thing. What a ridiculous graph. Yeah, yeah... the source is reliable. The content is not. It's an absolutely absurd graph. 74.80.58.186 (talk)

You don't understand, scientists made it, therefore it's infallible wisdom from the very peaks of Mount Olympus! 70.189.144.100 (talk) 21:27, 9 May 2011 (UTC)


 * Yeah this is what's wrong with wikipedia, this bureaucracy... Even ridiculous claims have place here if only they are labeled as "official" or have some reference behind them. Just because someone with phd in their signature writes something or some magazine release sth that doesn't mean its instantaneously true and valid. Come on have common sense... This image shouldn't be posted as reference on any page concerning drugs as it may deceive ignorant people. It shouldn't be used to lecture people as its obviously flawed... Zazae (talk) 23:54, 16 June 2012 (UTC)

Heroin's placement
I'm in my final year of pharmacy school, so I'm not quite a pharmacist yet; but nevertheless I have learned a lot about drugs, including illegal ones, and this chart seems quite off to both me and the professors I have showed it to. Other people have noted a lot of the problems with it, but I would like to add one more: heroin should not be that far to the right.

If we consider pure heroin, used safely, it would be all the way to the left; heroin doesn't cause any intrinsic harm, like most opioids (except some damage to the dopaminergic system, which is partly responsible for the physical dependence). As used by a lot of people on "the street", it's probably not quite so benign - appetite suppression, addiction, dirty product, and intravenous use are all reasons that users tend to be unhealthy. But even so, according to the studies I have been presented, meth and cocaine users are usually far worse off. — Preceding unsigned comment added by 65.36.30.56 (talk) 00:43, 21 June 2011 (UTC)


 * Wikipedia can only say what others say, can't interpret or adjust based on personal or personal-communication knowledge. The graph is traceable back to published scientific literature, so you'd want to raise your dispute with the authors there and/or find other publications of comparable reliability that support your alternate claims here. DMacks (talk) 00:55, 21 June 2011 (UTC)


 * The following are dangerous: using impure heroin (dosing is hard to manage and impurities may be harmful), using unsanitary needles, and improper intravenous injection. However, heroin its self is rather benign.


 * Notice how none of the issues with heroin have anything to do with the drug itself. I would challenge anyone to produce any source that claims opiods are harmful. --SelfStudyBuddyTALK-- 20:56, 9 July 2011 (UTC)


 * Either this image is wrong or Opiods is wrong. --SelfStudyBuddyTALK-- 20:44, 16 July 2011 (UTC)

I believe that the placement of heroin is a great example of how this graph, while written under the auspices of being "well researched", contains information that is based more on the prejudices of the psychiatrists being polled than actual definitive information. As has been mentioned on this page, the "physical harm" dimension seems to be based on the misinformed publics idea of heroin rather than what has been proven time and again in scientific research. While this graph may represent the viewpoints of a few esteemed psychiatrists, the information to be gleaned from it shows less about the effects of drugs, and more abouts the appaling lack of knowledge by some of the top doctors in the field. As such, it has no place being used as a graphic intended to represent what it's authors intended it for. I would hope that wikipedia would realize this, and remove it from pages where it is used to attempt to provide insight into the actual effects and consequences of drugs. As I said earlier, if there was a page discussing misinformation among the psychiatric proffesion, this graph may be a useful illustration. -BennyBoy — Preceding unsigned comment added by 74.61.48.143 (talk) 18:28, 9 September 2011 UTC)

I think a solution would be to change the name to "street heroin". I don't know how to do this however. DCH2900 (talk) 06:16, 16 January 2012 (UTC)

Shouldn't this graph have more qualifications where used?
I stumbled onto this image from the page about Poppers, where it bears the caption:

"Data from The Lancet shows alkyl nitrites to be the second least addictive and third least harmful of twenty popular recreational drugs.[22]"

I think this misrepresents the graph. Really it just shows that in the personal opinion of 20-odd psychiatrists it is the "second least addictive and third least harmful".

The sample size is tiny, and the data collected seems it would be very prone to bias. Surely when you ask psychiatrists about drugs, they will be biased because they tend to only see the worst cases, the small percentage of people who have caused themselves enough mental harm that they are seeking professional help. A drug like khat is not widely used in many areas in the USA/UK, so they may be just basing their opinion on what they have read in the media, or similar.

I would rather see the data from actual scientific studies of users health, with a good sample size, and including many types of users, casual, daily, etc.

I am not fundamentally opposed to the use of this chart, but I think where it is used, it should be made more clear exactly what this data is. The way it was presented to me on the Poppers page made me at first think it was some more impressive data than just the opinions of a few people. It was only because my own personal opinions clashed with the data that I decided to follow the trail, and find out if the science proved my opinions wrong. Many people may not have strong personal opinions on this subject and just take the graph as being scientific without further research, which could be harmful if they act on the information presented.

Jacobitten (talk) 04:26, 22 March 2012 (UTC)
 * I agree with you, but have a look at what happens on wikipedia if you correct it: http://being-human-sucks.blogspot.de/2014/02/the-sad-wikipedia-shitdrama-truth.html . — Preceding unsigned comment added by 37.201.226.82 (talk) 08:32, 22 February 2014 (UTC)

Proposition to remove
The document from which this graph is taken can be found here: http://dobrochan.ru/src/pdf/1109/lancetnorway.pdf.

In my opinion no further discussion is required for the graph to be removed entirely from Wikipedia, or at least the "Khat" article and any other similar articles focusing on a specific drug or substance in which the graph is included.

The graph is presented with little context and is potentially (and probably) misleading to users. The terms dependency and physical harm are ambiguous and are not defined in the image or captions or the graph. It is not, nor does it claimed to be, based on empirical evidence. It seems to have been created in the context of improving UK health policy, and has little relevance when included with articles about a specific substance. Furthermore, it would seem that the data is based on a survey of various unnamed professionals that includes law enforcement officers and excludes general practitioners. I do not claim the graph to be wholly useless or inaccurate, but simply inappropriate for the Wikipedia articles in which it is included.

Please feel free to make any consenting or dissenting arguments. — Preceding unsigned comment added by 72.219.10.107 (talk) 04:35, 22 February 2013 (UTC)


 * In concurrence with the stated objections on this talk page, I find it prudent to remove this graph from (at the least) the 'Cannabis (drug)' article. To be frank, the graphed data is subjective garbage. Opertinicy (talk) 06:08, 11 March 2013 (UTC)

Some praise for once
It seems that a lot of people have problems with this chart but it's not supposed to be Wikipedia's assessment of the drugs but rather reporting an assessment made by certain experts. We can disagree with it but it can't really be changed as it would no longer represent the original findings of the experts.

Anyway, this is far more real and progressive than the statistics that most governments come out with. I know that the chart shouldn't be changed but yes I think that tobacco and alcohol should be considered more harmful than the chart suggests. Their dependency levels seems about right. I would also suggest that cannabis is a bit less harmful than shown here but again there is little concrete evidence and statistics are muddled because many cannabis users, like myself, also use tobacco and regularly mix the two drugs. I would certainly agree with some of the above who claim that ecstasy is more harmful than indicated. I have witnessed people collapsing and losing parts of their memory because of the drug but then again it may well have been an unpure form and other environmental factors may have affected the incidents. What this chart should be is a wake up call to politicians, health experts and parents everywhere as to what the real dangers are. In an ideal world no person should ever be arrested for possession of these drugs but society should encourage (with or without a stick) treatment for those drugs at the far ends of the scale and they should recognize the damage caused by presently legal drugs before ranting and lying about the affects of other drugs which are shown to cause far less harm.--217.71.45.42 (talk) 19:53, 12 June 2013 (UTC)

Ecstasy correction
The data scale is way incorrect. Ecstasy on the pleasure scale can't be 1.5, for example cannabis is scaled 1.9 but if you compare ecstasy and cannabis, ecstasy is way more pleasureable. If the highest ranking for pleasure is 3.0 than ecstasy should be 3.0. — Preceding unsigned comment added by 90.137.144.227 (talk) 19:20, 5 August 2013 (UTC)

the expression of my hatred
And what atrocities this graph is committing can be found here: http://being-human-sucks.blogspot.de/2014/02/the-sad-wikipedia-shitdrama-truth.html. — Preceding unsigned comment added by C0NPAQ (talk • contribs) 21:57, 19 February 2014 (UTC)