Original post Vox.com 2/25/15 | Re-Post 4/8/15
Researchers have said for years that alcohol is more dangerous than marijuana. But what does that mean, exactly? And how do we know?
It’s certainly not because of any government-acknowledged evaluation. The federal government’s scheduling system evaluates drugs by medical value, first, and abuse potential, which is poorly defined under the law, second — but it excludes alcohol and tobacco altogether. Even if the federal classifications included alcohol and tobacco, both would likely fall in the same category as marijuana — schedule 1 — since they have no acknowledged medical use and some potential for abuse, making it hard to compare the drugs based off that.
This has left it up to researchers and drug experts to evaluate which drugs are truly the most dangerous. A 2010 study published in The Lancet, led by drug expert David Nutt, evaluated the use of 20 drugs in the UK, putting alcohol at the top of its harms rankings and hallucinogens at the bottom. Here at Vox, I’ve pointed out that alcohol is one of the three deadliest drugs in America.
There are big drawbacks to looking at drugs exclusively through these blunt measures. Alcohol, tobacco, and prescription painkillers are likely deadlier than other drugs because they are legal, so comparing their aggregate effects to illegal drugs is difficult. Some drugs are very harmful to individuals, but they’re so rarely used that they may not be a major public health threat. A few drugs are enormously dangerous in the short-term but not the long-term (heroin), or vice versa (tobacco). And looking at deaths or other harms caused by certain drugs doesn’t always account for substances, such as prescription medications, that are often mixed with others, making them more deadly or harmful than they would be alone.
For these reasons, it’s nearly impossible to come up with an exact measure of a substance’s harm. So I talked to drug experts about the reasons people take drugs (legal and illegal ones) and the risks behind them. Although experts generally agree that alcohol is more dangerous than marijuana, there was a lot of nuance in how they took on the issue — and there is enormous variation within what makes pot, alcohol, and other drugs dangerous. Here’s a breakdown of what experts said about some of the most widely used drugs.
Risks: One of the biggest short-term risks to alcohol is that it can heighten the risk of accidents, particularly car crashes. One study from Columbia University researchers found that drinking and driving multiplies the chance of a fatal accident by nearly 14 times. But if someone consumes alcohol with another drug, the risk is multiplied by more than 23 times.
Alcohol is also capable of making people more aggressive and violent, potentially leading to more violent crime.
In terms of health risks, alcohol can lead to extensive organ damage, especially to the liver. These problems are most prominent among heavy drinkers, but can occur among lighter drinkers who consistently consume alcohol over long periods of time.
Alcohol can also heighten the dangers of other drugs. It can further increase the risk of aheart attack or stroke when mixed with cocaine. It can enhance the effects of opioid-based painkillers, raising the chance of overdose. And it can interact with antidepressants to severely hinder a person’s reflexes.
Addiction is also a widespread problem, which makes it all the more difficult to deal with the other problems presented by alcohol.
Why people do it: Some people drink beer, wine, and other forms of alcohol to wind down at the end of the day. And although it’s not recommended, some people use alcohol to self-medicate through tough periods in their lives.
Alcohol can also be used for medical and hygienic purposes, such as to clean wounds and hands.
Bottom line: A lot of people can use alcohol for most of their lives without having any problems with it.
But alcohol is still a public health problem. The Centers for Disease Control and Prevention estimate that excessive drinking causes 88,000 deaths each year and one in 10 deaths among working-age US adults (ages 20 to 64). Alcohol is also capable of making people more aggressive, and it’s a factor in about 40 percent of violent crimes, according to the National Council on Alcoholism and Drug Dependence.
Risks: Marijuana has never reportedly caused an overdose death, but that doesn’t mean it’s harmless.
“The main risk of cannabis is losing control of your cannabis intake,” Mark Kleiman, a drug policy expert at UCLA, said. “That’s going to have consequences in terms of the amount of time you spend not fully functional. When that’s hours per day times years, that’s bad.”
Caulkins of Carnegie Mellon University put it another way: “At some level, we know that spending more than half of your waking hours intoxicated for years and years on end is not increasing the likelihood that you’ll win a Pulitzer Prize or discover the cure for cancer.”
The risk of abuse is compounded by the widespread perception that pot is harmless: since many marijuana users believe what they’re doing won’t hurt them, they feel much more comfortable falling into a habit of constantly using the drug.
A lot of research has linked adolescent marijuana use to a range of bad consequences, including cognitive deficiencies and worse educational outcomes. While it’s not clear marijuana’s relationship with these outcomes is cause-and-effect, it’s generally agreed upon that people younger than their mid-20s should avoid the drug.
The research on other health effects of marijuana is inconclusive. One study linked the use of potent marijuana to psychotic disorders, but other studies suggest people with psychotic disorders may be predisposed to pot use. Research on whether smoked marijuana causes lung disease or cancer has yielded conflicting results, with studies that control for tobacco smoking finding no significant effect from marijuana on lung cancer risk.
Marijuana also increases the chance of accidents. The previously mentioned study from Columbia University researchers found that people driving with marijuana in their system were nearly twice as likely to get in a fatal car crash. The increased risk indicates that some people likely die as a result of marijuana use every year, but it’s unclear how many due to inadequate data and reporting.
Why people do it: The euphoric high from marijuana lets some people relax by enhancing everyday activities, including music, food, and sex. The research and anecdotal evidence also suggests marijuana could be used to treat several medical problems, such as pain, nausea and loss of appetite, Parkinson’s disease, inflammatory bowel disease, PTSD (post-traumatic stress disorder), and epilepsy.
Bottom line: Marijuana is safer than most other drugs on this list, but it’s not harmless. It can have a seriously negative impact on some people’s productivity at work or school.
But many people can lead normal lives while regularly using pot. And experts largely agree that alcohol and especially tobacco are more dangerous drugs to individuals and society as a whole.
Risks: Tobacco destroys the body in various ways. It is the leading cause of lung cancer, which killed more than 200,000 people in 2011. It heightens the risk of heart attack and stroke. It also increases the risk of diabetes, leukemia, cardiovascular diseases, respiratory diseases, kidney disease, and intestinal disease. And secondhand smoke can increase bystanders’ risk of lung cancer and heart disease, among other issues.
Nicotine found in tobacco is hugely addictive, making it very difficult to quit even if someone knows the tremendous risks involved.
Why people do it: The slight buzz from tobacco is a cheap, legal way for some people to wind down, but it can come at an enormous cost to someone’s health if used over long periods of time.
Bottom line: Tobacco is the deadliest substance in America. The CDC estimates it kills 480,000 people each year — more than all reported homicides, traffic accidents, and drug overdoses combined. Even that may undercount the death toll of tobacco: a recent study found tobacco kills 60,000 more people each year than previously estimated.
Risks: The most common risk of opioid-based prescription painkillers is fatal overdoses.
Overdoses tend to happen in a few scenarios. Keith Humphreys, a drug expert at Stanford University, said some people try to “chase pain” by swallowing pills until their pain is relieved, and accidentally take too many. Many users underestimate how long the drug remains in their body, and consume more pills or other drugs before they should.
People who mix prescription painkillers with other drugs increase their chances of overdose. The CDC found that 31 percent of prescription painkiller-linked overdose deaths in 2011 were also linked to benzodiazepines, a legal anti-anxiety drug. Alcohol and muscle relaxants can also increase the risk.
Other side effects of painkillers include narcotic bowel syndrome, increased risk of bone fractures, and the potential for hormonal imbalance.
Prescription painkillers are highly addictive and some people abuse them to get high. A 2014 study published in JAMA Psychiatry found that addicted patients will resort to the more dangerous heroin if their painkiller supply is cut off, since it is an opioid as well.
Why people do it: Painkillers are good at alleviating pain. This addresses a very big health problem in America: a 2011 report from the Institute of Medicine found that about 100 million Americans suffer from chronic pain, and many are under-treated for it. There’s some debate, Humphreys noted, about whether painkillers are good for treating long-term pain, but they can relieve problems in the short-term.
Bottom line: More than 16,200 people died of prescription painkiller overdoses in 2013, according to the CDC. Although the drugs are often prescribed to deal with real, significant pain, they’re widely misused and can lead to deadly complications.
Risks: Crack and powder cocaine increase blood pressure and heart rate, raising the risk of heart attack or stroke in otherwise healthy people. Both drugs can also cause psychotic episodes, potentially making someone temporarily paranoid or violent, according to George Woody, a drug expert at the University of Pennsylvania.
Crashing after the high from cocaine can also cause severe depression, which can lead to suicidal thoughts. “You see this in emergency rooms, where somebody will come in and be suicidal,” Woody said. “Then you see them the next morning, and they’re fine.”
Cocaine can have terrible reactions with other drugs. Alcohol and cocaine can mix in the liver to form a chemical known as “cocaethylene,” which can heighten the high from cocaine but also the cardiovascular risks attached to the drug.
Although crack and powder cocaine are chemically similar, there are two major differences that make crack more accessible and potentially more harmful than powder cocaine: crack is smoked, so it takes effect more quickly, and it’s much cheaper.
Different forms of consumption can also bring their own medical issues. Snorting can hurt someone’s sense of smell and ability to swallow. Smoking may damage the lungs. Injecting can be more dangerous, since dirty needles can carry infectious diseases like HIV and hepatitis.
Cocaine is also very addictive, exacerbating some of the issues related to it. Some people will resort to crime, such as theft or drug dealing, or sex work to make money to obtain the drug.
Why people do it: Crack and powder cocaine’s temporary high makes users more energetic, attentive, and focused, though the effects can be achieved with safer, longer-lasting drugs.
Bottom line: Crack and powder cocaine can cause problems, ranging from heart attacks to violent behavior that leads to criminal acts. Neither appear to pose the same level of long-term risks of tobacco, but they can cause serious issues in the short-term.
Read more about this very important issue at Vox.com