The authors make a distinction between harm to user and harm to society. There are ‘16 harm criteria’, divided between the two categories. Harm is weighted. For example, mortality is treated as more harmful than damage. Still, to accept the findings means to accept the weightings. I’m unsure if I accept the weightings because of the individualist conception of harm that underpins the entire model.

Under harm to users:

• Physical
• • Drug-specific mortality
• • Drug-related mortality
• • Drug-specific damage
• • Drug-related damage
• Psychological
• • Dependence
• • Drug-specific impairment of mental function
• • Drug-related impairment of mental function
• Social
• • Loss of tangibles
• • Loss of relationships

Under harm to others:

• Physical and psychological
• • Injury
• Social
• • Crime
• • Environmental damage
• • Family adversities
• • International damage
• • Economic cost
• • Community

This does not seem dialectical. For example, I would not separate ‘community’ from any of the other types. A drug overdose (OD) harms the community as well as the victim, their relationships, and their family. The model must determine how to avoid double-counting these harms.

If an OD is counted in both categories, that’s a methodological flaw. If the model avoids double-counting, the basis must be arbitrary: a liberal will be working off very different premises to a communist, so there will never be agreement between bourgeois and socialist societies about what counts as harm and how to count it.

(On page 1564, the authors admit that they don’t have data for all the sub-categories, either, which causes another problem for comparison.)

Communists would likely reach a different consensus to scientists in a liberal democracy who are not dialectical materialists and who have been trained within a capitalist system where certain ‘realities’ are taken for granted, such as profit-making pharmaceutical and alcohol industries and the tragedy of ‘gang war’ (US ops), etc, in countries where illegal drugs are produced.

The graph shows the actual harm caused by drug use across a UK sample of available data; i.e. this is how much harm actual alcohol consumption has caused. The problem is that there are probably thousands of alcohol users to every heroin user.

The problem with relying on this data to make policy is that the results are determined by the legalisation and strong encouragement to consume alcohol and the criminalisation and taboo of the the others. The authors conclude:

the present drug classification systems have little relation to the evidence of harm.

According to the data, you might say that alcohol, heroin, crack, and meth should be prohibited. Or you might say that if alcohol is legalised, then so should heroin, crack, and meth. The latter would be devastating and, apparently (notwithstanding some mixed messages) not what the authors intended:

we should note that a low score in our assessment does not mean the drug is not harmful, since all drugs can be harmful under specific circumstances.

The problem with the graph comes down to a faulty comparison with all drugs against alcohol. The result can be read in so many different ways to justify a range of contradictory policies.

The problem with comparing anything with alcohol in the abstract is that it forgets the dialectical relation of alcohol to culture. The effects of this will always be skewed. It is incomparable to any other drug. The exception is perhaps tobacco. It would be interesting to re-draw the graph with tobacco counted twice. Once for today and once for before the massive campaign against smoking and the British smoking ban. If ‘old’ tobacco came above alcohol (I’m reasonably sure it would) while ‘new’ tobacco came sixth, the graph would instead show something different. If society suddenly took the same attitude to other drugs, alcohol would fall down the list.

The data could be used to show, for example, as discussed in this thread, that cannabis is ‘safe’ or at least ‘safer’ than alcohol. But the data do not support that. Because these data cannot tell us (a) how dangerous would be cannabis if it were legalised and encouraged to the extent of alcohol or (b) how safe would be alcohol if it were criminalised and as taboo as heroin. It only shows current harm.

Emphasis to indicate the authors’ political economic views, which should highlight why Marxists should treat the thesis with caution:

Limitations of this approach include the fact that we scored only harms. All drugs have some benefits to the user, at least initially, otherwise they would not be used, but this effect might attenuate over time with tolerance and withdrawal. Some drugs such as alcohol and tobacco have commercial benefits to society in terms of providing work and tax, which to some extent offset the harms and, although less easy to measure, is also true of production and dealing in illegal drugs.

The paper also warns against the general application of these findings:

Many of the harms of drugs are affected by their availability and legal status, which varies across countries, so our results are not necessarily applicable to countries with very different legal and cultural attitudes to drugs. Ideally, a model needs to distinguish between the harms resulting directly from drug use and those resulting from the control system for that drug. Furthermore, they do not relate to drugs when used for prescription purposes.

The paper ends: “aggressively targeting alcohol harms is a valid and necessary public health strategy.” Which means the reader is left with the message that the data are not really about relaxing other drug laws so much as tightening alcohol laws. I’d say that’s a mixed message as they are concerned (subtly) with e.g. the connection between drugs and racial policing, which means using the paper e.g. to decriminalise cannabis rather than to campaign against alcohol. I suppose these aren’t mutually exclusive but, then again, when this graph is usually cited, it’s usually in favour of making cannabis legal rather than prohibiting alcohol.