Which is the most toxic drug

Ranking of the most harmful drugs from the point of view of German doctors

Which drug is the most harmful? And how can the harmfulness actually be assessed? Experts from addiction medicine in Germany have dealt with this question and compiled a ranking.

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The dose makes the poison, goes a well-known wisdom. But the harmfulness of psychoactive substances is not only defined by the dose. In 2007, experts from the United Kingdom compiled a ranking list for the first time and published an update in 2010. 20 psychoactive substances were classified according to their harmfulness. When assessing the harmfulness, various criteria were incorporated that relate to the person consuming it as well as to other people or society. A research group from Germany took a similar approach and presented a current ranking that was expanded to include some substances.

Over 100 experts participated in the survey

More than 100 medical professionals took part, with an average of 15 years of experience in the treatment of addicts. 33 substances were presented to the experts for evaluation. Compared to previous studies, synthetic cannabinoids and cathinones as well as a number of pain relievers have been added to the list of substances.

In the assessment, a distinction was made between physical, psychological and social damage. The damage can relate to the consuming person as well as to other people. For example, relatives can suffer from the consequences of excessive alcohol consumption. In addition, traffic accidents in which other people are harmed comparatively often occur under the influence of alcohol. Alcohol can also have negative consequences in the workplace. The aim of the study was to ultimately summarize all criteria into a harmfulness value for each drug.

Alcohol way up on the harmfulness scale

The first three places on the harmfulness scale are taken by the illegal drugs crack, methamphetamine and heroin. Already in fourth place is the legal drug alcohol. The authors explain that, like earlier expert surveys, they came to the conclusion that alcohol is very harmful to both individuals and society. This is mainly due to the widespread use of alcohol in the population. In contrast to other drugs such as GHB or Ecstasy, which are classified as less harmful, alcohol is not subject to the Narcotics Act.

The new psychoactive substances from the group of cathinones and synthetic cannabinoids occupy eighth and ninth places on the harmfulness scale, i.e. they are in the upper third. For comparison: cannabis ranks 16th in the middle, just ahead of hallucinogenic mushrooms. Synthetic cannabinoids are therefore rated as more harmful than herbal cannabis.

Almost any drug can be consumed in a harmful way

In their article, however, the authors explain restrictively that these are relative assessments that primarily focus on the population as a whole. Rather, the following applies to the individual: Depending on the personal situation and intensity of consumption, almost any psychoactive substance can be consumed in a harmful way.



Bonnet, U., Specka, M., Soyka, M., Alberti, T., Bender, S., Grigoleit, T., Hermle, L., Hilger, J., Hillemacher, T., Kuhlmann, T., Kuhn, J., Luckhaus, C., L├╝decke, C., Reimer, J., Schneider, U., Schroeder, W., Stuppe, M., Wiesbeck, GA, Wodarz, N., McAnally, H. & Scherbaum , N. (2020). Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others - A Perspective of German Addiction Medicine Experts, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.592199/full