How Risky Are Drugs?

Other useful resources: How to Change Your Mind, (annotated summary); Phases of an LSD Trip; Precise dosing of LSD; How to Find a Psychedelic Guide

Our friends at Dance Safe have published a useful article where they compare the relative risks of certain drugs and other activities. The full article is here.

Risk assessment is the mental process of measuring the risks involved in engaging in a given activity. People perform risk assessments most often when they are trying to decide whether or not to engage in an activity they perceive to be “risky.” Using a drug, for example (any drug), has risks. Let’s see how the risk of using drugs compares with other activities.

What is a risk?

A risk is the potential of suffering some form of harm or loss.

What is risk assessment?

Risk assessment is the mental process of measuring the risks involved in engaging in a given activity. People perform risk assessments most often when they are trying to decide whether or not to engage in an activity they perceive to be “risky.” Using a drug, for example (any drug), has risks. Questions someone might ask themselves or their doctor before taking a particular drug, in order to assess the risks, include:

  • What are the negative side effects?

  • Does this drug interact dangerously with other drugs?

  • Is it addictive?

  • Will I experience withdrawal symptoms when I stop?

There are many other questions someone might ask. These are just a few examples.

Risk assessment is always a risk/benefit assessment.

To measure anything, a scale or counterweight is needed. The counterweight to a risk is a benefit. A person undertaking a risk assessment weighs the perceived risks against the perceived benefits (real or imagined), and the “heavier” side wins. Risk assessment, therefore, is always a risk/benefit assessment.

People perform risk/benefit assessments every day, even unconsciously. For example, every time someone gets into a car or an airplane they are making an unconscious decision that the benefits of rapid transportation outweigh the risk of injury or death.

Can recreational drug use have benefits?

A benefit is something that promotes or enhances well-being. Recreation itself is a benefit, and different people choose different types of recreational activities, depending on their tastes and preferences. The vast majority of people who use illicit drugs (and alcohol) are casual, non-addicted users who use moderately and report various kinds of benefits from their use, whether therapeutic, medicinal, recreational, or otherwise. Different people use different drugs and report different benefits. Although we do not provide much information about the potential benefits of various illicit drugs, it is important to understand these benefits, as well as the potential risks, in order to make an informed risk/benefit assessment.

What determines the weight of a risk.

The weight of a risk can be described as the severity of the possible harm that might occur from a given activity multiplied by the probability of the harm occurring. This can be expressed by the following equation:

(weight of risk) = (severity of harm) x (probability of occurrence)

Generally speaking, higher risk activities have higher probabilities of more severe harm, while lower risk activities have lower probabilities of less severe harm. For example, Russian roulette would be considered a very high risk activity (perhaps a 1 in 5 chance of death), while reading a book would be considered a very low risk activity (perhaps a 1 in a million chance of a paper cut). Of course, a harm that one person considers extremely severe another person might not care about very much at all. Like benefits, “harms” are also largely subjective, and their severity can be assessed differently by different people.

The risk of death

Death is generally considered the most severe potential harm that can result from using drugs. Below is a chart comparing the statistical probability of death occurring from using various drugs, engaging in various recreational activities, and being exposed to various types of accidents and illnesses.

Risk of Death from Various Recreational Drugs, Compared to Other Activities/Exposures

1 in 10 – Extremely High

  • Accident/Injury: Russian Roulette

1 in 100 – Very High

  • Drug Use: Tobacco, Methadone, Injecting

  • Leisure Activity: BASE Jumping, Serious Climbing, Grand Prix Racing

  • Disease/Illness: Heart Disease, Cancer, Respiratory Disease

  • Accident/Injury: Space Travel

  • Other: Deep Sea Fishing

1 in 1,000 – Quite High

  • Drug Use: Heroin, Morphine, Barbiturates, Alcohol

  • Leisure Activity: Hang Gliding, Parachuting, Motorbike Racing, Climbing

  • Disease/Illness : Hypothermia, etc., Mental Disorders, Strokes, Prostate Cancer

  • Accident/Injury: Violence (all), Sudden Infant Death, Hospitals (babies), Shaking (babies)

  • Other: Pollution, White Asbestos, Offshore Oil Work, Mining

1 in 10,000 – Medium

  • Drug Use: Solvents, Benzodiazepines, Dextropropoxy, Dihydrocodeine

  • Leisure Activity: Motor Sports**, Water Sports***, Mountain Hiking, Canoeing

  • Disease/Illness : Diabetes, Leukemia, Influenza, Skin Cancer

  • Accident/Injury: Suicide, Falls, Road Travel/Use, Helicopter travel, General anasthesia by dentist****

  • Other: Construction Work, Farming/Agriculture, Police Custody, Giving Birth (overall)

1 in 100,000 – Quite Low

  • Drug Use: Ecstasy/MDMA, Amphetamine, Cocaine, GHB, Prescription Drugs, Analgesics, Contraceptive Pill

  • Leisure Activity: Dance Parties, Fighting Sports, Snow Sports, Soccer & Rugby, DIY (home), Sports Spectator

  • Disease/Illness : Meningitis, HIV/AIDS, Asthma, Sudden Death Syndrome, Food Poisoning, Cervical Cancer

  • Accident/Injury: Airplane Travel, Rail Travel, etc., Stairs (falling), Eating (Choking), Electrocution, Drowning, Fires

  • Other: Child Abuse, Refusal of Intensive Care, Manufacturing (cars), Passive Smoking, X-rays, Machinery, Homicide, Guns

1 in 1 million – Very Low

  • Drug Use: LSD (acid), Mushrooms, Antibiotics, Viagra

  • Leisure Activity: Fairground Rides, Jogging, Swimming, Riding Sports

  • Disease/Illness : Legionnaire’s, Food Allergies

  • Accident/Injury: Falling Out of Bed, Clothing Fires, Boilers/Heaters, Police Cars, Toys

  • Other: Clerical/Office Work, Vaccination

1 in 10 million – Extremely Low

  • Drug Use: Herbal Cannabis, Cannabis Resin, Amyl Nitrates

  • Leisure Activity: Indoor Sports, Playgrounds, Gymnasiums

  • Disease/Illness : CJD (BSE), Toxic Shock Syndrome.

  • Accident/Injury: Insects, Dogs, Alarm Clocks, Lightening

  • Other: Nuclear Radiation, Sexual Intercourse

1 in 100 million – Minimal

  • Drug Use: Caffeine, Khat, Nitrous Oxide, Ketamine, DMT

  • Leisure Activity: Table Games, Computer Games, Masturbation

  • Disease/Illness: Bubonic Plague, Smallpox, Leprosy

  • Accident/Injury: Snakes, Birds, Cats, Sharks, Earthquakes

  • Other: State Executions, Spontaneous Combustion, UFOs/Aliens

Copyright © Russell Newcombe, 1999

Explanation of the above chart.

The above chart is based on the number of people who engaged in the particular activity or were exposed to the cause during a single year (1998) in the United Kingdom. Denominators are based on the most recent prevalence figures (or estimates) for each type of drug use or leisure activity. Activities which involve the entire British population are based on a denominator of 55 million. The above chart neither takes into account the frequency of occasions/exposures nor the magnitude or duration of the cause (i.e., dose of the drug, total flying hours, etc).

Disease/illness ratios are based on the number of people whose behavior exposes them to the disease (i.e., beef-eaters for CJD, sexually active persons for AIDS). Accident/Injury ratios are based on the number of people whose behaviors or qualities expose them to risk of that type of accident or injury (i.e., astronauts for space travel). Other exposure ratios are based on the number of people exposed to this kind of risk.

*Included as a theoretical and quasi-humorous example. The prevalence of Russian roulette playing is not known.
**There is an estimated 200,000 mountain climbers in the UK, and 116 deaths in a decade.
***Water sports involving equipment like boating, surfing, water skiing, scuba-diving and canoeing (1 in 13,200)
****”General Anesthesia.” There were 3 deaths among 35,000 people who received GA for dental work in Britain.

How useful is the chart.

The above chart portrays statistical probabilities only. Statistical probabilities do not reflect the actual chances of the potential harm occurring to every individual who undertakes the activity. This is because some individuals take more precautions than others when engaging in risky activities; some may be more prone to accident or injury than others; and some may be less healthy than others, etc. Nevertheless, statistical analyses like the above chart can assist consumers in performing risk assessments as well as provide useful information to policy-makers in determining medical, drug, and recreational policies.

Trip Brown