BF2S Forums You can't handle the truth on drugs

DesertFox- wrote:

Macbeth wrote:

DesertFox- wrote:

You asked for it

Wish I didn't need an account to view the article.

I'm just a bit skeptical since how they rate the drugs on a scale of 0-3 for society harm, physical harm, and dependency.

You can't view it? Perhaps it's because I'm on a uni connection and we get full text articles. *Interesting fact: I was distracted by a Victoria's Secret commercial while typing this.*

Either way, it's all in support of the graph that summarizes it nicely. They've got a figure that mirrors it as well. This tidbit from their methods might help though:

There are three main factors that together determine the harm associated with any drug of potential abuse: the physical harm to the individual user caused by the drug; the tendency of the drug to induce dependence; and the effect of drug use on families, communities, and society.

Physical
Assessment of the propensity of a drug to cause physical harm—ie, damage to organs or systems—involves a systematic consideration of the safety margin of the drug in terms of its acute toxicity, as well as its likelihood to produce health problems in the long term. The effect of a drug on physiological functions—eg, respiratory and cardiac—is a major determinant of physical harm. The route of administration is also relevant to the assessment of harm. Drugs that can be taken intravenously—eg, heroin—carry a high risk of causing sudden death from respiratory depression, and therefore score highly on any metric of acute harm. Tobacco and alcohol have a high propensity to cause illness and death as a result of chronic use. Recently published evidence shows that long-term cigarette smoking reduces life expectancy, on average, by 10 years.9 Tobacco and alcohol together account for about 90% of all drug-related deaths in the UK.

The UK Medicines and Healthcare Regulatory Authority, in common with similar bodies in Europe, the USA, and elsewhere, has well-established methods to assess the safety of medicinal drugs, which can be used as the basis of this element of risk appraisal. Indeed several drugs of abuse have licensed indications in medicine and will therefore have had such appraisals, albeit, in most cases, many years ago.

Three separate facets of physical harm can be identified. First, acute physical harm—ie, the immediate effects (eg, respiratory depression with opioids, acute cardiac crises with cocaine, and fatal poisonings). The acute toxicity of drugs is often measured by assessing the ratio of lethal dose to usual or therapeutic dose. Such data are available for many of the drugs we assess here.[5], [6] and [7] Second, chronic physical harm—ie, the health consequences of repeated use (eg, psychosis with stimulants, possible lung disease with cannabis). Finally, there are specific problems associated with intravenous drug use.

The route of administration is relevant not only to acute toxicity but also to so-called secondary harms. For instance, administration of drugs by the intravenous route can lead to the spread of blood-borne viruses such as hepatitis viruses and HIV, which have huge health implications for the individual and society. The potential for intravenous use is currently taken into account in the Misuse of Drugs Act classification and was treated as a separate parameter in our exercise.

Dependence
This dimension of harm involves interdependent elements—the pleasurable effects of the drug and its propensity to produce dependent behaviour. Highly pleasurable drugs such as opioids and cocaine are commonly abused, and the street value of drugs is generally determined by their pleasurable potential. Drug-induced pleasure has two components—the initial, rapid effect (colloquially known as the rush) and the euphoria that follows this, often extending over several hours (the high). The faster the drug enters the brain the stronger the rush, which is why there is a drive to formulate street drugs in ways that allow them to be injected intravenously or smoked: in both cases, effects on the brain can occur within 30 seconds. Heroin, crack cocaine, tobacco (nicotine), and cannabis (tetrahydrocannabinol) are all taken by one or other of these rapid routes. Absorption through the nasal mucosa, as with powdered cocaine, is also surprisingly rapid. Taking the same drugs by mouth, so that they are only slowly absorbed into the body, generally has a less powerful pleasurable effect, although it can be longer lasting.

An essential feature of drugs of abuse is that they encourage repeated use. This tendency is driven by various factors and mechanisms. The special nature of drug experiences certainly has a role. Indeed, in the case of hallucinogens (eg, lysergic acid diethylamide [LSD], mescaline, etc) it might be the only factor that drives regular use, and such drugs are mostly used infrequently. At the other extreme are drugs such as crack cocaine and nicotine, which, for most users, induce powerful dependence. Physical dependence or addiction involves increasing tolerance (ie, progressively higher doses being needed for the same effect), intense craving, and withdrawal reactions—eg, tremors, diarrhoea, sweating, and sleeplessness—when drug use is stopped. These effects indicate that adaptive changes occur as a result of drug use. Addictive drugs are generally used repeatedly and frequently, partly because of the power of the craving and partly to avoid withdrawal.

Psychological dependence is also characterised by repeated use of a drug, but without tolerance or physical symptoms directly related to drug withdrawal. Some drugs can lead to habitual use that seems to rest more on craving than physical withdrawal symptoms. For instance, cannabis use can lead to measurable withdrawal symptoms, but only several days after stopping long-standing use. Some drugs—eg, the benzodiazepines—can induce psychological dependence without tolerance, and physical withdrawal symptoms occur through fear of stopping. This form of dependence is less well studied and understood than is addiction but it is a genuine experience, in the sense that withdrawal symptoms can be induced simply by persuading a drug user that the drug dose is being progressively reduced although it is, in fact, being maintained at a constant level.10

The features of drugs that lead to dependence and withdrawal reactions have been reasonably well characterised. The half-life of the drug has an effect—those drugs that are cleared rapidly from the body tend to provoke more extreme reactions. The pharmacodynamic efficacy of the drug also has a role; the more efficacious it is, the greater the dependence. Finally, the degree of tolerance that develops on repeated use is also a factor: the greater the tolerance, the greater the dependence and withdrawal.

For many drugs there is a good correlation between events that occur in human beings and those observed in studies on animals. Also, drugs that share molecular specificity (ie, that bind with or interact with the same target molecules in the brain) tend to have similar pharmacological effects. Hence, some sensible predictions can be made about new compounds before they are used by human beings. Experimental studies of the dependence potential of old and new drugs are possible only in individuals who are already using drugs, so more population-based estimates of addictiveness (ie, capture rates) have been developed for the more commonly used drugs.11 These estimates suggest that smoked tobacco is the most addictive commonly used drug, with heroin and alcohol somewhat less so; psychedelics have a low addictive propensity.

Social
Drugs harm society in several ways—eg, through the various effects of intoxication, through damaging family and social life, and through the costs to systems of health care, social care, and police. Drugs that lead to intense intoxication are associated with huge costs in terms of accidental damage to the user, to others, and to property. Alcohol intoxication, for instance, often leads to violent behaviour and is a common cause of car and other accidents. Many drugs cause major damage to the family, either because of the effect of intoxication or because they distort the motivations of users, taking them away from their families and into drug-related activities, including crime.

Societal damage also occurs through the immense health-care costs of some drugs. Tobacco is estimated to cause up to 40% of all hospital illness and 60% of drug-related fatalities. Alcohol is involved in over half of all visits to accident and emergency departments and orthopaedic admissions.12 However, these drugs also generate tax revenue that can offset their health costs to some extent. Intravenous drug delivery brings particular problems in terms of blood-borne virus infections, especially HIV and hepatitis, leading to the infection of sexual partners as well as needle sharers. For drugs that have only recently become popular—eg, 3,4-methylenedioxy-N-methylamphetamine, better known as ecstasy or MDMA—the longer-term health and social consequences can be estimated only from animal toxicology at present. Of course, the overall use of a drug has a substantial bearing on the extent of social harm.

Dilbert_X wrote:

Depends on what you mean by 'harmful'.
Harmful to the user or to society.

Having schizophrenics walking the streets is more socially damaging than people with imploded noses for example.
Really I don't care if people harm themselves or become dependent, I do care if I'm harmed, my quality of life is affected or have to pick up the bill.

DesertFox- wrote:

Macbeth wrote:

They didn't give a detailed score breakdown of each drug? I would have liked to see how each one scored individually for dependence, physical harm, and society cost rather than all the scores lumped together.

Ugh...

Assessment of harm
Table 1 shows the assessment matrix that we designed, which includes all nine parameters of risk, created by dividing each of the three major categories of harm into three subgroups, as described above. Participants were asked to score each substance for each of these nine parameters, using a four-point scale, with 0 being no risk, 1 some, 2 moderate, and 3 extreme risk. For some analyses, the scores for the three parameters for each category were averaged to give a mean score for that category. For the sake of discussion, an overall harm rating was obtained by taking the mean of all nine scores.
http://static.bf2s.com/files/user/10249/Sci1.jpg
The scoring procedure was piloted by members of the panel of the Independent Inquiry into the Misuse of Drugs Act.13 Drugs and the Law, Report of the Independent Inquiry into the Misuse of Drugs Act 1971, The Police Foundation, London (2000).13 Once refined through this piloting, an assessment questionnaire based on table 1, with additional guidance notes, was used. Two independent groups of experts were asked to do the ratings. The first was the national group of consultant psychiatrists who were on the Royal College of Psychiatrists' register as specialists in addiction. Replies were received and analysed from 29 of the 77 registered doctors who were asked to assess 14 compounds—heroin, cocaine, alcohol, barbiturates, amphetamine, methadone, benzodiazepines, solvents, buprenorphine, tobacco, ecstasy, cannabis, LSD, and steroids. Tobacco and alcohol were included because their extensive use has provided reliable data on their risks and harms, providing familiar benchmarks against which the absolute harms of other drugs can be judged. However, direct comparison of the scores for tobacco and alcohol with those of the other drugs is not possible since the fact that they are legal could affect their harms in various ways, especially through easier availability.

Having established that this nine-parameter matrix worked well, we convened meetings of a second group of experts with a wider spread of expertise. These experts had experience in one of the many areas of addiction, ranging from chemistry, pharmacology, and forensic science, through psychiatry and other medical specialties, including epidemiology, as well as the legal and police services. The second set of assessments was done in a series of meetings run along delphic principles, a new approach that is being used widely to optimise knowledge in areas where issues and effects are very broad and not amenable to precise measurements or experimental testing,14 and which is becoming the standard method by which to develop consensus in medical matters. Since delphic analysis incorporates the best knowledge of experts in diverse disciplines, it is ideally applicable to a complex variable such as drug misuse and addiction. Initial scoring was done independently by each participant, and the scores for each individual parameter were then presented to the whole group for discussion, with a particular emphasis on elucidating the reasoning behind outlier scores. Individuals were then invited to revise their scores, if they wished, on any of the parameters, in the light of this discussion, after which a final mean score was calculated. The complexity of the process means that only a few drugs can be assessed in a single meeting, and four meetings were needed to complete the process. The number of members taking part in the scoring varied from eight to 16. However, the full range of expertise was maintained in each assessment.

This second set of assessments covered the 14 substances considered by the psychiatrists plus, for completeness, six other compounds (khat, 4-methylthioamphetamine [4-MTA], gamma 4-hydroxybutyric acid [GHB], ketamine, methylphenidate, and alkyl nitrites), some of which are not illegal, but for each of which there have been reports of abuse (table 2). Participants were told in advance which drugs were being covered at each meeting to allow them to update their knowledge and consider their opinion. Recent review articles[5], [6], [7], [15], [16], [17] and [18] were provided.


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Table 2.
The 20 substances assessed, showing their current status under the Misuse of Drugs Act
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Occasionally, individual experts were unable to give a score for a particular parameter for a particular drug and these missing values were ignored in the analysis—ie, they were neither treated as zero nor given some interpolated value. Data were analysed with the statistical functions in Microsoft Excel and S-plus.

Results
Use of this risk assessment system proved straightforward and practicable, both by questionnaire and in open delphic discussion. Figure 1 shows the overall mean scores of the independent expert group, averaged across all scorers, plotted in rank order for all 20 substances. The classification of each substance under the Misuse of Drugs Act is also shown. Although the two substances with the highest harm ratings (heroin and cocaine) are class A drugs, overall there was a surprisingly poor correlation between drugs' class according to the Misuse of Drugs Act and harm score. Of both the eight substances that scored highest and the eight that scored lowest, three were class A and two were unclassified. Alcohol, ketamine, tobacco, and solvents (all unclassified at the time of assessment) were ranked as more harmful than LSD, ecstasy, and its variant 4-MTA (all class A drugs). Indeed, the correlation between classification by the Misuse of Drugs Act and harm rating was not significant (Kendall's rank correlation −0·18; p=0·25; Spearman's rank correlation −0·26, p=0·26). Of the unclassified drugs, alcohol and ketamine were given especially high ratings. Interestingly, a very recent recommendation from the Advisory Council on the Misuse of Drugs that ketamine should be added to the Misuse of Drugs Act (as a class C drug) has just been accepted.19
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Figure 1. Mean harm scores for 20 substances

Classification under the Misuse of Drugs Act, where appropriate, is shown by the colour of each bar.

We compared the overall mean scores (averaged across all nine parameters) for the psychiatrists with those of the independent group for the 14 substances that were ranked by both groups (figure 2). The figure suggests that the scores have some validity and that the process is robust, in that it generates similar results in the hands of rather different sets of experts.
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Figure 2. Correlation between mean scores from the independent experts and the specialist addiction psychiatrists

1=heroin. 2=cocaine. 3=alcohol. 4=barbiturates. 5=amphetamine. 6=methadone. 7=benzodiazepines. 8=solvents. 9=buprenorphine. 10=tobacco. 11=ecstasy. 12=cannabis. 13=LSD. 14=steroids.


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Table 3 lists the independent group results for each of the three subcategories of harm. The scores in each category were averaged across all scorers and the substances are listed in rank order of harm, based on their overall score. Many of the drugs were consistent in their ranking across the three categories. Heroin, cocaine, barbiturates, and street methadone were in the top five places for all categories of harm, whereas khat, alkyl nitrites, and ecstasy were in the bottom five places for all. Some drugs differed substantially in their harm ratings across the three categories. For instance, cannabis was ranked low for physical harm but somewhat higher for dependence and harm to family and community. Anabolic steroids were ranked high for physical harm but low for dependence. Tobacco was high for dependence but distinctly lower for social harms, because it scored low on intoxication. Tobacco's mean score for physical harm was also modest, since the ratings for acute harm and potential for intravenous use were low, although the value for chronic harm was, unsurprisingly, very high.


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Table 3.
Mean independent group scores in each of the three categories of harm, for 20 substances, ranked by their overall score, and mean scores for each of the three subscales
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Drugs that can be administered by the intravenous route were generally ranked high, not solely because they were assigned exceptionally high scores for parameter three (ie, the propensity for intravenous use) and nine (health-care costs). Even if the scores for these two parameters were excluded from the analysis, the high ranking for such drugs persisted. Thus, drugs that can be administered intravenously were also judged to be very harmful in many other respects.

Mitch wrote:

There is no arguement when it comes to the intellegence of the civilizations who lived before us, ones who could predict future events, figure out planetary movements, figure out the science of time. They were also heavy drug users, lots of profits were on acid type drugs,

coincedence?


Theres ideas floating around that hallucinagenics (im sure thats spelled incorrectly) cause great ideas to float into your head, things you couldnt think of in normal states.. Maybe the people in charge dont want you obtaining this higher level of thinking. Just watch your TV and feed from our hand.

JohnG@lt wrote:

Mitch wrote:

There is no arguement when it comes to the intellegence of the civilizations who lived before us, ones who could predict future events, figure out planetary movements, figure out the science of time. They were also heavy drug users, lots of profits were on acid type drugs,

coincedence?


Theres ideas floating around that hallucinagenics (im sure thats spelled incorrectly) cause great ideas to float into your head, things you couldnt think of in normal states.. Maybe the people in charge dont want you obtaining this higher level of thinking. Just watch your TV and feed from our hand.

Taking your ideas from Timothy Leary is not a good idea mmmkay?

...
Caffeine intoxication


Main symptoms of caffeine intoxication.[59]
An acute overdose of caffeine, usually in excess of about 300 milligrams, dependent on body weight and level of caffeine tolerance, can result in a state of central nervous system over-stimulation called caffeine intoxication (DSM-IV 305.90),[82] or colloquially the "caffeine jitters". The symptoms of caffeine intoxication are not unlike overdoses of other stimulants. It may include restlessness, nervousness, excitement, insomnia, flushing of the face, increased urination, gastrointestinal disturbance, muscle twitching, a rambling flow of thought and speech, irritability, irregular or rapid heart beat, and psychomotor agitation.[80] In cases of much larger overdoses, mania, depression, lapses in judgment, disorientation, disinhibition, delusions, hallucinations, and psychosis may occur, and rhabdomyolysis (breakdown of skeletal muscle tissue) can be provoked.[83][84]
In cases of extreme overdose, death can result. The median lethal dose (LD50) given orally, is 192 milligrams per kilogram in rats.[2] The LD50 of caffeine in humans is dependent on weight and individual sensitivity and estimated to be about 150 to 200 milligrams per kilogram of body mass, roughly 80 to 100 cups of coffee for an average adult taken within a limited time frame that is dependent on half-life. Though achieving lethal dose with caffeine would be exceptionally difficult with regular coffee, there have been reported deaths from overdosing on caffeine pills, with serious symptoms of overdose requiring hospitalization occurring from as little as 2 grams of caffeine. An exception to this would be taking a drug such as fluvoxamine which blocks the liver enzyme responsible for the metabolism of caffeine, thus increasing the central effects and blood concentrations of caffeine dramatically at 5-fold. It is not contraindicated, but highly advisable to minimize the intake of caffeinated beverages, as drinking one cup of coffee will have the same effect as drinking five under normal conditions.[85][86][87][88] Death typically occurs due to ventricular fibrillation brought about by effects of caffeine on the cardiovascular system.
...

Dilbert_X wrote:

Still never heard of anyone being permanently brainfucked from drinking skunk coffee.
Not heard of anyone being permanently paranoid from a bad beer trip either.

eleven bravo wrote:

weed = schizophrenia? lol

eleven bravo wrote:

specops10-4 wrote:

eleven bravo wrote:

weed = schizophrenia? lol

It can cause it.  I'm in no way trying to scare you but I developed what I hope to be a mild form of it from smoking too much (if that really is possible) weed.

doubtful

if anything youre a schizophrenic that happens to smoke.