Een onderzoek van het wetenschappelijk magazine The Lancet stelde een top20 op van de meest gevaarlijke genotsmiddelen, beginnend met de meest schadelijke
Most dangerous drugs
Research recently published in the medical journal The Lancet rates the most dangerous drugs (starting with the worst) as follows:
klopt volgens mij idd geen zak van: heroine is niet heeeel slecht voor het lichaam mits je goed eet en slaapt.
xtc zo laag? Wat zit er dan in die xtc? Vast geen Amphetamine van nr 9.. is het dan ngo wel xtc?
cocaine slechter dan Street methadone (crystal meth, toch?) crystal meth is veel verslavender en vertyfter.
Zulke lijstjes zijn op zcih wel goed, maar ze moeten verschillende lijsten maken:
1) lichamelijke gezondheid
2) verslavingspotentieel
3) heftigheid roes (valt dat te vergelijken.. niet echt, maar wel een beetje)
Bij 2) staat tabak dan hoog, maar bij 3) heel laag. Dat levert bruikbare lijstjes op. Wanneer je bijvoorbeeld verslavingsgevoelig bent kan je dna naar dat lijstje kijken en besluiten om bepaalde zaken niet te doen.
aha.. in je bron wordt ergens vermeld dat het gaat om de volgorde in verslavend potentieel
dan klopt de lijst best aardig... toch?
aangezien ik alcohol drink kan ik keta dan ook wel eens gaan doen
Uitspraak van permanent verbannen op dinsdag 20 januari 2009 om 13:22:
Zulke lijstjes zijn op zcih wel goed, maar ze moeten verschillende lijsten maken:
1) lichamelijke gezondheid
2) verslavingspotentieel
3) heftigheid roes (valt dat te vergelijken.. niet echt, maar wel een beetje)
Bij 2) staat tabak dan hoog, maar bij 3) heel laag. Dat levert bruikbare lijstjes op. Wanneer je bijvoorbeeld verslavingsgevoelig bent kan je dna naar dat lijstje kijken en besluiten om bepaalde zaken niet te doen.
klopt volgens mij idd geen zak van: heroine is niet heeeel slecht voor het lichaam mits je goed eet en slaapt.
xtc zo laag? Wat zit er dan in die xtc? Vast geen Amphetamine van nr 9.. is het dan ngo wel xtc?
cocaine slechter dan Street methadone (crystal meth, toch?) crystal meth is veel verslavender en vertyfter.
Zulke lijstjes zijn op zcih wel goed, maar ze moeten verschillende lijsten maken:
1) lichamelijke gezondheid
2) verslavingspotentieel
3) heftigheid roes (valt dat te vergelijken.. niet echt, maar wel een beetje)
Bij 2) staat tabak dan hoog, maar bij 3) heel laag. Dat levert bruikbare lijstjes op. Wanneer je bijvoorbeeld verslavingsgevoelig bent kan je dna naar dat lijstje kijken en besluiten om bepaalde zaken niet te doen.
mee eens
In het volledige artikel wordt wel onderscheid gemaakt tussen deze punten.
je kan me veel wijs maken maar dat cannabis erger is dan lsd en ghb
het artikelDevelopment of a rational scale to assess the harm of drugs of potential misuse
Original TextProf David Nutt FMedSci a , Leslie A King PhD b, William Saulsbury MA c, Prof Colin Blakemore FRS d e
Summary
Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion. We also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) for reference. The process proved practicable, and yielded roughly similar scores and rankings of drug harm when used by two separate groups of experts. The ranking of drugs produced by our assessment of harm differed from those used by current regulatory systems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.
Introduction
Drug misuse is one of the major social, legal, and public-health challenges in the modern world. In the UK, the total burden of drug misuse, in terms of health, social, and crime-related costs, has been estimated to be between £10 billion and £16 billion per year,1 with the global burden being proportionately enormous.2, 3
Current approaches to counter drug misuse are interdiction of supply (via policing and customs control), education, and treatment. All three demand clarity in terms of the relative risks and harms that drugs engender. At present, in the UK, attitudes to policing and the punishments for possession and supply of drugs are scaled according to their classification under the Misuse of Drugs Act of 1971,4 while education and health-care provision are nominally tailored to the known actions and harms of specific drugs. Most other countries and international agencies—eg, the UN and WHO—have drug classification systems that purport to be structured according to the relative risks and dangers of illicit drugs. However, the process by which harms are determined is often undisclosed, and when made public can be ill-defined, opaque, and seemingly arbitrary. In part, this lack of clarity is due to the great range and complexity of factors that have to be taken into account in estimation of harm and the fact that scientific evidence is not only limited in many of the relevant areas but also evolves progressively and in unpredictable ways.
These qualifications apply to the evidence base of the current UK Misuse of Drugs Act, in which drugs are segregated into three classes—A, B, and C—that are intended to indicate the dangers of each drug, class A being the most harmful and class C the least. The classification of a drug has several consequences, in particular determining the legal penalties for importation, supply, and possession, as well as the degree of police effort targeted at restricting its use. The current classification system has evolved in an unsystematic way from somewhat arbitrary foundations with seemingly little scientific basis.
Here, we suggest a new system for assessing the potential harms of individual drugs on the basis of fact and scientific knowledge. This system is able to respond to evolving evidence about the potential harm of current drugs and to rank the threat presented by any new street drug.
Categories of harm
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.5—8
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—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.
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.
Table 1Table image
Assessment parameters
The scoring procedure was piloted by members of the panel of the Independent Inquiry into the Misuse of Drugs Act.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 articles5,6,7,15—18 were provided.
Table 2Table image
The 20 substances assessed, showing their current status under the Misuse of Drugs Act
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
Figure 1 Full-size image (40K)
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.
Figure 2 Full-size image (14K)
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.
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.
Table 3Table image
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
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.
Discussion
The results of this study do not provide justification for the sharp A, B, or C divisions of the current classifications in the UK Misuse of Drugs Act. Distinct categorisation is, of course, convenient for setting of priorities for policing, education, and social support, as well as to determine sentencing for possession or dealing. But neither the rank ordering of drugs nor their segregation into groups in the Misuse of Drugs Act classification is supported by the more complete assessment of harm described here. Sharply defined categories in any ranking system are essentially arbitrary unless there are obvious discontinuities in the full set of scores. Figure 1 shows only a hint of such a transition in the spectrum of harm, in the small step in the very middle of the distribution, between buprenorphine and cannabis. Interestingly, alcohol and tobacco are both in the top ten, higher-harm group. There is a rapidly accelerating harm value from alcohol upwards. So, if a three-category classification were to be retained, one possible interpretation of our findings is that drugs with harm scores equal to that of alcohol and above might be class A, cannabis and those below might be class C, and drugs in between might be class B. In that case, it is salutary to see that alcohol and tobacco—the most widely used unclassified substances—would have harm ratings comparable with class A and B illegal drugs, respectively.
Participants were asked to assess the harm of drugs administered in the form that they are normally used. In a few cases, the harms caused by a particular drug could not be completely isolated from interfering factors associated with the particular style of use. For example, cannabis is commonly smoked as a mixture with tobacco, which might have raised its scores for physical harm and dependence, among other factors. There is a further degree of uncertainty resulting from polydrug use, especially in the so-called recreational group of drugs that includes GHB, ketamine, ecstasy, and alcohol, for which adverse effects could be attributed mainly to one of the components of commonly used mixtures. Crack cocaine is generally deemed to be more dangerous than powdered cocaine, but they were not considered separately in this study. Similarly, the scores for the benzodiazepines might have been biased in the direction of the most abused drugs, especially temazepam. Individual scoring for particular benzodiazepines and for the various forms in which other drugs are used would be more appropriate should this or any other system of harm classification be used in a formal setting.
In view of the small numbers of independent scores, we did not think that estimation of correlations between the nine parameters was legitimate. There is quite likely to be some redundancy—ie, the nine parameters might not represent nine independent measures of risk. In much the same way, the principal components of the parameters were not extracted, partly because we thought that there were insufficient data and partly because reduction of the number of parameters to a core group might not be appropriate, at least until further assessment panels have independently validated the entire system.
Our analysis gave equal weight to each parameter of harm, and individual scores have simply been averaged. Such a procedure would not give a valid indication of harm for a drug that has extreme acute toxicity, such as the designer drug contaminant MPTP (1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine), a single dose of which can damage the substantia nigra of the basal ganglia so severely that it induces an extreme form of Parkinson's disease. Indeed, this simple method of integrating scores might not deal adequately with any substance that is extremely harmful in only one respect. Take tobacco, for instance. Smoking tobacco beyond the age of 30 years reduces life expectancy by an average of up to 10 years,9 and it is the commonest cause of drug-related deaths, placing a huge burden on health services. However, tobacco's short-term consequences and social effects are unexceptional. Of course, the weighting of individual parameters could be varied to emphasise one facet of risk or another, depending on the importance attached to each. Other procedural mechanisms, such as those of multi-criteria decision analysis,20 could be used to take account of variation of ranking across different parameters of harm. Despite these reservations about the interpretation of integrated scores and the need for further consideration of the weighting of parameters of harm, we were greatly encouraged by the general consistency of scores across scorers and across parameters of harm for most drugs.
Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.
We believe that a system of classification like ours, based on the scoring of harms by experts, on the basis of scientific evidence, has much to commend it. Our approach provides a comprehensive and transparent process for assessment of the danger of drugs, and builds on the approach to this issue developed in earlier publications5—8,11,12,21,22 but covers more parameters of harm and more drugs, as well as using the delphic approach, with a range of experts. The system is rigorous and transparent, and involves a formal, quantitative assessment of several aspects of harm. It can easily be reapplied as knowledge advances. We note that a numerical system has also been described by MacDonald and colleagues23 to assess the population harm of drug use, an approach that is complementary to the scheme described here, but as yet has not been applied to specific drugs. Other organisations (eg, the European Monitoring Centre for Drugs and Drug Addiction24 and the CAM committee of the Dutch government25) are currently exploring other risk assessment systems, some of which are also numerically based. Other systems use delphic methodology, although none uses such a comprehensive set of risk parameters and no other has reported on such a wide range of drugs as our method. We believe that our system could be developed to aid in decision-making by regulatory bodies—eg, the UK's Advisory Council on the Misuse of Drugs and the European Medicines Evaluation Agency—to provide an evidence-based approach to drug classification.
Contributors
All authors contributed to the study design, analysis, and writing of the manuscript. All authors saw and approved the final version of the manuscript.
Conflict of interest statement
We declare that we have no conflict of interest.
Acknowledgments
Some of the ideas developed in this paper arose out of discussion at workshops organised by the Beckley Foundation, to whom we are grateful. We thank David Spiegelhalter of the MRC Biostatistics Unit for advice on statistics. An early version of this paper was requested by the House of Commons Select Committee on Science and Technology to assist in their review on the evidence base of the drug laws, and appeared unacknowledged as Appendix 10 of their report.26
je kan me veel wijs maken maar dat cannabis erger is dan lsd en ghb
Tja, misschien in bepaalde opzichten. Dat lsd onder cannabis staat is wel heel logisch trouwens. Ik vind het uberhoupt vreemd dat lsd in de lijst staat.
Cannabis is slecht voor de longen en hersencellen etc. terwijl van lsd geen schadelijke effecten op het lichaam bekend zijn. Ook is cannabis aardig verslavend, lsd niet.
Cannabis is slecht voor de longen en hersencellen etc. terwijl van lsd geen schadelijke effecten op het lichaam bekend zijn. Ook is cannabis aardig verslavend, lsd niet.
Cannabis is slecht voor de longen en hersencellen etc. terwijl van lsd geen schadelijke effecten op het lichaam bekend zijn. Ook is cannabis aardig verslavend, lsd niet.
Uitspraak van inactief op dinsdag 20 januari 2009 om 14:30:
Dit onderzoek wordt verkeerd geïnterpreteerd.
Dit onderzoek richt zich op hoe veel schade bepaalde drugs op de maatschappij aanrichten, en niet op het individu. Vandaar dat alcohol zo hoog staat. Het wordt enorm veel gebruikt.
Het feit dat xtc op 18 staat verbaast mij ten zeerste. Ik krijg het gevoel dat ik moet stoppen met zuipen en roken. Dan kan ik 5 pilletjes per dag nemen
ghb mag zeker hoger op de lijst
afkicken van de ghb is even erg als afkicken van heroine en crack, al niet erger..
als je lang en veel gebruikt, kan het dodelijk zijn om er zomaar mee te stoppen
de afkick is een ware nachtmerrie
en doordat het zo ontzettend goedkoop en makkelijk te maken/krijgen is, is het nog gevaarlijker.
en ook omdat ghb nog niet zo bekend staat als een verslavende drugs, denken mensen er vaak te makkelijk over.
maarja het hangt er vanaf waar je je lijstje op baseert eigenlijk
als je kijkt naar in welke mate algemene problemen worden veroorzaakt door bepaalde drugs,
zal ghb waarshcijnlijk wel niet zo hoog scoren
maar het goedje word o zo onderschat
wat een budlijst. Wat ik lees hebben ze drie criteria genomen:
Nutt and colleagues used three factors to determine the harm associated with any drug: the physical harm to the user, the drug's potential for addiction and the impact on society of drug use.
en daarna een aantal 'experts' daarop laten scoren. De lijst is volgens mij vooral een weerspiegeling van wat je in de maatschappij ziet aan gevolgen. Van de top 5 heb je gewoon de meeste junkies op straat lopen. Dat valt dus op.
Ook vreemd dat LSD zo hoog staat.
verslaving: Kans op verslaving is er dan ook nauwelijks. bron lsd heeft een snelle tolerantie, na een paar dagen merk je er niks meer van. Afbouwen gaat niet gepaard met afkickverschijnselen.
Fysiek: LSD heeft nauwelijks negatieve lichamelijke impact. Geestelijk kan het des te heftiger zijn.
Misschien dat ze die geestelijke impact (kans op psychoses etc) onder impact op de maatschappij rekenen...
En ook vreemd dat xtc zo laag staat. Is fysiek toch een stuk slechter voor je. Bovendien zijn er voldoende mensen die elk weekend slikken, en daar goed van naar de kl*te gaan. En helemaal raar dat GHB zo laag staat. Dat is op geen enkele manier verdedigbaar in mijn ogen...
Maar goed, onzinnige lijst dus.
Ik zou wel eens graag een lijst zien van de verhoudingen werkzame dosis / LD50 dosis. Is volgens mij een veel zinnigere en objectievere lijst. Maar dat is weer n hele klus....
Dit onderzoek wordt verkeerd geïnterpreteerd.
Dit onderzoek richt zich op hoe veel schade bepaalde drugs op de maatschappij aanrichten, en niet op het individu. Vandaar dat alcohol zo hoog staat.
Dat klinkt idd wat logischer... GHB veroorzaakt relatief nog weinig maatschappelijke problemen, dus staat t lager. Maar dan nog, canabis zo hoog... Alsof dat zoveel maatschappelijke problemen veroorzaakt??
Hoe vaak heeft deze lijst nu onderhand al wel op dit forum gestaan... zucht..
Ben het overigens niet eens met deze lijst. Khat heeft hele volksstammen het zwijgen opgelegd.
Dat klinkt idd wat logischer... GHB veroorzaakt relatief nog weinig maatschappelijke problemen, dus staat t lager. Maar dan nog, canabis zo hoog... Alsof dat zoveel maatschappelijke problemen veroorzaakt??
1 op de 10 cannabisgebruikers raakt verslaafd volgens Nederlandse onderzoeken. Vaak presteren die mensen minder goed op hun school of werk of stoppen er helemaal mee. Kan ook dat deel van het onderzoek dus ook best begrijpen.
Ik zou wel eens graag een lijst zien van de verhoudingen werkzame dosis / LD50 dosis. Is volgens mij een veel zinnigere en objectievere lijst. Maar dat is weer n hele klus....
Is gewoon op erowid te vinden.
En overdosis is absoluut niet het enige gevaar van dit soort middelen. Ik vind dat andere schadefactoren ook mee moeten tellen, anders gaat het onderzoek alleen over directe overdoses na een drug, en niet over de schadelijkheid bij wijs gebruik.
Een lijst schadelijke drugs kan je niet maken, omdat je soorten risico´s niet kan wegen. Een kans op een psychose kan je niet vergelijken met mogelijke leverschade.
De LD50 wel ja. En de typical human doses.
Maar wat mij nou juist interesseert zou zijn:
caffeine: ld50 127 mg/kg. Werkzame dosis: 100-200 mg. Uitgaande van een 70 kg persoon, krijg je dan een verhouding van:
1:88
voor DMT wordt dat: ld50 110, werkzaam 60, verhouding bij 70 kg: 1:128
bij alcohol: 10 g/kg. werkzaam: 15 g. Verhouding bij 70 kg: 1:46
Zo zou je dus het volgende minilijstje krijgen voor deze drie stoffen:
Alcohol: 1:46
caffeine: 1:88
DMT: 1:128
Maar ik heb geen zin om dat voor al die 20 stoffen uit te rekenen. Maar zou dus wel een leuke lijst zijn, denk ik...
Een kans op een psychose kan je niet vergelijken met mogelijke leverschade.
daar heb je gelijk in...
Verslavingskans zou ook moeten meewegen. Maar de hoeveelheid verslaafden in de opvang zegt wel iets, maar ook niet veel...Kan ook heel erg aan cultuur enzo liggen. En idd, psychische risicos maar die zijn lastig schaalbaar.
je kan me veel wijs maken maar dat cannabis erger is dan lsd en ghb
Dit klopt echter wel degelijk,....
Het klopt allemaal wel, zijn meerdere onderzoeken die tot precies dezelfde conclusies komen.
Het gaat hierom om het totale gevaar, verslaving, kosten, lichamelijke kwesties bij elkaar gemengt. Er zijn ook mooie tabellen van trouwens ^^
Xtc/lsd/ghb zijn lichamelijk ook niet echt schadelijk, en de verslaving zit er ook niet snel in. Cannabis is zowiezo trickyer om het niet dagelijks te krijgen, en de schade aan je longen is toch behoorlijk, tenzij je het verdampt natuurlijk
het artikelDevelopment of a rational scale to assess the harm of drugs of potential misuse
Original TextProf David Nutt FMedSci a , Leslie A King PhD b, William Saulsbury MA c, Prof Colin Blakemore FRS d e
Summary
Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion. We also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) for reference. The process proved practicable, and yielded roughly similar scores and rankings of drug harm when used by two separate groups of experts. The ranking of drugs produced by our assessment of harm differed from those used by current regulatory systems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.
Introduction
Drug misuse is one of the major social, legal, and public-health challenges in the modern world. In the UK, the total burden of drug misuse, in terms of health, social, and crime-related costs, has been estimated to be between £10 billion and £16 billion per year,1 with the global burden being proportionately enormous.2, 3
Current approaches to counter drug misuse are interdiction of supply (via policing and customs control), education, and treatment. All three demand clarity in terms of the relative risks and harms that drugs engender. At present, in the UK, attitudes to policing and the punishments for possession and supply of drugs are scaled according to their classification under the Misuse of Drugs Act of 1971,4 while education and health-care provision are nominally tailored to the known actions and harms of specific drugs. Most other countries and international agencies—eg, the UN and WHO—have drug classification systems that purport to be structured according to the relative risks and dangers of illicit drugs. However, the process by which harms are determined is often undisclosed, and when made public can be ill-defined, opaque, and seemingly arbitrary. In part, this lack of clarity is due to the great range and complexity of factors that have to be taken into account in estimation of harm and the fact that scientific evidence is not only limited in many of the relevant areas but also evolves progressively and in unpredictable ways.
These qualifications apply to the evidence base of the current UK Misuse of Drugs Act, in which drugs are segregated into three classes—A, B, and C—that are intended to indicate the dangers of each drug, class A being the most harmful and class C the least. The classification of a drug has several consequences, in particular determining the legal penalties for importation, supply, and possession, as well as the degree of police effort targeted at restricting its use. The current classification system has evolved in an unsystematic way from somewhat arbitrary foundations with seemingly little scientific basis.
Here, we suggest a new system for assessing the potential harms of individual drugs on the basis of fact and scientific knowledge. This system is able to respond to evolving evidence about the potential harm of current drugs and to rank the threat presented by any new street drug.
Categories of harm
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.5—8
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—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.
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.
Table 1Table image
Assessment parameters
The scoring procedure was piloted by members of the panel of the Independent Inquiry into the Misuse of Drugs Act.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 articles5,6,7,15—18 were provided.
Table 2Table image
The 20 substances assessed, showing their current status under the Misuse of Drugs Act
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
Figure 1 Full-size image (40K)
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.
Figure 2 Full-size image (14K)
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.
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.
Table 3Table image
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
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.
Discussion
The results of this study do not provide justification for the sharp A, B, or C divisions of the current classifications in the UK Misuse of Drugs Act. Distinct categorisation is, of course, convenient for setting of priorities for policing, education, and social support, as well as to determine sentencing for possession or dealing. But neither the rank ordering of drugs nor their segregation into groups in the Misuse of Drugs Act classification is supported by the more complete assessment of harm described here. Sharply defined categories in any ranking system are essentially arbitrary unless there are obvious discontinuities in the full set of scores. Figure 1 shows only a hint of such a transition in the spectrum of harm, in the small step in the very middle of the distribution, between buprenorphine and cannabis. Interestingly, alcohol and tobacco are both in the top ten, higher-harm group. There is a rapidly accelerating harm value from alcohol upwards. So, if a three-category classification were to be retained, one possible interpretation of our findings is that drugs with harm scores equal to that of alcohol and above might be class A, cannabis and those below might be class C, and drugs in between might be class B. In that case, it is salutary to see that alcohol and tobacco—the most widely used unclassified substances—would have harm ratings comparable with class A and B illegal drugs, respectively.
Participants were asked to assess the harm of drugs administered in the form that they are normally used. In a few cases, the harms caused by a particular drug could not be completely isolated from interfering factors associated with the particular style of use. For example, cannabis is commonly smoked as a mixture with tobacco, which might have raised its scores for physical harm and dependence, among other factors. There is a further degree of uncertainty resulting from polydrug use, especially in the so-called recreational group of drugs that includes GHB, ketamine, ecstasy, and alcohol, for which adverse effects could be attributed mainly to one of the components of commonly used mixtures. Crack cocaine is generally deemed to be more dangerous than powdered cocaine, but they were not considered separately in this study. Similarly, the scores for the benzodiazepines might have been biased in the direction of the most abused drugs, especially temazepam. Individual scoring for particular benzodiazepines and for the various forms in which other drugs are used would be more appropriate should this or any other system of harm classification be used in a formal setting.
In view of the small numbers of independent scores, we did not think that estimation of correlations between the nine parameters was legitimate. There is quite likely to be some redundancy—ie, the nine parameters might not represent nine independent measures of risk. In much the same way, the principal components of the parameters were not extracted, partly because we thought that there were insufficient data and partly because reduction of the number of parameters to a core group might not be appropriate, at least until further assessment panels have independently validated the entire system.
Our analysis gave equal weight to each parameter of harm, and individual scores have simply been averaged. Such a procedure would not give a valid indication of harm for a drug that has extreme acute toxicity, such as the designer drug contaminant MPTP (1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine), a single dose of which can damage the substantia nigra of the basal ganglia so severely that it induces an extreme form of Parkinson's disease. Indeed, this simple method of integrating scores might not deal adequately with any substance that is extremely harmful in only one respect. Take tobacco, for instance. Smoking tobacco beyond the age of 30 years reduces life expectancy by an average of up to 10 years,9 and it is the commonest cause of drug-related deaths, placing a huge burden on health services. However, tobacco's short-term consequences and social effects are unexceptional. Of course, the weighting of individual parameters could be varied to emphasise one facet of risk or another, depending on the importance attached to each. Other procedural mechanisms, such as those of multi-criteria decision analysis,20 could be used to take account of variation of ranking across different parameters of harm. Despite these reservations about the interpretation of integrated scores and the need for further consideration of the weighting of parameters of harm, we were greatly encouraged by the general consistency of scores across scorers and across parameters of harm for most drugs.
Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. Our results also emphasise that the exclusion of alcohol and tobacco from the Misuse of Drugs Act is, from a scientific perspective, arbitrary. We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.
We believe that a system of classification like ours, based on the scoring of harms by experts, on the basis of scientific evidence, has much to commend it. Our approach provides a comprehensive and transparent process for assessment of the danger of drugs, and builds on the approach to this issue developed in earlier publications5—8,11,12,21,22 but covers more parameters of harm and more drugs, as well as using the delphic approach, with a range of experts. The system is rigorous and transparent, and involves a formal, quantitative assessment of several aspects of harm. It can easily be reapplied as knowledge advances. We note that a numerical system has also been described by MacDonald and colleagues23 to assess the population harm of drug use, an approach that is complementary to the scheme described here, but as yet has not been applied to specific drugs. Other organisations (eg, the European Monitoring Centre for Drugs and Drug Addiction24 and the CAM committee of the Dutch government25) are currently exploring other risk assessment systems, some of which are also numerically based. Other systems use delphic methodology, although none uses such a comprehensive set of risk parameters and no other has reported on such a wide range of drugs as our method. We believe that our system could be developed to aid in decision-making by regulatory bodies—eg, the UK's Advisory Council on the Misuse of Drugs and the European Medicines Evaluation Agency—to provide an evidence-based approach to drug classification.
Contributors
All authors contributed to the study design, analysis, and writing of the manuscript. All authors saw and approved the final version of the manuscript.
Conflict of interest statement
We declare that we have no conflict of interest.
Acknowledgments
Some of the ideas developed in this paper arose out of discussion at workshops organised by the Beckley Foundation, to whom we are grateful. We thank David Spiegelhalter of the MRC Biostatistics Unit for advice on statistics. An early version of this paper was requested by the House of Commons Select Committee on Science and Technology to assist in their review on the evidence base of the drug laws, and appeared unacknowledged as Appendix 10 of their report.26
Xtc/lsd/ghb zijn lichamelijk ook niet echt schadelijk, en de verslaving zit er ook niet snel in. Cannabis is zowiezo trickyer om het niet dagelijks te krijgen, en de schade aan je longen is toch behoorlijk, tenzij je het verdampt natuurlijk
Dit is bullshit.
Xtc is lichamelijk één van de destructiefste drugs.
Maar nogmaals, dit onderzoek wordt hier verkeerd geïnterpreteerd. Het gaat om schade aan de maatschappij, niet om schade op het individu.
Dit onderzoek wordt verkeerd geïnterpreteerd.
Dit onderzoek richt zich op hoe veel schade bepaalde drugs op de maatschappij aanrichten, en niet op het individu. Vandaar dat alcohol zo hoog staat. Het wordt enorm veel gebruikt.
dat denk ik ook, en recreatief gebruik niet ieder weekend volle bak aan de nr 1 t/m 20
Het is zelfs zo dat je, als je eenmaal echt veel gebruikt, niet zomaar kunt stoppen. Is echt gevaarlijk, omdat je er afhankelijk van bent geworden. Je moet langzaam afbouwen.
Maar nogmaals, dit onderzoek wordt hier verkeerd geïnterpreteerd. Het gaat om schade aan de maatschappij, niet om schade op het individu.
Ik heb de docu zelf bekeken, http://video.google.nl/googleplayer.swf?docId=6108672696241807159 , daar komt het toch allemaal wat genuanceerder over. Niet dat ik alles logisch vind, maar t is wel zinnig om wat meer argumenten te horen bij elke positie.
Komt steeds meer voor de laatste tijd hoor. Mensen die het elke avond gebruiken, vervolgens niet meer kunnen slapen zonder, en op het einde wakker 's nachts wakker worden en nog een buisje moeten nemen om verder te kunnen slapen. En als je op dat punt bent kan je niet ineens stoppen omdat je er afhankelijk van bent, maar moet je afbouwen.
Uiteindelijk dacht ik alleen maar aan mezelf, steeds zoekende met doseringen naar die momenten die je had toen je het voor het eerst gebruikte, en ik zag zelf niet in hoeveel ik veranderde tov hoe ik was voor de gbl..
Uiteindelijk, na de ergste afkick die ik tot toen toe had gehad ( had denk wel 4 of 5 zware afkick periodes) maar de afkick die ik toen kreeg was zo erg , dat had ik nog nooit ervaren, 2 weken zeer kort slapen 1 a 2 uur per nacht (met gbl) waanideen, angsten, nachten zitten huilen, nee dat was het voor mij.
afbouwen , sauna, detox rommel van de drogist, zoveel mogelijk appels eten , kalk tabletten, vit c tabletten , vit b12 tabletten (voor de eetlust) , druivesuiker, vit e etc, uiteindelijk heeft het me weer op het recht pad gebracht
Dit is bullshit.
Xtc is lichamelijk één van de destructiefste drugs.
lol, indd
Xtc valt wel mee, enige gevaar is de gebruiker zelf, het is vaak ook niet echt verslavend gezien je serotonine een paar weken nodig heeft om zich te herstellen.
Xtc valt wel mee, enige gevaar is de gebruiker zelf, het is vaak ook niet echt verslavend gezien je serotonine een paar weken nodig heeft om zich te herstellen.
Toch zijn er mensen die elke week pillen als biertjes slikken en daarmee enorme hersenschade oplopen.
99% kan er echter prima mee omgaan en procentueel gezien valt het reuze mee, die mensen nemen vaak ook veel meer andere dingen waaronder coke en speed. Wat het ook al weer een stuk gecompliceerder word.
99% kan er echter prima mee omgaan en procentueel gezien valt het reuze mee, die mensen nemen vaak ook veel meer andere dingen waaronder coke en speed. Wat het ook al weer een stuk gecompliceerder word.
Mag ik de cijfers zien waarop jij dat baseert? Volgens mij onderschat je het percentage probleemgebruiker, al is elke gebruiker in principe een probleemgebruiker omdat het bij eenmalig gebruik ook niet uitgesloten veilig is. Verre van zelfs.
Risico's onderschatten is dom.
laatste aanpassing
Mensen lees eerst het onderzoek of bekijk de docu van BBC!!!
Het onderzoek is op de volgende zaken gebaseerd:
1. Schade individu
2. Gevolgen omgeving/maatschappij
3. Sterkte van verslaving
Daarnaast is het een onderzoek wat over Groot Brittannië gaat.
het is vaak ook niet echt verslavend gezien je serotonine een paar weken nodig heeft om zich te herstellen
Het verslavingspotentieel is tov andere drugs idd niet echt groot (die 99% lijkt me uit de lucht gegrepen, en is natuurlijk sterk afhankelijk van wanneer je iemand een probleemgebruiker noemt, maar het is iig relatief klein).
Het verslavingspotentiaal is waarschijnlijk alleen niet heel erg afhankelijk van het serotonine punt wat je noemt (dit klopt wel verder), maar waarschijnlijk meer van het dopamine shot wat de Nucleus Accumbens (het genotscentrum/beloningscentrum) in de hersenen krijgt. Recent onderzoek naar verslaving toont aan dat dit erg belangrijk is bij verslaving, en de prettigheid van de ervaring veel minder. Merk ook op dat andere drugs die op serotonine werken (paddo's, LSD, 2CB) niet of nauwelijks verslavend zijn. XTC heeft alleen vergeleken met bepaalde andere drugs een wat kleiner effect op dopamine shot in de Nucleus Accumbens, en is waarschijnlijk daarom minder verslavend.
Misschien is die street methadone wel crystal meth(adone)?
Qua plek zou het kloppen, maar qua naam echt niet. Methadone is wat anders dan crystal meth(amphetamine)
het een is een opiaat, het ander een amfetamine.
dat is dan 17 + 2 = 19 / 2 = 8
8 is gelijk aan amphetamine
ja en wie zei dat je maar naar alle hartelust mag delen, optellen, aftrekken en vermenigvuldigen met de nummers die voor de lijst staan?
en dan ook nog maar 'ns gemiddelden mag nemen?
Uitspraak van verwijderd op dinsdag 20 januari 2009 om 14:46:
Narcose o.a...pentobarbital geloof ik ook.... (epilepsie middel)
Mja barbituraten zijn zoals eerder gezegd zware slaapmiddelen. Wat ik iig weet van pentobarbital is dat je er vele dagen mee in coma gehouden kan worden, in het ziekenhuis. Ik weet van een geval, en dat zal zeker geen zeldzaam geval zijn, die 2 weken in slaap is gehouden ermee. Ma
Dat lijkt me sowieso vrij duidelijk. Ik zou bijna willen zeggen in welke dosering ook, maar dat is nog net niet zo Nee maar alcohol is vele malen gevaarlijker dan LSD. LSD is niet schadelijk voor je lichaam en niet verslavend, terwijl alcohol op deze twee punten zo'n beetje het ergste is wat er is qua drugs
Zeker wel.
T is verslavender.
T is fysiek schadelijker.
En in het onderzoek hebben ze zoals gezegd gekeken naar de maatschappelijke impact. De hoeveelheid doden, ontwrichte gezinnen, agressie etc is enorm hoog van alcohol. Vergelijk dat met LSD...
Lijkt erop dat je gewoon niet weet waar je het over hebt, ofwel baseer je je op heeeeeel andere gegevens waar ik dan wel benieuwd naar ben.
In verhouding tot de werkende hoeveelheid, kan je lichaam zeer veel lsd verdragen. Het probleem is alleen dat het teveel aan lsd zich opslaat in het vet, waardoor je bij een volgende lichamelijke inspanning ( sport), spontaan kan gaan trippen.
ja en wie zei dat je maar naar alle hartelust mag delen, optellen, aftrekken en vermenigvuldigen met de nummers die voor de lijst staan?
en dan ook nog maar 'ns gemiddelden mag nemen?
Uitspraak van verwijderd op donderdag 22 januari 2009 om 10:47:
We zullen maar zeggen: fijn dat je rekenen beheerst op dit niveau. Dat is al heel wat he
Part Roy was ook serieus met zijn reken-post
het teveel aan lsd zich opslaat in vet
Ff googelen op lsd urban legend (oftewel: broodje aap)
Eerste hit:
A legend with particular appeal to anti-drug educators who wish to instill a fear of the potential long-term effects of LSD in their pupils, and also among casual high school age LSD users, is that the body stores crystallized LSD in spinal fluid or in fat cells, which at some point dislodges and causes horrific flashbacks, perhaps years later. Although the body does store some toxins in fat tissue, and residues of some drugs and toxins can be found in spinal fluid, LSD is not among these. LSD is metabolized by the liver, and has an elimination half-life of around 2.5 hours
En party roy kennen we inderdaad van zijn doordachte en intelligente bijdrages hier. Ik vond het al vreemd, zo'n schijnbaar loze/domme opmerking. Past helemaal niet bij party roy.
Dat lijkt me sowieso vrij duidelijk. Ik zou bijna willen zeggen in welke dosering ook, maar dat is nog net niet zo Nee maar alcohol is vele malen gevaarlijker dan LSD. LSD is niet schadelijk voor je lichaam en niet verslavend, terwijl alcohol op deze twee punten zo'n beetje het ergste is wat er is qua drugs
Ligt er maar net aan hoe je het gebruikt. Een zware alcoholverslaving treedt niet heel snel op. En bij normaal gebruik van alcohol is de kans veel kleiner dat je er negatieve gevolgen van ondervindt dan met een gebruikersdosis LSD. Zeg maar gerust dat je bij recreatief gebruik van de alcoholschade niks zal merken. Bij LSD is dit een ander verhaal.
Het is nogal achterdochtig om te zeggen dat LSD veiliger is om die reden.
Maar het is appels met peren vergelijken; lichamelijke risico's met psychische risico's. En naar LSD is te weinig onderzoek gedaan om de gevolgen duidelijk vast te kunnen stellen.
Het probleem is alleen dat het teveel aan lsd zich opslaat in het vet, waardoor je bij een volgende lichamelijke inspanning ( sport), spontaan kan gaan trippen.
Dit is een fabeltje. Flashbacks na LSD gebruik komen nauwelijks voor, en dat het zou komen dat het zich opslaat in je vet is gewoon pertinent niet waar. Het slaat zich niet op in je vet en verdwijnt compleet uit je lichaam
Ligt er maar net aan hoe je het gebruikt. Een zware alcoholverslaving treedt niet heel snel op. En bij normaal gebruik van alcohol is de kans veel kleiner dat je er negatieve gevolgen van ondervindt dan met een gebruikersdosis LSD. Zeg maar gerust dat je bij recreatief gebruik van de alcoholschade niks zal merken. Bij LSD is dit een ander verhaal.
Het is nogal achterdochtig om te zeggen dat LSD veiliger is om die reden.
Maar het is appels met peren vergelijken; lichamelijke risico's met psychische risico's. En naar LSD is te weinig onderzoek gedaan om de gevolgen duidelijk vast te kunnen stellen.
Van alcohol heb je ook geestelijke risico's. Of een zware alcoholverslaving optreedt hangt af van je definitie van zwaar. Alcohol is behoorlijk verslavend, en alcoholverslaving komt vrij veel voor. LSD is daarentegen helemaal niet verslavend. Ik vind zelf 10 glazen op een avond nog vallen onder recreatief gebruik, en hierdoor ben je al vrij zeker dat je (een klein beetje) schade oploopt. Bij LSD heb je bij eenmalig recreatief gebruik hoogstens een vervelende ervaring. Andere risico's zijn bijzonder klein. Ik zou alcohol dus zowel op geestelijke als lichamelijke risico's gevaarlijker inschatten.
En bij normaal gebruik van alcohol is de kans veel kleiner dat je er negatieve gevolgen van ondervindt dan met een gebruikersdosis LSD. Zeg maar gerust dat je bij recreatief gebruik van de alcoholschade niks zal merken. Bij LSD is dit een ander verhaal.
even wat cijfers over alcohol
op een rij:
# KPMG becijferde in 1995 dat alcoholproblemen op het werk de maatschappij zo'n 2½ miljard euro kost op jaarbasis
# jaarlijks sterven in Nederland 2500 mensen aan de directe gevolgen van alcohol
# Onder invloed van alcohol ontstaan veel vechtpartijen, huiselijk geweld en 17% van kindermishandeling.
# Bij een op de vier jonge mannen die sterft, speelt alcohol een rol. Daarmee is het de belangrijkste doodsoorzaak voor de leeftijdscategorie 15 tot 29 jaar.
# eschat wordt dat circa 2 tot 4% van de Nederlandse bevolking (ruim 300.000 mensen) aan alcohol verslaafd is (dagelijks meer dan twaalf glazen alcohol per dag). Tel daarbij op het aantal 'stevige drinkers' (gemiddeld zo'n acht glazen per dag), dan komen wij zeker op 650.000 mensen met een alcoholprobleem.
Over LSD:
# Bij de verslavingszorg hebben zich in 2004, 13 mensen gemeld met een LSD probleem.
# in Nederland 130.000 mensen zijn die enige ervaring hebben met LSD
# Geestelijke afhankelijkheid: nee.
# Tolerantie: Ja. Echter zo sterk, dat na een aantal dagen geen enkele dosis meer effect heeft.
# Ontwenningsverschijnselen: nee
# LSD kan bij personen die gevoelig zijn voor psychoses, een psychose oproepen.
# bad trip: het verschil tussen trip en werkelijkheid kan verloren gaan de gebruiker kan het idee krijgen dat hij de controle over zijn gedachten verliest. Dit alles kan zeer angstig zijn.
Dus....Zou ik best het tegenovergestelde durven beweren van wat jij zegt:
En bij normaal gebruik van LSD is de kans veel kleiner dat je er negatieve gevolgen van ondervindt dan met een gebruikersdosis alcohol. Zeg maar gerust dat je bij recreatief gebruik van de LSD schade niks zal merken. Bij alchol is dit een ander verhaal.
ok, dat klinkt wel weer wat overdreven. Maar een alcoholverslaving is veel trickier. Ik bedoel, het sluipt er veel makkelijker in door de sociale erkenning. In de docu die de aanleiding is voor dit topic, wordt ook gezegd: werd alcohol nu uitgevonden, dan zou het zeker een class A drug zijn...
Hoe de fuk kan je verslaafd raken aan GHB dan?
Vraagt je lichaam naar GHB of is het geestelijk, omdat je het een lekker gevoel vind?
Ergens verslaafd aan zijn is een flinke zwakte.
ghb is lichamelijk zeeeer verslavend
een afkick kan even ernstig zijn als die van crack of heroine
enja natuurlijk is het geestelijk ook verslavend, daar begin het allemaal mee he..
Uitspraak van verwijderd op woensdag 21 januari 2009 om 13:57:
Word op den duur vaak als slaapmiddel gebruikt, en vrijwel niks is sterker dan ghb
ghb is zeker geen slaapmiddel, het is een narcose middel.
op het begin zul je misschien wat beter in slaap komen.
maar na verloop van tijd verneukt het juist je slaap, meeste ghb verslaafde slapen maar een uurtje of 4/5/6 per nacht
als je gaat slapen tijdens ghb, word je standaard naar 2/3u weer wakker als het uitgewerkt is
want dan maakt je lichaam een stofje aan waar je wakker van word.
temazepam bijv dat is echt een slaapmiddel
veel mensen denken wel dat ghb een slaapmiddel is ja
maarja sowieso hebben heel veel mensen een verkeerd beeld van ghb
dat het niet verslavend is, of dat het extreem gevaarlijk is omdat er te veel domme mensen zijn die niet weten hoe ze het moeten gebruiken en gewoon slokje nemen en keihard nokkie gaan of iets
en nja komt er nog bij dat het ook als verkrachtingsdrug word gebruikt.
even wat cijfers over alcohol
op een rij:
# KPMG becijferde in 1995 dat alcoholproblemen op het werk de maatschappij zo'n 2½ miljard euro kost op jaarbasis
# jaarlijks sterven in Nederland 2500 mensen aan de directe gevolgen van alcohol
# Onder invloed van alcohol ontstaan veel vechtpartijen, huiselijk geweld en 17% van kindermishandeling.
# Bij een op de vier jonge mannen die sterft, speelt alcohol een rol. Daarmee is het de belangrijkste doodsoorzaak voor de leeftijdscategorie 15 tot 29 jaar.
# eschat wordt dat circa 2 tot 4% van de Nederlandse bevolking (ruim 300.000 mensen) aan alcohol verslaafd is (dagelijks meer dan twaalf glazen alcohol per dag). Tel daarbij op het aantal 'stevige drinkers' (gemiddeld zo'n acht glazen per dag), dan komen wij zeker op 650.000 mensen met een alcoholprobleem.
Dat is allemaal iets anders dan recreatief gebruik. Alcohol heeft een verslavingskans die LSD niet heeft inderdaad.
En bij LSD is het moeilijk directe gevolgen vast te stellen aangezien er onduidelijkheid is of LSD een hoofdfactor of een randfactor is geweest in het probleem.
Alcohol op nummer 1 is gevaarlijkste omdat het het dichts bij de samenleving zit en het meest schadelijke is bij verzaadiging! ( meer dan een aantal vodka's )
cocaine op nummer 2 omdat het een sluipmoordenaar is en geliefd is bij vele doelgroepen.
@tomaas:
dat is allemaal iets anders dan recreatief gebruik
Nou, vechtpartijen, kindermishandeling, dodelijke ongelukken kunnen best bij recreatief gebruik ontstaan.
Daarbij begint iedereen (ook die 650.000 probleemdrinkers) als recreatief gebruiker. Je kunt ook volhouden dat heroine minder erg dan lsd is, wanneer je enkel kijkt naar recreatief gebruik en voor het gemak alle probleemgebruikers buiten beschouwing wilt laten.
Bovendien wordt lsd ook therapeutisch gebruikt en als middel tot zelfontplooiing. Een korte blik in de gemiddelde studentenkroeg vertelt je dat dat met alcohol niet echt aan de orde is
Als je de middelen wilt vergelijken, is het in mijn ogen zeer terecht dat alchol boven lsd staat. Er zijn alleen zoveel misvattingen en spookverhalen over lsd... En alcohol is zo sterk sociaal geaccepteerd...
geen idee, maar wat ik ermee wil zeggen is dat ghb gewoon onderschat word
qua verslaving hoort het in het rijtje, herione, crack etc.
omdat als je eenmaal verslaafd bent, de lichamelijk afkick even erg als heroine kan zijn
en volgens mij is crack lichamelijk niet heel verslavend maar geestelijk wel heel erg
zo ook met ghb
Temazepam slaap je ook maar ff van in, werkt ook niet langer dan een paar uur.
Lorazepam/xanax/oxas zijn meer doorslapers ^^
Ik dacht dat jij wel verstand van benzo's had
Temazepam heeft ook gewoon een halfwaarde tijd van 8-10 uur hoor.
Die benzo's die jij op noemt hebben ongeveer ook dezelfde halfwaarde tijd.
Uitspraak van Jimz op vrijdag 23 januari 2009 om 18:47:
Dat wilt niet zeggen dat ze zo lang werken, na 2 uur merk je er amper wat van.
@ lorazepam is het 16 uur, bizar lang, stond in het bijsluitertje
Mmm ik slaap persoonlijk prima op temazepam, zal ook wel enigzins persoonsgebonden zijn.
Wat je over lorzepam zegt klopt wel inderdaad, 12-16 uur zag ik net ergens staan.
Dan vallen ze ook nog onder de kort tot middellangwerkende benzo's terwijl dat toch al vrij lang is.
Nou, vechtpartijen, kindermishandeling, dodelijke ongelukken kunnen best bij recreatief gebruik ontstaan.
Ten eerste heeft dat niet alleen met de alcohol te maken maar eerder met de randfactoren.
Ten tweede kan het voorkomen worden. Drinken met onderliggende agressiegevoelens of deelnemen aan het verkeer is gewoon dom.
De rest is moeilijk te zeggen, alles varieerd zo erg.
Het ligt aan de persoon zelf wat ie lekker vind.
Het ligt aan wat er te koop is.
Het ligt aan hoe makkelijk het te halen/maken is.
Het ligt aan de prijs.
Er zijn relatief nieuwe en oude drugs soorten (GHB vs Heroine) Wat ik bedoel is misschien is over 10 jaar GHB net zo gevaarlijk als heroine. Als voorbeeld dan het zal wel nooit gebeuren.
Er zijn "legale" drugs (Alcohol, nicotine) Nicotine is waarschijnlijk de meest dodelijke drug in de geschiedenis. Alcohol goede 2de plek.
geen idee, maar wat ik ermee wil zeggen is dat ghb gewoon onderschat word
qua verslaving hoort het in het rijtje, herione, crack etc.
omdat als je eenmaal verslaafd bent, de lichamelijk afkick even erg als heroine kan zijn
en volgens mij is crack lichamelijk niet heel verslavend maar geestelijk wel heel erg
zo ook met ghb
ik denk dat dat wel mee valt,
van ghb krijg je lang niet zoon dikke rush als van hero (geestelijk is hero dus al vele malen verslavender)
en jah verder treed lichamelijke verslaving van heroïne veel sneller op als bij ghb.
bij hero moet je echt wel sterk in je schoenen staan wil je dat bij recreatief gebruik houden.
Bij ghb moet je gewoon een beetje opletten dat het niet een paar keer per week gaat gebruiken want dan krijg je last van slapeloosheid zweten enzo, en daar valt ook nog wel mee te leven, gaat vanzelf wel weer weg. je moet deze verschijnselen natuurlijk niet onderdrukken door opnieuw ghb te pakken. want dan kom je idd in een zwaardere afkick terecht.
van ghb krijg je lang niet zoon dikke rush als van hero (geestelijk is hero dus al vele malen verslavender)
en jah verder treed lichamelijke verslaving van heroïne veel sneller op als bij ghb.
Mwa, heroine is vooral gevaarlijk vanwege het psychologische effect, meende dat roken ook verslavender is dan heroine. Lichamelijke verslaving was meende ik ook pas na een goed aantal weken gebruik, 1e paar keer word 90% zo ziek als een hond . De ontwenningsverschijnselen zijn wel debiel hard, maar vind ook dat ze in nl er wat dom mee omgaan, mgoed.
Wat ook van belang is, de duur waarop het gaat werken, ghb slik je, moet verwerkt worden in je lichaam en na een 15-30 minuten zou het moeten werken.
Heroine/crack/tabak/hennep werkt vrijwel meteen, dus je lichaam trekt veel sneller het verband tussen de werking en de handeling, waardoor de verslaving veel sneller tot stand zal komen.
omdat als je eenmaal verslaafd bent, de lichamelijk afkick even erg als heroine kan zijn
en volgens mij is crack lichamelijk niet heel verslavend maar geestelijk wel heel erg
zo ook met ghb
omdat als je eenmaal verslaafd bent, de lichamelijk afkick even erg als heroine kan zijn
en volgens mij is crack lichamelijk niet heel verslavend maar geestelijk wel heel erg
zo ook met ghb
Plotseling stoppen met een GHB-verslaving en de afkickverschijnselen negeren kan tot de dood leiden.
ghb mag zeker hoger op de lijst
afkicken van de ghb is even erg als afkicken van heroine en crack, al niet erger..
als je lang en veel gebruikt, kan het dodelijk zijn om er zomaar mee te stoppen
de afkick is een ware nachtmerrie
i know
De stof ghb zelf is eik geen probleem, niet giftig of slecht, de gebruiker is gewoon debiel.
Er zijn 100en afwegeningen die je kan maken hierin, maar ik snap die lijst wel, volgens mij klopt ie wel redelijk.
Er zijn 100en afwegeningen die je kan maken hierin, maar ik snap die lijst wel, volgens mij klopt ie wel redelijk.
Die lijst gaat over schade aan de maatschappij he? Niet over schade aan het indvidu.
Er zijn evenveel GHB-overdoseringen als alcoholvergiftigingen in Nederland. En je kan niet stellen dat GHB veilig is in een normale dosis. Daar is te weinig informatie voor.
Ook al is het een lichaamseigen stof, reken maar dat een flinke dosis voor schade kan zorgen. Er zijn al zat gevallen van nierschade na GHB-gebruik gerapporteerd.
G H Beeee G H Beeeee G H Beeeeeeeeeeeeeee
GHB GHB GHBeeeeeHeeeee
Dat moet ik nakijken, maar ookal is dit zo, iemand met nierschade of longkanker kost de maatschapij ook onwijs veel geld.
Integendeel, rokers sterven jonger en kosten de overheid minder geld dan niet-rokers. Bron CBS.
Alcohol is een anders verhaal, dat kost de overheid enorm veel geld.
De overheid heeft er enorm veel baat bij dat er zo veel rokers zijn. Ze ontvangen echt enorm veel accijns, rokers kunnen gewoon zonder problemen meedraaien in de maatschappij, en de kosten voor pensioen en zorg worden veel lager.
Vraag me af wat voor maatregelen de overheid zou moeten nemen als iedereen plots stopt met roken.
![[img width=416 height=342 cacheid=000082880000e71e629922c21a026c77a5]http://newsimg.bbc.co.uk/media/images/42718000/gif/_42718419_drugs_graph2_416.gif[/img]](/images/cache/000082880000e71e629922c21a026c77a5 "Bron: http://newsimg.bbc.co.uk/media/images/42718000/gif/_42718419_drugs_graph2_416.gif")
