I am sure that David Nutt and colleagues are correct in concluding that alcohol is the drug that has the greatest overall negative effect on the health and social wellbeing of the UK population. However, the presentation of the harm scores for each drug as directly comparable is open to misinterpretation. Although the individual criteria have been weighted, there does not seem to have been any normalisation to either the total numbers of users or the frequency of drug use. If the scores were truly comparable they would imply that if the number of opiate or crack users in the UK (currently estimated to be less than 1% of adults) were equal to the number of regular consumers of alcohol (69% of men and 54% of women in a national survey in 2009), the negative effect on society would be less than half of that currently attributable to alcohol. Furthermore, to suggest that these scores could be used by policy makers to modify the legal classification of drugs seems inappropriate because changes in classification would alterthe numbers of users and subsequently invalidate the scores.
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