Which is the most dangerous?

Comparing the dangers of cannabis,

ecstasy, cocaine and heroin.

The Nutt Harm Scale (2007) identifies three major factors that determine the potential harm
of any drug with abuse potential; the physical harm to the user, the potential for the drug to
induce dependence and the effect of the drug on families, communities and society as a
whole. The Misuse of Drugs Act suggests that ecstasy (MDMA), cocaine and heroin are
similarly high in danger, all classed as the highest ‘class A’; cannabis is a step lower, ‘Class
B’. However, when applying Nutt, King and Saulsbury’s (2007) criteria, heroin can be seen
to be most dangerous, with Cocaine lesser, but similarly high. MDMA and cannabis are
shown to be significantly less dangerous, ecstasy with a higher risk of physical harm and
cannabis with a higher risk of dependence.
Research shows heroin has the potential to cause the most physical harm, with risk of
mortality six to twenty times higher than that of non-users. Cocaine can cause comparatively
less but still high levels of physical harm. There is less difference between heroin’s average
lethal dose of fifty milligrams and effective dose of eight milligrams, compared to those of
cocaine (1200mg lethal, 80mg effective), MDMA (2000mg lethal, 125mg effective) and
cannabis (lethal dose unknown due to low toxicity) (Gable 2004). This can result in
accidental overdose due to varying purity or lowered tolerance after periods of abstinence
(National Institute on Drug Abuse, 2005), and in some cases overdose not due to change in
quality or quantity of drug but due to lower tolerance when administering in environments
where tolerance producing pavlovian conditioning has not occurred (Grenwich, Bácskai,
Farkas & Danics 2005). Intravenous heroin and cocaine use increases the risk of HIV,
Hepatitis C, endocarditis, abscesses and collapsed veins, a problem more common in Heroin
users where intravenous injection is the predominant route of administration (National
Institute on Drug Abuse 2005, 2010). Cocaine brings the acute health risks of heart attacks,
strokes, seizures and gastrointestinal complications. The risk of mortality is increased further
when cocaine is mixed with alcohol combine as cocaethylene which increases the heart rate
further. Chronic cocaine use can also cause loss of smell and tissue death when snorted,
bowel gangrene when ingested, lung damage when smoked and tooth damage caused by
bruxism. (National Insitue of Drug Abuse, 2010)
The physical harm associated with cannabis use is primarily due to smoking being the
most popular method of consumption. An increased risk of Bronchitis and cancer has been
found (Adlington et al., 2008) and there is evidence supporting a negative effect on birth
weight (Abel, 1983). Suggestions of risks to immunity (Leuchtenburger, 1983) reproductive
ability (Bloch 1983) have also been presented but the strength and methodology of the
research involved has been found to be questionable (Hollister, 1992, Fried, 1993). MDMA
use is mainly associated with the risks of Hyponatremia and Hypothermia. Hyponatremia
may occur due to MDMA causing the release of the antidiuretic hormone vasopressin which
can lead to lower sodium levels. This risk can be reduced by insuring users do not drink too
much water without ingesting salt over long periods of time, (Wolf et al., 2006). Hypothermia
can also occur with high doses of MDMA combined with the hot, crowded environment
found in dance clubs (Green, O’Shea & Colado, 2004). MDMA also causes Bruxism which
could cause tooth and jaw damage (Kalant, 2001).
Heroin and Cocaine are both highly addictive, producing tolerance, cravings, a loss of
control regarding use and the consumption of time and resources. However heroin is more
dangerous as it is physically addictive, producing strong withdrawal symptoms which can be
highly unpleasant and can be fatal for unborn foetuses. Cocaine is psychologically addictive
and so does not produce withdrawal symptoms but can produce strong cravings even after
long periods of abstinence (National Institute on Drug Abuse, 2005, 2001). Regular use of
MDMA can produce tolerance however reports of cravings or physical symptoms of
dependence are rare (Cottler, Womack & Ben-Abdullah, 2001). Heavy and long-term
cannabis use produces tolerance (Compton, Dewey & Martin, 1990) and withdrawal effects.
This suggests physical addiction is possible however these withdrawal effects have been seen
as mild and without medical complications (Budney, 2006).
All four drugs have been linked with impairment of cognitive ability however recent
evidence suggests that damage caused by cannabis and MDMA has been overstated and may
be reversible with abstinence. Reneman et al. (2001) found that though high, repeated doses
of MDMA lead to long-term decreases in functioning of the transporter protein, partial or full
recovery is possible. MDMA was also thought to decrease performance in many cognitive
tasks, however a recent study only found impairment of impulse control in heavy users
(Halpern et al. 2011), and it is unclear if this is a result of MDMA use or a factor that may
make it use more likely (Nigg et al. 2006). An association between cannabis and poor school
performance (Newcombe & Bentler, 1988) has been shown to be weak. When examined
alongside other factors, cannabis use being more likely to be a result of pre-existing factors
than their cause seems more likely (Fergusson & Horwood, 1997). Cannabis has been seen as
the cause of many cases of schizophrenia and psychosis however, research has shown that
although heavy and prolonged use does exacerbate (Hall, Solowij & Lemon, 1994) and
increase (Linszen, Dingermans & Lenior, 1990) the symptoms, it is highly unlikely that
cannabis caused the onset of any cases that would not have occurred on their own (Der,
Gupta & Murray, 1990). Frontal lobe damage and diminished impulse control has been seen
in long term heroin users (Lundqvist, 2005). Cocaine use has been linked with diminished
inhibitory control (Hester & Garavan, 2004) as well as post-use dysphoria and depression
(Frank, Madersheiud, Panicker, Williams & Kokoris, 1990).
Due to their significant risks of physical harm and dependence heroin and cocaine
pose a high risk to society; through risks to health and the cost of healthcare, both in
prevention and rehabilitation. Both drugs are also involved in violence and crime, with many
deaths associated with cocaine being caused by trauma and homicide (McCance-Katz, Kosten
& Jatlow, 1998) and with heroin use linking directly with crime figures (Silverman & Spruill,
2004). Heroin is more dangerous than cocaine due to its physical addictive qualities and it’s
higher risk of mortality through the spreading of HIV and hepatitis C. Cannabis poses a
relatively low risk of physical harm which can be reduced by replacing smoking with other
forms of consumption, such as vaporisation (Earleywine & Smucker Barnwell, 2007).
Cannabis should still be avoided by those with a predisposition or history of schizophrenia or
psychosis. MDMA’s health risks are in part associated with the dance club environment and
the risks could be lowered with adequate but not excessive hydration and users taking regular
breaks from dancing. Both Cannabis and MDMA contribute little to non-drug crime.

Word Count: 1036

 References

Adlington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., Hansell, A., Pritchard, A.,
Robingson, G., & Beasley, R. (2008) Cannabis use and risk of lung cancer: a case-control
study. European Respiratory Journal, 31 (2), 280-286.

Budney, A. J. (2006) Are specific dependence criteria necessary for different substance: how
can research on cannabis inform this issue? Addiction, 101, 12-133.

Compton, D. R., Dewey, W. L. & Martin, B. R. (1990) Cannabis dependence and tolerance
production. Advances in Alcohol and Substance Abuse, 9 (1-2), 129-147.

Cottler, L. B., Womack, S. B., Compton, W. M., & Ben-Abdallah, A. (2001). Ecstasy abuse
and dependence among adolescents and young adults: applicability and reliability of DSM-IV
criteria. Human Psychopharmacology: Clinical and Experimental, 16 (8), 599-606.

Der, G., Gupta, S., & Murray, R. M. (1990) Is schizophrenia disappearing? Lancet, 335, 513-
516.

Fergusson, D., & Horwood, J. (1997) Early onset cannabis use and psychosocial adjustment
in young adults. Addiction, 92, 279-296.

Frank, R. A., Manderscheid, P. Z., Panicker, S., Williams, H. P., & Kokoris, D. (1990)
Cocaine euphoria, dysphoria, and tolerance assessed using drug-induced changes in barin-
stimulation reward. Pharmacology, Biochemistry and Behaviour, 42, 771-779.

Fried, P. A. (1993) Prenatal exposure to tobacco and marijuana: effects during pregnancy,
infancy and early childhood. Clinical Obstretics and Gynecology, 319-336.

Gable, R. S. (2004) Comparison of acute lethal toxicity of commonly abused psychoactive

substances. Addiction, 99 (6), 686-696.
Green, A. R., O’Sheaolved, E., & Colado, M. I. (2004) A review of the mechanisms involved
in the acute MDMA (ecstasy)-induce hyperthermic response. European Journal of
Pharmocology, 500, 3-13.

Gerevich, J., Bácskai, E., Farkas, L., & Danics, Z. (2005) A case report: Pavlovian condition
as a risk factor of heroin ‘overdose’ death. Harm Reduction Journal, 2 (11), 1-4.

Hall, W., Solowij, N., & Lemon, J. (1994) The health and psychological consequences of
cannabis use. National Drug Strategy Monongraph Series no 25.Canberra: Australian
Government Publishing Service.

Hester, R. & Garavan, H. (2004) Executive dysfunction in cocaine addiction: evidence for
discordant frontal cingulate, and cerebellar activity. The Journal of Neuroscience, 24 (49),
11017-11022.

Hollister, L. E. (1992) Marijuana and immunity. Journal of Psychoactive Drugs, 24, 159-164.

Kalant, H. (2001) The pharmacology and toxicology of “ecstasy” (MDMA) and related
drugs. Canadian Medical Association Journal, 165 (7), 917-928.

Leuchtenburger, C. (1983) Effects of marihuana (cannabis) smoke on cellular biochemistry

of in vito test systems. In K.O. Fehr & H. Kalant (Eds.) Cannabis and health hazards.
Toronto: Addiction Research Foundation, 1983.

Linszen, D. H., Dingeremans P. M. & Lenior, M. E. (1990) Cannabis abuse and the course
and outcome of schizophrenia. Schizophrenia Bull, 16, 87-372.

Lundqvist, T. (2005) Cognitive consequences of cannabis use: Comparison with abuse of

stimulants and heroin with regard to attention, memory and executive functions.
Pharmacology, Biochemistry and Behaviour, 81, 319-330.

McCance-Katz, E. F., Kosten, T. R., & Jatlow, P. (1998) Concurrent use of cocaine and
alcohol is more potent and potentially more toxic than use of either alone- A multiple-dose
study. Biological Psychiatry, 44 (4), 250-259.
National Institute on Drug Abuse (2005) Heroin Abuse and Addiction. Retrieved from
http://www.nida.nih.gov/ResearchReports/Heroin

National Institute on Drug Abuse (2010) Cocaine Abuse and Addiction. Retrieved from
http://www.nida.nih.gov/ResearchReportsCocaine

Newcombe, T., & Bentler, P. (1988) Consequences of adolescent drug use: impact on the
lives of young adults. Newbury Park, California: Sage Pulblications.

Nigg J. T., Wong M. M., Martel M. M., Jester J. M., Puttler L. I., Glass J. M. et al. (2006).

Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents
at risk for alcoholism and other substance use disorders. Journal of the American Academy of
Child and Adolescent Psychiatry,  45, 468–75

Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007) Development of a rational
scale to assess the harm of drugs of potential misuse. Lancet, 369, 1047-1053.

Reneman, L., Booij, J., Reitsma, J. B., de Wolff, F. A., Gunning, W. B., den Heeten, G. J., &
van den Brink, W. (2001). Effects of does, sex and long-term abstention from use on toxic
effects of MDMA (ecstasy) on brain serotonin neurons. The Lancet, 358 (9296), 1864-1869.

Silverman, L. P., & Spruill, N. L. (2004) Urban crime and the price of heroin. Journal of
Urban Economics, 4 (1), 80-103.

Wolff, K., Tsapakis, E. M., Winstock, A. R., Hartley, D., Holt, D., Forsling, M. L., &
Aitchison, K. J. (2006). Vasopressin and oxytocin secretion in response to the consumption
of ecstasy in a clubbing population. Journal of Psychopharmacology. 20 (3), 400–10.