Drug harms in the UK: a multicriteria decision analysis

Objective: To compare the harms associated with commonly used psychoactive substances using a multicriteria decision framework. Experts scored drugs across dimensions including physical harm, dependence, intoxication, social impact, and related public health consequences. Heroin ranked among the highest-harm substances, driven by its strong dependence liability, overdose risk, and broad social and medical burden. The analysis emphasized that aggregate harm reflects more than acute toxicity alone and that an agent with moderate direct physiologic toxicity can still produce substantial population harm through addiction, crime, and treatment burden. The methodology also illustrated how expert judgment and weighting choices shape conclusions in relative-risk comparisons. While the approach was intended to support policy discussion rather than clinical prescribing, it provided a structured way to compare disparate substances on a common scale. The findings have been widely cited in debates about drug classification and control, particularly because they highlight the outsized harm profile of opioids relative to their euphoric effects.