BMJ Open 2:e000774 doi:10.1136/bmjopen-2011-000774
  • Addiction
    • Research

Quantifying the RR of harm to self and others from substance misuse: results from a survey of clinical experts across Scotland

  1. Killian Welch1
  1. 1NHS Lothian, Edinburgh, UK
  2. 2NHS Lanarkshire, Hairmyres Hospital, Glasgow, UK
  3. 3Maori Mental Health, Otahuhu, Auckland, New Zealand
  4. 4Division of Psychiatry, University of Edinburgh, Edinburgh, UK
  5. 5NHS Forth Valley, Falkirk, UK
  6. 6NHS Grampian, Aberdeen, UK
  1. Correspondence to Mark Taylor; marktaylor2{at}
  • Received 16 December 2011
  • Accepted 19 June 2012
  • Published 24 July 2012


Objective To produce an expert consensus hierarchy of harm to self and others from legal and illegal substance use.

Design Structured questionnaire with nine scored categories of harm for 19 different commonly used substances.

Setting/participants 292 clinical experts from across Scotland.

Results There was no stepped categorical distinction in harm between the different legal and illegal substances. Heroin was viewed as the most harmful, and cannabis the least harmful of the substances studied. Alcohol was ranked as the fourth most harmful substance, with alcohol, nicotine and volatile solvents being viewed as more harmful than some class A drugs.

Conclusions The harm rankings of 19 commonly used substances did not match the A, B, C classification under the Misuse of Drugs Act. The legality of a substance of misuse is not correlated with its perceived harm. These results could inform any legal review of drug misuse and help shape public health policy and practice.


  • To cite: Taylor M, Mackay K, Murphy J, et al. Quantifying the RR of harm to self and others from substance misuse: results from a survey of clinical experts across Scotland. BMJ Open 2012;2:e000774. doi:10.1136/bmjopen-2011-000774

  • Contributors MT and JM conceived and designed the study. All authors except KM and AM collected the data. AM helped analyse the results. All authors were involved in interpreting the results, drafting the paper and approving the final manuscript. All authors had full access to all data and can take responsibility for the accuracy and integrity of the data. MT is the guarantor of the study.

  • Funding The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors are employed by NHS Scotland except AM who is an employee of the University of Edinburgh. These employers were not involved in the data collection or interpretation of results.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The raw data are available on request from the corresponding author.

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