Article Text

Quantifying the RR of harm to self and others from substance misuse: results from a survey of clinical experts across Scotland
  1. Mark Taylor1,
  2. Kirsty Mackay2,
  3. Jen Murphy3,
  4. Andrew McIntosh4,
  5. Claire McIntosh5,
  6. Seonaid Anderson6,
  7. 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}


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.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • 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.