Evidence map›Paper›PMID 41476288›Full record

ArticleHarm reduction journal2025

US drug policy does not align with experts' rankings of drug harms: a multi-criteria decision analysis.

Michael Broman, Alan K Davis, Stacey Armstrong, Adam Levin, Kaltum Ahmed, Gustavo A Angarita, Brooke J Arterberry, Cecilia Bergeria, Mitch Earleywine, Kathryn S Gex and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Harm reduction journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Michael BromanCollege of Social Work, The Ohio State University, Columbus, OH, USA. broman.6@osu.edu.
Alan K DavisCollege of Social Work, The Ohio State University, Columbus, OH, USA.
Stacey ArmstrongCenter for Psychedelic Drug Research and Education, The Ohio State University, Columbus, OH, USA.
Adam LevinCenter for Psychedelic Drug Research and Education, The Ohio State University, Columbus, OH, USA.
Kaltum AhmedCollege of Social Work, The Ohio State University, Columbus, OH, USA.
Gustavo A AngaritaDepartment of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
Brooke J ArterberrySurvey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Cecilia BergeriaDepartment of Psychiatry and Behavioral Sciences, School of Medicine, John Hopkins University, Baltimore, MD, USA.
Mitch EarleywineDepartment of Psychology, University at Albany, Albany, NY, USA.
Kathryn S GexCollege of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Tom GregoireCollege of Social Work, The Ohio State University, Columbus, OH, USA.
Jamey J ListerNortheast & Caribbean Rural Opioid Technical Assistance Center, School of Social Work, The State University of New Jersey, Rutgers, New Brunswick, NJ, USA.
David S MathaiDepartment of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Nicky J MehtaniDivision of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
Nathan MenkeUniversity of Michigan Medical School, Ann Arbor, MI, USA.
Charles D NicholsSchool of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Hillary ShaubCenter for Psychedelic Drug Research and Education, The Ohio State University, Columbus, OH, USA.
Alayna P TackettDivision of Medical Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA.
Brandon WeissCenter for Psychedelic & Consciousness Research, Johns Hopkins University, Baltimore, MD, USA.
Nefize YalinCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neurosciences, King's College London, London, UK.
Lawrence D PhillipsLondon School of Economics and Political Science, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background United States drug policy is primarily based on the Controlled Substances Act of 1970 and largely contradicts scientific evidence about how to mitigate drugs' harms. Expert consensus on drug harms could inform policy that improves the health of people who use drugs while reducing negative societal impacts of drug use. Therefore, this study adapted and extended the relevant 2010 United Kingdom multi-criteria decision analysis, rating drug harms by criteria comprising health and social impacts to people who use drugs and their families, communities, and society.Methods Seventeen experts on drug use in the US, including three with lived experience of drug use and recovery, assessed 19 drugs across 18 criteria. Drugs were scored from 0 to 100 points on each criterion. Then, criteria were weighted to represent the experts' view of their relative importance, and each drug was assigned an overall harm score. We also created a numerical rating to represent Controlled Substances Act-defined harm.Results Fentanyl (scoring 90), methamphetamine (84), crack (83), and heroin (82) were the most harmful drugs. Cannabis (32) ranked in the middle, and mushrooms (3) were the least harmful. Drug-specific mortality and economic cost were the largest overall contributors to harm, while environmental damage was the smallest. The correlation between Controlled Substances Act-defined harm and experts' harm ratings was - 0.26.Conclusions These findings add to the growing international literature highlighting how drug policy contradicts expert assessments of drug harms across nations. To reduce these harms, public health strategies informed by evidence and expert input should be prioritized over punitive approaches.

Indexed as

Decision Support TechniquesDrug and Narcotic ControlHealth PolicyIllicit DrugsSubstance-Related DisordersHarm ReductionHumansUnited StatesIllicit DrugsControlled substances actDrug harmsDrug policyHarm reductionMulti-criteria decision analysisPublic healthSubstance use disorders

Identifiers

PMID41476288
PMCPMC12866486

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.