title: Physical harm due to chronic substance use.
abstract: Chronic use at high dose of illicit drugs, alcohol and tobacco is associated with physical disease. The relative physical harm of these substances has not been described before, but will benefit the guiding of policy measures about licit and illicit substances. The physical harm of 19 addictive substances (including alcohol and tobacco), consisting of toxicity and the risk and severity of somatic disease (not psychiatric disease) was assessed based on literature data and the professional opinion of experts using scores ranging from 0 (no physical harm) to 3 (very serious physical harm). For alcohol, tobacco and some illicit drugs strong associations between long-term use or use in high dose versus the risk of somatic disease have been described, whereas for other substances such data are not available. Magic mushrooms, LSD and methylphenidate obtained relatively low scores (0.45-0.65) for physical harm, whereas relatively high scores were given for heroin (2.09), crack (2.32), alcohol (2.13) and tobacco (2.10). For cannabis, tobacco, and alcohol the estimated societal disease burden was higher than at individual level. The present ranking solely based on their physical harm was very similar to a previous ranking based on a combination of dependence liability, physical harm and social impairments.
authors.affiliation: National Institute of Public Health and the Environment (RIVM), Centre for Health Protection, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. Jan.van.amsterdam@rivm.nl
authors.forename: Jan
authors.initials: J
authors.lastname: van Amsterdam
authors.forename: Ed
authors.initials: E
authors.lastname: Pennings
authors.forename: Tibor
authors.initials: T
authors.lastname: Brunt
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D012306:Risk; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000150:complications* / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs