title: Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach.
abstract: A comparative risk assessment of drugs including alcohol and tobacco using the margin of exposure (MOE) approach was conducted. The MOE is defined as ratio between toxicological threshold (benchmark dose) and estimated human intake. Median lethal dose values from animal experiments were used to derive the benchmark dose. The human intake was calculated for individual scenarios and population-based scenarios. The MOE was calculated using probabilistic Monte Carlo simulations. The benchmark dose values ranged from 2 mg/kg bodyweight for heroin to 531 mg/kg bodyweight for alcohol (ethanol). For individual exposure the four substances alcohol, nicotine, cocaine and heroin fall into the "high risk" category with MOE < 10, the rest of the compounds except THC fall into the "risk" category with MOE < 100. On a population scale, only alcohol would fall into the "high risk" category, and cigarette smoking would fall into the "risk" category, while all other agents (opiates, cocaine, amphetamine-type stimulants, ecstasy, and benzodiazepines) had MOEs > 100, and cannabis had a MOE > 10,000. The toxicological MOE approach validates epidemiological and social science-based drug ranking approaches especially in regard to the positions of alcohol and tobacco (high risk) and cannabis (low risk).
authors: 1] Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie &Psychotherapie, Dresden, Germany [2] Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Germany.
authors: Dirk W
authors: DW
authors: Lachenmeier
authors: 1] Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie &Psychotherapie, Dresden, Germany [2] Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health (CAMH), Toronto, Canada [3] Institute of Medical Sciences, University of Toronto (UofT), Toronto, Canada [4] Dalla Lana School of Public Health, UofT, Toronto, Canada [5] Dept. of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada [6] PAHO/WHO Collaborating Centre for Mental Health &Addiction, Toronto, Canada.
authors: Jürgen
authors: J
authors: Rehm
mesh_terms: D002188:Cannabis / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D011336:Probability; D018570:Risk Assessment / Q000379:methods*; D014026:Nicotiana
chemical_list: D013287:Illicit Drugs; D000431:Ethanol
references: Psychopharmacology (Berl). 1999 Aug;145(3):342-50
references: 10494584
references: Psychopharmacology (Berl). 2004 May;173(3-4):242-8
references: 14673568
references: Int J Epidemiol. 2011 Feb;40(1):210-8
references: 20819784
references: J Psychopharmacol. 2013 Jun;27(6):497-506
references: 23438502
references: Lancet. 2010 Nov 6;376(9752):1558-65
references: 21036393
references: Regul Toxicol Pharmacol. 2012 Mar;62(2):355-62
references: 22085590
references: Food Chem Toxicol. 2011 Nov;49(11):2921-33
references: 21802474
references: Addiction. 2011 Nov;106(11):1886-90
references: 21895823
references: Int J Drug Policy. 2011 Jul;22(4):243-6
references: 21652195
references: Sci Total Environ. 2012 Aug 15;432:432-9
references: 22836098
references: Forensic Sci Int. 2003 Apr 23;133(1-2):118-24
references: 12742698
references: Psychopharmacologia. 1974 Feb 6;34(4):317-24
references: 4812657
references: J Psychopharmacol. 2005 Jan;19(1):71-83
references: 15671132
references: BMC Med. 2014;12:189
references: 25424648
references: BMJ. 1994 Oct 15;309(6960):997-1001
references: 7950725
references: J Psychoactive Drugs. 1986 Oct-Dec;18(4):291-304
references: 2880943
references: Public Health. 1997 Sep;111(5):271-5
references: 9308373
references: Regul Toxicol Pharmacol. 2003 Feb;37(1):45-53
references: 12662908
references: Forensic Sci Med Pathol. 2005 Jun;1(2):97-103
references: 25869947
references: Hum Psychopharmacol. 2010 Mar;25(2):162-6
references: 20104506
references: Fundam Appl Toxicol. 1984 Oct;4(5):854-71
references: 6510615
references: Lancet. 2011 Feb 12;377(9765):552; author reply 555
references: 21315938
references: Int J Cancer. 2012 Sep 15;131(6):E995-1003
references: 22447328
references: Med Sci Law. 1983 Jul;23(3):193-8
references: 6633207
references: Lancet. 2007 Mar 24;369(9566):1047-53
references: 17382831
references: Addiction. 2011 Nov;106(11):1891-2; discussion 1896-8
references: 21895824
references: Psychopharmacology (Berl). 2008 Dec;201(2):171-81
references: 18695931
references: Eur Addict Res. 2010;16(4):202-7
references: 20606445
references: J Psychopharmacol. 2010 Feb;24(2):147-53
references: 19939875
references: Nicotine Tob Res. 2014 Jun;16(6):753-8
references: 24420328
references: Addiction. 2004 Jun;99(6):686-96
references: 15139867
references: J Toxicol Clin Toxicol. 1989;27(6):375-84
references: 2628586
references: Addiction. 2010 Jul;105(7):1146-9
references: 20148796
references: J Gen Intern Med. 2010 Apr;25(4):305-9
references: 20087676
references: Int J Cancer. 2014 Jan 1;134(1):144-53
references: 23784940
references: Psychopharmacology (Berl). 1999 Feb;141(4):385-94
references: 10090646
references: Eur J Intern Med. 2008 Dec;19(8):561-7
references: 19046719
references: Br Med J (Clin Res Ed). 1984 Aug 11;289(6441):351-3
references: 6432093
references: J Clin Pharmacol. 1981 Aug-Sep;21(8-9 Suppl):143S-152S
references: 6271820
references: Am J Drug Alcohol Abuse. 1993;19(3):263-81
references: 8213692
references: Arch Toxicol. 2014 Jan;88(1):5-7
references: 24091634
references: Addiction. 2011 Nov;106(11):1893-4; discussion 1896-8
references: 21895826