title: Ranking the harm of non-medically used prescription opioids in the UK.
abstract: A panel of nine experts applied multi-criteria decision analysis (MCDA) to determine the relative overall harm to users and harms to others of street heroin (injected and smoked) and eleven non-medically used prescription opioids. The experts assessed harm scores for each of the 13 opioids on each of 20 harm criteria, weighted the criteria and explored the resulting weighted harm scores for each opioid. Both forms of heroin scored very high: overall harm score of 99 for injected heroin and 72 for smoked heroin on a scale of 0-100. The main feature that distinguishes both forms of street heroin use is that their harm to others is more than five times that of the other eleven opioids. The overall harm score of fentanyl (including injection of fentanyl extracted from patches) and diamorphine (medically prescribed form of heroin) was 54 and 51, respectively, whereas that of orally used opioids ranged from 32 (pethidine) to 11 (codeine-containing pharmaceuticals). Injected street heroin, fentanyl and diamorphine emerged as most harmful to users, with the latter two very low in harm to others. Pethidine, methadone, morphine and oxycodone are also low in harm to others, while moderate in harm to users. We conclude that the overall harms of non-medically used prescription opioids are less than half that of injected street heroin. These data may give a basis for precautionary regulatory measures that should be considered if the rising trend in non-medical use of prescription opioids were to become evident in the UK.
authors.affiliation: Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: jan.van.amsterdam@amc.uva.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: van Amsterdam
authors.affiliation: Department of Management, London School of Economics and Political Science, London, UK.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Phillips
authors.affiliation: School of Physiology & Pharmacology, University of Bristol, Bristol, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Henderson
authors.affiliation: Kings College London, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bell
authors.affiliation: Faculty of Medicine, Department of Medicine, Imperial College London, London, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Bowden-Jones
authors.affiliation: Department of Psychology, University of Hull, Hull, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hammersley
authors.affiliation: TICTAC Communications Ltd, St George's University of London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Ramsey
authors.affiliation: Taylor Monroe, Ely, UK.
authors.forename: Polly
authors.initials: P
authors.lastname: Taylor
authors.affiliation: NHS, London, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Dale-Perera
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Melichar
authors.affiliation: Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.affiliation: Centre for Neuropychopharmacology, Imperial College London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Nutt
mesh_terms: D000280:Administration, Inhalation; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification*; D003661:Decision Support Techniques; D003663:Decision Trees; D004304:Dosage Forms; D003932:Heroin / Q000009:adverse effects / Q000145:classification; D006801:Humans; D007275:Injections, Intravenous; D009293:Opioid-Related Disorders / Q000145:classification* / Q000150:complications / Q000401:mortality / Q000523:psychology; D063487:Prescription Drug Misuse / Q000009:adverse effects* / Q000145:classification* / Q000401:mortality / Q000523:psychology; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous / Q000145:classification*; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid; D004304:Dosage Forms; D003932:Heroin
keywords: Harm; MCDA; Opioids; Prescription drugs; Ranking; Risk assessment; Street heroin