If you ever only see one documentary about drugs, let it be this one. The acclaimed BBC series Horizon episode “Is alcohol worse than ecstasy?” examines the dangers of the 20 drugs most commonly used in the United Kingdom.

It does this based upon a qualification by a group of scientists, composed of Britain’s leading drug experts and members of the Advisory Council on the Misuse of Drugs (ACMD). This group in 2007 published an article in The Lancet (to be found here), in which a rational scale for assessing the danger of drugs was developed. This scale took the form of a list, in which the 20 drugs were ranked according to potential harm.

In Great Britain, regulatory policy regarding drugs consists of a classification along three categories: Class A (most dangerous), Class B and Class C (least dangerous). Alcohol and tobacco are not included in the categorization. This approach, on the face of it, seems better than the Dutch system of ranking substances either as “hard drugs” or as “soft drugs”, as it allows for more nuance. There are, however, a number of problems with the British system. The system was invented in 1971, whereas a substance like ecstasy was added to it in 1977 – way before it was used the way it is today. This leads to a rather weird categorization: while lsd, mushrooms and ecstasy are ranked alongside heroin and crack in Class A, dangerous stuff like ketamin is ranked alongside sleeping pills in Class C.

The research group therefore wanted to develop a new method for assessing the danger of drugs. They did this by employing three criteria. The first of these is personal harm; what a drug does to you if you take it in. The second one is addictiveness; how fast you get hooked to it. The third one is societal harm; how much damage it can do to those around you and society at large.

Based on these criteria, and after consultation with other experts, the researchers assembled their list of twenty drugs, in order of harmfulness. And the results are remarkable. While, unsurprisingly, heroin and cocaine top the list as the most dangerous drugs, other results are counterintuitive (that is, if you base everything you know on media reports): alcohol and tobacco, for instance, turn out to be far more harmful than lsd and ecstasy, while marihuana is not the innocent drug it is often proclaimed to be.

Here’s the list (with some interesting graphs alongside it, click to enlarge):

1. Heroin

2. Cocaine

3. Barbiturates

4. Street methadone

5. Alcohol

6. Ketamine

7. Benzodiazepines

8. Amphetamine

9. Tobacco

10. Buprenorphine

11. Cannabis

12. Solvents

13. 4-MTA

14. LSD

15. Methylphenidate

16. Anabolic steroids

17. GHB

18. Ecstasy

19. Alkyl nitrates

20. Khat

So the place of ecstasy on this list, as the documentary has it, “massively conflicts with its reputation”.

Another report, this time by the Advisory Council on the Misuse of Drugs itself (from 2009, to be found here), based on a 12-month study of 4,000 research articles, addressed this particular issue. Ecstasy is a substance that has been the victim of a relentless media campaign. The report even addresses this: during the 1990s in Scotland, for example, every instance of a fatality involving ecstasy was widely reported on, while only a fraction of (far more frequent) fatalities with other drugs were reported on. Similar observations regarding media publicity can be made regarding Australia (see this report) and the Netherlands (see this report by the political party D66).

According to the researchers, however, ecstasy’s bad reputation is unwarranted. First of all, ecstasy is not physically addictive (it can, of course, like any drug, be psychologically addictive). Second, ecstasy is not harmful to society (ecstasy turns users into empathic softies, whereas alcohol and cocaine can make users prone to violence; the number of hospitalizations of ecstasy users is negligible, and nearly always due to combining it with other drugs; and just compare it to the million-wide addiction to alcohol and tobacco). The true danger is personal harm. Metastudies (pdf) reveal, however, that personal dangers predominantly arise in cases of chronic and excessive use.

All researchers in the BBC documentary make clear that media reporting about ecstasy has been biased and overblown. Quote:

It’s not a drug that’s hazard free, by any means. But having said that, many thousands of people in the UK have tried it, and a good proportion of those people derived pleasure and a good experience from it. So I’m not going to sit here and say that it’s a very dangerous drug.

And from The Guardian’s article on the 2007 The Lancet list:

The position of ecstasy near the bottom of the list was defended by Prof Nutt, who said that apart from some tragic isolated cases ecstasy is relatively safe. Despite about a third of young people having tried the drug and around half a million users every weekend, it causes fewer than 10 deaths a year. One person a day is killed by acute alcohol poisoning and thousands more from chronic use.

Thus, the researchers and experts of the ACMD in their 2009 report made the policy recommendation to the British government that the ABC-classification scheme needed revision: ecstasy needed to be downgraded to Class C, while alcohol, tobacco and marihuana needed to be included and upgraded to Class B and A. In addition, Prof. David Nutt, chair of the ACMD, wrote a paper for the Centre for Crime and Justice Studies of King’s College, London (to be found here), arguing along the same lines.

The researchers’ conclusions, however, did not match the political considerations of their employers. Hours before publication of the ACMD report, the Home Office sent a letter rejecting beforehand two of three policy recommendations. When David Nutt published his paper, moreover, he was immediately sacked by Alan Johnson, the Home Secretary.

This, however, led to a great deal of protest, as the ACMD in response threatened with mass resignation. The Guardian (here’s more):

The government was at the centre of a furious backlash from leading scientists last night following its sacking of Britain’s top drugs adviser.

The decision by the home secretary, Alan Johnson, to call on Professor David Nutt to resign as chairman of the Advisory Council on the Misuse of Drugs (ACMD) has thrown the future of the respected independent body into severe doubt. There were claims last night that many of those who sit on the 31-strong council – which advises ministers on what evidence there is of harm caused by drugs – may resign en masse, raising serious doubts about how ministers will justify policy decisions.

Several were this weekend seeking urgent reassurances from the government that it will not try to control their agenda and will allow them to speak out before they decide whether to quit. One is said to have already resigned.

In the end, five experts resigned from the ACMD. David Nutt in 2010 founded a rival organization, the Independent Scientific Committee on Drugs.

That’s a lot of intro, but here’s the BBC documentary. While informative in its entirety, the remarkable conclusions are, of course, that ecstasy is not nearly the dangerous drug it is portrayed to be; and that alcohol, were it invented today, would immediately be listed a Class A drug. I think that’s something to think about.