Substance users and addiction experts agree on harm rankings but disagree on benefits: users rate cannabis benefits higher | Research

The takeaway

Both substance-dependent users and addiction medicine experts ranked heroin, cocaine, and amphetamines as most harmful, but users rated the benefits of cannabis, nicotine, and traditional illicit drugs significantly higher than experts did.

Addiction professionals, policymakers, and readers interested in how perceptions of drug harm vary between users and experts.

Both users and experts rate alcohol harm higher than cannabis harm

What the researchers found

Users and experts produced similar overall harm rankings, both placing heroin, cocaine, and amphetamines at the top and cannabis, psychotropic mushrooms, and buprenorphine near the bottom. However, users rated the benefits of cannabis, nicotine, and traditional illicit drugs significantly more positively than experts. Both groups ranked alcohol and benzodiazepine harms higher than those of cannabis or psychotropic mushrooms, despite the latter being more heavily regulated.

Why it matters

Understanding where user and expert perceptions diverge can improve psychoeducation and inform drug policy debates, particularly for substances like cannabis and alcohol where regulatory status does not align with perceived harm.

The numbers in context

117 users and 101 experts; core substances with >50% user experience: nicotine, cannabis, alcohol, cocaine, heroin, amphetamine, methadone. Users rated cannabis benefits significantly higher than experts.

How the study worked

Structured interviews with 117 substance-dependent German adults seeking detoxification or rehabilitation, using the same questionnaire previously administered to 101 German addiction medicine experts. Harm and benefit ratings for 33 psychoactive substances were compared.

What this study cannot tell us

German sample may not generalize. Users were seeking treatment, not representative of all users. Limited experience with many substances among the user group. Potential "attraction bias" in users and "treatment bias" in experts.

How to read the evidence

Comparative survey with expert and user perspectives, but treatment-seeking user sample introduces selection bias.

When this study was published

Published in 2022.

The bigger picture

The finding that both users and experts consider alcohol and benzodiazepines more harmful than cannabis and psychotropic mushrooms, despite the latter being more strictly regulated, highlights the disconnect between drug scheduling and evidence-based harm assessment.

Questions still open

Would non-treatment-seeking users rate cannabis differently? Should drug policy weight expert or user perspectives more heavily? Can closing the user-expert gap in benefit perception reduce problematic use?

Common questions

Do substance users and experts agree on which drugs are most harmful?

Largely, yes. Both groups placed heroin, cocaine, and amphetamines at the top of the harm scale, with cannabis, buprenorphine, and psychotropic mushrooms at the lower end. The main disagreement was about perceived benefits.

How did cannabis harm compare to alcohol in these ratings?

Both users and experts ranked alcohol and benzodiazepines as more harmful than cannabis and psychotropic mushrooms, even though cannabis is more heavily regulated in most Western countries.

Read the original research

Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates.

Frontiers in psychiatry, 13, 1041762

View on PubMed ↗Publisher’s paper ↗

Citation

Bonnet, Udo; Specka, Michael; Kanti, Ann-Kristin; Scherbaum, Norbert. (2022). Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates.. Frontiers in psychiatry, 13, 1041762. https://doi.org/10.3389/fpsyt.2022.1041762