Assessment of harm

92. We were interested to find out the criteria used by the ACMD in making its assessments of harm. The ACMD told us that Professor Nutt and his colleagues on the ACMD Technical Committee had developed a risk assessment matrix to evaluate the harms associated with different drugs (see Table 3). Professor Nutt said: "The matrix was developed when I was working on the Runciman Report because it became quite clear that we did not have any systematic way of conceptualising the range of harms and any way of properly categorising them and rating them [...] When I became a member of the ACMD and Chairman of the Technical Committee, we set in process this procedure of getting all the members of the Technical Committee to work through in a systematic way the drugs".187 The Minister, referring to the matrix, told us: "We have a scientific basis for determining harm. The ACMD refer to that when they classify drugs".188

Table 3: ACMD Risk Assessment Matrix

Category

Parameter

Physical harm

Acute

Chronic

Parenteral

Dependence

Intensity of pleasure

Psychological dependence

Physical dependence

Social harms

Intoxication

Other social harms

Healthcare costs

93. Professor Colin Blakemore pointed out, however, that it was not trivial to "decide what weighting to give to the different criteria for harm". We asked the ACMD to explain how it determined the weighting given to harm in each domain. In response, the ACMD stated: "using [the ACMD Risk Assessment] matrix, and assigning a score to each parameter (0 = no risk; 1 = some risk; 2 = moderate risk; 3 = extreme risk), Professor Nutt and his colleagues have developed an overall harm rating. They have not, as yet, attempted to weight individual parameters".189 We welcome the initiative taken by the ACMD Technical Committee to develop a standard framework for the assessment of harm but

187 Q174

188 Q1201

we also note that determining harm scores using the matrix is almost as much an art as a science.

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