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Beyond Addiction
Ranking the Riskiest Drugs in the U.S.

It’s time to rethink your ideas about dangerous drugs. Some of the most threatening ones probably enjoy a prominent place in your home—or even your daily cup of coffee.

In our 2015 ranking of the country’s most harmful substances, alcohol reigns as the number-one offender. At No. 2, sugar is close behind. All things considered, both drugs inflict more damage than heavyweights such as heroin, crack and meth.

But don’t just take our word for it.

In producing the new list, we looked to Dr. David Nutt, former chief drug adviser to the British government. In 2010, he published a roundup of the U.K.’s riskiest drugs in The Lancet, a respected scientific journal. Nutt worked with a team of researchers to score the harmful properties of 20 well-known substances, including everything from street drugs to prescription painkillers.

But they took a novel slant. Nutt and his fellow scientists weighed more than a drug’s potential to damage—or destroy—the person using it. They also analyzed the havoc that a chemical can wreak on families and society at large.

To create the rankings, the Independent Scientific Committee on Drugs evaluated 16 factors. Nine of these related to the individual user and seven evaluated broader drug-related damage.

The scientists considered a given chemical’s capacity to cause mortality, impairment of mental functioning and dependence. But they also looked at drug-related crime, hardships visited on families, damage to the environment, economic cost and more.

The resulting rankings—with alcohol outstripping cocaine and heroin as the most risky—caused quite a stir.

But that was five years ago.

We decided it was high time to update Nutt’s index and to give it a U.S. focus. Manufacturers—both corporate and clandestine—constantly introduce new chemical combinations. Patterns of drug use and mortality rates fluctuate over time. Scientists make new discoveries and their thinking evolves.

We’ve added 11 new substances to the list, including bath salts, molly, synthetic pot and krokodil. (Look for the white text on the accompanying infographic.) As with the British version, our classifications are based on informed judgment. We relied heavily on the guidance of the Washington Poison Center in Seattle to rate the relative dangers of these newcomers.

Some of the most harmful chemicals—including sugar, alcohol and tobacco—aren’t even illegal. Therein lies a common source of confusion. “The reason we have drugs divided into legal and illegal ones is an historical artifact,” says Nutt. “Because it’s not illegal, people think it’s not a drug.”