{"id":26372,"date":"2026-10-19T16:48:00","date_gmt":"2026-10-19T22:48:00","guid":{"rendered":"https:\/\/crism.ca\/?page_id=26372"},"modified":"2026-11-09T15:21:31","modified_gmt":"2026-11-09T21:21:31","slug":"drug-harms-in-canada-a-multi-criteria-decision-analysis","status":"publish","type":"page","link":"https:\/\/crism.ca\/fr\/drug-harms-in-canada-a-multi-criteria-decision-analysis\/","title":{"rendered":"Drug harms in Canada: A multi-criteria decision analysis"},"content":{"rendered":"\t\t
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Drug harms in Canada: A multi-criteria decision analysis<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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A new Canada-wide scientific assessment has found that alcohol causes more harm overall than any other drug in the country<\/strong>\u2014ranking far above tobacco, opioids, cocaine, methamphetamine and cannabis.<\/p>

Led by multiple CRISM researchers and Node Principal Investigators (NPIs), in collaboration with national and international experts, this study was published\u00a0in the Journal of Psychopharmacology<\/i><\/a><\/strong>, on January 27, 2026. Using a multi-criteria decision analysis (MCDA), the study aimed to compare 16 of the most harmful and commonly used psychoactive substances in Canada across 16 types of harm. These included short- and long-term physical, mental and social harms to people who use drugs (e.g. loss of life, damage to physical health), and harms to others (e.g. environmental damage, economic costs), among other factors.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Primary Author<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Jean-Fran\u00e7ois Cr\u00e9pault, PhD<\/strong><\/div>
\u00a0<\/div>
Jean-Fran\u00e7ois (JF) is Senior Policy Advisor at the Centre for Addiction and Mental Health, where he develops and communicates evidence-informed public policy in the area of substance use to government and other stakeholders. His research focus is public health approaches to substance use and, more broadly, the governance of addictive substances and behaviours.<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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National and International Experts<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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  • Matthew Bonn <\/strong><\/strong>(Changemark Research+Evaluation, Vancouver, BC, Canada)<\/li>
  • Michael Chaiton<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada, Institute of Medical Science, University of Toronto, ON, Canada)<\/li>
  • Karleigh Darnay<\/strong>\u00a0(Centre for Addiction and Mental Health, Toronto, ON, Canada)<\/span><\/li>
  • Bernard Le Foll<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada, Department of Psychiatry, University of Toronto, ON, Canada)<\/li>
  • Sean Patenaude<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada)<\/li>
  • Peter Selby<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada
    Institute of Medical Science, University of Toronto, ON, Canada<\/li>
  • Adam Sherk<\/strong> (Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada, Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada)<\/li>
  • Kevin D. Shield<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada)<\/li>
  • Maria Zhang<\/strong> (Centre for Addiction and Mental Health, Toronto, ON, Canada, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada)<\/li>
  • Rose Crossin<\/strong> (Department of Population Health, University of Otago, Christchurch, New Zealand)<\/li>
  • Lawrence Phillips<\/strong> (Drug Science, London, United Kingdom)<\/li>
  • David Nutt<\/strong> (Drug Science, London, United Kingdom
    Division of Psychiatry, Imperial College, London, United Kingdom)<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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    CRISM Researchers<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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    \n\t\t\t\t\t\tCayley Russell\t\t\t\t\t<\/h2>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t
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    Multi-criteria decision analysis (MCDA) has been used to quantify drug harms in the United Kingdom, the European Union, Australia, and New Zealand. This study presents the result of an MCDA conducted in Canada, with the aim of informing Canadian drug policy and contributing to public understanding of drugs\u2019 relative harms.<\/p>

    MCDA tackles complex questions where no single measure captures the full picture. Rather than focusing on a single outcome, such as deaths or addiction, this approach brings together multiple forms of harm, from health effects to social and community impacts, and weights their relative importance.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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    A panel composed of 20 experts from six provinces determined 16 drugs to evaluate on 16 dimensions of harm\u00a0took part in a two-day decision conference. The panel first scored each drug on a scale from 0 to 100 for each of the 16 types of harm, then weighted the relative importance of each type of harm. Theses scores were then combined to produce an overall harm score for each substance, showing which drugs cause the greatest total harm in Canada.<\/div><\/section>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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    The analysis found that alcohol<\/strong> had the highest overall harm score, at 79 out of 100<\/strong>, followed by:<\/p>

    1. Tobacco (45)<\/strong><\/li>
    2. Non-prescription opioids (33)<\/strong><\/li>
    3. Cocaine (19)<\/strong><\/li>
    4. Methamphetamine (19)<\/strong><\/li>
    5. Cannabis (15)<\/strong><\/li><\/ol>

      These scores represent population-level harm<\/strong>, not how dangerous a drug might be for any one person. They reflect both how risky a substance is and how widely people use it, capturing its overall impact on people and society. The finding that alcohol causes the most harm aligns with results from previous MCDA studies in the United Kingdom, the European Union, Australia and New Zealand.<\/p>

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      The findings point to a clear need for drug policy that is informed by the real scale of harm in Canada.<\/strong> For alcohol in particular, the researchers point to proven, evidence-based measures such as controlling price, limiting availability, and restricting marketing and promotion<\/strong> as effective ways to reduce harm. More broadly, they emphasize that policymakers should reflect on the harms caused by substances as well as those caused by the laws and regulations that govern them.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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      Harm Criteria and Definitions<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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