Analysis: Aggregate Harms Associated With Use of Alcohol, Tobacco Far Outweigh Cannabis-Related Risks

OG article by NORML

January 30, 2026

A Journal of Psychopharmacology analysis by international experts ranked harms of 16 psychoactive substances, finding alcohol and tobacco cause far greater aggregate damage to users and society than cannabis. Scoring considered user harms (mortality, physical/mental damage, dependence) and societal impacts (environmental, economic, injuries). Alcohol ranked highest overall, followed by tobacco, non-prescription opioids, cocaine, and methamphetamine; cannabis ranked much lower. This aligns with prior expert panels in Australia, the EU, New Zealand, and UK, all placing alcohol as most harmful. A 2024 US study showed secondhand alcohol harms exceed those from other drugs, while recent US evaluations ranked only fentanyl, methamphetamine, crack, and heroin above alcohol. The multi-criteria decision analysis reinforces evidence that cannabis poses comparatively minimal risks relative to legal substances like alcohol and tobacco, supporting discussions on relative drug policy and harm reduction priorities.