Landmark CAMH-Led Study Ranks Drug Harms in Canada

Canadian researchers have delivered a groundbreaking assessment of psychoactive substance harms, placing alcohol firmly at the top of the list as the most damaging drug in the country. Published in the Journal of Psychopharmacology on January 26, 2026, the study titled 'Drug harms in Canada: A multi-criteria decision analysis' was spearheaded by Jean-François Crépault from the Centre for Addiction and Mental Health (CAMH), an institution closely affiliated with the University of Toronto's Dalla Lana School of Public Health. This multi-disciplinary effort involved 20 experts from across six provinces, drawing on expertise from fields like addiction medicine, epidemiology, public health, and clinical psychology.

The analysis stands out for its rigorous approach, adapting the multi-criteria decision analysis (MCDA) methodology first pioneered in a 2010 UK study by David Nutt and colleagues. MCDA allows experts to evaluate multiple drugs across various harm dimensions simultaneously, providing a holistic view rather than relying solely on metrics like overdose deaths. Panel members, including academics from institutions such as Dalhousie University and the University of Calgary, scored 16 common substances on 16 distinct harm criteria, ranging from physical health damage and dependence to economic costs and family adversity. Scores were weighted by the panel's consensus on each criterion's relative importance, yielding cumulative harm scores that reflect population-level impacts in the Canadian context.

This research is particularly timely as Canadian universities grapple with substance use on campuses. Institutions like the University of Victoria, home to the Canadian Institute for Substance Use Research led by Dr. Tim Naimi, have long highlighted alcohol's disproportionate role in student harms. The findings underscore the need for evidence-based policies in higher education settings, where alcohol remains ubiquitous.

Alcohol Tops the Rankings: Detailed Breakdown of Scores

Alcohol emerged with a commanding cumulative weighted score of 79 out of 100, far surpassing all other substances. Tobacco followed at 45, non-prescription opioids at 33, cocaine and methamphetamine tied at 19 each, and cannabis at 15. Lower-ranked drugs included prescription stimulants, LSD, and solvents, with many scoring below 10.

The panel evaluated harms in three clusters: physical, mental, and social, split between effects on users and others. Alcohol dominated nine categories outright, including drug-related physical health damage (think liver cirrhosis, cancers, and cardiovascular disease), withdrawal symptoms, short- and long-term mental impairment, loss of tangible assets like jobs or education, relationship breakdowns, injuries inflicted on others, family adversity, and massive economic costs.

For context, non-prescription opioids—often laced with fentanyl and contaminants like xylazine—ranked high due to acute mortality risks but lagged in broader social harms compared to alcohol. Cannabis, despite legalization, scored low overall but punches above in mental health impairments for some users. These rankings account for prevalence: alcohol's widespread use (about 76% of Canadians over 15 report past-year consumption) amplifies its population-level toll.

Why Alcohol Outranks Heroin, Opioids, and Even Tobacco

Unlike illicit drugs where harms are concentrated among smaller user groups, alcohol's damage permeates society due to its legal status, aggressive marketing, and cultural normalization. The study emphasizes that no level of alcohol consumption is without risk—recent global research from the World Health Organization confirms it causes over 200 diseases and injuries, from pancreatitis to intimate partner violence.

Harms to users include acute intoxication leading to emergency department visits (Canada's hospitals often serve as de facto alcohol detox centers), dependence affecting 12-14% post-pandemic per CAMH data, and chronic conditions shortening life expectancy. To others, alcohol fuels traffic fatalities (one in five impaired driving cases), child neglect, sexual assaults, and economic burdens totaling $19.7 billion annually—40% of all substance-related costs, per a 2023 Canadian Centre on Substance Use and Addiction report.

In comparison, tobacco excels in physical damage and mortality but lacks alcohol's acute social disruptions. Opioids devastate through overdoses but affect fewer people overall. This disconnect between perceived and actual risks calls for reevaluation, especially as provinces like Ontario expand alcohol sales into convenience stores, potentially normalizing binge drinking further.

Methodology: How Experts Built the Rankings

The two-day decision conference in Toronto on November 10-11, 2024, brought panelists together for transparent scoring using HiView3 software. Drugs were assessed independently (despite common polysubstance use), focusing on non-medical routes like beverage alcohol or street fentanyl. Prevalence data from the Canadian Alcohol and Drugs Survey informed volume-adjusted harms.

Scoring scaled from 0 (no harm) to 100 (worst offender per criterion), with ratios reflecting relative severity—e.g., alcohol at 100 for economic cost means it dwarfs others. Weights prioritized user mortality (high) and international damage (lower). This structured debate minimized bias, yielding results consistent with UK, EU, Australia, and New Zealand MCDAs, where alcohol invariably leads.

Photo by Nick Fewings on Unsplash

• Expert panel diversity: Addiction physicians, epidemiologists, harm reduction advocates, Indigenous health specialists.
• Canadian adaptations: Added withdrawal criterion; grouped non-prescription opioids as unregulated mixes.
• Evidence integration: Hospital data, prevalence surveys, economic analyses discussed in real-time.

Implications for Canadian Universities and College Campuses

Higher education institutions bear a heavy load from alcohol harms. The 2024-2025 Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS), covering 22,961 students aged 17-25 from 43 institutions across nine provinces and two territories, reveals 75% past-year alcohol use—far outpacing cannabis at 39%. Binge drinking (5+ drinks for men, 4+ for women on one occasion) remains prevalent, linking to academic declines, mental health crises, and assaults.

CPADS highlights harms: students report regretted sex, vandalism, and injuries tied to drinking. Trends show stable high use post-pandemic, with self-selection weighting ensuring representativeness. Universities like University of Toronto (CAMH affiliate) and Victoria are pivotal in response—offering counseling, but needing policy shifts like stricter event regulations or low/no-alcohol alternatives.

For faculty and researchers, this underscores opportunities in substance use studies. Aspiring academics can find roles advancing this work through platforms like research jobs in higher ed.

Stakeholder Perspectives: From Researchers to Policymakers

Lead author JF Crépault stresses regulation over prohibition: 'People have been enjoying alcohol for millennia... but there’s real consequences to the way you regulate or don’t regulate alcohol.' Dr. Tim Naimi of UVic warns against access expansions: 'Is that the kind of social norm that we want?' Indigenous panelists like Robert Henry highlighted cultural contexts, where alcohol exacerbates historical traumas.

Government responses vary—Ontario invests $10 million in safe sales training amid expansions, while federal guidelines now advise zero drinks weekly. Universities advocate via student health services, aligning with career advice for public health pros.

Real-World Impacts: Statistics and Case Studies

Alcohol's toll is stark: 6,500 alcohol-specific deaths yearly, per CCSA. In postsecondary settings, CPADS notes 20-30% of students experience alcohol-related academic interference. Case in point: Ontario universities report rising ER visits for alcohol poisoning during frosh week.

Comparatively, opioid crisis dominates headlines (33 score), but alcohol's $19.7B cost eclipses all. Post-legalization cannabis (15) shows youth mental health risks, yet lower overall harm.

• Physical: Alcohol causes 3x more hospitalizations than opioids.
• Social: Drives 40% family violence cases.
• Economic: Lost productivity alone hits $8B yearly.

Challenges and Solutions: Policy Reforms Ahead

Challenges include industry lobbying and cultural entrenchment. Solutions from the study: price hikes (10% cut consumption 7%), marketing curbs, availability limits. Campuses can implement: peer education, dry events, mental health integration.

Federal-territorial Chief Medical Officers push warning labels, backed by $19.7B cost data. For students, resources like higher ed jobs in counseling offer paths forward.

Photo by Philip Yu on Unsplash

Future Outlook: Trends and Research Directions

With no safe alcohol threshold affirmed, expect tighter guidelines. Postsecondary trends: declining youth smoking but persistent drinking. Universities lead via longitudinal studies, AI harm modeling.

Optimism lies in evidence: minimum pricing in BC reduced harms 30%. For career-builders, university jobs in epidemiology abound. Engage via Rate My Professor for insights, or higher ed career advice.

This study positions Canadian academia as global leaders in harm reduction, urging action for healthier campuses and society.