Alcohol and Tobacco have minimal short term health risks. Most people throw up rather than OD on Alcohol. Obviously driving while fucked us is dangerous, but the same is true of a lot of drugs. Driving stoned is an underappreciated risk.

LSD arguably the poster child for safe illegal drugs, but still physically risky due to people doing dangerous things in it and falling etc. However the mental risks with heavy use are significant much earlier. Luckily it’s not particularly addictive, but IMO it’s more dangerous than both Alcohol and Tobacco even as people claim otherwise.

Tobacco is seriously deadly long term, but the risks are low for the first 20 years. When you include risks from throwing up while unconscious etc, heavy use of many seemingly safe drugs end up risky on those timescales.

Something like cannabis, MDMA, or amphetamines would be. I think all of those have a decent claim to being safer than or comparably safe to alcohol.

Tobacco, as you say isn't particularly bad in the short term. But it is particularly addictive, so you end up with a large proportion of addicts / long term users for whom the longer term effects apply.

They just never really had the drive to improve their situation in life to the point where it often is easier to get high instead of confronting problems.

People have fatal overdoses on MDMA and hart attacks etc.

Amphetamines use is linked with cardiovascular issues and brain damage.

For each cause of death, the researchers compared trends in deaths in states with legal markets with those in states that had comprehensive medical cannabis programs and similar trends in death rates prior to implementing markets…

The study did not link cannabis use with traffic fatalities.

The study linked trends.

Cannabis use was not a factor in those deaths. Not listed as a cause. Not listed as intoxicated at time of accident.

There is a significant difference between the narrative being schlepped versus what data was actually accumulated.

Findings show that meta-analyses and culpability studies consistently indicate a slightly but significantly increased risk of crashes after acute cannabis use. These risks vary across included study type, crash severity, and method of substance application and measurement. Some studies show a significant correlation between high THC blood concentrations and car crash risk. Most studies do not support this relationship at lower THC concentrations. However, no scientifically supported clear cut-off concentration can be derived from these results. Further research is needed to determine dose-response effects on driving skills combined with measures of neuropsychological functioning related to driving skills and crash risk.

Suppose you have a study of 10k people split 5k:5k between smokers and non smokers. In the non smokers group you get say 10 cases of lung cancer and the smokers group you get 200. It’s really tempting to say the individual smokers got long cancer from smoking, but the base rate isn’t 0 so you don’t know who was screwed either way. Perhaps if nobody smoked in that total population there would have been 19 cases of lung cancer or perhaps 22.

Thus only thing you can say is smoking increases RISK of lung cancer not link it to specific cases.

People OD and die from drinking water, that doesn’t make it as dangerous as heroin.

From one rave “Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7. Using multiple cooling methods, the average time to achieve cooling was 2.7 hours. Serum drug analysis was performed on 3 patients, demonstrating toxic MDMA concentrations without the presence of other xenobiotics. Two capsules confiscated by police at the event contained 82% and 98% MDMA, respectively, without other pharmacologically active compounds. Capsule #2 contained 270 mg MDMA, which is more than twice the amount of MDMA usually contained in 1 dose. The MDMA-induced hyperthermia significantly contributed to the morbidity and mortality in this case series. Factors contributing to the severity of the hyperthermia include ingestion of large doses of MDMA, a warm ambient environment, and physical exertion.”

To be clear drug testing would have discovered fentanyl or other common drugs in their bloodstream, so it’s not just based on the pills recovered. Granted legalization would likely result in more consistent doses which would help, but the drug itself would still be risky if people just kept consuming more.

It appears thar heat stroke caused the problems not "toxic MDMA concentrations". The LD50 of MDMA is estimated to be 180mg/kg - Were those ravers taking tens of capsules? I presume there are toxicology reports from the deaths that estimated the dosages. But alcohol is poisonous if you have too much - we don't usually call it "toxic".

Weirdly they mention "a warm ambient environment" but what were the humidity levels? I presume there is good information on the underlying causes of death elsewhere? That summary is terribly uninformative.

"mortality from classic heat stroke approaches 80% and, for exertional heatstroke, 33% in the absence of prompt treatment" : https://www.nejm.org/doi/full/10.1056/NEJMcp2210623

Disclaimer: personally I'm not a MDMA user. I'm a concerned citizen that thinks raves are generally healthier than bars. "sensible" MDMA usage anecdotally within those events seems safe to me (sample of thousands of people, zero deaths). Number of people I know dead from MDMA: zero. Number of people I personally know dead from alcohol: many (I am a middle aged guy so some were long term effects, one was in a house fire).

Drunk driving is a more indirect risk, but I am also including that as one of the risks of Alcohol consumption elsewhere in the thread. If you’re objecting to the name fine, but the risk still exists as MDMA consumption regularly kills people due to this and other risks.

PS: Water toxicity is a similar situation. It’s not just the amount of water alone that’s a problem instead the amount they’ve been sweating is often a contributing factor. Oddly, they also mention MDMA as a risk: https://en.wikipedia.org/wiki/Water_intoxication

MDMA screws up the body's ability to regulate temperature. But without the warm environment and physical activity leading to hyperthermia, I can't imagine any of those people would have even needed medical attention.

That said, personally I would never call MDMA "the poster child for safe illegal drugs". Just because it won't kill you, doesn't mean it is safe or risk-free.

More broadly, I’m including traffic fatalities as a risk from alcohol and falls under LSD, so having deadly issues regulating body temperature definitely qualifies in an apples to apples comparison here.

Again, no, that San Francisco situation is strictly not describing an overdose. From the comfort of your living room, you can consume a massively higher amount of MDMA than what was described in that paper, and won't suffer significant medical issues.

> I’m including traffic fatalities as a risk from alcohol

OK, but that doesn't mean a drunk-driving fatality is an overdose on alcohol.

If they had taken that much at home it may not have resulted in an overdose, but in this situation it did.

I suppose you're free to say that, and everyone else is free to ignore this as ridiculous nonsense which is completely out-of-step with the widely-used definition of "overdose".

You're completely ignoring the context of the event. Have you ever been to a rave? Some promoters are good and understand the importance of providing free/inexpensive water, proper ventilation, and security who are able to spot attendees requiring medical intervention. Other promoters are shady AF and do none of those things. In the latter case, if someone consumes MDMA and also dances for hours without hydration and the venue is way too hot / oversold, yes that person is at risk of hyperthermia.

That can also happen even to sober people, I've literally seen it.

Try asking your GP about what it an insulin OD entails and they will refer to the results not the specific dose. Though obviously there’s a dose large enough it’s never appropriate.

And indeed some countries legally require it.

Alcohol is an _extremely_ harmful drug.

Risk of death is significant, but we’re talking under 0.1% per year.

that very few are overdosing isn't the issue.

No, LSD won't kill your body. But what are you? You aren't just your body, you are your mind and mental state and the consistency of that.

Do enough LSD, especially consistent high doses, and the "you" you know will die and be permanently replaced by something else.

I of course agree that LSD won't put you in a coffin. But there are more axes upon which a drug's danger should be evaluated than "what percentage of users are put in coffins?"

I had a college roommate who did a shit ton of LSD one night and I woke up to the fire alarm having been pulled and him punching holes in the wall.

The police (fire department called the police) dragged him off and the hospital had to give him a bunch of antidepressants to short circuit the LSD.

He was literally not the same person ever again. That is terrifying, even more so than chemical dependency, to me.

That said things can still happen on a bad trip. I posted my own personal experience downthread.

Once you can't seperate fantasy from reality you're just one bad trip from falling out of a window you thought was a door.

edit: The responses here just seem like denialism from people who got lucky to be honest.

You can be aware that you are tripping and still imagine that something is something else.

Roads looked like footpaths to me, windows looked like doors, knives looked like forks, and so on and so forth. I was aware that it wasn't real but couldn't be sure of the safety of existing in the world.

I basically had to sit in a corner for 10 hours, hope that the corner was actually the one I thought it was and that I wasn't going to fall down a staircase instead.

It was great fun but felt like russian roulette.

Because what you’re describing doesn’t resemble LSD at all. You’re describing deleriants like datura if anything.

A conundrum.

I consider myself lucky that the anxiety only shows up when on drugs, which is pretty easy to avoid by, y'know, not doing drugs. But clearly something permanently shifted inside my brain.

The inability to experience something I used to enjoy without a near-panic-attack is a bit more of an effect than a conversation might have.

And critically, lobotomy isn't a change from one set of mental states to another. That big chunk of brain doesn't grow back.

Post lobotomy people generally weren’t brain dead, even if diminished. So for extreme cases, yes it’s a solid comparison.

Yeah. If alcohol was discovered only today, there wouldn't be a government in the world that would legalise it.

It's legal because its grandfathered in, from the time before humans developed society and civilisation.

If you take enough of a drug that it makes you throw up, you did overdose. 'Overdose' doesn't mean you died. Fatal overdoses just get talked about more than other overdoses because they're the most harmful kind of overdose.

Alcohol abuse either kills people in the long term, or combined with automobiles. Very few people have a bit too much to drink some night and actually die from it. You'll generally black out long before you get a lethal dose.

With opioids, you can trivially take a lethal dose.

(That doesn't change what the word 'overdose' means. If you want to be more specific than the word is, feel free to use adjectives, e.g., 'fatal overdose', 'deadly overdose', etc.)

OD refers to excessive consumption or negative heath outcomes, so yes and sort of. With alcohol people will sometimes throw up before all that much alcohol enters the bloodstream, throwing up may qualify on its own but may prevent things like liver damage but throwing up itself could qualify as a negative health impact.

So for a collage kid throwing up really does provide meaningful protection for their liver. Though obviously it comes with its own risks of asphyxiation etc.

What on earth are you talking about? Alcohol can kill you in a single evening if you drink enough of it. How much shorter-term could its health risks be?

Of the ~3 million Americans that tried Alcohol for the first time in 2023 how many exactly died from an overdose that night? That’s what low risk looks like.

The risk on the first time they consumed alcohol is probably 1/100th of that due to younger ages etc.

Alcohol use kills both acutely and chronically. Alcohol is addictive. Long term use cause mental health issues.

LSD does not have the same health impacts and its lack of addiction potential gives it a significantly lower harm profile.

Do yourself a favour and read some material published by domain experts (may I recommend “Drugs Without the Hot Air” by David Nutt).

However, I’m looking at things from a per use basis because I’m not really attracted to drinking. So for me it’s about what risks are associated with drinking a beer vs dropping a tab vs smoking 1 more cigarette. Because people like me can choose to do some, all, or none of those things and it’s worth considering the risks on a per event basis.

Very few deaths are associated with LSD, but harm isn’t so binary. You can reasonably safely consume a lot of alcohol without issue, as in 1-3 beers a night for a decade, but daily LSD use at that level is another story.

This is not a useful metric at all, and is incredibly naive. Each of those activities carries with it the relative risks of addiction and long term harms. Your metric can lead to absurd conclusion that cigarettes are perfectly fine because nobody ever got cancer from having just one. The danger in tobacco is that people don't stop at just one.

> You can reasonably safely consume a lot of alcohol without issue, as in 1-3 beers a night for a decade

Some people can, but a significant minority of the people that try that will run into trouble and find their habit escalating. Even people like you who seem to think they are above addiction. And those who don't suffer addiction from that pattern will have increased their risk of cancer and various other diseases.

> but daily LSD use

Is so rare as to effectively constitute a complete fallacy of argument. That's the point, virtually nobody wants to use LSD on a daily basis, even amongst people who like and use LSD. Its risk profile is significantly lower than alcohol or tobacco as a result of that.

Seriously, go read up on this stuff, it's fascinating as well as enlightening.

Personal experience but Alcohol, Tobacco, opioids etc and never felt the pull. I tried smoking for a little under a year but didn’t really care for it. Used to drink fairly regularly but just kind of got bored with it to the point a found out beer eventually goes bad in your fridge.

> Is rare

Ok that may be personal bias in terms of use. I remember one guy saying enough LSD could replace sleep and things didn’t go well for him or a lot of other people.

So yes, I knew quite a few people that used it daily, but though none were able to function long term like that. Dad and various friends were connected to Timothy Leary and that’s about as much as I am comfortable sharing.

Sure, and that's your personal experience. If we were going by my personal experience we would get a different picture - that tobacco was highly addictive (though easy enough to quit in the end) but there was no issue at all with cocaine. Yet when we look at the harm profile of cocaine, we can see it's comparatively pretty bad and pulls people into spirals of addiction and self-destruction.

You can't really say "LSD is worse than booze" as a sweeping statement that you consider applies to everyone, and then use as justification your personal lack of issues with alcohol.

> I knew quite a few people that used it daily

No offence, but this is why the plural of anecdote is not data. Your sample bias here is extreme - people who were idealogically inclined to take acid daily as an almost pseudo-religious sacrament are not a representative sample.

Case studies are a major source of data in science. People exposed to extreme radiation doses from accidents play a significant role in our understanding of the consequences of said exposure and ways to treat it.

If the people I knew were able to handle that kind of LSD use then I would have a different opinion because LSD would be safer. Is 1% the use 1% as dangerous? Now that’s where you need controlled studies because the effect size diminishes, but feed 50 rats 1 gram of substance Y and they all die and that’s strong evidence on it’s own no need for statistical analysis.

Your theoretical study there tells you about substance toxicity, but it tells you very little about the real-world dangers of substance Y to rats.

Would rats choose to consume substance Y at all? How often and how compulsively? What are the effects on rats at the levels they choose to consume, rather than the effects on them at levels the scientists chose to dose them with? If most rats would choose to eat 1mg of Y, at most once a year, and that level doesn't seem to harm them, then that 50mg test has shown you nothing at all.

Substance Z doesn't kill at 50mg, in fact it's safe up to 1000mg, is it less harmful? Well that depends. If the rats compulsively gobble every bit of it they can find and then drop dead after a month, we can say that Z is much worse.

Imagine you worked in an alcoholic rehab centre. You have first hand evidence all around you of the horrific damage alcohol wreaks on its users. Many of them have liver problems, are aged by the booze and their tough lives. Some are battling cancers caused by the drink, others have severe mental impairments. Your impression of drinkers is likely very skewed.

That's what you're doing with your sample of LSD users. With alcohol you're explicitly excluding the equivalent group in your assessment - "You can reasonably safely consume a lot of alcohol without issue, as in 1-3 beers a night for a decade" - when we can be confident that the group of alcohol addicts is larger as a proportion and suffers from all sorts of issues you're happy to ignore.

This way of thinking is so common I'm considering naming it the "it's just a beer" fallacy. Most people who have a beer or two don't become alcoholics. Most people who drop acid once or twice don't become your dads friends. To gauge relative harm we need to figure out what 'most' means and what the consequences are across users. You don't get to select a moderate drinker and an extreme outlier acid-head and say "see! this one is worse!". That's not a valid comparison.

I could agree with tobacco but I don't believe LSD is more dangerous than alcohol. Most domestic violence, most fatal traffic accidents are under the influence of alcohol. It destroys families and communities. I don't see how LSD could be that damaging.

Like yeah if you take way too much lsd or take a tab a day it might fuck you up, but so will drinking a fifth of whiskey inside an hour, or having two or three cocktails every evening. Or take like double the top-end therapeutic dose of tylenol.

I’m not claiming most of them are strictly safe, just that most aren’t obviously in a whole different risk category from a couple of our legal drugs. Shit, I’ve given myself heart palpitations as a teen because nobody stopped me from getting a second triple-shot cappuccino.

That cop came to my school too. On a bicycle. He also told us that 50% of us would die in any car accident over 50mph. It was really hard to not laugh at him given the number of us who participated in the local streetracing scene. In a room full of students in jackets and ties, he stood there spouting lies in his spandex bike shorts.