Unveiling the CAMH Landmark Research on Drug Harms

The Centre for Addiction and Mental Health (CAMH), a leading research institution affiliated with the University of Toronto, released a pivotal study in January 2026 titled "Drug harms in Canada: A multi-criteria decision analysis." Published in the prestigious Journal of Psychopharmacology, this research marks the first comprehensive application of multi-criteria decision analysis (MCDA) to rank drug harms specifically within the Canadian context. Led by senior policy advisor Jean-François Crépault and senior scientist Dr. Jürgen Rehm, the study draws on expertise from researchers across multiple Canadian universities, including Dalhousie University and the University of Calgary. It evaluates 16 commonly used psychoactive substances, revealing alcohol as the clear leader in overall harm—a finding that resonates deeply within higher education circles, where student wellness and public health research intersect.

This investigation responds to Canada's evolving substance use landscape, including the ongoing opioid crisis and post-legalization cannabis trends. By quantifying harms at a population level, the study provides a nuanced tool for policymakers, educators, and university administrators to prioritize interventions. Its implications extend to postsecondary environments, where alcohol remains a staple in social life but poses significant risks to academic performance and mental health.

Decoding the Multi-Criteria Decision Analysis Approach

At its core, MCDA is a structured group decision-making technique designed to handle complex problems involving multiple conflicting criteria. In this CAMH study, researchers first assembled a national panel of 20 multidisciplinary experts from six provinces, spanning fields like addiction medicine, epidemiology, public health, and even lived experience with substance use. The process unfolded in three stages: establishing the panel, defining drugs and harm criteria, and convening a two-day decision conference.

During the conference, experts scored each of the 16 drugs on 16 distinct harm dimensions using a 0-100 scale, where 100 represents the worst possible harm observed for any drug. These dimensions split into two main groups: 10 harms to users (such as drug-specific mortality, physical health damage—both direct and indirect—dependence, withdrawal symptoms, short- and long-term mental functioning impairments, loss of tangibles like property or employment, and loss of relationships) and six harms to others (injury inflicted on non-users, organized crime involvement, family and social adversity, environmental damage, international damage, and economic costs). Panelists then weighted the relative importance of each criterion based on empirical data and professional judgment, yielding a weighted overall harm score that factors in both a drug's inherent risks and its prevalence in Canada.

This rigorous, transparent method builds on foundational MCDA work by Professor David Nutt's team in the UK, adapted for Canadian realities like regional drug toxicity patterns and policy environments. Unlike simplistic rankings based solely on mortality, MCDA captures the full spectrum of societal burdens, making it invaluable for evidence-based decision-making in universities and beyond.

The Definitive Rankings: Alcohol Far Ahead

The study's results are stark: alcohol secured the highest overall harm score of 79 out of 100, dwarfing all competitors. Tobacco trailed at 45, followed by non-prescription opioids (primarily fentanyl-contaminated street drugs) at 33, cocaine and methamphetamine tied at 19 each, and cannabis at 15. Lower-ranked substances included benzodiazepines, prescription opioids, ketamine, LSD, MDMA (ecstasy), mushrooms, prescription stimulants, crack cocaine variants, and solvents.

• Alcohol (79): Dominated nine categories, including physical health damage, withdrawal, mental impairments, relational losses, injuries to others, family adversity, and economic costs.
• Tobacco (45): High due to chronic disease prevalence and second-hand smoke harms.
• Non-prescription opioids (33): Elevated by acute toxicity deaths exceeding 80% of unregulated opioid fatalities.
• Cocaine/Methamphetamine (19 each): Punched above their prevalence weight with severe user harms and crime links.
• Cannabis (15): Moderate score reflecting legal access but rising dependence rates among youth.

These population-level scores underscore how regulation influences harm—alcohol's easy availability in convenience stores amplifies its toll, while prohibition inflates illegal drug dangers.

Why Alcohol Emerges as Canada's Most Damaging Substance

Alcohol's supremacy stems from its toxic profile—no safe consumption level exists, as per Canada's 2023 Guidance on Alcohol and Health, linking it causally to over 200 diseases and injuries. Acute effects include intoxication leading to falls, violence, and traffic crashes; chronic issues encompass liver cirrhosis, cancers, cardiovascular disease, and fetal alcohol spectrum disorder. Socially, it fuels intimate partner violence, child neglect, sexual assaults, and productivity losses totaling $19.7 billion annually—40% of all substance-related costs in Canada.

Crucially, harms extend beyond users: emergency departments often serve as "clearinghouses" for alcohol-intoxicated individuals, per lead author Crépault. Prevalence amplifies this—most Canadians use alcohol, normalizing binge drinking (four or more drinks in one sitting for women, five for men). Recent policy shifts, like Ontario's 2024 expansion of sales to grocery and big-box stores, have boosted accessibility without corresponding harm-reduction measures, experts warn.

In higher education, this manifests in elevated risks: alcohol contributes to 25% of campus sexual assaults and hampers retention rates.

Photo by Minh Đức on Unsplash

Global Benchmarks and Canadian Uniqueness

The CAMH findings mirror international MCDA studies: UK's 2010 analysis (alcohol 72/100, ahead of heroin), EU, Australia (alcohol 77), and New Zealand rankings all crown alcohol king due to ubiquity. Canada's twist? Tobacco ranks second (unlike heroin/meth in others), reflecting high smoking prevalence; non-prescription opioids third amid the fentanyl crisis (~74,000 toxicity deaths since 2016).

Yet Canada diverges in policy: while Australia and New Zealand tightened alcohol controls post-MCDA, Canadian provinces have liberalized sales. This gap highlights opportunities for universities to lead via research, as seen in contributions from Dalhousie University's Sherry H. Stewart on dependence harms.

Societal Ripples: From Economy to Families

Alcohol's economic bite—$19.7 billion yearly—encompasses healthcare ($6.5 billion), lost productivity, and criminal justice. It drives absenteeism, unemployment, and family breakdowns, with harms to others rivaling user impacts. Environmentally, production pollutes waterways; internationally, smuggling ties into organized crime.

In postsecondary contexts, the Canadian Postsecondary Education Alcohol and Drug Use Survey (CPADS) 2024-2025 reveals 75% of students aged 17-25 used alcohol in the past year, far exceeding cannabis (39%). Harms include academic interference (e.g., missed classes), mental health declines, and victimization.

Alcohol's Shadow Over Canadian Campuses

CPADS data paints a concerning picture: while overall substance use dipped slightly post-pandemic, hazardous drinking persists among university and college students. Binge drinking rates hover at 30-40% monthly, correlating with anxiety, depression, and GPA drops. Universities like the University of Manitoba report similar trends in their CPADS school reports, with 25% of students advocating for more on-campus alcohol education.

• High-risk harms: 20% experienced alcohol-related injuries; 15% faced assaults.
• Awareness gaps: Many underestimate long-term risks like cancer links.
• Trends: Post-cannabis legalization, dual use rose, compounding issues.

This underscores the need for tailored campus interventions, from policy audits to peer education.

Universities Stepping Up: Policies and Research Initiatives

Canadian institutions are responding proactively. Universities Canada convened leaders in 2014 for high-risk drinking strategies, evolving into modern frameworks like St. Francis Xavier's campus policy benchmarks. Recent studies, such as those in the Journal of American College Health, analyze Atlantic universities' alcohol policies, scoring them on availability limits and enforcement.

Research hubs thrive: University of Victoria's Canadian Institute for Substance Use Research, led by Dr. Tim Naimi, critiques sales expansions. Dalhousie and others contribute to national surveillance. For professionals, this opens doors in higher ed research jobs and counseling roles via higher ed career advice.

Photo by Philip Yu on Unsplash

Voices from the Experts and Stakeholders

"Alcohol clearly stands out," states Crépault, emphasizing regulation's role. Dr. Rehm adds, "Alcohol combines serious harms with very widespread use." Dr. Naimi laments normalization: "We just normalize alcohol being in every store." Students at Fanshawe College echoed surprise at accessibility's role.

Government invests $10 million in Ontario for safe sales training, but critics call for pricing hikes and marketing curbs. Industry pushes back, citing cultural traditions.

Pathways Forward: Evidence-Based Solutions

Recommendations mirror proven strategies: minimum unit pricing (as in Scotland, reducing consumption 10%), availability restrictions, ad bans, and brief interventions. For campuses: mandatory education, sober events, and screening tools. Future outlook? With AI-driven harm modeling and longitudinal CPADS, universities can pioneer.

Higher ed leaders can leverage this for university jobs in public health, while students explore professor ratings for substance research courses. Explore higher ed jobs or career advice to contribute.