Last Updated: August 1, 2022

What is a risk?

A risk is the potential of suffering some form of harm or loss.

• What is risk assessment?
• Risk assessment is always a risk/benefit assessment.
• Can recreational drug use have benefits?
• What determines the weight of a risk?
• The risk of death.

What is risk assessment?

Risk assessment is the mental process of measuring the risks involved in engaging in a given activity. People perform risk assessments most often when they are trying to decide whether or not to engage in an activity they perceive to be “risky.” Using a drug, for example (any drug), has risks. Questions someone might ask themselves or their doctor before taking a particular drug, in order to assess the risks, include:

• What are the negative side effects?
• Does this drug interact dangerously with other drugs?
• Is it psychologically rewarding and/or reinforcing?
• Will I experience withdrawal symptoms when I stop?

There are many other questions someone might ask. These are just a few examples.

Risk assessment is always a risk/benefit assessment.

To measure anything, a scale or counterweight is needed. The counterweight to a risk is a benefit. A person undertaking a risk assessment weighs the perceived risks against the perceived benefits (real or imagined), and the “heavier” side wins. Risk assessment, therefore, is always a risk/benefit assessment.

People perform risk/benefit assessments every day, even unconsciously. For example, every time someone gets into a car or an airplane they are making an unconscious decision that the benefits of rapid transportation outweigh the risk of injury or death.

Can recreational drug use have benefits?

A benefit is something that promotes or enhances well-being. Recreation itself is a benefit, and different people choose different types of recreational activities, depending on their tastes and preferences. The vast majority of people who use illicit drugs (and alcohol) are casual users who use moderately and report various kinds of benefits from doing so, whether they’re therapeutic, medicinal, recreational, or otherwise. Different people use different drugs and report different benefits. Although there isn’t as much information available about the potential benefits of various illicit drugs, it is important to understand what benefits exist, as well as the potential risks, in order to make an informed risk/benefit assessment.

What determines the weight of a risk.

The weight of a risk can be described as the severity of the possible harm that might occur from a given activity, multiplied by the probability of the harm occurring. This can be expressed by the following equation:

(weight of risk) = (severity of harm) x (probability of occurrence)

Generally speaking, higher risk activities have higher probabilities of more severe harm, while lower risk activities have lower probabilities of less severe harm. For example, Russian roulette would be considered a very high risk activity (perhaps a 1 in 5 chance of death), while reading a book would be considered a very low risk activity (perhaps a 1 in a million chance of a paper cut). Of course, a harm that one person considers extremely severe another person might not care about very much at all. Like benefits, “harms” are also largely subjective, and their severity can be assessed differently by different people.

The risk of death

Death is generally considered the most severe potential harm that can result from using drugs. There are many things that can increase the risk of death from substance use, including:

• The RoA (route of administration), which determines how quickly and effectively a drug reaches the brain. Faster and more intense onset increases the risk of overdose or adverse reactions, and can increase the rewarding/reinforcing nature of the drug. 
• The quantity of the drug ingested, which can determine its potential for toxicity, overdose, and adverse reactions. Dosing sometimes increases the intensity exponentially as you go up, and for some drugs an increase of a few milligrams can completely change the experience. 
• The environment that the drug is ingested in – overheating is a major concern of stimulant use, for example, and can lead to an increase in potential neurotoxicity (depending on the drug in question).
• Your personal medical history, including a family history of certain mental or physical health conditions that could be exacerbated by using certain substances. 
• Whether the substance has been tested and/or is adulterated – if you aren’t certain of what you’re ingesting, you’re unable to prepare and unable to consent to whatever drug experience you’re about to have. This is especially risky in terms of adulterants like fentanyl, which can be lethal in tiny quantities. 

Note: Generally the most intense RoA is injection, followed by smoking, then rectal, then snorting, then oral – but this varies from drug to drug. Always check the bioavailability (how much of a drug is able to reach the brain) of reach RoA for each unique substance. 

No drug use is 100% safe. Really, nothing is 100% safe. It is possible, however, to mitigate the potential risks of drug use as much as possible by considering the items in the list above. Do you have a history of high blood pressure? Stimulants might pose a higher risk to you in terms of cardiovascular complications. Are you prone to anxiety in public places? Maybe tripping in a crowded park isn’t the best setting for the experience. Have you tested your substance? If not, start with a lower dose than usual and have a sober sitter around to respond if something goes awry.