On an individual basis it would do a lot of damage, as heroin users have a very high risk of overdose and death, with annual mortality rates of 1–3%. However, in terms of damage across wider society, alcohol is considered to be more dangerous, as it is a major risk factor for violence, neglect, accidents, cancer and liver disease.
Here's a breakdown of what that looks like:
Alcohol: Far-Reaching Societal Damage
Widespread Use: Legal, socially accepted, and used by billions worldwide.
Harms Non-Users:
- Violence: Alcohol is a major factor in domestic abuse, violent crime, and assaults.
- Traffic Deaths: Drunk driving kills thousands of innocent people each year.
- Child Neglect & Family Breakdown: Common in households with chronic alcohol misuse.
- Economic Burden: Billions lost due to healthcare costs, lost productivity, and law enforcement.
- Chronic Health Burden: Causes liver cirrhosis, cancer, heart disease, and worsens mental illness.
- Cultural Normalisation: Makes it harder to address its harms compared to illicit drugs.
Heroin: Intense but More Contained Harm
Used by a Small Population: Far fewer users than alcohol.
- High Mortality Rate per User: Overdose, infections (HIV, Hep C), and long-term degradation.
- Social Spillover: Still exists, but less pervasive:
- Can contribute to crime, neglect, and strain on emergency services.
- Risk of needle sharing and homelessness can impact broader public health.