Jump-starting the conversation about harm reduction: making sense of drug effects

Figures & data

Table 1. The seven categories of the Drugs Wheel model, with a summary overview of reported effects, harms, and receptor activity (Abdulrahim & Bowden-Jones, 2015; Basavarajappa & Subbanna, 2019; Coulon & Gorji, 2016; Stolerman, 2010; Julien et al., 2011).

Category	Reported desired effects	Associated/correlated harms	Primarily responsible for effects of most in the group	Minor impact on effects of most in the group	Pharmacologically insignificant contribution to the effects of most in the group
Stimulants	Increased confidence, energy and sexual desire, reduced appetite, euphoria	Dopamine dysfunction, cardiovascular collapse, compulsive use, psychosis	DA, NA	5-HT	GABA, NMDA, OP, CAN, GluR
Empathogens	Feelings of pleasure, connection and mutual understanding, sensual arousal	Serotonin syndrome, risk of inappropriate hydration, depression, fatality	5-HT, DA	NA	GABA, NMDA, OP, CAN, GluR
Psychedelics	Spiritual experiences, perceptual enhancement, euphoria, visual/auditory hallucinations	Adverse psychological effects, delirium, accidental injury, serotonin syndrome, acute toxicity	5-HT	DA	GABA, NMDA, NA, OP, CAN, GluR
Dissociatives	Euphoria, relaxation, analgesia, visual/auditory hallucinations	Unconsciousness, feelings of intense detachment, temporary paralysis	NMDA	5-HT, GluR, DA, GABA	NA, OP, CAN
Depressants	Euphoria, increased confidence and sociability, disinhibited behaviours	Dependence, respiratory depression, reduced blood pressure and heart rate	GABA	GluR	DA, NA, 5-HT, NMDA, OP, CAN
Opioids	Analgesia, feelings of invincibility, euphoria, sedation	Dependence, respiratory depression, reduced blood pressure and heart rate, fatality	OP	DA	NA, 5-HT, GABA, NMDA, CAN, GluR
Cannabinoids	Relaxation, euphoria, altered consciousness, sensual arousal	Agitation, seizures, increased heart rate and blood pressure, coma	CAN	DA	NA, NMDA, OP

DA: Dopamine; NA: Norepinephrine; 5 HT: Serotonin; GABA: Gamma aminobutyric acid; NMDA: N-methyl-D-aspartate; OP: Opioid; CA: Cannabinoid; GluR: Glutamate.

Figure 1. An early version of the Drugs Wheel (12 September 2012).

Figure 2. A more recent version of the Drugs Wheel (12 October 2021) with established drugs in the outer ring, and NPS in the inner ring.

Figure 3. The Effects Wheel: drug effects and risks, allowing for harm reduction information to be given by category.

Figure 4. The Drugs Wheel on display outside The Loop's drug checking service at Boomtown Fair festival, UK, 2017.

Figure 5. The 'dechemicalized' Drugs Pyramid: adapted for the purpose of this paper.

Figure 6. The Drugs World Venn diagram: reprinted from www.InformationIsBeautiful.net with kind permission.

Figure 7. The Drugs Venn model: created by this paper's authors.

Basavarajappa, B. S., & Subbanna, S. (2019). Potential mechanisms underlying the deleterious effects of synthetic cannabinoids found in spice/k2 products. Brain Sciences, 9(1), 14. https://doi.org/10.3390/brainsci9010014

 PubMed Web of Science ®Google Scholar

Coulon, P., & Gorji, A. (2016). Tightrope or slackline? The neuroscience of psychoactive substances. Trends in Pharmacological Sciences, 37(7), 511–521. https://doi.org/10.1016/j.tips.2016.04.004

 PubMed Web of Science ®Google Scholar

Stolerman, I. (Ed.) (2010). Encyclopedia of psychopharmacology. Berlin: Springer Science & Business Media.

 Google Scholar

Julien, R. M., Advokat, C. D., & Comaty, J. E. (2011). A Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs, revised and updated. (12 ed.). Worth.

 Google Scholar