Just like the stock market, predicting which drugs present the greatest threat to society is not foolproof. But, as with financial stocks and shares, employing sources of intelligence to anticipate which illicit drugs will cause the greatest harm to individuals and wider society is possible.

Despite the significant sums of money used by various Western Governments to pursue the ‘war on drugs’ policy there is little sign of any reduction in drug use. What does change is how popular some drugs are and those that lose their appeal, neither is impacted by government policy or legislation.

Ketamine, a drug traditionally used as an anaesthetic is attracting scientific attention as a potential treatment for depression. This legitimate use may have contributed to the rise in its popularity as a recreational drug. The entrepreneur Elon Musk has recently endorsed Ketamine as a drug which has enhanced his professional and personal life. Ketamine induces feelings of happiness, relaxation, and detachment.

Health economists suggest that price and availability are the drivers of drug use, if the price is sufficiently low and supply is good then use of the drug is expected. Ketamine meets both such rules, having become more affordable and easier to purchase. Police seizures of the drug increased tenfold between 2021 and 2022, from 187kg to over 1800kg. An estimated 3.8% of those aged 16-24 report using Ketamine, a figure that has been rising over the last decade. All this suggests its popularity will grow further in 2024.

The risks associated with using Ketamine regularly and at higher doses include bladder problems, incontinence, mental health problems and fatal overdose. As Ketamine use increases in the population there will be an accompanying rise in those experiencing problems. Unfortunately, general and specialist treatment services are just not equipped to identify or effectively deal with these problems.

The second drug of concern in 2024 is an old staple, heroin. There are more than 293,000 regular users of opiates, of which heroin is the most common, in England and Wales alone.

Events thousands of miles away will have a direct impact on the UK illegal market. When the Taliban seized control in Afghanistan in 2022, they vowed to eliminate opium farming, they have been successful in this ambition. The UK relies heavily on opium from Afghanistan to supply the heroin market. Suppliers and distributers of heroin in the UK have proved their agility by substituting alternatives to ensure supply is uninterrupted, filling the gap with synthetic opiates like fentanyl. Synthetic opiates have prematurely killed hundreds of thousands of Americans in recent years, and although the UK has so far escaped this phenomenon, this won’t last.

The UK is already experiencing record numbers of drug-related deaths, this will be amplified in 2024 with an increase in the supply of synthetic opiates. One evidence-based way to reduce drug-related deaths is by providing safe places for people to use drugs. The Scottish Government has been trying to open drug consumption rooms to reverse the rising numbers dying prematurely. But as drug policy is devolved to Westminster, the implementation of these services has been actively blocked by politicians south of the border.

However, the persistence of Scottish politicians and other advocates has resulted in the opening of a drug consumption facility in Glasgow. There is no sign that the Westminster government or the Labour party would sanction such a service in England and Wales as they believe there is a lack of public support for these facilities. Drug consumption rooms can be misperceived as encouraging drug use despite evidence to the contrary. At the very least, popular opinion is that taxpayers’ money shouldn’t be wasted on people with ‘self-inflicted’ problems.

Another staple drug which looks set to create serious problems in 2024 is cocaine. During a cost-of-living crisis cocaine has emerged as a value product. Not only is it more affordable than ever, but its purity has been increasing. The appeal of cocaine when people’s incomes are squeezed is clear, this stimulant increases confidence, happiness and excitement.

This is no longer a drug of the affluent as it is used across all socio-demographic groups in the population. Little surprise then that hospitalisations and fatalities have risen dramatically at the same time.

The nation’s favourite drug, alcohol is commonly used with cocaine. Both drugs are a well-matched pairing as the stimulating effect of cocaine mitigates the depressant effect of alcohol. In practice this means people can drink alcohol for longer when also using cocaine. This increases the risk of harm to health over and above the risks associated with using either substance on its own.

Tolerance to both drugs develops quickly, meaning larger doses are taken to achieve the same effect. Dose and frequency are the two driving factors of harm with any drug including cocaine. Physical and psychological dependency develop rapidly when using cocaine, unlike alcohol where it can take years it is only a matter of weeks for cocaine.

The threat that all three drugs pose to individuals and wider society is preventable. But this is dependent on the political will to adopt a health-based rather than a penal approach to drug policy. It’s all too easy to point the finger of blame towards politicians but they are not really the culprits, we all are. It is the widely-held discriminatory view towards those who use opiates and other drugs that props up the impotent ‘war on drugs’ policy.

It is only when public opinion radically shifts, rejecting stigma and embracing humane support for those who develop problems with drugs, that we stand any chance of reducing the harm and fatalities associated with drugs.

Given the rising threat that drugs pose, an attitudinal shift is needed in 2024 more than ever.