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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Thursday 6th October 2011

If you have visited the home page of this website you will have read that ‘accidental plant poisoning is very unusual’. The USA, probably, has the most widespread network of publicly accessible poison information centres but of the over 4 million calls dealt with in a typical year around 60,000 involve plants and under 100 result in  a ‘major outcome’. As a result, there is a lack of detail on these poisonings and I’ve referred to some work done in Switzerland link to try and see which plants do the most harm.

In the UK, there is no publicly accessible poison information service. Instead there is the National Poisons Information Service (NPIS) that offers both a telephone enquiry service and an information website to medical professionals only. The NPIS has just published its latest annual report and it contains one of the most unscientific conclusions I have ever read.

*There are 14,000 products entries in the TOXBASE database and the NPIS spends a lot of time revising these entries. In 2010/11, over 4,000 entries were written or revised.

Before looking at that specific point, I’ll quickly run through some of the interesting figures in the report. There were approximately 510,000 users sessions for the TOXBASE website of which 465,111 originated from the UK and those sessions resulted in 1,121,300 individual substances* being accessed. There were also 49,595 calls, relating to patients, to the 24 hour telephone service of which just over 1,500 were referred to a consultant toxicologist.

There is no clear breakdown of the subjects of the various enquiries but a pie chart shows that ‘Plants/fungi’ accounted for 4.8% of the telephone enquiries, which is around 2,380 calls. For TOXBASE sessions, plants/fungi accounted for 1.0% or approximately 11,213. There is no more information about plant poisoning and that, in itself, is an indication of how few serious incidents occur.

‘Pharmaceuticals’ are by far the greatest problem accounting for nearly 70% of all enquiries both telephone and TOXBASE. For these the NPIS does give more information on the particular substances concerned. I take that to indicate that it would give information about any particular plant concerns and, since it does not, we can conclude that plants are not a special danger.

To return to that unscientific conclusion I referred to before. The NPIS annual report includes a section entitled ‘Areas of Interest 2010/11’ and the first of these is what the NPIS calls ‘Drugs of Misuse’.

We can see that 2.6% of telephone calls to NPIS (around 1290 calls) were related to these ‘drugs of misuse’ but the report does not appear to give the number of TOXBASE sessions. I find it interesting that the report gives a whole section to ‘drugs of misuse’ when nearly twice as many telephone calls were made about plants. 

The report notes that the arrival of newer recreational drugs is a challenge since the available data on these substances may be limited and, therefore, offering useful advice for treating those suffering from severe intoxication is problematic.

Catha edulis, khat

Catha edulis, khat

So far, so unexceptional, but then the report makes a truly amazing claim. It notes that the number of enquiries related to mephedrone, the artificial stimulant that is similar to the cathinones found in Catha edulis, khat, decreased as soon as the substance was classified as Class B in April 2010 and concludes ‘These changes suggest that the legal control of mephedrone and other cathinones enacted in April 2010 had an impact on the frequency of associated toxicity’. To be fair it does go on to say ‘It is acknowledged, however, that reductions in media reports and increasing familiarity of healthcare professionals with these substances may also have contributed to the observed pattern’ however it seems not to believe that effect to be substantial.

What is does not do, however, is to even consider the possibility that anyone having a bad experience as a result of using mephedrone, after April 2010, would be much less likely to seek medical help for fear of being arrested.

The notion that making a substance illegal immediately resulted in a decrease in its use flies in the face of all evidence about substance use since the Misuse of Drugs Act was passed into law in 1971.

As often happens, the press release announcing the publication of the report goes even further. It is headlined ‘Drop in ‘legal high’ poisonings following ban’ even though it later quotes Professor Simon Thomas, director of NPIS' Newcastle unit, as saying "So we cannot say that use has declined…it would appear to us that recommendations made by the Advisory Council on the Misuse of Drugs and implemented by Government have had the desired effect.”

He then goes on to say "Of course following the ban, the media's focus on mephedrone died down and this may also have contributed to the reductions in enquiry numbers." You would have thought that, as a scientist, Professor Thomas would know better than to draw conclusions based on absolutely no evidence.

I’ve tried to understand why the NPIS has demonstrated its total lack of knowledge on which to base comments about substance use. I rather hope it is simply due to a degree of stupidity. I hope this because the alternative, that at a time of pressure on budgets, it knows better than to say anything that appears to contradict government policy is rather frightening.