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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Friday 16th December 2011 

I thought I’d have another look at the situation regarding the harm caused by alcohol. Earlier this week, I wrote about the latest figures showing there were 1,173,386 alcohol-related hospital admissions in England in 2010/11.

I said, then, ‘[i]t is interesting to speculate how many people would have ended up in hospital if they had all used presently illegal substances rather than alcohol to alter their state of consciousness’ and, after looking at figures for drug use in England published in November, I hoped to engage in a bit of that speculation. As will see, however, that proved to be impossible.

Each year, the NHS produces ‘Statistics on Drug Misuse’ a report that collates the British Crime Survey figures on drug use together with statistics for NHS involvement with people who have used drugs of one sort or another. The report is produced for the different parts of the UK but the one I was looking at is for England only.

As with alcohol, getting at what is actually happening in hospitals is quite difficult. For example, there were 6,640 hospital admissions in 2010/11 where drug-related mental health or behavioural problems was given as the primary diagnosis plus 12,586 cases of ‘poisoning by drugs’ but, when you add the secondary diagnosis the number increases to 51,353. Over the last ten years, the number of primary diagnoses, in the two categories, has risen from 15,841 in 2000/01 to 19,226 in 2010/11, an increase of 21% but the primary and secondary diagnoses in 2000/01 were 25,683 meaning that measure has doubled.

Those figures, which are known as Hospital Episode Statistics (HES), take no account of the, approximately, 7% increase in the adult population from 2001 to 2011. That makes little difference to figures that are ‘about double’ but the 21% increase in the absolute number of primary diagnoses is more like a 12% per capita increase.

As far as I can tell, you can deduct ‘primary diagnoses’ from ‘primary and secondary diagnoses’ so the figures for secondary diagnoses only are 32,127 for 2010/11 against 9,842 for 2000/01. That very large increase suggests something else is going on and the NHS report does have a note saying ‘The quality and coverage of HES data have improved over time’. It seems likely that greater emphasis is being put on collecting secondary diagnosis information making the comparison with a decade ago meaningless.

But what about my postulation that fewer people would end up in hospital if they used the presently illegal drugs rather than alcohol to become intoxicated?

There’s a very big problem with exploring that hypothesis and that comes about because the NHS is, in effect, blind to the Misuse of Drugs Act. The HES data used to prepare the ‘Statistics on Drug Misuse’ are collected using the WHO’s ‘International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)’ for ‘drug misuse’ the relevant classifications are F10-F19. The introduction to this block of classifications 'V Mental and behavioural disorders' says it ‘contains a wide variety of disorders that differ in severity and clinical form but that are all attributable to the use of one or more psychoactive substances, which may or may not have been medically prescribed’. What was that? ‘may or may not have been medically prescribed’. So, the figures include people who have had problems of one sort or another with prescribed medication and, therefore, are of absolutely no value in determining the extent of harm being caused by the illicit psychoactive substances.

The UNODC, in its 2011 World Drugs Report says;

‘Non-medical use of prescription drugs is reportedly a growing health problem in a number of developed and developing countries’.

And;

‘In the United States, many emergency room visits are now related to prescription opioid use, and this drug class is also responsible for an increasing share of treatment admissions in that country’.

So, the UNODC is saying that increases in hospital admissions for ‘drug’ problems may well be being driven by deliberate or accidental misuse of prescribed medication.

It must be noted that people like Kathy Gyngell and Melanie Phillips often cite increased hospital admissions as evidence for their prohibitionist positions. But, as above, that data does not prove an increase in health problems from ‘illicit drugs’ only from ‘drugs’.