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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 31st August 2011

Last week, the Office for National Statistics published its annual report on drug related deaths in England and Wales. This follows the publication, earlier in the month, of similar data for Scotland. As with almost every statistical report, there are difficulties in fully understanding what the numbers presented mean and there is scope for misrepresentation by the media.

The first problem is that both documents refer to drug-related deaths (DRDs); that is deaths where a specific drug or drugs is mentioned on the death certificate or where the general term ‘drug overdose’ is used. Generally, the media reports these as drug deaths rather than drug-related and write about drugs ‘causing’ the deaths. The distinction between ‘drug-related deaths’ and ‘drug deaths’ may appear to be fine but it leads to the perpetuation of misinformation and, I believe, misinformation contributes to the problem.

I’m not intending to overload this blog with figures so, if you want the full detail, you should obtain your own copy of the report.

The ‘headline’ figures for England and Wales show that 2,747 people died of ‘All drug poisoning’ in 2010 against 2,878 in 2009; a small but not significant decrease. Within that, however, the number of males fell and the number of females increased. Of the 2,747 total, 1,784 were ascribed to ‘Drug misuse’, again a small fall from 2009’s 1,876 and, again, with a rise in females being more than offset by a fall in males.

‘All drug poisoning’ includes prescribed medications i.e. legal substances whereas ‘Drug misuse’ relates only to substances classified under the Misuse of Drugs Act. Note that not all deaths from legal substances are the result of legal use, they include things like sleeping pills bought ‘on the street’ or medications stolen from the designated patient or pharmacies.

Accidental poisoning remains the largest cause of DRDs, followed by deliberate self-poisoning with DRDs related to ‘Mental and behavioural disorders due to drug use’ amounting to only 22% of the total. The report notes that this category has shown a decreasing trend with an increase in the proportion of accidental poisonings but it says the reasons for this are not understood.

I’m not saying that I know what the reason for this increase in accidental overdoses is but I do know where I would start to look. The use of ‘cutting’ by the criminals who control the distribution of heroin and other illegal drugs means that users may not know the actual strength of the substances they are using, especially if police enforcement action has made their normal supplier unavailable and they have obtained their drugs from an untried source.

Trying to get a full picture of what is happening is complicated by the fact that there is a degree of laxity in the way cause of death is reported. It can be recorded simply as ‘drug overdose’ and around 12% of the total DRDs are reported in such non-specific terms. A further 30% of DRDs are have more than one substance named but there is no clear way to determine which substance was the actual cause of death and which an also-ran. So, in 42% of the total, it is not possible to reach any firm conclusion about what caused the death. That’s not very helpful when trying to formulate policies for reducing DRDs.

Take cannabis, for example. Cannabis was mentioned in 11 DRDs in 2010 but in only 2 of those instances was it the only substance mentioned. Incidentally, to discover that you need to be sufficiently interested to download the support Excel spreadsheet.  What the spreadsheet doesn’t say, however, is whether alcohol was a factor in those two cases or whether, as in the 2004 death of Lee Maisey reported on the cannabis plant page, the coroner ignored the toxicology results and cited cannabis as the cause of death in spite of evidence of very low consumption on the part of the deceased.

Turning to Scotland, and, again, you may want to obtain the full report,  there were 485 DRDs in 2010 a decrease of 60 from 2009 but still 193 higher than in 2000. Heroin/morphine was mentioned in 52% of DRDs and methadone in 36% but it is important to remember that those percentages are not additive because both substances could be reported for a single DRD.

It is impossible to make comparisons between Scotland and England and Wales because Scotland has a category for ‘Drug Abuse’ rather than the more detailed ‘Mental and behavioural disorders due to drug use’ used in England and Wales. As a result, 66% of Scottish DRDs are simply written off as ‘Drug Abuse’ suggesting a disinterest in trying to understand what is actually causing these avoidable deaths.

Since 2008, however, Scotland has tried to improve its recording of the relevance of substances in DRDs and cannabis has only been mentioned in one DRD, in 2008, as a result. Scotland also reports the number of DRDs where alcohol was also present but the 151 DRDs where alcohol was present with other substances must not be confused with the much higher number of deaths due to alcohol which runs at around 3,000 per year.

And that’s, probably, a good point to close on. A great deal of effort is put into looking at the less than 500 DRDs a year in Scotland whilst the industry that produces six times as many deaths receives massive encouragement from the Scottish government.