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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Sunday 1st September 2013

If you are a regular user of social networks, or the Internet in general, you are probably aware of its many shorthand ways of saying things. After the amusement arising from the Prime Minister’s evidence to the Leverson committee, there can’t be many people who don’t know what ‘LOL’ is supposed to mean. Actually, I have a little sympathy for David Cameron because expressing ‘lots of love’ as ‘LOL’ would be perfectly reasonable if it didn’t have another more widely understood meaning as ‘laughing out loud, laugh out loud, or sometimes lots of laughs’.

Less familiar, perhaps, is ‘tl;dr’. This means ‘too long; didn’t read’. It began, apparently, as a means of suggesting that a poster on an Internet forum was full of his own importance but, these days, it tends to be used on Twitter when someone wants to pass on a link but doesn’t want to face criticism if the linked article contains something stupid.

It is a shame that ‘tl;dr’ has been taken because I’d quite like to be able to use it to mean ‘tells lies; don’t read’. It would be useful to reflect my inability to continue reading a report once it has become clear that the information in it has been distorted to suit the agenda of the authors.

This morning, a new report from The Centre for Social Justice was being widely reported. ‘The Centre for Social Justice (CSJ) was established as an independent think-tank by the Rt Hon Iain Duncan Smith MP in 2004’ according to its own website and I won’t take the time to question how ‘independent’ it is.

The report entitled ‘NO QUICK FIX Exposing the depth of Britain’s drug and alcohol problem’ attracted the attention of quite a wide selection of printed and broadcast media including the BBC and ITV. Its title and its timing are both interesting. First, it doesn’t seem to be ‘exposing’ anything but rather repackaging material that is already in the public domain. And coming out on the first Sunday in September ensures good coverage because this is the weekend when people are beginning to feel the summer is over and it is time to turn attention to serious matters but, normally, there aren’t too many serious matters around especially as this is a holiday weekend in the USA. I suspect the CSJ is a little upset that President Obama’s statement on Syria has bumped it down the agenda.

Looking at the report, the CSJ seems to deserve some appreciation for its balance between the ‘problem’ substances. The introduction says;

‘Addiction and alcohol and drug abuse are taking a heavy toll on Britain. One in 20 adults in England (1.6 million) is dependent on alcohol and one in 100 (380,000) is addicted to heroin or crack cocaine.’

Putting alcohol at the top of the list of items causing social problems in Britain is commendable but happens all too rarely. It is a shame that the media ignored this point in favour of focussing on the ‘legal highs’ (better referred to NPS – New Psychoactive Substances). There can be no doubt that there are fashions in reporting and, at the moment, NPS are in fashion. So, we can’t blame the CSJ for its key point about alcohol being ignored. Or can we?

The CSJ issued a press release to accompany the report and, far from dealing with the main issue it is headlined;

‘Postmen are “unwitting drug mules” in deadly trade of ‘legal highs’’

It would be nice to have an obvious villain in the abusive relationship between the media and those organisations publishing reports but it isn’t that easy. In an ideal world, the press release accompanying a new report would simply say ‘Here is a report – read it’ but that doesn’t happen because many of the people who are paid to tell us what is going on don’t have the time or the inclination to find out what is going on. Instead you get these emotive press releases and can’t know whether that is the fault of the organisation issuing the report for trying to grab attention or the fault of the media for having demonstrated, time and again, that if you don’t give them something emotive you will be ignored.

But what of the report itself and why do I want to say tl;dr? I’ll pick just two pieces of information.

In the Executive Summary it says;

‘Each year more people are seeking treatment for their cannabis use, with a 36 per cent increase since 2005/06’ and references the National Treatment Agency (NTA). The NTA itself says;

‘Statistics show that illicit drug use is falling. For example, the Crime Survey for England and Wales (previously the British Crime Survey), has reported that the overall number of people who use drugs has fallen. While cannabis remains the most popular illicit substance by far, even its popularity has waned: whereas 11% of the population used it in 2001, this was down to just 7% in 2011.’ 
http://www.nta.nhs.uk/uploads/prevalence-commentary.pdf

Despite this lower prevalence, the CSJ’s Figure 10 shows an increase in cannabis treatment seekers year on year from 2005/6 and, again, references the NTA. But the NTA says this about the increases;

‘The number of cannabis cases appears to contradict wider data that indicates fewer young people are using the drug, but there may be several reasons for this discrepancy. First, the stronger strains of the drug now available are having a more pronounced affect with prolonged use, raising the likelihood of users needing help. Second, there has been a wider awareness and acknowledgement of the issues surrounding cannabis, particularly among the wider services that refer young people to specialist services. Third, specialist services themselves have become more alert and responsive to the problems that cannabis can cause for under-18s.’

In other words, it is wrong to infer that an increase in the number of people seeking help for their problem substance use means that there has been an increase in the total number of users who are finding problems with their use of cannabis. Also, today, comes news of a big increase in calls to helplines for young people suffering sexual abuse and that has been attributed to the increased publicity following the revelations about Jimmy Savile.  So, ‘awareness and acknowledgement’ coupled with services that are ‘more alert and responsive’ is likely to account for a large part of the increase in treatment seekers.  

Then there’s this from the first chapter immediately before Figure 1;

‘Despite having a population 30 per cent larger than the UK, Germany has half the total number of drug-related deaths.’

That’s truly shocking and shows that, as a nation, we are much more inclined to get intoxicated and have problems as a result. Or does it?

The number of ‘drug-induced deaths’ comes from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Its Table DRD-2 reports deaths in Germany in 2008 at 1449 against the UK’s 2569 seeming to justify the CSJ’s statement but a note under the table warns;

‘Absolute numbers from different countries are not directly comparable since differences remain in case definition and recording methods.’

Look a little closer and you find that there is an EMCDDA definition for General Mortality Registries ('Selection B' for ICD-9) but that neither Germany nor the UK uses it and the methods they do use are not comparable. In particular, the UK includes deaths from use and misuse of prescribed medications and it appears that Germany does not. Also, Germany collects its data via the police rather than the death certificates used in the UK so it could well be that cases are missed because the police are not involved.

I’m not saying that the UK doesn’t have twice the drug-related deaths of Germany – I don’t have enough information to be sure. What I can say is that it is wholly wrong to try and make an emotive point to support a ‘something must be done’ agenda based on incomparable data.

So, overall then another deeply flawed report on problem substance use that appears to be aiming at the truth - that alcohol is the biggest cause of problems, that, in spite of this, the majority of alcohol users (just as other substances) do so without coming to harm and that poverty and deprivation are the cause of the problem use not the result – but can’t bring itself to follow that line and ends up telling lies about the situation that will lead potential problem users to scoff and ignore it.

Unfortunately, BBC TV does not make its early morning news programme available to view again so I can’t direct you to the moment when I knew I’d be writing a piece like this even before I’d read one word of the report. That was the moment when the CSJ’s representative talked about ‘horse tranquilliser’ (i.e. ketamine) as if it were a ‘legal high’.

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