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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Sunday 19th August 2012

Figures for drug-related deaths in Scotland in 2011 have been published1 and have produced, as would be expected, some fairly hysterical reporting with cherry-picking of information to mislead readers.

The Herald Scotland, stating that drug-related deaths in 2011 were, at 584, the highest annual level ever reported, made a point of noting that this was ‘20% more than the previous year's figure of 485’2. Now, that is true, but the implication that drug deaths are running out of control is not justified.

It is indisputable that drug-related deaths have shown an upward trend for some time. This is because the drug users who started their use after drugs were outlawed and, thus, commercially attractive to criminals, are ageing. Drug-related deaths in the over 35 age groups have risen from 55 in 1996 to 301 for the 2010/2011 average (see below for the reason for using the average of the past two years). At the same time, deaths amongst under 35s have gone from 189 in 1996 to 234 in 2010/2011.

As the official report points out, year on year comparisons are misleading especially as 2010 had an unusually low level of deaths. The 584 figure is only 10 higher than the previous highest, in 2008. A more realistic way to look at the data is using a three year moving average. This shows that, while the long-term trend is up, the slope of the curve has turned down in recent years.

Chart showing drug-related deaths in Scotland

Incidentally, I prepared that chart because the one in the official publication has five plots on it and the one for the three-year moving average is a thin, pale line. It is almost as if the authors hope you won't notice it.

If you take the year on year figures and average 2010 and 2011 you see an apparent decline.

Drug-related deaths in Scotland

There is a possible justification for this approach. These are figures for registered deaths for the calendar year. Though deaths have to be registered within 8 days of a death certificate being issued no certificate can be issued, if a drug-related death is suspected, until the Procurator Fiscal has completed his investigation. Unusually, in 2010, severe winter weather arrived in late November and lasted to the end of the year. This disrupted many areas of everyday life and it would be surprising if the Procurator Fiscal did not fall behind with investigations.

In a normal year, when the worst winter weather tends to be in January and February, any delays in certifying deaths will be picked up in the same calendar year and the annual figures will not be distorted. The catch-up from any delays to the Procurator's work in December 2010 would fall into 2011.

If, and it is only ‘if’, you assume no drug-related deaths were registered in December 2010 then the monthly average for the 2010 total of 485 deaths is 44 for each of 11 months and the 2011 monthly average for each of thirteen months is also 44. Now, it is highly unlikely that no drug-related deaths were registered but it just shows how few deaths would need to be moved from one year to another to remove the shock element of the 2011 numbers.

Whether you rely on the three-year average or accept my suggestion about the weather, it is clear that the apparent increase from 2010 to 2011 is not as dramatic as it is being made out to be.

This is important because shock figures are used to justify extreme policies and the leader of the Scottish Conservative Party, Ruth Davidson, wasted no time in saying "This appalling loss of life illustrates the human disaster that is the methadone programme. It would appear hundreds of families are being blighted by what is little more than legalised drug-taking on an industrial scale."

You need to look closer at the numbers to see if there is any justification in placing the blame on opiate substitution therapy (OST) where heroin addicts are given methadone instead. The simple year on year figures show that methadone related deaths rose from 174 in 2010 to 275 in 2011.

The official statistics are not able to say whether the methadone concerned had been prescribed or misappropriated. The report in the Herald, however, quotes Biba Brand, head of the Scottish Drug Forum's National Quality Development Programme, as saying that its surveys suggest that the majority of methadone deaths are to people for whom methadone was not prescribed.

This might suggest that those on OST are able to obtain surplus methadone which they can divert to other users. That may be the case but it does not support the argument that OST should be ended. If anything, it shows that more investment in OST is required so that the needs of individuals can be better matched to the amount of methadone prescribed.

The danger of inadequate funding for treatment services has been illustrated, within the past week, by reports from Portugal that its economic difficulties are jeopardising the progress made since its change in the way it deals with drug users.3

The other point made by Ms Brand in the Herald was that problems with the quality of street heroin can lead users to seek supplies of diverted methadone. Lack of quality control of street heroin is a permanent problem but it is almost certainly worse just at the moment as, once again, there are reports of anthrax infected heroin causing deaths.4  

Pressure to end or curtail methadone based OST will be helped by another event this week. Oddly this also involves someone called Brand but, rather than trying to help problem drug users, this Brand, Russell Brand, is happy for his ill-informed arrogance to harm them.

Russell Brand, a comedian and ‘celebrity’, was a dependent heroin user. For him, total abstinence was his route to ending his addiction. That’s fine, it is good that he has been able to end his need for opiates but the ill-informed arrogance comes from his belief that what worked for him is the only way for anyone to get clean.

This past week, the BBC screened a documentary telling his story and providing a vehicle for his abstinence as the only form of treatment message with only minor inclusion of dissenting voices.

When I stopped smoking, in 1985, I did it by deciding, one day, to see if I felt better as a non-smoker than as a smoker. From that day, I never smoked again. I didn’t use any form of nicotine replacement nor any diversionary tactic such as chewing gum. It worked for me but I’m not arrogant enough to promote my method as something for other people and I most certainly wouldn’t argue that all other forms of smoking cessation are unnecessary and should be scrapped.

Ruth Davidson and Russell Brand are two of a kind. They are both happy to promote themselves at the expense of problem drug users.


1. Drug-related Deaths in Scotland in 2011 General Register Office for Scotland 17th August 2012
2. Drug deaths in Scotland reach highest ever level The Herald Scotland 18th August 2012
3. Once a model, crisis imperils Portugal's drug programme Reuters 13th August 2012
4. Addict dies of anthrax caught from infected heroin supply The Independent 18th August 2012  


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