Scottish Drug Deaths – The Whole Picture!

Over the past few months there has been a big push to slate the current Scottish Government on the increase in drug deaths in Scotland.  The apparent increase has been used as political point scoring by, in particular, the Tories, with Annie Wells trying to take credit for forcing the UKG to sit around the table and discuss it.

Most of us know that Drug Management (or however it is termed) is a reserved matter, the Scottish Government, whoever is in power, will always be constrained by this fact.  And lets be honest, the current Scottish Government has tried, and continues to do so, to manage and improve this statistic.

However, not all is as it seems when you actually take the time to read multiple reports, and in particular, read those reports in conjunction with the direct, and wrong, comparisons that is used by the media to slate the current Scottish Government.

On a side note, and before I continue, it is getting mildly tedious that the current Scottish Government cannot refute, or at least challenge the narrative with so many of these manipulation stories.  As usual, it is left to those within the movement to use what little voice they have to try and change the narrative and release stories within context to allow Scotland’s people the think for themselves.

Anyway, back to the point.  Many of the stories that have been released have stated how Scotland has the highest rate of Drug Deaths in Europe, and that it is higher than the USA and so on.  These headlines and easy retweets to a captive audience, where 140 characters an inflict serious damage on the current Scottish Government, and the 140 characters in return are usually ones of pity (because its reserved) rather than of refuting the claim, and challenging it outright based on how its is measured and compared.  So here I am, doing it for them for you to use how you feel its appropriate.

The NRS (National records for Scotland) has a lot of information on this, but it is word heavy.  It is an information overload that really isn’t going to be fully studied by the media because our media is lazy and they want clicks rather than truth.  All of the data I have used in this blog post are linked ta the foot.

This isn’t going to be a large blog post, because there is one paragraph that should have been used by the Current Scottish Government to refute the whole non-sense reporting on this, other than its “reserved”.

That paragraph related directly to the comparison we can take against England’s numbers.

On page 47 of the Drug Related Deaths in Scotland 2018 NRS report is paragraph G10.  I shall state below what it mentions.

“It should be noted that how information about drug-related/’misuse’ deaths is collected differs between Scotland and other parts of the UK. In particular:

  • In England and Wales, almost all drug-related deaths are certified by a coroner following an inquest, and cannot be registered until that is completed. As a result, about half of their drug-related deaths registered in (say) 2015 occurred in a previous year – more information can be found in the sections of the ONS publications on the effect of registration delays on the statistics. Very crudely, the England and Wales figures for (say) 2015 can be thought of as representing the deaths which occurred between (say) mid-2014 and mid-2015, so are less ‘up to date’ than Scottish figures for 2015, which can be thought of as representing the deaths which occurred in the whole of that year (as almost all Scottish deaths are registered within a few days of occurring); 
  • There is no English equivalent of the form (shown in Annex D) which is used by forensic pathologists in Scotland to provide details of deaths to NRS.
  • The UK’s other GMRs are usually told, by coroners, which drugs caused each death, but not about all the substances that were found in the body. It follows that some deaths could (in theory) be counted differently in, say, Scotland and England. For example, a death from intentional self-poisoning by an uncontrolled substance would be counted in Scotland (but not in England) if a controlled substance was present in the body but was not believed to have contributed to the death (because the presence of the controlled substance would not be recorded in the data for England)
  • NRS is more likely than ONS to be told which drugs caused a death. In Spring 2017, ONS said that: 
  • In around 1 in 8 cases, it receives only a very generic description of the death, such as ‘drug overdose’ or ‘drug-related death’. In contrast, Scotland had only about 8 drug-deaths per year (on average, from 2008 to 2015) for which NRS was not told which drugs caused them. 
  • In around 10% of opiate deaths, ONS is not told which opiate was involved. In contrast, Scotland had an average of only about 4 drug-deaths per year caused by opiates (possibly in combination with other substances) for which NRS was not told which particular opiates were involved.  
Such differences may affect the comparability of drug-death rates for Scotland and the UK as a whole, but are unlikely to account for the majority of the difference between those rates. For example: 
  • If the numbers of drug-related deaths were rising at 10% per year, their being registered (on average) six months earlier in Scotland than in England would increase the Scottish drug-death rate by only 5% (relative to the English one), all else being equal (because one would be comparing the Scottish number of deaths which occurred, broadly speaking, in [say] 2015 with the English number of deaths which occurred, broadly speaking, between [say] mid-2014 and mid-2015 – a period when drug-death rates were lower). 
  • On average, Scotland had only around 3 deaths per year from intentional self-poisoning by an uncontrolled substance for which a controlled substance was present in the body but was not believed to have contributed to the death. Such deaths are included in the drug-related death figures for Scotland, but not for England – but are too few in number to have much effect on the comparability of drug-death rates. 
  • ‘drug overdose’ and ‘opiate’ deaths in England are counted as drug-related/’misuse’ deaths, so the lack of information about which drugs were involved does not affect the comparability of the overall drug-death rates. (However, it could have a noticeable effect on any comparison of figures for deaths which were caused by particular drugs, of course.) 

It follows that the Scottish rate could well be at least 2½ times that of the UK as a whole even if there were no methodological differences.”

Now, what is written above is startling in what it is actually saying and how that related to the way Scottish figures are calculated, particularly the sentence in red.

The figure in Scotland, 1,187 drug related deaths is grouped as follows:

OLD CLASSIFICATION RULES

All causes of death: 1,187, of which, Drug Abuse 976, Accidental Poisoning 116, Intentional Self Poisoning 59, Assault by Drugs 0, Undetermined Intent 30.

NEW CLASSIFICATION RULES

All causes of death: 1,187, of which, Drug Abuse 45, Accidental Poisoning 1017, Intentional Self Poisoning 59, Assault by Drugs 0, Undetermined Intent 56.

England’s figures do not always count Accidental Poisoning where the drug is controlled and not “believed to have been a contributing factor”.

In Scotland, all controlled drug deaths are counted, and the decision on the classification is based on what the Procurator Fiscal “believes” based on probability and evidence, or lack of, and where a controlled drug is present.

The whole concept of the direct comparison is flawed.  The above doesnt even account for the fact that half of England’s drug deaths may not be counted until the following year.

I am not saying the Scottish numbers are not a reflection of reality, but directly comparing Scotland and England with such differing methodologies and then comparing Scotland with the EU is utterly ridiculous, and its all for a headline.

The EU report states that their definition is:

What is a drug-related death?
The EMCDDA has defined a ‘Drug-related deaths and mortality (DRD)’ epidemiological indicator with two complementary components:

  • regular national, population-based statistics on deaths directly attributable to the use of drugs (drug-induced deaths, also known as poisonings or overdoses)
  • estimations of the overall and cause-specific mortality among high-risk drug users.

Case definition
For the purpose of the EMCDDA regular national statistics, the definition of drug-related deaths is ‘deaths happening shortly after consumption of one or more illicit psychoactive drugs and directly related to this consumption, although they may often happen when such substances are taken in combination with other substances, such as alcohol or psychoactive medicines’. These deaths are often referred to as ‘drug-induced deaths’ or also, poisonings or overdoses.

So they classify their drug death numbers as deaths DIRECTLY related to consumption, whereas in Scotland it is at the discretion of the PF based on probability and evidence as a factor, or lack of.

So if we were to use the European definition, rudimental as it may seem, and discount the drug deaths without the assumption, in some cases, of accidental poisoning, Scotland would be sitting at around 200 deaths, or 37 cases per million, and Scotland would have accounted for only 2.3% of all EU drug deaths, which is almost entirely in line with other EU countries of a similar population size.

The USA figure is 70,237, or 212 cases per million, or nearly 6 times greater than Scotland’s.  As it stands, the 1,187, and the exceedingly erroneous method of calculating such a number implies that Scotland’s rate is 217 per million.

Lets not also forget that drug prescription for many mental health conditions has exploded in recent years.  For example, Tramadol increased by 218% between 2006 and 2016 and it is often used in combination with other medications, making it difficult to determine with fact, hence the scope for a PF to stipulate the cause based on effective “assumption”.

So with the above laid out, the choice becomes clearer as to whether or not you choose to believe the narrative that Scotland is a poor, drug ridden, nationalist country at the outer reaches of Europe, or not!

MW-GH572_drugs_MG_20180418124001

Personally, reading all of what I have, it is clear to me that there are significant holes in the methodology that Scotland uses to classify it drug deaths, which should be brought in line with internationally recognised standards, otherwise, the headline that appeared this year will be there every year on as the increase in prescription medications and the ambiguity prevails.

Sources

Click to access accidental-deaths-18-main-points.pdf

www.emcdda.europa.eu/system/files/publications/11485/20193286_TD0319444ENN_PDF.pdf

http://www.euro.who.int/en/health-topics/disease-prevention/illicit-drugs/data-and-statistics

https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2018

https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/accidental-deaths