Figures for UK deaths from legal highs cannot be trusted
A version of this post was published in The Guardian
At the last G8 summit, the prime minister said legal highs are a serious concern and claimed that the UK would lead the world in research into them. But at the same time David Cameron's government has introduced temporary banning orders on several legal highs, thus making this research very difficult. The new drugs minister, Norman Baker, has since rejected the idea of the UK joining in the more balanced approach being proposed by the EU and has set up a working group to explore local options to this so-called "growing threat".
The latest figures on these new psychoactive substances, for 2012, were published as two separate datasets: one from the National Programme on Substance Abuse Deaths claiming 68 deaths, and the other, from the Office for National Statistics, claiming 52. These numbers are tiny when compared, in both relative and absolute terms, with the 80,000 deaths per year from tobacco, the 8,000 from alcohol or even the 1,200 from opioids, but still the media have revelled in the seemingly large increase from the previous year.
DrugScience has looked into these data in some detail, and as explained in our letter published on Friday in the Lancet, on closer examination they look very suspect. For instance, most of the drugs identified as being "legal highs" are not in fact legal. Only 11 of the 68 are currently "legal highs".
Twenty deaths reported by the National Programme on Substance Abuse Deaths are associated with the PMA/PMMA types of amphetamines that have been illegal for over 30 years. These drugs are considerably more toxic than MDMA (ecstasy)and emerged as a direct consequence of MDMA production being restricted by the clampdown on sassafras oil and other precursors. PMA/PMMA drugs are intrinsically more toxic than MDMA, but are sold as ecstasy.
They also have slower onsets of action than MDMA, which can lead users to believe after the first dose that they haven't taken enough; they then take another dose which means that later when absorption is complete they have accidentally overdosed. This is one of many examples of the perverse effects of prohibition: limiting availability of a relatively low-harm drug can lead to greater harms from alternatives. We have advice on the ISCD website for anyone who might come across PMA. These drugs have caused deaths in other countries, particularly Canada, leading to calls from senior health officials to legalise MDMA to obviate the threat of these counterfeits.
The most frequent drug deaths reported by the Office for National Statistics were attributed to GHB (13 of the 52), which was made illegal in 2003 when we were part of the group reviewing its harms for the Advisory Council on the Misuse of Drugs. Among the drugs labelled "legal highs" were anabolic steroids and DNP (a weight-reducing agent), which are not even psychoactive. Intriguingly, according to the Office for National Statistics, there were only four deaths solely from mephedrone, despite it being the most popular stimulant in 2008/9.
The poor quality of the data currently being discussed in the media raises the question of whether this is just sloppy science or whether there has been some attempt to massage the figures to justify the current political focus on legal highs. It is also questionable whether we need two sets of drug-related mortality statistics.
The government and media attention on legal highs distracts from the much more important health issues of tobacco, alcohol and heroin deaths. What is certain is that if the current government review of legal highs is to be taken seriously and lead to health improvements then there must be a proper definition of terms and improved data collection. Moreover the data must be independently audited so the effects of any change in the law can be properly evaluated.