Professor John Robertson OBA

Media and opposition parties are morbidly determined to hang onto Scotland’s drug death status as a rare apparently objective stick to beat the SNP Government into submission with.

Earlier this year, they were all irrepressibly delighted to hear that there was a 12% increase from 2022 to 2023, following disturbing, for them, reductions in each of the two previous years after nearly three decades of satisfyingly climbing figures.¹

These National Records of Scotland data are based on post mortem blood tests and commonly presented as more reliable than the Suspected drug deaths in Scotland. The latter are collected by Police Scotland officers and are based on observations at the scene – drug use paraphernalia suggesting substance abuse immediately before death.

These latter data are also downplayed by media because they suggest a more steadily falling death rate than the data based on the presence of a drug in the bloodstream of the deceased.

From the Scottish Government’s Suspected drug deaths in Scotland, published on December 10, 2024:

• Quarter 1 – 320 deaths
• Q2 – 269
• Q3 – 244
• Total for 2024 so far – 833.

This is the first clearly falling trend on record, with the quarterly level varying little in the years before that, since the peak of 413 in Q2 2020.

The totals for Q1 – Q3 only, to allow comparison:

• 2020 – 1 047
• 2021 – 1 007
• 2022 – 797
• 2023 – 900
• 2024 – 833

Annual variations count for little, mean little, but trends over 5 years tell you what is really happening and, based on police observations of mortality scenes (presence of drug abuse material), the trend in Scotland is clearly down, 20% in 5 years.

Are the data based on post-mortem levels of drugs in the blood of the deceased more reliable?

There is a popular tendency, in the modern world, to see a non-human process based on the use of chemicals and devices as more scientific, more objective and thus reliable than a police officers judgement at the scene.

However, this view is, it can be argued, naïve, over-respectful of physical science and ignorant of debate within the scientific community.

From Post-mortem clinical pharmacology in the British Journal of Pharmacology, July 2008:

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.³

From Forensic science in the dock in the British Medical Journal, September 2004:

Investigations into the circumstances surrounding the death of David Kelly have led to the exchange of acrimonious views including allegations of conspiracy and murder. David Kelly, a government scientist and weapons expert, committed suicide by cutting his wrist and taking painkillers after he was identified in newspapers as the man the UK government believed was the source for a BBC report on Iraq. Impetus for the debate stems mainly from conflicting views about the cause of death, including issues that relate to postmortem toxicology results and their interpretation. Controversy occurs from the mistaken notion that postmortem laboratory measurements, taken in isolation, can be interpreted effectively.

The current controversy illustrates some universally held, but mistaken, notions about the process of death investigation in the United Kingdom and elsewhere. Many assume that forensic pathology is as evidence based as other branches of medicine. ⁴

Writing on the David Kelly case, investigative journalist, Robert Lewis argued:

It must be said that measuring the level of toxic substances in a dead person’s blood is still an extremely inexact science. Many toxicologists believe the attempt itself leads to ‘abuse of process, almost certainly to the miscarriage of justice. 5

I guess holding the above beliefs is not always conducive to a life-long career.

Sources:

1. https://publichealthscotland.scot/news/2024/august/drug-related-deaths-increase-in-scotland/
2. https://www.gov.scot/publications/suspected-drug-deaths-scotland-july-september-2024/documents/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC2561112/
4. https://www.bmj.com/content/329/7467/636.full
5. Lewis, R (2004) Dark Actors, Simon and Schuster, London