By Michael Colvin , NHS consultant
DEATHS from suicide, alcohol abuse and drug overdoses have been rising in Scotland for a few years. The number of drug-related deaths in early middle age has risen dramatically, swamping some improvements in younger age groups. There are known reasons for this. Ageing addicts with chronic health problems have become more vulnerable to overdose; prescription rates for strong painkillers have been rising and new drugs have come on to the market which are many times more potent than heroin.
Post-mortem examinations of drug overdose victims often find alcohol present too, but alcohol-related deaths are more commonly the result of chronic drinking on the brain and liver. The annual number of deaths from alcohol abuse trebled between 1990 and 2005. After some improvement, these deaths are rising again – there were 1,265 lives lost in 2016 – and there is a must-do-something attitude in Holyrood. Hence, we are soon to benefit from the minimum unit pricing of alcohol.
What is minimum unit pricing (MUP) if not a grown-up public health response to our unhealthy relationship with alcohol? Well, in truth, MUP is the selected intervention in a large experiment, based on the popular theories of 20th century epidemiologist Geoffrey Rose. It was he who suggested that a whole population could be considered unhealthy in its pattern of consumption. He also predicted that if the distribution curve of consumption could be shifted to the left, and we all drank a bit less, this would have a disproportionate impact on the number of really harmful drinkers. This is what the Scottish Government, with support from all sides, is attempting to do.
The Scottish Government has commissioned research by the University of Sheffield into the impact of MUP. It is estimated that, 20 years following its implementation at 50p per unit, alcohol-related deaths will be around 120 per year lower than they would have been without MUP. This may sound like the conservative product of sober calculation but it is more like an educated guess.
There is certainly no prediction of the total number of deaths in 2038, because no one imagines that the price of cider is the actual cause of alcohol-related death. With a reduction in consumption as the only short term aim of MUP it is quite possible that deaths will rise and the government will feel obliged to raise the price further.
Although there has been a public consultation on the minimum price to be set, there has been no real discussion about any potential harm from MUP, such as the possibility of “addiction transfer”. Addiction transfer is just what it sounds like. People who stop being addicted to something often become addicted to something else.
People who stop smoking tend to put on weight. Addiction to gambling or drugs can follow gastric surgery to treat obesity. Unfortunately the academics in Sheffield only report on the effects of MUP which are directly related to alcohol consumption. They say that heavy drinkers in poverty are the group who will benefit most from MUP, for instance, without any reference to drugs.
But consumers of large volumes of cheap alcohol must be vulnerable to drug use. And this matters, because drug overdoses are not only sweeping across America. Sweden, with its tight restrictions on the sale of alcohol, has the highest rate of fatal drug overdose in Western Europe, apart from our own. In Scotland, the rate of drug-related deaths is not far below those of the headline-grabbing national emergency in the United States.
We all want MUP to be a success, but some unhappy Scots, finding their favourite tipple out of reach, may simply reach for the painkillers. The broader effects of MUP will need to be considered before it can be declared a success.
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