Tuesday, March 9, 2010

Election Advertising, Drugs and Risk Communication

Way to stay classy, South Australian Labor Party. In a election advertisement I saw last night the Labor Party is wittering on about how it is tough on drug crime (with a picture that says 100 dead from ecstasy in the back ground - more about this figure later). It then cuts to the Opposition Liberal leader, Elizabeth Isoble Redmond, saying "Ecstasy is not as bad as some other drugs" and then the add voice-over says. "Not Bad Ms Redmond?" with the clear implication ecstasy is really, really bad.

Apart from the out and out quote-mining (Ms Redmond is quite right to say ecstasy is not as bad as other drugs, see below) which is obvious to anyone with a greater than room temperature IQ, the add is playing off a visceral fear of drugs, not on reality.

MDMA (Ecstasy) can by itself cause death or serious harm, and a big problem is that occurrence of the harm is unpredictable. To put this in perspective though, and in terms of Labours advertisement and Ms Redmonds' statement, in the five years from 2001 MDMA was associated with 82 deaths in Australia (where does the Ad get 100 from, and why are they using this figure? for another perspective see this report). The number of MDMA users in Australia is not clear, but around 10% of 14-19 year olds and 6% of 20-29 year olds use the drug at least once a week (around 20% take it once a month). This gives a crude case fatality rate in the region of 0.01%, not dissimilar to that of the pain killer paracetamol (around 0.01% for UK and the US, can't get Australian figures).

Both of these figures are distorted (multidrug use for MDMA and use in suicide for Paracetamol), but at least for acute ingestion, MDMA and the OTC analgesic paracetamol have similar toxic event incidences.

Another way to look at it is that it has been estimated that roughly 100,000 MDMA containing pills are consumed each weekend. This means that (over 5 years, if the MDMA consumption figures are correct to within an order of magnitude) there is one death for every 320,000 pills consumed (or 1 in 390,000 if we only look at cases where we are sure that MDMA was directly involved), so while deaths are relatively rare, they occur at an appreciable rate per pill .

Yet another way to look at it is to compare Ecstasy deaths with deaths from Heroin. The death rate for heroin users per million population, (death rates for all opioids but primarily heroin, with some opium and morphine deaths) in the 15-24 age group - where the majority are first time users/recreational users not dependent users - is 13.3 per million population, the death rate for ALL age groups using ecstasy, including new, recreational and long time users is 0.8 per million population.


This really needs to be adjusted for the user base. In 2004 roughly 6 times more people tried ecstasy than heroin (and 6 times more people used ecstasy within 12 months than heroin). Even if we consider only 20% of the 15-24 age group deaths were first time/recreational deaths to heroin alone the result is still around 1 in 100,000 users. This will be an underestimate of all first time/recreation use.

Ecstacy is a drug associated with risk. Whether the risk/benefit ratio (feeling good with MDMA verses removal of pain with paracetamol) is similar is a matter of debate. And while the risk is low it is very unpredictable.Still Elizabeth Isoble Redmonds' statement is 100% correct, and the Labor Party ads are pure scaremongering.

Educating people about these risks, given that people can wave away relatively high risks and yet run screaming from safe interventions like vaccines, is very problematical. Having the Labor Party, supposedly the Party of the Light on the Hill, producing such hysterical ads which play to peoples fear is beyond disappointing.

(disclaimer: I don't do research on MDMA, I try and kill pretend nerve cells with amyloid then rescue them with green tea extract. However, the folks two floors up are MDMA researchers, and I've been to enough presentations, poster sessions and marked enough of their theses to fake knowing something about MDMA)


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