Pubdate: Sun, 17 Apr 2016
Source: Sunday Star-Times (New Zealand)
Copyright: 2016 Sunday Star-Times
Author: Tony Wall


An Unemployed West Auckland Man Has Proven That Police Claims About 
Cannabis Hospital Admissions Were False. Tony Wall Reports.

The headline figures from a police intelligence report caught Steve 
Dawson's attention. Cannabis was causing 2000 hospital admissions a 
year costing more than $30 million, and was the "cornerstone" of drug 
harm in this country.

"I'd never met any of the 2000 a year who were clogging up the 
hospitals - you know, the stoned wandering the streets and A&Es 
saying 'help me!' - so I thought I'd look into it," he says.

A "practical sort of person" with a degree in sociology from 
Canterbury University, Dawson would spend the better part of the next 
five years battling red tape and Government stalling tactics in his 
efforts to find the truth.

The 111-page report in question was called New Cannabis: The 
Cornerstone of Illicit Drug Harm in New Zealand, and was produced in 
2007 by the National Drug Intelligence Bureau (NDIB), a police-led 
operation also involving Customs and Health.

Its author, NDIB strategic drug analyst Les Maxwell, painted a grim 
picture of New Zealand's most popular drug: cannabis was an 
"increasing threat" because it was getting stronger and was a 
"gateway" drug for young people.

But it was the report's claim on the number of people who were ending 
up in hospital that caught the media's eye.

"Perhaps surprisingly," Maxwell wrote, "cannabis-related hospital 
admissions between 2001 and 2005 exceeded admissions for opiates, 
amphetamines and cocaine combined", with about 2000 people a year 
ending up in hospital because of the drug.

The report put cannabis admissions into two categories: primary and 
secondary diagnosis. Primary diagnosis cases had tracked between 210 
and 250 a year, while secondary cases ranged between 1799 and 2012 a year.

Most of the primary admissions were because of psychotic disorder, 
the report said, while "harmful use" accounted for most secondary cases.

Maxwell put the cost of these admissions at $31m in 2005, up from 
$19m the year before, based on a whopping 58,000 hospital bed nights 
on average.

Senior police seized on Maxwell's findings. Detective Inspector 
Stuart Mills, the NDIB's co-ordinator, said the report provided the 
first big picture of cannabis' harmful effects.

"We talk about methamphetamine, but here we can see the harm it 
causes with the number of hospital admissions caused solely by 
cannabis," he told reporters.

To law reform campaigners, it signalled a "war on cannabis", 
culminating in a massive operation targeting the Switched on Gardener 
chain in 2010.

Dawson, formerly of Christchurch but now living in New Lynn, West 
Auckland, didn't buy the claims. A thin, pony-tailed man who looks 
younger than his 53 years, he is in some ways a caricature of a 
cannabis user: t-shirt, shorts and bare feet his dress code.

He is not a member of any pressure group or political party, but 
feels the cannabis debate has become emotional and politicised. After 
falling on hard times when some business ventures failed, he had the 
time to pick apart the methods used in preparing the Maxwell report.

If someone was going to make "sole causation" medical claims, they 
needed to be able to produce the evidence, he figured. So began his 
magnificent obsession.

In 2010, using the Official Information Act, Dawson set about trying 
to get his hands on the hospital data used in the report. The 
Ministry of Health said it was unavailable and referred him to the NDIB.

The NDIB provided a spreadsheet, but it was clearly not the raw data 
Dawson had requested, so he asked for the original file. It was lost, 
the bureau said, perhaps incorrectly saved.

Dawson went back to Health, but it, too, claimed the data was lost. 
"I had to get pretty cross with Health to finally get the file in July, 2013."

Having studied the literature and spoken to experts, it took him a 
few minutes to see what the bureau had done.

Hospitalisations are recorded by a worldwide system known as ICD10, 
which contains thousands of codes for diseases, symptoms, social 
circumstances and suchlike.

After a patient is discharged, a clinical coder goes through the 
doctor's notes and attributes a principal reason for the admission, 
as well as codes for other matters on the file.

What the NDIB had done for the Maxwell report, Dawson found, was look 
for all cannabis-related codes and remove all others, leaving just a 
"primary" and "secondary" reason for the admission.

Dawson flicks through the data and finds a case where a prostate 
cancer patient has spent 240 days in hospital - counted as a 
"cannabis-related" admission. "There's no study on the planet that 
makes that link."

Michael Baker, a professor in public health at the University of 
Otago in Wellington, confirms Dawson's theory.

The ICD-10 system records the principal reason for the hospital 
admission, Baker explains, and all other codes are "additional". They 
can record trivial things such as the person having a cold.

The additional codes are not ranked, he says, so it's incorrect to 
refer to "primary" and "secondary" diagnoses.

"Those [additional] things have not put the person in hospital, they 
are just things that were noted on their chart. It gives you totally 
the wrong answer if you go on a fishing expedition for the codes 
you're interested in."

Based on the principal code, just over 200 people a year are admitted 
to hospital because of cannabis. Police had exaggerated the numbers ten-fold.

Dawson thought he had proved his point and demanded that the Maxwell 
report be retracted and the Justice Ministry advised. But it seemed 
police hoped it would quietly go away.

In an October 2013 letter, national manager of intelligence Detective 
Superintendent Stephen Vaughan said the report had been removed from 
the police website and the internal police intranet.

He said the report was no longer referenced, "due to the fact that it 
is over six years old", and there had been "significant changes" to 
NDIB intelligence practices.

"The issues that you raise . . . would not occur in the current 
intelligence system," Vaughan wrote, saying there was no need for 
further action.

Dawson was not satisfied and continued to fire off letters. Finally, 
in August 2015, he received what he considered to be the "smoking 
gun" document, from Associate Health Minister Peter Dunne.

It included an email from Simon Ross, the Health Ministry's manager 
of analysis and reporting, who had met police NDIB members to discuss 
Dawson's concerns.

Ross had urged caution in using the ICD-10 data and said the NDIB 
should focus only on cases where a drug-related diagnosis was the 
primary reason for a hospital admission.

He said the cost estimates for the cannabis-related hospital 
admissions were also incorrect as they were based on the "secondary" 
diagnosis. A $2.5m estimated yearly cost was "much more realistic" 
than the $25m-$30m claimed.

It was important that in future his unit provided "robust peer 
review" of the way the NDIB presented health data. "Where we have not 
offered or provided this in the past, we should have."

Maxwell, who is still with the police, says he doesn't want to 
discuss his report.

NDIB co-ordinator John O'Keeffe says the bureau accepts the section 
of the report relating to the assessment of cannabis harm "was not as 
robust or as clear as it could have been, and could therefore be open 
to misinterpretation".

There was never any intention to mislead or misinform, and the NDIB 
stopped referring to the data some time ago, he says.

O'Keeffe says the Maxwell report was a high-level strategic document 
to assist policy and decision-makers. "It was not, nor was it ever 
intended to be, an operational document to inform drug enforcement operations."

Dawson remains suspicious and believes the Maxwell report did inform 
police operations, the Switched on Gardener raids the prime example, 
and that people went to jail because of it.

It's not good enough for police to say the report is "outdated", he 
says - a public retraction is warranted.

A drug harm sheet from a 2013 intelligence report, which he obtained 
under the Official Information Act, shows police continuing to 
combine "primary" and "secondary" data on the same graph, albeit with 
a caveat in the small print.

Dawson believes it's in police interests to overstate the harm that 
cannabis causes, to maintain their funding and operational powers.

He accepts cannabis causes harm, as do alcohol and tobacco, but 
thinks the authorities want to scare us, just like the Reefer Madness 
films of the 1930s.

"Now we have Reefer Madness 2.0, which is the New Zealand police 
fiddling health data."


Claim: There are more than 2000 cannabis-related hospital admissions each year

Fact: Between 200 and 250 people a year are admitted to hospital 
primarily because of cannabis

Claim: The cost of these admissions is $31m.

Fact: The cost is more like $2.5m.
- ---
MAP posted-by: Jay Bergstrom