Presentation to Parlimentary Cross Party Group Drugs and Alcohol

DRUG RELATED DEATHS

Recent trends

Co-ordinating Action on Drug Issues

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Stephen MalloyNational Training & Development Officer-Critical Incidents [email protected]

mailto:[email protected]

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Briefly discuss;

• Recent trends- Drug related deaths in 2008 • Overdose Prevention/intervention- Current and recent

developments

• Naloxone across Scotland- A brief look at how we got where we are

Drug related deaths in 2009

The pessimism/optimism balance

Discussing premature, early and Preventable(?) death.

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European picture ‘The evidence suggests that mortality rates declined in Spain and Italy, and were stable in Germany. In

addition, the other selected countries all achieved substantially greater reductions in drug-related deaths than England and Wales between 1999 and 2004/05, with Germany and Italy exceeding a 20% reduction and Spain (six cities) reducing the drug-related mortality rate by 17%’

Morgan O., et.al. Trends in overdose deaths from drug misuse in Europe: what do the data tell us? Addiction (2008) 103, 699–700)

UK• 20% target not met in UK ‘99/’05• DRDs not counted as a key performance indicator in 2008-2018 drugs strategy Bird M., et al. Missing

targets on drugs-related deaths, and a Scottish paradox International Journal on Drugs Policy (2009) doi:10.1016/j.drugpo.2009.10.001

Scotland

• The rate of drug deaths in Scotland is higher than other parts of the UK and Europe (EMCDDA, 2006). Most of these deaths (66%) occurred in people who were drug dependent (GROS, 2008), in their late twenties or thirties with a history of drug use and overdose (Zador. et al, 2005).

Rome A., Shaw A., Reducing drug users risk of overdose, Scottish Government (2008)

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Scottish Drug related Deaths 1996-2008

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1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20080

100

200

300

400

500

600

700

455574

Source: GROS 2009

Drug deaths increased by 26% from ’07-’08 . Expected to pass 600 in 2009 ?

131% increase in drug related deaths since 1998 *

Drug related deaths in 4 Health board areas 1998-2008

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0

50

100

150

200

250

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Greater Glasgow and Clyde Lothian Grampian Tayside

Source: GROS 2009

Brief overview 2008Drug Related Deaths in Scotland (GROS) 2008-574

DRDs by age & sex in Scotland 2008

• Aged 15-24yrs- 92 (16%) • Aged 25 to 34yrs- 211 (37%)

303 deaths under 35yrs

• Aged 35 to 44yrs- 174 (30%)• Aged 45yrs and over 97 (17%)

271 deaths 35+yrs

• Males- 461 (80%) Females- 113

• NOTE- 370 deaths were listed as drug abuse, 111 undetermined intent, 59 accidental poisoning and 34 as intentional self poisoning


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(Drug deaths increased by 26% from ’07-’08)

Age- all getting older• the lower quartile age at death rose from 22

years in 1996 to 27 years in 2008;

• the median age at death increased from 28 years in 1996 to 34 years in 2008

• the upper quartile age at death rose from 34 years in 1996 to 41 years in 2008.

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*Important note

• The figures given for 2008 are not directly comparable to figures up to 2008 due to a change in methods of collection/compilation

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Main substances recorded in 2008 (GROS)

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Benzodiazapines 364 Heroin/opiates

336

Alcohol-273

Methadone-181

Cocaine- 79

Amphetamines-12

Ecstasy- 7

Higher Risk Times

• Times when tolerance may be lowered;Release from prison/custody; recent detox (planned or unplanned); illnesses; change in

resources/means to procure substance; beginning/ending of substitute medication (planned or

unplanned)

• During periods of poly substance use (Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study Brådvik L., Berglund M., Arne Frank

A., Anna Lindgren A. and Löwenhielm P. (2009))Generally ‘anytime’- Poly substance use becoming the norm; Periods of depression/low mood; significant life events

(overlap with suicide, estimates suggest that up to 30% DRDs may be suicides); illnesses; festive periods; change in resources/means to procure substances; disconnected/unsupported

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A quick line or two......... on Cocaine

• Increasing use, (particularly in younger users) increasing problem

• Smoking and injecting

• Increased toxicity with other substances, risk of overdose

• Mixed with Alcohol- Cocaethylene (‘The combination of cocaine and alcohol appears to exert more cardiovascular toxicity than either drug alone in humans. Alcohol appears to potentiate cocaine hepatotoxicity in both humans and mice.’ Landry M.J., An overview of cocaethylene, an alcohol-derived, psychoactive, cocaine metabolite J Psychoactive Drugs, 1992 Jul-Sep, 24:3, 273-6 ).

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• So What’s being done (more recently) to help reduce Drug Related Deaths in Scotland ?

Overdose prevention, Intervention and Awareness

Scottish Drugs Forum- Critical Incident Training & Development Post. Funded by Scottish Government.

Overarching Aim

• To further develop and see overdose awareness information, ‘Training the Trainer’ and direct awareness sessions to become widely available to workers, families and people at risk of

overdose.

• National Partnership agreement with British Red Cross

• Multi agency training being delivered across sectors, Phoenix futures staff in prisons , also piloting training to PCSO’s, Police officers.

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SCOTTISH RESEARCH‘Reducing Drug users Risk of Overdose’.

Rome A., Shaw A., Scottish Government, 2008.

• Need for dedicated funding• Support for prisoners• Provision of naloxone

• More research• Suicide prevention

• Treatment & support• Young people in care

• Piloting innovative projects• National campaigns

• Data collectionScottishdrugsForum


Ongoing• National Drug Related death Forum- Recommendations

• National Drug Related Death Volunteer Forum- Work program

• Nation Drug Death Database

• HEAT target for accessing treatment- 90%/3 week waiting by 2013

• ADP Strategic plans- Reduce DRDs’/Overdose prevention

• Local Overdose/drug death prevention coordinators posts.

• SNFAD attending/developing training for families affected by overdose

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Naloxone A very brief (but interesting!) history

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Naloxone- early history• Allylcodine- Pohl, J: Ztschr. Exper. Path. Und Therap 18, 370, 1915

• Hart (1941) and Hart &McCawley (1944) synthesized N allylnormorphine (nalorphine) and studied its effects.

• H. F. Fraser, A. Wikler, A. J. Eisenman, and H. Isbell USE OF N-ALLYLNORMORPHINE IN TREATMENT OF METHADONE

POISONING IN MAN: REPORT OF TWO CASES JAMA April 5, 1952 148:1205-1207

• N-Allylnoroxymorphone-A New Potent Narcotic Antagonist: Foldes, Francis F. M.D.; Lunn, John N. M.B.; Moore, James M.D.; Brown, Ian M. M.B. American Journal of Medical Science 1963

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Skip forward

• Early 70’s- heralded as the opioid antithesis. Evans JM, Hogg MI, Lunn JN, Rosen M. Degree and duration of reversal by naloxone of effects of morphine in conscious subjects. Br Med J 1974; 2: 589–591.

• First ‘warnings’.....1975, an editorial in Lancet warned that in opioid addicts, “the doses should be small, since intravenous naloxone can precipitate a severe withdrawal syndrome in dependent addicts.” Editorial: Naloxone. Lancet 1975;1:734.

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Naloxone- Still further forward• 1992- J. Strang, BMJ- Should Naloxone amps be made available to IDUs?

The change

• Jersey Project -1998,Berlin Project-1999, San francisco-2001, Chicago- 2001, New Mexico-2001, Baltimore-2004, NYC-2004/5 and many other sites.

• Glasgow/Lanarkshire pilots/program-2006

• Inverness pilot-2009

• Welsh Program -2009

• June 2009- 16 site pilot in England

• All of Scotland-2010??

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Thanks for your attention

Stephen Malloy

National Training & Development Officer-Critical Incidents

[email protected] SDF office: 0141 221 1175


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mailto:[email protected]


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Documents

Presentation to Parlimentary Cross Party Group Drugs and Alcohol