An epidemic of solitary use is helping to drive Britain’s drug deaths crisis, says Dr David Patton.
Across the UK, drug-related deaths continue to rise, driven not only by increasingly potent substances but by something far simpler and far more human – many people are using drugs completely alone. From bedrooms to hostels to temporary accommodation, solitary use has quietly become one of the most dangerous and least discussed patterns in the country’s drug landscape.
As part of a recent UKRI-funded partnership with Derbyshire Healthcare NHS Foundation Trust, we listened to frontline workers and people currently using drugs across the county. Their message was clear. People are not dying because they don’t understand the risks – they’re dying because they have no one with them when something goes wrong.
For many participants, using alone was not a rare occurrence but the norm. Some described practical reasons, such as wanting control over their dose, avoiding pressure to share, or using in spaces where visitors weren’t allowed. Others spoke about shame, fear of judgement, or a desire to avoid chaotic environments. A few said they used alone most of the time because it simply felt safer than being around anyone else.
Shrinking networks
Frontline staff echoed these stories. They described older men with deteriorating health and shrinking social networks, women drinking in private due to stigma or fear of family consequences, people in hostels who hide their use because of rules, and individuals newly released from prison with nowhere safe to go. What connects these situations is not drug choice but disconnection. People’s social worlds have collapsed, and solitude has become a survival strategy long before it becomes a risk behaviour.
Stigma plays a central role in this. Many people avoid GPs, pharmacies and emergency departments because they fear being judged. Some go to great lengths to remain unseen when collecting equipment or medication, while others have withdrawn from services entirely because the shame feels too heavy to carry. When stigma becomes embedded in healthcare, housing, criminal justice and community settings, it creates the conditions where solitary use takes hold.
This is why solitary use needs to be understood not as a personal choice but as the end point of a broader crisis of loneliness, shame and invisibility. And it’s why reducing deaths requires more than advising people not to use alone – it requires building the kinds of relationships, environments and safety nets that make connection possible again.
Naloxone remains essential, but not only as an emergency intervention. It works best when it’s everywhere, carried by neighbours, family members, housing staff and members of the public. A kit in every home and workplace is less about equipment and more about creating a culture where people look out for one another.
Stigma-free access to injecting or smoking equipment is equally important. When people can obtain what they need through quiet, anonymous routes, they remain linked to services rather than pushed into hiding. Vending machines, discreet pharmacy collection and postal supply aren’t luxuries, they’re forms of connection that meet people where they are.
Communities matter
Community spaces matter too. Not treatment centres, but everyday places such as libraries, warm hubs, cafes and church halls where people can exist without labels. Many of the staff we spoke to described how small, ordinary interactions – a greeting, a familiar face, a place to sit – can be profoundly protective for someone who spends most of their life alone. People with lived experience also have a crucial role and, when properly paid and supported, bring trust and continuity into the system. They reach those who avoid formal services and often understand the emotional and relational realities of solitary use in ways that others cannot.
Housing policy must also reflect the importance of connection. Rules that force people into secrecy increase risk, while safer policies allow visits, check-ins and simple human presence. A place to live isn’t just shelter – it’s a container for relationships. Finally, people leaving prison need support that begins before release and continues afterwards. This includes safe accommodation, medication continuity and a named person who maintains contact. The first days after release are among the most dangerous in a person’s life, so connection during this period can be lifesaving.
The rise in drug deaths linked to solitary use tells us something important. People do not survive because they have the strongest willpower, or the deepest knowledge of risk. They survive because someone is close enough to notice when they need help. Solitary use removes that possibility.
If we want to save lives, we need to redesign our systems around connection, not surveillance, not punishment, not shame. Most of the answers already exist in the everyday practices of harm reduction, lived experience and community work. The task now is to centre them. People aren’t dying because they use drugs. They’re dying because they’re alone. Changing that reality begins with bringing people back into view.
UNDERSTANDING ‘MISSINGNESS’
Many people avoid GPs and healthcare for fear of being judged – some go to great lengths to remain unseen, Prof Andrea Williamson told the RCGP/Addiction Professionals conference. So how can we address this?
As a professor of general practice and inclusion health, Prof Andrea Williamson had studied nearly half a million GP records and more than 9m appointments to build up a picture of people who ‘tend to have a pattern of enduring missingness’. ‘Missingness’, she said, was defined as ‘the repeated tendency not to take up opportunities for care – such that it has a negative impact on the person and their outcomes’.
What the study team found was that ‘patients are not missing appointments because they’re no longer sick or they don’t need care. They’re missing appointments because they’ve got lots of challenges going on… really complex social circumstances.’ The data also showed an association with higher premature mortality.
The patterns of missingness continued through secondary care – missed outpatient appointments, a likelihood to discharge themselves from hospital, and a continued unwillingness to engage.
The NHS was under enormous pressure – austerity measures had seen a melting away of third sector and voluntary sector organisations and demanded the NHS be more flexible in meeting people’s needs. But people weren’t engaging with the NHS when they had the perception that it wasn’t helpful, and many had negative associations from being mistreated or feeling stigmatised.
We had to flip that into a positive by realising that every contact is important – from the reception staff, to the call handler talking about the next appointment, to the work in clinical care. Accessing care felt difficult when there was gatekeeping in place and a ‘sense of inflexibility’. We also needed to appreciate that people lived with competing demands – the need to prioritise other things above attending health appointments. ‘We tend to make the assumption in the NHS that people can just get time off to attend appointments,’ she said.
But looming large was the theme of mistrust and distrust – people experienced stigma, discrimination and being misunderstood. ‘A really important message that came across from our lived experience participants was that the NHS loves easy patients – it literally can’t cope with people when they’re more complicated,’ she said. ‘And that’s not a great thing to hear.’
Trying to understand what drives missingness – including thinking about social determinants, poverty and marginalisation – was the route to a much more person-centred approach, said Williamson. But we needed to go beyond reading the literature on good practice and ‘be really disruptive’, thinking about how we could bring this to the mainstream as a suite of interventions. DDN
Prof Andrea Williamson teaches and trains about the social determinants of health, inclusion health practice and trauma-informed care. She leads on research about ‘missingness’ in healthcare and is involved in wider research and policy work to improve care for people experiencing severe and multiple disadvantage.
From www.gla.ac.uk