Bucking the trend

Josie Smith Chris EmmersonUnlike in England, drug deaths in Wales have been falling since 2010 – a result that can be traced to Welsh public health policy and harm reduction practice, say Josie Smith and Chris Emmerson 


As previously reported in DDN (October, page 4), according to data from the Office for National Statistics (ONS), a total of 2,248 deaths from drug misuse were registered in England and Wales in 2014 – a rise of 14.9 per cent on 2013.

Building on the near 20 per cent increase in drug misuse deaths from the previous year, a notable change in the pattern of drug deaths seemed to be emerging.

However, this paints an inaccurate picture. While drug misuse deaths in England have risen dramatically over the last two years, drug deaths in Wales have fallen year-on-year since 2010, with a 30 per cent decrease in the last five years to a total of 113 deaths – a rate of 3.90 per 100,000 population.

With drug misuse deaths in England now at their highest level over the 22 years for which the ONS publishes figures, the need for credible explanations for the rise became urgent.

One set of explanations has focused on changes to drugs and those who use them. The ONS, in the statistical bulletin accompanying the release of the 2014 figures, points to changes in the purity of street heroin (as reported by SOCA, the UK’s Serious Organised Crime Agency) as a possible influence on variations in drug deaths over recent years. Sustained rises in reported purity coincided with increases in deaths involving heroin/morphine in England. The ONS also suggests that, with increasing numbers of deaths among older drug users, the generation who began injecting in the 1980s and 1990s are aging and therefore at higher risk of dying from drug-related causes as other health problems take their toll.

However, the same ONS report provides another key piece of information that challenges the focus on changes to drugs and this demographic of drug users as key reasons for rising drug deaths. It comes on page 19: ‘…whilst drug-related deaths in England have now reached an all time high, those in Wales have fallen over the same period, down 16.3 per cent in 2014 to 113. Indeed, the rate of drug misuse deaths across the Welsh population, at 39 per million, is now less than England for the first time since 2004.’

With no reason to believe that either heroin markets or drug-using careers in Wales are substantially different to England, how can we explain the difference?

The second narrative to emerge following the release of the figures is that the difference is down to policy and philosophy. With health policy devolved within the UK, it is the Welsh Government that decides the priorities for substance misuse in Wales. In contrast to England, where – as reported in last month’s article on the National Needle Exchange Forum meeting (DDN, October, page 16) – many users, frontline staff and managers are finding reduced funding and support for well-evidenced harm reduction approaches in favour of abstinence based ‘recovery’ models, Wales has maintained focus and funding for harm reduction.

In response to the release of the 2014 figures, deputy minister for health Vaughan Gething said, ‘These figures represent lives lost to families and communities across Wales and while I welcome the news of a further decrease, any death attributable to drugs is one too many.

‘Tackling drug misuse is a complex issue, which the Welsh Government has been working hard to address. The fact that drug-related deaths are falling at such a rate in Wales is testament to the significant work, which we and our partners are undertaking.

‘We are investing almost £50m a year in programmes including a bilingual substance misuse helpline, a take-home naloxone programme which reverses opiate overdose and the WEDINOS harm reduction project which tests substances. These figures show that this money is delivering tangible benefits.’

Also commenting on the figures, Josie Smith said, ‘It is a testament to the National Substance Misuse Strategy in Wales, Working together to reduce harm, ongoing support for harm reduction services and a willingness to innovate new approaches to reduce risk, that have resulted in fewer drug deaths in Wales. Problematic drug use in Wales remains but the most severe of consequences, that of premature death, is declining through better engagement, appropriate and evidence-informed interventions and collaborative working.’

Josie Smith is head of substance misuse programme and Chris Emmerson is information analyst specialist at Public Health Wales