All eyes were on Scotland last month in the run-up to the vote on independence, and, although the country eventually opted to stay part of the UK, there are signs that its drug-related death rate may be starting to head in a different direction.
Deaths were down by 9 per cent last year, to 526 (DDN, September, page 4), following a 2011 peak of 584 (DDN, September 2012, page 4) and just three fewer the following year. In England and Wales, however, the news was more grim. Male deaths involving illegal drugs were up by 23 per cent – to 1,444 – with female deaths up 12 per cent to 513 (see news story). There were 765 deaths involving heroin/morphine in England and Wales, while 220 involved the synthetic opiate painkiller tramadol – an all-time high.
As the Scottish Drug Forum (SDF) pointed out, however, the Scottish figures are no cause for complacency. Still the fifth highest ever recorded, the total was 66 per cent higher than a decade ago. Heroin and/or morphine were implicated in, or potentially contributed to, 221 deaths while methadone was implicated in 216.
When the Scottish figures were released community safety minister Roseanna Cunningham was quick to point out that – while the country still faced ‘a tough challenge’ – fewer young people were taking drugs and there were signs that the government’s approach was working. One of the key aspects of that approach is a national programme of naloxone provision, with nearly 4,000 kits issued in 2012/13. So how much of a role did that play?
‘Certainly we have evidence of a significant amount of naloxone use, and obviously a proportion of those kits issued will have been lives saved,’ SDF director David Liddell tells DDN. ‘I think it’s very hard to be definitive about naloxone, but we’re very encouraged by the roll-out and what’s happened, and the government providing funding to drive that as a national programme.’
However, the deaths data tend to suggest a ‘levelling off’ rather than an actual decline just yet, he points out. ‘Alongside that is a caveat that – just like in England – there’s an increasing number of older problem drug users and certainly, from some of the work we’ve done, what we’re seeing is a number who are quite isolated and living alone. So obviously naloxone is not going to impact on those individuals.’
Clearly, problems of failing physical and mental health, alongside social issues, will continue to be a factor for this group, he adds. ‘That’s where the cautious optimism comes from. We’ve turned little bit of a corner here, but we can hardly be complacent with that number of deaths.’
What’s the best approach when it comes to that older population – renewed determination on the part of services to engage them and keep them engaged? ‘We’ve had all those issues of “parked on methadone” and so on – and certainly our sense is that that represents quite a small proportion of the overall population who’ve been long-term on methadone – but I do think there is an issue for people who’ve been in services a long time,’ he states. ‘That they’ve almost become like the wallpaper, and if they’re not causing any major hassle and are relatively stable then they’re maybe not given the level of support that they could usefully get.’
SDF research in this area has raised some interesting issues, he adds. ‘Some of our interviews did highlight things such as how an older user might benefit from having an older worker, for example. There were some suggestions that the older users found it hard to relate to very young workers, who they perhaps thought were a bit wet behind the ears. So it’s just about services just looking more specifically at the needs of this population.’
That population is far from homogenous, he stresses. ‘In our European study we talked about over-35s, which some people would think was actually very young, but you might be talking about someone who’s been using for 20 years. So I think there are those kinds of issues for services, and also for local planning structures and governments. There were quite interesting examples of services for older users in countries like Germany, such as dedicated residential services. Also, something that’s starting to happen is better links between addiction services and services for older people, so that there’s a better understanding across the sectors of what the issues are now but also projecting five, ten, 15 years ahead.’
Figures for deaths relating to new psychoactive substances (NPS) now make headline news, but the picture can be slightly more complicated than the media make out, he points out. Of the 60 Scottish deaths in which NPS were implicated, or potentially contributed to, in 39 cases ‘the only NPSs present were benzodiazepines (usually phenazepam)’, says the document, compared to 19 cases in which NPS like AMT, BZP or PMA were present (and two in which both types were present).
So if in around 67 per cent of the NPS cases, the only NPS used was a benzodiazepine – and usually in combination with other drugs including alcohol – could there be a popular misconception about this new trend?
‘Yes, I was quite frustrated with some aspects of the Scottish coverage of our figures,’ he says. ‘It’s not to say that new psychoactive substances isn’t a major issue – of course it is – but it’s the representation of the deaths almost as if there’s a new problem emerging while the old one has sort of gone away. Which of course is not the case.’
Drug-related deaths in Scotland 2013 at www.gro-scotland.gov.uk
Deaths related to drug poisoning in England and Wales, 2013 at www.ons.gov.uk