The number of deaths related to heroin and morphine fell from 41 per cent of total drug-related deaths in 2010 to 32 per cent in 2011, according to figures released by the International Centre for Drug Policy (ICDP) at St George’s, University of London.

The total number of drug-related deaths in the UK fell by seven per cent from 1,883 in 2010 to 1,757 in 2011, says the National programme on substance abuse deaths (np-SAD) 2012 report, continuing the downward trend that saw deaths fall by 14 per cent between 2009 and 2010. The number of deaths from legal highs ‘remained steady’ in 2011, however, following a large increase the previous year.

Deaths related to methadone rose by four per cent to 31 per cent between 2010 and 2011, while deaths involving other opiates including prescription painkillers rose by six per cent to 28 per cent. Deaths involving cocaine rose from 8.7 to 9.2 per cent of the total and amphetamines from 2.9 to 3.7 per cent. The report covers deaths that have been formally investigated, and includes information from coroners and police forces across the UK. More than 70 per cent of the deaths were of males, and 66 per cent were under the age of 45.

‘Whilst an overall decline in drug-related deaths in the UK is indeed excellent news, further monitoring of the situation needs to happen over the next few years,’ said acting director of the ICDP, Professor Fabrizio Schifano. ‘Particular attention needs to be paid to both the emerging issues of novel psychoactive substances, which are commonly known as ‘legal highs’, and the increasing concern relating to prescription drugs’ misuse and related fatalities.’ 

Meanwhile, Scottish GPs have ‘minimal’ awareness of the country’s naloxone programme, according to research by the University of Aberdeen. ‘GPs tend to classify naloxone provision as a specialist service and therefore assume it is not part of their remit,’ says the document, including ‘those with higher involvement of specialist training in substance misuse’. The report calls for improved training and information resources for GPs. Two of Northern Ireland’s health trusts – the Belfast Trust and the South-Eastern Trust – have failed to distribute naloxone, despite it being available to them since July 2012, the BBC has reported.

Drug-related deaths in the UK at www.sgul.ac.uk

General practitioner engagement with the Scottish National Naloxone Programme: a needs assessment project at www.healthscotland.com/documents/6258.aspx

Local authorities are ‘not ready to take responsibility’ for hepatitis C, according to an audit of English commission­ers and local councils by the Hepatitis C Trust. 

Despite local authorities assuming responsibility for public health, just a quarter are aware of how many people in their area are living with – or at risk of – hepatitis C, says Opportunity knocks? An audit of hepatitis C services during the transition, while only 20 per cent have an appointed hepatitis C lead. Fewer still have a strategy for tackling the virus, and just 40 per cent have arrangements in place with NHS commissioners to coordinate hepatitis C work. Almost half of NHS commissioners, meanwhile, have no measures in place to increase treatment. 

All local authorities need to develop a comprehensive hepatitis C strategy, jointly agreed with commissioning groups and taking account of local need, says the document, as well as having a designated liver health lead on their health and wellbeing board with hepatitis C a clear part of their remit. The report also calls for Public Health England to set out plans to establish a national liver intelligence network, and for authorities to ensure that preventative measures are targeted to all at-risk groups in their local communities.

 The number of hospital admissions for alcohol-related liver disease in people under 30 has risen dramatically in the last decade, according to figures from Balance, the North East Alcohol Office. 

 There was a 117 per cent increase in admissions for under 30s in England between 2002 and 2012, with 115 people under the age of 30 admitted to hospital last year compared to just 23 in 2002/03. The North East, however, saw an increase of 400 per cent over the same period. 

 The total number of admissions across all ages rose from 25,706 in 2002/03 to 49,456 in 2011/12 – an increase of 92 per cent. Admissions for women have increased by 91 per cent in England, rising to 114 per cent in Yorkshire and the Humber. 

 Alcohol Concern chief executive Eric Appleby said the figures were ‘terrifying’, showing an increase in alcohol-related liver disease ‘across both sexes, in every age group, in every region of the country. It’s particularly sad to see the number of young people with this awful disease more than doubling. We have to start taking this seriously – if this was any other illness immediate action would be taken to halt this, so we call on the Department of Health to outline what action it intends to take.’

Council call

London’s drug and sexual health services are failing to respond appropriately to gay men’s drug use, according to NAT (National Aids Trust). The trust has written to councils calling for action to address a ‘recent and rapid rise’ in the use of mephedrone, crystal meth and GHB/GBL in London’s gay scene, citing high levels of injecting drug use and needle sharing. ‘We are calling on the London councils as they take on their new responsibility for commissioning both sexual health and drug services to meet this challenge and commission integrated sexual health and drugs services tailored specifically for gay men,’ said NAT chief executive Deborah Jack. ‘This is essential if we are going to reduce the high rates of HIV and STI transmission.’ See news focus page 6

EC warning

The ongoing economic crisis will see more young people selling and producing drugs – especially home-grown cannabis – at the same time as budget cuts hit treatment and harm reduction services, according to a new report from the European Commission (EC). The study was a ‘wake-up call for Europe’, said EU justice commissioner Viviane Reding. Study available at ec.europa.eu

Rural relief 

UNODC and the United Nations Industrial Development Organization (UNIDO) are to promote grassroots development in poor rural communities dependent on the cultivation of drug crops. ‘We need to ensure that they are provided the tools to support their livelihoods, through capacity-building activities and job opportunities,’ said UNIDO director general Kandeh Yumkella. Afghanistan could serve as a pilot country to develop a joint UNODC-UNIDO project, he added. 

The Francis report: What about drug and alcohol services?

The Francis report into the Mid Staffs NHS Trust dominated the headlines and reignited the debate about health service provision. But what are the likely implications for the substance use sector, asks DDN

Called the ‘worst scandal in the history of the NHS’, the appalling neglect of patients at the Mid Staffordshire NHS Foundation Trust led to a public inquiry chaired by Robert Francis QC and, last month, the publication of his vast and damning report, weighing in at nearly 2,000 pages over three volumes. 

‘There were and are a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies, all of whom might have been expected by patients and the public to detect and do something effective to remedy non-compliance with acceptable standards of care,’ wrote Francis to health secretary Jeremy Hunt. ‘For years that did not occur.’ 

Gambling on health.

There is a ‘great deal in common’ between alcohol and gambling problems, as well as the way they can be treated and prevented, according to a report from Alcohol Concern Cymru and the Royal College of Psychiatrists (RCPysch) in Wales. ‘Whilst fewer people suffer gambling problems than they do with alcohol, such problems can destroy their lives and their families,’ said chair of RCPysch’s Faculty of Addictions, Dr Raman Sahkuja. ‘It is vital that access to appropriate advice and treatment is available and well-funded, especially when considering that often people with alcohol problems participate in unhealthy gambling, and vice versa.’ 

A losing bet at www.alcoholconcern.org.uk

Supply and demand of illicit drugs in Europe is entering an ‘important new era’, according to a report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol, with both globalisation and the internet having a profound impact. 

Technology has been a ‘significant game-changer’ in the trafficking, production and distribution of drugs, says EU drugs markets, with the internet acting as both marketplace and communication tool, while globalisation has meant more countries being used as storage, transit or production locations. The market is ‘increasingly dynamic, innovative and quick to react to challenges’, states the report, with new trafficking routes and ‘multi-substance consignments’ replacing the trafficking of specific drugs along well-defined routes. There is also a growing trend for producing drugs close to their intended markets so they are less likely to be intercepted. 

The number of heroin and crack cocaine users in England has fallen below 300,000 for the first time, according to figures issued by the NTA. 

The figure stood at 298,752 in 2010-11, according to Esti­mates of the prevalence of opiate use and/or crack cocaine use, down from a peak of more than 332,000 in 2005-06. The number of people injecting has also fallen to just over 93,400 from nearly 130,000 over the same period, it says. 

The estimates ‘support the continuing shift away from the most harmful drugs, particularly among younger people,’ the agency states. However, while the number of under-35s using heroin and crack is falling, the number of ‘entrenched users’ aged over 35 continues to increase. 

The number of people starting a new treatment programme for addiction to heroin and/or crack has fallen to 47,210 in 2011-12 from 64,288 in 2005-6, as local authorities take over lead responsibility for commissioning substance misuse services from next month. 

 ‘The NTA is handing over to Public Health England and local authorities a world class drug treatment system, with rapid access to evidence-based interventions and increasing rates of recovery,’ said chief executive Paul Hayes. ‘The new public health landscape presents both opportunities and challenges. Local authorities are well placed to bring together all the support people need to help them recover from addiction, including access to housing, employment and social networks. However the strong recovery ambition called for in the government’s 2010 drug strategy, and the investment in treatment, must be maintained if we are to consolidate and build on the gains we have made.’

Estimates of the prevalence of opiate use and/or crack cocaine use, 2010/11 at www.nta.nhs.uk

A minimum price of 50p per unit of alcohol should be introduced for ‘all alcohol sales’ along with prohibition of ‘all alcohol advertising and sponsorship’, according to a report from the Alcohol Health Alliance, British Liver Trust and University of Stirling. 

Health first – an evidence based alcohol strategy for the UK also wants to see ‘at least’ one third of every alcohol label given over to ‘an evidence based health warning’ and for the sale of alcohol in shops to be restricted to specific times of the day and designated areas.

The document is supported by organisations including Alcohol Concern, Cancer Research UK and ten royal colleges, and among its other recommendations are for the tax on every alcohol product to be ‘proportionate to the volume of alcohol it contains’, a tightening of the drink driving limit and the development of guidelines for ‘the portrayal of alcohol in television and film’. Public health and community safety should be given priority in all alcohol policy making, it states, with no involvement by drinks companies in policy development or health promotion.

Prescription for change?

With addiction to prescription and over-the-counter drugs at epidemic proportions in the US, GPs here are being warned to take care when prescribing any drugs that could lead to dependence

 ‘Prescription drug abuse’ is classified as an epidemic by America’s Centers for Disease Control and Prevention, 

prompting the Obama administration to issue a specific prevention plan to expand on its 2010 National Drug Control Strategy (DDN, May 2010, page 5). As former White House drugs advisor Keith Humphreys told DDN last year, legal pharmaceutical drugs are the leading cause of overdose in the US, and one in eight American teenagers have taken potentially addictive legal drugs like Vicodin and OxyContin (June, page 16).

Sound investment

Every pound spent on family support services in the drug and alcohol sector saves the public purse £4.70 in NHS and criminal justice costs, according to new research by Adfam. An inde­pendent social return on investment (SROI) study commissioned by the charity, the first of its kind in the sector, demonstrates the power­ful case to fund and expand family services, it says. ‘This research provides sound evidence to what we already know – that supporting families makes both moral and economic sense,’ said chief executive Vivienne Evans. Full briefing on the research available at www.adfam.org.uk. See Family Matters column, page 13.

Evidence examination

The ACMD’s recovery committee (DDN, January, page 18) has published its first report, intended to ‘map out the terrain’ that it will examine in more detail in a forthcoming series of focussed reviews. Recovery from drug and alcohol dependence: an overview of the evidence at www.homeoffice.gov.uk/agencies-public-bodies/acmd/

A consensus statement has been issued by the Royal College of General Practitioners (RCGP) and Royal College of Psychiatrists (RCPsych) cautioning against the long-term prescribing of medicines that carry a risk of addiction. 

The statement, which is supported by nearly 20 other organisations including the NTA, SMMGP, National Pharmacy Association and the British Association of Social Workers, says medicines such as tranquilisers and painkillers should not be prescribed for long periods ‘except in exceptional circumstances’. While many patients may feel that the drugs are beneficial, it is vital that they understand the risks and are able to make informed choices, say the organisations, which also call for ‘rigorous and holistic’ reviews to be regularly carried out.

The statement acknowledges the challenges faced by people who have developed an addiction to prescription or over-the-counter medicines, and stresses that ‘extreme caution’ should be taken when reducing or stopping the medication, including seeking specialist help. Some medicines – such as benzodiazepines – carry a known risk of dependence, which can be ‘devastating to those affected and their families’, it states, and stresses that prescribing should always be informed by up-to-date guidance. Patients should also be offered ‘appropriate non‐pharmacological options’ where appropriate.