There were 4,393 deaths related to drug poisoning registered in England and Wales last year, according to the latest figures from the Office for National Statistics (ONS), just up from 2018’s record figure of 4,359 (DDN, September 2019, page 4). Once again, men accounted for around two thirds of the deaths, while over half of all poisonings involved an opiate. Read comment and reaction from leading organisations in the sector. To add your comment email the editor - email@example.com Just under 2,900 of the deaths were as a result of drug misuse, representing a slight – but ‘not statistically significant’ – fall from last year. As in previous years, the highest rate of drug misuse deaths was in the North East, at 95 deaths per million people, compared to 33.6 deaths per million in the East of England. Rates of drug poisoning deaths have been consistently higher in the most deprived areas, particularly among people in their forties, while deaths involving cocaine have now increased for eight years in a row. Read more comment in November DDN Magazine ONS points out that the data relates to deaths registered last year and therefore does not cover those that occurred during the pandemic. ‘The number of deaths due to drug poisoning registered in 2019 remains at a similar level to 2018,’ said deputy director of health analysis and life events, Ben Humberstone. ‘Almost half of all drug-related deaths involved opiates such as heroin and morphine.’ Poisonings involving cocaine have risen by more than 26 per cent for women and 7 per cent for men since last year, while poisonings involving NPS and fentanyl have remained stable. Drug-related poisoning rates have been on a ‘steep upward trend’ since 2012, says ONS, in line with trajectories in Scotland and Northern Europe. The age at which most people died from drug misuse has also continued to increase over time, with 20-29-year-olds having the highest rates during the first decade of figures, 30-39-year-olds between 2003 and 2015, and 40-49-year-olds since then. ‘It is possible that the pattern of findings by age shows that a generation of people born in the 1960s and 1970s, known as Generation X, have died from drug misuse in greater numbers over time,’ ONS states. Change Grow Live chief executive Mark Moody said that a ‘critical tipping point’ had now been reached. ‘The drug-related crisis has been worsening for over a decade. At the heart of the trend is a perfect storm of factors – disinvestment, an ageing population of people using drugs, and increasingly complex health needs. Adding to these challenges, the global coronavirus pandemic has, and continues to, impact vulnerable people most. This includes people with chronic health problems linked to drug use and people without a place to live.’ An ‘evidence-based system’ was the only way out of the crisis, he stated. It was clear that cocaine use had increased ‘exponentially’ in the last decade, said We Are With You deputy CEO Laura Bunt, with many people remaining unaware of the potential harms. ‘We need much better education early on in schools and throughout the population on how to use drugs in the safest way possible and what support is out there.’ It was ‘no surprise’ that drug-related deaths were highest in the most deprived areas, she said, with ‘the impact of the COVID-19 crisis likely to exacerbate many of these issues. These figures are stark, but with some simple changes they can be brought down. The evidence is clear on what works; hopefully there is now the will to implement it.’ ‘The reality is that local alcohol and drug services are operating under immense pressure as our funding continues to decrease,’ said executive director at Humankind, Karen Tyrell, while the dissolution of PHE made it ‘feel like we have now come to a critical point. We are waiting to hear the outcome of the second stage of the Dame Carol Black review but the spending review has been shelved by government, so it may be some time before we see any change in terms of improved funding.’ The sector needed to now focus on keeping harm reduction services open, getting naloxone to as many people as possible, providing a range of easily accessible online groups and being flexible in its approach to prescribed medication, she stressed. ‘Government inaction’ was contributing to the deaths, added Release executive director Niamh Eastwood. ‘In the last 12 months, two parliamentary select committees – the Health and Social Care Select Committee and the Scottish Affairs Select Committee – have called for drug policy reform in the UK in order to tackle drug related deaths, citing the need for investment in treatment and harm reduction, supporting calls for overdose prevention sites and calling for a review of the law to end criminal sanctions for possession offences. If the home secretary and the prime minister continue to ignore these calls then they will continue to be responsible for the deaths of thousands of people every year. It is time to stop playing politics and listen to the evidence.’ Deaths related to drug poisoning in England and Wales: 2019 registrations at www.ons.gov.uk Comment and reaction from treatment providers Mark Moody, chief executive of Change Grow Live The rate of drug-related deaths remains at crisis levels. Behind these statistics, are 4,393 unique people with their own story. Each death represents a profound, personal tragedy for families and communities across the country. The drug-related crisis has been worsening for over a decade. At the heart of the trend is a perfect storm of factors; disinvestment, an ageing population of people using drugs, and increasingly complex health needs. Adding to these challenges, the global coronavirus pandemic has, and continues to, impact vulnerable people most. This includes people with chronic health problems linked to drug use and people without a place to live. It is concerning to see that deaths involving cocaine have increased again, for the eighth successive year, with a 25 per cent increase in the cocaine-related death rate for women. Treatment services have a key role to play in supporting people, especially as cocaine purity at a retail level is at the highest levels for a decade. We have reached a critical tipping point Right now, and in the long term, the pandemic will increase the pressure on local treatment services. Many of these services are already stretched, with frontline staff and volunteers going above and beyond to meet demand. At the same time, poverty, inequality, and unemployment are likely to lead to more people using drugs and alcohol within communities. Last year, we wrote to party leaders before the General Election. Our message stays the same; our sole focus cannot just be trying to stop people from dying as a result of substance misuse. Instead, as a society, we must help people to change their lives for the better. We do not know what the full impact of the pandemic will be, or how long it will last. But we do know that the time we have now, to plan and prepare, is critical. An evidence-based system is the only way out of the current crisis No single sector or organisation has all the solutions to the drug-related deaths crisis. The starting point for developing these solutions must be evidence and, crucially, the conviction to act on the best evidence available. The time for an overhaul of current drug laws, which are outdated and not evidence based, is long overdue. Services also need to be adequately resourced, but not in isolation. Drug-related deaths are not an issue faced only by the drug treatment sector. Substance misuse, social inequality, and poor health – mental and physical – are all connected. This is clearly shown in the data as, over the last decade, the death rate has been significantly higher in deprived areas. Services across different sectors of health and social care should be provided with the resources and autonomy to break down arbitrary and harmful divisions, especially those between substance misuse and mental health services. This will reduce stigma and allow passionate frontline workers to focus on people instead of processes. We are at a crucial tipping point. Without a change in direction and without evidence-based approaches, deaths will continue to increase. Each drug-related death is a tragedy, and we know that we are not alone in our ambition to make a difference and help people change the direction of their lives. ----- Drug related deaths have a catastrophic and widespread effect on families and communities. Emma Knape, Head of Corporate Services at Delphi Medical The latest DRD figures demonstrate that across the country, increasing numbers of people face difficult issues and experiences related to drug misuse. All communities, but especially those communities dealing with high levels of drug related deaths, require increased attention and resource to bring about effective and sustainable change. As the lead provider of the drug and alcohol service in Blackpool, Delphi Medical are wholly committed to playing our role in driving forward change in the town. We want better for the people who use our services, and we will keep fighting to reach these better outcomes. Blackpool’s long-standing history of problems associated with drug use affect almost every facet of local society. Following widespread national cuts to public health funding, drug treatment services in the town have been forced to operate on drastically reduced budgets. Our new report outlines the holistic approach taken in Blackpool to create better support and outcomes for some of the most vulnerable people in society – amidst these unprecedented challenges. With the collaborative approach already showing positive results, the report details a step-change in preventing drug-related harm in Blackpool, and offers an innovative collaborative model for services across the country faced with increasing budget cuts. ----- Turning Point responds to latest drug related deaths numbers In response to new statistics published today by the ONS that show drug related deaths remain at an all-time high, Graham Parsons, Chief Pharmacist at Turning Point said: “Drug related deaths are preventable deaths. Investment in high quality, free to access, evidence-based treatment services is critical, not only to protect communities from drug related crime and anti-social behaviour but to save lives. This is even more vital in deprived communities as shown by the statistics.' 'Nationally, funding has been reduced by 37% over the past decade and this reduction needs to be reversed. There are a number of factors that have led to the increase in the number of deaths, treatment remains the key protective factor. There is indisputable evidence that treatment saves lives and it’s time for action to provide the investment that can reverse this tragic loss of human life.' 'These statistics show that almost half of deaths are related to opiates. Long term heroin users with poor health, who frequently engage in poly-drug and alcohol use, are most at risk. For this group the best way to prevent drug related deaths is to get people into treatment. Turning Point works hard to let people know we are here if they want help and we will fast track anyone identified as being particularly vulnerable and at high risk into treatment. However, we know that in many areas the resources aren’t available to invest in reaching out to people who need help rather than waiting for them to come into services.' 'Wide scale distribution of naloxone kits which can be used to save someone’s life if they overdose from heroin or other opioids is also key to preventing deaths. At Turning Point we have also been delivering training to community pharmacies to deliver Take Home Naloxone services in order to make it even more accessible.' ----- Laura Bunt, Deputy CEO at We Are With You This is a really sad day. Every drug-related death is preventable, and each death has a huge impact on families and communities, continuing to be felt years down the line. Our thoughts are with the thousands of people who have lost a loved one in the past year. People who use drugs are often misunderstood, but behind most deaths are stories of trauma and people doing their best to cope with emotional pain that has never been resolved. We know that people who use drugs problematically but aren’t in treatment are most likely to die of a drug-related cause. The government's proposed new addiction strategy represents an opportunity to get more people the support they need. This includes improving the diversity of treatment through making services much more easily available to all communities, normalising seeking support, and reaching people where they are. It’s also clear that cocaine use has increased exponentially in the last decade, with both crack and powder becoming increasingly available and affordable, yet many people remain unaware of the potential harms. We need much better education early on in schools and throughout the population on how to use drugs in the safest way possible and what support is out there. We also need to recognise that problematic drug use is often a reaction to people’s surroundings. Issues such as rising homelessness, poor mental health and a lack of economic opportunities in some areas all lead to people using drugs. It’s therefore no surprise that drug-related deaths are highest in the UK’s most deprived areas, with the impact of the COVID-19 crisis likely to exacerbate many of these issues. For people already facing issues with drugs, alcohol and mental health, these may intensify over the coming months. It’s more important than ever that the government stays true to its levelling up agenda to address inequalities across the country. These figures are stark, but with some simple changes they can be brought down. The evidence is clear on what works; hopefully there is now the will to implement it. ----- Karen Tyrell, executive director, Humankind We’ve reached a critical point with drug related deaths - here are five things we all must do better, says Karen Tyrell. I was a drug worker myself 20 years ago and the ever-inflating drug related deaths total still makes me feel sick at heart. The latest figures, just announced, show another desperately sad increase. We get into this sector because we care. These are people we did our best for and who were cared for by their family and friends. We know they’re not just numbers on a spreadsheet somewhere. But the reality is that local alcohol and drug services are operating under immense pressure as our funding continues to decrease. And given that we are in a world which also has a pandemic, it doesn’t feel hopeful that this is going to change quickly. Indeed, the dissolution of Public Health England, too, makes it feel like we have now come to a critical point. We are waiting to hear the outcome of the second stage of the Dame Carol Black review – but the spending review has been shelved by Government, so it may be some time before we see any change in terms of improved funding. Which leaves it up to us, as a sector, to step up. There are a few things I think we can all do better. We need to go back to basics and get the fundamentals right. This could save lives, help improve capacity in the system, and help more people to move forward with their lives and regain good health: \tFocus on our harm reduction services, keep them open and get them right. We need to deliver great harm reduction advice including overdose prevention, and offer a broad range of needle and syringe provision. These services need to be easy to get, consistently available and low threshold. \tGet naloxone out to as many people as possible. Treat it as a normal part of how treatment starts, not an optional add on. Make sure it is everywhere. \tMake sure we all provide a good range of online groups which are easy to access for as many people as need them. Yes, I know not everyone has a computer – but it’s been a lifeline to many and is an opportunity for us to build a new way of providing a wider range of support to more people. \tFlex our approach to prescribed medication where we can to make it easier for people to stay in treatment. This means being careful, but also being brave. \tBuild on the work we saw happen in lockdown, bringing communities together. This means helping people to see a bright future with opportunities to connect, and rebuild their lives with meaning. There was a lot of creativity and partnership working in local services and communities – let’s grow that with our commissioners and partners. Our services and the infrastructure of a once good treatment system are more than frayed at the edges; they are beginning to fall apart. So it’s time to not just make do, but mend. We can still do it by returning to the basics of a good system, being creative and using smart, new technology to reach more people in more areas. The drug-related deaths figure always gives us pause for thought. We all have an opportunity for change. If you need drug and alcohol services, please do reach out. We’re here to help. ----- Niamh Eastwood, executive director, Release People are dying and government inaction is contributing to these deaths. In the last 12 months, two parliamentary select committees – the Health and Social Care Select Committee and the Scottish Affairs Select Committee – have called for drug policy reform in the UK in order to tackle drug-related deaths, citing the need for investment in treatment and harm reduction, supporting calls for overdose prevention sites and calling for a review of the law to end criminal sanctions for possession offences. If the Home Secretary and the Prime Minister continue to ignore these calls, then they will continue to be responsible for the deaths of thousands of people every year. It is time to stop playing politics and listen to the evidence.’ The public health crisis that we are all now experiencing as a result of COVID-19 has exposed how structural inequalities have contributed to high deaths rates due the virus, we have seen the same thing in drug-related deaths for the last decade. It is no surprise that in areas of deprivation, where austerity has destroyed social safety nets, we are witnessing the highest levels of drug related deaths linked to drug dependency. Investment in these communities, adequate housing, restoring benefits to a decent level, along with drug policy and harm reduction initiatives can save lives. The most socially deprived communities have rates of deaths that are five and half times greater than the least deprived, exacerbating the inequality they already experience. The North East had a significantly higher rate of deaths relating to drug misuse than all other English regions with 95 deaths per million people, the highest rate of drug misuse of any English region for the past seven consecutive years. Overall trends in drug misuse have largely been increasing in each English region, and Wales, since the data time series began in 1993. The Government’s own advisory body – the Advisory Council on the Misuse of Drugs – gave advice 4 years ago now on how to prevent more of these deaths. Despite ample evidence, it is tragic and hugely irresponsible that this expert advice has been largely ignored by central government. Drug deaths are not inevitable. This public health crisis will not abate unless we scale up harm reduction initiatives and pursue policies based on science and evidence rather than ideology and moralism. ----- The statistics show a 26.5% increase in cocaine-related deaths among women. Dr Prun Bijral, medical director at Change Grow Live, comments: Increased cocaine purity and greater availability of cocaine has correlated with a national increase in problematic cocaine use. This is particularly evident among women, and we have seen a 24 per cent increase in the rate of cocaine use by women over the last six years. This increase in usage is consistent with the rise in the cocaine-related death rate among women that we are now witnessing. Problematic cocaine use among women and men is a growing problem. It is therefore essential that we engage more people with treatment services that can address the root causes of this behaviour. It is also more important than ever for treatment providers and research bodies to develop the range of clinical interventions that are available for people using cocaine. Many women struggling with their cocaine use may be apprehensive about walking through the doors of a drug treatment centre. However, online support services are growing in their reach and availability, often led at a grassroots level. Our message to anyone concerned about their cocaine use is to talk to your GP and find out more about the range of support, both online and in-person, that is available now.