The majority of drug-related deaths in Scotland in 2011 were among people not in receipt of a substitute prescription, according to a new report by ISD Scotland and NHS Scotland.
The year saw the highest number of drug-related deaths ever registered in Scotland (DDN, September 2012, page 4), with methadone ‘implicated in or potentially contributing to’ 47 per cent of them, leading to a government review of substitute prescribing. However, according to analysis of 438 of the deaths in the National drug-related deaths database (Scotland) report 2011, 74 per cent of those who died were not receiving a substitute prescription at the time of their death, and nearly 60 per cent of those where methadone was implicated were not in receipt of a methadone prescription.
The figures ‘helped to contextualise’ the 2011 statistics, said the Scottish Drugs Forum (SDF). According to the document, the high levels of overall deaths involving methadone could have been the result of a number of factors, including users seeking different drugs during the 2010/11 heroin ‘drought’ and high levels of poly drug use, with 97 per cent of fatalities having more than one drug present in their system.
In terms of the ‘significant number’ of deaths involving people who were on a methadone programme, however, the report points to potential factors such as poor dosing regimes, poly drug use, lack of access to prescribing support, older age and poor overall health.
‘There is a huge body of evidence around the protective nature of substitute therapy for drug users,’ said SDF director David Liddell. ‘What is clear from the statistics is that most people who died had dropped out of treatment for a range of reasons and this is clearly worrying.’
Failure to frame opioid replacement therapy (ORT) in the context of a range of interventions was too often ‘an unfortunate feature’ of public debate, he stated, with ‘simplistic arguments around whether or not we should have ORT. The debate must move on from this narrow lens and focus on the wider issues of how to respond effectively and holistically to the needs of the 60,000 people with drug problems.’
National drug-related deaths database (Scotland) report 2011 at www.isdscotland.org