Who cares?

Drug-related deaths:

Like so many others, Darren’s death was preventable, says
Dr Chris Ford.

I still cry when I think of Darren months after his death. He was young and had done well in treatment – I felt I must discover why he had died, as so many others die, and drug-related deaths in the UK continue to rise.

I first met Darren in 1997. He was 17 years old and registered to ask for help with his heroin problem. He was also a charmer with a cheeky smile, but he looked unwell. He had been injecting for about six months and realised he couldn’t manage without heroin. He also told me he had an alcohol problem, which had improved since he took up heroin – he had been drinking up to two bottles of vodka a day but now only drank beer. The other drug he liked was diazepam, which he could pinch from his mother on occasions.

His request was to go on methadone and then become drug free. I said that was possible, but asked if I could see his injecting sites first. Darren rolled up his sleeves and revealed the worst injecting tissue damage I had ever seen. My first job was to teach him how to inject.

Darren settled well into treatment and after about nine months of methadone maintenance, he felt ready to become drug free so we discussed the pros and cons. He reduced over about six months and was very pleased. He agreed to continue counselling and to come back if he was at risk of relapsing.

After six months he relapsed – first on alcohol and benzos, and then heroin, and repeated this pattern for about 14 years. Mostly he would do outpatient detox with us, but did have two attempts at rehabilitation. For most of the time on maintenance, he worked as an apprentice in a butcher’s. He loved the work and dreamed of having his own shop. His relapses were usually started by increasing his alcohol, but a couple were when he found crack.

Having relapsed again in early 2011, Darren once again settled quickly on methadone maintenance. He had been drinking a lot and we discussed that as he had chronic hepatitis C, perhaps he should think more seriously about treatment. He smiled and said he would think about it. But early in 2012, having learnt that I was retiring, he said he must detox now as other services ‘may not understand me so well’.

Piecing together what happened in the four years leading up to his death made me angry. He had again relapsed on alcohol and benzodiazepines and was determined not to relapse on heroin, so presented asking for benzodiazepines. Both the local service and his GP turned him down, saying they were very addictive. Darren found it easy to get them from the internet so his habit increased enormously, mainly to try and curtail his alcohol. He started to feel more unwell and realised that his drinking was not helping his hepatitis C, so changed to heroin. He lost his job, split up with his girlfriend and had rows with his mum, so presented for help at the local service.

He was told to come back a week later for an assessment and was ten minutes late, so was made to come back the next day. He was told buprenorphine was the best drug for him, disagreed – and this almost got him excluded for a month. He decided to give it another try and presented in the morning in withdrawals. After four attempts he got his first dose.

Darren soon realised it wasn’t going to work, but the service insisted he continued. He dropped out of treatment, his alcohol and benzodiazepines went out of control, and he added crack and heroin. After several months, heroin helped him reduce his alcohol and he started to buy methadone off the street. He was even able to start work again. He tried the local service again and this time they agreed to continue methadone. All continued well for several months but after a series of missed appointments, he again dropped out of treatment, took up alcohol, lost his job and was thrown out of his flat. Darren’s last year is hazy but he seemed to isolate from friends and family, drank all he could get hold of and injected any drugs.

He was found dead in a stairwell with a needle in his arm and a can of strong lager by his side. He was only 36 years old.

The USA tops the chart in terms of opioid overdose deaths, increasing 255 per cent between 1999 and 2015. In England and Wales the rate increased by 35 per cent between 1999 and 2015, and then by a shocking 64 per cent linked to heroin and morphine over the last two years – the highest since records began. The UK now has the highest proportion (38 per cent) of the European total.

Australia, Germany, Luxembourg, Norway, Switzerland, Greece and Italy are reducing overdose deaths. What do they have in common? Extremely good access to opioid substitution therapy (OST). What else helps? Drug consumption rooms (DCRs), heroin-assisted treatment, measures to reduce homelessness, and take-home naloxone.

What do I think killed Darren? People not seeing him as a person and services not seeing him as an individual – as well as the UK government replacing extremely effective harm reduction with abstinence. Overdose deaths can be reduced – the science is easy. It’s the policies that need changing.

Chris Ford is clinical director at IDHDP