Co-ordinating action on drug issues

Drug Related DeathsDrug Related Deaths

Dave Liddell

Co-ordinating action on drug issues

Drug-related deaths, Scotland Drug-related deaths, Scotland 1996 – 2002 Source:GRO1996 – 2002 Source:GRO

244 224 249 291 292

332 382

0

100

200

300

400

500

1996 1997 1998 1999 2000 2001 2002

year

deat

hs

Co-ordinating action on drug issues

Drug-related deaths by Health Board Area: Drug-related deaths by Health Board Area: 1996 - 2002 Source:GRO1996 - 2002 Source:GRO

0

20

40

60

80

100

120

140

Argyll & Clyde 18 16 23 30 31 22 31

Greater Glasgow 90 67 93 100 104 96 126

Lothian 58 48 37 39 37 54 39

Tayside 24 30 23 14 14 19 14

Grampian 29 22 26 38 31 46 47

1996 1997 1998 1999 2000 2001 2002

Co-ordinating action on drug issues

Drug-related deaths by Health Board Area: Drug-related deaths by Health Board Area: 1996 – 2002 Source:GRO1996 – 2002 Source:GRO

0

5

10

15

20

25

30

Dumfries & Galloway 4 7 4 7 7 8 9

Fife 3 8 13 9 12 11 12

Forth Valley 0 4 2 8 4 9 24

Highland 2 3 1 7 1 5 8

Borders 2 1 1 0 1 1 0

1996 1997 1998 1999 2000 2001 2002

Co-ordinating action on drug issues

Drug-related deaths; selected drugs involved, Drug-related deaths; selected drugs involved, Scotland 1996 – 2002 Source GROScotland 1996 – 2002 Source GRO

0

50

100

150

200

250

300

1996 1997 1998 1999 2000 2001 2002

Year

Heroin/

Diazepam

Methadone

Cocaine

Ecstasy

Temazepam

Co-ordinating action on drug issues

Poly drug usePoly drug use

•Heroin/diazepam combinations

DiazepamHeroin/Diazepam

Heroin9115757

Co-ordinating action on drug issues

Injecting opiates – low toleranceSource: Andrew Preston

Blood level of heroin

lethal dose

unconsciousness

acute intoxication

Co-ordinating action on drug issues

High toleranceSource: Andrew Preston

Blood level of heroin

Time

lethal doseunconsciousness

acute intoxication

Co-ordinating action on drug issues

Poly drug use & high toleranceSource: Andrew Preston

temazepam

Blood level

lethal doseunconsciousness

intoxication

alcohol

heroin

1hr 3hrs 5hrs 7hrs 9hs 11hrs 12hrs

Co-ordinating action on drug issues

Greater Glasgow drug-related deaths 2002: Greater Glasgow drug-related deaths 2002: Age Groups Source: GGDATAge Groups Source: GGDAT

Greater Glasgow Drug Related Deaths 2002: Age Groups

8%3% 2%4%

20%22%

15%

26%

0%

10%

20%

30%

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-55

age groups

•55% aged 30 and over

Co-ordinating action on drug issues

Prison release & drug-related deaths, Greater Prison release & drug-related deaths, Greater Glasgow 2002 Source: GGDATGlasgow 2002 Source: GGDAT

22%

14%11%

4%8%

4%

37%

0%

10%

20%

30%

40%

up to 7days

8 - 14days

15 - 30days

31 - 60days

61 -- 90days

91 - 365days

morethan 1year

time lapse between prison release & death

Co-ordinating action on drug issues

Drug Deaths by Deprivation categories 2002Drug Deaths by Deprivation categories 2002 Greater Glasgow Source: GGDAT Greater Glasgow Source: GGDAT

6%3%

12%

27%

3% 4%1%

44%

0%

10%

20%

30%

40%

50%

3 4 5 6 7 ? NFA repeat

Deprivation Categories

Co-ordinating action on drug issues

Drug deaths – what we knowDrug deaths – what we know

• High purity heroin seldom the cause of overdose death

• Overdose less common among new or inexperienced users – older users predominate

• Large proportion of deaths are a mixture of opiates and Benzodiazepines –many also include alcohol

• Most are not in specialist ‘treatment’

• Recent history of overdose

Co-ordinating action on drug issues

Drug deaths – what we knowDrug deaths – what we know• Factors potentially adding to poly drug use and therefore

increased overdose risk

• Low purity heroin?

• Liver damage of those on methadone(heroin?)

• Low dose methadone prescribing

Co-ordinating action on drug issues

Drug deaths – what we knowDrug deaths – what we know

• Loss of tolerance and increased risk of overdose from :-

• Prison releases

• Detoxification

Co-ordinating action on drug issues

Drug deaths – what we knowDrug deaths – what we know• 137 individuals Source: John Strang et al BMJ May 2003

• At discharge:

• 43 Still Tolerant

• 57 Reduced Tolerance

• 37 Lost Tolerance

• 3 deaths occurred within four months all within the last group

Co-ordinating action on drug issues

Drug deaths – what we can doDrug deaths – what we can do

• Improve prescribing

• Methadone dosage, other prescribing options, access, end to ‘zero tolerance regimes’

• Higher overdose in high risk groups - outreach

• Most overdoses are witnessed – critical incidents training

Co-ordinating action on drug issues

Drug deaths – what we can doDrug deaths – what we can do

• High overdose rates over 30s – routes out/employability

• Better aftercare/continuity of care for those who have under gone detoxification

• Retox for high risk individuals leaving prison

Co-ordinating action on drug issues

ConclusionConclusion

• An impact can be made on reducing the number of deaths

• Services and DAATs need to regular review practice

• Recent death figures are encouraging