Worst figures since 2001
The latest official figures from Deaths Related to Drug Poisoning in England and Wales 2014 revealed a 64% hike in deaths involving heroin/morphine – from 579 in 2012 to 952 deaths in 2014.
There were a total of 3,346 registered drug poisoning deaths in 2014 – the highest since comparable records began in 1993.
Of those, 2,248 (67%) were due to drug misuse involving illegal drugs.
A complex number of factors such as the increased availability of heroin, price, street level purity, the age of those taking the drug and the combination of other narcotics taken can influence the number of deaths.
Since 1993, there has been an increase in deaths where heroin is more frequently taken with other substances, from 30% in 1993 to 48% in 2014. The substances most frequently mentioned alongside heroin on death certificates are alcohol, diazepam, methadone and cocaine.
Between 2008 and 2012, deaths involving heroin and/or morphine had steadily declined; a fall which coincided with a “heroin drought” in the UK, which reduced availability in some areas.
However, very sadly, drug-related deaths have increased rapidly again in the last three years and a similar pattern can be seen across Europe (see my recent post on the findings of the annual EMCDDA report).
Most deaths involving heroin now occur among 30 to 49 year olds
This is a shift from the situation back in 1993 where deaths occurred predominantly among those in their twenties.
The recent rise in heroin deaths is not confined to just England and Wales. A National Records of Scotland report, published on August 25, revealed a sharp spike in the number of deaths from heroin and morphine.
More than half of the 613 drug-related deaths in Scotland were attributed to heroin or morphine; with 309 lives lost. The figure is a 39% increase on the number of deaths from the drug in 2012.
The UN report points out that heroin related deaths in the United States of America increased sharply from 5,925 in 2012 to 8,257 in 2013 – an increase of 39%.
Naloxone a key part of the response
The rise of heroin-related deaths in the US and Scotland have prompted the governments in those two countries to make naloxone much more easily available.
Naloxone is an opioid antagonist drug developed in the 1960s which counters the effects of opiate overdoses, greatly improving the chances of survival. It rapidly reverses the effects of heroin or methadone, the most lethal of which is the way they cause respiratory depression – the factor most closely associated with death by overdose. Naloxone can be injected into a vein or muscle (and is even available as a nasal spray).
A number of recent initiatives involve training heroin users and their relatives and friends on how to administer naloxone – see here for details of an evaluation of this approach.
Currently naloxone can only be supplied under prescription, therefore non-medical services (such as hostels) which may experience frequent opiate-related overdoses are not able to legally hold stocks of it to use in an emergency (ACMD report, 2012).
However, next month (October 2015), changes to the medicines regulations will make anti-overdose drug naloxone easier to obtain.
Following recommendations by the World Health Organisation and the Advisory Council on the Misuse of Drugs that take-home naloxone should be made more widely available, Public Health England released an Public Health England advice note for local authorities and local partners promoting the wider availability of naloxone to reduce overdose death from heroin and similar drugs (Public Health England, 2015).
Heroin use in the UK has been steadily declining over recent years, so to lose an increasing number of people to this drug is doubly sad.
It is to be hoped that the take-up of naloxone has a significant impact and there is a distinct improvement in next year’s figures.