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.
2 Responses
An interesting article – however, I am not convinced that the prevalence of ‘heroin use in the UK has been steadily declining over recent years’. In fact, I think there are good arguments supporting the view that heroin use has increased in Britain over recent years (as it has in the USA and other countries). CSEW estimates of the prevalence of heroin use – though clearly under-estimated due to the household survey methodology – indicate a constant 0.1% rate of last-year heroin use among adults from 2001/02 to 2014/15. The official ‘Glasgow’ prevalence estimates, based on debatable statistical methods, indicate that there were 281,320 opiate users in England in 2004/05, 286,566 in 2005/06, 273,123 in 2006/07, 261,792 in 2010/11, and 256,163 in 2011/12. That’s an estimated drop of just 10% over 7 years, and a statistically non-significant change over the last 2 years of the estimate. It should also be noted that the latest ‘Glasgow’ estimate is now three years out of date. Even so, it still indicates that there were around a quarter-million heroin users in England in 2011/12 – a huge number. Other indicators of the prevalence of heroin use, such as the numbers entering treatment or the number of heroin-related deaths – along with evidence of increasing opium yields in Afghanistan and other producer countries – are more consistent with the hypothesis of rising (rather than stable or falling) levels of heroin use. Lastly, in Liverpool, where I have been in touch with local heroin users for 30 years, my informants consistently inform me that there are growing numbers of people using heroin, as well as more heroin dealers than ever before.
It is quite possible that the reduced attractiveness and effectiveness of drug treatment services brought about by our Full Recovery treatment policy (eg. greater pressure on service users to abstain from illicit heroin, the gradual reprioritization of reduction/detox regimes over maintenance prescribing, etc.) has led to a drop-off in the proportion of heroin users coming forward for help – as well as an increase in the number of ‘officially drug-free’ ex-treatment clients who relapse into illicit heroin use. This implies that ‘hidden’ (untreated) heroin use may be growing at a greater rate than previously – which, coupled with the greater numbers of heroin users in treatment, is consistent with the hypothesis of rising numbers of heroin users overall. Assuming that the rate of heroin-related mortality among heroin users has not actually changed that much (there are no trends in relevant indicators which support this view), this strongly suggests that the huge annual rise (by two-thirds!) in the number of heroin-related deaths in 2014 is actually a reflection of the rising number of heroin users in Britain. If and when updated (and hopefully improved) estimates of the prevalence of heroin use over the last three years become available, we will have some way of assessing this plausible hypothesis.
Hi Russell, very interested in your Liverpool front line accounts. I accept your arguments about CSEW and I don’t know anyone who believes in the Glasgow estimates. The big rise in the number of heroin deaths is worrying, although these do seem to be of older people, rather than new users.
On the other side of the coin, I’m not sure why there has been such a big decrease in crime, and a big drop in the numbers of people on DRRs etc. unless there are fewer heroin users.
Again, I’m not confident of how we will get an accurate assessment of the number of heroin users on a national level, but you’ve certainly got me questioning the accepted wisdom that heroin is less popular than it used to be.