Reducing heroin-related deaths

Drug treatment key

Maintaining the capacity and quality of drug treatment is essential to prevent further increases in opioid-related deaths.

That is the principal conclusion of a new (12 December 2016) report ‘Reducing opioid-related deaths in the UK’ by the Advisory Council on the Misuse of Drugs (ACMD) which investigates the causes of the increase in drug-related deaths and the most effective potential responses.

The figures

There has been a sharp rise in the number of people dying from heroin and other opioids over the last three years:

The findings

The ACMD’s Drug-Related Deaths (DRDs) Working Group found that there is a sizeable number of people who have used heroin since the 1980s and 1990s with complex health problems. These people are increasingly vulnerable to opioid-related deaths as they age.

The figure below shows that people born in the 1960s and 1970s have continued to be at the highest risk of opioid-related death for 20 years:

The report says:

We can assert with a good degree of confidence that the increasing vulnerability of the UK’s ageing cohort of heroin or opioid users with increasingly complex health needs (including long-term conditions and poly-substance use), social care needs, and continuing multiple risk behaviours is highly likely to have contributed to recent increases in drug-related deaths.

The panel of experts also outlines other potentially important issues:

Other factors, including changes in the availability of street heroin, socio-economic changes (including cuts to health and social care, welfare benefits and local authority services) and changes in treatment services and commissioning practices may also have contributed to these increases.

The recommendations

In response to the increase in opioid-related deaths, the report makes the following recommendations:

  • improve the current data processes by creating data standards for local reporting that feed into national systems
  • central and local government implement strategies to protect current levels of investment in evidence-based drug treatment to promote recovery
  • central and local governments continue to invest in high quality, tailored opioid substitute therapy (OST) of optimal dosage and duration
  • naloxone, medication used to reverse the effects of opioid overdose, is made available routinely, cheaply and easily to people who use opioids and to their families and friends
  • governments consider the potential to reduce drug-related deaths and other harms through the provision of medically supervised drug consumption clinics in localities with a high concentration of injecting drug use
  • governments encouraged to carry out more research on drug-related deaths and treatment services
  • an integrated approach for drug users at risk of drug-related death that includes access to physical and mental health and social care services

The expert panel raised concerns that ‘drug treatment and prevention services in England are planned to be among those public health services that receive the most substantial funding cuts as a consequence of the government’s decision to cut the public health grant’.

Annette Dale-Perera, co-chair of the ACMD’s Drug-Related Deaths Working Group, said:

We can assert with a good degree of confidence that the ageing profile of heroin users with increasingly complex health needs, social care needs and continuing multiple risk behaviours has contributed to recent increases in drug-related deaths.

The greater availability of heroin at street level, the deepening of socio-economic deprivation since the financial crisis of 2008, changes to drug treatment and commissioning practices, and the lack of access to mainstream mental and physical health services for this ageing cohort have also potentially had an impact.

Alex Stevens, co-chair of the ACMD’s Drug-Related Deaths Working Group, said:

We welcome the government’s commitment to reducing preventable heroin-related deaths but they must ensure the current standard and availability of drug treatment is at least maintained.

Without continued government intervention, it is likely that opioid-related deaths will continue to rise.

There are evidence-based steps that the government could take to limit and potentially reverse this increase. Most importantly, national governments in the UK could at least maintain investment in opioid substitution therapy of optimal dosage and duration.

Governments’ previous investments in effective drug treatment have limited increases in opioid-related deaths in the past. They now have the opportunity to act to save more lives.

This report vindicates the importance of the ACMD; the advisory group took its own decision to produce a report on this key, and increasingly worrying issue (that is to say, it was not asked by government to produce it) and has been prepared to emphasise that funding sufficient good quality treatment is the only way to stop an increasing number of individuals dying from their heroin (and other opioid) use.

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