One thousand nine hundred and fifty-seven people died from drug-related causes in England and Wales last year. That’s a 21% jump with a significant rise in deaths related to heroin and morphine. The data for Scotland, released last month, showed a 9% drop compared to 2012, though this was still the fifth highest on record.
What’s come as a surprise to me on the day after the release of the data is how little attention it attracted from the media. Where is the outrage?
The headlines in the England and Wales report can be found here, but I’ve picked out some things that jumped out at me.
- Methadone related deaths are much the same at 429 (last year 414), about 15% of total deaths.
- There was a lower rise in deaths related to NPS (new psychoactive substances) than expected (up ‘only’ 15%), though it’s too soon to know the trend. The total number of deaths was 60. Watch out for cathinones (like mephedrone) though, up 44% from 2012
- Benzodiazepine deaths are up by 20% (342 in total). This represents the highest number of deaths for these drugs since records began.
- Tramadol prescribing is up by 29% over five years. Deaths involving tramadol have continued to rise, with 220 deaths in 2013. This is almost 2.5 times the number seen in 2009 (87 deaths). I’ve blogged before about tramadol concerns and I think we’re going to see this trend continue.
- Mortality rates in England from drug related causes increased from 28 deaths per million population to 33.9 deaths per million.
The full report can be found here.
I took a look at the mortality rate from drug-related causes in Scotland to make a comparison and allowing for confidence intervals and differences in the way the data are collected, it’s not easy reading. The Scottish Government’s report stated:
For Scotland as a whole, the average of 544 drug-related deaths per year represented a death rate of 0.10 per 1,000 population
Expressed per million population, this is is 100 compared to England’s 33.9. Why is mortality in Scotland two and a half times that of England? In fact if we compare rates in the EMCDDA report, we find that Scotland is second only to Estonia in Europe in the drugs deaths’ league table with most countries trailing a long way behind.
And the cause for the sharp rise in deaths in England and Wales? We don’t know.
DrugScope is one of the few agencies to respond to the report so far and highlights the Take Home Naloxone Programme as a possible response. In Scotland, we have a national programme, but it’s still in its infancy and too soon to expect it to have made an impact.
I’m a strong advocate for naloxone, having reversed overdose with it more than once, but it’s a first-aid solution to a complex problem. With more prescription medications implicated in deaths, we ought to be looking at prescribing practices. We either have an epidemic of pain such as we’ve never seen before, or prescribing for chronic pain is changing, and not for the better. The evidence for opiates in chronic pain, or lack of it, does not support the trend.
I also wonder about the protective effects of communities of recovery. Are relapses to opiate use and overdose reduced when people are strongly linked to recovery communities? This would be an interesting research question to address.