Drug Related Deaths

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					  Co-ordinating action on drug issues




Drug Related Deaths

     Dave Liddell
                 Co-ordinating action on drug issues



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


         500
                                                              382
         400                                           332
                                        291     292
                               249
deaths




         300   244     224
         200
         100
           0
               1996   1997     1998    1999     2000   2001   2002
                                        year
                   Co-ordinating action on drug issues



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


       140
       120
       100

          80
          60

          40
          20

           0
                  1996    1997    1998    1999     2000   2001    2002
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
                    Co-ordinating action on drug issues



Drug-related deaths by Health Board Area:
        1996 – 2002 Source:GRO
               30



               25



               20



               15



               10



                5



                0
                        1996   1997     1998    1999     2000     2001     2002
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
              Co-ordinating action on drug issues



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

300


250


200                                                        Hero in/

                                                           Diazep am
150
                                                           M et had o ne

                                                           Co caine
100
                                                           Ecst asy

                                                           Temazep am
50


 0
      1996   1997   1998   1999    2000   2001      2002
                           Ye ar
                Co-ordinating action on drug issues




                              Poly drug use


    •Heroin/diazepam combinations




           57   157      91            Heroin




Diazepam
            Heroin/Diazepam
                       Co-ordinating action on drug issues


     Injecting opiates – low tolerance
     Source: Andrew Preston




                                          lethal dose


 Blood
level of                                          unconsciousness
 heroin
                                                             acute intoxication
                       Co-ordinating action on drug issues


     High tolerance
     Source: Andrew Preston




                                          lethal dose
                                                  unconsciousness
                                                           acute intoxication
 Blood
level of
 heroin




                                        Time
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    Poly drug use & high tolerance
    Source: Andrew Preston


                                      temazepam
                                                    lethal dose
                                                             unconsciousness
                                                                      intoxication
Blood
level
                                                             alcohol



                                                              heroin




        1hr    3hrs   5hrs     7hrs    9hs    11hrs     12hrs
                   Co-ordinating action on drug issues



        Greater Glasgow drug-related deaths 2002:
                Age Groups Source: GGDAT
•55% aged 30 and over




         Greater Glasgow Drug Related Deaths 2002: Age
                           Groups

 30%
                          26%
                                  22%
                                          20%
 20%
                  15%
                                                   8%
 10%
           4%                                              3%      2%
   0%
          15-19   20-24   25-29   30-34   35-39   40-44   45-49   50-55
                                  age groups
                     Co-ordinating action on drug issues



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

40%
                                                                    37%
30%

                                                           22%
20%
       14%
10%
                   11%
                                       8%
                             4%                  4%
0%
       up to 7     8 - 14   15 - 30   31 - 60   61 -- 90 91 - 365    more
        days        days     days      days      days      days     than 1
                                                                     year
                 time lapse between prison release & death
                  Co-ordinating action on drug issues



      Drug Deaths by Deprivation categories 2002
            Greater Glasgow Source: GGDAT


50%                                                44%

40%
                                     27%
30%

20%                    12%
10%    6%                                                                4%
             3%                                                  3%
                                                                                1%
0%
        3     4          5              6            7               ?   NFA   repeat

                             D e pr i v a t i on C a t e gor i e s
                   Co-ordinating action on drug issues




                   Drug 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
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                Drug 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
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            Drug deaths – what we know

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


• Prison releases


• Detoxification
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                  Drug 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
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                Drug 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 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




                         Conclusion
• An impact can be made on reducing the number of deaths
• Services and DAATs need to regular review practice
• Recent death figures are encouraging