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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
Co-ordinating action on drug issues
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
Co-ordinating action on drug issues
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
Co-ordinating action on drug issues
Drug deaths – what we know
• Loss of tolerance and increased risk of
overdose from :-
• Prison releases
• Detoxification
Co-ordinating action on drug issues
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
Co-ordinating action on drug issues
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
