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Co-ordinating action on drug issues
Drug Related DeathsDrug Related Deaths
Dave Liddell
Co-ordinating action on drug issues
Drug-related deaths, Scotland Drug-related deaths, Scotland 1996 – 2002 Source:GRO1996 – 2002 Source:GRO
244 224 249 291 292
332 382
0
100
200
300
400
500
1996 1997 1998 1999 2000 2001 2002
year
deat
hs
Co-ordinating action on drug issues
Drug-related deaths by Health Board Area: Drug-related deaths by Health Board Area: 1996 - 2002 Source:GRO1996 - 2002 Source:GRO
0
20
40
60
80
100
120
140
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
1996 1997 1998 1999 2000 2001 2002
Co-ordinating action on drug issues
Drug-related deaths by Health Board Area: Drug-related deaths by Health Board Area: 1996 – 2002 Source:GRO1996 – 2002 Source:GRO
0
5
10
15
20
25
30
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
1996 1997 1998 1999 2000 2001 2002
Co-ordinating action on drug issues
Drug-related deaths; selected drugs involved, Drug-related deaths; selected drugs involved, Scotland 1996 – 2002 Source GROScotland 1996 – 2002 Source GRO
0
50
100
150
200
250
300
1996 1997 1998 1999 2000 2001 2002
Year
Heroin/
Diazepam
Methadone
Cocaine
Ecstasy
Temazepam
Co-ordinating action on drug issues
Poly drug usePoly drug use
•Heroin/diazepam combinations
DiazepamHeroin/Diazepam
Heroin9115757
Co-ordinating action on drug issues
Injecting opiates – low toleranceSource: Andrew Preston
Blood level of heroin
lethal dose
unconsciousness
acute intoxication
Co-ordinating action on drug issues
High toleranceSource: Andrew Preston
Blood level of heroin
Time
lethal doseunconsciousness
acute intoxication
Co-ordinating action on drug issues
Poly drug use & high toleranceSource: Andrew Preston
temazepam
Blood level
lethal doseunconsciousness
intoxication
alcohol
heroin
1hr 3hrs 5hrs 7hrs 9hs 11hrs 12hrs
Co-ordinating action on drug issues
Greater Glasgow drug-related deaths 2002: Greater Glasgow drug-related deaths 2002: Age Groups Source: GGDATAge Groups Source: GGDAT
Greater Glasgow Drug Related Deaths 2002: Age Groups
8%3% 2%4%
20%22%
15%
26%
0%
10%
20%
30%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-55
age groups
•55% aged 30 and over
Co-ordinating action on drug issues
Prison release & drug-related deaths, Greater Prison release & drug-related deaths, Greater Glasgow 2002 Source: GGDATGlasgow 2002 Source: GGDAT
22%
14%11%
4%8%
4%
37%
0%
10%
20%
30%
40%
up to 7days
8 - 14days
15 - 30days
31 - 60days
61 -- 90days
91 - 365days
morethan 1year
time lapse between prison release & death
Co-ordinating action on drug issues
Drug Deaths by Deprivation categories 2002Drug Deaths by Deprivation categories 2002 Greater Glasgow Source: GGDAT Greater Glasgow Source: GGDAT
6%3%
12%
27%
3% 4%1%
44%
0%
10%
20%
30%
40%
50%
3 4 5 6 7 ? NFA repeat
Deprivation Categories
Co-ordinating action on drug issues
Drug deaths – what we knowDrug 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 knowDrug 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 knowDrug 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 knowDrug 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 doDrug 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 doDrug 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
ConclusionConclusion
• An impact can be made on reducing the number of deaths
• Services and DAATs need to regular review practice
• Recent death figures are encouraging