The ONS has published the latest figures for drug-related deaths in England and Wales, covering all deaths registered in 2017.
It reports that there were 3,756 deaths last year due to drug poisonings – the highest since records began. This includes poisonings from both legal medicinal drugs (accidents and suicides) as well as deaths from all illicit drug misuse, which has actually seen a fall (from 2,593 to 2,503) for the first time since 2012. The most significant, and continuing, rise is in cocaine deaths, up 16% to 432, a near fourfold increase since 2011.
There are significant variations across the country, which can be explained by differences in rates of drug use and wider health inequalities.
What continues to concern us is that some regions are showing larger increases in recent years. Drug misuse in the North East accounted for 83.2 deaths per 1M population, a further 7% increase from 2016. This contrasts with a significant fall in London by 24% to 24.6 deaths per 1M.
This blog looks at some of the report’s main findings and the actions we’re taking to tackle these issues.
Reasons for high numbers of deaths
Although deaths from heroin and/or morphine have fallen a little, over half (53%) of all deaths related to drug poisoning still involve an opiate.
This is likely still due to an older generation of long term heroin users with failing health and higher overdose risks.
40-49 year olds have the highest rate of drug misuse deaths but rates have fallen in all age groups except the very oldest (50-69 and 70+), perhaps further supporting the idea of an ageing cohort at greatest risk of overdose death.
We also know that around half of opiate-related deaths occur among those who have never or have not been in drug treatment for several years. People who are in treatment and prescribed medicines are:
- less likely to inject drugs
- less likely to overdose
- less likely to contract blood-borne viruses such as HIV and hepatitis C
- more likely to be tested and treated, or vaccinated against hepatitis B
These treatments can reduce harm and provide drug users with the stability and safety to build their recovery. UK clinical guidelines highlight the crucial role opioid substitution treatments, like methadone and buprenorphine, have in preventing drug-related deaths.
It’s vital that drug services do all they can to make their services as accessible as possible and increase their efforts to engage those most at risk.
And local areas will want to continue to expand their provision of naloxone to prevent opioid overdoses becoming opioid deaths, especially if the threatened availability of further potent opioids, like fentanyl, becomes a reality.
Treatment centres need to be flexible to emerging threats
These latest figures for 2017 show a significant increase in cocaine related deaths from the 371 deaths registered in 2016 to 432. This continues a rise seen from 2011 when there were about a quarter as many deaths.
Part of this increase will be due to crack use – post-mortem testing cannot differentiate powder cocaine and crack cocaine so they are reported as one. We know crack use has been increasing in some areas and is often associated with heroin users, making users doubly vulnerable to dying.
Public Health England is working with the Home Office in an England-wide investigation, including an in-depth review in six localities with high crack prevalence. The work will improve our understanding of the reasons behind the increase in crack use and lead to better local responses to the problem.
These latest figures for 2017 show increases in deaths involving the potent opioids, fentanyl and fentanyl analogues, from 58 to 75 and from 1 to 31 respectively.
Many of these will relate to overdose deaths in late 2016 and early 2017, primarily in Yorkshire and the Humber, that involved heroin mixed with fentanyl.
PHE continues to work with drug testing labs and local drug services to get more rapid and detailed information on confirmed and suspected cases of fentanyl. And we have provided local areas with target figures for their provision of naloxone, the opioid overdose antidote.
The continuing news of problems with synthetic cannabinoids (SCRAs) in certain areas of the country is something we are very concerned about and we have been actively supporting local areas and national government.
Deaths involving new psychoactive substances (NPS) are very low compared with heroin (1.0 deaths per 1M population compared with 20.5 per 1M respectively) and they halved in 2017, from 123 to 61, following the introduction of the Psychoactive Substances Act. However, the main falls were in deaths involving the cathinone stimulants and other NPS – SCRAs are now involved in one third of all NPS deaths.
Reducing the harms caused by NPS and new patterns of drug use will remain a priority. Our pilot drug health harms intelligence system, RIDR, is helping frontline staff better understand the harms of new substances and be able to respond and treat patients more rapidly.
An increasing number of deaths involve some prescription and over-the-counter medicines, like codeine, antidepressants and pregabalin. Some may be the result of misuse and of suicide but PHE’s prescribed medicines review will help us understand how prescribing may be contributing to the availability of these medicines and to accidental overdoses.
Despite recent reports of increased ecstasy use and higher tablet strengths, reported deaths from ecstasy fell slightly for the first time since 2010. Widespread publicity on high-strength ecstasy tablets and safer drug use messages may be a contributing factor.
In summary, while reported deaths from illicit drugs have fallen for the first time in 5 years, numbers remain far too high. Continued easy access to drug treatment, proactive targeting of those most at risk of harm and an expansion of naloxone provision is critical in addressing drug related deaths.
Support must also go beyond treatment services to address the wider circumstances of those most at risk. In last year’s drug strategy, the Government committed to the drug misuse prevention and treatment agenda and, if we are to end the avoidable and tragic waste of lives, local authorities must continue to invest in these areas.