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ALL EYES WERE ON SCOTLAND
last
month in the run-up to the vote on
independence, and, although the
country eventually opted to stay part
of the UK, there are signs that its drug-
related death rate may be starting to
head in a different direction.
Deaths were down by 9 per cent
last year, to 526 (
DDN
, September,
page 4), following a 2011 peak of 584
(
DDN
, September 2012, page 4) and
just three fewer the following year. In
England and Wales, however, the news
was more grim. Male deaths involving
illegal drugs were up by 23 per cent –
to 1,444 – with female deaths up 12
per cent to 513 (see news story, page
4). There were 765 deaths involving
heroin/morphine in England and Wales,
while 220 involved the synthetic opiate
painkiller tramadol – an all-time high.
As the Scottish Drug Forum (SDF)
pointed out, however, the Scottish
figures are no cause for complacency.
Still the fifth highest ever recorded, the
total was 66 per cent higher than a
decade ago. Heroin and/or morphine
were implicated in, or potentially
contributed to, 221 deaths while
methadone was implicated in 216.
When the Scottish figures were
released community safety minister
Roseanna Cunningham was quick to
point out that – while the country still
faced ‘a tough challenge’ – fewer
young people were taking drugs and
there were signs that the government’s
approach was working. One of the key
aspects of that approach is a national
programme of naloxone provision, with
nearly 4,000 kits issued in 2012/13. So
how much of a role did that play?
‘Certainly we have evidence of a
significant amount of naloxone use, and
obviously a proportion of those kits
issued will have been lives saved,’ SDF
director David Liddell tells
DDN
. ‘I think
it’s very hard to be definitive about
naloxone, but we’re very encouraged
by the roll-out and what’s happened,
and the government providing funding
to drive that as a national programme.’
However, the deaths data tend to
suggest a ‘levelling off’ rather than an
actual decline just yet, he points out.
‘Alongside that is a caveat that – just
like in England – there’s an increasing
number of older problem drug users
and certainly, from some of the work
we’ve done, what we’re seeing is a
number who are quite isolated and living
alone. So obviously naloxone is not
going to impact on those individuals.’
Clearly, problems of failing physical
and mental health, alongside social
issues, will continue to be a factor for
this group, he adds. ‘That’s where the
cautious optimism comes from. We’ve
turned little bit of a corner here, but we
can hardly be complacent with that
number of deaths.’
What’s the best approach when it
comes to that older population –
renewed determination on the part of
services to engage them and keep
them engaged? ‘We’ve had all those
issues of “parked on methadone” and
so on – and certainly our sense is that
that represents quite a small
proportion of the overall population
who’ve been long-term on methadone
– but I do think there is an issue for
people who’ve been in services a long
time,’ he states. ‘That they’ve almost
become like the wallpaper, and if
they’re not causing any major hassle
and are relatively stable then they’re
maybe not given the level of support
that they could usefully get.’
SDF research in this area has raised
some interesting issues, he adds.
‘Some of our interviews did highlight
things such as how an older user
might benefit from having an older
worker, for example. There were some
suggestions that the older users found
it hard to relate to very young workers,
who they perhaps thought were a bit
wet behind the ears. So it’s just about
services just looking more specifically
at the needs of this population.’
That population is far from
homogenous, he stresses. ‘In our
European study we talked about over-
35s, which some people would think
was actually very young, but you might
be talking about someone who’s been
using for 20 years. So I think there are
those kinds of issues for services, and
also for local planning structures and
governments. There were quite
interesting examples of services for
older users in countries like Germany,
such as dedicated residential services.
Also, something that’s starting to
happen is better links between
addiction services and services for
older people, so that there’s a better
understanding across the sectors of
what the issues are now but also
projecting five, ten, 15 years ahead.’
Figures for deaths relating to new
psychoactive substances (NPS) now
make headline news, but the picture
can be slightly more complicated than
the media make out, he points out. Of
the 60 Scottish deaths in which NPS
were implicated, or potentially
contributed to, in 39 cases ‘the only
NPSs present were benzodiazepines
(usually phenazepam)’, says the
document, compared to 19 cases in
which NPS like AMT, BZP or PMA
were present (and two in which both
types were present).
So if in around 67 per cent of the
NPS cases, the only NPS used was a
benzodiazepine – and usually in
combination with other drugs including
alcohol – could there be a popular
misconception about this new trend?
‘Yes, I was quite frustrated with
some aspects of the Scottish coverage
of our figures,’ he says. ‘It’s not to say
that new psychoactive substances
isn’t a major issue – of course it is –
but it’s the representation of the
deaths almost as if there’s a new
problem emerging while the old one
has sort of gone away. Which of
course is not the case.’
Drug-related deaths in Scotland
2013 at www.gro-scotland.gov.uk
Deaths related to drug poisoning in
England and Wales, 2013 at
www.ons.gov.uk
Are the rates of drug-related deaths north and south of the border really
going in different directions?
News focus |
Analysis
COUNTRIES APART?
8 |
drinkanddrugsnews
| October 2014
www.drinkanddrugsnews.com
‘We have evidence of a significant
amount of naloxone use, and
obviously a proportion of those kits
issued will have been lives saved.’
David Liddell