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Reducing drug related deaths: 
London 2014 
Dr Judith Yates GP Birmingham 
International Doctors for Healthier Drug 
Polic...
Reducing drug related death 
o National and international drug related deaths 
o Shock of recent rise in death rates in En...
Drug Related Deaths (until last month): 
had been falling for last four years, from 2009-2012 
Drug Misuse related Deaths ...
Shocking rise in number of deaths registered in 2013 
(Office of National Statistics: 2014) 
2000 
1800 
1600 
1400 
1200 ...
Heroin/Morphine deaths increased by 
32% in 2013 
Office of National Statistics 2014 
1000 
900 
800 
700 
600 
500 
400 
...
Preventing accidental opioid overdose deaths 
in Europe 
o 1.3 million users of opioids in Europe 
o 27 million users of o...
UK = 5th highest rate in EU 
of deaths/million population. 
Mortality due to drug-induced deaths in EU, Croatia, Turkey an...
Number of road traffic accident 
(RTA) deaths in UK 1926-2012 
10,000 
9,000 
8,000 
7,000 
6,000 
5,000 
4,000 
3,000 
2,...
Measures to Reduce Road Traffic 
Accidents (RTAs) 
1. Use seat belts. (1983 in UK) 
2. Enforcement of speed limits. 
3. Pr...
Reducing Drug Related Deaths: 
A multi-pronged plan 
1. What increases risk? 
2. What reduces risk?
1.What Increases risk? 
1. Lack of appropriate non-coercive Opiate Substitute 
Treatment (OST) 
2. Reduced tolerance after...
Lack of Opiate Substitute Treatment 
increases risk of overdose: 
Mortality rate of people on waiting list for methadone t...
Prison release increases risk of OD: 
o Heroin overdose deaths increase 7 times in the two 
weeks after prison release. 
o...
2. What Reduces Risk? 
A: Prevent overdoses from happening 
B: Reducing fatal outcomes when overdoses do occur. 
• The fir...
B: What reduces fatal outcome 
following opiate overdose? 
B: Reducing fatal outcomes Amsterdam DCR: 6.10.14 
when overdos...
What reduces risk of fatal overdose? 
2. Better response to opiate overdose 
and wider access to take home naloxone.
Talking about Naloxone: 
United Nations Commission on Narcotic Drugs 
UNODC 2012 
Resolution 55/7: 
“Encourages all Member...
Talking about Naloxone: 
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 
“Preventing Overdose Deaths” 20...
Talking about Naloxone: 
UNODC/WHO 2013: “Opioid overdose - preventing and 
reducing opioid overdose mortality” 
“Programm...
Talking about Naloxone: 
WHO: Commission on Narcotic Drugs, Vienna 2014 
Draft “normative guidance” (February 2014) : 
“Pe...
Stigma? Approximately 20 people die of 
anaphylaxis (eg peanut allergy) per year. 10 of them 
have no previous history of ...
Conclusions: 
Four Ways to Save Lives and Also Save Money 
Your help is needed: 
1. Scatter gun approach to take-home-nalo...
A multi-pronged approach
Reducing drug-related deaths: London 2014
Reducing drug-related deaths: London 2014
Reducing drug-related deaths: London 2014
Reducing drug-related deaths: London 2014
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Reducing drug-related deaths: London 2014

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In the UK, a shocking rise in number of deaths were registered in 2013. Lack of Opiate Substitute Treatment increases risk of overdose.

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Reducing drug-related deaths: London 2014

  1. 1. Reducing drug related deaths: London 2014 Dr Judith Yates GP Birmingham International Doctors for Healthier Drug Policies IDHDP.com SMMGP website moderator @judithyates1 dryates@btinternet.com
  2. 2. Reducing drug related death o National and international drug related deaths o Shock of recent rise in death rates in England o How to reduce risk of drug related death. o How to reduce risk of fatal outcome of OD. A multi-pronged approach
  3. 3. Drug Related Deaths (until last month): had been falling for last four years, from 2009-2012 Drug Misuse related Deaths England and Wales 1993- 2012 Source: Office for National Statistics 2013 2,500 2,000 1,500 1,000 500 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Number of deaths years 1993-2012
  4. 4. Shocking rise in number of deaths registered in 2013 (Office of National Statistics: 2014) 2000 1800 1600 1400 1200 1000 800 600 400 200 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 number of drug related deaths Number of “drug misuse” Deaths 1993-2013 England Wales Scotland 350 300 250 200 150 100 50 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 number of deaths Number of deaths from "drug misuse" in London London
  5. 5. Heroin/Morphine deaths increased by 32% in 2013 Office of National Statistics 2014 1000 900 800 700 600 500 400 300 200 100 0 2006 2007 2008 2009 2010 2011 2012 2013 number of deahts. heroin and morphine methadone tramadol novel psychoactive substance
  6. 6. Preventing accidental opioid overdose deaths in Europe o 1.3 million users of opioids in Europe o 27 million users of opioids worldwide (0.6% world pop) o 70,000: deaths in Europe in the first decade of the 21st century o 6,100: deaths in Europe 2012 o 1,496 deaths in England and Wales 2012 o 250,000 overdose deaths world wide in 2010. WHO This represents 2 million years of life lost. Preventing opioid overdoses in Europe EMCDDA, Lisbon, October 2012 (revised 2014)
  7. 7. UK = 5th highest rate in EU of deaths/million population. Mortality due to drug-induced deaths in EU, Croatia, Turkey and Norway (European Monitoring committee for Drugs and Drug Addiction 2013) 100 90 80 70 60 50 40 30 20 10 0 drug related deaths per million popiulation
  8. 8. Number of road traffic accident (RTA) deaths in UK 1926-2012 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Deaths in RTA UK 1920-2012 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Number of deaths year https://www.gov.uk/government/collections/road-accidents-and-safety-statistics
  9. 9. Measures to Reduce Road Traffic Accidents (RTAs) 1. Use seat belts. (1983 in UK) 2. Enforcement of speed limits. 3. Prohibition of alcohol in excess of legal use while driving. 4. Prompt medical attention when an RTA occurs. 5. Put speed bumps along intersections. Drivers will be forced to reduce speed rather than speed up to beat a changing stoplight. Speeding through intersections and running red lights are among the biggest cause of traffic accidents. 6. Zebra crossings should be provided for pedestrians for safe road crossings at appropriate places. 7. Signals for road crossings at important busy places where a large number of people have to cross the road everyday. 8. Road Safety Day/Road Safety Week in schools. Charlton, R. and Smith, G. (2003), ‘How to reduce the toll of road traffic accidents’, Journal of The Royal Society Of Medicine, 96(10), pp. 475–476 (via Prof Ilana Crome et al EMCDDA: Preventing Opiate Overdose in Europe..October 2012. ) http://www.emcdda.europa.eu/scientific-studies/2012/preventing-overdoses
  10. 10. Reducing Drug Related Deaths: A multi-pronged plan 1. What increases risk? 2. What reduces risk?
  11. 11. 1.What Increases risk? 1. Lack of appropriate non-coercive Opiate Substitute Treatment (OST) 2. Reduced tolerance after abstinence (prison or planned detox) 3. Mixing opiates with other respiratory depressants especially benzodiazepines and alcohol. 4. Availability - heroin - prescribed opiates (fentanyl/tramadol/oxycodone) 5. Criminalisation of drug use leads to risky secretive injecting habits and danger of OD. 6. Not testing for and treating Hepatitis C and HIV 7. Poor response to overdose .
  12. 12. Lack of Opiate Substitute Treatment increases risk of overdose: Mortality rate of people on waiting list for methadone treatment for in Israel, compared to those with immediate treatment access: o The mortality while on the waiting list was higher: (5.0/100 person years) for the 225 on waiting list o than for the 358 admitted to treatment: (0.42/100 person years, P < 0.0005) Peles E1, Schreiber S, Adelson M. Opiate-dependent patients on a waiting list for methadone maintenance treatment are at high risk for mortality until treatment entry. J Addict Med. 2013 May-Jun;7(3):177-82.
  13. 13. Prison release increases risk of OD: o Heroin overdose deaths increase 7 times in the two weeks after prison release. o Of people who have a history of injecting, 1 in 200 will die in the first 4 weeks. o The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in May 2012 • preliminary phase 5,600 prisoners on release. • 56,000 prisoners on release, and will give a definitive conclusion on lives saved in real-world application Strang J, Bird SM, Parmar Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial. MKJ Urban Health. 2013 Oct;90(5):983-96
  14. 14. 2. What Reduces Risk? A: Prevent overdoses from happening B: Reducing fatal outcomes when overdoses do occur. • The first involves a set of interventions geared towards the complete prevention of overdoses, • while the second focuses on reducing fatal outcomes when overdoses do occur (Frisher et al., 2012) A: Prevent overdoses from happening o Increase access to non-coercive and non-time limited OST. o Properly planned prison and detox discharges. “N-Alive”? “Through the gate”? o Stop criminalising people who use drugs. The sky hasn’t fallen in on Portugal. o Reduce prescribed and illicit availability. “Strict regulation of drug use”. o Increase awareness of risk: information about dangers of mixing respiratory depressants. o Test and treat for hepatitis C and HIV.
  15. 15. B: What reduces fatal outcome following opiate overdose? B: Reducing fatal outcomes Amsterdam DCR: 6.10.14 when overdoses occur: 1. Drug consumption rooms Birmingham DCR: 6.9.14 “a reduction in overdose mortality at population level was documented in the area of Vancouver, where a supervised injecting facility operates” (Marshall et al., 2011)
  16. 16. What reduces risk of fatal overdose? 2. Better response to opiate overdose and wider access to take home naloxone.
  17. 17. Talking about Naloxone: United Nations Commission on Narcotic Drugs UNODC 2012 Resolution 55/7: “Encourages all Member States …..to share best practices ………..including the use of opioid receptor antagonists such as naloxone” http://www.unodc.org/documents/commissions/CND/Drug_Resolutions/2010-2019/2012/CND_Res-55-7.pdf
  18. 18. Talking about Naloxone: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) “Preventing Overdose Deaths” 2013 o Currently, five European countries (Denmark, Germany, Italy, Romania and the United Kingdom) report the existence of naloxone programmes. Scotland and Wales have recently launched a nationwide programme o the measure is regarded as a low-cost approach that can empower healthcare workers and people who use drugs to save lives. http://www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths 2013
  19. 19. Talking about Naloxone: UNODC/WHO 2013: “Opioid overdose - preventing and reducing opioid overdose mortality” “Programmes in which naloxone is made available to the community… exist to some extent in more than a dozen countries, including: Afghanistan, Australia, Canada, China, India, Italy, Kazakhstan, Kyrgyzstan, Tajikistan, Thailand, United Kingdom, United States, Ukraine and Viet Nam, although generally on a pilot or experimental basis.” (Also Denmark, Germany, Romania, Norway and Estonia mentioned in recent EMCDDA report)
  20. 20. Talking about Naloxone: WHO: Commission on Narcotic Drugs, Vienna 2014 Draft “normative guidance” (February 2014) : “People likely to witness opiate overdose should have access to naloxone and be instructed in its administration to enable them to use it for the emergency management of opiate overdose” WHO verbal statement UNCND 2014
  21. 21. Stigma? Approximately 20 people die of anaphylaxis (eg peanut allergy) per year. 10 of them have no previous history of allergy. o In response to this, “In the year to 30 September 2006, almost 165,000 prescriptions were dispensed in the community in England for Epipens, at a cost of about £8.2 million" CHAPTER 4: The Extent and Burden of Allergy in the United Kingdom http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/16607.htm o “Carry two adrenaline auto-injectors with you at all times..” MHRA: Guidance, June 2014 http://www.anaphylaxis.org.uk/userfiles/files/MHRA_AAI_Guidance_June2014.pdf o Cost around £52 for two epipen kits per year. A naloxone “kit” costs £18 and lasts 3 years. Are “our” patients worth less?
  22. 22. Conclusions: Four Ways to Save Lives and Also Save Money Your help is needed: 1. Scatter gun approach to take-home-naloxone. 2. Test and treat for Hepatitis C . Don’t wait for liver failure. 3. Be willing to consider the case for “Safe Consumption Rooms” in the UK. 4. Stop the war on people who use drugs: “Support don’t punish”. An increasingly mainstream opinion. Join (free) 747 doctors from 78 countries “International Doctors for Healthier Drug Policies” IDHDP.com
  23. 23. A multi-pronged approach

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