Co-ordinating Action on Drug Issues<br />DRUG RELATED DEATHS Recent trends<br />Stephen Malloy<br />National Training & De...
Co-ordinating Action on Drug Issues<br />Briefly discuss;<br /><ul><li>Recent trends- Drug related deaths in 2008
Overdose Prevention/intervention- Current and recent developments
Naloxone across Scotland- A brief look at how we got where we are </li></ul>ScottishdrugsForum<br />
Drug related deaths in 2009<br />The pessimism/optimism balance<br />Discussing premature, early and Preventable(?) death....
European picture <br />‘The evidence suggests that mortality rates declined in Spain and Italy, and were stable in Germany...
Co-ordinating Action on Drug Issues<br />Scottish Drug related Deaths 1996-2008<br />131% increase in drug related deaths ...
Co-ordinating Action on Drug Issues<br />Drug related deaths in 4 Health board areas 1998-2008<br />Source: GROS 2009<br /...
Drug Related Deaths in Scotland (GROS) 2008-574<br />DRDs by age & sex in Scotland 2008<br />Aged 15-24yrs- 92 (16%)<br />...
Age- all getting older<br />the lower quartile age at death rose from 22 years in 1996 to 27 years in 2008;<br />the media...
*Important note<br />The figures given for 2008 are not directly comparable to figures up to 2008 due to a change in metho...
Co-ordinating Action on Drug Issues<br />Main substances recorded in 2008 (GROS)<br />ScottishdrugsForum<br />
Higher Risk Times<br />Times when tolerance may be lowered;<br />Release from prison/custody; recent detox (planned or unp...
Co-ordinating Action on Drug Issues<br />A quick line or two......... on Cocaine<br />Increasing use, (particularly in you...
Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />So What’s being done (more recently) to help reduce Drug ...
Co-ordinating Action on Drug Issues<br />Overdose prevention, Intervention and Awareness<br />Scottish Drugs Forum- Critic...
Co-ordinating Action on Drug Issues<br />SCOTTISH RESEARCH<br />‘Reducing Drug users Risk of Overdose’. <br />Rome A., Sha...
Ongoing<br />National Drug Related death Forum- Recommendations<br />National Drug Related Death Volunteer Forum- Work pro...
Naloxone A very brief (but interesting!) history<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
Naloxone- early history<br />Allylcodine- Pohl, J: Ztschr. Exper. Path. Und Therap 18, 370, 1915<br />Hart (1941) and Hart...
Skip forward<br />Early 70’s- heralded as the opioid antithesis. Evans JM, Hogg MI, Lunn JN, Rosen M. Degree and duration ...
Naloxone- Still further forward<br />1992- J. Strang, BMJ- Should Naloxone amps be made available to IDUs?<br />The change...
Co-ordinating Action on Drug Issues<br />Thanks for your attention<br />Stephen Malloy<br />National Training & Developmen...
Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
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Presentation to Parlimentary Cross Party Group Drugs and Alcohol

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  • Greater Glasgow &amp; Clyde 115, 129, 132, 117, 152, 131, 151, 111, 162, 157, 197, annual avg. from ’04-’08 156 population 1,191,584 death per 1000 population 0.13
  • 131% relates to current definition used by GROS
  • Presentation to Parlimentary Cross Party Group Drugs and Alcohol

    1. 1. Co-ordinating Action on Drug Issues<br />DRUG RELATED DEATHS Recent trends<br />Stephen Malloy<br />National Training & Development Officer-Critical Incidents stephen@sdf.org.uk<br />ScottishdrugsForum<br />
    2. 2. Co-ordinating Action on Drug Issues<br />Briefly discuss;<br /><ul><li>Recent trends- Drug related deaths in 2008
    3. 3. Overdose Prevention/intervention- Current and recent developments
    4. 4. Naloxone across Scotland- A brief look at how we got where we are </li></ul>ScottishdrugsForum<br />
    5. 5. Drug related deaths in 2009<br />The pessimism/optimism balance<br />Discussing premature, early and Preventable(?) death.<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    6. 6. European picture <br />‘The evidence suggests that mortality rates declined in Spain and Italy, and were stable in Germany. In addition, the other selected countries all achieved substantially greater reductions in drug-related deaths than England and Wales between 1999 and 2004/05, with Germany and Italy exceeding a 20% reduction and Spain (six cities) reducing the drug-related mortality rate by 17%’<br /> Morgan O., et.al. Trends in overdose deaths from drug misuse in Europe: what do the data tell us? Addiction (2008) 103, 699–700)<br />UK<br />20% target not met in UK ‘99/’05<br />DRDs not counted as a key performance indicator in 2008-2018 drugs strategy Bird M., et al. Missing targets on drugs-related deaths, and a Scottish paradox International Journal on Drugs Policy (2009) doi:10.1016/j.drugpo.2009.10.001<br />Scotland<br />The rate of drug deaths in Scotland is higher than other parts of the UK and Europe (EMCDDA, 2006). Most of these deaths (66%) occurred in people who were drug dependent (GROS, 2008), in their late twenties or thirties with a history of drug use and overdose (Zador. et al, 2005). <br />Rome A., Shaw A., Reducing drug users risk of overdose, Scottish Government (2008)<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    7. 7. Co-ordinating Action on Drug Issues<br />Scottish Drug related Deaths 1996-2008<br />131% increase in drug related deaths since 1998 *<br />Drug deaths increased by 26% from ’07-’08 . Expected to pass 600 in 2009 ?<br />Source: GROS 2009<br />ScottishdrugsForum<br />
    8. 8. Co-ordinating Action on Drug Issues<br />Drug related deaths in 4 Health board areas 1998-2008<br />Source: GROS 2009<br />ScottishdrugsForum<br />
    9. 9. Drug Related Deaths in Scotland (GROS) 2008-574<br />DRDs by age & sex in Scotland 2008<br />Aged 15-24yrs- 92 (16%)<br />Aged 25 to 34yrs- 211 (37%)<br />303 deaths under 35yrs<br />Aged 35 to 44yrs- 174 (30%)<br />Aged 45yrs and over 97 (17%)<br />271 deaths 35+yrs<br />Males- 461 (80%) Females- 113<br />NOTE- 370 deaths were listed as drug abuse, 111 undetermined intent, 59 accidental poisoning and 34 as intentional self poisoning<br />Co-ordinating Action on Drug Issues<br />Brief overview 2008<br />(Drug deaths increased by 26% from ’07-’08) <br />ScottishdrugsForum<br />
    10. 10. Age- all getting older<br />the lower quartile age at death rose from 22 years in 1996 to 27 years in 2008;<br />the median age at death increased from 28 years in 1996 to 34 years in 2008<br />the upper quartile age at death rose from 34 years in 1996 to 41 years in 2008.<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    11. 11. *Important note<br />The figures given for 2008 are not directly comparable to figures up to 2008 due to a change in methods of collection/compilation<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    12. 12. Co-ordinating Action on Drug Issues<br />Main substances recorded in 2008 (GROS)<br />ScottishdrugsForum<br />
    13. 13. Higher Risk Times<br />Times when tolerance may be lowered;<br />Release from prison/custody; recent detox (planned or unplanned); illnesses; change in resources/means to procure substance; beginning/ending of substitute medication (planned or unplanned) <br />During periods of poly substance use (Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study Brådvik L., Berglund M., Arne Frank A., Anna Lindgren A. and Löwenhielm P. (2009))<br />Generally ‘anytime’- Poly substance use becoming the norm; Periods of depression/low mood; significant life events (overlap with suicide, estimates suggest that up to 30% DRDs may be suicides); illnesses; festive periods; change in resources/means to procure substances; disconnected/unsupported<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    14. 14. Co-ordinating Action on Drug Issues<br />A quick line or two......... on Cocaine<br />Increasing use, (particularly in younger users) increasing problem<br />Smoking and injecting<br />Increased toxicity with other substances, risk of overdose<br />Mixed with Alcohol- Cocaethylene (‘The combination of cocaine and alcohol appears to exert more cardiovascular toxicity than either drug alone in humans. Alcohol appears to potentiate cocaine hepatotoxicity in both humans and mice.’Landry M.J., An overview of cocaethylene, an alcohol-derived, psychoactive, cocaine metabolite J Psychoactive Drugs, 1992 Jul-Sep, 24:3, 273-6 ).<br />ScottishdrugsForum<br />
    15. 15. Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />So What’s being done (more recently) to help reduce Drug Related Deaths in Scotland ?<br />
    16. 16. Co-ordinating Action on Drug Issues<br />Overdose prevention, Intervention and Awareness<br />Scottish Drugs Forum- Critical Incident Training & Development Post. Funded by Scottish Government.<br />Overarching Aim<br />To further develop and see overdose awareness information, ‘Training the Trainer’ and direct awareness sessions to become widely available to workers, families and people at risk of overdose.<br />National Partnership agreement with British Red Cross<br />Multi agency training being delivered across sectors, Phoenix futures staff in prisons , also piloting training to PCSO’s, <br />Police officers.<br />ScottishdrugsForum<br />
    17. 17. Co-ordinating Action on Drug Issues<br />SCOTTISH RESEARCH<br />‘Reducing Drug users Risk of Overdose’. <br />Rome A., Shaw A., Scottish Government, 2008. <br />• Need for dedicated funding<br />• Support for prisoners<br />• Provision of naloxone<br />• More research<br />• Suicide prevention<br />• Treatment & support<br />• Young people in care<br />• Piloting innovative projects<br />• National campaigns<br />• Data collection<br />ScottishdrugsForum<br />
    18. 18. Ongoing<br />National Drug Related death Forum- Recommendations<br />National Drug Related Death Volunteer Forum- Work program<br />Nation Drug Death Database<br />HEAT target for accessing treatment- 90%/3 week waiting by 2013<br />ADP Strategic plans- Reduce DRDs’/Overdose prevention<br />Local Overdose/drug death prevention coordinators posts.<br />SNFAD attending/developing training for families affected by overdose<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    19. 19. Naloxone A very brief (but interesting!) history<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    20. 20. Naloxone- early history<br />Allylcodine- Pohl, J: Ztschr. Exper. Path. Und Therap 18, 370, 1915<br />Hart (1941) and Hart &McCawley (1944) synthesized N allylnormorphine (nalorphine) and studied its effects.<br />H. F. Fraser, A. Wikler, A. J. Eisenman, and H. Isbell<br /> USE OF N-ALLYLNORMORPHINE IN TREATMENT OF METHADONE POISONING IN MAN: REPORT OF TWO CASES JAMA April 5, 1952 148:1205-1207<br />N-Allylnoroxymorphone-A New Potent Narcotic Antagonist: Foldes, Francis F. M.D.; Lunn, John N. M.B.; Moore, James M.D.; Brown, Ian M. M.B. American Journal of Medical Science 1963 <br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    21. 21. Skip forward<br />Early 70’s- heralded as the opioid antithesis. Evans JM, Hogg MI, Lunn JN, Rosen M. Degree and duration of reversal by naloxone of effects of morphine in conscious subjects. Br Med J 1974; 2: 589–591.<br />First ‘warnings’.....1975, an editorial in Lancet warned that in opioid addicts, “the doses should be small, since intravenous naloxone can precipitate a severe withdrawal syndrome in dependent addicts.” Editorial: Naloxone. Lancet 1975;1:734.<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    22. 22. Naloxone- Still further forward<br />1992- J. Strang, BMJ- Should Naloxone amps be made available to IDUs?<br />The change<br />Jersey Project -1998,Berlin Project-1999, San francisco-2001, Chicago- 2001, New Mexico-2001, Baltimore-2004, NYC-2004/5and many other sites.<br />Glasgow/Lanarkshire pilots/program-2006<br />Inverness pilot-2009<br />Welsh Program -2009<br />June 2009- 16 site pilot in England<br />All of Scotland-2010??<br />Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    23. 23. Co-ordinating Action on Drug Issues<br />Thanks for your attention<br />Stephen Malloy<br />National Training & Development Officer-Critical Incidents <br />stephen@sdf.org.uk<br />SDF office: 0141 221 1175<br />ScottishdrugsForum<br />
    24. 24. Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    25. 25. Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />
    26. 26. Co-ordinating Action on Drug Issues<br />ScottishdrugsForum<br />

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