Scotland’s drug death toll at record high

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Scotland has yet again recorded its highest ever number of drug-related fatalities, with 1,187 registered in 2018.

Silhouettes to illustrate anonymous drug related deaths

The number, which was described as ‘shocking’ by public health minister Joe FitzPatrick, represents the fifth consecutive increase and is almost 30 per cent higher than 2017’s record figure of 934 (DDN, July/August 2018, page 4) and nearly double that of a decade ago. The death rate is almost three times that of the UK as a whole and remains higher than anywhere else in the EU.

More than 70 per cent of the deaths were males and more than a third occurred in the Greater Glasgow & Clyde NHS board area. One or more opioids including heroin, morphine or methadone were implicated in, or potentially contributed, to 86 per cent of the total. Worryingly, methadone was implicated in, or potentially contributed to, 47 per cent of the deaths, and benzodiazepines to 67 per cent. Deaths involving MDMA and cocaine were also the highest since records began. People aged 35-44 accounted for 37 per cent of the deaths, and those aged 45-54 for 29 per cent.

Only 40 per cent of people with a drug problem in Scotland are in treatment, the Scottish Drugs Forum (SDF) points out, with some areas seeing poor retention rates and waiting times for OST of up to six months. A large proportion of people are also on ‘sub-optimal’ doses of methadone, SDF adds, in contravention of clinical guidelines and WHO recommendations.

‘The number of people who have lost their lives because of drug use is shocking,’ said Joe FitzPatrick. ‘It is vital this tragedy is treated as a public health issue, and we are prepared to take innovative and bold measures in order to save the lives of those most at risk. Last week, I gave evidence to the Scottish Affairs Committee and I asked for help in persuading the UK government to either act now to enable us to implement a range of public health focused responses – including the introduction of supervised drug consumption facilities – or devolve the power to the Scottish Parliament so that we can act.’

Release called on the government to make sure that treatment was properly funded and that initiatives like peer naloxone programmes were adequately resourced.

‘The UK government has continuously blocked the establishment of an overdose prevention site in Glasgow,’ said executive director Niamh Eastwood. ‘This decision by Westminster has contributed to the increasing drug related deaths in Scotland and has tied the hands of Holyrood and drug treatment experts in Scotland. With drug-related deaths at an all-time high in Scotland the UK government must now give the green light to the establishment of an overdose prevention site or risk responsibility for further deaths.’

While Scotland prided itself on having ‘an equalities and rights-based approach’ to policy and service provision, the figures suggested that the country’s self-image was a ‘dangerous self-delusion’ stated SDF CEO David Liddell. ‘NHS patients are receiving treatment that does not meet standards laid out in national and international good practice guidance. With any other patient group, this would rightly be regarded as both scandalous and a national priority for action.’

The number of deaths involving methadone were ‘of particular concern’, he stated. ‘If people are not getting the substitute medication dose they require then it is no wonder they “top up” with street drugs and get involved in polydrug use – which is a huge feature in these figures, accounting for the vast majority of deaths. The obvious question we need to ask is why are NHS patients being treated in ways that are clearly contrary to the good practice recommended in the guidelines? Why is this being allowed to continue?’

The belief that the lower the dose the better someone was doing ‘flies in the face’ of decades of evidence, he said, while stigma also continued to be a key issue.

‘We have stigmatised drug use and people with a drug problem and also a life-saving pharmaceutical treatment. The government and politicians, the NHS, drug services, the media and wider society have a part to play in this. We can prevent drug deaths – as stakeholders we all need to do what we can to reverse this national scandal – that responsibility lies with us all.’

Drug-related deaths in Scotland in 2018 at www.nrscotland.gov.uk. Read the report here