What can we do about drug related deaths?
2018 had the highest number of drug related deaths on record. What can be done to bring the number down?
Official ONS statistics show 4,359 people died as a result of drug related causes in England and Wales in 2018. That’s both the highest number of deaths ever recorded and the highest annual increase since the Office for National Statistics began keeping records in 1993.
It was a tough day for families and people who work in drug treatment. At Addaction we knew and remember many of those who died. It may seem like an impossible crisis, but the vast majority of these deaths are preventable.
Four Addaction staff members from across England explore what can be done to bring this spiralling number down.
Better Naloxone provision
By Rachel Britton, Lead Clinical Pharmacist
Naloxone is an opioid reversal drug which works by preventing drugs such as heroin from binding to receptors in the brain. It’s not a panacea for treating overdose as it only (temporarily) reverses the effects of opioids (and not other drugs such as benzos). Anyone who overdoses should be seen by emergency services, but naloxone buys people vital time until that support arrives.
Drug services can give out naloxone without a prescription and anyone can administer it in order to save a life. Yet there’s still work to do to make sure it’s is always there when it’s needed. At Addaction we’ve recently revised our policy through cutting the amount of paperwork and simplifying naloxone training. In Cornwall this approach, together with asking clients to ‘opt out’ rather than ‘opt in’, has seen a massive upsurge in the amount of naloxone disseminated.
But it’s also vital people who work for organisations outside of drug services have and know how to use naloxone. In Birmingham the charity Change Grow Live recently trained 40 police officers. They are now the first police force to carry the drug. Meanwhile, Addaction Liverpool is training staff who work in homeless hostels and in Lincoln we’re training council workers. Hopefully naloxone will become commonplace in public services in the next few years.
Yet we also need to think beyond public services. One of our naloxone champions recently suggested training staff of a local fast food restaurant as people are suspected to be using substances in their toilets. This is the kind of creative thinking that can save lives.
Naloxone is easy to use and can be the difference between life and death. Our job is to make sure people have it when they need it.
Outreach in the community
By Ian Treasure, Service Manager at Blackpool Fulfilling Lives
A lot of people who take drugs, particularly those who are part of the homeless community, lead quite chaotic lives. What we really need is outreach people on the ground — especially those with lived experience. It can be as simple as buying someone a cup of coffee and then asking to see them again the next day. Then you go back and start to do some motivational work, show them that somebody cares and that they’re not being judged.
It can take multiple individual connections like this to get people to engage with a service, then many more to achieve stability. But if we keep going back, showing people that change is possible and we can support them, that’s how we build meaningful relationships that can actually have an impact.
For this reason we have a Lived Experience Team, dedicated to hearing and communicating the views of people who use our services. Many of the Navigators in our outreach team also have lived experience and we work on an “assertive outreach” basis. This means meeting people in the community, where they live, rather than in an office environment. We do this from 7am to 9pm on weekdays and 10am to 6pm on weekends, meaning we can reach people outside of normal office hours.
New harm reduction measures in urban areas
By Caz Anderson, Service Manager at Addaction Bournemouth
Some harm reduction measures are now commonplace in cities. Prescribed medicines like methadone are vital in giving people the stability to start to address their opiate use. And needle exchanges help stop the spread of blood borne viruses like Hepatitis. These are essential in the fight against drug related deaths.
However, as drug deaths continue to rise, new measures to help further reduce harm are also being discussed. Drug consumption rooms are a safe space where people can use drugs without fear of recrimination. There’s never been a recorded overdose in any of the 78 consumption rooms around Europe as trained medical staff are on hand with naloxone and to call an ambulance.
But consumption rooms don’t just reduce harm, they’re also a great way to engage people. People outside of treatment are most likely to die of a drug related cause so anything that gets them through the door and interacting with staff should be seen as a positive. Consumption rooms also reduce the likelihood that people will use drugs in public spaces, improving the wellbeing of the whole community.
One issue is that consumption rooms are expensive to run. They should never be introduced at the expense of current treatment services, instead finding the extra funding would show we are putting people’s well-being first in the face of spiralling deaths.
Proper time with people
By Karen Tyrell, Executive Director of External Affairs
Ask most people who’ve been through drug treatment what worked for them and they are very unlikely to mention the name of a service or a particular medication or therapy. Instead, they normally talk about an individual. A person who connected with them. Someone who didn’t just see them as a drug user, but saw their potential and believed in them even when they didn’t believe in themselves.
Building these kind of relationships takes time. It involves listening to people and getting to know them. It’s about working at a pace people feel comfortable with, letting them open up slowly, rather than rigidly following a set of pre-designed steps.
Forging sincere connections is what gets drug workers up in the morning. But they need the space to flourish. Government cuts to council budgets mean local authorities in England have cut public health budgets by an average of 27% in the past four years, with drug treatment services taking a big hit in the process. When treatment funding is cut inevitably so are staff, leading to higher caseloads and less time with clients. If you have a caseload north of 60 people it becomes very difficult to forge the kind of meaningful relationships which we know are instrumental to people’s recovery. It’s no surprise the areas with the highest rates of drug related deaths are those which have seen the most drastic funding cuts.
To reduce drug related deaths we have to invest in people and that means properly funded treatment services.
If you or someone you love needs help or support, reach out. You can chat to a trained advisor at addaction.org.uk.