Drug-Related Deaths in Suffolk Alison Amstutz Senior Health Improvement Commissioner (Sexual Health and Drugs and Alcohol) Public Health, Suffolk County Council

Note on Definitions & Terminology Deaths related to drug poisoning - involving both legal and illegal drugs Drug misuse - involving controlled drugs A drug misuse death is defined as a death where: the underlying cause is drug abuse or drug dependence the underlying cause is drug poisoning and where any of the substances controlled under the Misuse of Drugs Act 1971 are involved

Note on Definitions & Terminology Cont. Includes accidents and suicides involving drug poisonings, as well as deaths from drug abuse and drug dependence. They do not include other adverse effects of drugs (for example, anaphylactic shock), or other types of accidents (for example, a car crash) where the driver was under the influence of drugs. Drug poisoning deaths involve a broad spectrum of substances, including legal and illegal drugs, prescription type drugs (either prescribed to the individual or obtained by other means) and over-the-counter medications. Some of these deaths may also be from complications of drug abuse, such as deep vein thrombosis or septicaemia from intravenous drug use, rather than an acute drug overdose. Over half of all drug poisoning deaths involve more than one drug and/or alcohol - not possible to tell which substance was primarily responsible for the death.

Headlines In 2016: 3,744 drug poisoning deaths involving both legal and illegal drugs in England and Wales; this is 70 higher than 2015 (an increase of 2%) and the highest number since comparable statistics began in 1993. Of these 3,744 deaths, 69% (2,593) were drug misuse deaths. Increase in the rate of deaths related to drug misuse in Wales from 58.3 deaths per 1 million population in 2015 to 66.9 per 1 million in 2016; deaths in England have remained comparable between 2015 and 2016. People aged 40 to 49 years had the highest rate of drug misuse deaths in 2016, overtaking those aged 30 to 39 years. Over half (54%) of all deaths related to drug poisoning in 2016 involved an opiate (mainly heroin and/or morphine). The highest mortality rate from drug misuse was in the North East with 77.4 deaths per 1 million population, a 13% increase from 2015; the lowest rate (29.1 deaths per 1 million population) was in the East Midlands, which remained stable.

Suffolk Trend

Suffolk by District

How Does Suffolk Compare

Mortality by Selected Substances Heroin and/or morphine Benzodiazepines Cocaine Amphetamines New psychoactive substances

Part 2

Maximising opportunities to reduce future drug-related deaths in Suffolk Profile of drug-related deaths in Suffolk Using reviews of drug-related deaths to enhance provision Access to & quality of treatment services Harm reduction as central to everyone’s work Prioritise the care & treatment response to those identified as high risk DRD Response to those leaving prison Workforce development Network development Support to families & communities to better understand substance misuse & to develop preventative strategies

Profile of drug-related deaths in Suffolk Identify sources of data Data analysis: Number of DRD Number of near misses through monitoring of Naloxone usage By gender, age, ethnicity, district Alcohol alone Drug alone by opioid, stimulant, other Vulnerable characteristics Trend data; comparison over time National & regional comparison

Using reviews of drug-related deaths to enhance provision Review SIRIs raised by Turning Point to inform practice & wider system issues Establish process to learn from near misses Stakeholder audit of SIRIs, including quality assurance Multi-agency reviews where appropriate Test out solutions Develop a process to share learning & make recommendations for change across the system

Access to & quality of treatment services Dissemination of access information, including out of hours provision Quality visits, risk management Benchmark drug treatment services against recommended practice Strengthen joined up working between substance misuse services, mental health & housing Work with GPs & acute doctors to support prescribing practices & dose optimisation

Harm reduction as central to everyone’s work Ensure relevant services engaging with service users provide information & advice on risks of & preventing overdose Availability of naloxone to appropriate organisations & service users Ageing cohort of heroin users – focus on engaging in treatment – addressing other physical & mental health needs, BBV & HIV testing, safer injecting advice, COPD, CVD

Prioritise the care & treatment response to those identified as high risk DRD Develop pathway between MVA & Turning Point for high risk clients Explore possibility of cross referencing opiate overdose A&E data with Turning Point data to ascertain numbers engaged in treatment at time of overdose to inform assertive outreach Investigate possibility of A&E supplying naloxone to opiate overdose patients Disseminate MVA overdose toolkit Develop a process to flag those who drop out of treatment, present at A&E, move to Suffolk

Response to those leaving prison Ensure process in place for rapidly transferring service users between local prisons & Turning Point, including rapid access to prescribing Explore possibility of naloxone provision for at risk Suffolk males on release from HMP Norwich

Workforce development Understanding of high risk practices for targeted workforce groups; GP Practices, A&E, pharmacies, housing associations, substance misuse services

Network development Robust mechanism for dissemination of drug alerts Service user input

Support to families & communities to better understand substance misuse & to develop preventative strategies Emphasis on those families with multi-agency involvement Service user & family engagement Explore potential for co-production Support to those bereaved by a DRD

Get involved Strategic Partnership Project groups Campaigns Sharing good practice Sharing evidence Sharing data Contact Sigi Mermagen sigi.mermagen@suffolk.gov.uk

References Office for National Statistics (2017) Deaths related to drug poisoning in England and Wales: 2016 registrations Public Health England (2017) Health matters: preventing drug misuse deaths. https://www.gov.uk/government/publications/health-matters-preventing-drug-misuse-deaths/health-matters-preventing-drug-misuse-deaths Public Health England (2016) Understanding and preventing drug-related deaths: The report of a national expert working group to investigate drug-related deaths in England Public Health England (2013)Turning Evidence into Practice: Preventing drug-related deaths