1. Tackling Drug related deaths in Bristol Jody Clark Substance Misuse Team Bristol City Council

2. Classifying Drug Related Deaths Immediate Causes Overdose - 29 Accidental poisoning - 1 Volatile Substances - 0 Other short-term cause - 4 IC- Accidents under the influence - 0 Long Term Causes Long term complications - 2 Heavy alcohol use - 6 Smoking related diseases - 0

3. Deaths 2009-2014

4. 2009-2015

6. 29 Overdose deaths Opiates – 27 – Heroin - 19 – Methadone - 12 (6 with heroin, 6 without) – Tramadol - 1 – Oxycodone - 1 Non opiates – MDMA – 1 – Pregabalin - 1

7. Known factors influencing the increase

8. Increasing complexities Aging cohort of people who use opiates with increasingly complex health needs? Snapshot of physical health of 1520 Shared Care clients identified 58 conditions – HCV 14.1% – Respiratory problems (excluding COPD) 8.2% – Mobility issues 7.1% – COPD 5.7% – Ulcers/abcesses 5.5%

9. Purity Normal purity levels Avon and Somerset – Heroin ~20% – Crack ~35% Recent seizures largely remain within these ranges. Cases of increased purity – Heroin 60% – Crack 90%

10. Organised Criminal Gangs Intelligence to suggest an organised attempt to take over local drug markets by groups based outside of Avon and Somerset Improvements in purity linked to developing market share. Is it likely to return to normal once established?

11. Homelessness Increase in Street homelessness. Rough sleepers count: – 5 in 2010 – 76 in 2015

12. Trends in drug use Injecting rates remain higher than national Poly drug use the norm – 60% crack use – Alcohol – Benzos New kids in the block – Pregabalin and gabapentin – Spice

13. Challenges Treatment outcomes

14. Public Health Outcome Framework

15. Treatment engagement

16. More trends in drug use People using alone Poly drug use 301 NSP clients also receive OST – 148 (30%) clients report no injecting on their most recent TOP

17. Naloxone Supplied 410 doses Dec 2009- Apr 2015 531 doses 2015/16 – 74 doses April to September – 452 doses October to March An additional 31 doses were issued to hostel staff and homeless outreach workers in 15/16

18. Naloxone used

19. Next steps Increase the strategic priority of the health needs of people who use drugs- especially injectors to reduce fatalities Policies, strategies and interventions need to be linked to the needs of people Identify those who inject drugs Address peoples alcohol use

20. Any questions? Jody.clark@bristol.gov.uk 0117 91 22311