1. Causes of Drug Related Death
Ren Masetti
Drug and Alcohol Training
Health Outreach NHS
Causes of Drug Related Death

2. Why are drug users dying?
Using illegal drugs is risky
In a sense, the answer is easy – they are risky
The whole game is fraught with risk

3. Weve known this for a long time….See how dangerous it is…

4. Why are drug users dying?
Some drugs are riskier than others

6. Why are drug users dying?
Because the drugs we use to help people recover are risky

7. Why are drug users dying?
It’s a dangerous game
“Drugs are illegal because they are harmful”
HM Drug Strategy 2016
There is something not mentioned in the strategy that is even more dangerous than using drugs or being on drugs like methadone…

8. Why are drug users dying?
NOT BEING ON DRUGS OR METHADONE
In other words, recovery from addiction is hard and comes with its own significant risks

9. But why is it so bad here? Transform website – accessed 12/9/17
Heroin is heroin, whether youre in the UK or Portugal
The success of Portugal’s
decriminalisation policy
– in seven charts
Transform website – accessed 12/9/17

10. How bad is it?
Almost one in three drugs overdoses in Europe are recorded in the UK
ONS.gov.uk Sept, 2016
Very very bad

11. Drug Related Deaths
“Drug related deaths have increased by 65.5% and opioid related deaths by 107% in England and Wales between 2012 and 2015”
ONS online (accessed November 2016)
They now exceed traffic fatalities…
Drug and Alcohol Findings UK, 2017
We are a country that is winning the war on drugs – one body at a time

12. An uncomfortable read…
Causes of Drug Related Death?
Drug related deaths in England and Wales, BMJ Oct 2016
An uncomfortable read…
So – why us? The BMJ has some suggestions…

13. Why us? Part 1
Drug purity has risen

14. Easily accessible, very strong…
Arguably, The PSA has led to the creation of some incredibly powerful substances that are sold in a completely unregulated market (Synthetic cannabinoids, Fentanyl etc.)

15. Why us? – Part 2 Drug users are getting older
Their problems are harder to cure
There is less money
New recruits are harder to find

16. Drug misuse: Findings from the 2013/14 Crime Survey for England and Wales

17. Why us? – Part 3
UK Drug Policy Since 2010

18. UK Drug Policy in a Nutshell
Recover or Die
Let me explain…

19. When did the deaths start to rise

20. Full Recovery A radical new approach
Based on what we wanted rather than what we know works
Abstinence at the heart of ALL services for drug users
We should “challenge the evidence base” and not be “burdened by the evidence”
Imagine this approach in other areas…
We grew tired of basing our policy on things with a track record of working and started to base our drug policy on what we would like to happen.
What we want is a drug – free lifestyle for everyone.
A bit like a child who wants to learn to ride a bike, so asks Santa for a Unicorn – when what you need ….is a boring bike!

21. Recovery in Mental Health
The service user decides how far they want to go: Support groups? Free of medication? On meds but happier? Clean works for cutting?
Full recovery came from the idea of Recovery in the mental health field

22. Recovery from drugs
“Supporting every individual to live a life free from drugs”
This includes the end of:
“The routine maintenance of peoples addictions with substitute drugs”
HM Drugs Strategy 2016

23. So what’s wrong with that?
“A chronic relapsing condition”
Similar to diabetes and asthma
Accessed 23/8/17

24. So what’s wrong with that?
People need practice…
People usually need to relapse a few times
Drug policy has moved us away from this:
We talk about “successful completions” as being drug free – so if you relapse you are “unsuccessful”
We talk about “relapse prevention” but shouldn’t we be focussing on “relapse retention” – working with people when they relapse and while they are using

25. The cycle of change
Ive been training for 26 years. Thousands of people have heard me bang on about this without really grasping what it means.
This is how people change
They need practice
Our services are for people so they need to reflect this model

26. There’s only one thing worse than using drugs or being on methadone…
Disengaging or engaging at the wrong time on the cycle of change
Tolerance Drop
Relapse
Death
What I meant was a policy of “drug –free now for all” means…

27. Things that will stop drug users dying…
Appropriate diamorphine prescribing
Effective methadone prescribing
(i.e. following the new prescribing guidelines)

28. “Drug users who receive pharmacological and psychosocial interventions have a 50% lower risk of death than those following abstinence regimens”
BMJ 2016

29. Things that will stop drug users dying…
Needle exchange promotion
Safer injecting
We have mountains of evidence that it stops things that kill people like HEP C, HIV and…

34. Things that will stop drug users dying…
Consumption rooms
Appropriate means people who don’t take to methadone or other treatments
Effective means maintenance above a sub-effective dose until the client wants to change with lots of psychosocial support alongside

35. Consumption rooms
Lets be clear… if we fund harm reduction we might not see everyone being drug free…

36. Healthier drug users who are alive
We will see more of this – healthier drug users

37. Our current approach may be leading to some of this…
What the BMJ suggests is that…

38. And lots of this…