1. Co-ordinating action on drug issues Drug Related Deaths Drug Related Deaths Dave Liddell

2. Co-ordinating action on drug issues Drug-related deaths, Scotland 1996 – 2002 Source:GRO

3. Co-ordinating action on drug issues Drug-related deaths by Health Board Area: 1996 - 2002 Source:GRO

4. Co-ordinating action on drug issues Drug-related deaths by Health Board Area: 1996 – 2002 Source:GRO

5. Co-ordinating action on drug issues Drug-related deaths; selected drugs involved, Scotland 1996 – 2002 Source GRO

6. Co-ordinating action on drug issues Poly drug use Heroin/diazepam combinations Diazepam Heroin/Diazepam Heroin 91 15757

7. Co-ordinating action on drug issues Injecting opiates – low tolerance Source: Andrew Preston Blood level of heroin lethal dose unconsciousness acute intoxication

8. Co-ordinating action on drug issues High tolerance Source: Andrew Preston Blood level of heroin Time lethal dose unconsciousness acute intoxication

9. Co-ordinating action on drug issues Poly drug use & high tolerance Source: Andrew Preston temazepam

10. Co-ordinating action on drug issues Greater Glasgow drug-related deaths 2002: Age Groups Source: GGDAT 55% aged 30 and over

11. Co-ordinating action on drug issues Prison release & drug-related deaths, Greater Glasgow 2002 Source: GGDAT

12. Co-ordinating action on drug issues Drug Deaths by Deprivation categories 2002 Greater Glasgow Source: GGDAT

13. Co-ordinating action on drug issues Drug deaths – what we know High purity heroin seldom the cause of overdose death Overdose less common among new or inexperienced users – older users predominate Large proportion of deaths are a mixture of opiates and Benzodiazepines –many also include alcohol Most are not in specialist ‘treatment’ Recent history of overdose

14. Co-ordinating action on drug issues Drug deaths – what we know Factors potentially adding to poly drug use and therefore increased overdose risk Low purity heroin? Liver damage of those on methadone(heroin?) Low dose methadone prescribing

15. Co-ordinating action on drug issues Drug deaths – what we know Loss of tolerance and increased risk of overdose from :- Prison releases Detoxification

16. Co-ordinating action on drug issues Drug deaths – what we know 137 individuals Source: John Strang et al BMJ May 2003 At discharge: 43 Still Tolerant 57 Reduced Tolerance 37 Lost Tolerance 3 deaths occurred within four months all within the last group

17. Co-ordinating action on drug issues Drug deaths – what we can do Improve prescribing Methadone dosage, other prescribing options, access, end to ‘zero tolerance regimes’ Higher overdose in high risk groups - outreach Most overdoses are witnessed – critical incidents training

18. Co-ordinating action on drug issues Drug deaths – what we can do High overdose rates over 30s – routes out/employability Better aftercare/continuity of care for those who have under gone detoxification Retox for high risk individuals leaving prison

19. Co-ordinating action on drug issues Conclusion An impact can be made on reducing the number of deaths Services and DAATs need to regular review practice Recent death figures are encouraging