UK Drug Deaths 2014: Skyrocketing Numbers Highlight Naloxone Need, Policy Failures

New figures show a shocking jump in the number of drug poisoning deaths to the highest level since records began in 1993, challenging government claims about the successes of current drug policy and highlighting the urgent need for a nationwide roll-out of naloxone.

According to data from the Office for National Statistics (ONS), 3,346 drug poisoning deaths occurred in England and Wales in 2014, 67 percent of which involved an illegal drug.

Much of this was accounted for by a sharp increase in the number of deaths involving heroin and/or morphine which rose from 579 in 2012 to 952 in 2014. Cocaine-related deaths also rocketed from 192 in 2013 to 247 in 2014.

England saw a 17 percent rise in the rate of drug misuse deaths to 39.7 per million in 2014, whereas Wales experienced a 16 percent decrease to 39.0 deaths per million, the lowest since 2006.

The alarming uptick in deaths across multiple substances -- including opiates, cocaine, amphetamines, benzodiazepines and barbiturates -- raises serious questions about Prime Minister David Cameron’s claim in October last year that “the evidence is that what we’re doing is working.” While he was mainly referring to prevalence rates, this is a poor metric for success when people are dying because of a failing government policy (N.B. drug poisoning deaths had increased in 2013, also, meaning Cameron had this data to draw on before hastily reaching his self-congratulatory conclusion).

Leaving the ineptitude of government drug policy to one side for the moment, explanations from both the media and ONS as to why there has been such an increase have so far fallen short and require exploring.

Increased heroin purity is unlikely to be behind the rise in overdose deaths

“Drug deaths soared to a record level after an influx of cheaper and more potent heroin onto British streets,” began The Telegraph’s article on the subject. This inaccurate assertion that purity was the primary reason behind the rise originates in the ONS’s more tentative claim that “the increase in user-level purity, and the changes in price, may partly explain the increase in heroin related deaths in 2013 and 2014.”

However, purity is agreed by experts in the drugs field to only really affect new users, people who relapse from rehab, and users recently released from prison. People who use regularly know their own tolerance level and the purity available on their local market. When there are purity increases, they tend to be by only a few percent over a couple of months, during which period people who use regularly buy and adjust their dosages repeatedly.

Furthermore, in terms of overdose deaths, purity only affects people who inject and snort, yet smoking remains the most common route of administration for people using heroin. It is almost impossible to overdose whilst smoking heroin without the presence of another central nervous system depressant.

The Telegraph’s extrapolation of the ONS’s discussion of purity as the most important factor in the increase in drug misuse deaths, despite the evident equivocation of the assertion that purity “may partly explain the increase in heroin related deaths,” is thus largely without base.

While The Telegraph’s failure in its coverage is apparent, some onus should be placed on the ONS for not sufficiently addressing any of the issues related to purity, despite flagging it as a potential reason for increased heroin/morphine deaths. This perhaps suggests an unwillingness to consider alternative, and more controversial, explanations. Speaking to the Guardian, drug policy analyst Harry Shapiro raised other potential reasons such as the figures raising questions about the devolution of responsibility for treatment services from the National Treatment Agency for Substance Misuse to local authorities already in the process of slashing their budgets. Additionally, he highlighted the "increasing reluctance to prescribe methadone," in drug treatment settings despite it being effective for opioid dependency and having a solid evidence base.

ONS analysis of rise in drug misuse deaths is lacking

As the report underscores, the largest increases in drug misuse deaths were recorded in the 30-69 age group, with the steepest rise (25 percent) among 40-49 year olds.

The ONS attempts to offer some analysis of this trend, albeit brief, noting “people receiving treatment for drug misuse are getting older ... this ageing drug using population experience wider health problems, making them harder to treat, thus impacting on mortality.”

However, when addressing other sub-section variations, notably geographical, the ONS’s fleeting analysis is curiously absent. 

For example, London has a drug misuse death rate of 25.4 deaths per million people, while the North East recorded a rate of 69.3 deaths per million. This huge regional disparity only worsened last year; while the drug misuse death rate increased 10 percent in London, the North East saw a 33 percent upsurge.

This alarming and apparently increasing gap deserves more than the two paragraphs without a single piece of explanatory analysis given to it by the ONS.

The rise in heroin/morphine-related deaths reveal the need for increase provision of naloxone and harm reduction services

Given the disturbing trend in heroin/morphine deaths in particular, these new figures highlight the need for a comprehensive national program that will ensure access to naloxone, a cheap and effective opioid overdose antidote drug. Naloxone should be provided to all those working with people who are vulnerable to overdose deaths, and for friends and family members of people who use opiates.

The government did recently introduce the Human Medicines (Amendment) (No.3) Regulations 2015 to expand naloxone access in the UK, removing the requirement that it be supplied solely by registered medical staff so that drug service workers may also distribute it to people who use drugs. This should go some way toward increasing provision in England where the most recent figures indicate that naloxone is only provided by around a third of local authorities. Conversely, Scotland has a national program already in place.

However, in reality the new regulations don’t go far enough. As Kirstie Douse, Release’s head of legal services, recently wrote for Injecting Advice, hostel workers and those working with homeless people, some of the people most vulnerable to overdoses, will not be able to supply naloxone under the new legislation unless they are commissioned as drug service providers by either the NHS, a local authority, Public Health England or a Public Health Agency. The revelation of this shocking health policy failure must spur the government to amend this legislation to include all people who work with people who use drugs.

Most importantly, there must be a review of existing drug treatment services to ensure evidence-driven policy and practice. Sadly this seems incredibly unlikely given the government's desire to stick to a dangerous abstinence-based recovery agenda that flies in the face of best practice.

Responding to the figures, a Department of Health spokesperson stated, "Our drugs strategy is about helping people get off drugs and stay off them for good, and we will continue to help local authorities give tailored treatment to users." With such drug-free rhetoric being doled out, even after being presented with the latest statistics, it is unlikely that the trend of recent years will be changing in the future. Perhaps someone should tell the Department of Health that you can't help people "get off drugs" when they're dead.