Reducing Opioid-Related Deaths in the UK
In recent years, there have been substantial increases in the number of people dying in the UK where illicit drugs are reported to be involved in their death. The largest increase has been in deaths related to the misuse of opioid substances; 2,677 opioid-related deaths were registered in the UK in 2015. The Advisory Council on the Misuse of Drugs (ACMD) therefore set up a dedicated working group to examine how to reduce drug-related deaths, with a focus on opioid-related deaths.
- That the UK has high-quality systems for the recording of opioid-related deaths, but that more could be done to improve national information, especially on toxicology and prescribing, as well as on the contribution of opioid use to levels of mortality from other causes.
- That a probable cause of the recent increases in drug-related deaths (DRDs) is the existence of a prematurely ageing cohort of people who have been using heroin since the 1980s and 1990s.
- The vulnerability of these and other people who use heroin is likely to have been reduced by a reduction in the availability of heroin at street level that occurred in the UK in 2010 to 2012. Recent increases may represent a return to the underlying, increasing trend as heroin availability subsequently increased.
- Other contributory causes of recent increases in deaths include multiple health risks (including poly-substance use and chronic use of alcohol and tobacco) among an ageing cohort of heroin or opioid users, deepening of socio-economic deprivation since the financial crisis of 2008, and changes to drug treatment and commissioning practices.
- There are a number of evidence-based approaches that can be used to reduce the risk of death among people who use opioids. The strongest evidence supports the provision of opioid substitution treatment (OST) of optimal quality, dosage and duration.
- Other substance misuse treatment options could be further developed in order to reduce the risk of death including broader provision of naloxone, heroin-assisted treatment for those for whom other forms of OST are not effective, medically supervised drug consumption clinics, treatment for alcohol problems, and assertive outreach to engage heroin users who are not in treatment into OST (especially for those who are homeless and/or have mental health problems).
- Improve access for heroin users to treatment for mental health problems, smoking cessation and tobacco harm reduction, HIV / hepatitis B / hepatitis C prevention and treatment, physical healthcare treatment for long-term conditions such as coronary and pulmonary heart disease, and other services (such as housing and employment services) which support wider recovery outcomes could reduce vulnerability to DRDs.
- The report makes a number of recommendations for the reduction of opioid-related deaths; most importantly that investment in evidence-based OST be maintained. It is estimated that OST was preventing approximately 880 deaths per year in England in 2008 to 2011 (White et al., 2015). Without the expansion of OST that occurred in the 2000s, it is likely that opioid-related deaths would be even higher than they currently are. These services are currently under threat from reductions in local and national funding, especially in England.
- The age profile of opioid-related deaths (discussed in chapter 3) suggests that relatively few young people are initiating problematic opioid use. Numbers of opioid related deaths among people under 30 have fallen substantially since the early 2000s. This suggests that the UK is likely to see a long-term reduction in opioid related deaths, as long as there is no new wave of initiation into problematic opioid use (e.g. larger increases in the misuse of heroin, fentanyl and/or oxycodone), as was seen with heroin in the 1980s and 1990s.
- However, in the short to medium term, we are likely to see an increasing number of deaths among a shrinking population of prematurely ageing, increasingly vulnerable heroin or opioid users. Deaths among this cohort have been reduced and limited by previous government interventions, including those implemented after the ACMD’s report in 2000. ACMD calls on the government to renew and extend efforts to prevent these deaths.