Clinical & Policy Updates:
SMMGP Policy Update September 2014
|Download the PDF version of this Update here! (PDF*, 81K)|
The 2013 ONS report on drug related deaths was published last month. Key points from the report are summarised below:
- 2,955 drug poisoning deaths (involving both legal and illegal drugs) were registered in 2013* in England and Wales (2,032 male and 923 female deaths). *Note: 1,488 deaths (just over half) occurred in previous years but were only registered in 2013.
- Male drug poisoning deaths increased by 19% compared with 2012. Female drug poisoning deaths have increased every year since 2009.
- Male drug misuse deaths (involving illegal drugs) increased by 23%, from 1,177 in 2012 to 1,444 in 2013. Female drug misuse deaths increased by 12%, from 459 in 2012 to 513 in 2013.
- Heroin/morphine remain the substances most commonly involved in drug poisoning deaths. 765 deaths involved heroin/morphine in 2013 - a sharp rise of 32% from 579 deaths in 2012.
- Males aged 30-39 accounted for one third of all male drug misuse deaths in England and Wales.
- Of all female drug misuse deaths, the age group 40-49 accounted for 27% (the largest group) followed by 50-69 year olds (25%).
- North East England had the highest mortality rate from drug misuse at 52 deaths per million population, closely followed by the North West (47). London is lowest (23).
- Deaths involving tramadol have continued to rise, with 220 deaths in 2013. This is almost 2.5 times the number seen in 2009 (87 deaths).
- Male mortality rates significantly increased in three substance categories: heroin/morphine, benzodiazepines and paracetamol. Female mortality rates remained relatively stable except for a sharp increase in the cocaine-related death rate.
The reality of the many lives lost to drug overdoses in England and Wales during the period in question, casts a long shadow. Whilst explaining deaths from some drugs listed in the reports appear to be relatively straight forward (e.g. those involving tramadol) it is too difficult to comment in a brief policy summary about the whys and wherefores of the increase in deaths attributable to heroin. However comment from agencies in the field reflect the alarm bells that have been rung, and we concur. Drugscope Chief Executive Marcus Roberts, comments that it "raises serious concerns" in their response.
Other observations on the drug related death figures include a reflective blog post on the "Recovery Review"site.
Concomitant to the discussions on the drug related death figures we were stunned - along with others in the field - to learn that the wider roll-out of the provision of naloxone has been delayed until October 2015. Various organisations and agencies have expressed their utter dismay at this decision and SMMGP is participating in a "naloxone summit" during October 2014 to discuss and consider what can be done to remedy this unacceptable situation. Whilst we know that wider access to naloxone is not the answer, support for a national programme is one way of sending a clear message that the untimely deaths of people who use drugs, matter.
PHE Alcohol, drugs and tobacco division produced a briefing dated August 2014 for local areas to coincide with legal changes allowing the provision of aluminium foil for smoking drugs by drug treatment providers (from 5th September 2014). The provision of aluminium foil can prevent or reverse the transition to injecting drugs, and so prevent the infections and other harms than can result from injecting.
The legal provision of foil by drug treatment providers is subject to strict conditions - namely that foil can only be provided in the context of structured steps either to engage people in a treatment plan or as part of a treatment plan. These conditions are explained in detail along with corresponding implications for monitoring activity at needle and syringe programmes.
It feels as if it has taken a long time for this to be legislated. However, with needle exchange services providers under siege from funding cuts, it is now a small but welcome sign of support for traditional harm reduction approaches in heroin use.
Having read the PHE briefing, we moved over to the Injecting Advice website, where "Tips for supplying foil" cuts through the red tape for providers of this important tool for change.
Available via the PHE website, the updated guidance (July 2014) replaces the 2007 (NTA) publication and is intended for health professionals who are not doctors and who have an interest in working as or already work as NMP non-medical prescribers. It allows for increased availability and responsiveness of prescribing interventions. The guidance was written by an expert group convened by PHE Alcohol, Drugs and Tobacco and the National Substance Misuse Non-medical Prescribing Forum.
The document defines how non-medical prescribing can be safely delivered within drug and alcohol treatment.
This guidance is long overdue as the original guidance long predated the law change allowing NMPs to prescribe controlled drugs. The new guidance looks at both the requirements to develop new NMPs but also the support, development and governance structures needed to enable them to fulfil this role. NMPs have a vital role to play in the delivery of drug and alcohol treatment and this guides both the individual NMPs and the organisations they work for.
The "Making the case" guide aims to help people working in drug and alcohol services use the skills, assets and testimony of colleagues and service users to tell a positive story about their work and to ensure that treatment and recovery do not slip down the political agenda in their local area. This short, practical guide is full of ideas and case studies about communicating the benefits of drug and alcohol treatment to the different audiences who matter - local decision makers, the local community and local media. With sections on sourcing statistics and data, crafting key messages, developing narratives from your service users and staff and building positive community relations, the guide is intended to give the sector a head start on promoting its work, to help maintain the investment and support it needs to keep on doing it.
Drugscope have provided a timely and useful practical guide for making a case to promote the benefits of drug and alcohol treatment to decision makers in local areas. Money that previously was safely allocated to fund drug and alcohol treatment has been absorbed elsewhere in public health. Police and Crime Commissioners determine where the funding allocated to them will be spent. There is a real danger that the gains made over the past decade in drug and alcohol treatment will be lost. For example, we are hearing many reports of established shared care schemes being dismantled - from practitioners and service users alike, all of whom share their sadness that relationships that have been built over sometimes many years, are now ending.
RCGP and SMMGP co-produced a document to make the case for primary care based drug and alcohol treatment in January 2013 entitled "Primary care drug and alcohol treatment: commission and provision against a backdrop of localism" (PDF, 202K). It is well worth revisiting it.