Written by: Ian Hamilton, Lecturer in Mental Health and Addiction, University of York
For the fifth year in a row, the number of drug-related deaths reported in England and Wales has risen to record levels, according to the latest figures from the Office for National Statistics. In 2017, 2,503 deaths were recorded as “drug misuse”. This comes on top of July’s announcement of an 8% increase in drug-related deaths in Scotland.
In Great Britain, as a whole, deaths from drugs overtook traffic fatalities as a leading cause of death in 2008, and they have risen particularly sharply since 2012.
Jump in a car and everything around you is designed with safety in mind, from the roads to the construction of the vehicle. But with drugs, you are on your own. Policy effort is centred on preventing drug use rather than protecting people when they use substances.
Blaming the dead
The government’s response to these latest figures will undoubtedly be to deflect attention from the failure of policy and blame those who died instead, arguing that they were part of an ageing cohort of drug users whose lifestyles and poor choices contributed to their early deaths.
The people most likely to die are working class, over 40 and living in de-industrialised areas. Drug death rates are nine times higher in the most deprived neighbourhoods than in the richest areas.
Unfortunately, investment in treatment does not match local need, so those areas with the greatest need get the least resources.
Deaths could be reduced
There is a lot of research on how to reduce these deaths. In 2016, the government’s scientific advisers, the Advisory Council on the Misuse of Drugs (ACMD), summarised this evidence for ministers in a report. The ACMD’s recommendations include wider provision of naloxone, a medicine that reverses opioid overdose.
The ACMD also called for central funding of heroin-assisted treatment. It advised that areas with high concentrations of injecting drug use should consider setting up medically supervised drug consumption rooms. These have been shown to reduce drug-related health problems.
The most important recommendation was to invest in opioid substitution therapy. This treatment prescribes substitutes for heroin – such as methadone or buprenorphine – to people who are dependent. It is effective in retaining patients, reducing crime and avoiding the spread of infectious disease, such as HIV and viral hepatitis. It is estimated that the expansion of this treatment in the 2000s was saving about 880 lives per year by the end of that decade.
Since then, there have been substantial cuts to the funding of drug treatment services. Spending on adult drug treatment services is projected to have fallen by 26% in the four years from 2014. This led the ACMD to describe funding cuts as “the biggest single threat” to the outcomes of drug treatment.
In its response to the ACMD’s recommendations, ministers claimed to accept them all, except drug consumption rooms. But their actions have not lived up to this claim. There has been no new funding for opioid substitution therapy, which continues to be cut.
A survey of local authorities in 2017, conducted by the charity Release, found that the provision of naloxone in England is still patchy and inadequate. Some areas with high levels of drug-related deaths, like Hartlepool, had no plans to introduce this life-saving medication.
The government also failed to follow ACMD’s recommendation to improve reporting and research on drug-related deaths. Taken together, there has been a comprehensive failure to take steps to reduce deaths. And, predictably, deaths have risen.
Death by indifference
Fatal road traffic accidents have successfully been reduced, not by banning cars but by employing evidence of what is effective in protecting people while they drive. We won’t reduce drug-related deaths by continuing to focus on banning drugs.
It’s not lack of know how that’s killing people – we already know how to reduce deaths – but, as with road traffic deaths, investment and political will are needed to stop people dying as a result of using drugs. Government policy has the veneer of caring about people who die and the family and friends they leave behind, but another 2,503 needless deaths suggest otherwise.
Ian Hamilton is affiliated with Alcohol Research UK.
Alex Stevens is a member of the Advisory Council on the Misuse of Drugs. He was the lead author of its 2016 report on Reducing Opioid-Related Deaths in the UK. He does not speak for the ACMD, but writes here in his capacity as an academic.