Figures for drugs overdose deaths are shocking but they are avoidable

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TODAY the Scottish Drugs Forum holds a conference in Glasgow to mark International Overdose Awareness Day. For Scotland this is particularly poignant, as new figures show another record high of 706 deaths from drugs overdose in 2015. The average age of the people who died was just 42. These are the ultimate indicators of our health inequalities.

These deaths are tragic for individuals, friends and family. The impact of a death on parents, partners and children can be devastating. A second consecutive record year in terms of this toll begins to take on the dimensions of a national tragedy. The hope and challenge lie in the fact that this tragedy could be avoided. These deaths are not inevitable; they are preventable. We know enough about how to protect people but our systems and services fail to prevent these deaths. The evidence is clear. Other countries have reduced overdose deaths to relatively low numbers by providing effective services based in evidence and a shared vision of what can be achieved and how. Critically, they have maximised the proportion of their drug users in these services.

Latest figures show Scotland has an all-time high of 61,500 people with an opiate or benzodiazepine (a class of psychoactive drugs) problem. Less than 50 per cent of this group is in treatment. We know that being in effective treatment protects people against overdose. We need to look at ways to increase the reach and retention rates of services.

The conference will explore additional provision that would increase engagement with the most vulnerable problem drug users and encourage further engagement via supervised injecting facilities (Sif) and heroin assisted treatment (Hat).

Hundreds of people suffer the indignity of injecting drugs in public spaces that are unsanitary and unsafe. International evidence shows there are practical means to address this issue that would also reduce overdose deaths. There are various forms of Sifs: legally sanctioned sites where people can use their pre-obtained drugs under supervision from trained staff. There has never been an overdose death in such a facility anywhere in the world.

There are various models of supervised injecting facilities worldwide. In 2014, there were 88 such centres in Denmark, Norway, Germany, Netherlands, Spain, Switzerland, Canada and Australia.

The main objectives of such services are to reduce mortality and morbidity; provide an environment that enables lower-risk, more hygienic drug consumption; stabilise and promote the health of people who use drugs; reach as much of the target population as possible; reduce public drug use and associated nuisance; and avoid increases in crime in and around the facilities

The evidence of effectiveness to meet these objectives is overwhelming; the case for providing such facilities in Scotland is pressing and clear. Sifs can be regarded as an extension of needle and syringe programmes: if we provide people with sterile equipment to inject drugs, we should provide a sterile environment in which to do so.

Today Dr Marianne Jauncey, medical director of a Sif in Sydney, Australia will share her experience and Marcus Keane, of the Ana Liffey Drug Project in Ireland, will be talking about the progress on providing a Sif in Dublin.

Heroin-assisted treatment – the prescribing and supervised injecting of diamorphine – is also well evidenced in several countries. Findings from international trials suggest that the supervision of “medicinal heroin” can be an effective treatment for a small number of people who have previously been failed by other treatments such as methadone and buprenorphine.

Hat was introduced in Switzerland in the 1990’s and Dr Thilo Beck will talk about the Swiss experience. Professor Sir John Strang will present on the UK randomised injectable opioid treatment trial that had encouraging results. There are valuable lessons for Scotland.

Preservation of life should be a primary aim of services and our national aspiration. We speak eloquently about equalities and inclusion. Yet our drug death figures represent a national challenge to our image of ourselves. The development of evidence-based, life-saving services would be an opportunity to show that we care. We can rise to the challenge and grasp the opportunity. David Liddell is chief executive of the Scottish Drugs Forum.