‘Hidden killer’ fears as drug deaths spike
From just a handful a year in Wales, the number of heroin deaths has risen significantly. Estel Farell-Roig looks at the situation
THE number of deaths in Wales caused by heroin and other opiates is spiralling, amid fears that spending cuts are squeezing access to potentially lifesaving treatments for the most at-risk drug users.
Over the course of the past 15 years, opiate-related deaths in Wales have trebled. And while charities are cautious of linking tightening budgets directly with increased death rates, a special investigation conducted by Wales Online found multiple users had experienced serious delays in gaining access to crucial opiate-replacement therapy treatments.
Martin Blakeborough, chief executive of drugs charity Kaleidoscope, said “We are hit by 0% budgets, with nurses having wage increases of 2.5%, so we will have to make cuts to services.”
THE other week, Lisa went to buy £100 worth of heroin – instead she was given brown sugar. But, it was too late and, by the time she noticed, she had already injected some into her groin. Now, her right leg is swollen and she had to spend some time in hospital earlier this month.
“Every time I inject, I worry it is going to be the last one,” she said.
Lisa is right to be worried – especially because heroin deaths have been slowly rising since the early 1990s in Wales, according to the ONS.
In Swansea, the number of deaths where any opiates were mentioned on the drug certificate has grown consistently from around three or four a year in the early 1990s to more than 20 a year in recent years and a tragic 40 deaths from opiates in 2017.
In Cardiff the picture is similar, with as few as one death in 1994 and a peak of 24 deaths in 2016.
Across Wales, the figures show the number of deaths rising steadily to 58 in 2000 and on to 158 in 2016.
Although heroin is the most commonly cited opiate, in 2017, there were also three deaths where fentanyl was recorded on the death certificate – a powerful opioid which is up to 100 times stronger than morphine.
Lisa, who said she has also been sold heroin that is so “dirty” it doesn’t cook properly, has been using since she was 15 when she was first injected the drug.
She is now 36 and has spent the past 20 years trying to get clean – relapse after relapse. She has spent more time clean than not, she is quick to point out.
Lisa, who also smokes crack cocaine sometimes, is currently waiting to get back on her prescription of Suboxone, which is used to treat opioid addiction, after she was cut off last April for missing an appointment, she claims.
At the time, Lisa – who was living in Birchgrove, Swansea, before becoming homeless last week – was “looking so well”, in her own words, thanks to the medicine.
“I was thriving, I was doing lots of writing and doing courses,” says Lisa, speaking from a shop doorway in Swansea city centre, covered in a black blanket and smoking a cigarette. “I was doing so well.
“An appointment is all it takes. I have a bipolar disorder and I struggle with appointments.
“I wouldn’t be sitting here if I was on the script – getting on the script would change my life. I wouldn’t need to mix with people who use drugs then.
“The process should be quicker. It is the system that has messed me up.”
Research has shown that drugs like methadone or buprenorphine (which Sudoxone contains) – a group of treatments known as opiate replacement therapy – are effective at treating addiction.
Some claim that real-terms spending cuts have made it harder for addicts to access such treatments and are contributing to the rise in deaths, however drugs charities in Wales are reluctant to link the two.
Lisa, who has also spent time living in Port Talbot, claims she has been waiting since last April to get back on the prescription of Suboxone, but says she is very close now and she has been given a key worker with the community drugs team.
In a couple of weeks, Lisa could be back on the script and getting her life back on track.
She said: “I don’t want to be ill – I am scared of withdrawing. I am using heroin to survive.
“I was clean for eight years, it is only recently I have started using again.”
When she is withdrawing, she told us, her whole body aches and she starts vomiting.
Lisa thinks the increase in deaths may be linked to the fact people don’t know the strength of what they are using as well as people mixing the Class A drug with drugs such as Valium, which is used to treat anxiety and typically produces a calming effect.
Lisa said her tolerance is quite high but that she doesn’t use any tablets on top, adding, if there were facilities where she could have the drug tested, she would have them tested before injecting.
Another change in recent years is how much “advertising” drug dealers do, said Michael (not his real name), who used to drink alcohol heavily as well as smoking heroin.
Michael, who relapsed after losing his daughter a year-and-a-half ago, said drug dealers are texting him “all the time, and so many of them”.
“There are lots of them – they walk around like they own this place,” he continued. “If you don’t answer to their text, they will ring you. They are trying to squeeze all the money out of you.
“Today alone I have had 16 messages from drug dealers.”
Lisa agreed, saying she has already had several texts from dealers by 9am.
“I get texts from six or seven different dealers and they are texting me at different times of the day,” she added.
Michael, from Swansea, isn’t using at the moment and is currently on a methadone pro-
I wouldn’t be sitting here if I was on the script - getting on the script would change my life. I wouldn’t need to mix with people who use drugs then - Lisa
gramme. However, he is unable to remember exactly for how long. The 46-year-old, who first tried heroin when he moved to Wales in his 20s, claimed it is quicker for people to get help if they commit a crime.
Barrie, who has previously opened up about his struggles with heroin addiction, agreed with Lisa and Michael that more people seem to be mixing heroin with other drugs.
But he thinks the increase in heroin deaths may also be linked with an increase in the quality of the heroin available in the area.
Barrie – who first tried heroin at the age of 13 when a drug dealer gave it to him, together with crack – has tried to get clean a couple of times in the past, but, because of his mental health problems, he ends up using again.
At the moment, the 34-yearold, injects twice a day – in the morning and at night.
Recently, he has been trying to put his life back together – but, since we published his story back in June, his house has been raided by police and his life is now full of uncertainty.
Barrie – who has been living in the property in Victoria Road, Port Talbot, since April last year – said police burst into the property at around 8am.
The landlord has now told them he wants them out of the property because he needs to carry out works.
Unless they find somewhere else, in less than a month, Barrie, his brother Trevor and his friend Ryan will be out on the streets. They would be joining the increasing number of homeless people in Neath Port Talbot, which has seen the number of homeless people triple in one year due to a a combination of factors.
“I was not happy when the police came in but I felt there was nothing I could do,” said Barrie, speaking from his bed as he smokes a cigarette. Their home consists of one small room – and quite a lot of space is taken over by the two beds – but they try to keep it tidy.
Barrie, however, doesn’t look well – he has lost weight since we last saw him and, even though he is just as eloquent as last time, his appearance looks a little bit less looked after.
“It is depressing because I was just trying to get back on my feet – they say they try to help but I don’t see how,” said Barrie.
“I can’t see a way out – it is really hard. I have been on the streets before and it is not a nice prospect. It would probably make my habit worse.”
He added: “I would like to stop, but heroin is the only thing that gives me escapism. What they are doing isn’t really helping and, as soon as you are in the system, you can’t get out. It is a circle and you can’t get out.”
Barrie, is from Neath Port Talbot, a county with one of the UK’s 10 worst heroin death rates. Between 2014 and 2016, it had a rate of 5.7 deaths per 100,000 people caused by heroin and morphine misuse, the highest in Wales. The average across England is 1.9, while in Wales it’s 2.3. Neighbouring Swansea is also high, with 4.9 deaths per 100,000.
This increase in heroin deaths comes at the same time two Welsh counties have been named in the top five hotspots for drug deaths in England and Wales in 2017 .
Neath Port Talbot had the highest rate in Wales for deaths related to drug misuse. This was the second highest in the UK – only Blackpool was higher. Swansea had the fourth highest.
If falling government spending is to blame, the evidence is not clear cut.
In Wales, substance misuse services receive funding from the Welsh Government, local authorities and organisations such as the police.
The Welsh Government has maintained the funding of nearly £50 million to tackle substance misuse in the past few years, with the funding having stayed at £49.181 million since 2014-15 after it was cut £500,000 from £49.681 million in 2013-14.
This is a smaller cut than in England where the BBC found £162 million had been cut from treatment budgets over the same period, but still accounts for a drop when inflation is taken into account.
We spoke to councils around Wales to find out how much money they were allocating to help drug addicts.
Among the biggest drops in spending was at Cardiff Council, where it has fallen by almost 20% since 2013; from £1,556,833 in 2013-14 to £1,236,869 in 2017-18.
The Western Bay Area Planning Board – a partnership of all agencies in Swansea, Neath Port Talbot and Bridgend involved – has seen spending reduced by a smaller amount, just under £100,000; from £5,241,726 in 2013-14 to £5,146,171 in 201718.
A Welsh Government spokesman said: “We are committed to tackling the avoidable harm caused by substance misuse.
“Despite continued cuts to our overall budget by the UK Government we have maintained funding of nearly £50 million a year to tackle substance misuse, including work to reduce heroin overdoses.”
The spokesman said that, since the launch their substance misuse strategy in 2008, they have seen sustained improvements in waiting times for services.
“Data on drug related deaths is used as part of a mix of evidence to help us formulate policy,” he added. “However, the number of drug deaths in Wales are relatively small and fluctuate from year-to-year and not necessarily because of increased drug usage.”
Rob Barker, Cwm Taf service manager for drug support service Barod, said that he didn’t know whether people using heroin with other depressant based substances such as Valium and alcohol is one of the main reasons behind the increase, but said poly drug use of this kind increases the risk of experiencing an overdose, whether fatal or non-fatal.
“It is therefore vital that those who do undertake such behaviour have access to Naloxone [a medication used to block the effects of opioids] and do not use substances out of sight of other people, just in case they do overdose,” he added.
Mr Barker said access to Opioid Substitute Treatment (OST) is a pivotal part of the journey of recovery for some and it is vital that it is readily accessible as it provides a benefits such as access to a variety of health-care services, structure and responsibility within that person daily/ weekly lives and a reduction in drug-related crime.
They focus on doing outreach work to try to engage with people, Mr Barker said, and one of the biggest barriers to accessing treatment is stigma.
Martin Blakebrough, chief executive of the drug and alcohol charity Kaleidoscope, said the budget to services hasn’t been cut but hasn’t been increased either, which means it has been cut when factoring in cost of living.
He added that, as a provider, they have had cuts via the Welsh Government via the slashing of capital money, meaning they now have to find money for rent of building or IT.
“We are also hit by 0% budgets, with nurses having wage increases of 2.5%, so we will have to make cuts to services,” he added. “Things are not as bad as in England.
“We still however have uneven services and cuts does mean waiting lists to get into services.”
Mr Blakebrough said there is around a ten week wait to access methadone treatment in Newport .
Still, Barrie feels services don’t understand people struggling with addiction like himself and he doesn’t think “one million appointments” is the solution. It is quite hard to get help as they make you go through so many “hoops”, he said, and, if you miss an appointment, they may cut you off your script.
He claimed there is a threemonth waiting list to get methadone and then, if you miss an appointment, they cut you off so you are back to square one.
Barrie claimed a lot of people try to get help but then they fall out of favour with services for missing an appointment.
Despite everything, Barrie tries to stay positive; he also has goals and, if he was to get clean, he would like to finish the A-level in art he started at Parc Prison.