Drug deaths antidepressant link
ANTIDEPRESSANTS have been linked to more fatal overdoses in Scotland than methadone for the third year in a row, amid a surge in drug deaths among people treated for depression and anxiety.
Although rarely the cause of death, antidepressants are increasingly being found in post-mortems of individuals who have suffered an accidental drug death, according to a report by ISD Scotland.
In 2016, they were mentioned in 47 per cent of post-mortems – up from 21 per cent in 2009. After heroin, morphine and alcohol, antidepressants were more likely to be detected than any other substance, including methadone, which was found in 373 post-mortems compared to 385 for antidepressants.
In about one-third of cases, the antidepressants had not been prescribed “[suggesting] that illicit use of these substances may be increasing or that their use may be a potential risk factor for drugrelated death”.
Heroin, morphine, methadone and buprenorphine – better known by the brand name Subutex – were still the leading causes of death, however. Pathologists blamed them for 618 of the 865 accidental drug deaths in Scotland in 2016. In the vast majority of fatal overdoses multiple substances were detected, however. Addicts often mix illicit and prescription drugs to enhance their high, but doing so significantly increases toxicity and risk of death.
In cases where people ended their lives intentionally by overdose, antidepressants were the most common cause of death – cited in 20 out of 47 suicides.
Dr Ahmed Khan, a consultant in addiction psychiatry and chair at the Royal College of Psychiatrists Scotland, said it partly reflected increased intervention.
He said: “When people abuse opiates their chances of having a depressive illness are very much higher - some people cite up to six times higher. More and more people with drug-related problems are now in contact with mental health services than ever before, and more and more people are subsequently being diagnosed with mental illnesses.”
It comes as figures also reveal that the number of drug deaths involving people recently treated for depression and anxiety have soared almost four-fold since 2009. In 2009, 98 people who died following an accidental overdose were recorded as having depression. By 2016, this had risen to 387. Among patients suffering from anxiety, non-intentional drug deaths have risen from 66 to 255 over the same period.
Meanwhile, drug deaths among patients treated for chronic pain have increased faster than for any other physical condition, from fewer than one per cent in 2009 to 11 per cent in 2016, or 90 cases.
Fatal overdoses, including opioid-related drug deaths, hit a record high in Scotland in 2016. Scotland’s drug-related death rate, at 16 per 100,000, is higher than anywhere else in the UK or Europe, and increasing. In the US, where the death rate from drug overdoses is running at 19.8 per 100,000, a national public health emergency has been declared in relation to opioids and the report added that Scotland’s “proximity to these high rates is noteworthy”.
Dr Khan added that Scotland had a long-standing issue with substance abuse. He said: “Even in the 1930s, barbiturate deaths in Scotland were the highest in the world. This situation with heroin is only 30 to 40 years old, it’s still relatively new. Even our alcohol problems remain terrible.”
SCOTLAND’S statistics in relation to alcohol abuse make for grim enough reading, but the country also suffers major problems with drugs. Our drug-related death rate is higher than anywhere else in the UK or Europe. And it’s increasing. Every year since 2014, numbers of both drug and opioid-related deaths have reached their highest recorded levels. All this is known, but a notable aspect of the latest statistics for fatal overdoses, issued yesterday, is the presence of antidepressants in victims.
Though not necessarily the cause of death, in 2016 they were found in 47 per cent of post-mortems. That’s an increase of 26 per cent from 2009. Part of the reason, as suggested by addictions expert Dr Ahmed Khan, seems to be that opiate users are more likely to suffer depression and have been increasingly referred to mental health services, where they are prescribed antidepressants.
It’s a grim picture. To appreciate the gravity of the situation regarding drug overdose deaths generally in Scotland, the rate at 16 per 100,000 is only 3.8 behind that in the United States – where it’s been declared a national public health emergency. We’re reaching a similar crisis point.
In both places, the situation suggests something deeply wrong in our societies. Drugs, like drink, are frequently taken as a form of escape. Individuals caught up in such problems are likely to be living among social deprivation, often alone and without a place in conventional society.
It’s the role of government to make our societies decent places to live in for all, not places from which to escape. In Scotland, with its complex constitutional position, we can argue indefinitely about whether any set of social circumstances is the responsibility of Holyrood or Westminster.
But this is not an issue where political finger-pointing is likely to achieve much. Certainly, there’s a place for antidepressants in mental health care and, indeed, campaigns to reduce the stigma of mental illness have caused more people to come forward for the likes of antidepressants.
Their increased association with the more serious end of drug use probably reflects their prevalence in wider society, though it was significant that, in this milieu, illicit use of such substances had increased.
Meanwhile, the stresses and strains of modern society, and the complex drug consumption that can go with these, won’t be tackled in a day. Longer-term solutions are required, such as more investment in mental health services, research into alternatives, and a better warning system to identify those at risk of overdose.
It’s dispiriting to keep hearing about Scotland’s desperate problems with drug and alcohol abuse. But we cannot give up hope that the situation can be changed.