Posted on: 23 October, 2024
Today it has been revealed that 5,448 people tragically lost their lives to a drug related death (or drug poisoning) in the year recorded as 2023. This is the highest year on record, an increase of over 11% from 2022, the 12th consecutive year that deaths have risen and places the United Kingdom as the country with significantly the most deaths in Europe. Our deepest condolences go to all those who have been affected by a tragic drug death, and we hope that these shocking figures enable policy makers to recognise the immediate need for action to reduce further suffering.
Over half of these deaths involved more than one substance (often referred to as polydrug use), just under half of the deaths involved an opioid, whilst cocaine deaths surged by an astonishing 30%. Deaths related to cocaine have risen by over 1000% in just a decade, and may reflect the belief that cocaine is purer, cheaper and more available than ever before.
The Northeast of England – also one of the least affluent parts of the country – remains the highest for deaths by population rate, whilst London holds the lowest rate. This indicates that, like Scotland, people from more deprived areas are more likely to die from a drug related death. Deprivation, poverty and a lack of opportunity are deeply entwined with drug deaths and this highlights the need for addressing the underlying factors of substance dependency.
Wales also witnessed a sharp increase of deaths of over 18% meaning the rate of drug deaths is equivalent to 129.2 deaths per million people.
There is difficulty in analysing deaths related to the increased prevalence of synthetic opioids given that recording for these substances only began half way through the relevant time period. This, alongside delays in inquests and toxicology reports, means that we may not be seeing the full picture until 2026 or 2027 as almost two thirds of the recorded deaths are from years prior to 2023. There have however been recorded deaths related to synthetic opioids in every region in England.
Around a third of the deaths recorded were female (33%), with two thirds male and the most likely cohort of people to die from drugs in 2023 were those born in the 1970’s, which is consistent with previous recorded years. Deaths among young people in the cohorts under 20 and 20-29 thankfully both decreased, which may possibly reflect a reduction in use of controlled substances among young people.
The starkest rise by substance type is in cocaine deaths, and there is fear among providers that this group may not be those who are in treatment. Given the largest cohort of people by substance type is opioids, we need to consider how we can better reach people who use cocaine. Namely, people who use dangerous levels of cocaine, without fully understanding the harms on the body it can cause, given its relative social acceptability compared to other drugs. This harm is particularly pronounced for middle aged and older people, with increased risk of stroke, seizure and heart attacks.
This is particularly worrying as many people who use cocaine will be using it alongside alcohol. Alcohol and cocaine combine in the body to create cocaethylene, which is a different chemical with different, and often greater, harms. There are currently no medication options available for stimulant replacement drugs, so treatment is solely rooted in psychosocial interventions, which creates challenges for those aiming to manage cocaine use and treatment. From a public health perspective, a greater focus on reducing harmful levels of alcohol consumption may in turn reduce harmful levels of cocaine consumption.
The importance of effective drug treatment, and its benefits of reducing deaths is evidenced by the comparatively smaller increase of people dying from drugs who had methadone in their toxicology report. The protective factors of treatment are essential, however there is significant work to be done for providers to engage more people who use other drugs into the treatment system.
Today’s news is also worrying for treatment providers given a lack of clarity for funding related to the uplift announced in 2021. Assurances from government that the uplift will be ringfenced is essential to continue to develop treatment capacity responsive to need.
Recommendations:
There are several evidence-based measures, many of which were recommended by the Home Affairs Select Committee’s report on drugs last year, which must be implemented by the government at the earliest opportunity. These include greater use of diversion schemes, the trialling of overdose prevention centres and the use of diamorphine (heroin) assisted treatment which would all reduce drug harm.
Any approach must encompass a joined up, whole system strategy that utilises every possible tool to increase the number of people accessing treatment, and which educates people who use drugs on their harms, and how to mitigate these harms.
Cranstoun endeavours to provide an intervention for people to get treatment at every phase of the criminal justice system. Given the inextricable link between criminality and substance use, the use of ‘reachable moments’ such as on arrest, in custody or during incarceration are essential for engagement. Providers often struggle to reach the most at-risk cohorts and this, alongside enhanced outreach to meet people who use drugs where they are, are key to reducing deaths. Additionally, naloxone must be made more available, including in places like custody.
The criminality of possessing controlled substances does inherently increase risk for people using substances, and the government should look at legislative overhaul to change this, however in interim the use of effective diversion is essential. Diversion can better assist in reducing the root cause of offending, thereby reducing recidivism whilst assisting in reducing substance use through treatment and education.
Other methods for engaging more people in treatment, thereby reducing risk, includes the roll out of overdose prevention centres and widespread reintroduction of diamorphine assisted treatment. Not only do both ensure that people at risk are seeing trained health professionals every day, but they can help to tackle associated harms related to injecting practices and blood-borne viruses. Crucially, they help treatment providers engage more people who are unlikely otherwise to enter meaningful treatment.
Collaboration and information sharing between providers, government and other partners is essential to better understand the landscape of the drug market and how best to respond. This could be further improved with more funding, and wider roll out of drug checking services. Such interventions can go beyond treatment settings to educate people on the harms of their use, and how to get support or reduce said harm.
Summary
Cranstoun implores the new government to break from past administrations and implement a plan to address drug deaths which is rooted in evidence. It is promising that one of the ministers responsible for policies related to controlled substances – Dame Diana Johnson – has previously advocated for harm reduction measures in an official capacity, when she Chaired the Home Affairs Select Committee.
Without immediate actions, such as those recommended by Cranstoun, the UK is quickly heading towards a catastrophic public health emergency, of which the scale could be inconceivable, and the ability to turn the tide will become ever more challenging. There is still time for the impact to be mitigated, but time is quickly running out. Without being able to fully understand the scale until the publication of figures in 2026 or 2027, today’s figures must act as a strong warning signal of the scale of this crisis.
Our deepest thoughts and condolences are with all of those affected by a drug death. The scale of suffering is hard to comprehend and we will continue to champion the need for better policies which reduce preventable deaths.
Dr Steve Brinksman, Medical Director at Cranstoun, said: “This is the 12th consecutive year that drug-related deaths have risen. Now is an opportunity for the new government to take a fresh approach to address what is driving drug-related deaths.
“2023 was the year we saw potent, synthetic opioids, namely nitazenes, contaminate the drug supply in parts of the country, this has led to increased numbers of overdoses, and tragically more people losing their lives.
“Without a fresh and health-led effort, we risk sleepwalking into a similar crisis as we see in North America with these types of drugs.
“Breaking down barriers to help people access drug treatment, drug checking, better data and intelligence sharing and longer-term funding allocations would help organisations plan and mitigate some of these threats, but more importantly, keep people who use drugs safe.”
Luke O’Neil, Interim Director of New Business and Services, said: “Our condolences are with those who have tragically lost someone to drugs in 2023. Annual drug-related deaths have now almost doubled since 2010, and the families of all of those who have lost someone unnecessarily have our thoughts today.
“Now is the time for reform and collaboration – this should be an opportunity for the new government to set out a road map to address this travesty.
“We have continued to see that the areas where drug related deaths are highest, are in the areas of the country with the highest levels of deprivation. To truly get on top of this situation an approach which looks to tackle the root causes of poverty must also be at the heart any solution.
“However, due to delays in registrations for drug-related deaths, these statistics do not show the full picture for 2023. With almost two-thirds of the recorded deaths published today happening in years prior to 2023, the true picture is likely to be much bleaker.
“We’re also calling for on the government to ensure that the uplift in treatment funding, which is due to expire in 2025 is maintained and that the global evidence to tackle this crisis is followed.”
“Last year, when we first saw a spike in synthetic opioids we launched a major report, with cross-party backing, detailing how this crisis can be tackled. I hope that the government are able to look at our approach and recommendations and take them forwards. Our suggested approach would reduce the harm and cost associated with substance use, and save lives.”