Agenda item

Report of Gerald Tompkins, Consultant in Public Health, Gateshead Council

The Committee received a report providing an update on the current position in Gateshead in respect of drug-related deaths and the action being taken to address this.

The Committee were advised that deaths involving opioids (such as heroin) account for the majority of drug poisoning deaths. Heroin related deaths in England and Wales have more than doubled since 2012 to the highest number since record began 20 years ago. Deaths also arise from misuse of other illegal substances including cocaine and new psychoactive substances (NPS), as well as from the misuse of prescription medication. Alcohol is also mentioned in around a third of drug misuse deaths annually in England.

In 2012 there were 6 DRDs in Gateshead. By 2016 this had risen to 19, and in the period 2014-16 Gateshead had the 6^th highest rate of drug-related deaths in England. The number fell back to 12 in 2017, but already in 2018 there have been 18 deaths so far this year.

The 2016 annual report records that the Gateshead picture follows the national trend in terms of an increase in the number of deaths, gender and primary substance. The report records that:

·         In terms of demographic factors all but one of the 19 deaths were males, and 12 were between 19 and 34 years of age with oldest being 54. Seven people lived with family or friends, and in five of these cases at least one member of the family was in the house when the person died. Nine people lived alone and of these nine, six died alone. Three people were homeless, and all but one were unemployed.

·         Opioids (such as heroin) accounted for the majority of drug deaths (16) or were present in the system. Fifteen deaths involved opioids and diazepam. Prescription medications (Pregabalin and Gabapentin) were present in nine deaths in small amounts, a small number also had traces of over-the-counter medication. NPS accounted for the one female death. Alcohol was present in half of the deaths, which is higher than the national average.

·         14 people were open or known to the adult drug and alcohol service (Evolve), 10 were currently in treatment, four were previously known. Five were not known to the drug and alcohol service, one of whom was prescribed by their GP (not in shared care).

·         13 of the19 cases had some form of mental health condition or had previously attempted suicide (though note deaths from suicide are not included in the DRD figures, even where the deceased is a known user).

Similar analysis will be included in the 2017 annual report, which has not yet been published. Overall there were 12 deaths and analysis to date shows that:

There were 8 males and 4 females, with ages ranging from 31-50;

Most were known to treatment services, and most of those were still in treatment at the time of death;

The majority were long term drug users and known to use multiple substances;

Majority were known to multiple services and were known to have some sort of mental health condition – anxiety, depression

The analysis to date of the deaths in 2018 suggests common factors:

·         Most of the deaths are of men, aged 30-46;

·         Most were long term users;

·         Most involve multiple substances including prescription and illegal drugs, as well as alcohol; and

·         Cocaine is emerging as a factor

The Committee were advised that progress to date is as follows:-

·         Naloxone is now routinely issued to those dependent on opioids. Naloxone is an injectable medication that acts rapidly to block the effects of opioids, especially in overdose

·         In 2017, the Public Health team undertook a review and audit of substance misuse services, focused on shared care with the outcome reported to the Health and Wellbeing Board in October. In the light of the review, the Council has developed a revised model for local substance misuse services, and the procurement process for this is currently in progress;

·         Immediate action was taken (in 2017) in respect of safety issues concerning the prescribing of methadone in high strength forms (10mg/1ml), given the increased risk it poses if supervised doses find their way into communities and the rise in drug related deaths locally and regionally. Public Health met with the CCG and wrote to GPs to highlight this issue and remove this option for prescribing from the formulary;

·         The pathway of care was also amended to ensure all new service users commence their treatment with Evolve, initiating and stabilising on their opioid substitution treatment before being referred back to their local GP;

·         For complex service users, such as those also requiring prescriptions for Gabapentin and Pregabalin, GPs must also consult with Evolve and refer where required. This was to help address the issue of inadvertent prescribing of ‘abusable’ medication e.g. Gabapentin, Benzodiazepines and Pregabalin;

·         The completion of the Gateshead Substance Misuse Strategy and the resulting action plans has galvanised multi-agency working by the following shared objectives:

o   Reduce demand/Prevention across the life course

o   Reduce supply/Protection and responsibility

o   Build recovery/Health and Wellbeing services

·         The Dual Diagnosis/Needs group has been established to address issues of substance misuse and mental health;

·         Continued development of referral pathways within the Criminal Justice Systems (including prisons);

·         The DRD panel organised a workshop to be held in early June to examine in more depth the factors behind the rise in deaths in 2018.