1. Drug-related deaths Phil Conley Health Improvement Programme Manager September 2015

2. ONS headlines 2014 figures published 3 September 2015 There were 3,346 drug poisoning deaths registered in England and Wales in 2014, the highest since comparable records began in 1993. Of these, 2,248 (or 67%) were drug misuse deaths involving illegal drugs. Deaths involving heroin and/or morphine increased by almost two-thirds between 2012 and 2014, from 579 to 952 deaths. Deaths involving cocaine increased sharply to 247 in 2014 – up from 169 deaths in 2013. In England there was a 17% rise in the drug misuse mortality rate. 21% increase last year. 2

3. Age-standardised mortality rate for drug-related deaths, by sex, deaths registered in 1993 to 2014 3

4. Age-standardised mortality rates for selected substances, England and Wales, deaths registered between 1993–2014 4 Benzodiazepines Rate per million population

5. Percentage of drug-related deaths mentioning (i) one substance alone and (ii) alcohol, 1993-2014 5

6. Age-specific mortality rate for drug misuse deaths registered in 1993 to 2014, England and Wales 6

7. Regional variation Highest rates in NE and NW / lowest in London (half). England 17% increase includes small falls in Y&H and EM (Wales decreasing and -16% this time). 7

8. Greater Manchester Crude mortality rate for deaths related to drug misuse, by local authority, deaths registered between 2006 and 2014 8

9. Possible causes? Year of death/reporting issue? – PHE analysis of 1999-2013 ONS data and NDTMS match suggests not. Push towards recovery and people leaving treatment before ready? – PHE analysis found little change in the proportion of opiate deaths where the individual had recently been in treatment (i.e. within one year). NB Treatment is a protective factor with majority of opiate deaths (60%) in 2011 had not been in treatment since at least the start of 2007 Heroin drought and then return …... at higher strength/purity? 9

10. Possible causes? Lack of naloxone coverage? Older, iller drug users more susceptible to OD / compromised health e.g. community acquired pneumonia reported as DRDs? More poly-drug (and alcohol) use? NPS Availability/use – e.g. more chem-sex / more GHB/GBL deaths Coroners switch to labs better at detecting NPS Increased prison release and post-prison deaths? Not learning the lessons – confidential inquiry coverage? Austerity? Thoughts / Possible solutions? 10

11. Naloxone - a relaxing of the rules 1 October 2015, new legislation - no need for the usual Prescription Only Medicine requirements, just a requirement that the supply is suitably recorded People employed or engaged in drug treatment services will be able to supply from: Specialist drug treatment services Primary care drug services Needle and syringe programmes, including those provided from pharmacies A pharmacy providing supervised consumption of opioid substitute medication Outreach workers would be able to carry stocks of naloxone and supply it to drug users Staff can supply individuals. The law does not list these so they could be a drug user, carer, friend, family member, hostel manager or an individual working in another facility where there may be a risk of opioid overdose 11