1. Drug-Related Deaths in Suffolk Alison Amstutz Senior Health Improvement Commissioner (Sexual Health and Drugs and Alcohol) Public Health, Suffolk County Council

2. Note on Definitions & Terminology
Deaths related to drug poisoning - involving both legal and illegal drugs
Drug misuse - involving controlled drugs
A drug misuse death is defined as a death where:
the underlying cause is drug abuse or drug dependence
the underlying cause is drug poisoning and where any of the substances controlled under the Misuse of Drugs Act 1971 are involved

3. Note on Definitions & Terminology Cont.
Includes accidents and suicides involving drug poisonings, as well as deaths from drug abuse and drug dependence. They do not include other adverse effects of drugs (for example, anaphylactic shock), or other types of accidents (for example, a car crash) where the driver was under the influence of drugs.
Drug poisoning deaths involve a broad spectrum of substances, including legal and illegal drugs, prescription type drugs (either prescribed to the individual or obtained by other means) and over-the-counter medications. Some of these deaths may also be from complications of drug abuse, such as deep vein thrombosis or septicaemia from intravenous drug use, rather than an acute drug overdose.
Over half of all drug poisoning deaths involve more than one drug and/or alcohol - not possible to tell which substance was primarily responsible for the death.

4. Headlines
In 2016:
3,744 drug poisoning deaths involving both legal and illegal drugs in England and Wales; this is 70 higher than 2015 (an increase of 2%) and the highest number since comparable statistics began in 1993.
Of these 3,744 deaths, 69% (2,593) were drug misuse deaths.
Increase in the rate of deaths related to drug misuse in Wales from 58.3 deaths per 1 million population in 2015 to 66.9 per 1 million in 2016; deaths in England have remained comparable between 2015 and 2016.
People aged 40 to 49 years had the highest rate of drug misuse deaths in 2016, overtaking those aged 30 to 39 years.
Over half (54%) of all deaths related to drug poisoning in 2016 involved an opiate (mainly heroin and/or morphine).
The highest mortality rate from drug misuse was in the North East with 77.4 deaths per 1 million population, a 13% increase from 2015; the lowest rate (29.1 deaths per 1 million population) was in the East Midlands, which remained stable.

7. Suffolk Trend

8. Suffolk by District

9. How Does Suffolk Compare

10. Mortality by Selected Substances
Heroin and/or morphine
Benzodiazepines
Cocaine
Amphetamines
New psychoactive substances

11. Part 2

12. Maximising opportunities to reduce future drug-related deaths in Suffolk
Profile of drug-related deaths in Suffolk
Using reviews of drug-related deaths to enhance provision
Access to & quality of treatment services
Harm reduction as central to everyone’s work
Prioritise the care & treatment response to those identified as high risk DRD
Response to those leaving prison
Workforce development
Network development
Support to families & communities to better understand substance misuse & to develop preventative strategies

13. Profile of drug-related deaths in Suffolk
Identify sources of data
Data analysis:
Number of DRD
Number of near misses through monitoring of Naloxone usage
By gender, age, ethnicity, district
Alcohol alone
Drug alone by opioid, stimulant, other
Vulnerable characteristics
Trend data; comparison over time
National & regional comparison

14. Using reviews of drug-related deaths to enhance provision
Review SIRIs raised by Turning Point to inform practice & wider system issues
Establish process to learn from near misses
Stakeholder audit of SIRIs, including quality assurance
Multi-agency reviews where appropriate
Test out solutions
Develop a process to share learning & make recommendations for change across the system

15. Access to & quality of treatment services
Dissemination of access information, including out of hours provision
Quality visits, risk management
Benchmark drug treatment services against recommended practice
Strengthen joined up working between substance misuse services, mental health & housing
Work with GPs & acute doctors to support prescribing practices & dose optimisation

16. Harm reduction as central to everyone’s work
Ensure relevant services engaging with service users provide information & advice on risks of & preventing overdose
Availability of naloxone to appropriate organisations & service users
Ageing cohort of heroin users – focus on engaging in treatment – addressing other physical & mental health needs, BBV & HIV testing, safer injecting advice, COPD, CVD

17. Prioritise the care & treatment response to those identified as high risk DRD
Develop pathway between MVA & Turning Point for high risk clients
Explore possibility of cross referencing opiate overdose A&E data with Turning Point data to ascertain numbers engaged in treatment at time of overdose to inform assertive outreach
Investigate possibility of A&E supplying naloxone to opiate overdose patients
Disseminate MVA overdose toolkit
Develop a process to flag those who drop out of treatment, present at A&E, move to Suffolk

18. Response to those leaving prison
Ensure process in place for rapidly transferring service users between local prisons & Turning Point, including rapid access to prescribing
Explore possibility of naloxone provision for at risk Suffolk males on release from HMP Norwich

19. Workforce development
Understanding of high risk practices for targeted workforce groups; GP Practices, A&E, pharmacies, housing associations, substance misuse services

20. Network development Robust mechanism for dissemination of drug alerts
Service user input

21. Support to families & communities to better understand substance misuse & to develop preventative strategies
Emphasis on those families with multi-agency involvement
Service user & family engagement
Explore potential for co-production
Support to those bereaved by a DRD

22. Get involved Strategic Partnership Project groups Campaigns
Sharing good practice
Sharing evidence
Sharing data
Contact Sigi Mermagen

23. References
Office for National Statistics (2017) Deaths related to drug poisoning in England and Wales: 2016 registrations
Public Health England (2017) Health matters: preventing drug misuse deaths.
Public Health England (2016) Understanding and preventing drug-related deaths: The report of a national expert working group to investigate drug-related deaths in England
Public Health England (2013)Turning Evidence into Practice: Preventing drug-related deaths