Scotland's drug deaths could be cut if we cared enough to intervene

Scotland's drug deaths could be cut if we cared enough to intervene

by Jonathan Stanley
article from Tuesday 12, February, 2019

YOU WOULD THINK it was the late 80s again. Yet Scotland, with about 8 per cent of the UK population, accounts for two thirds of deaths related to counterfeit alprazolam. Latest figuresshow that in total there were 934 drug-related deaths in Scotland in 2017, the largest number since records began in 1996 and more than double the figure from 2007.

We should be honest. Drug addicts are not looked on kindly by wider society and often for understandable reasons. It can be easy to be blindsided by this in considering their health and their survival. But old addicts don't just fade away, they die. We must tackle the drugs that kill them.

The Scottish Government's own data shows there is an ageing drug addict population in Scotland, and the average age is rising all the time. Many are 'maintained' on methadone and take a multitude of other drugs, legal and otherwise. The danger is such a cohort is treated as some hangover or legacy from earlier times and so not of great clinical priority.

Multiple drug combinations feature heavily in drug-related deaths as worryingly do a number of novel and long-duration sedatives. This is where alprazolam and etizolam feature. Neither has a function within the NHS yet are available on private prescription or otherwise imported illegally. Then there are pills marketed by illegal drug dealers as Xanax (alprazolam) but are in fact etizolam.  There were 126 fatalities in Scotland from Xanax or fake Xanax between 2015 and 2017.

I find it bizarre that such drugs are classed as Class C drugs when in overdose or in combination with others are clearly lethal and highly addictive. 

I find it chilling one third of all people who died from drug overdoses had a recorded diagnosis of chest problems within six months of death. 

It is sad and shocking that about three quarters of those dying from drug overdose had been using drugs for ten years or more before they died. Most of them live alone and almost all in their own homes. They leave a significant number of bereaved children every year. About half live in the poorest fifth of the population and existing evidence tells us this is associated with poor health outcomes.

These are not the hidden ill. These are people in poor health with known drug problems who are accessing primary or even secondary healthcare. Chest problems alongside drugs that depress the respiratory system hardly make for a healthy mix.

I'm furious the private market for hawking addictive drugs remains with us, concealed by professional reputation and autonomy. There simply isn't a role in the UK for a private market provision of addictive drugs. The conflict of interest must be obvious to anyone – that anyone making money from drugs that are addictive is a questionable practice. It is from these private prescriptions that many pills enter the black market. 

Health care is of course is devolved in Scotland. There is considerable pressure not to prescribe Valium-like drugs to patients for good reason, but otherwise mental healthcare remains poor. I have seen some of this first hand with cases badly served by overstretched GPs and a psychiatry service that takes months to deliver cursory assessments of patients, with essentially no oversight of their care and with minimal coordination with GPs.

While we can reclassify substance addiction as an illness without any change in the law, we also need instead to take the provision of addiction and mental health services seriously and redirect Police Scotland to treat ALL drugs that cause respiratory depression, including opioids andbenzodiazepines (Valium, Xanax) as Class A drugs and crack down on illicit and privately prescribed drugs.

Any private prescription for such addictive drugs in Scotland needs review. Every one. There can no hiding place outside the NHS where addicts can so easily access these drugs without some way of holding the prescriber to account. 

The mental health and well being of known long term addicts needs special attention and if requires a specialist service. Otherwise we are simply waiting for people to die of overdoses that we know are on their way to that horrid and tragic fate. 

There are no deserving and undeserving cases in healthcare and certainly not in a tax-funded public service. After 20 years of devolution why are we still doing so badly in preventing needless deaths and in failing to rehabilitate drug addicts?


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