As the Conservative Party Conference comes to a close it’s an important time to reflect on the unprecedented number of lives lost to preventable drug related deaths in England and Wales last year.

While drug reform isn’t high on the Conservative Party agenda, further criminalisation and stigmatisation of people who use drugs seems to be. At the 2021 Conservative party conference Priti Patel reinstated the classic ‘tough on crime’ rhetoric, promising to double down on middle class and recreational drug users, in an attempt to curve drug use and supply in the UK. However, as many in policy space would agree, the proposed strategy will do nothing to tackle the immense level of drug related harm and deaths in this country.

The latest ONS data for drug related deaths (DRDs) in England and Wales revealed an expected, but undoubtedly tragic, increase in the number of people dying from drug related harm in 2020. It’s disheartening that again we are seeing a record number of deaths as a result of harmful and ineffective drug policy. Many of us advocating for reform are saddened that we have to reiterate our calls for the Conservative government to take urgent action. The only way we will address this national crisis is progressive drug policy reforms, and major investment into treatment and harm reduction services.

As echoed by George Charlton back in August:

 “I’m lost for words, but not at all surprised to see another rise in UK drug related deaths. It’s a tragedy that so many families have once again lost so many loved ones to needless and avoidable drug related deaths. How can we expect anything else but more deaths as the cowardly government continues to bury its head in the sand, and follow a strategy which even Dame Carol Black says in her laters report, is broken.” 

Deaths relating to drug misuse in England and Wales

The ONS data shows that there were 4,561 deaths relating to drug poisoning in 2020, this is an increase of 3.8% since 2019. The statistical analysis states this isn’t a significant increase from the previous year. However, it’s extremely concerning to see after a decade of austerity under a Conservative party government the number of DRDs have more than doubled.

Advocates have repeatedly raised concerns how the pandemic would impact the most vulnerable groups in society, and the knock on effect this would have for drug related harm and deaths. While the latest statistics aren’t reflective of this period, seeing an increase of 3.8% deaths from the previous year certainly signals a devastating increase in lives lost during 2021.

This shows that the endless calls from advocates are not being taken seriously enough. While the Conservative government says they are committed to addressing drug related harm, they appear to be doing so by using the same ineffective approach from the past 50 years. The exact approach these latest statistics show doesn’t work. George Charlton said:

“It seems to me that politicians are more concerned about winning votes, keeping their seats, and not upsetting their constituents; whilst knowing that their lack of action is killing people who use drugs. Every one of the needless and avoidable 4561 deaths are more than just numbers, they are someone’s son, someone’s daughter, Someone’s husband, Someone’s wife, they are someone’s Life.”  

Gendered differences in drug related deaths 

Another key finding shows that males accounted for 68% of total deaths relating to drugs in 2020. This gendered difference in drug related harm is a persistent trend, and an area of policy that needs some more attention. We already know that men are more likely to be diagnosed with a mental health condition, and more likely to commit suicide as a result of poor mental health. Problematic drug use is often a strong indicator of poor mental wellbeing, and more needs to be done to support men.

Regional differences in drug related deaths 

There were dramatic regional differences in the rates of DRDs across the country. In the North East there were 104.6 deaths per million people, the highest rate in the country; which accounted for 9% of all DRDs in England. There was also a significant increase in the rates of DRDs in the North West (74.2 per million), East Midlands (43 per million) and West Midlands (58.4 per million), as well as slight increases in the East, South East and South West of the country. 

Comparatively the rate of DRDs in London has decreased since 2019, with 33.1 deaths per million people in 2020; although DRDs in London accounts for 10% of all DRDs in England. As raised previously, the North-South divide is very clear when looking at drug related deaths and harm across the country. It’s well understood that the disproportionate level of DRDs in the North of the country is linked to pervasive social, economic and political marginalisation, and the level of deprivation and poverty that is prevalent in these areas. 

Key findings in Wales 

In Wales the rate of DRDs has decreased from 56.2 per million in 2019, to 51.1 per million in 2020, which is the lowest since 2014, and lower than the rate for England. It is encouraging to see a decrease in the number of DRDs taking place in this part of the country; especially considering that less than a decade ago the rate of DRDs in Wales was higher than any other region in England. Although the CEO of Kaleidoscope, Martin Blakebrough, said there is much more to be done to reduce the number of lives lost to drug related harm.

“Luckily, Wales has not suffered the budget cuts to drug and alcohol services that England has, but despite some positive stats, there’s a lot more to be done. Our government takes a health based approach toward drug use, but we are still hampered by many Home Office policies that impede our approach. Current laws are not fit for purpose. They prevent us from setting up safer places to inject, and allow for the incarceration of many drug users who fit the profile of real complexity and vulnerability. Inmates with serious mental health issues are left to deteriorate in prison. Today’s figures are loud and clear, when nothing changes, nothing changes.” 

But clearly something is working here, and it’s important that we recognise this improvement, and ultimately celebrate the lives that have been saved in Wales. Martin Blakebrough believes that the roll out of Naloxone is helping to save lives.

“In Wales I believe the roll out of overdose reversing Naloxone is beginning to make a difference, not least because people who use drugs are at the centre of its provision, distributing the kits and training through their peer networks. Our Peer to Peer Naloxone Pilot, co-produced with the Welsh Government, saw a team with lived experience deliver 237 lifesaving kits into the hands of those who need them most. That’s 237 more people on the streets of Newport trained to reverse overdose with a kit at their disposal. The target for the pilot was 60, yet the group delivered four times as many in just two months.”  

Martin also highlights that there have been advancements within effective treatment medications, which is contributing to the reduction in drug related deaths, however highlights the importance of further investment and reform to address this crisis. 

“In Wales we have also led the way with the novel treatment Buvidal, an opiate replacement therapy which is injected once a month. This frees our patients’ time to focus on improving other areas of their lives, such as finding employment and housing. This medication has become another tool in our treatment toolbox, thanks to leadership at Governmental level and the flexibility of prescribing agencies such as Kaleidoscope and our NHS partners in Gwent and Cardiff. Innovations like this, combined with further investment and drug law reform could turn the tide on drug related death. Let’s support, not punish, people who use drugs.’’ 

Drug related deaths across age cohorts

There is a distinctive cohort from Gen X that are disproportionately affected by drug related harm and death; we are at the point where we recognise this is a problem, but policy hasn’t gone far enough to proactively address this ongoing trend.

Deaths relating to drug misuse was the lowest among those under 20, accounting for less than 1% of DRDs. This is an important finding to consider, because often the media and politicians talk of the harm that drugs cause to young people. Without a doubt drug related death amongst young people is an awful reality; however there is a need for us to be realistic in acknowledging that drug related harm and death is most prevalent amongst those aged 45-59, accounting for over 21% of DRDs; as well as those aged 50-59, accounting for 18% of DRDs.   

Types of drugs involved in drug related deaths 

Nearly 50% of all DRDs involved an opiate; with heroin and morphine present in 59% of these deaths; which is fairly consistent with previous years. The statistics also show there has been a considerable hike in deaths involving codeine (not from compound formula). In 2019 there were 2.9 deaths per 1 million, in 2020 there are 3.7 per 1 million. Where deaths are involving opiates it’s important to consider how they could have been prevented with life saving treatments, such as Naloxone. 

Deaths involving cocaine accounted for 17% of DRDs in 2020, which is an increase of 9.7% since 2019. This is quite a dramatic increase, and again, an important finding that needs to be addressed. While there’s no drug like Naloxone to reverse a cocaine overdose, there are other medical inventions, such as defibrillation, which can help to save lives. 

Deaths involving any amphetamine accounted for 4% of DRD’s, of which under half were caused by MDMA (82 deaths). It’s clear that MDMA equates to relatively less harm than other drugs, and it’s important to question whether policy reforms, harm reduction education, drug testing and faster medical intervention could have prevented these deaths. 

Less than 1% of DRDs involved cannabis, and it’s unlikely that cannabis alone would have caused these deaths. This shows that cannabis is comparatively less harmful than other drugs, including prescribable drugs, and reinforces our calls for legalisation and regulation. 

Deaths involving prescription drugs 

Where deaths occur as a result of prescription drugs, education around the harms of these types of drugs is really important. People may see these types of drugs as inherently less harmful because of their pharmaceutical status, but like any medication there are risks, especially when mixed with other drugs and alcohol. 

In 2020 over 10% of DRDs involve benzodiazepines, which has increased by 1% since 2019. It’s difficult to know whether they were prescribed or bought from the illicit market, which is why educating users is of key importance here. 

Moreover, antidepressants were involved in 11% of deaths, this shows the complex relationship between mental health and drug use; and perhaps signals the importance of non-pharmaceutical therapies for these groups. 

Solutions to prevent drug related deaths

There is no single solution for this tragic loss of life. Problematic drug use and drug related harm and death is a complex problem to tackle, and will require a dynamic response. It’s fantastic to see more areas of the country initiating diversion schemes, for those found in possession of drugs for personal use. This will play an important role in breaking cycles of incarceration, which perpetuates harms experienced by problematic drug users, and creates a pathway for drug treatment and social intervention.

The next vital step would be to decriminalise the possession of small quantities of drugs, to ensure that  drug use is no longer seen as a criminal issue, but rightly recognised as a health and medical issue. It’s clear from the positive impact that decriminalisation has had in Portugal that this will be an essential step forward. The recent de facto decriminalisation of Class A drugs in Scotland signals a possible push for reform across the UK, which is supported by the leader of the Opposition, Keir Starmer. While this leaves many advocates hopeful, the Conservative party, namely Priti Patel, remain heavily opposed to such reforms. 

There is a significant amount of work to be done around de-stigmatising drug use and people who use drugs, as long as people continue to believe that people who take drugs are in some way undeserving of life, there will be more lives lost. Unfortunately the current strategy promoted by Priti Patel at the Conservative Party conference this year shows there is very little progress towards the humanisation of these groups within politics. Instead, the Conservative government seems committed to demonising certain groups, such as the middle class and recreational drug users, in an attempt to shift the narrative away from drug policy failures.

Finally, as raised by Dame Carol Black, there is a dire need for further investment into drug treatment services, as well as the roll out of crucial harm reduction services and interventions, such as drug consumption rooms. George Charlton said:

“The question I’m left with is whether Boris will get his head out of the sand and show great leadership and repeal the failed MODA, follow the global evidence base around harm reduction, listen to Dame Carol Black and the ACMD, all of whom point to what works  and show that he genuinely cares about the lives of people who use drugs”.

The persistent rise in drug related deaths shows that we need to urgently review how we treat and respond to drug related harm and death in this country. Priti Patel’s speech at the Conservative Party conference is not only concerning, but outright harmful. Immediate action needs to be taken by the Conservative government to address this crisis. While simultaneously assessing what has already worked in certain parts of the country, for example Wales, and how we can streamline these responses across the whole country.

Drug related deaths are preventable, prohibition doesn’t work; something has to give or we will continue to see such a harrowing loss of life year on year.

This piece was written by Content Officer Ella Walsh tweets @snoop_ella

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