Rehab 4 Addiction

Drug overdose rates in the UK up by 3.8% in 2020. Can NHS safe injecting rooms (SIRs) and prescriptions alleviate the problem?

UK government statistics (1) have shown that the incidence of drug overdose deaths grew by 3.8% between 2019 and 2020 in England and Wales.

Though the UK government has changed its policy in recent weeks with regard to illegal drug use, it has missed a key element – safe injecting rooms (SIRs).

These have proven to stop drug overdose deaths altogether where the drugs have been injected in the SIR.

In this article, we will review the death rates, look at a UK Faculty of Public Health public letter calling for SIRs to be included in government policy and review the evidence supporting such calls.

UK Drug Overdose Death Rates Up

Between 2019 and 2020 drug overdose death rates grew by 3.8%. Let’s look at the breakdown of these figures.

  • There were 4561 drug poisoning deaths
  • 3108 were men
  • 1453 were women
  • 2263 (49.6%) were from opiates, a 4.8% growth on 2019
  • 777 were from cocaine use, a 9.7% growth on 2019

The Office of National Statistics suggested five reasons for this increase in overdose death rates:

  • The most common age of those who have died is in the 45-49 range, suggesting weaker bodies to handle overdoses
  • Among those who use drugs, mixing opiates and cocaine with gabapentinoids and benzodiazepines has become fashionable. These increase the risks of overdose
  • Many of those who died had disengaged with drug treatment services
  • There has been a growth in the availability of cheap cocaine and heroin
  • The purity of both substances has improved too

Could UK drug overdose rates be dropped to zero?

Evidence from around the world has shown that this is a distinct possibility if safe injecting rooms (SIRs) were used.

Faculty of Public Health Calls for Safe Injecting Rooms

The UK Faculty of Public Health has published a public letter (2), signed by drugs professionals and doctors, calling for the provision of safe injecting rooms (SIRs) to end drug overdose deaths.

The letter points out that zero deaths have occurred in any SIR that has been established.

This is very slightly wrong as the Joseph Rowntree Foundation (3) reported that there was one death in Germany in 2002 where the user died of anaphylactic shock, a whole-body allergic reaction.

Referring to SIRs as ‘Overdose Prevention Centres (OPCs)’, the public letter states, “Available evidence demonstrates that OPCs are effective in preventing drug deaths, with reviews highlighting that there has never been a fatal overdose reported in the over 130 sites available globally. Evidence reviews also highlight the benefits of OPCs in facilitating patient referrals to treatment services and the adoption of safer injecting practices to reduce blood-borne virus transmission.”

In the next sections of this article, we will assess that evidence, both from the Joseph Rowntree Foundation (3) and a review of systematic reviews for the Welsh Government in 2017 (4).

Joseph Rowntree Foundation Report

Where it comes to harm reduction, it is important to understand that this isn’t to say that people simply stop having healthcare emergencies when they inject.

The Joseph Rowntree Foundation report (3) shows that SIRs merely offer safe places for these emergencies to take place.

The report showed that a study looking at a safe injecting room in New South Wales in Australia had 81 overdose incidents.

None led to death. These emergencies were quickly dealt with thanks to medically trained staff being on hand to be able to intervene in those incidents.

Naxolone, a medication that can halt the effects of opiates on the body, can be injected into the person and thereby save their lives.

At the same time, equipment is on hand at such SIRs to tackle problems such as cardiac arrest from an overdose of cocaine.

Having a doctor or a nurse at the unit at all times, so such emergencies can be quickly dealt with.

Where the user was out of sight of a medical professional this could result in their death – a very common problem with regards to the current death rate in England and Wales.

The medical professional can take appropriate action to resolve the incident, or call for help should such an incident escalate beyond their capabilities.

Another advantage shown by the report is that early intervention can be less costly in resources and money.

This is because less needs to be done at an early stage than should the user be found in a late stage of the crisis brought about by the overdose.

These advantages shown in the report are based on very strong evidence that in the next section we will review.

Advantages of Safe Injecting Rooms – Research

One of the highest grades of research available is the ‘systematic review’ that reviews the evidence of existing research papers.

In 2017 the devolved government of Wales commissioned a review of systematic reviews (4) to assess what the very best available evidence is on safe injecting rooms (SIRs).

The report showed that while the majority of SIRs around the world are in Europe, the majority of research has been into those in Australia, Canada and the US.

It did show that the evidence as a whole can be transferred between countries and cities.

Overall, the Welsh government review showed that SIRs:

  • Reduce overdose death rates and emergencies related to them
  • Reduce overall drug-related harm
  • Reduce drug use and dealing related incidents in public spaces
  • Reduces crime, violence and trafficking in the areas in which the SIRs are sited

The paper also showed that safe injecting rooms improve access to addiction treatment, though this is disputed in the JRF report (3).

The JRF report showed that while access was improved, there was neither a measurable drop in injected drug use nor an increase in the use of addiction treatment services.

SIRs are only about reducing harm and its costs to public health and should be used in conjunction with other strategies to reduce drug use.

The Welsh government report also showed that SIRs support the reduction in drug-related harms, that include:

  • Safer injecting conditions thanks to sterile equipment and the clean environment of the SIRs
  • Reduces syringe sharing and thereby blood-borne disease transmission
  • Thanks to the safe space, reduces the incidence of rushed injections
  • Improving the user’s control of the injection process
  • Increased the rates at which people sought education over safer injection practices

Some of these improvements in the environment could work together. Strikingly, the report showed that the reduction in risky injecting practices and the presence of healthcare workers together resulted in the reduction in overdose-related deaths.

This research showed that science is in a rare situation of almost being beyond reasonable doubt as to the positive benefits of SIRs.

Community Views of SIRs

With the evidence so concrete and the rates of overdose poisoning rates increasing in recent years across the UK, it appears that there is little in the way of evidence against them.

But what about community opinions, both among those who inject drugs and those who live and work near SIRs?

The Welsh government report (4) showed that communities surrounding the safe injecting rooms found that these reduced the impact of drug use in the immediate areas.

This included:

  • Less drug related trafficking and violence
  • Lower nuisance levels from public injecting and misbehaviour

The report also argued that harder-to-reach elements of the drug injecting community were more likely to use SIRs too. This is not entirely supported by the next paper we look at.

Other evidence (5) shows that the availability of clean and hygienic, supervised units for injecting drugs were widely welcomed by the drug-using community.

Briefly, the research that looked at the drug injecting community in Scotland found that 75% of users would be likely to use SIRs.

Those in city centres such as Glasgow and Edinburgh (83%) were more likely among this group than those who were away from such urban centres (72%).

Among the 1469 people who inject drugs surveyed, 87% of those who injected in public spaces showed a preference for a safe injecting room. Those who had an overdose also were more likely to use such a facility (80%).

It’s Just a Question of Politics

When one looks at other areas of science around illegal drugs such as the safety of cannabis, there is a genuine debate among research papers as to solutions.

For example, should increased community adult psychosis rates be accepted to reduce harm to minors?

Where it comes to safe injecting rooms on the other hand, there is very little in the way of empirical evidence against it.

With the evidence so strongly in favour, the decision can only be in the hands of politicians and government to make that decision.

As we have seen from the Faculty of Public Health letter (2) most health professionals in drug treatment are firmly in support.

Where politics is concerned, there is a great deal of ‘othering’ where the politicians tend to view the problem outside of the central concern of the electorate.

The injecting drug user is so badly stigmatised, it almost appears as if their lives matter less.

But where deaths can be stopped altogether, and in the case of England and Wales this amounts to well over 4,000 a year, the decision should be seen as one of humanity as opposed to mere politics.

Notes

  1. Deaths related to drug poisoning in England and Wales: 2020 registrations https://bit.ly/3yQTGB8
  2. FPH lead cross-sector call to pilot Overdose Prevention Centres in the UK https://www.fph.org.uk/news-events/fph-news/fph-lead-cross-sector-call-to-pilot-overdose-prevention-centres-in-the-uk/
  3. The Report of the Independent Working Group on Drug Consumption Rooms https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/9781859354711.pdf
  4. A Review of the Effectiveness of Medically Supervised Injecting Centres https://gov.wales/sites/default/files/publications/2019-01/180320atisn12038doc2_0.pdf
  5. High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs https://www.sciencedirect.com/science/article/pii/S0955395920300724
  6. See more in Alcohol Rehab in Bristol.
boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.