While we were on the countdown to Christmas and enjoying everything that comes with the festive season, the 2022 drug-related-death figures for England and Wales, published by the Office for National Statistics, were announced, following a four-month delay. Professionally, it made us take stock of where we are and how far we still have to go, to help prevent people dying from substance use.
A total of 318 people across Wales lost their lives from substance use in 2022. It is easy to argue that that is 318 too many. All have left loved one’s behind and created a ripple effect of grief, anger, and sadness, on those affected, for the rest of their lives. For those that may have celebrated a drop in fatalities compared to the year before (322 people died from a drug-related death in 2021), those celebrations should be short lived. The latest figures are the third highest on record and we are facing some significant challenges that could stretch individuals, services, and policymakers like never before.
One of the major concerns we face is the ever-growing use of cocaine and crack cocaine, of which is translating to an increasing number of fatalities associated to the stimulant-based substance, each year. Just eight years ago in 2014, there was a recorded total of 7 deaths associated to cocaine in Wales. Fast forward to 2022, and this figure now stands at 52. That is an unprecedented 643% increase.
It is a similar situation across the border, and so not unique to Wales. There are factors outside of our control as to why this is, from North America’s lack of demand for the stimulant in recent times, to the targeting of the European and UK drug markets by those in South America, to fill this void. Subsequently, we seem to have more cocaine on our streets than we have ever had before, resulting in ‘deals’ being made available by those selling, to be more ‘appetising’ to those buying. We now have around 180,000 people in the UK using crack cocaine, on top of those who use the powder form of the substance. It is likely that many also use other substance too, which can pose greater health related risks, including overdose. However, the current legislation deems it illegal for safer inhalation pipes (aka crack pipes) to be provided by harm reduction services such as needle and syringe provisions. Therefore, people who use crack have little incentive to engage with harm reduction services, yet initial findings from a study that is utilising pilot sites distributing crack pipes across the UK, say they are seeing up to 300 new people engaging with services. So, it is easy to see how harm reduction work, and how it can save lives.
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Another grave concern is the increase in fatalities, across England and Wales, associated to novel opioids. In 2022, a total of 39 people fell victim to such substances, compared to 3 in 2021. While there may be mitigating factors to this, including coroners now testing for such substances more routinely upon post-mortem examinations compared to the year before, it is also widely accepted that the 39 people identified is just the tip of the iceberg and this figure could be higher. To get a clearer picture moving forward, we need a more consistent approach across the country when it comes to testing for such substances following a death, but this does come at a financial cost. And what is around the corner could pull us deeper into a public health crisis.
Nitazenes are a group of synthetic opioids that are more toxic, dangerous, and lethal compared to their street heroin counterpart, with some substances within this group being up 500 times more potent and therefore significantly more deadly. The smallest of dose can pose a huge threat, often to people who unintentionally, and have no intention of, consuming the drug. Across the UK, nitazenes, upon analysis, have been found in heroin samples, as you may expect, with both being opioid-based substances. But what is alarming is that in Wales, they have been found, on numerous occasions, as confirmed by WEDINOS, within benzodiazepine samples. So, there is a likelihood that people with no previous experience and thus tolerance to opioids, could consume these dangerous substances. As nitazenes can come in many forms including pills and powders, without testing, it is hard to know whether they are in a drug sample. And this may just be the start. Up until 2022, Afghanistan was consistently the global leader for illicit opium poppy cultivation and opium production. However, following a ban enforced by the Taliban in relation to the cultivation and production of the substance, a significant decline has since been reported. With no sign of this ban being lifted, the threat and emergence of synthetic opioids such as nitazenes is a real one that we are already facing and there are widespread concerns that is only going in one direction. China, India and to a lesser extent, Russia, are now coming to the forefront as the main players in the production of these clandestine laboratory produced substances.
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So, what can be done? Firstly, we need to ensure that as many people as possible carry naloxone, even if they themselves don’t use opioids. Naloxone can temporarily reverse the effects of an opioid overdose, but as mentioned, people who use other substances may still encounter the likes of nitazenes. Naloxone is available from any drug and alcohol treatment service, as well as via Barod’s Wales-wide click and deliver service.
Given the fragile nature of our illicit drugs market, and the emergence of nitazenes, community-based drug checking services are paramount to helping identify rogue samples and allow people to make more informed decisions about their substance use. The Loop, a drug-checking service that have provided both front and back of house testing at festivals across the UK over the last few years, have since established a monthly drop-in drug checking service in Bristol. Essentially this allows people to walk in off the streets, get their substances tested and receive the results along with harm reduction information, within a matter of hours, if not quicker. It also allows for greater knowledge of what substances are in circulation that can then help advise other people. This is the first of its kind in the UK and will no doubt help save lives across the city.
There are a range of other solutions too, ideally established alongside one another. All eyes are on Glasgow following the announcement of the UK’s first legally sanctioned overdose prevention centre, due to be opened later this year in the Scottish city. Add access to rapid/ same day opioid substitution prescribing, diamorphine assisted treatment and drug diversion schemes, to name just a few, these harm reduction initiatives are doable, and have been facilitated with great success, across the UK. The implementation of such services does require financial backing, and it is imperative that if they were, they do not financially undermine what is already available.
But for now, we must be ready with what resources we currently have at our disposal. The substance use sector is resilient, and one that often rises to the challenge, often armed with limited resources and wealth of ingenuity and flexibility. But that can sometimes only take you so far, and we must urge those in power to help us establish services and facilities that can ultimately support a health-based approach to substance use, allowing for the creation of a more prosperous and equal Wales.
Rob Barker is the campaigns and communications lead for Barod. Rob previously undertook a Churchill Fellowship in 2017 researching the policies and procedures of establishing a drug consumption room. This research took Rob across North America and Europe. Twitter: @RobBarkerW