The picture painted by the latest statistics on drug deaths in Britain is a sad one: of a large population of ageing, long-term heroin users – hangovers from the heroin epidemic of the 1980s and 90s – being increasingly ignored by health services, slowly keeling over, one by one.
Released this morning, the Office of National Statistics' drug-related death figures for 2015 show that the number of heroin-related deaths in England and Wales is the highest it's ever been – doubling from 579 in 2012 to 1,201 in 2015. Of the 2,479 deaths caused by illegal drugs, around half (1,201) are heroin-related, and it's these that are the main driver behind the rise in drug deaths from 2012 to 2015.
Ecstasy deaths have continued to climb back up to mid-2000s rates – there were 57 deaths in 2015 and 58 in 2005 – after a temporary fall due to the reduced MDMA content of pills. Cocaine deaths rose from 247 in 2014 to an all-time high of 320 in 2015. But this isn't quite the middle-class snorting crisis it seems: half of the cocaine deaths in 2015 also featured heroin on the death certificate, indicating the use of crack, rather than powder cocaine.
Most surprising is the doubling of deaths relating to mephedrone, from 22 in 2014 to 44 in 2015. In 2009, mephedrone – known as "meow meow" by the tabloids – was the first legal high to really reach the mainstream, and was banned amid much media panic in 2010. This could be reflective of a group of ageing former heroin users who started to inject mephedrone, or "M-smack", because of its cheap price.
But the real story here is that there has been a generational shift in drug fatalities. And this – as a report into the rise of drug deaths, published today by Public Health England, found – is mainly down to the fact that most of Britain's heroin-using population are old. As the ONS report notes, for the first time since records began in 1993, the mortality rate in 2015 was higher in people aged 50 to 69 than it was for those aged 20 to 29, and the biggest rise in heroin deaths was among people in that older age bracket.
What these statistics reveal is a tragic story about working class guys who typically started using heroin as teenagers 30 or 40 years ago, and may have received some help for their addiction when they were visible to the authorities – due to being homeless or nicking things – but since dropping off the radar have been left to their own devices.
Most of them are dying in the north-east and north-west of England, in places such as Blackpool and Burnley, where they have lived all their lives. In London – one of the epicentres of the 1980s heroin epidemic, alongside Liverpool, Manchester and Glasgow – people are dying from heroin at half the rate of those in the north. But this is likely because of the gentrification of the city. London has been decanting its long-term heroin users to outlying areas for years, because the houses of multiple occupation where they lived have been turned into luxury flats. Meanwhile, deaths in the north-east are the highest because the region suffered its heroin epidemic in the 1990s, and so fewer users had already died than those in areas hit during the 1980s.
For an insight into who is dying and why, I spoke to Paul Hayes, chief executive of Collective Voice, an umbrella group for third-sector substance misuse services. He was chief executive of the government's National Treatment Agency between 2001 and 2013.
"A lot of the money the government invested in drug treatment in the 2000s was on the back of crime," he said. "But if you are invisible, marginalised and disenfranchised – if you're not causing any trouble – why should they spend any money on you? If you're quietly living in some council flat in Middlesbrough, not impacting on anybody, just on benefits, smoking, drinking and using smack, and then you die, so what? After they become old and less dangerous, the less reason for us to spend any money on them. On the other hand, if you are visible – say, street homeless or dangerous, maybe a burglar – then you get money spent on you."
Hayes says the 1970s American Marxist sociologist Steven Spitzer divided the poor into two groups: "social junk" and "social dynamite": "He said that society is interested in neutralising the dynamite, so they are locked up, shot if they are in the Philippines, or in western society we invest in them. But the junk just gets ignored." Part of the reason people are dying in such increasing numbers is that the dynamite is transforming into junk because they are getting old. "Their ability to break into your house is diminishing, they are becoming less and less of a threat," said Hayes.
These people are literally being left to rot, suffering not only from the physical and mental ravages of heroin addiction, but other conditions – such as lung disease and hepatitis – that further weaken already frail bodies and make them particularly vulnerable to accidental overdose.
Hayes says the NHS is not equipped to deal with this population. Many don't have a GP, and when they go to A&E they find it hard to cope with the situation. They fail to keep appointments for severe heart or lung problems. "The people who need the NHS the most don't get help," he pointed out. "There is a structural and cultural barrier for these people, so we need to get together the key players, identify who these vulnerable people are and target them with interventions."
But it's not just about the NHS. Kevin Jaffray, a former heroin user who now works as an advocate and trainer in the drug sector, says rehabs and drug services are also unfit for Britain's ageing heroin-using population.
"The majority of those in rehab are aged between 20 to 40, as drug use usually – and I say this loosely – peaks in the twenties. Therefore, most services are specifically designed to cater to that age group. Once you get into the 45-plus age group, your needs become a combination of multiple factors that are far too demanding and complex for drug and alcohol providers, and far too risky for mental health services. You become a burden that no one wants to deal with. So I'd say getting dismissed from any kind of support and left to just quietly die in the corner is actually a bonus, because to be dismissed at least means you managed to get in the door for some sort of treatment in the first place."
The PHE report says that deaths will continue to rise unless the "general health and other needs of the ageing cohort" are met. However, with right-wing think-tanks and politicians eager to end the use of methadone, the report warns that "without the implementation over the past decade of evidence-based and effective drug harm reduction and treatment interventions that reduce deaths, we might well assume that death rates would be even higher than they are".
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