England and Wales are mired in a public health crisis, but does anyone care?
This was the question repeatedly asked after the release of yesterday's Office for National Statistics (ONS) report into drug deaths. Wherever you looked, records tumbled: the highest number of drug deaths overall (4,359) and the highest annual increase (16 percent) of drug deaths since records began in 1993. Record numbers of deaths for opiates (2,208), ecstasy (92), benzodiazepine (430), and cocaine (637), the last of which have more than doubled since 2015 as a nation of crack smokers and powder snorters use product at "historically high levels" of purity.
Deaths for those aged between 40 to 49 and 30 to 39 continued their general upward trend and recorded highest ever figures, with drug overdoses now the leading killer of men aged 35 to 49. Long-term drug users who started using in the 1980s and 90s are traditionally most vulnerable, but the number of deaths among millennials and Generation Z-ers have risen this year too: 48.9 per million people – the highest amount since 2009 – were recorded for 2018.
Even new psychoactive substances – which last year the government proclaimed to have handled with its 2016 Psychoactive Substances Act – saw record numbers (125) of deaths. Not living in the south? Then your chance of being affected is substantially higher. The north-east has almost three times the amount of deaths per million people (96.3) than London (34.9).
"Nothing in the data surprised me," says Harry Sumnall, Professor in Substance Use at the Public Health Institute. "We've been used to expecting rapid increases, despite us knowing more and more about how to reduce those deaths."
An obvious place to focus our disquiet is austerity, with Alex Stevens, Professor in Criminal Justice at Kent University, reporting central government cuts have led to an average nationwide 27 percent reduction in drug treatment services, with over 50 percent cuts in some of the north's most affected areas.
A 2018 ONS survey found Blackpool had the highest rates of death due to heroin and morphine misuse in England and Wales, with nearby towns Burnley and Hyndburn also in the top six worst-affected areas. "Councils are hit with this terrible combination of massive funding cuts and massive pressure on all their services due to the effects of poverty and austerity," says Alex Stevens. "Blackpool has huge problems with child sexual exploitation, child protection and adult social care, all of which is draining the money local authorities have to spend on drug treatment services, while the government is cutting funding for these treatments at the same time."
While cuts are certainly a causal factor, we should also view them as one part of a broader failing of some of society's most vulnerable and stigmatised individuals. "It's about the wider health and social support systems that people can draw upon.," says Harry, using the example of recently released inmates: "Prisoners are much more likely to overdose in the three or four weeks after release than they are for the rest of their drug-taking career. So it's making sure they are identified as having a drug misuse issue before being released, given a naloxone kit [to reverse the effect of an opioid overdose], have someone to meet them at the prison gate for support and get them into community-based drug treatments."
Earlier this year, nearly 35,000 naloxone kits were distributed in Scotland, and Harry would like them to be as common a sight as the defibrillators we see outside public toilets and train stations across the country. Scotland, of course, is going through its own public health crisis, with its highest drug death per-capita ratio in the EU leading to the formation of a drugs task force. So should England and Wales be doing the same?
"We don't need a task force. The evidence is there," says Alex Stevens, adding that evidence shows the most effective method of decreasing deaths among heroin users is with opioid substitute treatment (OST) and moving users onto courses of buprenorphine and methadone. "We need to increase the coverage and quality of those services. But we also need to innovate by expanding heroin-assisted treatment to attract those people for whom methadone or buprenorphine doesn't work."
Opiates have been mentioned on 51 percent of the drug poisoning death certificates since 2006, but the rise of cocaine in recent years has been stark. The situation is muddied by the inability for coroners in England and Wales to differentiate between powder cocaine and crack, so it's harder to make definitive calls about whether increased deaths can be attributed to habitual crack users or the so called middle-class dinner party coke-taker.
A Freedom of Information request by VICE found the numbers of death certificates where both opiates and cocaine are recorded have stayed broadly the same. This year, 367 (57 percent) of 637 cocaine deaths also had opiates registered – a very slight reduction on the three preceding years, all 60 percent. "It's likely that lots of people are dying of both heroin and crack, but there's also a chance that people are dying from cocaine alone," says Alex Stevens.
Cocaine has been the drug du jour for tabloids seeking a lurid headline in recent years, usurping ecstasy, which has benefited hugely from work done by organisations The Loop and Anyone's Child. Despite The Loop's drug-testing at festivals and work with the media regarding the super-strength ecstasy and MDMA hitting our shores from the Netherlands, 92 deaths were recorded – a 40 percent incense on 2017's 52.
It's increasingly puzzling to see the government do little more than produce electioneering promises like putting 20,000 more bobbies on the beat, when other countries display pragmatism and compassion. Drug consumption rooms have been successfully introduced across Europe, while Portugal – which decriminalised drugs in 2001 – recorded just 51 drug-related deaths in 2017.
"We have this crisis and such a high number of deaths located in a specific segment of our communities," says Harry Sumnall. "We're not talking about radical changes. We're not talking about legal regulation of all drugs. There's lots that can be done literally within a couple of months, and it's not being treated with the urgency required. So that begs the question: why?"