Number Of Drug-related Deaths Research Articles

Jail Characteristics and Availability of Opioid Treatment Services: Results from a Nationally Representative Survey.

The current wave of the opioid epidemic has contributed to a record number of drug-related overdoses and a significant proportion of people who experience opioid use disorder are admitted to local jails. These correctional facilities serve as the principal entry point to the criminal justice system as nearly every person who is taken into custody is admitted to a local detention center. Although jails are recognized as primary intervention points for people who may require treatment for opioid use disorder, services in these facilities remain deficient. The absence of jail-based treatment has become a pressing concern as the number of drug-related deaths in custody continues to rise and the risk of post-release overdose also remains high. The present study draws on the opioid-related module of the 2019 Bureau of Justice Statistics' Census of Jails to assess the relationships between the characteristics of 2588 local detention centers and the availability of treatment services. These specific approaches included screening for opioid use disorder, providing medication to manage withdrawal symptoms, administering medication for opioid use disorder (MOUD), providing overdose reversal medication at the time of release, and linking people with community-based care following release from the detention center. The results demonstrate facilities located in the Northeast, larger jails, those in urban areas, and detention centers with higher turnover rates are significantly more likely to provide a wider variety of opioid treatment services. These findings have important implications for the prioritization of policies and the allocation of resources to support the adoption of opioid treatment services in local jails.

Drug-related Death low Registration in Iran: A Mixed Method Approach for Causes, Recommendations to Solve This Problem and Geographical Evaluation of an Intervention.

The death registration is conducted by different systems in Iran. The drug-related death registration is exclusively conducted by Ministry of Health and Medical Education (MOHME) and Legal Medicine Organization (LMO). This study investigates the causes of undercounting drug-related deaths (DRDs) in Iran, provides recommendations for addressing this issue, and provides a geographical evaluation of the integrity and quality of drug-related mortality registration (2014-2017). This is a mix-method study. In part1, individual targeted interviews were conducted with 12 experts in death registration in MOHME and LMO to collect data on the causes of low registration in Iran and provide recommendations for resolving the issue. Part2 of the study involved an intervention in the form of a memorandum of understanding on reduction of low-registrations. This memorandum was signed to transfer information about the corpses between the MOHME and LMO. First, the number of DRDs (2014- 2017) was examined using capture-recapture method and, then, we calculated and compared the rate of pre-intervention (2014-2016) and post-intervention (2017) under-registration to assess whether this memorandum of understanding had been effective in reduction of under-registrations. In part1, according to the participants, the causes of undercounting DRDs in LMO and MOHME were arranged and categorized into 4 categories: weak administration system, physician and personnel training problems, system constraints, and client-related problems. Also, some suggestions were presented to help resolving the problem of undercounting; these suggestions concern the administrative system, technology, and educational domains. In part 2, about half of the provinces in Iran had a positive performance in reducing the undercount. At the macro level, the memorandum of understanding between the two organizations responsible for registering deaths was effective. However, increasing the quality of data registrations requires monitoring at the micro and organizational levels to lead to a positive performance in reducing death under-registration in all provinces.

Drug-Related Morbidity and Mortality in Maine: Lost Productivity from 2015 to 2020

he authors characterize drug-related morbidity and mortality in Maine between 2015 and 2020, as well as the impact on labor market and nonmarket productivity. We find that prevalence of drug misuse and the number of drug-related deaths have increased across time, and both are lower among females vs males. Drug-related morbidity is concentrated among individuals aged 18–25, while mortality is concentrated among those aged 25–54. Lost productivity has increased across time and is lower among females vs males. In 2019, lost productivity was $271 million (annual) from morbidity and $565 million (lifetime) from mortality. These estimates reflect the lost value to Maine that occurs when individuals cannot fully contribute to the labor market or nonmarket activities. On balance, our study provides important information about the drug epidemic in Maine, which may be helpful to decision makers as they design and evaluate relevant policies and programs.

Scottish drug-related deaths fall for first time in five years

The number of drug-related deaths in Scotland fell by 8% in 2021, compared with the previous year, according to data from Police Scotland. A quarterly report, published on 15 March 2022, said that between January and December 2021, 1,295 suspected drug-related deaths were recorded: 116 fewer deaths than the suspected 1,411 deaths recorded during the […]

Drug-related deaths increase by 6% in England and Wales to record levels

The number of drug-related deaths in England and Wales rose by 6.5% in 2021, reaching the highest number since records began, according to a report by the Office for National Statistics (ONS). The report, published on 3 August 2022, also noted a “significant increase” in the number of deaths involving new psychoactive substances, such as […]

Years of Life Lost (YLLs) due to drug-related deaths in the Islamic Republic Of Iran (2014-2017): a temporal and geographic pattern.

The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.

Commentary on Cousins et al. (2016): Accumulating evidence on risk of mortality on and off opioid substitution treatment.

The National Irish cohort study strengthens evidence on the hazards of leaving opioid substitution treatment (OST) and dangers of short duration treatment and provides the first piece of evidence for future syntheses of the effect of supervised consumption on mortality risk in people on OST We know that methadone and buprenorphine are ‘essential medicines’ for the treatment of heroin and other opioid dependence and the prevention of drug-related harm 1-3. There is good evidence from multiple studies that patients have better outcomes, including a reduced risk of mortality during opioid substitution treatment (OST) 4-8. Heroin and other opioid use, especially if injected, are inherently risky, and the risk of mortality is heightened at specific times—such as in periods of low tolerance to the effect of opioids immediately after prison release or treatment discharge, or when taken in combination with alcohol, benzodiazepines and other drugs 6, 9-12. Clinicians and policymakers need evidence both on how best to deliver treatment and manage opioid dependence in order to reduce the mortality risk and number of drug-related deaths in the population and, critically, on whether changes to drug treatment have had an impact upon mortality risk and other health outcomes. As in many situations, randomized controlled trials (RCT) may not be best placed to provide this evidence. Typically they are underpowered to detect small, but important, effects on relatively rare outcomes such as mortality. Therefore, policy makers are increasingly reliant upon evidence from large clinical administrative databases of patients in receipt of interventions in the real world. For instance, recent studies have shown how the combination of OST and HIV can reduce HIV and all-cause mortality among HIV-positive opioid-dependent people; that initiation onto buprenorphine may reduce elevations in mortality seen during induction onto methadone; and direct criminal justice referral into treatment may lead to reduced mortality risk during treatment compared to other routes into treatment 13-16. The study by Cousins and colleagues uses administrative data on the delivery of OST in primary care in Ireland to investigate two issues 17. The first is whether treatment transitions, the period at the start and immediately after the end of episodes of opiate substitution therapy, are associated with increased mortality risk. The second issue tests specifically whether ‘supervised consumption’ (i.e. direct observation of methadone or buprenorphine consumption by the pharmacist) is associated with a reduction in mortality risk. The study corroborates the extreme transitory risk in mortality in the period immediately following treatment cessation and highlights a problem with treatment duration and retention 5-7. If the mortality risk is as high as 4% (four per 100 person-years) in the first month after treatment—eight times higher than risk during treatment and four times higher than other periods out of treatment—then it is highly likely that treatment duration needs to be longer than the mean or median 168 and 83 days (5.5 and 2.7 months), respectively, that were provided to patients in National Irish cohort 17. Cousins and colleagues do not find evidence for the increased mortality risk at the beginning of treatment observed in other settings 5, 6, 15, 18. However, as the authors point out, this may be because a proportion of patients in their database initiated their treatment in specialist services before being transferred to primary care. Ecological evidence from Great Britain suggests that after supervised consumption was introduced patient safety was improved, as measured by the OD4 index that calculates the number of methadone related deaths per amount of methadone prescribed 19. However, there was no direct evidence that people exposed to supervised consumption have a reduced mortality risk. This study provides weak evidence in favour of supervised consumption, and forms the first piece of evidence which can contribute to a future synthesis of the effect of supervised consumption including, as the authors highlight, the impact upon the diversion of methadone. We need and look forward to more studies such as that by Cousins et al., so we can develop ‘stratified medicine’ for treatment of opioid dependence and can pool experience and evidence from different health-care systems in order to tailor specific treatments and ensure that ‘the right patient gets the right treatment at the right time’. M.H. and P.V. have received unrestricted research grants as co-applicants from Gillead, and received honoraria to speak at conferences from Abbvie, Gillead, Merck and Jansenn. L.D. has received untied educational grants from Reckitt Benckiser and Mundipharma.

Increasing number of drug-related deaths – do substitution treatment programs fail?

Background More than 200 drug-related deaths occur in Austria every year. Despite multifarious addiction treatment programs, drug-related mortality has increased. In many cases the cause of death remains obscure. It is an ethical responsibility to avoid drug deaths; therefore it is required to identify the main causes and risk factors of drug related deaths. Methods After approval of the ethics committee of Vienna and Lower Austria and written and signed informed consent of patients and control persons, blood was taken in …

Estimating Prevalence of Injecting Drug Users and Associated Heroin-Related Death Rates in England by Using Regional Data and Incorporating Prior Information

SummaryInjecting drug users (IDUs) have a direct social and economic effect yet can typically be regarded as a hidden population within a community. We estimate the size of the IDU population across the nine different Government Office regions of England in 2005–2006 by using capture–recapture methods with age (ranging from 15 to 64 years) and gender as covariate information. We consider a Bayesian model averaging approach using log-linear models, where we can include explicit prior information within the analysis in relation to the total IDU population (elicited from the number of drug-related deaths and injectors’ drug-related death rates). Estimation at the regional level allows for regional heterogeneity with these regional estimates aggregated to obtain a posterior mean estimate for the number of England's IDUs of 195840 with 95% credible interval (181700, 210480). There is significant variation in the estimated regional prevalence of current IDUs per million of population aged 15–64 years, and in injecting drug-related death rates across the gender × age cross-classifications. The propensity of an IDU to be seen by at least one source also exhibits strong regional variability with London having the lowest propensity of being observed (posterior mean probability 0.21) and the South West the highest propensity (posterior mean 0.46).

A comparative study of adverse drug reactions during two heat waves that occurred in France in 2003 and 2006

Heat waves could reveal or aggravate several 'serious' adverse drug reactions (ADRs) in elderly. Thus, we wanted to describe the main characteristics of heat-related 'serious' ADRs occurred in patients older than 70 years during these two events in France (2003 and 2006). We analysed 'serious' ADRs reported to the network of French pharmacovigilance centres in summer 2003 and 2006 and suspected to be heat related. 'Serious' ADRs occurred during summers with heat waves (2003 and 2006) were compared with ADRs occurred during the same months in the summers of 2004 and 2005 (reference period). Patients' characteristics and number of 'serious' ADRs were similar whatever the year of the study. Number of drug-related deaths seemed higher in 2003 than in 2004-2005. More 'serious' heat-related ADRs were reported in the summers of 2003 and 2006 (68 in 2003 and 72 in 2006). Comparing with the reference period, metabolic ADRs were less frequent during the summers of 2003 (29%, p = 0.0001) and 2006 (39%, p = 0.003). Occurrence of other ADRs was similar whatever the period. Drugs more frequently involved during heat waves were diuretics, serotonic antidepressants, angiotensin converting inhibitors and proton pump inhibitors. Differences between 2003 and 2006 were found for non-dopaminergic (atropinic) antiparkinsonians or antiepileptics (most frequently involved in 2006) and beta-blockers or proton pump inhibitors (less frequently involved in 2006). The present study underlines the interest of a National Pharmacovigilance Database to follow each year the role of drugs in heat-related ADRs. This survey should be associated with other pharmacoepidemiological methods, such as case-control or population-based studies.

Estimating the levels of acute drug-related deaths in France, 2001–2002: A simple technique to measure bias in overdoses recording

Objective: To estimate under-recording of drug-related deaths in France.Materials: A capture-recapture indicator is proposed with a view to estimating the number of drug-related deaths. The indicator is applied when cross-checking general mortality registry and police data sources.Results: The under-recording of drug-related deaths was reaching 40% for the 2 years considered on the basis of the estimator.Conclusion: The hypothesis adopted is that the deaths were subject to erroneous coding, and the causes classified as unknown or ill-defined. Official data should be interpreted with caution. Nevertheless, this issue should not hide the effects of an early implemented harm reduction policy. Further analysis is required to confirm and extrapolate the findings.

The Prevalence of Fentanyl in Drug-Related Deaths in Philadelphia 2004–2006

Fentanyl is an increasingly common drug of abuse. The Philadelphia Medical Examiner's Office reported 252 drug-related deaths in Philadelphia that tested positive for fentanyl during the year 2006 in comparison to 22 and 19 in 2005 and 2004, respectively. We reviewed the data from 2004 to 2006 from the Philadelphia Medical Examiner's office. Key words such as fentanyl, drug, cocaine, ethanol, medic (medication), tox (intoxication), or poison were used as search words. In comparison to 2004 and 2005 data, there was a statistically significant increase in number of drug-related deaths (DRDs) and the percentage of DRDs that tested positive for fentanyl in 2006. We postulate that the increase in DRDs in 2006 may be related to increase use or abuse of fentanyl, lack of general public awareness that fentanyl is a potent opioid, inadequate dose of naloxone and/or the surge of clandestinely manufactured fentanyl.

Retrospective study of forensic medicine’s management of drug related deaths in Romania: 2001-2007

Comparing the number of drug related deaths - DRD - reported officially in Romania to the one forwarded by the rest of the European countries (of course, keeping the proportions related to population and drug use incidence) - based on a range of several dozens cases, for countries with a small population, up to a couple of hundreds, in the case of bigger states - the national and international organizations have permanently shown a reluctance with regard to under-reporting casuistry. Forensic Medicine, as primary link in identifying these cases, has the benefit of plurivalence in reporting, offering the possibility both of collecting statistical data, and of passing anatomo-pathological, medical, criminal, criminological conclusions. For this reason, important measures were taken for creating medico-legal management algorithms for DRD-susceptible cases, which materialized in reports assessed by the European fora as being a real progress. We will present in this material the data of a study which practically covered the entire medico-legal casuistry reported by Romania at the EMCDDA European Center between 2001 and 2007.

News and Notes

News and Notes

A coordinated response to the high drug death rate in Brighton & Hove

Concern about the increasing number of drug related deaths in Brighton & Hove prompted a Confidential Inquiry into 69 deaths. This led to recommendations concerning better data collection, identifying vulnerable populations, improving responses to overdose, and modifying service organization. Heroin-related deaths were halved between 2000 and 2003, but the rate for total drug deaths remained the highest at 25.3 per 100,000 (2003) in participating coroners’ jurisdictions. In a subsequent Capture Recapture study, the prevalence of intravenous drug use in Brighton & Hove was estimated at 2 per cent of people aged 15-44, higher than Liverpool or London. The proportion of opiate drug users dying from opiate overdose was also highest in Brighton & Hove, at 2.1 per cent. A network of interlocking services was established within strong multi-agency partnerships, supplemented by: increasing the numbers in treatment; fast tracking hospital discharges and prison releases into treatment; new specialist posts in the local prison, the accident and emergency department and police custody suite; and participation by pharmacists and primary care services. This was underpinned by good liaison with the coroner.

Age differentials in the impacts of reduced heroin: Effects of a “heroin shortage” in NSW, Australia

Background : This paper uses a unique event, the Australian heroin shortage, to see whether an abrupt, substantial and sustained change in heroin supply had different effects on harms related to heroin use among younger and older heroin users. Method : Indicator data were examined by age group on the number of persons entering treatment for heroin and amphetamine dependence, arrests for heroin use/possession and number of drug related deaths in NSW, Australia. Data were analysed using times series analysis. Results : There was a 41% reduction in the number of new registrations for opioid pharmacotherapy per month among 25–34 year olds, and a 26% reduction among 15–24 year olds, but no apparent changes among older age groups. Similarly, reductions in the number of non-pharmacological heroin treatment episodes were most pronounced among younger age groups. There was a 49% reduction in the number of heroin possession/use offences among those aged 15–24 years, compared to declines of 31–40% among older age groups. Declines in heroin related deaths were greatest among 15–24 year olds (65% reduction). There was no change in other drug related deaths in any age group. Conclusions : A reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people, across a number of outcome domains.

Public injection rooms, a help to heroin addicts?

The situation regarding heroin addicts in Norway gives cause for considerable concern. Harm reduction measures are seen as an important supplement to current assistance and treatment provisions for drug addicts. Introducing public injection rooms has been proposed as a component of the overall harm reduction strategy. The article discusses arguments put forward in the Norwegian debate concerning the injecting room initiative. Will public injecting rooms reduce the relatively high number of drug-related deaths? Will public injecting rooms help improve the generally bad health of drug addicts? Will public injecting rooms contribute to enhancing drug addicts' sense of dignity and self-worth? One of the motivations behind the introduction of public injecting rooms is to enable the social and health authorities to get in touch with drug addicts. Is this realistic? Will public injection rooms facilitate the misuse of drugs? What about public injecting rooms in light of UN conventions on drugs and national legislation in Norway? Would public injecting rooms be of any real help in relation to the many problems heroin addicts face on a daily basis?

The role of dihydrocodeine in causing death among drug users in the west of Scotland.

There has been a wealth of information relating to the role of methadone in fatalities over the past decade. However, a dearth exists in the literature of deaths involving dihydrocodeine, a substitute that is being increasingly prescribed by general practitioners for drug harm reduction purposes. Over the past five years in the Strathclyde region of Scotland there has been an increase in the number of drug related deaths involving dihydrocodeine with the largest increase occurring in the latter two years. This in combination with a general acceptance for this drug as a substitute for methadone amongst general practitioners highlights its potential abuse factor which is addressed in this paper. As the number of methadone deaths in relation to the total number of accidental drug related deaths per annum decrease, those related to dihydrocodeine are shown to be increasing.

Public injection rooms, a help to heroin addicts?

The situation regarding heroin addicts in Norway is a matter of big concern and thus harm reduction measures are seen as an important supplement to help and treatment services to drug addicts. Public injection rooms are proposed to be included in the harm reduction strategy. In the article arguments in the Norwegian debate why public injecting should be established are discussed. Will public injecting rooms reduce the relatively high number of drug related deaths? Are public injecting rooms a measure in improving the bad health condition seen among the group of drug addicts? Will public injecting rooms be a way of raising the dignity of the drug addicts? Could public injecting rooms be motivated as a way of getting in touch with drug addicts? Will public injection rooms facilitate the misuse of drugs? What about public injecting rooms in the light of the UN-conventions and the penal laws? The main focus of the article is if public injecting rooms would be of any real help to the many problems seen in the group of heroin addicts.

Drug related deaths in the Strathclyde region of Scotland, 1995–1998

The misuse of drugs, both illicit and prescribed has increased dramatically in the west of Scotland over the last few decades. Consequently, the number of drug related deaths has risen as a direct result. Since, discrepancies exist between data collected by the Department of Forensic Medicine and Science, University of Glasgow and official statistics, this project, was funded to investigate all known drug related deaths that occurred within the Strathclyde region of Scotland in an effort to improve the accuracy of statistics and the dissemination of information pertaining to them. Changes in medical treatment, legislation and patterns of drug taking were noted and the effects of these on the year-by-year death tolls evaluated.