Family Practice Vol. 19, No. 1, 93-94
© Oxford University Press 2002
Deaths from drugs of abuse in Sheffield 1997–1999: what are the implications for GPs prescribing to heroin addicts?
a Institute of General Practice and Primary Care, Northern General Hospital, Sheffield S5 7AU and
b Community Health, Sheffield, UK.
Oliver P, Keen J and Mathers N. Deaths from drugs of abuse in Sheffield 1997-1999: what are the implications for GPs prescribing to heroin addicts? Family Practice 2002; 19: 93–94.
Received 4 April 2001; Accepted 3 September 2001.
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsCommentReferences |
|---|
Objective. Our aim was to examine the characteristics of drug abuse deaths in Sheffield between 1997 and 1999 with particular attention on the role of prescribed medication and the impact of increased methadone prescribing.
Methods. Information was made available on all deaths reported to the City of Sheffield Coroner between 1 January 1997 and 31 December 31 1999. These records were searched to identify individuals who died from a ‘drug of abuse’-related poisoning.
Results. A total of 82 drug of abuse-related deaths occurred in Sheffield during the 3-year period. The number of deaths rose from 16 in 1997 to 34 in 1999 (112%), with the largest increase occurring between 1997 and 1998. The mean age over the period of study was 29.4 years (SD 7.5 years), the overwhelming majority of which were male (92%), single (89%) and unemployed (84%). Heroin on its own or in combination with other drugs was considered to be responsible for death in 70% of all cases. Deaths attributable either wholly or partially to methadone poisoning fell from 37% in 1997 to 18% in 1999.
Conclusions. Given that the proportion of deaths involving methadone over this period fell against a background of increased prescribing, then it would appear that the availabilty of methadone is not a factor involved in the increase in the number of drug of abuse-related deaths in this study.
Keywords. Deaths, benzodiazepines, heroin, methadone.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsCommentReferences |
|---|
Recent reports in the UK of criminal charges being brought against GPs following the death of patients receiving methadone treatment have highlighted the dilemma facing GPs considering prescribing for heroin misusers.1 Despite an extensive evidence base for the use of methadone in the treatment of heroin dependence,2,3 the drug remains dangerous in overdose and drug users remain a high risk population due to risk-taking behaviours such as injecting and mixing drugs. The introduction of the UK Government's orange book on the clinical management of drug users sought to provide prescribers with straightforward guidelines on the treatment of drug users in primary care,4 and in Sheffield has been accompanied by a substantial increase in the number of prescriptions for methadone due largely to the introduction of a primary care prescribing clinic introduced in April 1998. The present paper aims to examine the characteristics of drug abuse deaths in Sheffield between 1997 and 1999 with particular attention on the role of prescribed medication and the impact of increased methadone prescribing.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsCommentReferences |
|---|
Ethics approval was granted on 23 September 1999 by the South Sheffield research ethics committee (SS99).
Information was made available on all deaths reported to the City of Sheffield Coroner between 1 January 1997 and 31 December 1999. These records were searched to identify individuals who died from a ‘drug of abuse’-related poisoning. For the purposes of this study, a drug of abuse is defined as all controlled substances (excluding cannabis), other opioids, benzodiazepines, cyclizine and solvents. Alcohol was included only where it was detected in combination with another (defined) drug.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsCommentReferences |
|---|
A total of 82 drug of abuse-related deaths occurred in Sheffield during the 3-year period. The number of deaths rose from 16 in 1997 to 34 in 1999 (112%), with the largest increase occurring between 1997 and 1998 when deaths doubled. The mean age over the period of study was 29.4 years (SD 7.5 years), the overwhelming majority of which were male (92%), single (89%) and unemployed (84%).
Heroin on its own or in combination with other drugs was considered in the coroner's findings to be responsible for death in 70% of all cases over the study period (Table 1
). A significant increase in the number of deaths involving combinations of heroin with other drugs was seen over the 3 years. Deaths attributable either wholly or partially to methadone poisoning fell from 37% in 1997 to 18% in 1999.
|
Where heroin or methadone was implicated alongside another drug, the most common concomitants were benzodiazepines and alcohol. When a prescription medicine is found to have contributed to death, the coroner normally attempts to establish the source of the drug. In these instances, prescribed methadone was found to be involved in 14 cases, of which six were in injectable form, four oral and four half oral–half injectables. In the remaining six cases, the source of the methadone was unknown (i.e. diverted).
|
Comment |
|---|
|
TopAbstractIntroductionMethodsResultsCommentReferences |
|---|
The increase in the number of drug of abuse-related deaths in Sheffield between 1997 and 1999 was probably due to a complex interaction between a number of factors. Increases in the number of drug users, changes in drug-taking behaviours, purity of heroin and availability of treatment services have all been suggested as factors contributing to drug abuse deaths. However, given that the proportion of deaths involving methadone over this period fell against a background of increased prescribing (there is good reason to suspect that methadone prescriptions doubled over this period), then it would appear that this is not one of them. Indeed, there is good evidence to suggest that some lives may have been saved if methadone had been more widely available to these people.5 Although the relative contribution of benzodiazepines to opiate overdose is difficult to assess, there is some evidence to suggest that they may have an additive or synergistic effect on respiratory depression6 and should therefore be prescribed to drug dependants with care and only within national guidelines.
|
Acknowledgments |
|---|
This work was funded by Sheffield Health.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsCommentReferences |
|---|
1 Clews G. British Medical Association News Review 2000; September 30, 18–20.
2 Ward J, Hall W, Mattick R. Role of maintenance treatment in opioid dependence. Lancet 1999; 353: 221–226.[Web of Science][Medline]
3 Hutchinson SJ, Taylor A, Gruer L et al. One year follow-up of opiate injectors treated with oral methadone in a GP-centred programme. Addiction 2000; 95: 1055–1068.[Web of Science][Medline]
4 Department of Health. Drug Misuse and Dependence—Guidelines on Clinical Management. London: HMSO, 1999.
5 Grönbladh L, Öhlund LS, Gunne LM. Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatr Scand 1990; 82: 223–227.[Web of Science][Medline]
6
McCormick GY, White WJ, Zagon IS, Lang CM. Effects of diazepam on arterial blood gas concentrations and pH of adult rats acutely and chronically exposed to methadone. J Pharmacol Exp Ther 1984; 230: 353–359.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C McCowan, B Kidd, and T Fahey Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study BMJ, June 16, 2009; 338(jun16_4): b2225 - b2225. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||