Understanding Problem Drug Use

• It is estimated that injecting heroin users have 20 to 30 times higher risk of death than others of the same age [2].
   
  
• Overdose accounts for the majority of drug related deaths in Europe [3].
   
  
• The annual numbers of opiate-related deaths extracted by Byrne (2001) from the Dublin coroners' records between 1998 and 2001 were consistently higher than those reported by the General Mortality Register. These variations may be related to differences in the definition of opiate-related deaths applied in each case [4].
   
  
• Deaths as on indirect result of drug use are not systematically documented. According to the Health Research Board small scale studies on this issue suggest that there is an underestimation of opiate related deaths. Such studies provide little information on deaths as a result of other drugs [5].
   
  
• There is lack of uniformity in how drug related deaths are reported/recorded thus the true number remains unknown. Drug related deaths and all other deaths among drug users need to be recorded systematically. An Irish National Drug-Related Deaths Index was launched Sept 2005 [6].
   
  
• The majority of overdose victims die alone. Most of these deaths are not immediate therefore there is time for intervention [3]. According to a report published by the Scottish Executive less then a half of those present at the scene of on overdose had tried cardio pulmonary resuscitation (CPR) [7].
   
  
• Those that are most at risk of overdose include
• Poly drug users (those using more than one drug) - poly drug use may be involved in 66% of cases - Benzodiazepines, Alcohol and Methadone are particularly likely to be implicated.
• Those who have lost opiate tolerance following detoxification or a period in prison. Following a review of the Dublin coroners' cases, Byrne reported that 13% of drug-related deaths were associated with imprisonment or recent release from prison [8].
• Those using new heroin of unknown purity
• Those with dual diagnosis and other complex needs.
• Rough Sleepers. Scottish Report
• Older drug user (over 30's) [9, 10, 11].
 
• Factors making overdose more likely
• Haste
• Isolation
• Fear of detection
• Fear of drugs being stolen [12].
 
• Overdose reduction strategies include
• Education of those at risk and their families, friends and carers in recognition and treatment of overdose
• Training for others who may come in contact with overdose situations including drug service personnel, health professionals, ambulance and police service personnel, prison officers and staff, drug users, their peers, friends, families and carers.
• Widespread availability of Naloxone (Narcon) to those most at risk and those who will most likely use it in a timely manner e.g. ambulance crew. Naloxone, is a drug that if used quickly prevents death from overdose.
• Peer education projects- promoting behavioural change and improving management of overdose, recognising that that knowledge and expertise exists within the drug using community.
• Safer injection Rooms targeted at high risk individuals.
• Wide-ranging prescribing option including heroin prescription. Scottish Report
• Greater provision of outreach services and out of hours services [13, 14].