[LONG READ] Drug deaths are on the rise and we need action

We often hear that drug-related-overdoses are ‘preventable’, yet under the current political and legislative landscape, is this truly achievable? While I don’t like to say it, at present, there is an inevitability that people will overdose following substance use, and more worrisome, people will die from taking drugs. But with basic, compassionate, intuitive foresight, this doesn’t have to be the case. 

The latest drug-related-death statistics across England and Wales highlight that something is not working, and hasn’t been for some time. Across England and Wales, a total of 5,448 people (93 deaths per million) died as a result of substance use in 2023 in some capacity, while in Wales, this figure was 377 (129.2 deaths per million). Unfortunately, these respective figures have one significant thing in common: they represent the highest figure associated with drug-related-deaths since records began. At no point in history have more people died from substance use in Wales, and across England and Wales combined. 

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While those within the substance use sector mourn, grieve and question political motivation when it comes to proactively stemming drug deaths, outside of the sector there seems to be little footprint in terms of attention, anger and constructive pathways to deal with a public health emergency. Often, evidence is ignored and opinions come up trumps when political narratives regarding how to reduce drug use and its harms are laid out. A perceived lack of ambition by those that we often look to for leadership can often reaffirm many people’s perception that society is happy to leave anyone affected by substance use behind. And those willing to be the disrupters, to shift the narrative and openly proclaim that more can, and should be done, to reduce the ever growing rates of early mortality among a marginalised community, are often outmuscled and outvoiced by those that, consciously or not, aim to keep the ‘us and them’ perception rolling on.

A perceived lack of ambition by those that we often look to for leadership can often reaffirm many people’s perception that society is happy to leave anyone affected by substance use behind.

There are forces at play that are not within the influence, or control, of those delivering substance use services, and that of drug policy reform advocates, to make overdoses, and fatal ones at that, a thing of the past. Lately, we have heard from people with living experience of substance use that certain drugs are more available and accessible than ever before. A prime example of this is cocaine. In the 12 months ending in March 2023, border forces in the UK accounted for 82% of powder cocaine seizures, resulting in a total of 15.22 tonnes worth of the stimulant drug not entering the UK drug scene. While border control accounts for the significant majority of drug seizures, compared to seizures undertaken by police forces, the availability of cocaine is anecdotally reported to be as high as we have ever seen it. It is here you could argue that something is not working, regardless of the fact that cultivation and production of cocaine at its source is at its respective record levels, too. 

Therefore, just how much cocaine is in circulation, what can be done about it, and how did we get here? As ever with substance use, we have to look at the causes, other societal issues that often lead to people consuming drugs. It begs the question whether health inequality, deprivation, poverty, and many other socioeconomic factors, being at an all-time high, subsequently leads to people undertaking risky behaviour like never before. Only when we can truly identify and stem the roots can we stop the harm of substance use flourishing. Until then, it feels like whatever is being implemented is damage limitation with a degree of (hesitant) acceptance that the worst will occur. Yet, as already commented, it doesn’t have to be this way.

From the harm reduction field’s perspective, we can only do so much. In Wales, we saw fatalities associated with cocaine rise by 25% from 2022 to 2023, and have risen by 828% in the last decade. It must be noted that fatalities from powder cocaine and those due to crack cocaine use are not distinguished within the ONS data. However, simply put, these figures are dire. While we can point fingers as to who could do better and whose responsibility it is to ensure such statistics don’t become the norm (I am all for people being held to account), we should be playing to our strengths. One of the things we do well within the substance use sector in Wales is work collaboratively, and it is more important than ever to bring everyone who can influence change closer. We are stronger together.

In June 2024, we launched our blueprint for Wales titled ‘Setting the blueprint for a more equal and prosperous Wales for people who use substances’, at the Pierhead in Cardiff Bay. While such a document is unique to Wales, its contents are littered with evidence-based initiatives that are already in play, just not in Wales.

One of the things we do well within the substance use sector in Wales is work collaboratively, and it is more important than ever to bring everyone who can influence change closer.

Our blueprint outlines 10 ‘asks’ that, if implemented, would see Wales become a world leader in offering a significant range of innovative harm reduction interventions on top of other groundbreaking initiatives that are already being delivered. While I don’t necessarily believe it requires people to be ‘brave’ to implement all 10 ‘asks’, it does require a certain level of will, and for those that the ‘asks’ are aimed towards, to recognise that various aspects of current drug policy have failed a section of our society for too long. Would anyone dare to be so honest?

Our 10 ‘asks’ have all been coproduced with people who use our services and identify both gaps and improvements within current drug policy. Just under half of all referrals to substance use services was for alcohol use, resulting in 7,532 people seeking support between 2022 and 2023. Additionally, in the same time frame, Wales recorded a total of 8,464 people being admitted to hospital with an alcohol-specific condition, such as alcoholic liver disease, all of which 100% attributable to the use of alcohol. Therefore, a significant number of people, 271 per 100,0000, are suffering from conditions due to alcohol use. The Equality Act (2010) specifically excludes alcohol from its list of protected characteristics. Therefore, a significant number of people who have a current or historic alcohol-related dependency, are at risk of discrimination due to the current law failing them.

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Furthermore, more can be done to protect people at the scene of a drug-related overdose and ensure the appropriate responses are undertaken to save a life. Many overdoses occur with others around, and overdose management training stresses that one of the first responses to such an event is to call 999, in order to bring medical professionals to the scene. However, there is the possibility that people who experience or witness a drug-related overdose may be in possession of illegal drugs. Subsequently, there is a fear that those at the scene could be searched for possession, arrested, and later prosecuted. As a result, this could lead to the emergency services initially not being called, or people leaving the scene, and therefore a health emergency not being effectively responded to. Consequently, this could result in a threat to life for the individual who has experienced an overdose. Yet, the introduction of a drug overdose good Samaritan act could provide legal protection to those at the scene and therefore remove any barriers to the situation being responded to in the most appropriate manner.

These are just two of our ‘asks’, with the rest outlined below:

1. Welsh Government and key stakeholders to adopt a change in language to help reduce stigma among people who use substances.
2. Concerned others to be a recognised group of people within their own right and adequately supported to improve the health and wellbeing of themselves and their loved ones.
3. An alcohol-related exclusion clause removed within the Equality Act 2010.
4. To establish memorandums of understanding to enable the implementation of enhanced harm reduction centres in Wales.
5. A drug overdose good Samaritan act to be enacted.
6. To be able to give out safer inhalation devices to people who use crack cocaine.
7. Community drug checking services to be part of harm reduction interventions across Wales.
8. All substance use services in Wales to be underpinned by a trauma-informed approach.
9. An updated substance use delivery plan to help provide consistent standardisation of care across Wales and to provide strategic foundations to mitigate growing concerns that are a threat to life.
10. Young People with lived and living experience of substance use to be at the heart of the design and delivery of young person’s services.

Within each ‘ask’, there are additional calls to action, too. Also, devolved matters dictate who each ‘ask’ is aimed towards in relation to implementing that respective call to action. As justice and policing are not devolved, ‘asks’ such as ‘A drug overdose good Samaritan act to be enacted’ is primarily aimed at the UK Government given the legislative nature of the ‘ask’. Yet, Welsh police forces and the Welsh Government can still play a significant role in limiting the number of fatal drug overdoses in Wales in line with international evidence relating to similar laws. All the ‘asks’ are steeped in evidence, and many have a strong history of making significant inroads in preserving life, saving taxpayer money and rebuilding communities that can lead to a cohort of people previously shunned by society, finding their voice again.

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The National Crime Agency recently highlighted that ‘there has never been a more dangerous time to take drugs’. Nitazenes, a group of dangerous synthetic opioids that can be up to five-hundred times more toxic than street-based heroin, have been found in various drug samples, submitted by the general public and analysed by Public Health Wales’s funded drug checking service, WEDINOS. Given the levels of toxicity of nitazenes, even the smallest dose can lead to significant harm and death. What is more worrying is that nitazenes have been more commonly found in non-opioid samples, particularly benzodiazepines, leading to the potential unintentional use of the drug within a cohort of people that do not have any tolerance to opioids at all. Unfortunately, it is not uncommon for services like Barod to hear of people buying what they believe to be legitimate prescribed medications online only to find they are counterfeit and therefore unaware of its actual contents. This can, and has led to people losing their lives, just like 23-year old opera singer, Alex Harpum.

All the ‘asks’ are steeped in evidence, and many have a strong history of making significant inroads in preserving life, saving taxpayer money and rebuilding communities that can lead to a cohort of people previously shunned by society, finding their voice again.

While WEDINOS is quite rightly applauded for its work for over a decade, we need additional drug-checking services in Wales. Ones that are more timely and more accessible, and which allow walk-ins and results within the hour, not a few days later. This would allow people like Alex the opportunity to gain a better understanding of what their sample contains, and therefore make a more informed decision whether to go ahead and still consume that substance. That is why one of our ‘asks’ is calling for ‘Community drug checking services to be part of harm reduction interventions across Wales’.

We don’t necessarily believe that implementing all these ‘asks’ will suddenly solve a problem like overdoses – there are many initiatives that could supplement our recommendations, including a national rollout of diamorphine assisted treatment to complement other pharmacological offerings helping people rebuild their lives on multiple fronts. But we aim to play to our strengths and work with others to advocate for additional harm reduction measures to be included in the discussion. What we do believe though is that by implementing these 10 ‘asks’, we can start to move ideology into reality that overdoses can be preventable. They can also have a ripple effect on people’s self-worth and their importance to society. The establishment and beyond can finally acknowledge that people affected by substance use should no longer be left in the wilderness and we can progress with ensuring that Wales becomes a more equal and prosperous nation for people affected by substance use.

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