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The Royal College of Psychiatrists Improving the lives of people with mental illness

Northern Ireland CPD Blog

12   June 2017


Rising Mortality Among UK Addicts - the NI Experience - Dr Billy Gregg


The Royal College of Psychiatrists  hosted  a Public Mental  Health Conference Rising Mortality among UK addicts at  their headquarters in Prescott Street London  on Monday  22 May  2017 at  which representatives from all of   four UK  countries presented their regional data on deaths attributable to  substance  use.


Professor Colin Drummond highlighted at the meeting and subsequently in the BMJ that changes to the commissioning of alcohol and drug services in England had resulted in a serious loss of expertise, resources, and training posts within the NHS.  There is some emerging evidence that service providers for addiction services outside the NHS may be struggling to meet the needs of more complex patients.


In 2015 drug related deaths across the UK were the highest ever recorded, with most deaths being primarily linked to opiods or cocaine use, often used in combination with other drugs including alcohol.    During 2015 there were 258 recorded drug related deaths plus deaths due to drug misuse across Northern Ireland (NI).   


There was a significant rise in alcohol related deaths in 2015 (310) in NI, approaching the relative death rates in Scotland and substantially higher than the rates in England or Wales.   

Around 2,300 people die from smoking related illnesses in NI each year. 


Deaths from alcohol or drug use are commoner in males and in areas of social deprivation across the UK.


Some of the increase in drug related deaths has been linked to the failing health of an ageing cohort of UK drug users.  Other possible explanations include a shift towards more risky drug use, the use of more potent opiods drugs, such as fentanyl or the use of new psychoactive substances or lack of access to high quality addiction treatment services.   Suicide may also be a factor.


The most recent Confidential Inquiry into Homicides and Suicides (2016) reported that NI had the highest rates of suicide in the UK.  It also noted that “over half the patients who died by suicide had a history of alcohol or drug misuse. There were national differences, with alcohol misuse a more common antecedent of suicide in Scotland and Northern Ireland.   This inquiry also found that opiods were the most likely drugs to be used in fatal self-poisoning.


Northern Ireland has the highest relative prescription rates in the UK for most opiods as well as for pregabalin and gabapentin and this is contributing to our particularly striking levels of prescription drug misuse.  Pregabalin misuse is now a serious problem and has been linked to deaths in individuals, particularly in those who are also using opiods or other sedatives.


Key Points

1. Drug and alcohol services need to be adequately funded to provide a comprehensive range of services across statutory, voluntary and community sectors to meet the needs of service users, some of whom are getting older and who have complex comorbidities.


2. More care is required when prescribing opiods and gabapentenoids and particularly those with a history of substance use or mental health disorders.  These drugs should be prescribed in limited amounts and the benefits and risks of prescribing these medications should be kept under review.   Prescribing high dose opiods for chronic non-cancer pain (pain lasting more than 3 months) is not supported by the current evidence. 


3.  Mental  health, Addiction Service and Primary  Care Services need to  develop integrated care pathways which  ensure the physical  and mental  health  disorders in individuals who  misuse alcohol  or drugs   are being addressed.  


For more information please contact Dr Billy Gregg, Consultant in Addiction Psychiatry.


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