Recreational drug overdoses are relatively few

Only one person a month was taken to hospital in Shetland after overdosing on recreational drugs last year, despite a well-established heroin scene in the islands which cost two lives in 2010. In fact, the vast majority of islanders who passed through the Gilbert Bain’s accident and emergency department after an overdose either poisoned themselves with too much drink or had attempted self-harm or suicide with medicines like painkillers and sedatives.

According to figures obtained from NHS Shetland only 12 of the 74 cases (16 per cent) of overdoses seen at the hospital last year were put down to recreational drug use. Exactly half (37 cases) were due to drinking too much, including two people who did so with the intention of causing self-harm.

Overdose cases seen at accident and emergency in the Gilbert Bain Hospital

A further 25 of the cases (34 per cent) were people who overdosed on drugs and medicines to cause self-harm.

A more accurate picture is obtained by looking at the figures for several years and calculating an average. Over a period of four years there was an average of 14 cases a year of accidental recreational drug overdose, including a blip in 2009 when there were 19 cases, 13 of which were heroin overdoses serious enough for the person to be admitted to a hospital ward. Normally fewer than four cases a year end up in the wards due to heroin overdose.

Director of public health Sarah Taylor said the blip in 2009 was purely down to two or three people having repeated problems. “What you tend to find is a small number of people with quite a lot of problems who might come in a few times,” she explained.

Looking at the NHS statistics in more detail, in the 10 years from 2001 to the end of 2010, 275 people were admitted to a hospital ward with an overdose. Of those, only one case was attributed to cocaine poisoning, back in 2006, and two to cannabis. Most cases involved primarily alcohol (140 cases), benzodiazepines (60) – such as temazepam and diazepam – heroin (24) and other opioids (10) while 14 had taken “psychostimulants with abuse potential”.

Of course, many, if not most illegal drug users, want to avoid ambulances and hospitals so the frequency of overdose is likely to be higher than that recorded in the statistics with some managing to survive the incident at home or declining to go to hospital once a doctor or ambulance paramedic has brought them round.

Dr Taylor said: “We do find situations where people don’t want to come in to be treated. They don’t want people to know or they think they’re okay. People in a situation where they are taking drugs on a regular basis might have a different view of their health than the rest of us.”

The concept of overdose is an interesting one to examine. How many of the dozens, or possibly hundreds of people who throw up while out drinking at the weekend consider that they have overdosed on a drug, albeit a legal one? More likely they may laugh about it afterwards with their friends.

While not denouncing such behaviour Dr Taylor sought to bring a little reality to bear: “If you know that you are going to go out and get so drunk that you are going to vomit as part of your evening I would say that is an overdose. You might think that is acceptable but I think probably it is not acceptable. Taking drugs to that level is doing your body some harm.”

She offered her own definition of overdose, which is “if you take a drug, including alcohol, and it has effects beyond what you are expecting”. Strictly speaking, an overdose of prescription drugs is taking more than is recommended on the label but with illegal drugs the strength is unknown and, as with alcohol, when under the influence you may lose your ability to limit your intake.

With heroin, the number of deaths and potentially fatal overdoses in Scotland has given rise to a national scheme to prescribe addicts a supply of naloxone to inject, or for their friends and family to give, which can save their lives by bringing them out of an unconscious state.

Studies have shown that injectors are 15 times more likely to overdose on heroin, and stop breathing, than those who smoke the drug.

Now a take-home naloxone scheme is being organised in Shetland. Normally the antidote has been administered by an ambulance paramedic or doctor at the scene or in hospital. It reverses the sedative effect of such opiates almost instantly, although it is short-lasting and repeat doses may be required.

Dr Taylor said that because it has few side effects it can actually be given to a suspected overdose sufferer as a precaution.

The antidote has been used over the years in Shetland, although no figures are readily available for the number of doses administered by doctors, nurses and ambulance paramedics.

The idea of a “take home” scheme has been around for a long time, particularly in the United States and European countries, where it is linked with a reduction in drugs deaths of up to 34 per cent. Schemes have been developed in England and Wales in recent years before reaching Central Scotland and Highland region and now becoming a national requirement.

Making naloxone readily available is one of the results of the systematic analysis of drug deaths in Scotland. In Shetland all sudden deaths, including suicides, are studied by a specialist group to learn lessons. But there is now another island group which looks specifically at each drugs-related sudden death. The information, which includes details about each dead user’s drug history and habits and the circumstances in which they lived, is fed into a national database.

Locally the body is called the Shetland Critical Incident Review Group. It has also agreed to gather information about non-fatal over–doses, which could be useful in preventing incidents being repeated.

Details of the review group’s discussions and its findings are not made public. However, it reports annually to the Shetland Alcohol and Drugs Partnership (SADP) which has members from the NHS, the council, drugs and alcohol agencies, the courts and emergency services.

Dr Taylor said: “It looks at individual cases but that is obviously confidential information and so when it reports to SADP it pulls out the lessons learnt and any actions that have been agreed.”

The drug deaths recorded by official statistics do not include those when drug users have accidents, die from blood-borne viruses or, which happens frequently, from infections or complications where drug use was not the direct and immediate cause of death.

Dr Taylor said: “You might have somebody who was a known drug user but you can’t show that drugs were implicated in their actual death. It’s not that every drug user who has a sudden death would appear on those statistics.”

The review group does not examine alcohol-related deaths. As Dr Taylor said, drug deaths tend to be acute (abrupt) whereas the vast majority of deaths relating to alcohol result from long-term deterioration or from indirect causes like accidents. She said: “It’s not unheard of but it is rare for somebody to drink so much in one acute episode that they kill themselves.”

Despite the much-publicised perils of drugs and too much drink, Dr Taylor said mind-altering drugs had always been around and she believes it would be naive to say that society could do without them. “Every society has recreational drug use as a part of it. People all over the world take drugs for the effects that they have on them. And the vast majority of people who take drugs don’t die. It’s the truth.”

She thought it would be helpful if people made themselves better informed about the whole range of substances that are available in Shetland, their effects and the damage they can cause. She also wished those with addiction problems could be treated with more compassion in the community than is often shown. She said often the drug problem was just “the front end” of something much more troubling in the person’s life that they are trying to cope with.

“I would like people to have compassion for individuals because probably many of us know individuals who are affected by substances one way or another. We should be trying to help people to overcome their problems and do that in ways that don’t cause harm to themselves and other people.”