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Cited by 16Opioid Use Disorder TreatmentForensic Toxicology and Drug AnalysisSubstance Abuse Treatment and Outcomes

Substance misuse-related poisoning deaths, England and Wales, 1993–2016

Open access
Handley, SA, Ramsey, JD, Flanagan, RJ·2018·Drug Science, Policy and Law
DOI 10.1177/2050324518767445
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Abstract

Context: In recent years there has been an increase in the availability of ‘novel psychoactive substances (NPS)’ or ‘legal highs’. In turn, there is concern as to the risks these compounds pose as compared to those posed by traditionally misused substances such as illicit diamorphine (heroin), methadone, cocaine, and amfetamines. Methods: We reviewed deaths where opiates/opioids, stimulants, hypnosedatives, hallucinogens, or volatile substances were mentioned on the death certificate in England and Wales, 1993–2016 as recorded on the Office for National Statistics drug poisoning deaths database. Deaths were analysed by year of registration of death, age, sex, intent, drug(s) involved, and the presence of alcohol (ethanol). Results: There were 68,347 drug-related deaths in England and Wales (includes both licit and illicit substances), of which 15,457 were either coded as, or had mention of, drug dependent/non-dependent substance abuse on the death certificate. Opioids, particularly diamorphine/morphine and methadone, featured in most deaths. Diamorphine/morphine-related deaths (17,402) increased from 155 in 1993 to 981 in 2001, and then remained relatively stable until 2010 (791). Thereafter, annual numbers of deaths fell to 579 in 2012, but have since increased to 1,209 (2016). Deaths in the age group 20–29 years declined from 46% (1993), to 13% (2016), whereas in those aged 40–49 years the percentage of deaths increased from 13% (1993) to 33% (2016). Methadone was mentioned in 7,894 deaths (1993–2016). Annual numbers of such deaths increased from 206 to 437, 1993–7, then declined, but have since increased, reaching 413 in 2016. As to age, a similar pattern as to diamorphine/morphine-related deaths is apparent. Annual numbers of deaths involving cocaine (1993–2016: 3,342), reached 235 in 2008, declined, but have since increased (2011: 112, 2016: 371). Annual numbers of deaths involving methylenedioxyamfetamine/ methylenedioxyethamfetamine/ methylenedioxymetamfetamine (‘ecstasy’) (1993–2016: 853), have also increased steadily in recent years (2010; 8, 2016: 65). There were relatively few mentions of ‘novel stimulants’ (1993–2016: 386) on death certificates and such deaths have declined in recent years (2015: 88, 2016: 57). Mephedrone was most frequently mentioned (122), as was para-methoxyamfetamine/ para-methoxymetamfetamine (88). Conversely, although synthetic cannabinoids were mentioned infrequently (1993–2016: 37), such deaths have increased recently (2015: 8, 2016: 26). Conclusions: Illicit diamorphine (heroin) and methadone continue to be the principal drugs of abuse involved in fatal poisonings in England and Wales. The increase in such deaths in recent years has been largely due to an increase in deaths amongst older users, although the role of potent synthetic opioids such as carfentanil is a cause for concern. Overall, stimulants and related compounds have been implicated in an increasing number of deaths annually. The impact of the plethora of NPS that have appeared in recent years on fatal poisonings may have been mitigated by legislation.

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  • The FDA loosened its rules and allowed a discontinuation trial to provide evidence of efficacy for esketamine.

    “As Janssen could not provide two positive efficacy trials, the FDA loosened its rules and allowed a discontinuation trial to provide evidence of efficacy.18”

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  • The 4-point MADRS difference for esketamine is less than minimal clinical change and about one quarter the placebo response, so its clinical relevance is doubtful.

    “A 4-point difference therefore corresponds to less than”

    From Are we repeating mistakes of the past? A review of the evidence for esketamine (2021) · cites this paper as [18]

  • The FDA normally requires two positive efficacy trials, each convincing on its own, to license a drug.

    “The FDA normally requires two positive efficacy trials in order to license a drug,”

    From Are we repeating mistakes of the past? A review of the evidence for esketamine (2021) · cites this paper as [18]

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Authors
Handley, S., Ramsey, J., & Flanagan, R.
Affiliations
  • King's College Hospital NHS Foundation Trust (GB)
  • St George's, University of London (GB)
Corresponding author
Flanagan, RJ
Venue
Drug Science, Policy and Law
Publisher
SAGE Publications
Published
2018-01
Volume
4
ISSN
2050-3245 (ISSN-L)
DOI
10.1177/2050324518767445
OpenAlex
W2795864438
Cited by
16
References
45
Citations by year
2023: 2 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 3
FWCI
2.88
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
Drug Science Policy and Law (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
drug poisoning deaths, substance abuse, new psychoactive substances, opioid-related deaths, heroin, methadone, cocaine, amphetamine, hallucinogens, volatile compounds, age and sex differences, England and Wales, drug policy, harm reduction, death certificate coding

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