Overdose deaths from s treet heroin and prescribed methadone: analysis and prevention options. Professor John Strang National Addiction Centre, London, UK. Issues to be covered today. T opic 1: Analysis of the overdose death problem Topic 2: How could we respond more effectively?.
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Professor John Strang
National Addiction Centre, London, UK
1993 1997 2000 2001 (% change)
Total annual -England 821 1237 1561 1524 (-2%)
Heroin and Morphine 187 445 926 889 (-4%)
Methadone 232 421 238 207 (-13%)
Cocaine 12 39 80 96 (+20%)
MDMA/Ecstasy 8 12 36 55 (+53%)
“ associated substances: 1993-2001 (ONS).Methadone heals, but methadone also kills. The challenge is to achieve the former without incurring the latter”.
[48% in first 3 years; 45% SDS£6]
(c2=44.2, p<0.001 [data missing on 4])
(Gossop, Griffiths, Powis, Williamson and Strang, BMJ, 1996)
(Strang, Griffiths, Powis, Fountain, Williamson and Gossop, Drug and Alcohol Review, 1999)
(McGregor, Darke, Ali and Christie, Addiction, 1998)
Drug dependence prior to prison
Substance Misuse in Prisoners 2002 Singleton N, Farrell M, Meltzer H ONS.
Faggianoet al (2007) Cochrane review of significance of dose in methadone OST
Retention rate - RCTs: High versus low doses at shorter follow-ups: RR=1.36 [1.13,1.63], and at longer ones: RR=1.62 [0.95,2.77].
Opioid use (self reported), times/w - RCTs: high versus low doses WMD= -2.00 [-4.77,0.77] high vs middle doses WMD= -1.89[-3.43, -0.35]
Opioid abstinence, (urine based) at >3-4w-RCTs: high versus low doses: RR=1.59 [1.16,2.18] high vs middle doses RR=1.51[0.63,3.61]
Cocaine abstinence (urine based) at >3-4 w - RCTs: high versus low doses RR=1.81 [1.15,2.85]
Overdose mortality: high dose versus low dose at 6 years follow up: RR=0.29 [0.02-5.34] high dose vs middle dose at 6 years follow-up: 0.38 [0.02-9.34] middle dose vs low dose at 6 years follow-up: RR=0.57 [0.06-5.06]
What is the OD4 Index? associated substances: 1993-2001 (ONS).
OD4 = ODDDD (Overdose Deaths per Daily Dispensed Dose)
Thus essentially a measure of safety of a medication, as applied
Person unconscious, and cannot be
woken – UNROUSABLE
CYANOSIS – BLUE lips or tongue
Not breathing at all or breathing slowly –
Pin point pupils
A – Ambulance - CALL AMBULANCE
B- Breathing - Check Airway – clear if blocked, Check breathing.
C – reCovery - If breathing, place in recovery position – if not breathing, begin basic life support
***All significant at p<0.001
102 carers attending 4 organisations
Evidence of potential to extend naloxone…
Strang, Manning, Mayet et al, (2008) Family carers and prevention of heroin overdose deaths: ……
Drugs: Education, Prevention & Policy, 15: 211-218.