Soaring drug addiction fatalities are a problem psychiatry can address

There is a serious drug epidemic killing twice as many people now as it did in 2012. The shame is that this death toll is preventable and many people are dying unnecessarily. The services that are supposed to care for them have been dramatically cut and are no longer fit for purpose.

Yet why is there no public outrage, no government ministers speaking out against this needless loss of life? Perhaps, unjustly, because this illness is addiction and in particular, addiction to heroin, where deaths are now at their highest on record.

"Without proper care there are serious risks including epileptic fits and hallucinations, brain damage, suicide and risk of overdose. Yet many services do not have doctors or nurses with sufficient specialist training and competence to provide safe care."

In 2016, 3,744 drug-poisoning deaths involving both legal and illegal drugs were registered in England and Wales, according to the Office for National Statistics – the highest number since comparable statistics began in 1993.

Of those, 2,038 were due to opiates, of which heroin and morphine claimed 1,209 lives (double the 597 deaths in 2012). Prescription deaths accounted for 829 lives, including 58 deaths due to the very strong prescription painkiller Fentanyl – a threefold rise from the 22 deaths in 2013.

Spiralling care provision

Last week’s (Thursday Nov 30) report by the Care Quality Commission (CQC) details a catalogue of failings of addictions services across England which adds yet another layer of risk to the multiple serious risks people with addictions are already exposed to.

The CQC has had to take action against nearly three quarters of services to protect the safety of the public. Only eight years ago, three quarters of services were judged to be “good” or “excellent” by inspectors, and addiction services in England were internationally highly regarded as an example of good practice in this field.

The difficulty is that people with addiction problems are highly stigmatised, and as a result, often regarded by many as unworthy of proper care. The reality is that addiction can be a severe and potentially fatal condition. Yet the dangers of addiction are greatly underestimated; a recent Royal College of Psychiatrists’ survey, for example, revealed that less than a quarter of the public are aware that addiction to opioids is more deadly than some cancers.

But addictions are highly treatable with the right specialist care. Detoxification from drugs and alcohol is a medical procedure which carries significant risks, particularly for people with severe dependence and a combination of physical and mental health problems, which needs skilled clinical care.

Diane, a recovering alcoholic, can testify to this. She finally managed to quit alcohol after her life hit rock bottom and trying to drink less didn’t work.

She said: “Without my psychiatrist I wouldn’t be here today. He just sat me down and said: “Look, if you don’t do this, this is what will happen to your body and you will die.”

Window of opportunity

Without proper care there are serious risks including epileptic fits and hallucinations, brain damage, suicide and risk of overdose. Yet many services do not have doctors or nurses with sufficient specialist training and competence to provide safe care. The decision in 2013, to move addictions services out of the NHS into financially stretched local authorities, while at the same time cutting public health grants, means that these services have been dramatically cut and continually retendered, resulting in a race to the bottom in terms of quality.

In 2008 there were eight NHS inpatient addiction treatment units in London; there are now none. The picture in the rest of England is similarly bleak. Specialist NHS units have been largely replaced by independent sector units, often ill-equipped to deal with the complex mental and physical health of people who need their help.

Today’s CQC report show an extreme and sustained deterioration in the quality and safety of patient care following the loss of NHS involvement in addictions services. The current drive to bring together the NHS and local authorities in the wider healthcare system provides a window of opportunity to jointly commission and provide addiction services, and begin to rebuild the standard of care, which will save lives.

We need to address the catastrophic decline in the number of addictions psychiatry consultants in recent years as a result of service cuts and loss of NHS addiction services. The Royal College of Psychiatrists’ 2017 census found just 39 full-time addictions psychiatry posts in England, less than half of the number in 2011.

We urgently need more psychiatrists, nurses and other professionals specialising in addictions to ensure that safe, effective treatment can be delivered. The Royal College of Psychiatrists’ advice is that at least 60 training places for addictions psychiatrists are needed in England. We also need to tackle the stigma of addictions and recognise that this group deserves an equal right to excellent care as people with other serious mental and physical health problems. If they were your parent, child, brother or sister, you would expect no less.

Professor Colin Drummond is Chair of the Addictions Faculty, Royal College of Psychiatrists.