Britain’s toxic overdose epidemic: What we know

Image copyright Getty Images Image caption A brief look at toxicology expert Becky Rogerson of the Department of Public Health Policy at UCLH/BIBA Image caption Health officials are concerned about the effects of opioids and prescription drugs on youngsters

As England’s desperate opioid crisis rages on, these are the places where the fatalities are increasing. Some are high-profile footballers and celebrities. Others are ordinary residents. At Manchester’s Trafford Hospital, coroners are conducting more autopsies and inquests than ever before. Information on the five highest recorded numbers of overdose deaths in each county is calculated every year. Here is what we know. Middlesbrough, North Yorkshire, Dorset, Wiltshire, Norfolk and Oxfordshire have the highest number of deaths.

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One important thing to note: Middlesbrough did not have a “pandemic” – meaning a sudden epidemic spread across Britain – and as such is not treated as a worrying area by public health departments. Yet as one of the 10 highest areas recorded in England’s most recent statistics, the figures point to an alarming trend.

What is an overdose?

Image copyright PA Image caption The vital signs are recorded and health professionals must try to save people

Nationally, the number of recorded overdoses increased from 12,919 in 2015 to a record high of 17,281 last year.

The increased number is partly because more deaths have been recorded, while the number of drug overdoses appears to have increased as well.

More than 2,000 of these fatalities were suicides, but it is the numbers of people dying from overdoses, many of them accidental, that are causing worry.

Rates of death for heroin and cocaine overdoses in England and Wales increased between 2014 and 2017 by between 25% and 30%.

Were deaths caused by opioids?

Image copyright Getty Images Image caption Official data has suggested the epidemic is spreading to other areas

While opioids, heroin and cocaine were identified as the chief cause of death, heroin represented by far the highest increase in fatalities, and figures for cocaine showed a sharp decline.

Deaths from opioids such as methadone and oxycodone, which are often prescribed to people suffering chronic pain, rose by 33%, while deaths from heroin and cocaine combined showed a 23% increase.

As of April this year, the Fentanyl analogue carfentanil – which is used for tranquilising elephants and other large animals – had been detected in 15 deaths in the last year.

These drugs are cheaper than other drugs, as it is not possible to produce more of them cheaply. And while they can’t be manufactured easily, there is a heightened need to be mindful of the risks of overdosing.

How are the deaths assessed?

Image copyright PA Image caption Data from all of England and Wales are counted up in UK Deathstat, the statistics portal

There are a number of different ways to test for the opioids and other drugs in relation to each other in order to classify a death as “strategic” or “statistical”.

Strategic deaths tend to be determined by the coroner because they are linked to a particular place or event in the community. By contrast, statistical deaths are more likely to be related to the person’s medical conditions.

There are also various “treatment” classes for treating pain, but it’s important to note they are recorded separately in the statistics.

How do people die?

Image copyright PA Image caption Fentanyl had been detected in 15 deaths in April, leading some to be deemed to be linked to the outbreak

If someone dies after an accidental drug overdose they are described as having died from a natural cause, by entering them into the nationally-tracked statistics.

Drug overdoses are described as having involved “extensive involvement of or interaction with a substance” in the person’s system, such as being administered an opioid, cocaine or ketamine by anyone such as a chemist, police officer or ambulance. They are classified as having been accidental deaths.

Image copyright AFP Image caption The death of comedian Garry Shandling is being treated as a possible result of fentanyl

Deaths in the statistics do not simply mean deaths which have taken place within the last year – but may go back many years. It is important to distinguish between incidents which might have been significant to the coroner, and those that have been linked to other causes.

Information on accidental drug overdoses is published in the post-mortem and inquest statistics in the Information Registers of England and Wales. This information is updated annually and information on all homicides is updated annually.

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