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Summary of those dying in contact with UK Drug or Alcohol Treatment Services


UK Addiction Treatment Services


This report details the causes of mortality of those identified, via the National Drug Treatment Monitoring System(NDTMS) dataset, as having died whilst in contact with structured drug treatment services in the North West of England within the years 2003/04 and 2004/05. The NDTMS was established to collect data on all clients in contact with structured drug addiction treatment services (i.e. high threshold tier 3 and 4 services as defined by the Models of Care, see NTA, 2002). The NDTMS dataset was used to identify drug users who had been reported by service providers as having died in years 2003/04 and 2004/05. The Office of National Statistics (ONS) provided semi-anonomised death certificates for those individuals confirmed as dead. This exercise established that, of the 191 death certificates received by the Centre for Public Health, Liverpool John Moores University, 59 individuals (30.9%) died from a drug related death (DRD) using the National Drug Strategy definition of a DRD (see below for explanation of the DRD definition). The majority of individuals died from other causes, for example bacterial and viral infections, liver disease and intentional self-harm. Whilst these deaths were not classed as a DRD according to the Drug Strategy, these causes of death were likely to be associated with drug use. Therefore, whilst only 30.9% of deaths were classed as a DRD, the majority of deaths within this dataset were likely to be drug-associated deaths. The results also found that those dying from DRD were significantly younger in comparison to those dying from causes not defined as DRD. The report highlights the need to address possible health and social problems that an ageing treatment population in the region may encounter, for example opportunistic infections after years of poor health. It also highlights the need to record deaths that, whilst not classed as DRD, are associated with prolonged drug use. This report is the first in a series of themed reports, based on the NDTMS North West regional dataset by the Centre for Public Health, Liverpool John Moores University. Drug Related Deaths (DRD) In 2000, the Advisory Council on the Misuse of Drugs raised concern about the increasing number of deaths related to drug use within the UK (ACMD, 2000), despite increases in average life expectancy for both males and females (ONS, 2004). In response, the Department of Health Action Plan 2001 initiated a plan to reduce the number of DRD (as classified by the National Drug Strategy definition of DRD) by 20% by 2004. The Drug Strategy definition of a DRD is deaths where the underlying cause is poisoning, drug abuse or drug dependence and where any of the substances controlled under the Misuse of Drugs Act (1971) are involved’. According to this definition, the majority of DRD are related to acute drug toxicity and typically occur in young men under thirty years of age (NTA, 2004). The following causes of death are included as a headline indicator of a DRD (the relevant codes from the World Health Organization International Classification of Disease Register version 10 (ICD-10) are given in brackets):
a) Deaths where the underlying cause of death has been coded to the following categories of mental and behavioural disorders due to psychoactive substance use (excluding alcohol, tobacco and volatile solvents)
(i) Opioids (F11)
(ii) Cannabinoids (F12)
(iii) Sedatives or hypnotics (F13)
(iv) Cocaine (F14)
(v) Other stimulants, including caffeine (F15)
(vi) Hallucinogens (F16)
(vii) Multiple drug use and use of other psychoactive substances (F19)
b) Deaths coded to the following categories and where a drug controlled under the Misuse of Drugs Act 1971 was mentioned in the death record:
(i) Accidental poisoning by drugs, medicaments and biological substances (X40-X44)
(ii) Intentional self-poisoning by drugs, medicaments and biological substances
(X60-X64)
(iii) Poisoning by drugs, medicaments and biological substances, undetermined intent (Y10-Y14)
(iv) Assault by drugs, medicaments and biological substances (X85)
(v) Mental and behavioural disorders due to the use of volatile solvents (F18)

Drug associated deaths
Whilst the government has set targets to reduce DRD according to the Drugs Strategy definition, concern has also been raised about the vulnerability of drug users to various infectious diseases which can result in considerable levels of morbidity and mortality (ACMD, 2000; HPA et al., 2005a), including viral infections (such as hepatitis C and HIV) and bacterial infections (such as tetanus and Staphylcoccus aureus). Evidence reveals that more than two in five injecting drug users have been infected with hepatitis C (HPA et al., 2005). There is also evidence that individuals with a history of drug problems often encounter issues predisposing them to suicide, such as poor mental health, physical illness and social isolation. Research has also suggested a link between HIV and hepatitis C positive status (infections often linked to intravenous drug use) and suicide (ACMD, 2000).

Methodology
For this report, NDTMS data for all clients in contact with North West treatment services between April 2003 and March 2005 were interrogated to identify those drug users who were reported by the addiction treatment providers as having died. The information was also used to investigate whether there had been any changes in the profile of individuals discharged as dead within the NDTMS dataset between 2003/04 and 2004/05 and also to identify any potential differences in the characteristics of those dying from a DRD, those dying from residual causes and those still alive within the NDTMS. The regional NDTMS dataset was interrogated to identify those individuals that had been reported by treatment providers as dying between April 2003 and March 2005. These individuals were identified from their attributor code (incorporating their initials, date of birth and gender) and information in relation to their partial postcode of residence discharge date, agency name and agency client reference code were extracted from the dataset. Each individual was given a unique study number. The extracted information was sent to the reporting agency along with a request to identify each individual’s full name. The agency was asked to post this information to the ONS in a pre-addressed, pre-paid envelope provided. Once the ONS had received client information from the reporting agency, death certificates were identified for each individual confirmed dead. The names were removed from death certificates and replaced with the unique study number. The anonymous death certificates, containing cause of death (in accordance with the World Health Organization International Classification of Disease Register version 10 see www.who.it/classifications/icd/en/), verdict of inquest (if one took place) and the clients unique study number were returned to the Centre for Public Health, 
Liverpool John Moores University.