2. What will be covered Prevalence of Suicide and drug use Globally/European/Scotland Challenges/barriers that exist Examples of good practice Questions ScottishdrugsForum
3. Global suicide WHO Every year, nearly one million people die from suicide. For every suicide 6 people on average are affected (WHO) Risk factors Mental illness-primarily depression and alcohol use disorders, Prevention identification persons suffering from mental and substance use disorders, http://www.who.int/mental_health/prevention/en/
4. Suicide and Scotland 746 deaths in 2009 2 a day in Scotland Confidential enquiry into Homicide and Suicide (Manchester Uni 2008) Twice as likely in Scotland to die by suicide - alcohol and drugs play a part 7 days post discharge ScottishdrugsForum
6. Illicit drug use at the global level Globally, UNODC estimates that between 155 and 250 million people (3.5 to 5.7% of the population aged15-64)used illicit substances at least once in 2008. Number of "problem drug users“ aged 15-64 years : 16-38 million persons (UNODC 2010) Number of people who inject drugs aged 15-64 years : 11-21 million persons (UNODC 2010) ScottishdrugsForum
7. UNODC 2010 world drug report In 2008, 12% - 30% of problem drug users had received treatment in the past year which means that between 11 and 33.5 million problem drug users did not receive treatment that year ScottishdrugsForum
8. Drugs across Europe Report from the commission- 2010 progress review of the EU Drugs Action Plan (2009-2012) 25 to 30 million adults — aged 15 to 64 — have taken some type of illicit drug in the last year Between 1.2 and 1.5 million adults are problem opioidusers. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2009 Annual Report on the State of the Drugs Problem in Europe. Combined estimates include 22.5 million cannabis users and 4 million cocaine users. ScottishdrugsForum
9. Just to mention...... Every year, 6 500 to 7 000 people die in the EU from a drug overdose. (ECMDDA 2010) ScottishdrugsForum
10. Scottish Drug use 55000-60000 opiate/benzo users (ISD 2009) ~ 1.7% of population age 15-64 Examples GGC A&A Tayside 2.53%(95% CI 2.46 - 2.66%) 1.96%(95% CI 1.86-2.10%) 1.96%(95% CI 1.86-2.10%) ISD Drug Misuse Stats 2010-http://www.drugmisuse.isdscotland.org/publications/09dmss/09dmss.pdf ScottishdrugsForum
11. The substances formerly known as ‘legal highs’ Newly emerging substances and research chemicals? ScottishdrugsForum
12. “If you are looking at drugs you are looking at people depressed. You cannot see a drug addict out there that is not depressed, that is not stressed out..” Mental Health Foundation Research 2003
13. primary mental health disorder may lead to substance misuse • substance misuse may worsen mental health disorder • substance misuse (intoxication/dependence) may lead to mental health problems • withdrawal from substance use often leads to mental health problems • substance misuse and mental health problems may develop concurrently.
14. Co morbidity General population studies Dutch NEMESIS study (7076) UK National Co morbidity Study Finnish (245) Lifetime - 43% males; 15% females : mood and substance misuse (DeGraaf 2003) 12% males 6% females drug dependence and neurotic disorders (Coulthard 2002) 39% one month prevalence (Aalto-Setala 2001) ScottishdrugsForum
15. Psychiatric disorder in substance misuse population Cumulative 15%-93%! Psychotic disorders (20%) Affective disorder (30%-55%) Personality disorders (65%-85%) ScottishdrugsForum
16. ‘Vulnerable’ groups Adolescents in detoxification Glasgow homeless Dutch homeless Prisoners in remand Street workers/prostitutes 75% Hannesdottir (2001) 22% Kershaw (2000) 27% Reinking (2001) 81 % Singleton (1998) 70% Gilchrist (2004) ScottishdrugsForum
17. So what do we know...... Alcohol dependence, opiate and benzodiazepine dependence, and mixed drug dependence have all been related independently to an increased risk of suicide(Miles 1977; Pokorny 1983; Harris & Barraclough1997; Borges et al. 2000) ScottishdrugsForum
18. Global research- risk of suicide in those using opiates Females were significantly more likely than males to have attempted suicide (50% vs. 31%) Darke & Ross 2000 223 participants 40% reported at least one suicide attempt. Darke & Ross 2000 Overall, heroin users are 14 times more likely than peers to die from suicide Darke & Ross 2002 Recent suicidal behaviour is a major clinical problem for heroin users, and for females and Residentital Rehabilitation entrants in particular. Darke et al 2004 ScottishdrugsForum
19. Scotland and Lanarkshire Delivering for mental health mental health and substance misuse 2007 ScottishdrugsForum
21. Lanarkshire Psychiatric conditions were mentioned more frequently than medical conditions, and over half of the drug deaths were recorded as having depression (55%) and/ or anxiety (35%) Within Lanarkshire, 8.6% of North Lanarkshire patients and 8.7% of South Lanarkshire patients are prescribed drugs for anxiety, depression or psychosis compared to 8.1% in Scotland overall (North and South Lanarkshire Health and Well Being Profiles, 2008). ScottishdrugsForum
22. Scottish Research and subsequent responses to research Risk & Protective Factors (Platt 2008)- Substance misuse HEAT targets NHS Scotland , HEAT 5 Commitment 13 Chooselife 2002 20% decrease in suicide by 2013, Drug Related Death Review Group (local and national) Road to Recovery http://www.scotland.gov.uk/Publications/2008/05/22161610/0
23. Challenges Stigma/societal/cultural considerations Assessment Service capacity Skills required for working with clients experiencing Co morbid MH conditions Substance use during treatment? Economics Pragmatic Solutions ScottishdrugsForum
27. Solutions? Not sitting in a silo Regular assessment of suicide Joint training Working together Integrated, not sequential or serial pathways ScottishdrugsForum
28. Good Practice Joint training for staff in suicide intervention skills, overdose awareness and for some Naloxone training. Outcomes from local DRD groups being fedback to GP’s, staff, peers Working to attend GP “Protected Learning Time” PLT Involvement of operational staff on DRD COMMUNICATION ScottishdrugsForum
30. Summary and opening up for questions Q. Those of you who work with people with alcohol problems do you highlight the risk of topping up with methadone? Q. How many of you are involved with Commitment 13 in your area? ScottishdrugsForum
