Case study

Responding to drug related deaths in Newcastle

Review of drug related deaths in Newcastle informed a naloxone scheme, delivery plan and commissioning plan for a complete recovery system

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Summary

An intensive review was carried out of all drug related deaths in Newcastle in 2013 to 2014, after an increase in this period. Support was also provided by the local PHE team. The review’s findings informed the implementation of a naloxone (an opiate antagonist) scheme, a local delivery plan and a commissioning plan for an integrated recovery focused system.

Background

Drug related deaths have risen over the past 3 years, and are at the highest levels since recording began. The North East has the highest rate in the UK, an area with marked deprivation, health inequalities and a high prevalence of drug use.

Although the numbers aren’t huge, they are often indicative of other factors or system failures, particularly affecting the most vulnerable in society, and they can often be prevented.

The recent PHE expert review into drug related deaths found that factors responsible for increase in drug related deaths are multiple and complex. However it is likely that an increase in availability of heroin and an ageing cohort of heroin users experiencing cumulative physical and mental health conditions that make them more susceptible to overdose, are significant causes.

Significant changes in supply have also been reported by the latest DrugWise annual street drugs snapshot.

What was involved?

Newcastle has had a Critical Incident Review Procedure in place for suspected drug related deaths (sDRD) before inquest, which started in 2006. It was developed with a range of partners including Northumbria Police and the Coroner’s Office. An increase in sDRD reports in 2013 to 2014, anecdotal reports of increased overdose rates, feedback about changes in supply and other trends such as increased drug related litter all led to an in-depth review of all cases.

The review included previous review findings, requests for other information (safeguarding, children’s services) and access to coroners’ files. The purpose of the review was to determine whether the trend was likely to continue and improve practice and processes. A life course approach was used to look at common issues or themes and to develop a more systematic approach.

A report of recommendations presented to various groups, both internal and external to the local authority, and to user and carer groups. Independent input and support was provided by the PHE Centre team.

What happened next?

Improvement recommendations focused on:

  • risk management, including standardised practice
  • the city’s confidential review process
  • annual intelligence profiles
  • drug and alcohol planning
  • training and workforce development

Public Health then worked with the local clinical provider to learn from their own internal drug related deaths review of all cases over a five year period.

What works well?

Strategic buy-in and partnership is key to tackling this agenda in Newcastle. The review highlighted developmental areas across the life course themes:

  • implementation of a local naloxone programme
  • a protocol to identify earlier and better support families where there is parental misuse, for both treatment services and social care staff
  • early warning alerts and responses new patterns of use
  • an annual drug intelligence snapshot (and a separate alcohol snapshot) is now produced and informs delivery priorities for both drugs and alcohol, covering early intervention and prevention; building recovery; and risk management and safeguarding

What could be better?

  • continued emphasis on integrating and linking substance misuse services with health services such as mental health, respiratory, stop smoking, diet and nutrition, sexual health, dental health and other services.
  • training plans for 2017 to 2018 are in place to tackle earlier identification and intervention, building a train the trainer network across the city and to clarify pathways to specialist support
  • supporting families where there is parental misuse; identifying as early as possible and taking a ‘think family’ approach to care planning
  • focus on criminal justice pathways, including opportunities to mandate testing on arrest, and to pick up offenders at an earlier stage in the criminal justice journey
  • consistency in intelligence and data sharing with other key areas such as accident and emergency and the ambulance service

Next steps

The recommendations have formed part of the city’s drug and alcohol delivery plan, and partners continue to focus on intervening and responding earlier to risk management to better support individuals, their families and communities.

Further information

Contact: Rachael Hope, Community Safety Specialist – Drugs, Newcastle City Council E: Rachael Hope T: 0191 2788293

Published 1 March 2017