New evidence shows the risk of drug related death is more acute in deprived areas—a finding that tells us a lot about the UK’s underlying structural inequalities, says Ian Hamilton

Two recent reports on drug related deaths make for sobering reading. The first from Scotland sets another unenviable record, as it marks the nation’s seventh consecutive annual rise in drug related deaths: its 1339 deaths in 2020 are a 5% increase from 2019. The second covering England and Wales finds that these regions’ 4561 deaths in 2020 are the highest since records began in 1993.

Scotland now has the highest rate of drug related deaths in Europe, while combining the deaths from England and Wales makes up nearly a third of all deaths reported across Europe. This is a clear warning sign that all is not well in the UK. Indeed, these fatalities tell us as much about our underlying structural problems as they do about the risk of using drugs. A clear indicator of this is the unequal way that these deaths are distributed, with the risk of dying due to drugs elevated in the most deprived areas. For Scotland, the difference is stark: those from the most deprived areas are 18 times more likely to die compared with those living in the most affluent areas. For England and Wales, the ratio isn’t as great but it’s still significant, with the risk three times greater in the north east compared with London.

We know that the covid-19 pandemic has amplified inequalities, as poverty, unemployment, poor housing, and homelessness have all been felt most acutely by those from the lowest socioeconomic groups. The failure of successive governments to “level up” has left too many people seeking their own solutions. For some, drugs are the available and affordable antidote to the daily struggle for survival. Heroin, cocaine, diazepam, and alcohol all provide the instant and short term effective relief that the state won’t. 

Until effective ways of reducing social inequality are implemented, the best that we can hope for is timely specialist support for those developing drug related problems, such as dependency. As Dame Carol Black recently pointed out in her government sponsored review of drugs: “The government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences.”      

We will have to wait for the autumn spending review to see whether the necessary investment in treatment will be made, but the prime minister and home secretary have already made some worrying public statements. Both Boris Johnson and Priti Patel seem to be keen on linking drugs with crime rather than advocating for investment in treatment. They both know that appearing tough on crime appeals to their voters, while at the same time neatly distracting attention from the decade of cuts their party has imposed on treatment. This is not simply a benign political strategy—it compounds the stigma experienced and felt by those who need help with problems due to drugs. Stigma prevents people seeking treatment in a timely way by suggesting that they should face new types of punishment—a narrative that adds to the existing barriers people face in seeking help.

All this hampers the move to frame problem drug use as a health rather than criminal issue. This perceptual shift really matters as it makes clear that support, not punishment, should be the aim of policy and resource allocation. 

Even if the government can’t or won’t solve the structural problems that contribute to drug related deaths, we have the evidence of how to reduce harm. Some of these interventions, such as drug consumption rooms, often make the news, but it is the more mundane options that could have the biggest impact even if they don’t make for eye catching headlines. For example, ensuring that adequate doses of substitute drugs for opiates, like methadone and buprenorphine, are available to everyone who could benefit would halt the rise in fatalities. Although these medications are relatively cheap, the infrastructure needed to administer them does require money.

The biggest investment, however, will be professional staffing, such as addiction psychiatrists, pharmacists, and specialist nurses. Given the decimation of addiction psychiatry in recent years, this part of the workforce will take time to re-establish and nurture. Problem drug use is an issue that will be with us for years, so we need to build a workforce to meet demand and ensure that avoidable drug fatalities are just that—avoided.

Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. Twitter: @ian_hamilton_

Competing interests: none declared.