INCLUSION
ALL BY MYSELF
An epidemic of solitary use is helping to drive Britain’ s drug deaths crisis, says Dr David Patton
Across the UK, drug-related deaths continue to rise, driven not only by increasingly potent substances but by something far simpler and far more human – many people are using drugs completely alone. From bedrooms to hostels to temporary accommodation, solitary use has quietly become one of the most dangerous and least discussed patterns in the country’ s drug landscape.
As part of a recent UKRI-funded partnership with Derbyshire Healthcare NHS Foundation Trust, we listened to frontline workers and people currently using drugs across the county. Their message was clear. People are not dying because they don’ t understand the risks – they’ re dying because they have no one with them when something goes wrong.
For many participants, using alone was not a rare occurrence but the norm. Some described practical reasons, such as wanting control over their dose, avoiding pressure to share, or using in spaces where visitors weren’ t allowed. Others spoke about shame, fear of judgement, or a desire to avoid chaotic environments. A few said they used alone most of the time because it simply felt safer than being around anyone else.
SHRINKING NETWORKS Frontline staff echoed these stories. They described older men with deteriorating health and shrinking social networks, women drinking in private due to stigma or fear of family consequences, people in hostels who hide their use because of rules, and individuals newly released from prison with nowhere safe to go. What connects these situations is not drug choice but disconnection. People’ s social worlds have collapsed, and solitude has become a survival strategy long before it becomes a risk behaviour.
Stigma plays a central role in this. Many people avoid GPs, pharmacies and emergency departments because they fear being judged. Some go to great lengths to remain unseen when collecting equipment or medication, while others have withdrawn from services entirely because the shame feels too heavy to carry. When stigma becomes embedded in healthcare, housing, criminal justice and community settings, it creates the conditions where solitary use takes hold.
This is why solitary use needs to be understood not as a personal choice but as the end point of a broader crisis of loneliness, shame and invisibility. And it’ s why reducing deaths requires more than advising people not to use alone – it requires building the kinds of relationships, environments and safety nets that make connection possible again.
Naloxone remains essential, but not only as an emergency intervention. It works best when it’ s everywhere, carried by neighbours, family members, housing staff and members of the public. A kit in every home and workplace is less about equipment and more about creating a culture where people look out for one another.
Stigma-free access to injecting or smoking equipment is equally important. When people can obtain what they need through quiet, anonymous routes, they remain linked to services rather than pushed into hiding. Vending machines, discreet pharmacy collection and postal supply aren’ t luxuries, they’ re forms of connection that meet people where they are.
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