More on drug-related deaths at
Like so many others, Darren’s death was preventable, says Dr Chris Ford
Both the local
service and his
GP turned him
they [benzo -
Darren found it
easy to get
them from the
internet so his
mainly to try
and curtail his
I STILL CRY WHEN I THINK OF DARREN
months after his death. He was young and
had done well in treatment – I felt I must
discover why he had died, as so many others
die, and drug-related deaths in the UK
continue to rise.
I first met Darren in 1997. He was 17
years old and registered to ask for help with
his heroin problem. He was also a charmer
with a cheeky smile, but he looked unwell. He
had been injecting for about six months and
realised he couldn’t manage without heroin.
He also told me he had an alcohol problem,
which had improved since he took up heroin
– he had been drinking up to two bottles of
vodka a day but now only drank beer. The
other drug he liked was diazepam, which he
could pinch from his mother on occasions.
His request was to go on methadone and
then become drug free. I said that was
possible, but asked if I could see his
injecting sites first. Darren rolled up his
sleeves and revealed the worst injecting
tissue damage I had ever seen. My first job
was to teach him how to inject.
Darren settled well into treatment and
after about nine months of methadone
maintenance, he felt ready to become drug
free so we discussed the pros and cons. He
reduced over about six months and was very
pleased. He agreed to continue counselling
and to come back if he was at risk of relapsing.
After six months he relapsed – first on
alcohol and benzos, and then heroin, and
repeated this pattern for about 14 years.
Mostly he would do outpatient detox with
us, but did have two attempts at
rehabilitation. For most of the time on
maintenance, he worked as an apprentice in
a butcher’s. He loved the work and dre amed
of having his own shop. His relapses were
usually started by increasing his alcohol, but
a couple were when he found crack.
Having relapsed again in early 2011,
Darren once again settled quickly on
methadone maintenance. He had been
drinking a lot and we discussed that as he
had chronic hepatitis C, perhaps he should
think more seriously about treatment. He
smiled and said he would think about it. But
early in 2012, having learnt that I was
retiring, he said he must detox now as other
services ‘may not understand me so well’.
Piecing together what happened in the
four years leading up to his death made me
angry. He had again relapsed on alcohol and
benzodiazepines and was determined not to
relapse on heroin, so presented asking for
benzodiazepines. Both the local service and
his GP turned him down, saying they were
very addictive. Darren found it easy to get
them from the internet so his habit
increased enormously, mainly to try and
curtail his alcohol. He started to feel more
unwell and realised that his drinking was
not helping his hepatitis C, so changed to
heroin. He lost his job, split up with his
girlfriend and had rows with his mum, so
presented for help at the local service.
He was told to come back a week later for
an assessment and was ten minutes late, so
was made to come back the next day. He was
told buprenorphine was the best drug for him,
disagreed – and this almost got him excluded
for a month. He decided to give it another try
and presented in the morning in withdrawals.
After four attempts he got his first dose.
Darren soon realised it wasn’t going to
work, but the service insisted he continued.
He dropped out of treatment, his alcohol
and benzodiazepines went out of control,
and he added crack and heroin. After several
months, heroin helped him reduce his
alcohol and he started to buy methadone
off the street. He was even able to start
work again. He tried the local service again
and this time they agreed to continue
methadone. All continued well for several
months but after a series of missed
appointments, he again dropped out of
treatment, took up alcohol, lost his job and
was thrown out of his flat. Darren’s last year
is hazy but he seemed to isolate from
friends and family, drank all he could get
hold of and injected any drugs.
He was found dead in a stairwell with a
needle in his arm and a can of strong lager
by his side. He was only 36 years old.
The USA tops the chart in terms of opioid
overdose deaths, increasing 255 per cent
between 1999 and 2015. In England and
Wales the rate increased by 35 per cent
between 1999 and 2015, and then by a
shocking 64 per cent linked to heroin and
morphine over the last two years – the
highest since records began. The UK now
has the highest proportion (38 per cent) of
the European total.
Australia, Germany, Luxembourg,
Norway, Switzerland, Greece and Italy are
reducing overdose deaths. What do they
have in common? Extremely good access to
opioid substitution therapy (OST). What else
helps? Drug consumption rooms (DCRs),
heroin-assisted treatment, measures to
reduce homelessness, and take-home
What do I think killed Darren? People not
seeing him as a person and services not
seeing him as an individual – as well as the
UK government replacing extremely effective
harm reduction with abstinence. Overdose
deaths can be reduced – the science is easy.
It’s the policies that need changing.
Chris Ford is clinical director at IDHDP
June 2017 | drinkanddrugsnews | 17