DDN March 2022 March 2022 | Page 14



Around 2013-14 , like many in the sector we began to see a rise in deaths within our services . As with other providers we were beginning to see a rise in all-cause mortality deaths , so we decided to take a closer look . Our task was to investigate the complexity of risk factors for premature all-cause mortality within the treatment population , and the impact of current clinical management .

There were 316 deaths of people engaged with Derbyshire Healthcare NHS Foundation Trust ’ s ( DHCFT ) substance misuse services – or up to one year post-discharge – between 1 January 2012 and 20 August 2020 . The data cut-off point meant we only had a partial year for 2020 so it wasn ’ t included , but deaths in 2020 and 2021 exceeded those for 2019 .
OVERDOSE Overdose ( predominantly opiate ) was by far the most common cause of death at 115 cases , constituting 40 per cent of deaths for which the cause was known . The cause of death was unascertainable or not yet known in 21 cases ( 7 per cent ). After heroin or opiate toxicity , drugs such as diazepam , temazepam , gabapentin , mirtazapine and increasingly pregabalin were frequently highlighted under section 1b (‘ underlying cause ’ of the main cause of death ) on the death certificate . All other deaths were physical health-related with
With death rates rising across services , Derbyshire Healthcare NHS Foundation Trust decided to dig a little deeper into the statistics . Martin Smith reports
the exception of suicides , of which there were 20 ( 6.3 per cent ). The most common causes of physical health deaths were predominantly liver disease , COPD , bacterial infections and cancers .
The highest number of deaths occurred in the 35-39 age group , followed closely by the 40-44 age group . The age profile of overdose deaths followed the same pattern , but with a more pronounced peak in the 35-39 age group . The data suggests that those aged 50 and over are more likely to die from a physical health condition than an overdose – in the 50-plus age group 19 per cent of deaths were due to overdose , compared to 39 per cent of deaths in those aged 35-49 .
When only chronic causes of deaths are analysed ( brain-related illnesses , cancer , cardiovascular illness , diabetes , liver disease , lung conditions and kidney disease ), the age profile becomes slightly older , with a peak in the 45-49-year age bracket . However , the data shows many deaths at a young age from these causes , with 58 per cent of deaths occurring in those aged under 50 and 22 per cent in those under 40 .
The data shows that most individuals ( 161 , or 52 per cent ) were found alone , while 37 per cent ( 115 ) died in a hospital , hospice or care home . Most deaths in hospital were caused by physical health conditions – only 11 were due to overdose . Twenty-six of the people that died in hospital were receiving end of life care . Only 11 per cent of all decedents were known to have died in the presence of friends – of those people who were found alone , 80 per cent were male . Of the 115 people who died by overdose , an even greater proportion ( 72 per cent ) were found alone . Ten per cent of overdose deaths occurred in hospital and 18 per cent in the presence of friends .
PHYSICAL HEALTH CONDITIONS Physical health conditions were highly prevalent in the cohort that died , with 81 per cent of people ( 251 ) having at least one such condition – 60 per cent ( 186 ) had two or more . The most commonly occurring conditions were chronic obstructive pulmonary disease ( COPD ) at the time of death . In this study 243 decedents were under the
Deaths of substance misuse service users from any cause
Number of deaths
50 45 40 35 30 25 20 15 10 5 age of 50 . Of these 191 had at least one long-term health condition such as COPD , liver disease , or a heart condition , and 155 had an identifiable mental health condition , such as anxiety and depression disorders , personality disorder , PTSD or psychotic illness . Poor physical health and life-limiting conditions will continue to be a challenge to the sector . Three quarters of the people who died had also had at least one hospital admission in the previous 12 months – a significant red flag and a clear indicator of risk regardless of reason for hospital admission .
In addressing overdoses we started rolling out naloxone in 2015 , and it ’ s likely that deaths both locally and nationally would have seen a greater increase without it . However , the prerequisite for naloxone effectiveness is that another person is present and available to administer it at the time of an overdose . With the number of people using drugs alone , living in isolation , and dying alone it is becoming clear that further interventions will be required , and it is highly likely that technology will play a key role .