Community pharmacists’ role in preventing drug related deaths (DRDs): an investigation into current UK practice

Ramesh Yadav, University of Bath

The term drug related death (DRD) refers to a fatality where the coroner’s verdict associates drug poisoning with the cause of death. DRD statistics are collated by the Office of National Statistics (ONS) for England and Wales. DRDs include those associated with prescribed drugs and over the counter medicines. However, most commonly DRDs are associated with illicit drugs e.g. heroin, and in such cases the ONS refer to this as a ‘drug misuse death’.  For the purposes of reporting, deaths associated with the use of methadone, a prescribed substitute for heroin, are also classed as ‘drug misuse deaths’. 

 Drug misuse deaths have received significant focus in both the literature and the media in recent years. Incidence has risen in the UK in recent decades, as heroin dependence has escalated. However a small decline has been seen in the past two years. The prescribing of methadone has also increased significantly, to treat the increasing problem of heroin dependence. There is however concern about the risk of methadone related deaths. Overdose is related to a phenomenon called neuroadaption or ‘tolerance’. There is an increased risk of overdose (i) when starting treatment during the titration phase, (ii) if a break in treatment occurs for more than three consecutive days, (iii) after discharge from treatment, for example if relapse occurs, and (iv) if the patient is intoxicated with other substances that shift the dose-response curve to the left, for example alcohol or benzodiazepines. 

 Strang et al (2010) showed that a shift in methadone treatment policy which was introduced from the mid 1990’s has prevented methadone related deaths increasing as prescribing increased. In brief, this policy involves supervising the consumption of methadone doses, withholding dosing of intoxicated patient’s, retitrating patients who have missed more than 3 days treatment and providing overdose prevention advice on completion of detoxification. As the vast majority of methadone treatment in the UK is provided in primary care, community pharmacists undertake most methadone dispensing. They often see patients on a daily basis. They are therefore the main healthcare professional responsible for ensuring that methadone treatment is undertaken in accordance with policy to prevent overdose. However, it is unknown to what extent pharmacists do implement this policy and what more could be done to reduce methadone related deaths further. 

 In 2010 there were 565 methadone related deaths in the UK. Based on anecdotal evidence from practice, it is hypothesised that policy to prevent methadone related deaths is not being fully implemented by pharmacists, and that more could be done to reduce this figure.

This project is running from August 2013 to May 2020.