Non-medical use of opioids - with a focus on NPS LAUREN COMBER – HOME OFFICE, UNITED KINGDOM 5TH WHO-UNODC EXPERT CONSULTATION ON NPS NON-MEDICAL USE OF OPIOIDS - UK 350000 327,466 Opiate and/or crack 300,783 293,879 300000 cocaine 257,476 Opiate 281,320 Opiate 256,163 257,476 users in England. 250000 Equates to 7.3 users per 1000 192,999 200000 population. 182,828 166,640 Crack cocaine 150000 Estimated number of users 100000 50000 0 2004/05 2005/06 2006/07 2008/09 2009/10 2010/11 2011/12 2014/15 300 Deaths related to 250 Opioid Pain Tramadol Meds - 2016 200 Codeine not from compound formulation6 Fentanyl and Fentanyl analogues: Dihydrocodeine not from 150 • 2017 – 106 Deaths - 75 compound formulation (fentanyl) + 31 (fentanyl Oxycodone analogue) • 2016 – 59 Deaths - 58 (fentanyl) 100 Fentanyl + 1 (fentanyl analogue) Codeine: Buprenorphine • 2017 – 156 Deaths 50 • 2016 – 131 Deaths Tramadol 0 • 2017 & 2016 – 185 Deaths but down from 2014 high. OPIOID ANALGESICS - PRESCRIPTIONS Top opioid analgesic prescription items dispensed in Opioid analgesics - prescription the community in England 2007-2017 items dispensed in the community 9,000,000 Tramadol Hydrochloride in England 8,000,000 30,000,000 Morphine Sulfate 7,000,000 25,000,000 Codeine Phosphate 6,000,000 20,000,000 Buprenorphine 5,000,000 15,000,000 Dihydrocodeine Tartrate 4,000,000 10,000,000 Oxycodone 5,000,000 3,000,000 Hydrochloride Fentanyl 0 2,000,000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Diamorphine 1,000,000 Hydrochloride (Systemic) Dipipanone 0 Hydrochloride PREVENTION DRUG INFORMATION SYSTEMS AND ALERTS FRANK is the government’s drugs information PHE issued guidance for local areas on and advice website. It is an established brand in England and provides high quality, impartial how they could develop their local information on the effects and harms of a networks and systems for gathering and wide range of drugs. It also has regular assessing information on drug threats, updates on NPS, and stories on particular and issuing warning and alerts, and threats channel this information up into regional The FRANK website is aimed at young people, and national systems but it is also widely used by people who are concerned about a friend or family member’s Regional and national alert systems use drug use. standardised scoring to assess There is also a FRANK helpline, which is mostly intelligence and decide whether to issue used by an older demographic alerts PUBLIC HEALTH RESPONSE Surveillance Reducing Harm Treatment National data collection. Naloxone – Supplied without a Treatment penetration is around 60%. prescription. Improving provision. Rapid access to coroners’ post- Clinical Guidelines – “The Orange Book”, “NPS Toolkit” and “Neptune mortem toxicology. Looking to extend to include nasal naloxone. Guidance” National Early Warning System. Longstanding treatment services – Opioid Substitution Therapy focus on waiting times, access points Hospital admissions data – Report and central Government funding Illicit Drug Reactions (RIDR), Heroin Assisted Treatment allocated to local areas. CASE STUDY – FENTANYL Understanding Messaging Responding • Collating all available intel on • Advising local partners on the • Mapping and expanding hospital admission, deaths, relative toxicity of fentanyls naloxone availability toxicology, etc and risks of exposure • Providing guidance to local • Working with coroners, labs, • Sharing clear messages for government NCA and police to improve real-time data flow on drug services and drug users seizures and deaths PRESCRIBED MEDICINES REVIEW The review will bring together the best available evidence on: • prevalence and prescribing patterns • the nature and likely causes of dependence and the short term discontinuation or longer term withdrawal symptoms associated with prescribed medicines among some people who take these medicines • effective prevention and treatment of dependence, withdrawal and discontinuation syndrome for each drug category SUPPLY REDUCTION Legislative Controls Law Enforcement International ➢ Misuse of Drugs Act 1971 ➢ National Crime Agency Cooperation dedicate resources to closely ➢ Bilateral/Multilateral ➢ Temporary Class Drug Order monitor and disrupt supply of Cooperation ➢ Psychoactive Substances Act synthetic drugs. ➢ Data/Information sharing 2016 ➢ Continue to develop the threat picture. ➢ International Controls ➢ Dark Net activity. ➢ Border detection. First ever conviction for the supply of fentanyl Kyle Enos, pleaded guilty in August 2017 to importing, supplying and exporting class A drugs over the dark net to various outlets in the UK, US and Canada by post. Enos was jailed in February for 8 years. THANK YOU – QUESTIONS? Lauren Comber, International Drug Policy, Home Office [email protected].