An exploratory study of information sources and key findings on UK cocaine-related deaths (original) (raw)
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Background and rationale for focusing on cocaine-related emergencies. The use and seizures of cocaine have increased during the last decade, particularly in some countries, and cocaine is now the second most used illicit drug in Europe, after cannabis. However, levels of use differ widely between countries, and there is a noticeable diversity among cocaine users, both in patterns of use and sociodemographic characteristics, which complicate an assessment of the prevalence of the drug’s use, its health and social consequences, and the necessary responses. Cocaine-related health consequences are difficult to observe. This is partly due to the often unspecific or chronic nature of the pathologies typically arising from the long-term use of cocaine, and also to the difficulties in establishing causal links between illness and the use of the drug. Data on market indicators (e.g. seizures) and prevalence of use can help to approximate the extent of cocaine use and availability at a European level, but the traditional indicators of drug problems (e.g. treatment demand or drug-related deaths) may not identify many of the health consequences of use. Data from drug users attending hospital emergency departments (and other health emergency services) may be a useful source of information on the consequences of drug use that are not recorded elsewhere, and can also capture new or emerging drug-related problems. In the United States, data on drug-related hospital emergencies from the Drug Abuse Warning Network (DAWN) system are widely used to help monitor problems related to drug use in general, including cocaine. In Europe, however, although some information on drug-related hospital emergencies is available from several countries, it has not been systematically collated. Objectives. This publication completes and expands on the paper in European Addiction Research by Mena et al. (2013) on cocaine-related health emergencies in Europe. Its objectives are: • To present a summarised literature review of the most common health problems caused by cocaine use, focused on cardiovascular, cerebrovascular and neurological problems. • To describe the sources of information on drug- and cocaine-related health emergencies in Europe and analyse relevant data from European countries’ recent annual National reports to the EMCDDA. • To discuss the limitations of the data collected on cocaine-related acute emergencies and the public health implications of the cocaine-related results. • To discuss the broader issue of using data from emergency settings to help monitor problems related to drug use. Methods. A review of the literature on cocaine-related health consequences was conducted by the EMCDDA focused on the topics mentioned above. Information on hospitals’ data collection on cocaine-related health emergencies was requested from drug-related death (DRD) experts in 30 countries (the 28 EU Member States, Turkey and Norway). Relevant information in each country’s focal point annual report to the EMCDDA from 2007–11 (published in 2008–12) was used to expand on the DRD experts’ responses. Where available, statistics reported by the national focal points to the EMCDDA on cocaine-related cases in hospital emergency departments or other settings from 1999–2011 were used to identify long-term trends. Data on drug-related visits to hospital emergency departments were obtained from 19 countries. Results. The literature review revealed a wide range of consequences of cocaine use, including mainly cardiovascular, cerebrovascular and neurological complications. It was found that cocaine–alcohol and cocaine–heroin combinations might present particularly severe health risks compared to the health risk of cocaine taken alone. Data on cocaine-related emergencies were obtained from 17 of the 19 countries for which data on drug-related visits to hospital emergency departments were obtained (these data were not reported from Estonia and Malta), although they are sparse in some cases. In the most recent year for which data were available, the United Kingdom reported the highest number of cocaine-related emergency episodes (4209 and 2 247 according to two sources, 2010–11 data), followed by Spain (2 386) in 2011, Italy (2 408) in 2008 and the Netherlands (an estimated 1 176 cases annually on average) from 2006–10. The cases are mainly male adults in their thirties, and many had used other drugs together with cocaine. Where information is available, most cases are related to acute intoxication. There has been a large (two- to three-fold) increase in the number of cocaine-related episodes reported from these countries since the end of the 1990s, although these increases peaked in Spain and England in 2007–08. Data on drug-related road traffic accidents are reported in only some countries’ National reports and are usually sparse. Where available, the data on the type of substances involved show that alcohol is by far the most common psychoactive substance involved, frequently followed by psychoactive medicines. Cocaine is rarely specifically mentioned, but may be included in a broader category such as ‘stimulant drugs’. Limitations. There are limitations to the data currently available on illicit drug- and cocaine-related emergencies in Europe, and analysis must be conducted with caution. The countries’ approaches to recording and reporting emergencies vary, however, with formal indicators established only in Spain and the Netherlands. In some countries the data provided from a specific source are not updated the following year in the National reports (in Belgium and in Italy, for instance). Some of the data from some countries are based on local or sentinel monitoring systems, which are valuable in providing information on trends (when based on stable data collection) but which do not provide a complete account of the numbers. The picture provided here is therefore incomplete and underestimates the actual extent of cocainerelated problems, particularly because of the absence or limitation of data from some countries with a known relatively high prevalence of use. Nonetheless, we believe that we have captured data from most of the countries that bear the largest burden of cocaine-related emergency cases. Conclusions. This study reveals the substantial levels of morbidity related to cocaine use, translated into the large number of cocaine cases seen in various emergency settings in European countries. This health burden is often not captured by other traditional drug indicators. The report also points to the potential for early prevention, assessment and referral opportunities that may currently be overlooked, including the referral of some patients who may benefit from specific counselling or treatment. In varying degrees, many European countries are able to monitor the morbidity associated with drug use (including the harms related to cocaine) using data from hospitals, particularly emergency departments, as well as from other emergency settings, but the absence of a coherent European wide monitoring system means the overall picture is difficult to determine. Although the implementation of such a system for monitoring drug-related emergencies has both practical and cost implications, our findings suggest that it would constitute an important indirect indicator of several aspects of drug use. Investment in this area could, for example, provide an indicator of drug use trends, help to monitor the consequences of drug use within Europe — in particular new psychoactive drugs, prescription drugs and polydrug use — and measure hospital emergency departments’ drug-related workload.
2010
The Annual Report on drug-related deaths in the United Kingdom published by the national programme on Substance Abuse Deaths (np-SAD) is used by the UK Government, national and international agencies, academics, and commissioners and service providers as an indicator of the extent and nature of drug misuse, and makes a contribution towards the prevention of substance abuse problems. The Programme could not achieve its goals and objectives without the invaluable voluntary collaboration and cooperation of coroners and their officers across England, Wales, Northern Ireland, Guernsey, Jersey, and the Isle of Man. Scottish drug-related deaths data is provided by the Scottish Crime and Drug Enforcement Agency. Additional data is provided by the Northern Ireland Statistics and Research Agency on drug-related poisonings from the General Mortality Register. The contributions from all are important as it enables the Programme to maintain a UKwide reporting and surveillance system. We thank them all for their active participation and support. The findings show an increase in deaths in 2009 reported directly to np-SAD by coroners from England, Wales, Northern Ireland and the Islands when compared to the number reported in last year's report. Deaths in Scotland have remained stable. The np-SAD has an ongoing programme of visits to a representative sample of coroner areas to monitor the quality, accuracy and comprehensiveness of the data received on drug-related death. As in previous years, the statistics in this report are intended to inform authorities at the local, regional and national levels, as well as health professionals and the general public, about the serious consequences of drug abuse, especially polydrug use. This year's report provides a more detailed analysis for 'drug misuse' deaths for England and looks in particular at differences between age-groups, the mortality of drug users aged over 40, and polysubstance implication in death. The report also provides a number of indications of changes in patterns of drug abuse, trends over time, and emerging issues from our surveillance activities so that appropriate and timely action can be taken. The Programme would like to express their thanks to the Department of Health for its support for this very important programme.
Deaths related to cocaine consumption: southern spanish experience
Annales de Toxicologie Analytique, 2008
Introduction: In the last few years, cocaine has emerged as a major cause of morbidity and mortality in our country. The objective of this study was to get an insight into the presence of cocaine and related compounds in forensic cases received in the Department of Seville of the Spanish National Institute of Toxicology in 2005. Materials and Methods: Toxicological analyses were performed in all samples received, following our laboratory normal procedures. Ethanol was analysed by means of headspace GC-FID. Screening of drugs of abuse was performed by means of CEDIA. Extraction was accomplished by SPE (Bond-Elut, certified) and the extracts were analysed by gas chromatography with NPD and gas chromatography-mass spectrometry (GC-MS). Results: Cocaine and its metabolites were detected in 76 of the blood samples analysed and in 119 (61.57%) of the studied cases, only the metabolites were detected. Ethanol and ethylbenzoylecgonine were detected in 12 cases. Cocaine blood concentrations ranged from 0.02-7.24 mg/L. In 41 cases blood cocaine concentration was below 0.1 mg/L, in 25 was between 0.1-0.5 mg/L, in 9 cases between 0.5-1 and in 8 cases over 1 g/L. Conclusions: As it has been stated before, it seems that with the exception of massive drug exposure, cocaine-related deaths occur for the major part after prolonged drug use and it is almost impossible to correlate a specific blood concentration to toxicity. However, our results some differences between blood cocaine concentrations in people who died in road accidents and those who died in a different manner.
Drug-related deaths in the UK : Annual Report 2012
2013
We are grateful to the coroners listed below, their deputies, officers and assistants, for providing the information in this report. We apologise if we have inadvertently omitted anyone. This list may differ from the list of jurisdictions given in Appendix 1 due to the fact that many jurisdictions are being merged as coroners retire, and in anticipation of the expected restructuring of the Coroners' Service in England and Wales. We wish all those who have recently retired all the best for the future, and thank them for supporting the surveillance work of the np-SAD. In some areas, the coroners do not have the resources to provide information but have kindly permitted others that collate such information to pass this on to us on their behalf; we thank those individuals who have contributed information in this way. In addition, a number of coroners in Kent and North Wales who previously have been unable to provide data have now agreed to do so; this information will appear in future reports. We are also indebted to the Scottish Crime and Drug Enforcement Agency and the Northern Ireland Statistics and Research Agency for the provision of data relating to their respective countries. We would like to thank Jessica Baah-Achamfour and Christine Goodair for their help in preparing this publication. Table of contents viii List of tables and figures x
Emergency health consequences of cocaine use in Europe
This study reveals the substantial levels of morbidity related to cocaine use, translated into the large number of cocaine cases seen in various emergency settings in European countries. This health burden is often not captured by other traditional drug indicators. The report also points to the potential for early prevention, assessment and referral opportunities that may currently be overlooked, including the referral of some patients who may benefit from specific counseling or treatment. This study provides a review of the monitoring of drug-related acute emergencies in 30 European countries.