Explaining the Differences in Opioid Overdose Deaths between Scotland and England/Wales: Implications for European Opioid Policies

Abstract

<b><i>Backgrounds:</i></b> Between 2009 and 2018, the number of opioid-related deaths (ORDs) in Scotland showed a dramatic increase, whereas in England and Wales, a much lower increase in ORD was seen. This regional difference is remarkable, and the situation in Scotland is worrisome. Therefore, it is important to identify the drivers of ORD in Scotland. <b><i>Methods:</i></b> A systematic literature review according to PRISMA guidelines was conducted to identify peer-reviewed studies about key drivers for the observed differences in ORDs between Scotland and England/Wales. In addition, non-peer-reviewed reports on nationwide statistical data were retrieved via Google and Google Scholar and analysed to quantify differences in ORD drivers between Scotland and England/Wales. <b><i>Results:</i></b> The systematic review identified some important drivers of ORD, but none of these studies provided direct or indirect comparisons of ORD drivers in Scotland and England/Wales. However, the reports with nationwide statistical data showed important differences in ORD drivers between Scotland and England/Wales, including a higher prevalence of people using opioids in a problematic way (PUOP), more polydrug use in people using drugs in a problematic way (PUDP), a higher age of PUDP, and lower treatment coverage and efficacy of PUDP in Scotland compared to England/Wales, but no regional differences in injecting drug use, incarceration/prison release without treatment, and social deprivation in PUDP. <b><i>Conclusion:</i></b> It is concluded that the opioid crisis in Scotland is best explained by a combination of drivers, consisting of a higher population involvement in (problematic) opioid use (notably methadone), relatively more polydrug use (notably benzodiazepines and gabapentinoids), a steeper ageing of the PUOP population in the past 2 decades, and lower treatment coverage and efficacy in Scotland compared to England/Wales. The findings have important consequences for strategies to handle the opioid crisis in Scotland.

The Socio-Demographics and Health Service Use of Opioid Overdose Decedents in Wales: A Cross-Sectional Data Linkage Study

“…A recent systematic review carried out by van Amsterdam et al [5] concluded that the increased opioids overdose deaths in Scotland compared to England and Wales can be explained by multiple factors, notable amongst which are concurrent use of benzodiazepines and gabapentinoids. These findings confirm data from North-American studies identifying concurrent benzodiazepine use as increasing risk of fatal overdose in opioid users.…”

“…A recent study of fatal opioid overdose decedents in the UK is lacking [5]. We describe findings from a retrospective cross-sectional study using routine linked data to identify and describe characteristics of death (including substances involved and intent), demographic characteristics, residential mobility, and patterns of healthcare service usage of opioid overdose decedents over 3 years prior to death.…”

Effectiveness and Safety of Low-Threshold Opioid-Agonist Treatment in Hard-To-Reach Populations with Opioid Dependence

“…A Canadian study found that among people who injected drugs, participation in low-threshold OAT (also among those receiving Met) in primary care settings was significantly associated with improved survival [28]. In contrast, lower OAT coverage and efficacy in Scotland than England/Wales have been mooted as an explanation for the opioid crisis and deaths in Scotland [37].…”

Take-Home Naloxone and the Prevention of Deaths from Heroin Overdose: Pursuing Strong Science, Fuller Understanding, Greater Impact

“…Annual deaths from prescription opioids have quadrupled over the last couple of decades plus, more recently, heroin deaths quadrupling over the last decade, as well as a recent explosion in deaths involving fentanyl and analogues (mostly illicitly manufactured) [1]. Europe has a variable problem [2], with some countries such as Scot-land severely afflicted, and nearly 9,000 European citizens dying annually of opioid overdose (strangely higher in northern Europe) (Fig. 1).…”