Opioid overdose death in Wales: A linked data autopsy study

crossref(2020)

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Abstract BackgroundFatal opioid overdose is a growing public health problem, the incidence of which is rising in the UK and in other western countries. We sought to describe factors associated with deaths, demographic characteristics, and service usage patterns of decedents of opioid overdose in a nation of the UK.MethodsWe carried out a retrospective cross-sectional analysis of opioid related deaths between 01/01/2012 and 11/10/2018 in Wales, UK, as identified from Office for National Statistics data. In addition to ONS records, the Welsh Demographic Service and National Health Service datasets were interrogated for records spanning the preceding three years. Records were linked on an individual basis using a deterministic algorithm. Decedents’ circumstances of death, demographic characteristics, and residency and service use patterns were described. Additionally, data pertaining to circumstances of death were briefly analysed.Results638 people died of opioid overdose in Wales between 01/01/2012 and 11/10/2018. Decedents were mostly male and around 50 years of age. Incidence per head of population was higher at the end of this period, peaking in 2015. In the 3 years prior to death the majority of decedents changed address at least once, but rarely moved far geographically. Over 80% of decedents visited the ED, the majority via emergency ambulance; over 60% were admitted to hospital; and over 30% visited specialist drug services on one or more occasion. Decedents who did not attend drug services were more likely to have died intentionally.ConclusionsHigh risk opioid users are often men of around 50 years of age living peripatetic lifestyles. It appears that those at high risk of dying from opioid overdose death use emergency medical services and are admitted to hospital comparatively often. They are less likely to visit specialist drug services however. Group differences between high risk opioid users who visit specialist drug services and those who do not appear to exist in relation to suicidality. Further research is needed in to delivering abstinence focussed or harm reduction based interventions via emergency services or inpatient hospital settings, and in understanding differences in suicidality between drug service attenders and non-attenders.
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