DRUG RELATED DEATH

DRUG RELATED DEATH

A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, change normal bodily function. There is no single, actual definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage. 

Drug misuse is a term used commonly for prescription medications with clinical efficacy but abuse potential and known adverse effects linked to improper use, such as psychiatric medications with sedative,, analgesic, or stimulant properties. Prescription misuse has been variably and inconsistently defined based on drug prescription status, the uses that occur without a prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of abuse or dependence symptoms. Tolerance relates to the pharmacological property of substances in which chronic use leads to a change in the central nervous system, meaning that more of the substance is needed in order to produce desired effects. Stopping or reducing the use of this substance would cause withdrawal symptoms to occur. 

The definition of drug related death refers to those deaths that are cause directly by the consumption of drug of abuse. These death occur generally shortly after the consumption of the substances. Often these death are referred to as ‘overdose’, although equivalent concepts are also death directly related to drug use, poisonings,  or drug induced death. Drug related death is an important indicator of the health impact of the more severe formsof drug use, and can also be useful for monitoring trends in problem drug use.

The number drug related death per million people is relatively low in the Netherlands. In 2005, 10.9 per million persons aged15-64 died as a direct result of drug use. Mortality due to drug related death varies widely among European countries, ranging from 4 to almost 80 death per million in population aged 15-64. Compared to other European countries the difference in mortality between 15-39 years-olds and 15-64 years-olds is rather small in Netherlands. In absolute numbers, 120 persons aged 15-64 died in 2005 as a direct result of drug use of which 64 persons were aged 15-39. This reflects the fact  that  the population of problem drug users in the Netherlands is ageing. Also in most other EU-15 Member States the mean aged of drug related deaths is increasing, suggesting a decrease in the incidence of heroin use among young people. Furthermore, in all European countries mortality rates among men are substantially higher than among women.

Factor influencing the number of drug related deaths in community are the number of people using drug associated with overdose, the proportion of injectors, prevalence of polydrug use, availability and policy of treatment services and emergency services. An explanation for the relative low number of drug related  deathsin the Netherlands could be the relatively small proportion of heroin users that injectand the relatively high number of methadone users.  

The first thing to note in any  discussion of whether illicit drug related mortality matters is the extent of the problem. As would be expected, given the epidemiology of illicit drug use, the majority of deaths occur amongst younger people, with the average age at death being approximately 30 years. As a general rule, the prevention of premature death is uncontroversial. Few would argue that premature death due to leukemia,  for example, does not matter, or that the victims in some way deserved to die. Drug use, raises the passion that are rarely seen when discussing death due to other cause. Unlike a disease brought on by some external factors, death due to drug use is essentially self-inflicted.  

Even we assume that drug  related death are self-inflicted, however, it is unclear how they could be distinguished from other fatalities that are universally deemed worthy of clinical interest and intervention. Even if it is assumed that drug use, and dependant drug use, is a freely choosen pathway to mortality, drawing distinction between death due to drug use and death due to suicide is difficult. If killing oneself, or attempting to kill oneself, further blurring distinctions between drug related mortality and suicide.   

The harms attributes to drug use include accidental death, chronic disease, birth defects, cognitive impairment, misuse of resources, violence and acquisitive crime. To summarize that material, we know far less about drug harm than politicians claim, and what we do know refutes orthodox political positions. Despite the heady confidence with which politicians around the world have erected criminal penalty scales for difference drug offences no one has yet formulated a well-documented ranking of inherent drug dangers. Some experts rate alcohol, tobacco, barbiturates, heroin, LSD, and finally marijuanaas least dangerous. Both of this ranking reverse the judgment about drug dangerousness implicit in current drug laws. 

In assessing the harm cause by different drugs, the first point to clarify is that an unbiased assessment cannot be made simply by comparing drugs as they now happen to be used. A drug’s impact depends upon dosage, duration of use, purity, legal status, method of ingestion and a host of social factors. Comparing heroin  and beer is equally unfair because heroin’s illicit status puts it at a disadvantages. A fair comparison would pit beer against a pure, mild and legal opiate beverage used by a similar group under comparable circumstances. When such a comparison was possible prior to 1910, a number of commentators claimed that alcohol was more damaging than morphine or heroin. In those days, alcohol was “hard” and cocaine based beverages, like Coca Cola, were “soft” drinks. Anti-alcohol opinion from that period, however, is often unreliable because some prohibitionist slandered alcohol to further their political cause.

The other result that has been anticipate was that drug damage will generally vary more among groups using different drugs. Alcohol and opiates can be used as an example. Both drugs will exhibit the same sort of use distribution. Difference in harm between light and heavy alcohol users will be far greater than the average differences between alcohol and opiate using groups. Indeed, there probably will not be significant average differences between these two group. In other word, the damage a given drug causes depends more on the user than on the drug. 

Drug related deaths, after having increased strongly over the 1985-1991 period, declined over the 1991-1997 period by 30%, mainly reflecting improved treatment services, including substitution treatment. However, faced with increased heroin supply in the late 1990s as a consequence of expansion of opium production and an ongoing increased in number of drug related deaths in the new provinces, this positive trend was not maintained. 

In other words, available data suggest that rising levels of drug availability over the 1997-2000 period did not affect the general population. But led to higher levels of drug consumption among established drug abuser. This led to a larger number of drug related deaths. Similarly first signs of ending the drug oversupply, did not affect the drug incidence rate, but reduced consumption levels of those already taking drugs, and thus contributed to lower levels of drug related deaths in 2001. 

In conclusion, further research is needed urgently on mortality after release from prison, as well as interventions to reduce the risk of drug related death during the transition from prison to community. At present, the regional and cultural variations in drug use limit what can be learnt from the strategies and experiences of other countries around the world. Nevertheless, the elevation in risk clearly exists, and findings from pharmaceutical experimental studies of remedial interventions are likely to be transferable between countries.