Deaths from cocaine double and toll is set to grow
Key quote: "Three years ago, 80 per cent of our treatment service's clients were [using] ecstasy and 20 per cent cocaine, cannabis and other drugs. Now it's 80 per cent cocaine." John Arthur, manager of drugs support and advice group Crew 2000
LETHAL cocktails of cocaine and alcohol will wreak a "heavy toll" in years to come, the country's drugs tsar warned yesterday as fresh figures revealed the Class A drug was responsible for a record number of deaths last year.
In Scotland's capital alone, cocaine is now present in the blood of about 15 per cent of people who have died from drugs.
And Tom Wood, chairman of the Scottish Association of Alcohol and Drug Action Teams, warned the number of people dying after taking cocaine was likely to rise even higher.
The former deputy chief constable of Lothian and Borders Police also highlighted the health dangers of mixing cocaine, regarded as the drug of choice among many young professionals, and alcohol.
"Five years ago there wouldn't have been a trace of cocaine in the deaths. But the drug was present in a number of cases last year and more this year," Mr Wood said.
"The increased use of cocaine, particularly combined with alcohol, will reap a heavy toll in coming years."
Experts said the increased availability and falling cost of cocaine on Scotland's streets combined with a "sophisticated" new breed of drug user, who grew up with the 1990s ecstasy boom, has fuelled demand.
Cocaine-related fatalities across the country jumped almost tenfold in four years, from four in 2000 to 38 in 2004, and figures published today will reveal the number of deaths was even higher last year.
The Scotsman has learned that the number of drug deaths in Edinburgh doubled last year, from 17 in 2004 to around 40.
Across the Lothians, 57 drug-related deaths were recorded in 2005, compared with 36 the previous year. Cocaine was present in the blood of about one in seven of those who died.
This summer alone, at least five people have died after taking cocaine in Scotland's capital. Some of those are believed to have also taken large quantities of alcohol which, combined with the hot weather, can put intolerable strain on the heart.
Mr Wood said those most at risk of dying from cocaine included traditional heroin users, who were taking advantage of an increasingly inexpensive, readily available alternative.
He added: "But there are also more recreational drug users who are switching to cocaine, who think it's relatively harmless. They think it's sexy and 'showbiz'.
"More idiots in wine bars are shoving it up their noses. They don't realise that it's incredibly powerful and dangerous, particularly mixed with alcohol."
Mr Wood said the rising problem of cocaine abuse demanded a radical shift in treatment services.
"Traditionally, our services have been geared towards opiates, but the increasing prevalence of cocaine means we need a rethink throughout Scotland.
"The prediction nationally is for bad news in years to come on drug deaths because of cocaine. I predict that despite increasingly developed early interventions, the attrition rate will continue to run high."
Detective Superintendent Gill Wood, of the Scottish Crime and Drug Enforcement Agency, also expressed concerns.
She said: "Deaths from cocaine are increasing nationally.
"We hope that more people are becoming aware of the health risks associated with cocaine - which is clearly a very dangerous drug."
Last year's Know the Score advertising campaign, which graphically highlighted the damage cocaine causes to the body, would be repeated later in the year, Ms Wood added.
Scottish Executive figures released last month show that cocaine use among Scots in their late 20s and early 30s has almost doubled in a year.
The Scottish Drugs Misuse survey for 2004 suggested cocaine had become the drug of choice for young professionals.
Across all age groups, use of the Class A drug increased slightly, but in the 25-29 age group it almost doubled, from 1.4 per cent to 2.7 per cent of the population. In the 30-34 age group there was also a marked jump, from 1.9 per cent to 2.8 per cent.
John Arthur, manager of drugs support and advice group Crew 2000, said cocaine had become increasingly popular in Scotland's club scene over the past five years.
He said: "We now have a generation of people who grew up using ecstasy, who don't have such a negative reaction to using drugs recreationally.
"Traditionally, Scotland has been fixated on opiates but that's changing.
"Cocaine has a different cachet. It's not taboo and it's part of the norm for many people."
Crew 2000 provides one of Scotland's two cocaine treatment services - with the other located in Aberdeen.
Mr Arthur added: "Three years ago, 80 per cent of our treatment service's clients were [using] ecstasy and 20 per cent cocaine, cannabis and other drugs. Now it's 80 per cent cocaine.
"We need to be looking at some kind of cocaine strategy for Scotland so we have the services in place to meet the demand."
It is believed there are about 51,000 "problem" drug users in Scotland, with most addicted to heroin.
However, experts warn it is difficult to say whether deaths linked to cocaine are of heroin users who have dabbled in the drug or "a new genre of middle-class deaths".
Alistair Ramsay, chairman of consultancy Drugwise - which offers support and advice to industry and schools - said: "We're seeing an evolution in accessibility to cocaine.
"Scotland is being targeted by Colombian cartels, which are becoming better than ever at distributing and marketing cocaine and we're now seeing the casualties.
"The question is whether drug services in Scotland are geared up to deal with this evolution."
Experts say cocaine is becoming increasing popular "across society" - from the homeless and long-term heroin addicts to white-collar professionals.
David Liddell, director of the Scottish Drugs Forum, admitted it was difficult to know the true extent of cocaine's popularity because many recreational users "don't think they have a problem".
Mr Liddell added: "There has been an increase in the number of people using cocaine and crack but ... we shouldn't take our eye off the scale of the heroin problem which still exists.
"Most drugs deaths are driven by opiates."
However, it is accepted that many young professionals who seek help tend to approach their GP rather than attending conventional drugs schemes, and are therefore under-represented in official statistics.
According to a report released by the European Union's drug agency in November, Britain is now top of Europe's "league table" for cocaine abuse.
The annual report of the European Monitoring Centre for Drugs and Drug Addiction found that nearly 12 per cent of people under the age of 35 in Britain had tried the drug at least once.
The EU's experts believe these figures underestimate the situation as there is a serious under-reporting of cocaine-related deaths, with the drug playing "a determining role" in around 10 per cent of all narcotic deaths.
Mixing cocaine with alcohol leads to a sharp increase in its toxicity. Mr Wood said analysis of drug deaths in the Lothians showed that fatalities almost always occurred following a protracted period of drug abuse, often involving a combination of substances.
Analysis of fatalities carried out by the Lothian Drug Related Deaths Group, involving police and NHS Lothian, showed that, last year, 29 per cent of people who died had a record of previous overdoses.
Methadone use was indicated in 14 of the 27 available toxicology reports, while 33 per cent indicated alcohol abuse.
Mr Wood said: "We refer to these statistics as drug deaths and we picture in our minds the tragic teenager who dies after a first flirtation with deadly substances.
"In fact, we typically see a sad group of addicts who, year on year, pay the price of addictions and die of chronic multi-drug and alcohol abuse, often accompanied by medical conditions you would normally associate with people twice their age. In some cases it appears that they simply give up the will to live."
Drink still a big killer as fatalities above 1,500 again
DRINK-RELATED deaths in Scotland have more than doubled since the start of the 1990s. They are now running at record levels in the Lothian, Argyll and Clyde, Lanarkshire and Fife health board areas.
In 1990 there were 657 alcohol-related deaths but by 1997 the annual toll crossed the 1,000 mark to reach 1,061.
By 2000 the death toll stood at 1,292, hitting a record 1,525 in 2003 before dipping to 1,478 the following year.
In 2005 the figure again increased and stood at 1,513, according to statistics given to the SNP MSP Stewart Stevenson in response to a parliamentary question.
Other figures showed that heroin and morphine deaths have increased by 35 per cent since 1999 and totalled 225 in 2004. In 1996 the total was 84.
Greater Glasgow was the area worst affected by drink- related deaths, with 376 last year.
In 1998 the figure was 319 - and during some of the intervening years the death toll was even higher than now, reaching 406 in 2003.
Lothian health board area had 221 drink-related deaths last year while the then Argyll and Clyde health board had 177, Lanarkshire 184 and Fife 76.
Shona Robison, the SNP health spokeswoman, said: "We already know from the latest official figures that there has been a massive increase in the number of patients discharged from Scottish hospitals with alcohol-related conditions.
"The fact that more people are dying from drink as well as drug-related deaths should come as a stark warning that we have a lot of work still to do to combat Scotland's drink and drugs problems."
The Tories also attacked the Executive over the figures which, they said, showed one death every six hours in Scotland from alcohol abuse.
Dr Nanette Milne, the Conservatives' health spokeswoman, said: "Society has clearly changed over the past two decades and we now see women drinking as much as men.
"Sadly, this would suggest that the Labour-Lib Dem Executive's strategy to tackle alcohol abuse isn't making any real impact on the problem."
A spokesman for the Executive said measures had been introduced to tackle the problem. The licensing act brought tough action to tackle binge and under-age drinking, and anti-social behaviour legislation would help tackle drink-related crime and disorder.
Too many people risking their lives with lethal combination
WHILE many cocaine users may believe the drug and alcohol are "made for each other", research suggests it is a dangerous combination.
Studies show the risk of sudden death is up to 18 times greater when the two are used together.
Experts say that, while the combination intensifies cocaine's euphoric effects, it also increases the likelihood of liver damage and puts more stress on the heart.
However, drugs workers warn that the safety message is not getting through to many users.
John Arthur, the manager of the support and advice group Crew 2000, said: "One guy I know says cocaine and alcohol are made for each other.
"Using any stimulant with alcohol - a depressant - stops it from depressing the system. The crude answer is that cocaine allows you to drink more.
"Rather than falling into a drunken stupor halfway through the night, you are able to keep on drinking.
"However, when you take both into the system, the liver produces a new chemical - cocaethylene - which some studies suggest is more toxic to the liver and other organs."
Some studies believe cocaethylene is particularly damaging to the heart.
Although experts say additional research needs to be done, the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death. One survey in the United States found it was also the major cause of heart failure and cardiovascular arrest in cocaine abusers.
A report prepared for the Home Office earlier this year put heroin and cocaine at the top of the league table of harm - it examined 20 substances for their addictive qualities, social harm and physical damage.
Repeated cocaine snorting damages the membranes that line the nose. The drug also causes increased blood pressure and a higher heart rate. Other physical problems linked to it include convulsions, nausea, blurred vision, chest pain, fever, muscle spasms and coma.
Deaths related to cocaine are often a result of cardiac arrest or seizures and respiratory failure.
People attempting to stop taking it have reported feelings of tiredness, panic, insomnia and extreme emotional and physical distress. Symptoms can include diarrhoea, vomiting, the shakes, anorexia and sweating.
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