Drug misuse deaths: can pharmacists help shift the balance?

While deaths from drug misuse are falling in some parts of the UK, they remain historically high. With new guidance enabling pharmacy-led take-home naloxone alongside supervised opioid substitution therapy (OST) and needle and syringe programmes, pharmacists are being positioned as a first stop for preventing fatal overdoses.

Drug deaths – the scale of the problem

The latest figures reveal a mixed picture. Scotland registered 1,017 drug misuse deaths in 2024 – down 13% on the previous year and the lowest total since 2017. Yet even with that decline, the rate remains 3.6 times higher than it was at the start of the millennium.

In England and Wales, the recent story is one of escalation. The Office for National Statistics reported 5,448 drug poisoning deaths registered in 2023 – an 11% increase on 2022 and the highest number since records began in 1993. Within that total, 3,618 deaths were identified as drug misuse, relating to substances controlled under the Misuse of Drugs Act 1971 or cases of drug dependence.

However, these figures might not even reflect the true picture, as concerns have been raised about under-reporting.

Research from King’s College London, reported by the BBC, found that more than 13,000 opioid deaths between 2011 and 2022 were missing from official statistics in England and Wales – suggesting the true toll was over 50% higher than previously recorded.

Meanwhile, Northern Ireland recorded 154 drug-related deaths in 2022, a significant fall on the year before but still 40% higher than in 2012.

The burden is not evenly spread. Scotland’s most deprived areas have rates 12 times higher than the least deprived, while the North East of England has consistently recorded the highest mortality of any English region.

In Scotland, a three-year pilot of the UK’s first safer drug consumption facility opened in Glasgow in January 2025, reflecting the scale of the crisis.

Opioids continue to dominate. They were implicated in four out of five deaths in Scotland, nearly half of all drug poisonings in England and Wales, and more than half in Northern Ireland.

Related Article: Research review: a look at the latest clinical papers

Polydrug use is an increasing feature, though, with benzodiazepines and cocaine commonly implicated alongside opioids. Synthetic opioids such as nitazenes – described in official Scottish statistics as being hundreds of times more potent than heroin in some cases – are now appearing in UK mortality data, while xylazine – a powerful veterinary sedative – has been detected in a small but growing number of cases.

The policy response – pharmacy at the frontline

Against this backdrop, governments across the UK have turned to community pharmacy as a frontline resource in harm reduction.

Guidance issued in England in early 2024 describes community pharmacies as ‘vital’ in the care of people who use drugs. It highlights the role of pharmacists in supervised consumption of opioid substitution therapy, dispensing, needle and syringe programmes, and, increasingly, in the provision of take-home naloxone.

In fact, naloxone – the emergency antidote to opioid overdose – has become the focal point of legislative change. Amendments to the Human Medicines Regulations in 2024 enabled pharmacists and pharmacy technicians to supply naloxone without prescription, provided they are suitably trained.

In Scotland, a national pharmacy naloxone supply service was introduced in 2023, requiring every community pharmacy to hold supplies for emergency administration.

The practical reality – what the guidance says

While naloxone has been the headline change, the 2024 guidance sets out other practical steps for community pharmacists and pharmacy teams in delivering substance misuse services day to day.

These include:

• Supervising safely – check patients are not intoxicated before supervised doses, observe ingestion, and record missed doses promptly.
• Dispensing carefully – follow instalment directions, store controlled drugs securely, and report concerns about diversion.
• Supplying naloxone – keep stock of naloxone, ensure staff are trained in overdose recognition and product use, and give clear advice when supplying.
• Supporting safer injecting – provide clean equipment, dispose of returns safely, and signpost to blood-borne virus testing or vaccination.
• Acting on red flags – treat missed doses, intoxication or safeguarding concerns as triggers for immediate action and communication with prescribers or drug services.
• Staying trained – make sure all staff, including locums, are trained in overdose response, safeguarding, and trauma-informed care.
• Working together – maintain links with local drug services, GPs, hospitals and criminal justice teams to ensure joined-up care.

The strategic view – pharmacy as a safety net

Alongside official guidance, leading pharmacy figures have been making the case for a stronger role in harm reduction. Professor Amira Guirguis – a pharmacist, independent prescriber and member of the Advisory Council on the Misuse of Drugs – is one of them.

Professor Guirguis believes pharmacists play a key role as a frontline safety net in the care of people who use drugs.

She says: ‘Their accessibility, clinical expertise and harm reduction interventions help reduce stigma, support retention in treatment, prevent relapse and premature drug-related deaths.’

Professor Guirguis – who is also deputy pro vice chancellor at Swansea University and principal investigator of the first Home Office-licensed pharmacist-led drug checking service in the UK – stresses that pharmacists’ skills in medicines management and prescribing continuity are central to keeping people safe, particularly when patients are at risk of dropping out of treatment or missing doses.

‘Pharmacist prescribers ensure continuity of care across healthcare settings, ensuring timely access to prescriptions, even out of hours, monitoring of adherence and missed doses,’ she explains.

‘To prevent deaths from the use of drugs, pharmacists identify at-risk individuals, monitor the diversion of medicines, address safeguarding concerns, and signpost to specialist services including mental health support.’

She also points to the profession’s role in sharing intelligence through national drug alerts and drug checking services, contributing to early warning systems that can prevent harm on a wider scale.

Related Article: Seven illnesses meningitis is often mistaken for

The everyday reality – countless small interventions

For many pharmacists working in primary care and community settings, the challenges of dealing with drug misuse are part of daily practice.

According to Shilpa Patel, pharmacist and practice partner at WellBN, a GP surgery in Brighton, the daily contact that pharmacists have with patients gives them a unique insight into patterns of use.

‘As a pharmacist working in general practice and specialising in the prevention of drug misuse, I see the very real impact medicines can have when they are not used safely,’ she says.

‘Misuse often doesn’t start with bad intentions – it can creep in through unmonitored repeat prescriptions, risky combinations, or people trying to manage symptoms on their own.’

As Ms Patel observes, pharmacists are often the first to spot early warning signs, whether they come in the form of changes in how a patient collects medicines, requests for early refills or subtle shifts in behaviour.

‘Patients see us more often than they see their GP, and they usually feel comfortable talking openly with us,’ Ms Patel adds.

‘Sometimes prevention is as simple as starting a non-judgemental conversation, offering harm-reduction advice, or pointing someone towards support services before things escalate.’

Barriers and opportunities

Despite momentum behind pharmacy’s role in reducing drug misuse deaths, challenges remain. Workload and staffing pressures are already widely acknowledged in community pharmacy, raising questions about capacity to deliver new services.

Another challenge is that the people most at risk of overdose are often the least likely to seek help from healthcare services. However, it could be argued that this makes pharmacies’ accessibility all the more important, since they may be the most likely point of contact.

Related Article: MenB vaccination programme to be rolled out in pharmacies

Partnerships in prevention

The fight to prevent drug-related harm is not one that pharmacists face alone. Ms Patel stresses the importance of working closely with prescribers to ensure treatment is safe and appropriate, reviewing repeat medications, and reducing the risks linked to dependence.

Interventions also go beyond medicines, with advice on alcohol, smoking or safe storage – small steps that reduce risks long before specialist support is needed.

‘Everyday pharmacy practice gives us countless small opportunities to intervene – and those interventions really do matter,’ Ms Patel explains.

‘By noticing the patterns, asking the right questions, and building trust, pharmacists can play a central role in reducing drug-related harm and ultimately saving lives.’