Introduction: Guernsey is a British Protectorate island (population 65000) in the English Channel. Illicit drugs are difficult to import and expensive people look to alternative substances.
Objectives: To establish patterns of drug misuse among patients referred for treatment.
Methods: Case note audit of all referred patients in 2011-13, cross referenced with sudden unexpected death case review results.
Results: 280 patients were referred for primary opiate dependency. Reported patterns of use tended to follow local availability and both poly-drug and pharmaceutical drug misuse were the norm.
233 (83%) reported misusing prescription only medicines (POMs) and over the counter (OTC) drugs, particularly opiates and benzodiazepines. Buprenorphine products were most commonly used (36%), followed by benzodiazepines (30%), dihydrocodeine (18%), heroin (7%) and codeine (7%). A high risk sub-group (9%) injecting fentanyl (derived from fentanyl patches) was identified.
On the island from 2002- 2011 there were as many fentanyl-related deaths as heroin-related deaths at post mortem case review. Opiate-related deaths were over-represented compared to alcohol-related deaths in the Bailiwick.
High rates of pharmaceutical drug misuse on Guernsey may reflect the low availability of illicit drugs like heroin and cocaine. This increases demand for addictive POMs and OTCs. Prescribers in rural and island communities need to be more cautious when prescribing addictive POMs, and pharmacists need to monitor for OTC drug misuse particularly of opioid-containing medications.