Drug-Related Deaths in Scotland in 1997

G W L Jackson, BSc, MA
Statistician, National Records of Scotland (NRS)

Dr S K Cole MD, FRCOG, FFCM, FRCP(Ed.)
Consultant Medical Adviser to the Registrar General for Scotland

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Introduction

1 In its enquiry in 1993 into drug abuse in Scotland, the House of Commons Select Committee on Scottish Affairs expressed concern about the quality of available information on deaths resulting from drug abuse. In response to the Select Committee's concern an improved system for collecting information on drug-related deaths in Scotland was introduced in 1994. A paper[Footnote 1] published in June 1995 by the Registrar General for Scotland described this revised system. The paper outlined the definitions used and presented data for 1992, 1993 and 1994. The figures for 1994, which were collected using the revised system, provided a base-line against which future trends could be assessed. Further short papers published in 1996 and 1997 gave information about drug-related deaths in 1995 and 1996. The present paper gives figures for 1997.

2 The system introduced in 1994 uses a specially designed questionnaire, completed by forensic pathologists, for all deaths involving drugs or persons known or suspected to be drug-dependent. Additionally, NRS follow up all cases of deaths of young people where the information on the death certificate is vague or suggests that there might be a background of drug abuse. A copy of the questionnaire currently used is attached.

3 The definition of a 'drug related death' is not straightforward. A useful discussion on the definitional problems may be found in a recent article in the Office for National Statistics publication Population trends[Footnote 2]. For the analyses presented in this paper the following categories, coded according to the International Classification of Diseases (Ninth Revision), ICD9, have been included:

• Drug dependence (304);
• Accidental poisoning by drugs, medicaments and biologicals (E850 - E858); and
• Poisoning by solid or liquid substances, undetermined whether accidentally or purposely inflicted (E980).

All known suicides have been excluded, as have road traffic and other accidents which occurred under the influence of drugs and deaths from AIDS where the risk factor was believed to be the sharing of needles. The categories selected will include deaths from occasional or experimental misuse of drugs and accidental overdoses of prescribed medicine as well as some unrecognised suicides.

4 To aid interpretation of the figures, Tables 1 - 3 below categorise deaths according to whether drug dependence was known (or strongly suspected) or not known and, for the latter category, sub-groups based on the types of drug(s) involved. The second column (headed 'Opiates etc.') covers deaths involving a strong opiate (e.g. morphine, heroin, methadone) or an illegal drug (e.g. cocaine, ecstasy, LSD). The third and fourth columns include deaths from two or more drugs or a single drug respectively,excluding those covered by the second column. In effect the probability of drug-dependence decreases from the left to the right of the tables.

Summary of results for 1997

(Note: the tables are available for downloading in WK1 format, click to download)

Recent trends

5 The broad total of drug-related deaths, as defined above, fell slightly from 267 in 1996 to 263 in 1997. Within this total the number of deaths of known or suspected drug addicts fell from 172 to 142. However, the number of deaths involving 'opiates etc.' amongst those not known or suspected to be drug addicts rose from 15 to 32. Of the 121 cases not known or suspected to be drug-dependent the number of deaths where the drug was not stated was 26 compared to 33 in 1996. because of the relatively small numbers involved, and for some cases the lack of clear evidence on drug misuse, care should be taken when assessing the trends shown in this table.

Table 1: Drug-related deaths, 1992-1997

Health board areas

6 The number of deaths of those known or suspected to be drug-dependent in Greater Glasgow Health board area fell from 78 to 49 and that for Lothian Health board Area fell from 42 to 29. When the 'opiates etc.' sub-category of those not known or suspected to be drug-dependent is included, the reduction for Greater Glasgow is from 79 to 54 and for Lothian from 44 to 37. For other health board areas, the changes were less marked.

Table 2: Drug-related deaths, by health board area, 1997

Age groups

7 As in previous years the majority of deaths were to persons aged under 45, with almost half aged between 25 and 44 and almost a third aged under 25. Of the 48 cases aged 45 and over, only 4 were known or suspected to be drug-dependent.

Table 3: Drug-related deaths, by age, 1997

Types of drug

8 Table 4 gives a breakdown by health board area of selected drugs involved in the deaths either alone or, more commonly, in combination with other drugs. Since the table records individual mentions of particular drugs it involves double counting of some deaths. The drugs listed in the table were mentioned in 149 of the 263 deaths. The table shows a marked geographical difference in the reported involvement of certain drugs in the deaths concerned. Methadone was involved in the majority of deaths in Lothian and Tayside but in a smaller proportion in Glasgow. Conversely, morphine was mentioned in a large proportion of deaths in Glasgow but in only one death in Tayside, and not at all in Lothian; heroin showed a similar pattern.

Table 4. Drug-related deaths; selected drugs involved[Footnote 1], by health board area, 1997

Table footnote

1. Individual deaths often involved more than one of these drugs. The numbers given are mentions of the drug and should not be added to give total deaths.

Footnotes

1. Arrundale J and Cole S K. Collection of information on drug-related deaths by the National Records of Scotland. NRS, 1995.

2. Christopherson O, Rooney C and Kelly S. Drug-related mortality: methods and trends. Population trends 93, ONS, 1998

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