Drug Related Deaths in Scotland in 1998

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

NOTE:

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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 [Reference 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, 1997 and 1998 gave information about drug-related deaths in 1995, 1996, and 1997. The present paper gives figures for 1998.

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 (Annex A).

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 [Reference 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 of Annex B 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. heroin, morphine, 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 1998 (Annex B)

(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, increased slightly from 263 in 1997 to 276 in 1998. Within this total the number of deaths of known or suspected drug addicts rose from 142 to 179, whereas the number of deaths of persons not known or suspected to be drug addicts fell from 121 to 97. Because of the relatively small numbers involved, and the possibility that more complete information is being reported, care should be taken when assessing the trends shown in this table.

Table 1: Drug-related deaths in Scotland, 1994-1998

Health board areas

6. The number of deaths of those known or suspected to be drug-dependent in Greater Glasgow Health Board area rose from 49 in 1997 to 71 in 1998; Argyll & Clyde, up from 7 to 19, and Lanarkshire, up from 8 to 16, also showed sizeable increases. For other health board areas, the changes were less marked. Lothian, with 28 deaths in 1998 compared to 29 in 1997, had the second highest total in this category.

Table 2: Drug-related deaths, by health board area, 1998

Age groups

7. As in previous years the majority of deaths were to persons aged under 45, with over a half aged between 25 and 44 and a third aged under 25. Of the 32 cases aged 45 and over, only 6 were known or suspected to be drug-dependent.

Table 3: Drug-related deaths, by age 1998

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 186 of the 276 deaths. In previous years heroin and morphine were shown separately in this table. However it is believed that for the overwhelming majority of cases where morphine has been identified in post-mortem toxicological tests its presence is a result of heroin use. We have therefore chosen to show a combined column for 'heroin/morphine'. The table shows that heroin/morphine was involved in 114 (41%) of the deaths analysed in this report. Diazepam was involved in 105 (38%) of the deaths and methadone was involved in 64 (23%).

Table 4: Drug-related deaths; selected drugs involved [Footnote 1], by health board area, 1998

Footnotes

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

2. See paragraph 3 of commentary.

9. 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 but in a smaller proportion of the deaths in Greater Glasgow. Conversely, heroin/morphine was mentioned in 64 of the 94 deaths in Greater Glasgow but in only 6 of the 37 deaths in Lothian. Of the benzodiazepines, diazepam was involved in many deaths throughout central Scotland but temazepam was involved mainly in Greater Glasgow and Argyll & Clyde.

10. The presence of alcohol was mentioned for 85 of the 276 deaths covered by this analysis. The blood-alcohol level was not given for all cases but where mentioned it was often at a relatively low level.

References

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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