Occasional Paper

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 have been published in each subsequent year. This paper gives figures for 1999.

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, National Records of Scotland (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 an article in the Office for National Statistics publication Population Trends [Reference 2]. More recently, a report [Reference 3] by the Advisory Council on the Misuse of Drugs (ACMD) considered current systems used in the United Kingdom to collect and analyse data on drug related deaths. In its report the ACMD recommended that 'a short life technical working group' should be brought together to reach agreement on a consistent coding framework to be used in future across England, Wales, Scotland and Northern Ireland'. NRS are represented on this group and it is likely that future papers in this series will take account of the working group's recommendations. However, NRS will ensure that an appropriate time series can be produced for any new definitional approach and that comparisons with the current approach are possible.

4. As in previous years the analyses presented in this paper cover the following categories (the relevant codes from the International Classification of Diseases, Ninth Revision (ICD9), are given in brackets):

1. Drug dependence (ICD9 304), excluding solvent abuse (ICD9 304.6);
2. Accidental poisoning by drugs, medicaments and biologicals (ICD9 E850 - E858); and
3. Poisoning by solid or liquid substances, undetermined whether accidentally or purposely inflicted (ICD9 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.

5. To aid interpretation of the figures, Tables 1-3 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.