National Records of Scotland

Preserving the past, Recording the present, Informing the future

Occasional Paper

Occasional Paper

No.8
Published on 7 August 2002

Drug - Related Deaths in Scotland in 2001

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

This paper describes the system by which the Registrar General for Scotland collects information on drug-related deaths in Scotland and presents selected statistical information covering the period 1996 to 2001.

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Contents

  1. Introduction
  2. Background
  3. Summary of Results
  4. Footnotes
  5. Annex A

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Introduction

1. This paper gives information about drug-related deaths in Scotland over the period 1996 - 2001 using the new definition for baseline figures introduced last year. The new definition was agreed by a working party set up following the publication, by the Advisory Council on the Misuse of Drugs (ACMD), of a report [Footnote 1] on 'Reducing drug related deaths'. The Office for National Statistics has also prepared data on drug-related deaths in England and Wales using this new definition [Footnote 2].

2. Paragraphs 3 - 5 below give some background to the collection of information on drug-related deaths in Scotland; paragraphs 6 - 13 summarise the main points arising from the information for 2001 and earlier years presented in Tables 1 - 6; and Annex A gives a detailed description of the definition used.

Background

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 Trend [Footnote 3]. More recently, a report [Footnote 1] 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 was represented on this group and this paper presents information on drug-related deaths using the approach agreed. A full description of the new definition is given in Annex A.

4. The new definition differs in two significant ways from that used previously by NRS. First, for deaths where habitual drug abuse was not known or suspected, it limits inclusion to those where particular drugs are known to have been involved. Second, it includes deaths from intentional self-harm (suicides). Further information about the differences between the old and the new definitions may be found in NRS Occasional Paper No. 5, Drug-related deaths in Scotland in 2000 [Footnote 4].

5. Drug-related deaths are identified using details from death registrations supplemented by information from a specially designed questionnaire, completed by forensic pathologists, for all deaths involving drugs or persons known or suspected to be drug-dependent. Additionally, NRS follows 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. View a copy of the questionnaire currently used. A paper [Footnote 5] published in June 1995 by NRS described this enhancement to the data collection system.

Summary of results

Recent trends (Table 1)

Table 1: Drug-related deaths, Scotland, 1996 - 2001

Year Total Cause of death category(ICD10 codes)
Drug abuse (F11-F16,F19) Accidental poisoning (X40-X44)
Intentional self-poisoning
(X60-X64)
Assault by drugs, etc.
(X85)
 Undetermined (Y10-Y14)
1996 244 175 10 41 - 18
1997 224 142 14 42 - 26
1998 249 179 16 32 - 22
1999 291 227 12 19 1 32
2000 292 220 11 34 - 27
2001 332 227 19 34 - 52

6. There were 332 drug-related deaths in 2001, 40 (14 %) more than in 2000 and 88 more than in 1996. Within these totals, the number of deaths of known or suspected habitual drug abusers increased slightly from 220 in 2000 to 227 in 2001. Since 1996, the number of deaths in this category has risen by 30 per cent. Between 2000 and 2001 there was a large increase, from 27 to 52, in the number of deaths coded to the 'undetermined' category. These represent drug-related deaths of persons who were not known or suspected drug abusers and where it was not clear if the death was accidental or suicidal.

Health board areas (Tables 2 and 3)

Table 2: Drug-related deaths, by health board area, 1996 - 2001

Health board area 1996 1997 1998 1999 2000 2001
             
Scotland 244 224 249 291 292 332
Argyll & Clyde 18 16 23 30 31 22
Ayrshire & Arran 3 6 4 15 20 35
Borders 2 1 1 - 1 1
Dumfries & Galloway 4 7 4 7 7 8
Fife 3 8 13 9 12 11
Forth Valley - 4 2 8 4 9
Grampian 29 22 26 38 31 46
Greater Glasgow 90 67 93 100 104 96
Highland 2 3 1 7 1 5
Lanarkshire 11 12 21 23 29 24
Lothian 58 48 37 39 37 54
Orkney - - - - - -
Shetland - - 1 - 1 1
Tayside 24 30 23 14 14 19
Western Isles - - - 1 - 1

Table 3: Drug-related deaths, by health board area, 2001

Health board area Total Cause of death category (ICD10 codes)
Drug abuse
(F11-F16, F19)
 Accidental poisoning (X40-X44) Intentional self-poisoning (X60-X64)
Assault by drugs, etc.
(X85)
 Undetermined (Y10-Y14)
Scotland 332 227 19 34 - 52
Argyll & Clyde 22 18 - 1 - 3
Ayrshire & Arran 35 21 2 5 - 7
Borders 1 - - 1 - -
Dumfries & Galloway 8 5 - 2 - 1
Fife 11 8 - 1 - 2
Forth Valley 9 3 - 4 - 2
Grampian 46 32 5 2 - 7
Greater Glasgow 96 72 6 5 - 13
Highland 5 1 - 2 - 2
Lanarkshire 24 20 - 2 - 2
Lothian 54 35 6 4 - 9
Orkney - - - - - -
Shetland 1 1 - - - -
Tayside 19 10 - 5 - 4
Western Isles 1 1 - - - -

7. Of the 332 deaths in 2001, 96 (29%) occurred in the Greater Glasgow Health Board area. Lothian, with 54 (16%), and Grampian with 46 (14%), had the next highest totals. Whilst the number of drug-related deaths in Greater Glasgow fell slightly between 2000 and 2001 there were large increases in Lothian, Grampian and Ayrshire & Arran.

8. Because of the relatively small numbers involved, particularly for some health board areas, and the possibility that more complete information has been reported in recent years, care should be taken when assessing the trends shown in Table 1 and Table 2.

Age groups and sex (Table 4)

Table 4: Drug-related deaths, by age and by sex, Scotland, 2001

  Total Cause of death category (ICD10 codes)
Drug abuse (F11-F16,F19) Accidental poisoning (X40-X44) Intentional self-poisoning (X60-X64)
Assault by drugs, etc.
(X85)
 Undetermined (Y10-Y14)
All deaths 332 227 19 34 - 52
Under 25 80 53 7 5 - 15
25-34 140 115 8 5 - 12
35-44 69 44 1 10 - 14
45 and over 43 15 3 14 - 11
             
Males 267 195 19 19 - 34
Females 65 32 - 15 - 18

9. Most deaths (87%) were to persons aged under 45, with almost a quarter (24%) aged under 25. Of the 43 cases aged 45 and over, only 15 were known, or suspected, to be drug-dependent. Men accounted for four out of five (80 %) of the 332 drug-related deaths in 2001. Almost three-quarters (73%) of the male deaths were of known or suspected drug abusers compared to under a half (49%) of the female deaths.

Types of drug involved (Tables 5 and 6)

10. Tables 5 and 6 give information on the involvement of selected drugs, either alone or, more commonly, in combination with other drugs. Since the tables record individual mentions of particular drugs they involve double counting of some deaths. 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. The tables therefore show a combined figure for 'heroin/morphine'.

11. In 2001, the drugs listed were known to be involved in 296 (89%) of the 332 deaths. Heroin/morphine was involved in 216 (65%) of the deaths; diazepam was involved in 156 (47%) of the deaths; and methadone was involved in 69 (21%) of the deaths. A wide range of drug combinations was recorded. Of particular note was the fact that diazepam was also mentioned in over half (110) of the 216 deaths involving heroin/morphine. The presence of alcohol was mentioned for 140 of the 332 drug-related deaths in 2001. The blood-alcohol level was not given for all cases but, where mentioned, it was often at a relatively low level.

Table 5: Drug-related deaths; selected drugs involved [Footnote 1], Scotland, 1996 - 2001

 
Heroin/
morphine [Footnote 2]
 Diazepam Methadone Temazepam Ecstasy Cocaine
1996 84 84 100 48 9 3
1997 74 93 86 33 2 5
1998 121 113 64 58 3 4
1999 167 142 63 56 8 12
2000 196 146 55 39 11 4
2001 216 156 69 20 20 19
Table Footnotes

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.

2. See paragraph 10 of commentary.

12. Table 5 shows that there have been significant increases in the involvement of heroin/morphine, and to a lesser extent diazepam, between 1996 and 2001. There have also been marked increases in the smaller numbers involving cocaine and ecstasy. Between 1996 and 2000 there was a downward trend in the number of deaths involving methadone, but there was an increase in the latest year. The table also shows a marked reduction in the number of deaths involving temazepam.

Table 6: Drug-related deaths; selected drugs involved [Footnote 1], by health board area, 2001

Health board area
Heroin/
morphine [Footnote 2]
 Diazepam Methadone Temazepam Ecstasy Cocaine
Scotland 216 156 69 20 20 19
Argyll & Clyde 16 14 6 2 1 -
Ayrshire & Arran 21 15 6 3 1 3
Borders 1 - - - - -
Dumfries & Galloway 6 2 2 - - 2
Fife 8 4 4 - 1 -
Forth Valley 4 - - 1 - -
Grampian 28 15 9 1 4 2
Greater Glasgow 78 52 12 6 8 6
Highland 2 2 - - - -
Lanarkshire 17 17 3 2 2 3
Lothian 29 18 14 3 3 3
Orkney - - - - - -
Shetland - 1 1 - - -
Tayside 5 15 12 2 - -
Western Isles 1 1 - - - -
Table Footnotes

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.

2. See paragraph 10 of commentary.

13. Table 6 shows some geographical differences in the reported involvement of certain drugs. For example, heroin/morphine was mentioned in a much larger proportion (78 out of 96) of the deaths in Greater Glasgow than in Lothian (29 out of 54). A similar picture emerges for diazepam which was involved in 52 out of 96 of the deaths in Greater Glasgow compared to only 18 out of 54 in Lothian. However the pattern is reversed for methadone - only 12 out of 96 deaths in Greater Glasgow compared to 14 out of 54 in Lothian. It should also be noted that methadone was involved in 12 of the 19 deaths in Tayside.

Footnotes

1. The Advisory Council on the Misuse of Drugs. Reducing drug related deaths. Home Office, 2000.

2. Deaths related to drug poisoning: results for England and Wales, 1993 - 2000. Health Statistics Quarterly 13. ONS, 2002.

3. Christophersen O, Rooney C and Kelly S. Drug-related mortality: methods and trends. Population Trends 93, ONS, 1998

4. NRS Occasional Paper No. 5, Drug-related deaths in Scotland in 2000. NRS, 2001

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

Annex A

Additional notes on the new baseline definition

The new baseline covers the following cause of death categories (the relevant codes from the International Classification of Diseases, Tenth Revision (ICD10), are given in brackets):

a) deaths where the underlying cause of death has been coded to the following sub-categories of 'mental and behavioural disorders due to psychoactive substance use':

  1. opioids (F11);

  2. cannabinoids (F12);

  3. sedatives or hypnotics (F13);

  4. cocaine (F14);

  5. other stimulants, including caffeine (F15);

  6. hallucinogens (F16); and

  7. multiple drug use and use of other psychoactive substances (F19).

b) deaths coded to the following categories and where a drug listed under the Misuse of Drugs Act (1971) was known to be present in the body at the time of death:

  1. accidental poisoning (X40 - X44);

  2. intentional self-poisoning by drugs, medicaments and biological substances (X60 - X64);

  3. assault by drugs, medicaments and biological substances (X85); and

  4. event of undetermined intent, poisoning (Y10 - Y14).

Categories of death excluded:

a) deaths coded to mental and behavioural disorders due to the use of alcohol (F10), tobacco (F17) and volatile substances (F18);

b) deaths coded to drug abuse which were caused by secondary infections and related complications (for example the 20 or so deaths in 2000 caused by clostridium novyi infection);

c) deaths from AIDS where the risk factor was believed to be the sharing of needles;

d) deaths from road traffic and other accidents which occurred under the influence of drugs; and

e) deaths where a drug listed under the Misuse of Drugs Act was present because it was part of a compound analgesic or cold remedy: specific examples are:

Co-proxamol:  paracetamol, dextropropoxyphene

Co-dydramol:  paracetamol, dihydrocodeine

Co-codamol:   paracetamol, codeine sulphate

All three of these compound analgesics, but particularly co-proxamol, are commonly used in suicidal overdoses.

Note: As it is believed that dextropropoxyphene is rarely if ever available other than as a constituent of a paracetamol compound, it has been ignored on all occasions (even if there is no mention of a compound analgesic or paracetamol). However, deaths involving codeine or dihydrocodeine without mention of paracetamol have been included in the baseline as these drugs are routinely available on their own and known to be abused in this form.

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