3.1 Overall numbers
3.1.1 On the basis of the definition used for these statistics, there were 485 drug-related deaths in 2010. While this represents 60 (11 per cent) fewer deaths than in 2009, it was still the third-highest number recorded since this series of figures began in 1996, and was 30 (7 per cent) more than in 2007, 193 (66 per cent) more than in 2000, and 241 (99 per cent) more than in 1996. The figures in Table 1 show that the number of drug-related deaths has risen in six of the past ten years: until recently, the long-term trend clearly appeared to be upwards.
3.1.2 The statistics show some year to year fluctuations. For this reason, moving annual averages are likely to provide a better guide to the long-term trend than the change between one year and the next. Figure 1 illustrates this:
3.1.3 Looking at the chart, it is clear that, for many years, the individual years' figures tended to fluctuate around a long-term upward trend, and were generally within the likely range for random statistical year to year variation about the trend. It also appears that:
Despite the falls in 2009 and 2010, the number of deaths in 2010 was still above the level of 2007 and earlier years, so it is unclear whether the long-term trend has definitely changed. For example, if (in August 2012) it were found that there had been a significant rise in the number of deaths in 2011, one would assume that the long-term trend from previous years still applied and that the figure for 2010 had been unusually low relative to that long-term trend. However, it would be reasonable to conclude that the long-term trend had definitely changed if there were a further significant reduction in the number of deaths in 2011.
3.2 Underlying causes of death
3.2.1 Table 2 shows the number of drug-related deaths categorised by the underlying cause, using groupings of the ICD codes. The majority (312 or 64 per cent in 2010) were coded to 'drug abuse' (which is described within the ICD classification as 'Mental and behavioural disorders due to psychoactive substance use').
3.2.2 As some of the figures can fluctuate markedly from year-to-year, a better indication of the main changes over the years shown in the table should be obtained from a comparison of the averages for the 5-year periods at the start and end. These show that there have been increases in the numbers of deaths for which the underlying cause is 'drug abuse' (from an average of 189 per year in 1996-2000 to an average of 328 in 2006-2010), 'accidental poisoning' (from an average of 13 to an average of 55), and 'undetermined intent' (from an average of 25 to an average of 80). There was little change in the number of deaths caused by intentional self-poisoning (averages of 34 per year in 1996-2000, and 33 in 2006-2010).
3.3.1 The NRS database records a wide range of drug combinations (e.g., in 2006, diazepam was mentioned in almost a fifth of the deaths for which heroin or morphine were reported; and heroin, morphine or methadone were mentioned in over half of the deaths for which cocaine was reported). A complete list of all the substances which were reported to NRS for every death from poisoning (including deaths which are not counted as 'drug-related' for the purpose of these statistics) can be found in Table 6.12 of the Vital Events Reference Tables, which are available on this website. . .'Unspecified drug(s)' is recorded in only a small proportion of cases (on average, under 3 per cent per year). Table 3, Table 6 and Table7 give information on the frequency of reporting of selected drugs, whether alone or in combination with other substances. The drugs listed in these tables are reported in the majority of drug-related deaths (for example, not counting alcohol, at least one of them was reported in 91 per cent of the drug-related deaths in 2000, and in 88 per cent of cases in 2010). The tables show a combined figure for 'heroin/morphine' because it is believed that, in the overwhelming majority of cases where morphine has been identified in post-mortem toxicological tests, its presence is a result of heroin use.
3.3.2 Since these tables record individual mentions of particular drugs, there will be multiple-counting of some deaths (e.g. if both heroin and diazepam were implicated in, or potentially contributed to, the cause of a death in 2010, that death will be counted in three of the columns of Table 3: under 'heroin/morphine', under 'benzodiazepines' and under 'diazepam'). Therefore, these tables do not give the numbers of deaths that are attributable to each of the drugs mentioned. When more than one drug was reported for a particular death, it may not be possible to deduce, from the information held in the NRS database, which (if any) of them was thought to be the (main) cause of the death, except to the extent that, for 2008 onwards, the database distinguishes between (a) drugs which were implicated in, or which potentially contributed to, the cause of death and (b) any other drugs which were present, but which were not considered to have had any direct contribution to the death. NRS's database has no information about the amounts of each drug that were found, or the possible consequences of taking particular combinations of drugs.
3.3.3 For 2008 onwards, the standard basis for figures for individual drugs is 'drugs which were implicated in, or which potentially contributed to, the cause of death' (further information in Section 2). Table 3 shows that heroin/morphine was implicated in, or potentially contributed to, the cause of 254 (52 per cent) of the deaths in 2010; methadone was implicated in, or potentially contributed to, 174 (36 per cent) of the deaths; and benzodiazepines were implicated in, or potentially contributed to, 122 (25 per cent) of the deaths. Cocaine, ecstasy and amphetamines were implicated in, or potentially contributed to, 33, 0 and 3 deaths respectively. Alcohol was implicated in, or potentially contributed to, the cause of 127 of the 485 drug-related deaths in 2010.
3.3.4 Table 3 also shows that there were clearly fewer cases in 2010 (compared with 2008 and 2009) where heroin/morphine, benzodiazepines or alcohol were implicated in, or potentially contributed to, the death. For example, heroin/morphine was implicated in, or potentially contributed to, 324 deaths in 2008, 322 deaths in 2009 and 254 deaths in 2010; for benzodiazepines, the corresponding figures were 115, 116 and 93. However, between 2008, 2009 and 2010, there were only small changes in the numbers of cases where methadone or cocaine were implicated in, or potentially contributed to, the cause of death: for methadone, the figures were 169 in 2008, 173 in 2009 and 174 in 2010; for cocaine, the corresponding figures were 36, 32 and 33.
3.3.5 It is not possible to make a direct comparison with the figures for earlier years because there is a break in the series between 2007 and 2008, due to the revision, with effect from 2008, of the questionnaire which collects information about the drugs which were found in the body (paragraphs 2.3 to 2.7). The statistics may also be affected by other differences, between years or between areas, in the reporting of drugs found in the body (paragraph 2.8). Therefore, apparent changes in the numbers of deaths for which particular drugs were reported must be interpreted with caution, and with the knowledge that there is a clear break in the figures between 2007 and 2008. The change in the method of data collection may have contributed to the apparent large percentage increases, between 2007 and 2008, in the figures for methadone, benzodiazepines generally and diazepam specifically.
3.3.6 Because some of the figures can fluctuate markedly from year to year, the main changes over time are best identified by comparing the averages for 1996-2000 and 2003-2007 (the latter being the final 5-year period before the break in the series). These show that there were marked increases in the numbers of deaths for which there were reports of:
3.3.7 However, while comparing 5-year averages should reduce the effect of year-to-year fluctuations, it will not necessarily give the full picture. In this case, it does not reveal some marked changes during the period:
3.3.8 As mentioned in Section 2, NRS can also produce, for 2008 onwards, figures on the basis of 'all drugs which were found to be present in the body', including any other drugs which were present, but which were not considered to have had any direct contribution to the death. The lower half of Table 6 shows figures for 2010 on this basis. The main differences between the two halves of the table are in the figures for benzodiazepines (and diazepam in particular): benzodiazepines were found to be present in the body in the case of 324 of the drug-related deaths in 2010, but had been implicated in, or potentially contributed to, only 122 of those deaths (for diazepam, the equivalent figures are 288 and 93). There are also large percentage differences between the figures in the two halves of the table for cocaine (found present in 50 cases; implicated in, or potentially contributed to, 33 deaths), amphetamines (for which the numbers are 9 and 3, respectively) and alcohol (219 and 127). The figures for heroin/morphine and methadone do not differ much between the two halves of the table: these drugs were believed to be implicated in, or to have contributed to, the death in almost every case in which they were found.
3.3.9 Most drug-related deaths are of people who took more than one drug: in such cases, it may not be possible to say which particular drug caused the death. Table 7 shows the numbers of drug-related deaths for which only one drug was reported, which are the minimum numbers of deaths which may be wholly attributable to the specified drugs. The top half of the table shows deaths for which only one drug (and, perhaps, alcohol) was found to be present in the body: all these deaths must be wholly attributable to the specified drug (or, perhaps, to that drug in combination with alcohol). These numbers are all small, when compared to the total number of drug-related deaths: there were 30 deaths for which the only drug reported was heroin/morphine; 20 deaths for which only methadone was mentioned; and 7 deaths for which only a benzodiazepine was reported. In total, there were 37 deaths for which alcohol was mentioned along with only one drug.
3.3.10 The lower half of Table 7 shows deaths for which only one drug (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death.
The numbers here are larger, because this part of the table will include deaths for which other drugs were mentioned as being present but not considered to have had any direct contribution to the death. So, for example, the figures for methadone are the numbers of deaths for which only methadone (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death - any other drugs (such as diazepam) which were found to be present in the body were not considered to have had any direct contribution to the death. There were 123 deaths for which heroin/morphine was the only drug which was believed to have been implicated in, or to have contributed to, the death; 69 deaths for which methadone was the only such drug; and 73 deaths for which alcohol was implicated in, or potentially contributed to, the cause of death, along with one drug. The numbers for each of the other drugs shown are all in single figures, so there were very few deaths which were believed to be due solely to one of those drugs alone.
3.3.11 In the lower half of Table 7, the sum of the figures for heroin/morphine, methadone, benzodiazepines, cocaine, ecstasy and amphetamines is 204, or 42 per cent of the total of 485 drug-related deaths in 2010. This means that one of these drugs was the only drug which was implicated in, or potentially contributed to, the cause of two-fifths of all drug-related deaths in 2010. Information from NRS's database (which does not appear in any of the tables) shows that there were also 40 deaths for which a drug which is not shown in the table was the only drug which was implicated in, or potentially contributed to, the cause of death (including 16 cases where the only drug was dihydrocodeine; 3 cases where it was gamma hydroxybutyrate; 3 cases where it was mephedrone; and 5 cases where it was 'unspecified drug' - in some of these cases, alcohol was also implicated). Therefore, there was a total of 244 cases (50 per cent of all drug-related deaths) where only one drug was believed to have been implicated in, or potentially contributed to, the cause of death.
3.4 Sex and age
3.4.1 Table 4 shows that males accounted for the vast majority (363, or 75 per cent) of the drug-related deaths in 2010. This was the case throughout the past decade, although the precise balance between the sexes has varied from year to year. For example, between 2008 and 2010, the number of male drug-related deaths dropped (from 461 to 363) whereas the number of female deaths was more stable, so the male percentage fell from 80 per cent to 75 per cent. Comparing the averages for 1996-2000 and 2006-2010, to reduce the effects of year-to-year fluctuations on the figures, the percentage increases in the number of drug-related deaths were about the same for males (90 per cent) and females (94 per cent).
3.4.2 In recent years, of the age-groups shown, the largest number of drug-related deaths has tended to be among 25-34 year olds: using the averages for 2006-2010, 171 out of 496 deaths (34 per cent) were of 25-34 year olds. There were almost as large numbers in the 35-44 age-group (on average, 159 per year from 2006 to 2010, or 32 per cent). In 2010, there were 161 drug-related deaths of people aged 25-34 (representing 33 per cent of all drug-related deaths) and 158 drug-related deaths of 35-44 year olds (also 33 per cent). In addition, 65 people aged under 25 died (13 per cent), as did 76 people aged 45-54 (16 per cent) and 25 who were aged 55 and over (5 per cent).The table shows that the number of deaths in a particular age-group can fluctuate markedly over the years (for example, the number of under 25s who died was 100 in 2002, 48 in 2005, 94 in 2007 and 65 in 2010). However, some clear trends can be seen. Comparing the averages for 1996-2000 and 2006-2010 (to reduce the effects of year-to-year fluctuations on the figures), there have been large percentage increases in the number of deaths of 35-44 year olds (from an average of 46 per year in 1996-2000 to an average of 159 in 2006-2010) and people aged 45-54 (from an average of 12 to an average of 65); the number of deaths of 25-34 year olds rose less rapidly (from an average of 108 to an average of 171), as did deaths of people aged 55 and over (from an average of 10 to an average of 23); and there was a fall in the number of people aged under 25 who died (from an average of 83 to an average of 78).
3.4.3 Changes in the ages of drug-related deaths can also be seen from the values of the lower quartile (a quarter of drug-related deaths were of people of this age or under), median (half the deaths were of people of this age or under) and upper quartile (a quarter of the deaths were of people of this age or older), which appear in the table.
The median is used (rather than the average) because it should be affected less by any unusually high (or low) values.
3.4.4 Table 5 shows that, in 2010, 250 (69 per cent) of the male deaths were of known or suspected drug abusers compared to 62 (51 per cent) of the female deaths. Of the 25 deaths aged 55 and over, only 8 (32 per cent) were of people who were known, or suspected, to be drug-dependent. The table also provides a more detailed breakdown of the numbers by age-group for each sex.
3.4.5 Table 6 provides information about the ages and sexes of people who died having taken various drugs (perhaps more than one of the substances listed in the table, and maybe other drugs as well). The top half of the table provides figures on the standard basis: 'drugs which were implicated in, or potentially contributed to, the cause of death'. As mentioned earlier, men accounted for 75 per cent of all drug-related deaths in 2010. However, where the drugs listed below were implicated in, or potentially contributed to, the cause of death, men accounted for the following percentages of the deaths:
There were no great differences between the distributions by age of people for whom heroin/morphine, methadone, benzodiazepines or alcohol were implicated in, or potentially contributed to, the cause of their deaths - but there was a clear difference for cocaine (for which people aged 25-34 accounted for almost two-thirds of the deaths, compared with only a third of all drug-related deaths).
3.4.6 The lower part of Table 6 provides figures for all drugs which were found present in the body, including those which were not considered to have had any direct contribution to the death. Women accounted for 25 per cent of all drug-related deaths in 2010, but for a higher percentage of the deaths for which methadone was found (29 per cent - 53 out of 182) and for lower proportions of deaths for which heroin/morphine was found (20 per cent - 54 out of 269) and alcohol was found (19 per cent - 42 out of 219). Again, there was a marked difference between the distributions by age of the people who died having taken cocaine and those who died after taking other drugs.
3.4.7 The top half of Table 7 gives the numbers of deaths for which only one drug (and, perhaps, alcohol) was found to be present in the body: all these deaths must be wholly attributable to the specified drug (or, perhaps, to that drug in combination with alcohol). The numbers are all relatively small, so there is little that can be said about the ages and sexes of the people involved. The bottom half of the table shows deaths for which only one drug (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death. Paragraph 3.3.10 explained why these numbers are larger. However, only for heroin/morphine (123 deaths) and, possibly, methadone (69 deaths) are the figures large enough for analysis of the ages and sexes of the people involved. The main points to note are that females accounted for only 19 per cent (23 out of 123) of the deaths for which heroin/morphine (and, perhaps, alcohol) was the only drug which was implicated in, or potentially contributed to, the cause of death, and for 32 per cent (22 out of 69) of the deaths for which methadone (and, perhaps, alcohol) was the only drug which was implicated in, or potentially contributed to, the cause of death, compared with 25 per cent of all drug-related deaths in 2010. The distributions by age were similar to that of all drug-related deaths.
3.4.8 Table 8 provides, for a number of age-groups, drug-related death rates per 1,000 population. The top part of the table shows how these rates have changed, for Scotland as a whole, over the years from 2000 to 2010. Throughout the period, the drug-related death rate per 1,000 population has been highest for people aged 25-34 (it was 0.24 in 2010, and averaged 0.27 over the five years from 2006 to 2010). The rate for 35-44 year olds was a little lower (0.22 in 2010, with a latest 5-year average of 0.21). For both the 15-24 and 45-54 age-groups, the rate has been around 0.10 in recent years; for 55-64 year olds it has been about 0.03. Since 2000, the rates for the 25-34, 35-44 and 45-54 age-groups have tended to increase, whereas there has been relatively little change in the rates for 15-24 and 55-64 year olds.