Annex G: Drug-related Deaths – comparison with other countries

G1. This Annex uses figures for the latest year (at the time of writing) for which other countries’ statistics were available from a European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) report. It explains that Scotland’s drug-related death figures imply a drug-death rate (relative to the number of people aged 15 to 64, inclusive) which is higher than those that have been reported by all the EU countries (although a footnote in the EMCDDA’s table states that caution is required when comparing drug-induced deaths due to issues of coding, coverage and under-reporting in some countries). This Annex concludes by showing that the normally-published figures for Scotland imply a drug-death rate (relative to the size of the population of all ages) roughly two and a half times that of the UK as a whole.

G2. When using the EMCDDA’s figures for other countries, it must be remembered that the EMCDDA stated that difference in the national practices of coding the causes of deaths implies that direct comparisons between countries in the numbers or rates of DRDs should be made with caution (in the ‘Limitations’ section of its note on ‘Methods and Definitions’, which is available on the EMCDDA’s website).

G3. That note gives some examples of differences between countries, such as (Note: the points in square brackets have been added by NRS):

G4. It has been suggested that better identification and recording of such deaths may be a reason for the drug-death rate appearing to be higher in the UK (and, hence, Scotland) than in several other countries. For example:

G5. Table EMCDDA gives the number of ‘drug-induced’ deaths aged 15 to 64 inclusive, and the resulting rate per million population of that age, for various countries. These numbers were copied from Table A6 of the EMCDDA’s ‘European Drug Report 2017’, available on the EMCDDA website. ‘Drug-induced deaths’ is the EMCDDA’s term for deaths directly caused by illegal drugs, which it defines in terms of particular codes for the underlying causes of death, in some cases in combination with certain codes for the types of substance involved. The EU countries are listed in order of the native language versions of their names - for example, Germany appears between Denmark and Estonia; and Austria is between Netherlands and Poland. Although the report refers to the latest statistics being for 2015, some countries’ data are for earlier years, and Public Health England (which supplies the EMCDDA with the statistics for the UK) has confirmed that the UK’s figure in the EMCDDA’s Table A6 is (broadly speaking) the number of such deaths which occurred in 2014. (The Scottish component of the UK figure is the number of such deaths that were registered in Scotland in that year. Because deaths in Scotland are normally registered within a few days, the number that were registered in Scotland in any given year will be similar to the number that occurred in Scotland in that year.)

G6. The corresponding figures for Scotland for 2014 have been added at the foot of the table. They were produced as follows:

G7. The resulting drug-induced death rate (aged 15-64) for Scotland is 160 per million population. This appears to be higher than for any of the countries shown in the EMCDDA table. The next highest rates are for Estonia (103 per million) and Sweden (100 per million). Scotland’s drug-induced death rate is much higher than that of the UK as a whole (60 per million) – but that is what one would expect, given Scotland’s share of the UK’s drug-related/’misuse’ deaths (refer to paragraphs G9 and G10, below).

G8. It must be remembered that the figures for some countries may not be truly comparable with those for Scotland (or the UK as a whole), for reasons like those given in paragraphs G2 to G4. Table A6 in the the EMCDDA’s ‘European Drug Report 2017’ includes the following footnote:
"Caution is required when comparing drug-induced deaths due to issues of coding, coverage and under-reporting in some countries"
Because some countries’ figures may be affected by (say) under-reporting, one cannot say that Scotland has a drug-induced death rate (aged 15-64) which is definitely ‘X’ times the level for the EU as a whole, or higher than that of exactly ‘Y’ EU countries. However, it appears certain that Scotland’s rate is well above the level of most (if not all) of the EU countries.

G9. Scotland’s drug-related death rate is also seen to be much higher than that of the UK as a whole when the comparison uses the kind of drug-death figures that are normally published for Scotland, England and Wales, and Northern Ireland. As an example, in terms of the definition that is used for most of the statistics in this report (that introduced in 2001 for the ‘baseline’ figures for the UK Drugs Strategy), the following numbers of drug-related deaths were registered in 2014:

So, the UK had a total of 2,950 drug-related/’misuse’ deaths registered in 2014, of which around 21% were registered in Scotland. As Scotland accounts for only about 8% of the population of the UK, Scotland’s drug-death rate (per head of population) appeared to be roughly two and a half times that of the UK as a whole.

G10. It should be noted that how information about drug-related/’misuse’ deaths is collected differs between Scotland and other parts of the UK. In particular:

Such differences may affect the comparability of drug-death rates for Scotland and the UK as a whole, but are unlikely to account for the majority of the difference between those rates. For example: It follows that the Scottish rate could well be at least double that of the UK as a whole even if there were no methodological differences.