National Records of Scotland

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Drug-related Deaths in Scotland in 2004

Drug-related Deaths in Scotland in 2004

Published on 31 August 2005

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 2004.

Contents

Tables
Introduction
Data sources
Summary of results

Recent trends
Health board areas
Age groups and sex
Types of drug involved

Annex A - Notes on the definition of 'drug-related' deaths
Annex B - Questionnaire
Enquiries
Statistical Service in Scotland

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Tables

Table 1
Drug-related deaths, Scotland, 1996-2004
(Excel    CSV    PDF)
Table 2
Drug-related deaths, by health board area, 1996-2004
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Table 3
Drug-related deaths, by health board area, 2004
(Excel    CSV    PDF)
Table 4
Drug-related deaths, by age and by sex, Scotland, 2004
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Table 5
Drug-related deaths; selected drugs involved, Scotland, 1996-2004
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Table 6
Drug-related deaths; selected drugs involved, by health board area, 2004
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Introduction

1. This paper gives information about drug-related deaths in Scotland over the period 1996 – 2004, using the definition for baseline figures introduced in 2001. This 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.

2.  Paragraph 3 below gives some background on the collection of information on drug-related deaths in Scotland; paragraphs 4 – 11 summarise the main points arising from the information for 2004 and earlier years presented in Tables 1 – 6; and Annex A gives background on the definition of drug-related deaths including a detailed description of the definition used in this paper.

Data sources

3.  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, the National Records of Scotland (NRS) follows up all cases of deaths of 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 B). A paper [Footnote 2] published in June 1995 by NRS described this enhancement to the data collection system.

Summary of results  

Recent trends (Table 1)

4. There were 356 drug-related deaths in 2004, 39 (12 %) more than in 2003 but 26 (7%) fewer than in 2002. Within these totals, the number of deaths of known or suspected habitual drug abusers rose slightly, from 216 in 2003 to 232 in 2004, though this was still substantially lower than the figure of 280 recorded in 2002. Table 1 also shows that there was a large increase in the number of drug-related deaths coded to ‘accidental poisoning’. It is possible that this change may be due to poorer quality information being available on those who were known drug abusers.

Health board areas (Tables 2 and 3)

5. Of the 356 deaths in 2004, 120 (34%) occurred in the Greater Glasgow Health Board area. Grampian with 39 (11%) had the next highest total and was closely followed by Lothian with 36 (10%), Argyll & Clyde with 35 (10%) and Lanarkshire with 33 (9%). The Greater Glasgow total showed an increase of 13 since 2003, and there were increases of 8 in both Argyll and Clyde and Lanarkshire. However, Lothian had 4 fewer deaths than in 2003.

6. 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 Tables 1 and 2.

Age groups and sex (Table 4)

7. Most deaths (87%) were to persons aged under 45, with almost a quarter (23%) aged under 25.  Of the 45 cases aged 45 and over, only 19 were known, or suspected, to be drug-dependent. Men accounted for 81% of the 356 drug-related deaths in 2004. Some two-thirds (67%) of the male deaths were of known or suspected drug abusers compared to only 55% of the female deaths.

Types of drug involved (Tables 5 and 6)

8. 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’.  

9. In 2004, the drugs listed in the Tables were known to be involved in 303 (85%) of the 356 deaths. Heroin/morphine was involved in 225 (63%) of the deaths; diazepam was involved in 113 (32%) of the deaths; and methadone was involved in 80 (22%) of the deaths. Cocaine and ecstasy were involved in 38 and 17 cases respectively. A wide range of drug combinations was recorded. Of particular note was the fact that diazepam was also mentioned in 76 (34%) of the 225 deaths involving heroin/morphine. The presence of alcohol was mentioned for 116 of the 356 drug-related deaths in 2004. The blood-alcohol level was not given for all cases but, where mentioned, it was often at a relatively low level.

10. Table 5 shows that, since 1996, there has been a significant increase in the involvement of heroin/morphine. The numbers of deaths involving diazepam peaked in 2002 since when it has dropped back significantly. Since 1996, there have also been marked increases in the smaller numbers involving cocaine and ecstasy. However, whilst the number of deaths involving cocaine has continued to increase recently, that for ecstasy has fallen slightly in recent years. Between 1996 and 2000 there was a downward trend in the number of deaths involving methadone, but there has been an increase since then, almost back to the 1996 level (100). The table also shows a substantial decline in the number of deaths involving temazepam between 2003 and 2004.

11. Table 6 shows some geographical differences in the reported involvement of certain drugs.  For example, heroin/morphine was mentioned in a larger proportion of the deaths in Greater Glasgow (85 out of 120) and Grampian (26 out of 39) than in Lothian (17 out of 36). Greater Glasgow also showed a relatively high proportion (39 out of 120) involving methadone. This contrasts the very low proportion (2 out of 39) in Grampian. The table also shows that diazepam was involved in almost a half (57 out of 120) of the deaths in Greater Glasgow.

Annex A

Notes on the definition of ‘drug-related’ deaths

1. 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 [Footnote 3]. More recently, a report [Footnote1] 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.

2. The 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’:

(i)
opioids (F11);
(ii)
cannabinoids (F12);
(iii)
sedatives or hypnotics (F13);
(iv)
cocaine (F14);
(v)
other stimulants, including caffeine (F15);
(vi)
hallucinogens (F16); and
(vii)
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:

(i)
accidental poisoning (X40 – X44);
(ii)
intentional self-poisoning by drugs, medicaments and biological substances (X60 – X64);
(iii)
assault by drugs, medicaments and biological substances (X85); and
(iv)
event of undetermined intent, poisoning (Y10 – Y14).

3. 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.

Annex B

Confidential form to be completed in all deaths involving drugs, solvents or poisons 
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Enquiries

Statistical Service in Scotland

Footnote

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

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

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

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