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Drug-related Deaths in Scotland in 2002

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 (ONS) publication Population Trends [Reference 3]. More recently, a report [Reference 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'. The General Register Office for Scotland (GROS) was represented on this group and this paper presents information on drug-related deaths using the approach agreed.

2. 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):

1. 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).
2. 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).

3. Categories of death excluded:

1. deaths coded to mental and behavioural disorders due to the use of alcohol (F10), tobacco (F17) and volatile substances (F18);
2. 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);
3. deaths from AIDS where the risk factor was believed to be the sharing of needles;
4. deaths from road traffic and other accidents which occurred under the influence of drugs; and
5. 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.

4. The new definition differs in two significant ways from that used previously by GROS. 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 GROS Occasional Paper No. 5, Drug-related deaths in Scotland in 2000.

References

1. The 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 General Register Office for Scotland. GROS, 1995.

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

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