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Occasional Paper

No.8

Published on 7 August 2002

Drug - Related Deaths in Scotland in 2001

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.

NOTE: The questionnaire associated with this paper is available for downloading in PDF format.

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Introduction

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

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 [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, GROS 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 GROS described this enhancement to the data collection system.

Summary of results

Recent trends (Table 1)

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)

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)

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 Footnotes

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 Footnotes

Footnotes

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.