The National Records of Scotland (NRS) has published its latest statistics on drug deaths, which show 1,330 people died of drug misuse in 2021. This is a reduction of one percent on the 1,339 who died in 2020 and the second highest figure on record.
It is the first time since 2013 that drug misuse deaths have not increased. That year there were three fewer deaths (0.5 percent) than in 2012. However overall drug-related deaths have been increasing since 1996 with the overall trend steeper in the last eight years.
But what else do the figures tell us? Who is dying and why? How does that compare to rates across the UK? Does Scotland still have the highest drug rate in Europe?
Ferret Fact Service looked at the numbers in detail.
The numbers in detail
In 2021 1,330 people died of drug overdoses — officially recorded as drug misuse deaths — across Scotland.
This is a reduction of one percent in the figures as a whole, which some organisations claimed is not a statistically significant decline.
The number of women who died of drug-related deaths increased by eight percent from 366 to 397, a record number of deaths.
Meanwhile the number of men who died in 2021 fell by from 973 to 933, a decrease of four per cent.
Men are 2.4 times more likely to die but the gap between genders has been decreasing. In the early 2000s men were four times more likely to die. The number of women dying has increased by 150 percent since 2014.
The City of Dundee still has the highest drug death rate of all local authority areas, with 45.2 deaths per 100,000 population when looking at the five year period from 2017-2021. It is closely followed by Glasgow City (44.4) and Inverclyde (35.7).
When looking at health board areas, Greater Glasgow and Clyde has the highest rate and it has also seen the number of deaths increase most dramatically over the last two decades. It has risen from 8.9 per 100,000 population in the period 2000-2004 to 33.7 per 100,000 population in 2017-2021.
Ayrshire and Arran (28.1) and Tayside (27.1) were the second and third health boards with the highest drug rates.
The average age of drug misuse deaths has increased from 32 to 44 over the last
21 years and 65 per cent of all drug misuse deaths were of people aged between 35 and 54. More than half of all women and men were under 45 when they died in 2021.
Poly drug use
For the second year running the data showed 93 per cent of those who died had taken more than one controlled substance, known as “poly drug use”.
The vast majority – 84 per cent – involved opiates or opioids (such as heroin, morphine and methadone) and 69 per cent involved benzodiazepines including diazepam and Etizolam, which is found in so-called street valium.
There has been a five fold increase in deaths involving benzodiazepines since 2015. During this time the number has risen from 191 to being associated with 918 deaths in 2021.
How is the Scottish death rate calculated?
It has been widely claimed that because of the way drug related deaths are calculated in Scotland, comparisons between its drug death rate and that of other countries were not credible.
The Ferret Fact Service has previously looked at some of these claims and found them false.
The annual NRS bulletin now provides three figures.
The first is the widely reported figure of 1,330 of drug misuse deaths — previously referred to as drug-related deaths. This covers drug poisoning deaths but only those where the substances involved are controlled in the UK. This means that deaths from drugs like aspirin or paracetamol are excluded.
Deaths due to any other health conditions or accident are not counted either.
The second figure of 1,444 includes drug poisoning deaths which were excluded from the official drug-related deaths count, the NRS clarified.
It also gives a third statistic of 1,111. This is the number of deaths that it uses for comparing the drug death rate with other UK and European countries.
This includes a slightly different list of substances as the drugs controlled in each country are different, and only people aged 15-64 are included, rather than all ages as captured by the larger figure.
However as 2021 data is not yet available for most European countries, it is the equivalent 2020 figure that it has used for this year’s comparison.
This means the Scottish figure used by the NRS comparison purposes is 245 deaths per million of the population.
Comparisons to the UK and Europe
There are some differences in the way drug deaths are categorised between Scotland and the rest of the UK. In Scotland, drug related deaths are usually registered more quickly, as the rest of the UK usually requires a coroner to certify the death after an inquest. This means that Scotland’s statistics are likely to be slightly more up-to-date.
A small number of deaths would be recorded by Scottish statistics but not in the rest of the UK. For example, a person might intentionally overdose on a legal substance, but also have illegal drugs in their system. This would be counted in Scotland and not in England.
However this accounts for a small number of deaths each year (three on average), so would not greatly affect any comparison between the rest of the UK and Scotland.
With this caveat the NRS finds that the death rate in Scotland is over 3.7 times the rate in the UK as a whole. After Scotland, the north east of England and Northern Ireland have the highest rates at 96 per million. London has a death rate of 33 per million of the population.
When it comes to European comparisons the NRS advises caution.
It warns that some countries’ figures may be affected by under-reporting — which is not likely to be the case in Scotland due to its robust identification and recording methods.
The report notes “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’ European countries”.
However it also states that “it appears certain that Scotland’s rate is well above the level of most (if not all) of the European countries for which figures are available from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) report.”
According to the EMCDDA Scotland’s death rate also remains the worst in Europe by a considerable margin.
Using a slightly different definition of “drug induced deaths” the EMCDDA calculates a Scottish rate of 327 per million population aged 15-64 in 2020.
This was much higher than the rates reported for any other country, the next largest being 85 per million for Norway. It notes that there are issues of coding, coverage and under-reporting in some countries.
Data is not available for all countries and some is several years out of date.
Risk factors for drug related deaths
Deprivation is statistically related to drug related deaths.
According to 2021’s data people in the 20 per cent most deprived areas were more than 15 times as likely to have a drug misuse death as those in the 20 per cent least deprived areas.
In general this ratio has widened over the past two decades, though it was higher last year.
A study published by Glasgow University researchers in the Lancet Public Health journal on 28 July found that extreme forms of disadvantage, including opiate addiction were connected with premature death before 75.
Using population data from Glasgow, researchers looked at the impact on mortality rates of those who had experienced homelessness, justice involvement, opioid dependence, and psychosis.
Their research suggests that those who experience more than one of these disadvantages, are most at risk of premature and avoidable death.
Those in Glasgow who had experienced opiate dependence were more than seven times likely to die prematurely – defined as under 75 — than those who had not. But add in an additional factor – homelessness, prison or psychosis — and it was 11 times more likely that people would die prematurely.
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