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National Drug Related Deaths Database (Scotland) Report: Analysis of Deaths occurring in 2013

Posted in Research

This is the fifth report from the National Drug-Related Deaths Database (NDRDD) for Scotland which presents data for the calendar year 2013 and trend data back to 2009. The NDRDD was established to collect detailed information regarding the nature, health and social circumstances of individuals who have died a drug-related death. This report analyses a specific cohort of drug-related deaths in Scotland on which National Statistics have already been published by National Records of Scotland (NRS).

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Key Findings

Profile of Individuals

  • As in previous years, over three quarters (76%) of those who died were male and half (50%) lived in the most deprived areas of Scotland.
  • The mean age of individuals suffering a drug-related death increased from 34.4 in 2009 to 39.1 in 2013.
  • The percentage of deaths among individuals aged 35 and over has increased from half of deaths (50%) in 2009 to two-thirds (66%) of deaths in 2013.
  • More than half of the cohort lived on their own all of the time (232, 53%) – a known risk factor for drug-related death.
  • Nine out of ten (88%) of individuals were known to be using drugs prior to death and, of these, almost two-thirds (64%) also had a history of intravenous (IV) drug use.
  • In 2013, almost one third (31%) were prescribed an Opioid Replacement Therapy (ORT) drug at the time of death (an increase since 2009 (21%)), while over half (51%) had been prescribed an ORT at some point since 2009.
  • Over one third of the 2013 cohort (37%) had been prescribed an anti-depressant in the 30 days before death (the most commonly prescribed substance being mirtazapine). Diazepam was recently prescribed to one-fifth (21%) and gabapentin to one-tenth (10%) of the cohort. Anti-depressant and gabapentin prescriptions have both increased since NDRDD started in 2009.
  • Almost three quarters (72%) had a medical condition recorded in the six months prior to death, while almost two thirds (63%) had a psychiatric condition recorded (higher than in any previous cohort).
  • The average number of medical conditions in relation to which individuals were admitted to an acute hospital increased from 1.0 in 2009 to 1.4 in 2013, suggesting that multiple morbidity in the cohort may be increasing over time.
  • Over a third of those who died (36%), were a parent or parental figure. 273 Children lost a parent or parental figure to a drug-related death in 2013.

Contact with Services

  • Over half of individuals (53%) had been in contact with a drug treatment service in the six months before death. Half of individuals (50%) were in contact with services for reasons other than management of a drug misuse problem in the six months before death.
  • Ten per cent had been discharged from an acute or psychiatric hospital within four weeks of death, rising to 28% discharged within the past six months.
  • The percentage of the cohort with experience of an acute or psychiatric inpatient stay (93%) increased over time (2009: 86%). 
  • Around one third (31%) had been in police custody and around one in ten (13%) had been in prison in the six months prior to death.
  • Collectively, seven in ten individuals (71%) who died a drug-related death in 2013 had been in contact with a service (drug treatment, hospital, police or prison) which may have identified them as being at risk of drug-related death.

Drugs Present and Implicated in Death

  • As in previous years, in almost all cases (97%) there was more than one drug present in the body at death and in 68% of cases more than one drug was implicated in death, indicating the presence of polydrug use amongst this cohort.
  • The drug most frequently found to be present in the body at death was diazepam (66%), followed by heroin/morphine (50%), methadone (47%), alcohol (42%) and anti-depressants (39%). Opioids (methadone, heroin, morphine or buprenorphine) were present in 82% of cases.
  • The percentage of deaths with diazepam present declined from 77% in 2009 to 66% in 2013. The decrease in diazepam presence among females was particularly marked (from 80% in 2012 to 61% in 2013). For the first time, diazepam was not the substance most likely to be found present in female drug-related deaths (antidepressants were found in 62% of female deaths.
  • The percentage of deaths with heroin-morphine present was similar to the past two years, while the percentage with methadone present decreased from a peak of 56% in 2011 to 47% in 2013.
  • The drug most frequently found to be implicated in death in 2013 was heroin/morphine (44%), followed by methadone (42%), diazepam (19%) and alcohol (18%). Opioids (methadone, heroin, morphine or buprenorphine) were implicated in 76% of cases.

Novel Psychoactive Substances

  • Between 2009 and 2013, there were 203 cases with a 'Novel' Psychoactive Substance (NPS) present in the body at time of death. 2013 Had the highest number of cases to date (108), an increase of 129% from the previous high of 47 in 2011.
  • Deaths with NPS present in the body at time of death could be broadly categorised into two types: mainly those featuring Benzodiazepine-type NPS (e.g. Phenazepam, Etizolam) and to a lesser extent Stimulant-type NPS (e.g. PMA/PMMA, BZP, Mephedrone).
  • Almost all deaths with NPS present in the body at time of death had co-presence of other drugs; typically combinations of NPS, opioids, alcohol and benzodiazepines.

Deaths by Suicide

  • In addition to the 448 non-intentional deaths in the 2013 NDRDD, 37 deaths by suicide were recorded. Again, these were largely a subset of the 526 drug-related deaths (including suicide statistics) already published by National Records Scotland (NRS) in August 2014.
  • Almost two-thirds (65%) of deaths by suicide recorded by NDRDD were among males. The mean age of deaths by suicide (45.3) was six years higher than the main NDRDD cohort (39.1).

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