Missing targets on drugs-related deaths, and a Scottish paradox

2010

GH with SH (and with others) conducted Scotland's capture-recapture studies and provided data for Bayesian analyses which were programmed by RK. They incorporated expert opinion by SB and SH. Research questions were framed by SB who acts as guarantor and initially drafted the paper, which was edited by co-authors. Ethical approval: not required.

Drugs and Alcohol Today

Purpose The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths. Design/methodology/approach Using quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age. Findings The data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100...

2002

Addiction Research & Theory, 2013

Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiaterelated DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35þ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.

2017

This describes a study that involved age-period-cohort analyses to investigate whether cohort effects from exposure to the changing political context from the 1980s could explain the recent trends in drug-related deaths in Scotland. We present evidence consistent with this; evidence of an increased risk of drug-related deaths for the cohort born between 1960 and 1980, especially amongst males, and in those living in the most deprived areas. The cohort at highest risk occurred earlier in the most deprived areas. To our knowledge this is the first report showing such a cohort effect.

British Medical Journal, 2008

Objectives To examine the "Scottish effect"-namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation-and, more specifically, to examine the extent to which the Scottish effect is explained by cross national differences in the prevalence of problem drug use. Design Secondary analysis of cohort study (the DORIS study). Participants 1033 Scottish drug users recruited to the cohort study in 33 drug treatment facilities across Scotland in 2001-2 and followed up 33 months later in 2004-5. Results 38 deaths occurred in the cohort, giving a standardised mortality ratio for the cohort of 1244 (95% credible interval 876 to 1678). Only 22 of the 38 deaths in drug users were classified as drug related deaths. From estimates of the size of the problem drug using populations in both England and Scotland, the contribution of deaths in drug users to national death rates can be estimated: the attributable risk fraction for Scotland is 17.3% (12.3% to 22.8%) and that for England is 11.1% (7.8% to 14.8%). Excluding estimated numbers of deaths in drug users would bring down age standardised mortality at ages 15-54 years from 196 to 162 per 100 000 in Scotland and from 138 to 122 per 100 000 in England; 32.0% (22.3% to 43.0%) of the excess mortality in Scotland is due to drug use. Conclusion Although problem drug use is a low prevalence risk behaviour, it carries a high mortality; the standardised mortality ratio for Scottish drug users is 12 times as high as for the general population. The higher prevalence of problem drug use in Scotland than in England accounts for a third of Scotland's excess mortality over England. Successful public health efforts to reduce the prevalence of problem drug use in Scotland or deaths in Scottish drug users would have a dramatic impact on overall mortality in Scotland.

The Lancet Psychiatry

Journal of Public Health

In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put ‘people, health and human rights at the centre’. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childho...

The Misuse of Drugs Act 1971 is a reserved matter under Schedule 5 B1 of The Scotland Act 1998. Interpretation of the 1971 Act, where possible, is devolved to the Scottish Parliament. Scotland’s current drug policy document ‘The Road to Recovery' (2008) sets out strategic actions designed to promote recovery and reduce the impact of drug use through improving the life chances of those most likely to develop problematic drug use. At the same time the Scottish Drugs Strategy Delivery Commission (DSDC) was set up to replace the Scottish Advisory Committee on Drug Misuse in order to help “the Scottish Government deliver a drugs policy that is fit for the 21st century for all the people of Scotland.”(Scottish Government Press Release, 2009). In order to formulate and implement devolved elements of drug policy the Scottish Government set up the Scottish Drug Policy Unit who work with national organisations to implement the recovery agenda, formulate new policy and devolve relevant policy making powers to local communities. In addition the Scottish Government collaborate with various organisations representing a wide section of civil society in order to gather, collate and implement good practice There is therefore a working framework in place for good evidenced based drug policy formulation and implementation. However it is suggested here that as a result of the structure of drug policy being reserved, strategic goals such as recovery and a focus on public health initiatives are compromised.