Types of drug-related deaths
The straight answer is that we do not know exactly how many drug-related deaths there are in the UK. This is because it depends on what definition of drug-related deaths is used, which is not a simple question. For example, these could include
- people who are dependent on drugs and overdose
- suicides by overdose, of people who have no previous history of using drugs
- accidental poisoning or overdose
- ecstasy-related deaths where people have died from overheating through dancing non-stop in hot clubs, rather than from the direct effect of the drugs
- deaths associated with cigarette smoking
- deaths from accidents where people are drunk or under the influence of drugs
- murders and manslaughters where people are drunk or under the influence of drugs
- deaths from driving while drunk or intoxicated
- deaths from AIDS among injecting drug users
- deaths which had nothing to do with the presence of a drug in the body, but were a result of ill-health caused in part by drug use.
- Cause of death is recorded on death certificates but doctors may not mention drugs, even where drugs might be involved.
Despite these difficulties there are estimates of the possible number of deaths associated with different drugs:
England and Wales
According to the ONS publication: Deaths related to drug poisoning in England and Wales: 2019 registrations, published in October 2020
- 4,393 deaths related to drug poisoning were registered in 2019 in England and Wales, equivalent to an age-standardised mortality rate of 76.7 deaths per million people; this is similar to the rate in 2018 (76.3 deaths per million) when there were 4,359 registered deaths.
- Among males, there were 104.7 drug poisoning deaths registered per million in 2019 (2,968 deaths), and the female rate was 49.1 deaths per million (1,425 deaths); neither rates were statistically significantly different to those in 2018.
- Males accounted for two-thirds of drug poisoning deaths in 2019, or 2,968 of 4,393 registered deaths, consistent with previous years.
- Two-thirds (or 2,883) of registered drug poisoning deaths were related to drug misuse, a small fall since 2018 but not statistically significant, accounting for 50.4 deaths per million people in 2019.
- The North East had a statistically significantly higher rate of deaths relating to drug misuse than all other English regions (95.0 deaths per million people); East of England had the lowest rate (33.6 deaths per million people).
- Since the 2018 registration year, there were no statistically significant changes to age-standardised rates of any specific drug mentioned on the death certificate, though deaths involving cocaine increased for the eighth successive year, by 7.7% for male deaths and by 26.5% for female deaths.
- New analysis by deprivation shows that, in the last decade, rates of drug poisoning deaths have been higher in the most deprived areas of England and Wales compared with the least; this is particularly the case among those aged in their forties where rates reach peaks that are at least 5.5 times higher in the most deprived areas.
According to drug related deaths statistics published in Scotland in December 2020: Drug-related Deaths in Scotland in 2019:
The number of drug-related deaths has increased almost every year. In 2019 there were 1,264, which is the largest number ever recorded and more than double the number recorded a decade ago.
- Males accounted for 69% of the drug-related deaths in 2019, a similar proportion to recent years.
- The median age of drug-related deaths has increased from 28 to 42 over the last 20 years.
- In 2019, over two-thirds (68%) of all drug-related deaths were of people aged between 35 and 54: there were 856 such deaths, 69 more than in 2018. There was also an increase in 15-24 year old drug-related deaths, from 64 in 2018 to 76 in 2019
- Three-quarters of all drug-related deaths were in the following five Health Board areas: Greater Glasgow & Clyde (404), Lanarkshire (163), Lothian (155), Tayside
(118) and Ayrshire & Arran (108). Together, they accounted for a slightly higher proportion of the total than in most of the previous ten years.
- The Health Board areas with the largest increases over the last decade (using a five year average) were Greater Glasgow & Clyde (up by 152), Lothian (up 67), Lanarkshire (up 66), Tayside (up 52) and Ayrshire & Arran (up 45).
- Of the 1,264 drug-related deaths in 2019, these substances were implicated in, or potentially contributed to the cause of, the following numbers of deaths:
- heroin and/or morphine 645 deaths, more than in any previous year and 51% of the total;
- methadone 560 deaths, the same as in 2018 (44%);
- one or more opiates or opioids (including heroin/morphine and methadone) 1,092 deaths, more than in any previous year (86%);
- ‘street’ benzodiazepines (such as etizolam) 814 deaths, more than in any previous year (64%);
- ‘prescribable’ benzodiazepines (such as diazepam) 195 deaths, fewer than in 2017 and 2018 (15%);
- gabapentin and/or pregabalin 438 deaths, more than in any previous year (35%);
- cocaine 365 deaths, more than in any previous year (29%).
- Scotland’s figures imply a drug-death rate that is nearly three times that of the UK as a whole. It is also higher than that reported for any other EU country. (However, countries differ in how deaths are recorded and coded, and there may be under-reporting in some cases)
Reducing drug related deaths
In 2016 the Advisory Council on the Misuse of Drugs (ACMD) explored the substantial increases in the number of people dying in the UK where illicit drugs are reported to be involved. The largest increase was in deaths related to the misuse of opioids; 2,677 opioid-related deaths were registered in the UK in 2015.
Their report stated the following:
Through our brief review of the potential causes of recent trends in opioid-related death, the ACMD can assert … that the ageing profile of heroin users with increasingly complex health needs (including long-term conditions and poly-substance use), social care needs and continuing multiple risk behaviours has contributed to recent increases in drug-related deaths.
Other possible causes of recent increases include greater availability of heroin at street level, deepening of socio-economic deprivation since the financial crisis of 2008, changes to drug treatment and commissioning practices, and lack of access to mainstream mental and physical health services for this ageing cohort.
We found that although the current definition and measurement of opioid-related deaths across the UK is consistent and useful, there are weaknesses in current data collection methods that mean the trends over time can be difficult to interpret. Improving the processes of collecting information on opioid-related deaths would ensure that policy makers have better information to make better decisions to reduce deaths.The ACMD also recommends that governments fund independent research in order to provide a better understanding of the causes and drivers of trends in opioid-related deaths, as well as all other drug-related deaths.
Updated December 2020