3.1.1 Based on the definition used for these statistics, there were 584 drug-related deaths in 2011, 99 (20 per cent) more than in 2010. This was the highest number recorded since the series of figures began in 1996, was 10 (2 per cent) more than the previous largest figure (which was 574 in 2008), and was 252 (76 per cent) more than in 2001. The figures in Table 1 show that the number of drug-related deaths has risen in six of the past ten years: the long-term trend appears to be upwards.
3.1.2 The statistics show some year to year fluctuations. For this reason, moving annual averages are likely to provide a better guide to the long-term trend than the change between any two individual years. Figure 1 illustrates this:
3.1.3 Looking at the chart, it is clear that, for many years, the individual years' figures tended to fluctuate around a long-term upward trend, and were generally within the likely range for random statistical year to year variation about the trend. It also appears that:
The rise in the number of deaths in 2011 suggests that there is still a long-term upward trend, and the figure for 2010 appears unusually low relative to that long-term trend. On the other hand, due to the falls in 2009 and 2010, there has been little change recently in the 3-year moving average (its latest three values are 525, 535 and 538). Therefore, it could be argued that the annual number of deaths might be 'levelling off' - and, if so, that the figure for 2011 would be unusually high relative to the more-or-less level trend that is suggested by the latest three values of the 3-year moving average.
3.2 Underlying causes of death
3.2.1 As explained in paragraph 2.6, NRS implemented WHO updates to the coding rules at the start of 2011. This changed the classification of the underlying cause of many drug-related deaths. However, NRS has estimated what the figures for 2011 would have been, had the data been coded using the old rules.
3.2.2 Table 2 shows the number of drug-related deaths categorised by the underlying cause, defined in terms of groupings of the ICD codes. The final row gives the figures for 2011 that were produced by applying the new coding rules: the majority of drug-related deaths (346, or 59 per cent) were coded to 'accidental poisoning'. This covers the relevant categories within the ICD classification's section for 'Accidental poisoning by and exposure to noxious substances' (for example, it includes ICD-10 code X42 which is defined as 'Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens] not elsewhere classified'). Most of the other drug-related deaths in 2011 (190, or 33 per cent of the total) were counted as 'undetermined intent', which covers a number of ICD categories whose titles are along these lines: 'poisoning by and exposure to [name/type of substance], undetermined intent'.
3.2.3 Table 2 also provides NRS's estimates of the figures that would have been produced for 2011, had the old coding rules been used. On that basis, the underlying cause for the majority of drug-related deaths (417, or 71 per cent) would have been 'drug abuse', which covers the relevant categories within the ICD classification's section for 'Mental and behavioural disorders due to psychoactive substance use'.
3.2.4 Because some of the figures can fluctuate markedly from year-to-year, a better indication of the longer-term changes should be obtained from a comparison of the averages for 5-year periods. These show increases in deaths for which the underlying cause (on the basis of the old coding rules) was 'drug abuse' (from an average of 199 per year in 1997-2001 to an average of 356 in 2007-2011), 'accidental poisoning' (from an average of 14 to an average of 56), and 'undetermined intent' (from an average of 32 to an average of 85). There was no change in deaths caused by intentional self-poisoning (averages of 32 per year in both 1997-2001 and 2007-2011).
3.3.1 The NRS database records a wide range of drug combinations (e.g. in 2006, diazepam was mentioned in almost a fifth of the deaths for which heroin or morphine were reported; and heroin, morphine or methadone were mentioned in over half of the deaths for which cocaine was reported). A complete list of all the substances which were reported to NRS for every death from poisoning (including deaths which are not counted as 'drug-related' for the purpose of these statistics) can be found in Table 6.12 of the Vital Events Reference Tables, which are available on the NRS website. 'Unspecified drug(s)' is recorded in only a small proportion of cases (on average, under 3 per cent per year). Table 3, Table 6 and Table 7 give information on the frequency of reporting of selected drugs, whether alone or in combination with other substances. The drugs listed in these tables are reported in the majority of drug-related deaths (for example, not counting alcohol, at least one of them was reported in 91 per cent of the drug-related deaths in 2000, and in 86 per cent of cases in 2011). The tables show a combined figure for 'heroin/morphine' because it is believed that, in the overwhelming majority of cases where morphine has been identified in post-mortem toxicological tests, its presence is a result of heroin use.
3.3.2 Since these tables record individual mentions of particular drugs, there will be multiple-counting of some deaths (e.g. if both heroin and diazepam were implicated in, or potentially contributed to, the cause of a death in 2011, that death will be counted in three of the 'drug' columns of Table 3: 'heroin/morphine', 'benzodiazepines' and 'diazepam'). Therefore, these tables do not give the numbers of deaths that are attributable to each of the drugs mentioned. When more than one drug was reported for a particular death, it may not be possible to deduce, from the information held in the NRS database, which (if any) of them was thought to be the (main) cause of the death, except to the extent that, for 2008 onwards, the database distinguishes between (a) drugs which were implicated in, or which potentially contributed to, the cause of death and (b) any other drugs which were present, but which were not considered to have had any direct contribution to the death. NRS's database has no information about the amounts of each drug that were found, or the possible consequences of taking particular combinations of drugs.
3.3.3 For 2008 onwards, the standard basis for figures for individual drugs is 'drugs which were implicated in, or which potentially contributed to, the cause of death' (further information about this is given in Section 2). Table 3 shows that heroin/morphine was implicated in, or potentially contributed to, the cause of 206 (35 per cent) of the 584 deaths in 2011; methadone was implicated in, or potentially contributed to, 275 (47 per cent); and benzodiazepines were implicated in, or potentially contributed to, 185 (32 per cent). Cocaine, ecstasy and amphetamines were implicated in, or potentially contributed to, 36, 8 and 24 deaths respectively. Alcohol was implicated in, or potentially contributed to, the cause of 129 of the 584 drug-related deaths in 2011.
3.3.4 Table 3 also shows that there were clearly fewer cases in 2011 (compared with 2008, 2009 and 2010) where heroin and/or morphine were implicated in, or potentially contributed to, the death: 206 in 2011 compared with 324 in 2008, 322 in 2009 and 254 in 2010. However, there was a large increase in cases where methadone was implicated in, or potentially contributed to, the cause of death: 275 in 2011, compared with 169 in 2008, 173 in 2009 and 174 in 2010. Benzodiazepines were implicated in, or potentially contributed to, more deaths in 2011: 185, compared with 149 in 2008, 154 in 2009 and 122 in 2010. While there was little change in the number of deaths for which cocaine was implicated, or to which it potentially contributed (36 in 2011; 36, 32 and 33 in the previous three years), there were large percentage rises in the relatively small numbers for ecstasy and amphetamines.
3.3.5 It is not possible to make a direct comparison with the figures for earlier years because there is a break in the series between 2007 and 2008, due to the revision of the questionnaire which collects information about the drugs found in the body (as explained in paragraphs 2.3 to 2.5). The statistics may also be affected by other differences, between years or between areas, in the reporting of drugs found in the body (examples of which are given in paragraph 2.8). Therefore, apparent changes in the numbers of deaths for which particular drugs were reported must be interpreted with caution, and with the knowledge that there is a clear break in the figures between 2007 and 2008. The change in the method of data collection may have contributed to the apparent large percentage increases, between 2007 and 2008, in the figures for methadone, benzodiazepines generally and diazepam specifically.
3.3.6 Because some of the figures can fluctuate markedly from year to year, the main changes over time are best identified by comparing the averages for 1996-2000 and 2003-2007 (the latter being the final 5-year period before the break in the series). These show that there were marked increases in the numbers of deaths for which there were reports of:
There was not much change in the numbers of deaths for which there were reports of:
There was a marked fall in the number of deaths for which temazepam was reported (from an average of 47 per year in 1996-2000 to an average of 12 in 2003-2007).
3.3.7 However, while comparing 5-year averages should reduce the effect of year-to-year fluctuations, it will not necessarily give the full picture. In this case, it does not reveal some marked changes during the period:
3.3.8 As mentioned in Section 2, NRS can also produce, for 2008 onwards, figures on the basis of 'all drugs which were found to be present in the body', including any other drugs which were present, but which were not considered to have had any direct contribution to the death. The lower half of Table 6 shows figures for 2011 on this basis. The main differences between the two halves of the table are in the figures for benzodiazepines (and diazepam in particular): benzodiazepines were found to be present in the body in the case of 423 of the drug-related deaths in 2011, but had been implicated in, or potentially contributed to, only 185 of those deaths (for diazepam, the equivalent figures are 357 and 123). There are also large percentage differences between the figures in the two halves of the table for cocaine (found present in 55 cases; implicated in, or potentially contributed to, 36 deaths), amphetamines (for which the numbers are 35 and 24, respectively) and alcohol (241 and 129). The figures for heroin/morphine and methadone do not differ much between the two halves of the table, these drugs were believed to be implicated in, or to have contributed to, the death in almost every case in which they were found.
3.3.9 Most drug-related deaths are of people who took more than one drug, in such cases, it may not be possible to say which particular drug caused the death. Table 7 shows the numbers of drug-related deaths for which only one drug was reported, which are the minimum numbers of deaths which may be wholly attributable to the specified drugs. The top half of the table shows deaths for which only one drug (and, perhaps, alcohol) was found to be present in the body: all these deaths must be wholly attributable to the specified drug (or, perhaps, to that drug in combination with alcohol). These numbers are all small, when compared to the total number of drug-related deaths: there were 16 deaths for which the only drug reported was heroin/morphine; 14 deaths for which only methadone was mentioned; and 5 deaths for which only a benzodiazepine was reported. In total, there were 32 deaths for which alcohol was mentioned along with only one drug.
3.3.10 The lower half of Table 7 shows deaths for which only one drug (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death. The numbers here are larger, because this part of the table includes deaths for which other drugs were mentioned as being present but were not considered to have had any direct contribution to the death. So, for example, the figures for methadone are the numbers of deaths for which only methadone (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death - any other drugs (such as diazepam) which were found to be present in the body were not considered to have had any direct contribution to the death. There were 81 deaths for which heroin/morphine was the only drug which was believed to have been implicated in, or to have contributed to, the death; 112 deaths for which methadone was the only such drug; and 75 deaths for which alcohol was implicated in, or potentially contributed to, the cause of death, along with one drug. The numbers for each of the other drugs shown are all in single figures, so there were very few deaths which were believed to be due solely to one of those drugs alone.
3.3.11 In the lower half of Table 7, the sum of the figures for heroin/morphine, methadone, benzodiazepines, cocaine, ecstasy and amphetamines is 211, or 36 per cent of the total of 584 drug-related deaths in 2011. This means that one of these drugs was the only drug which was implicated in, or potentially contributed to, the cause of over a third of all drug-related deaths in 2011. Information from NRS's database (which does not appear in any of the tables) shows that there were also 53 deaths for which a drug which is not shown in the table was the only drug which was implicated in, or potentially contributed to, the cause of death (including 21 cases where the only drug was dihydrocodeine; 8 cases where it was codeine; 3 cases where it was oxycodone; and 5 cases where it was 'unspecified drug' - in some of these cases, alcohol was also implicated). Therefore, there was a total of 264 cases (45 per cent of all drug-related deaths) where only one drug was believed to have been implicated in, or potentially contributed to, the cause of death.
3.4.1 Table 4 shows that males accounted for the vast majority (429, or 73 per cent) of the drug-related deaths in 2011. This was the case throughout the past decade, although the precise balance between the sexes has varied from year to year. For example, between 2008 and 2011, the number of male drug-related deaths dropped (from 461 to 429) whereas the number of female deaths rose (from 113 to 155) so the male percentage fell from 80 per cent to 73 per cent. Comparing the averages for 1997-2001 and 2007-2011, to reduce the effects of year-to-year fluctuations on the figures, the percentage increase in the number of drug-related deaths was greater for females (117 per cent) than for males (85 per cent).
3.4.2 In recent years, of the age-groups shown, the largest number of drug-related deaths have been among 25-34 and 35-44 year olds: using the averages for 2007-2011, 177 out of 529 deaths (33 per cent) were of 25-34 year olds and almost as many were in the 35-44 age-group (176, also 33 per cent). In 2011, there were 212 drug-related deaths of people aged 35-44 (representing 36 per cent of all drug-related deaths) and 184 among 25-34 year olds (32 per cent). In addition, 58 people aged under 25 died (10 per cent), as did 94 who were aged 45-54 (16 per cent) and 36 people aged 55 and over (6 per cent). The table shows that the number of deaths in a particular age-group can fluctuate markedly over the years (for example, the number of under 25s who died was 100 in 2002, 48 in 2005, 94 in 2007 and 65 in 2010). However, some clear trends can be seen. Comparing the averages for 1997-2001 and 2007-2011 (to reduce the effects of year-to-year fluctuations on the figures), there have been large percentage increases in the number of deaths of 35-44 year olds (from an average of 54 per year in 1997-2001 to an average of 176 in 2007-2011) and people aged 45-54 (from an average of 16 to an average of 73); the number of deaths of 25-34 year olds rose less markedly (from an average of 115 to an average of 177), as did deaths of people aged 55 and over (from an average of 11 to an average of 27); and there was a fall in the number of people aged under 25 who died (from an average of 82 to an average of 76).
3.4.3 Changes in the ages of drug-related deaths can also be seen from the values of the lower quartile age at death (a quarter of drug-related deaths were of people of this age or under), the median age at death (half the deaths were of people of this age or under) and the upper quartile age at death (a quarter of the deaths were of people of this age or older), which appear in the table:
The median is used (rather than the average) because it should be affected less by any unusually high (or low) values.
3.4.4 The lower part of Table 5 shows that, when the underlying cause of death is determined using the old coding rules, 328 (76 per cent) of the male deaths in 2011 were of known or suspected drug abusers compared to 89 (57 per cent) of the female deaths. Of the 36 deaths aged 55 and over, only 7 (19 per cent) were of people who were known, or suspected, to be drug-dependent. The table also provides a more detailed breakdown of the numbers by age-group for each sex.
3.4.5 Table 6 provides information about the ages and sexes of people who died having taken various drugs (perhaps more than one of the substances listed in the table, and maybe other drugs as well). The top half of the table provides figures on the standard basis: 'drugs which were implicated in, or potentially contributed to, the cause of death'. As mentioned earlier, men accounted for 73 per cent of all drug-related deaths in 2011. However, where the drugs listed below were implicated in, or potentially contributed to, the cause of death, men accounted for the following percentages of the deaths:
There were no great differences between the distributions by age of people for whom heroin/morphine, methadone, benzodiazepines, cocaine or alcohol were implicated in, or potentially contributed to, the cause of their deaths. The most noticeable point was that people aged 25-34 accounted for over 40% of such deaths involving benzodiazepines or cocaine, compared with only 32% of all drug-related deaths.
3.4.6 The lower part of Table 6 provides figures for all drugs which were found present in the body, including those which were not considered to have had any direct contribution to the death. Women accounted for 27 per cent of all drug-related deaths in 2011, and for a similar percentage of the deaths for which heroin/morphine, methadone, benzodiazepines, or alcohol were found (between 23 per cent and 28 per cent, in each case), but for only 16 per cent of deaths in which cocaine was found. Again, there was not much difference between the distributions by age of the people who died having taken the different drugs, apart from 25-34 year olds accounting for 44% of those who died after taking cocaine.
3.4.7 The top half of Table 7 gives the numbers of deaths for which only one drug (and, perhaps, alcohol) was found to be present in the body: all these deaths must be wholly attributable to the specified drug (or, perhaps, to that drug in combination with alcohol). The numbers are all relatively small, so there is little that can be said about the ages and sexes of the people involved. The bottom half of the table shows deaths for which only one drug (and, perhaps, alcohol) was implicated in, or potentially contributed to, the death. Paragraph 3.3.10 explained why these numbers are larger. However, only for heroin/morphine (81 deaths) and methadone (112 deaths) are the figures large enough for analysis of the ages and sexes of the people involved. The main points to note are that females accounted for only 22 per cent (18 out of 81) of the deaths for which heroin/morphine (and, perhaps, alcohol) was the only drug which was implicated in, or potentially contributed to, the cause of death, and for 29 per cent (33 out of 112) of the deaths for which methadone (and, perhaps, alcohol) was the only drug which was implicated in, or potentially contributed to, the cause of death, compared with 27 per cent of all drug-related deaths in 2011. The distributions by age were similar to that of all drug-related deaths.
3.4.8 Table 8 provides, for a number of age-groups for Scotland as a whole, drug-related death rates per 1,000 population, and shows how these have changed, from 2000 to 2011. For all but the latest year, the drug-related death rate per 1,000 population was highest for people aged 25-34 (it averaged 0.27 over the five years from 2007 to 2011). The rate for 35-44 year olds was higher in 2011 (0.30 per 1,000 population, compared with 0.27 for 25-34 year olds), and had a latest 5-year average of 0.24). For both the 15-24 and 45-54 age-groups, the rate has been around 0.10 in recent years; for 55-64 year olds it has been about 0.03. Since 2000, the rates for the 25-34, 35-44 and 45-54 age-groups have tended to increase, whereas there has been relatively little change in the rates for 15-24 and 55-64 year olds.