4.1 Deaths are normally classified by geographical area on the basis of the usual place of residence of the deceased (or, if that is not known, or is outwith Scotland, on the basis of the location of the place of death). Table HB1 shows the numbers of drug- related deaths for each Health Board area. Of the 545 deaths in 2009, 200 (37 per cent) were counted against the Greater Glasgow & Clyde NHS Board area. Lothian, with 81 (15 per cent), had the next highest total followed by Grampian (52 or 10 per cent), Lanarkshire (47 or 9 per cent), Tayside (44 or 8 per cent), Ayrshire & Arran (39 or 7 per cent) and Fife (32 or 6 per cent).
4.2 Because of the generally small numbers involved, particularly for some Health Board areas, great care should be taken when assessing any apparent trends shown in the table. Year-to-year variation in the figures could result in apparently large percentage changes. This is more likely for the areas with smaller populations, but can also be seen sometimes in the figures for the more populous areas (e.g. Greater Glasgow & Clyde: 151 in 2004; 111 in 2005; 162 in 2006). Therefore, using 5-year moving annual averages should ‘smooth out’ the effects of any fluctuations, and so provide a better indication of the longer-term trends. The areas with the largest increases between their annual averages for 1996-2000 and 2005-2009 were Greater Glasgow & Clyde (up by 52, from 113 to 165), Lanarkshire (up by 25, from 19 to 44), Lothian (up by 22, from 44 to 66) and Ayrshire & Arran (up by 21, from 10 to 31).
4.3 The table also shows the population of each Health Board area, and what its average number of drug-related deaths per year (for 2005-2009) represented per 1,000 population (using the population in the middle of the 5-year period as a proxy for the average population over the whole period). For Scotland as a whole, the average of 466 drug-related deaths per year represented a rate of 0.09 per 1,000 population. Only one area had a higher rate than this: Greater Glasgow & Clyde (0.14). The next highest rate was for Tayside (0.09); five areas had rates of 0.08.
4.4 Table HB2 gives a breakdown by cause of death for each Health Board area. Table HB3 shows some geographical differences in the reporting of certain drugs: figures which should be used with particular care, in the light of the points mentioned in sections 2 and 3.3, the effects of which could be proportionately greater on the figures of some of the areas with lower populations. Note also that the figures given in Table HB3 are on GROS's new standard basis (drugs implicated in, or which potentially contributed to, the cause of death), and so are not comparable to the previous edition's figures for 2008 (which were on the basis of "all drugs which were found to be present in the body"). As mentioned earlier, the GROS web site has versions ofTable HB3 which give (i) figures for 2008 on the new standard basis and (ii) figures for 2009 on the "all drugs which were found to be present in the body" basis.
4.5 Table HB3 shows that, for most NHS Board areas, heroin/morphine was believed to have been implicated in, or to have potentially contributed to, a majority of the deaths - for example, 33 out of 52 in Grampian, 111 out of 200 in Greater Glasgow & Clyde, 35 out of 47 in Lanarkshire, and 31 out of 44 in Tayside. However, there was a lower proportion in Lothian (36 out of 81). Greater Glasgow & Clyde had an above-average proportion for which methadone was implicated in, or potentially contributed (74 out of 200) as did Lothian (35 out of 81); there were lower proportions in Fife (8 out of 32), Grampian (9 out of 52) and Lanarkshire (9 out of 47). The table also shows that benzodiazepines were implicated in, or potentially contributed, only small proportions of the deaths in some areas but in more than half the deaths in Grampian (28 out of 52), Lothian (47 out of 81) and Tayside (28 out of 44) - although this comparison might be affected by differences in reporting practices (see section 2).
4.6 The lower part of Table 8 provides, for each Health Board, for a number of age- groups, the drug-related death rate per 1,000 population. As with the overall rates in Table HB1, the figures were calculated using the average number of drug-related deaths per year (for 2005-2009), by taking the population in the middle of the 5-year period as a proxy for the average population over the whole period. Even though the figures are five-year averages, they must still be used with caution for the less populated areas (e.g. just three 15-24 year old drug-related deaths in the five years from 2005 to 2009, inclusive, caused Western Isles to have a death rate for that age-group which was double its rate for Scotland as a whole). Of the more populous areas, Greater Glasgow & Clyde had the highest drug-related death rates: 0.33 for 25-34 year olds and 0.34 for the 35-44 age-group; both well above the overall rates for Scotland as a whole (0.25 and 0.20, respectively). Ayrshire & Arran and Tayside had rates for 25-34 year olds which were almost as high (0.29 and 0.30, respectively), but their rates for the 35-44 age-group were much lower (0.19 and 0.23, respectively) and not far from the level for Scotland as a whole. Greater Glasgow & Clyde's death rate for 45-54 year olds was 0.13, well above the overall level of 0.08, which also happened to be the highest figure for any of the other areas. However, the pattern was less clear for the 15-24 age-group, for which several areas had death rates which were above the overall level.