E1. The term ‘New Psychoactive Substances’ (NPSs) is meant to cover the kinds of substances that people have, in recent years, begun to use for intoxicating purposes. In general, when an NPS first became available, it would not have been a controlled substance under the Misuse of Drugs Act 1971. Some NPSs may still not be controlled under that Act: if so, they will be covered by the Psychoactive Substances Act, which came into force on 26 May 2016. The definition of NPSs therefore includes substances which some people have described as ‘legal highs’ (by which is meant substances which were legally available at the time of the death, whether or not they have since become controlled under the Misuse of Drugs Act or become subject to the Psychoactive Substances Act).
E2 Tables NPS1 to NPS3 show the numbers of deaths involving NPSs. The main points from those figures are set out in paragraph E8 onwards, but first we must say something about the kinds of statistics that are available and which drugs are counted as NPSs. The tables distinguish between deaths for which NPSs:
In each case, the figures are sub-divided into:
In addition, the figures under (a) are further sub-divided, in order to show the extent to which deaths appear to have been due to the use of one (or more) NPSs alone or due to the use of combination of them and other types of substance.
E3. Deaths involving a particular substance may be counted in different ways at different times, because the classification of that substance may have changed. For example, mephedrone is an NPS. It was a ‘legal high’ until 15 April 2010, because it was not a controlled substance until it became a Class B drug with effect from 00.01 hours on 16 April 2010. Therefore, a death which was due solely to mephedrone, with no other substance found to be present in the body, would be counted as follows:
Note: National Records of Scotland (NRS) uses the date of death to determine how to count a drug because the information that NRS has does not include when the person used the drug.
E4. The next three paragraphs list the NPSs which are counted for the purpose of statistics of deaths registered in Scotland up to the end of 2016, distinguishing between:
Note that these are not comprehensive lists of NPSs: they cover only the NPSs which were involved in deaths which were registered in Scotland by the end of 2016. (They do not include a few other NPSs whose names are in the look-up table that NRS uses to identify the types of substance that are involved in drug-related deaths.)
E5. The following NPSs were already controlled substances at the start of 2009:
A death due solely to one of these drugs would be counted in this publication's statistics of drug-related deaths. It would also be counted in the figures for deaths involving NPSs.
E6. The following NPSs became controlled substances between the start of 2009 and the end of 2016.
| Substance | Controlled with effect from: |
|---|---|
| BZP / Benzylpiperazine | 23 December 2009 |
| CPP / Chlorophenylpiperazine | 23 December 2009 |
| TFMPP / Trifluoromethylphenlpiperazine | 23 December 2009 |
| Chloromethcathinone | 16 April 2010 |
| MDPV / Methylenedioxypyrovalerone | 16 April 2010 |
| Mephedrone / 4-Methylmethcathinone | 16 April 2010 |
| 4-MEC / Methylethcathinone/ | 16 April 2010 |
| Methylone | 16 April 2010 |
| PVP | 16 April 2010 |
| Naphyrone | 23 July 2010 |
| Phenazepam | 13 June 2012 |
| APB / 2-aminopropyl-benzofuran/ 5 APB / 6 APB | 10 June 2013 (temporary class order); 10 June 2014 (class B drug) |
| API / 5-API / 5-IT / 5-(2-aminopropyl)indole - APB | 10 June 2013 (temporary class order); 10 June 2014 (class B drug) |
| AMT / Alphamethyltryptamine | 7 January 2015 |
| 5-MEO-DALT | 7 January 2015 |
| 4-4’DMAR | 11 March 2015 |
| Ethylphenidate | 10 April 2015 (Temporary Class Drug Order) 31 May 2017 (Class B drug) |
| MPA / Methylthienylpropamine / Methiopropamine | 27 November 2015 (Temporary Class Drug Order) |
| AKB48 | 14 December 2016 |
| MDMB-CHMICA | 14 December 2016 |
| 5F-PB-22 | 14 December 2016 |
A death due solely to one of these drugs would not be counted in this publication's statistics of drug-related deaths if it occurred before the relevant date, because it would not have involved a drug that was controlled at the time. However, it would be counted in the figures for deaths involving NPSs. A death due solely to one of these drugs would be counted in this publication's statistics of drug-related deaths if the person died on or after the specified date. It would also be counted in the figures for deaths involving NPSs.
E7. The following are among the NPSs that had not become controlled substances by the end of 2016:
A death involving only these substances would not be counted in this publication's statistics of drug-related deaths because it would not have involved a drug that was controlled at the time. However, it would be counted in the figures for deaths involving NPSs.
E8. Table NPS1 provides the numbers of deaths involving NPSs which were registered in Scotland in 2016. The figures are broken down as described in paragraph E2, and also by the type(s) of NPS that were involved, distinguishing between cases where:
The figures in Table NPS1 may be understood better by looking also at Table NPS3, which lists all the substances that were reported to NRS for every death, registered in Scotland in 2016, which involved NPSs (Note: because of its size, this table is not included here. It is available via the publication’s ‘List of Tables and Figures’, which can be found via its home page on the NRS website.). From Table NPS3, one can observe which NPSs were found in the body in each case, whether the person had taken more than one NPS, and whether other substances (such as heroin, methadone and/or other ‘traditional’ drugs) were also present.
E9. The top half of part (i) of Table NPS1 sshows that there were 286 deaths in 2016 for which one or more NPSs were implicated in, or potentially contributed to, the cause of death. In 277 cases, the only NPSs present were benzodiazepines (usually etizolam, but sometimes another, such as diclazepam or phenazepam); in 8 cases, other types of NPS were present (for example PMA, PMMA, MXP); and there was one death for which both benzodiazepine NPSs and other types of NPS were present. Almost all of these deaths (281 out of 286) fall within the definition of ‘drug-related deaths’ that is used to produce the statistics given in the main body of this report – this is 281 out of 286 are included in the 867 drug-related deaths that were registered in 2016. In only a small proportion of cases (4 out of 286) were NPSs the only substances that were implicated in the death. This can be seen from part (i) of Table NPS3: its lists of the substances which were reported for each death show that, in most cases, ‘traditional’ drugs (such as heroin and methadone) were also implicated in these deaths.
E10. The lower half of part (i) of Table NPS1 provides a breakdown of the 286 deaths (in which one or more NPSs were implicated in, or potentially contributed to, the cause of death) by the deceased’s person’s age (for example there were 84 aged 25-34, 118 were in the 35-44 age-group, and 60 were 45-54 year olds) and sex (191 were men).
E11. Part (ii) of Table NPS1 shows that there were 60 deaths in 2016 for which NPSs were present but were not considered to have contributed to the death. In all cases the only NPSs present were benzodiazepines; and almost all of the deaths (59 out of 60) were counted in the statistics in the main body of this report – this is 59 out of 60 are included in the 867 drug-related deaths that were registered in 2016. The table shows that most of these deaths were of people who were aged 25-34 (18), 35-44 (18) or 45-54 (16), and most were men (46). In Table NPS3, part (ii) lists the substances which were reported for such deaths: it shows that ‘traditional’ drugs (such as heroin and methadone) were usually implicated in these deaths.
E12. Table NPS2 provides a summary of the numbers of deaths which have involved NPSs in recent years. It appears that the first Scottish deaths involving NPSs were registered in 2009. Of course, it is possible that NPSs were involved in some deaths in Scotland in earlier years, but their presence was not identified (for example, perhaps because other drugs were found, and it appeared to the investigators that those other drugs had caused the deaths) - but all the data can tell us is that none of the deaths that were registered in Scotland in 2008 or earlier years were reported to involve NPSs.
E13. The number of deaths involving NPSs increased rapidly between 2009 and 2013, was almost unchanged in 2014 and 2015, then more than trebled between 2015 and 2016: 4 were registered in 2009, 11 in 2010, 47 in 2011, 47 in 2012, 113 in 2013, 114 in 2014, 112 in 2015 and 346 in 2016. The sub-totals at the foot of Table NPS2 show that this report's statistics of drug-related deaths for each year include almost all the deaths which involved NPSs (3 out of 4 such deaths in 2009, 8 out of 11 in 2010, 45 out of 47 in 2011, 45 out of 47 in 2012, 110 out of 113 in 2013, 107 out of 114 in 2014, 108 out of 112 in 2015, and 340 out of 346 in 2016 ).
E14. Table NPS2 also shows that deaths for which NPSs were the only substances implicated in, or potentially contributing to, the death, generally represented only a small proportion of deaths which involved NPSs. The relevant numbers are 0 out of 4 in 2009, 7 out of 11 in 2010, 1 out of 47 in 2011, 5 out of 47 in 2012, 6 out of 113 in 2013, 7 out of 114 in 2014, 3 out of 112 in 2015, and 4 out of 346 in 2016: so the proportion was small in every year apart from 2010. The main reason for 2010 being the exception is that there were several deaths in that year for which mephedrone was the only substance that was implicated in the death.