Natalie Davies brings together national statistics on rising rates of drug-related deaths, exploring how they differ by region, type of drugs, and sex.

  1. Trends over time
  2. Comparison of countries and regions
  3. Type of drugs
  4. Sex

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In England and Wales, there were 4,561 drug-related deaths registered in 2020, which was 4% higher than the 4,393 deaths registered in 2019. Two-thirds of these were classified as ‘drug misuse’ deaths, which meant that they involved someone who was dependent on drugs or using illicit substances.

In Northern Ireland, there were 218 registered drug-related deaths in 2020 – more than double the number of deaths recorded a decade ago (92 deaths), and higher than the 191 deaths in 2019. The number of drug misuse deaths also increased from 165 in 2019 to 182 in 2020, and almost tripled from the 64 drug misuse deaths registered in 2010.

In Scotland, there were 1,339 drug-related deaths in 2020; a 5% increase from 2019 and the largest number since records began in 1996. The number of drug-related deaths has increased substantially over the last 20 years in Scotland; there were 4.5 times as many deaths in 2020 compared with 2000.

Comment: The number of drug-related deaths has continued to rise across the UK. In 2016, Public Health England convened an independent expert working group to establish the causes of this upward trend. In 2016 they reported that the recent increase was mainly caused by: an ‘ageing cohort’ of people who use heroin, “many of whom started to use heroin in the 1980s and 90s, who are now experiencing cumulative physical and mental health conditions that make them more susceptible to overdose”. The working group also noted an increase in the availability of heroin, following a period where there had been a fall in the purity and availability of heroin. Other factors included improved reporting of drug-related deaths, an increase in the use of more than one type of drug (‘polydrug use’), and an increase in the prescribing of some medicines. From the beginning of 2020, the COVID-19 pandemic may have also played a role, for example through treatment access being reduced during national lockdowns. Social distancing practices and policies also made people more vulnerable to overdosing in circumstances where no one else would be present. It is also important to note that many people’s health was compromised by COVID-19.

2. Comparison of countries and regions

The North East of England has had the highest rate of drug misuse deaths of any English region for the past eight years. In 2020, the rate of drug misuse deaths in the North East stood at 104.6 deaths per million, while London (which had the lowest rate) was at 33.1 deaths per million.

In Northern Ireland between 2010 and 2020, people living in the most deprived areas were almost five times more likely to die from a drug-related death than those in the least deprived areas. The 20% of areas that were most deprived in Northern Ireland experienced the highest rate of drug-misuse deaths at 6.5 per 100,000 population in the preceding five years, compared with the least deprived 20% of areas at 1.4 per 100,000 population.

In 2020, Scotland’s drug-related death rate stood at over 3.5 times that for the UK as a whole, and was higher than that of any European country. Greater Glasgow and Clyde had the highest drug-related death rate of all health board areas, followed by Ayrshire and Arran and Tayside. People in the most deprived parts of Scotland were 18 times as likely to die of a drug-related death in 2020 as those in the least deprived areas, compared with the early 2000s, when those in the most deprived areas were around 10 times as likely to have a drug-related death as those in the least deprived areas.

Comment: There is a marked North–South divide in the rate of drug-related deaths in the UK, both when comparing Scotland with England/Wales, and when comparing regions of England. The 2016 Public Health England report into drug-related deaths found that an important explanation for this is the link between economic and health inequalities, deprivation, and drug-related deaths. Another factor could be that the rates of drug-related deaths are highest in areas where the rates of illicit drug use are highest, which was found to be the case in the North East and the North West of England.

3. Type of drugs

In England and Wales, approximately half of all drug-related deaths registered in 2020 involved an opiate (2,263 deaths) and 777 deaths involved cocaine, which was 10% more than 2019, and more than five times the amount recorded a decade ago (144 deaths in 2010). There has also been an increasing number of deaths involving benzodiazepines (a 19% rise between 2019 and 2020), pregabalin (a 41% rise), gabapentin (a 33% rise) and zopiclone (a 4% rise).

In Northern Ireland, opioids were the most commonly-mentioned type of drugs on death certificates, featuring in 133 (61%) of the 218 drug-related deaths registered in 2020. The next most commonly-mentioned type of drug was benzodiazepines, appearing on 100 death certificates. Two-thirds (66%) of drug-related deaths in 2020 involved two or more drugs. By contrast, in 2010, 55% of drug-related deaths involved two or more drugs.

In Scotland, more than one drug was present in 93% of drug-related deaths; opioids were involved in 89% of cases, benzodiazepines in 73%, gabapentin or pregabalin in 37%, and cocaine in 34%. Drug-related deaths where benzodiazepines were implicated have risen sharply in the last five years, from fewer than 200 deaths per year prior to 2016 to nearly 1,000 in 2020. This increase was largely due to deaths where ‘street’ benzodiazepines (such as etizolam) were implicated, which rose from 58 in 2015 to 879 in 2020. ‘Street’ benzodiazepines were implicated in 66% of all drug-related deaths in 2020.

Comment: Across the UK, benzodiazepines – a group of drugs originally designed for use in the medical treatment of anxiety and insomnia – are an increasingly common feature of drug-related deaths. When someone has an opioid overdose, they experience difficulty breathing (known as ‘respiratory depression’), which can prove fatal without urgent intervention, including rescue breathing, cardiopulmonary resuscitation, and administration of naloxone. The use of benzodiazepines, which have a muscle-relaxing effect, in combination with opioids, can increase the likelihood of a fatal overdose by further supressing breathing.

4. Sex

In England and Wales, there were 3,108 registered deaths among men in 2020, compared with 1,453 deaths among women.

In Northern Ireland, men accounted for 70% of drug-related deaths in 2020. There were 153 drug-related deaths among men and 65 among women. Deaths due to drug misuse accounted for a greater percentage of drug-related deaths among men than women (88% vs. 74%).

In Scotland, men were 2.7 times more likely to die of a drug-related death in 2020 than women. However, this gap is smaller than it used to be. In the early 2000s, men were more than four times as likely to have a drug-related death as women.

Comment: Men are more likely to die from drug-related deaths across the UK, which fits with overall patterns of substance use whereby men are more likely to use, and experience harms from, drugs and alcohol. However, the Scottish Drug Deaths Taskforce has reported that there should be more focus on the increasing rates of drug-related deaths among women. In Scotland, overall levels of drug-related deaths have risen; however, the data shows that levels have risen faster among women than among men.

by Natalie Davies

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