1. An Overview of Drug Related Deaths in Scotland Andy Rome Director Figure 8 Consultancy Services Ltd

2. Overview - Knowledge and Action What do we know? What do we not know? What are we doing? What could we be doing?

3. Figure 8 Consultancy Services Ltd Knowledge 51,582 problem drug users in Scotland in 2003 (Hay et al 2004) 317 people died in 2003 of a drug related death 51,265 problem drug users did not die of a drug related death in 2003 (99.4%)

4. Figure 8 Consultancy Services Ltd Number of drug related deaths in Scotland 1996-2003

5. Figure 8 Consultancy Services Ltd Knowledge Why did 317 people die? Why did 51,265 not die? Why did 317 people die that day?

6. Figure 8 Consultancy Services Ltd What is a Drug Related Death? “The definition of a drug related death is not straightforward” (GROS 2003) ACMD working group “To reach agreement on consistent coding framework to be used in England, Wales, Scotland and Northern Ireland.”

7. Figure 8 Consultancy Services Ltd Classifications of DRDs Mental and behavioural disorders due to psychoactive substance use (F11-F19) Accidental poisoning (X40-X44) Intentional self-poisoning (X60-X64) Assault by drugs, medicaments and biological substances (X85) Event of undetermined intent (Y10-Y14)

8. Figure 8 Consultancy Services Ltd What is not a Drug Related Death? Deaths coded to mental and behavioural disorders due to the use of alcohol (F10) tobacco (F17) and volatile substances (F18) Deaths coded to drug abuse which were caused by secondary infections and related complications (e.g. clostridium novyi) Deaths from AIDS where the risk factor was believed to be the sharing of needles

9. Figure 8 Consultancy Services Ltd What is not a Drug Related Death? Deaths from road traffic or other accidents which occurred under the influence of drugs Deaths where a drug listed under the Misuse of Drugs Act was present because it was part of a compound analgesic or cold remedy. (GROS, 2003)

10. Figure 8 Consultancy Services Ltd Deaths by category 1996-2003 (GROS, 2003)

11. Figure 8 Consultancy Services Ltd Research - International Australia D. Zador 23 articles (at least!) Zador DA, Sunjic SD (2002) Darke S, Zador D. (1996) Fatal heroin ‘overdose’: A review Coleridge J. et al (1992)

12. Figure 8 Consultancy Services Ltd Research - International Europe Davids E, et al (2003)1 Davids E, et al (2003)2 Kraus L, Muller-Kalthoff T. (2002) Risser D, et al (2001) Risser D, et al (1996) Marx A, et al (1994)

13. Figure 8 Consultancy Services Ltd Research - UK Shah R, et al (2001) Webb L, et al (2003) Hickman M, et al (2003) Ghodse H, et al (1998)

14. Figure 8 Consultancy Services Ltd Research - Scotland Stenhouse G, Grieve JH (2003) Bird SM, et al (2003) Seymour A, et al (2000) Seymour A, et al (2001)1 Seymour A, et al (2001)2 Seymour A, et al (2003)

15. Figure 8 Consultancy Services Ltd Knowledge - Monitoring Good national monitoring systems Good analysis of data – By drug – By Age/Gender – Classification – Locality Good prevalence data

16. Figure 8 Consultancy Services Ltd Action Strategies to fill knowledge gaps Strategies to prevent deaths

17. Figure 8 Consultancy Services Ltd Strategies to fill knowledge gaps National National Investigation into Drug Related Deaths in Scotland, 2003 STRADA training programme Local DAAT sub-groups

18. Figure 8 Consultancy Services Ltd Aims of National Investigation To collect and analyse information relating to the clinical and social circumstances surrounding all drug-related deaths in Scotland for the period January – December 2003. To identify patterns in social and clinical circumstances surrounding the deaths, and the associations between them. To make recommendations for policy and practice which may lead to a future reduction in drug-related deaths.

19. Figure 8 Consultancy Services Ltd Aims of National Investigation A comparison of the service utilisation and other characteristics of a group of living injectors in Glasgow with a comparable sample of deceased cases also resident in Glasgow prior to death. Extended interviews with a sub-sample of living injectors who had survived an overdose in the 6 months prior to interview to obtain more information about survivors’ beliefs, experience and knowledge of overdose. A comparison of the characteristics of Scottish drug related deaths with a sample of London drug deaths for the same year (2003).

20. Figure 8 Consultancy Services Ltd Local strategic planning

21. Figure 8 Consultancy Services Ltd Causes of death by Health Board

22. Figure 8 Consultancy Services Ltd Strategies to prevent deaths National framework Realistic, meaningful goals Local implementation plans sensitive to local needs

23. Figure 8 Consultancy Services Ltd Sources of information Drug-related deaths in Scotland in 2003 www.gro-scotland.gov.uk Estimating the National and Local Prevalence of Problematic Drug Misuse in Scotland, 2003 www.drugmisuse.isdscotland.org All research articles www.ncbi.nlm.nih.gov