Drug-related deaths in Scotland in 2019 Published on 15 December 2020 Statistics of drug-related deaths in 2019 and earlier years, broken down by age, sex, selected drugs reported, underlying cause of death and NHS Board and Council areas. Drug-related deaths in Scotland, 2019 Summary Drug-related deaths Drug-related deaths, 1996 to 2019 continue to increase 1,264 The number of drug-related The dashed line shows the 5-year moving average and the shaded area deaths has increased almost shows the likely range of variation every year. In 2019 there around the 5-year moving average. were 1,264, which is the largest number ever recorded and more than 527 double the number recorded a decade ago. 244 1996 2013 2019 Largest increase was in Drug-related death rates by age group, 2000 to 2019 35-54 year olds 15-24 25-34 35-44 45-54 55-64 Most of the increase in drug related death rates* has 0.6 occurred in the 35-44 year old and 45-54 year old age 0.4 groups. 0.2 0.0 * Deaths per 1,000 people 2000 2019 2000 2019 2000 2019 2000 2019 2000 2019 Death rates vary Drug-related death rates by health board, 2015 to 2019 geographically Greater Glasgow & Clyde 0.27 Tayside 0.21 Greater Glasgow & Clyde Ayrshire & Arran 0.20 had the highest rate* at 0.27 Scotland 0.18 per 1,000 population, Lanarkshire 0.18 Forth Valley 0.17 followed by Tayside and Fife 0.16 Ayrshire & Arran with rates Lothian 0.15 of 0.21 and 0.20 per 1,000 Dumfries & Galloway 0.14 Grampian 0.14 population respectively. Borders 0.13 Highland 0.10 Orkney 0.06 * Rates are based on 5-year averages to Shetland 0.05 reduce year-to-year fluctuations. Western Isles 0.05 www.nrscotland.gov.uk Source: Drug-related deaths in Scotland, 2019 Key Points 1,264 drug-related deaths were registered in Scotland in 2019, 6% (77) more than in 2018. This was the largest number ever recorded, and more than double that of ten years earlier (545 in 2009). Males accounted for 69% of the drug-related deaths in 2019, a similar proportion to recent years. The median age of drug-related deaths has increased from 28 to 42 over the last 20 years. In 2019, over two-thirds (68%) of all drug-related deaths were of people aged between 35 and 54: there were 856 such deaths, 69 more than in 2018. There was also an increase in 15-24 year old drug-related deaths, from 64 in 2018 to 76 in 2019. Three-quarters of all drug-related deaths were in the following five Health Board areas: Greater Glasgow & Clyde (404), Lanarkshire (163), Lothian (155), Tayside (118) and Ayrshire & Arran (108). Together, they accounted for a slightly higher proportion of the total than in most of the previous ten years. The Health Board areas with the largest increases over the last decade (using a five year average) were Greater Glasgow & Clyde (up by 152), Lothian (up 67), Lanarkshire (up 66), Tayside (up 52) and Ayrshire & Arran (up 45). Scotland’s drug-death rate was higher than those reported for all the EU countries, and was approximately 3½ times that of the UK as a whole. Of the 1,264 drug-related deaths in 2019, these substances were implicated in, or potentially contributed to the cause of, the following numbers of deaths: - heroin and/or morphine 645 deaths, more than in any previous year and 51% of the total; - methadone 560 deaths, the same as in 2018 (44%); - one or more opiates or opioids (including heroin/morphine and methadone) 1,092 deaths, more than in any previous year (86%); - ‘street’ benzodiazepines (such as etizolam) 814 deaths, more than in any previous year (64%) - ‘prescribable’ benzodiazepines (such as diazepam) 195 deaths, fewer than in 2017 and 2018 (15%) - gabapentin and/or pregabalin 438 deaths, more than in any previous year (35%); - cocaine 365 deaths, more than in any previous year (29%). 94% of all drug-related deaths were of people who took more than one substance. 3 © Crown Copyright 2020 Contents List of Tables ..................................................................................................................... 5 List of Figures ................................................................................................................... 6 Summary. ........................................................................................................................... 7 1. Introduction ....................................................................................................... 10 2. Data sources ..................................................................................................... 11 3. Drug-related deaths: trends, causes of death, drugs reported, sex and age .... 14 3.1 Overall numbers .................................................................................................. 14 3.2 Underlying causes of death ................................................................................. 16 3.3 Selected drugs reported ...................................................................................... 17 3.4 Sex and age ........................................................................................................ 21 3.5 Death rates for problem drug users ..................................................................... 24 4. NHS Board areas: trends, causes, drugs reported, and death rates by age- group and relative to the estimated number of problem drug users .................. 25 5. Council areas (trends, causes, drugs reported and death rates by age-group) and areas with smaller populations ................................................................... 28 Annex A: The definition of drug-related deaths used for these statistics (the National Records of Scotland (NRS) implementation of the ‘baseline’ definition for the UK Drugs Strategy) ........................................................................................... 30 Annex B: Some other definitions of drug-related deaths ................................................... 35 Annex C: References ....................................................................................................... 40 Annex D: The questionnaire used to obtain further information about drug-related deaths, with effect from 2014 ......................................................................................... 41 Annex E: So-called ‘New Psychoactive Substances’ ........................................................ 42 Annex F: A consistent series of drug-related death numbers, based on the classification at the end of the latest year covered by the publication .................................... 46 Annex G: Drug-related Deaths – comparison with other countries ................................... 49 Annex H: ‘Prescribable’ and ‘street’ benzodiazepines ...................................................... 53 6. Notes on statistical publications ........................................................................ 86 7. Related organisations ....................................................................................... 88 4 © Crown Copyright 2020 List of Tables Table 1: Drug-related deaths in Scotland, 1996 – 2019 .......................................... 55 Table 2: Drug-related deaths by underlying cause of death1, Scotland, 1996 – 2019 56 Table 3: Drug-related deaths by selected drugs reported1, Scotland, 1996 – 2019 57 Table 4: Drug-related deaths by sex and age, Scotland, 1996 – 2019 ................... 58 Table 5: Drug-related deaths by sex, age and underlying cause of death1, Scotland, 2019 .......................................................................................................... 59 Table 6: Drug-related deaths by sex, age and selected drugs reported1, Scotland, 2019 .......................................................................................................... 60 Table 7: Drug-related deaths involving only one drug by sex, age and selected drugs reported1, Scotland, 2019 .......................................................................... 61 Table 8: Drug-related deaths per 1,000 population, Scotland, 2000 to 2019 .......... 62 Table 9: Drug-related deaths by sex and age-group: average for 2013 to 2017, and relative to the estimated number of problem drug users in 2015/16 .......... 63 Table HB1: Drug-related deaths by NHS Board area, 2009 - 2019 (with averages for 2005-2009 and 2015-2019) ....................................................................... 64 Table HB2: Drug-related deaths by underlying cause of death1 and NHS Board area, 2019 .......................................................................................................... 65 Table HB3: Drug-related deaths by selected drugs reported1 and NHS Board area, 2019 .......................................................................................................... 66 Table HB4: Drug-related deaths per 1,000 population, NHS Board areas, annual averages for 2015 to 2019 1 ...................................................................... 67 Table HB5: Drug-related deaths by NHS Board area: average for 2013 to 2017, and relative to the estimated number of problem drug users in 2015/16 .......... 68 Table C1: Drug-related deaths by council area, 2009 - 2019 (with averages for 2005- 2009 and 2015-2019) ................................................................................ 70 Table C2: Drug-related deaths by underlying cause1 and council area, 2019 ........... 71 Table C3: Drug-related deaths by selected drugs reported1 and council area, 2019 . 72 Table C4: Drug-related deaths per 1,000 population, council areas, annual