Transcript Overview of ICP 9 - Scottish Drugs Forum

An Overview of Drug Related
Deaths in Scotland
Andy Rome
Director
Figure 8 Consultancy Services Ltd
Overview - Knowledge and Action




What do we know?
What do we not know?
What are we doing?
What could we be doing?
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%)
Figure 8 Consultancy Services Ltd
Number of drug related deaths in
Scotland 1996-2003
400
350
300
250
200
150
100
50
0
1996 1997 1998 1999 2000 2001 2002 2003 2004
Figure 8 Consultancy Services Ltd
Knowledge

Why did 317 people die?
Why did 51,265 not die?

Why did 317 people die that day?

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.”
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)
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
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)
Figure 8 Consultancy Services Ltd
Deaths by category 1996-2003
Drug-related deaths, Scotland, 1996-2003
Year
Total
Drug abuse
(F11-F16, F19)
1996
1997
1998
1999
2000
2001
2002
2003
244
224
249
291
292
332
382
317
175
142
179
227
220
227
280
216
Cause of death category (ICD10 codes)
Accidental
Intentional
Assault by
poisoning
self-poisoning
drugs, etc.
(X40-X44)
(X60-X64)
(X85)
10
14
16
12
11
19
17
15
41
42
32
19
34
34
30
40
1
-
Undeterm ined
(Y10-Y14)
18
26
22
32
27
52
55
46
(GROS, 2003)
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)
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)
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)
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)
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
Figure 8 Consultancy Services Ltd
Action


Strategies to fill knowledge gaps
Strategies to prevent deaths
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
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.
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).
Figure 8 Consultancy Services Ltd
Local strategic planning
Drug-related deaths, by age and by sex, Scotland, 2003
Total
Drug abuse
(F11-F16, F19)
Cause of death category (ICD10 codes)
Accidental
Intentional
Assault by
poisoning
self-poisoning
drugs, etc.
(X40-X44)
(X60-X64)
(X85)
Undeterm ined
(Y10-Y14)
All ages
317
216
15
40
-
46
Under 25
25-34
35-44
45 and over
78
123
80
36
56
97
53
10
7
2
5
1
5
8
9
18
-
10
16
13
7
Males
Females
256
61
190
26
12
3
24
16
-
30
16
Figure 8 Consultancy Services Ltd
Causes of death by Health Board
Drug-related deaths, by health board area, 2003
Health board
area
Total
Drug abuse
(F11-F16, F19)
Scotland
Argyll & Clyde
Ayrshire & Arran
Borders
Dumfries & Gallow ay
Fife
Forth Valley
Grampian
Greater Glasgow
Highland
Lanarkshire
Lothian
Orkney
Shetland
Tayside
Western Isles
Cause of death category (ICD10 codes)
Accidental
Intentional
Assault by
poisoning
self-poisoning
drugs, etc.
(X40-X44)
(X60-X64)
(X85)
Undeterm ined
(Y10-Y14)
317
216
15
40
-
46
27
19
2
9
12
22
11
1
7
7
1
-
1
4
1
2
-
3
4
1
1
3
12
37
107
7
25
5
27
81
1
20
3
7
1
1
3
13
2
2
-
6
4
6
3
3
40
19
1
23
11
-
2
1
9
2
-
-
6
6
-
Figure 8 Consultancy Services Ltd
Strategies to prevent deaths



National framework
Realistic, meaningful goals
Local implementation plans sensitive to local
needs
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

Figure 8 Consultancy Services Ltd