Drug-related deaths – another unwelcome record for Scotland

The latest figures for drug-related deaths in Scotland were released this month and they don’t make for good reading. According to statistics released by National Records Scotland, a total of 934 deaths were registered in 2017. This represents an 8% increase on the previous year and more than double the figure for 2007, which was 455.

As was the case in previous years, problem drug use associated with the use of opiates or opioids (e.g. heroin, morphine and methadone) are the leading cause of these deaths. These drugs were implicated in, or potentially contributed to 87% (815) of the deaths recorded in 2017.

The 934 deaths in 2017 is the highest ever recorded and marks the fourth consecutive year in which the total number of deaths has risen. Over the last decade the number of deaths has increased by 105%. During this time the average number of deaths per year was 687, just under double than in the previous decade from 1997-2007 (average of 366 deaths). Although men still account for the majority of deaths, a recent report by the Scottish Government highlights an increase in the proportion of deaths among women from 19% in 2002-2006 to 29% in 2012-2016.

SPICe_Blog_2018_Health_Drug Deaths_Timeseries

Why do drug-related deaths keep increasing?

The underlying causes of drug-related deaths are complex and there is no consensus on why they have increased steadily over the last decade in Scotland. A number of contributing factors have been suggested.

An ageing population of people with a drug problem

The chart below shows how the proportion of people over the age of 35 dying because of drug misuse has increased dramatically over the last decade. The figures show that the highest number of drug-related deaths in 2017 was among people aged 35-44.

SPICe_Blog_2018_Health_Drug Deaths_By broad age group

Many of the people in this demographic have a long history of drug and alcohol misuse and suffer from health problems usually associated with people in the general population who are fifteen years older. A report published by the Scottish Drug Forum points out:

“They are generally drawn from the most deprived communities in Scotland where they grew up as children and adolescents and may have numerous consequent health inequalities. Furthermore, they may have spent most of their adult lives dependent on illicit drugs and have lived an associated lifestyle which can have a very negative impact on general health.”

Austerity and welfare reform

The 2008 financial crisis has resulted in the pursuit of austerity policies and welfare reform. A report by the Advisory Council on the Misuse of Drugs, published in 2016, states that areas that experience the highest rates of drug-related deaths are among those that have experienced the greatest reductions in funding for local authority services and welfare benefits for working age adults.

A more recent report by the Scottish Government exploring why drug-related deaths are increasing in women also highlights these factors:

“People who use drugs may also be particularly vulnerable to these changes, for a number of reasons. Firstly, they are more likely to live in the most deprived areas of Scotland, which are often disproportionately affected by current and historical economic policies, particularly austerity; secondly; they typically experience extremely precarious financial and social circumstances, with high rates of unemployment and welfare benefit receipt; and thirdly, they often have complex health and social needs requiring care from statutory services.”

The link between drug-related deaths and deprivation is also reflected in geographical data. Health boards with the highest average annual number of drug related deaths such as Greater Glasgow and Clyde, Tayside and Lothian encompass the cities of Glasgow, Dundee and Edinburgh where the largest areas of concentrated deprivation in Scotland occur.

SPICe_Blog_2018_Health_Drug Deaths_Drug deaths by NHS board

Last year, there was criticism of the Scottish Government’s decision to cut funding for Alcohol and Drugs Partnerships (ADPs). The 2016-17 budget saw a fall in funding allocation of 22% which was maintained in 2017-18. While the Scottish Government maintain that the funding for services is actually higher due to the expectation that it will be supplemented from NHS Board budgets, the British Medical Association Scotland, writing to the Scottish Parliament’s Health and Sport Committee, expressed concern over the impact for the delivery of services:

“Reducing the funds available for such support services is a false economy, which will only increase pressures on the health service and general practice in particular. It is hard to see how this decision is compatible with the Scottish Government’s stated priorities in relation to reducing alcohol harm. Funding to ADPs should be restored to 2015/16 levels in the next Scottish budget.”

Change in funding allocation for Alcohol and Drug Partnerships

NHS Board 2017-18 (£) Change since 2014-15 (£)
Ayrshire and Arran 3,538,392 -957,572
Borders 1,049,582 -304,625
Dumfries & Galloway 1,531,827 -460,033
Fife 3,297,788 -973,693
Forth Valley 2,653,555 -704,896
Grampian 4,511,429 -1,258,876
Greater Glasgow and Clyde 14,479,282 -4,213,360
Highland 2,847,456 -807,905
Lanarkshire 5,424,984 -1,434,164
Lothian 8,887,134 -2,630,049
Orkney 4,158,654 3,590,934
Shetland 427,044 -179,345
Tayside 462,201 -4,902,815
Western Isles 530,673 -172,670
Total Scotland 53,800,001 -15,409,070

Source: Scottish Government

Despite the reduction in funding for ADPs, national performance against the waiting time target for drug services has been exceeded, although there is variation across the country. For example, 79.9% of clients seeking help in Lothian were seen within 3 weeks. The target is 90%.

The national drug strategy – a fresh approach?

The need to tackle the problem has been recognised by the Scottish Government in the process of refreshing the 2008 national drugs strategy “The Road to Recovery”. In a recent debate on safe injection facilities, the then Minister for Public Health and Sport, Aileen Campbell said:

“Our refreshed strategy will seek to build on the achievements of the road to recovery strategy. It is also important that it seeks to rectify the gaps and shortfalls that have become all too evident. The new strategy must be innovative in its approach. It must be guided by the evidence of what works and it must be unafraid to suggest approaches that might make some people uncomfortable, at first. That will include ideas such as SDCFs [Safer Drug Consumption Facilities] or heroin-assisted treatment. Against the backdrop of rising numbers of drug-related deaths, those bold ideas could be what makes the difference. […] I would welcome all members who want to contribute to the refreshed strategy. The strategy will be backed by an additional £20 million each year during the current parliamentary session, and I have been clear that that money is not just to produce more of the same. Instead, I want it to encourage new thinking and approaches, and to encourage ambitious and innovative front-line responses.”

The full debate can be viewed in the video below.

Recent reaction to the latest drug-related death statistics in the media has prompted calls for a cross-party approach to develop the revised strategy. The extent to which the Parliament is involved in shaping this will become clearer in the run up to its expected publication later this year.

A more detailed overview of some of the issues covered in this blog can be found in SPICe’s briefing on drug misuse.

Damon Davies, Researcher, Brexit, Environment and Rural Affairs and Kathleen Robson, Justice, Health and Social Affairs