Abstract
Drug-related deaths have increased significantly in Scotland in recent years, with a much greater percentage increase in deaths among women than among men. We undertook a mixed-methods project to identify explanations for this trend, comprising three parallel methodological strands: (i) an analysis of available routine data, including drug treatment data, death registrations, and surveys of people using needle exchanges; (ii) thematic analysis of interviews and focus groups with professional stakeholders and (iii) secondary analysis of interviews with women who use drugs. Results indicated that the observed trend is likely to reflect multiple, interacting causes. Potential contributors identified were: ageing; changing patterns of substance use; increasing prevalence of physical and mental health co-morbidities; changing relationships and parenting roles; changes to treatment services and wider health and social care provision; unintended consequences or poor implementation of recovery-oriented practice; and changes in the social security system. Policy responses to rising drug-related death rates require a gender-informed approach, recognising the commonalities and differences between men and women who use drugs; the diversity of experiences within each gender; and the intersections between gender and other forms of inequality, such as poverty.
Highlights
Drug-related deaths (DRD) have been increasing in Scotland in recent years (National Records of Scotland, 2019b)
Explanations are ordered by theme, rather than importance; starting with potential changes in the measurement of DRD that may have created the erroneous impression of a trend, before moving on to consider explanations relating to individual factors, communities and services, and societal trends
Analysis of National Records of Scotland (NRS) data show that the trend in DRDs among women was not substantially affected by changes in the legal classification of drugs since 2000 (Table S2.1, Supplementary Material): the number of deaths excluded from the standard DRD figures because the substance involved was not controlled at the time of death were relatively small in number across the time series and were not higher among women
Summary
Drug-related deaths (DRD) have been increasing in Scotland in recent years (National Records of Scotland, 2019b). Men account for the majority of DRD, the percentage of women has increased over time, from 19% in 2004–2008 to 29% in 2014–2018. When comparing the annual averages for these two periods, the percentage increase in the number of DRDs was greater for women (212%) than for men (75%). A number of explanations have been proposed for the overall increase in DRD observed throughout the UK and a number of other high-income countries, including a prematurely ageing cohort of people who use opioids; a rebound in heroin availability in recent years; polysubstance use; physical and mental health co-morbidities; worsening socioeconomic circumstances; and changes in drug treatment provision (Advisory Council on the Misuse of Drugs, 2016). To date there has been limited consideration of the reasons why current trends in DRD differ by gender
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