Drug Related Deaths In Scotland Research Articles

Systematic review: The relationship between gabapentinoids, etizolam, and drug related deaths in Scotland.

In recent years Scotland has been experiencing a disproportionally high number of drug related deaths compared to other European countries, causing significant individual, societal and economic burden. A possible cause of this is the increase in average number of substances involved in Scottish drug related deaths, as well as the changing pattern of substances involved. Opioids, cocaine, and alcohol have been consistently involved in the culture of drug use in Scotland, however recently National Records Scotland have identified that designer benzodiazepines such as etizolam, and prescription drugs such as gabapentinoids are increasingly being detected in Scottish toxicology reports. A systematic literature review following PRISMA guidelines was conducted through searching PubMed and Google Scholar to identify peer-reviewed articles published in English between 2013 and 2023 that investigated Scottish population data on gabapentinoids and etizolam to establish their contribution to the rise in Scottish drug related deaths. 18 studies were included in the review. A high use prevalence of etizolam and gabapentinoids in Scotland has been identified, with both substance-related deaths showing recent increase, marked since 2015. This pattern is replicated in the Scottish prison system. There has also been a significant increase of gabapentinoids prescriptions in Scotland. Polydrug use was identified as the most common determinant of both etizolam and gabapentinoids related adverse effects and fatality in Scotland, especially concurrent opioid use. The results indicate the literature on individual characteristics of Scottish at-risk users of gabapentinoids and etizolam is limited, however the data shows both substances are being used by older cohort, with adverse effects seen more in older women.

Drug-related deaths in Scotland rose by 10% in 2023

Drug-related deaths in Scotland rose by 10% in 2023

Development of an intervention to manage benzodiazepine dependence and high-risk use in the context of escalating drug related deaths in Scotland: an application of the MRC framework

BackgroundScotland has the highest rate of drug related deaths (DRD) in Europe. These are deaths in people who use drugs such as heroin, cocaine, benzodiazepines and gabapentinoids. It is a feature of deaths in Scotland that people use combinations of drugs which increases the chance of a DRD. Many deaths involve ‘street’ benzodiazepines, especially a drug called etizolam. Many of the ‘street’ benzodiazepines are not licensed in the UK so come from illegal sources. People who use opiates can be prescribed a safer replacement medication (e.g., methadone). While guidance on management of benzodiazepines use highlights that there is little evidence to support replacement prescribing, practice and evidence are emerging.AimTo develop an intervention to address ‘street’ benzodiazepines use in people who also use opiates.MethodsThe MRC Framework for Complex Interventions was used to inform research design. Co-production of the intervention was achieved through three online workshops with clinicians, academics working in the area of substance use, and people with lived experience (PWLE). Each workshop was followed by a PWLE group meeting. Outputs from workshops were discussed and refined by the PWLE group and then further explored at the next workshop.ResultsAfter these six sessions, a finalised logic model for the intervention was successfully achieved that was acceptable to clinicians and PWLE. Key components of the intervention were: prescribing of diazepam; anxiety management, sleep, and pain; and harm reduction resources (locked box and a range of tips), personal safety conversations, as well as a virtual learning environment.ConclusionA co-produced intervention was developed for next stage clinical feasibility testing.

Fewer drug-related deaths in Scotland

Fewer drug-related deaths in Scotland

National increase in the community supply of take‐home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis

BackgroundTake-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the ‘How to save a life’ (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN. MethodsWe used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020–December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021). ResultsThe total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, p<0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, p<0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, p = 0.042). The trend during the post-campaign period was stable. ConclusionsThe HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.

Policy traps and policy placebos: assessing drug policy network responses to drug related deaths

PurposeThis study focuses on emergency and strategic responses to drug-related deaths. This paper uses policy network theory and policy analysis frameworks to subject programme development and financial decision-making processes to critical scrutiny.Design/methodology/approachA qualitative, case-based design focuses on Scottish Government responses to rising drug-related deaths, using publicly available data to produce interpretive critical analysis.FindingsAnalysis indicates that established drug policy communities influence emergency and strategic policy and programme development in relation to drug deaths. Results reveal that policy communities aid government to develop placebo policies and avoid policy traps associated with social determinants of drug-related deaths. This study documents a lack of transparency and accountability in financial decision-making by a third party operating on behalf of Scottish Government. To improve accountability necessitates that drug policy decisions acknowledge existing legislative duties to address socio-economic inequality in this policy area.Research limitations/implicationsIn seeking convergence and corroboration publicly available data sources were identified that focus on emergency and strategic responses to drug-related deaths in Scotland. The authors recognise the potential for bias in qualitative and interpretive analysis of this data (Bowen, 2009).Practical implicationsThis study provides robust critical analysis on how policy networks exert influence on spending decisions related to drug policy in Scotland. This is useful for researchers and drug policy advisors.Originality/valueWhile much has been written on drug deaths in Scotland, using policy network and policy success frameworks to examine policy and programme development, provides originality of analysis in this under-researched aspect of drug policy.

Pedagogies of hope and drug-related deaths in Scotland

The incidence of drug-related deaths in Scotland has reached crisis proportions. Comparable only to the rust belt States in the US these figures point to the impact of the rapid scale of deindustrialisation and a global neoliberal economy, based on austerity, deepening class divisions and a return to a more naked form of capitalism. The question is, does a critical pedagogy have a role to play in understanding and addressing the challenges involved? In other words, how can a practice of such a pedagogy allow participants to deconstruct and decode the structures of domination that oppress and divide them/us? Such pedagogy has undergone differing degrees of reassessment as it no longer serves as an ‘adequate platform from which to mount a vigorous challenge to the current social division of labour’. However, the need for a critical pedagogy, rooted in a Freirean notion of hope, for such communities has never been more apparent. This article will attempt to resolve the extent to which such a pedagogy translate from its esoteric detachment to one rooted in history, place and practices, and one capable of engaging with the most disadvantaged, and colonialised fraction of the Scottish society.

From the clinic to the street: the changing role of benzodiazepines in the Scottish overdose epidemic

Drug-related deaths in Scotland increased for seven years in a row between 2014 and 2020 consolidating Scotland's place at the top of the United Kingdom and European drug-related mortality charts. One of the defining features of this recent and rapid rise has been the role of benzodiazepines which are now involved in two-thirds of all cases. Policy decisions over four decades have contributed to the supply and demand drivers of this unique element of the Scottish overdose crisis. An illicit market once populated by diverted prescription medications is now dominated by a toxic supply of NPS-type benzodiazepines or so-called 'street benzos' which have increased the risk environment for people who use drugs. In response, Scotland needs to urgently expand its harm reduction infrastructure and implement safer supply, drug testing and drug consumption rooms. Such a response should be made in parallel to addressing the socioeconomic inequalities which are fuelling an epidemic of global significance.

Scottish drug-related deaths fall for first time in five years

The number of drug-related deaths in Scotland fell by 8% in 2021, compared with the previous year, according to data from Police Scotland. A quarterly report, published on 15 March 2022, said that between January and December 2021, 1,295 suspected drug-related deaths were recorded: 116 fewer deaths than the suspected 1,411 deaths recorded during the […]

Drug-related deaths in Scotland: what is the solution?

Drug-related deaths in Scotland: what is the solution?

Scotland logs highest number of drug-related deaths on record in 2020

The number of drug-related deaths in Scotland rose to more than 1,300 in 2020 — its highest annual number since records began in 1996 — new data from the National Records of Scotland (NRS) has shown. The 1,339 deaths related to drug misuse that were registered in the nation in 2020 represent a 5% increase […]

Drug-related deaths in Scotland

Drug-related deaths in Scotland

Drug-related deaths in Scotland rose by 6% in 2019

Drug-related deaths in Scotland rose by 6% in 2019

Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

PurposeThe purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths.Design/methodology/approachUsing quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age.FindingsThe data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area.Research limitations/implicationsThe research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles.Practical implicationsThis research contributes to making unarguable links between entrenched structural inequality and increased drug-related death.Social implicationsThis paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms.Originality/valueWhile several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.

Drug-related deaths in Scotland 1979\u20132013: evidence of a vulnerable cohort of young men living in deprived areas

BackgroundEven after accounting for deprivation, mortality rates are higher in Scotland relative to the rest of Western Europe. Higher mortality from alcohol- and drug-related deaths (DRDs), violence and suicide (particularly in young adults) contribute to this ‘excess’ mortality. Age-period and cohort effects help explain the trends in alcohol-related deaths and suicide, respectively. This study investigated whether age, period or cohort effects might explain recent trends in DRDs in Scotland and relate to exposure to the changing political context from the 1980s.MethodsWe analysed data on DRDs from 1979 to 2013 by sex and deprivation using shaded contour plots and intrinsic estimator regression modelling to identify and quantify relative age, period and cohort effects.ResultsThe peak age for DRDs fell around 1990, especially for males as rates increased for those aged 18 to 45 years. There was evidence of a cohort effect, especially among males living in the most deprived areas; those born between 1960 and 1980 had an increased risk of DRD, highest for those born 1970 to 1975. The cohort effect started around a decade earlier in the most deprived areas compared to the rest of the population.ConclusionAge-standardised rates for DRDs among young adults rose during the 1990s in Scotland due to an increased risk of DRD for the cohort born between 1960 and 1980, especially for males living in the most deprived areas. This cohort effect is consistent with the hypothesis that exposure to the changing social, economic and political contexts of the 1980s created a delayed negative health impact.

Gabapentinoids prescribed prior to a fifth of drug-related deaths in Scotland

Gabapentinoids prescribed prior to a fifth of drug-related deaths in Scotland

A case of septicaemic anthrax in an intravenous drug user

BackgroundIn 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax. In 2008, there were 574 drug related deaths in Scotland, of which 336 were associated with heroin and or morphine. We report a rare case of septicaemic anthrax caused by injecting heroin contaminated with anthrax in Scotland.Case PresentationA 32 year old intravenous drug user (IVDU), presented with a 12 hour history of increasing purulent discharge from a chronic sinus in his left groin. He had a tachycardia, pyrexia, leukocytosis and an elevated C-reactive protein (CRP). He was treated with Vancomycin, Clindamycin, Ciprofloxacin, Gentamicin and Metronidazole. Blood cultures grew Bacillus anthracis within 24 hours of presentation. He had a computed tomography (CT) scan and magnetic resonance imagining (MRI) of his abdomen, pelvis and thighs performed. These showed inflammatory change relating to the iliopsoas and an area of necrosis in the adductor magnus.He underwent an exploration of his left thigh. This revealed chronically indurated subcutaneous tissues with no evidence of a collection or necrotic muscle. Treatment with Vancomycin, Ciprofloxacin and Clindamycin continued for 14 days. Negative Pressure Wound Therapy (NPWT) device was applied utilising the Venturi™ wound sealing kit. Following 4 weeks of treatment, the wound dimensions had reduced by 77%.ConclusionsAlthough systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in IVDU patients. This case shows that patients with significant bacteraemia may present with no signs of haemodynamic compromise. Prompt recognition and treatment with high dose IV antimicrobial therapy increases the likelihood of survival. The use of simple wound therapy adjuncts such as NPWT can give excellent wound healing results.

Differences between injectors and non-injectors, and a high prevalence of benzodiazepines among drug related deaths in Scotland 2003

Drug related deaths (DRDs) have been increasing in Scotland over at least the past decade. This study aimed to describe the characteristics (gender, age, ICD10 cause of death), toxicology and circumstances of all Scotland's DRDs in 2003 to help inform a national overdose prevention strategy. Coronial files for 300/317 (95%) DRDs registered with the General Register Office for Scotland (GROS) in 2003 were examined retrospectively (in 2004). Characteristics: 241/300 (80%) were male. Mean age at death was 32.8 years (SE 0.63, range 16–82). Route of administration was injecting for 137/268 (51%) who were classifiable. Classified injectors were more likely to be male (91%: 124/137) and younger (mean age of 32 years) than those whose death was by a non-injecting route (male: 87/131 (66%) and mean age of 35 years). Twenty-five to forty-four year olds made up 108/137 DRDs by injecting (79%), but only 62/131 (47%) by non-injecting routes. Cases of intentional self-poisoning (injectors 1; non-injecting 34) and undetermined intent (injectors 14; non-injecting 26) were infrequent among injectors. Of those who died by the injecting route, 108/137 were known intravenous drug users, but so too were 29/131 DRDs by non-injecting routes. Toxicology: overall 38/300 cases of DRD (13%) were negative for opioid drugs–only 2/137 DRDs by injecting (1%) were negative for opioids compared with 33/131 (25%) by non-injecting route. Methadone was present for 15/137 DRDs by injecting route (11%) and for 57/131 DRDs by non-injecting routes (44%, p < 0.001). Presence of dihydrocodeine, and anti-depressants was about three times and six times respectively, more likely in DRDs by non-injecting routes. Irrespective of route, two-thirds of DRDs tested positive for benzodiazepines (202/300 DRDs). Circumstances: time between overdose and death was within the hour for 61/137 DRDs (45%) by injecting, but rarely by non-injecting routes (3%: 4/131). Three out of four DRDs occurred in a house or flat: 98/137 DRDs (72%) by the injecting route and 101/131 (77%) by non-injecting routes. Interpretation: A relatively high proportion of cases died by non-injecting routes. National mortality databases should separate out cases of injecting-related DRD from non-injecting cases, and public health strategies to reduce DRDs should distinguish between these groups. Widespread availability in Scotland of prescribed and illicit benzodiazepines needs attention.

Drug-related deaths by region, sex, and age group per 100 injecting drug users in Scotland, 2000–01

In 2000 and 2001, there were 292 and 332 drug-related deaths in Scotland, respectively. Of the 332 people who died in 2001, 65 were of female sex, 80 were younger than 25 years, and 112 were older than 34 years. We assessed the effect of region, sex, and age group on drug-related deaths in Scotland per 100 injecting drug users. We used published regional estimates of current injecting drug users (n=22805), their sex (30% female) and age distribution (8% older than 34 years in mid-1990s), or corresponding data for problem drug users (21% older than 34 years in 2000) to compare observed with expected drug-related deaths by region, sex, and age group per 1000 population or per 100 injecting drug users. Regional population-based expectations fitted poorly to observed drug-related deaths, but those based on injecting drug users fitted tolerably. Drug-related deaths in 2001 per 100 injecting drug users were significantly lower in female (0.9 [95% CI 0.6-1.1]) than in male drug users (1.5; 1.3-1.7). They were between two and six times more frequent per 100 injecting drug users older than 34 years than younger than 25 years, depending on whether current injecting drug users' age distribution was assumed to be the same as problem drug users' or as injecting drug users' in the mid-1990s (2.1 [1.7-2.5] or 5.3 [4.3-6.3], respectively). Older and male injecting drug users were at highest risk of drug-related death. Injecting drug users' age distribution should be assessed and compared across countries.