Shocking, Disturbing, Preventable: Drug-related Deaths in Scotland Rise Again
A year and a half after the SNP government declared a public health emergency to tackle drug deaths in Scotland, figures published last week by the National Records of Scotland reveal that drug-related deaths in Scotland have risen again for the sixth consecutive year.
There were 1,264 drug-related deaths registered in Scotland in 2019. This is a 6% increase on the shocking number of deaths registered in 2018, and the highest recorded figure since records began. With a drug-death rate three and a half times the rate of the UK as a whole, and higher than any other country in the EU, the need for urgent action and change has never been clearer.
Drug-related deaths in Scotland have been rising at an unprecedented rate for years, and such deaths have more than doubled in a decade. Whilst recent figures for 2019 are upsetting and disturbing, they do not come as a surprise to those working on the frontline of drug services and drug policy reform in Scotland, who predicted, warned against, and have been fighting to prevent, such deaths. The 2019 figures represent the failure of drug policy to protect, and care for, some of the most vulnerable people in society.
‘Recovering Justice’ hosted an event to coincide with the release of the Scottish drug death figures which brought together national and international experts to discuss drug policy reform. This event included talks from the former Prime Minister of New Zealand, Helen Clarke; author Johann Hari; Alison Thewliss, MP; Monica Lennon, MSP; and drugs reform activist, Peter Krykant. Peter, who runs an unregulated mobile safer consumption facility from his van in Glasgow, when speaking at this event, stated that:
“We all need to come together, no matter your political stance. It is distressing that we have to fight tooth and nail for internationally recognised interventions… people are dying preventable deaths”.
Safer drug consumption facilities like Peter’s have been shown around the world to make communities safer and save lives, particularly among people who use opioids. Drug Consumption Rooms (DCRs) ensure that people are able to use drugs in the presence of medical professionals, with access to sterile injection equipment and naloxone – an opioid overdose antidote – if needed. There are no recorded occasions of anyone dying from a drug overdose in any DCR, and they are supported by the UK Government’s own Advisory Committee.
Despite several proposed, and delayed, pilot schemes, DCRs are still not permitted in any part of the UK. Whilst health policy is devolved to Scotland and Wales, the drug laws are reserved to Westminster. England and Wales are certainly experiencing their own public health emergency in relation to rising drug-deaths, however the current situation in Scotland is measurably worse. Westminster must listen to repeated calls to help end Scotland’s drug death crisis from experts in harm reduction and overdose prevention – and if a legal exemption for such facilities is not granted, then the relevant drug laws should be devolved to the Scottish Parliament.
Authorities in Scotland, and elsewhere in the UK, must also listen to evidence which supports that decriminalisation reduces drug-related deaths: with Portugal, who decriminalised the possession of all drugs in 2001, having one of the lowest drug-death rates in Europe. Following the loss of 1,264 lives last year in Scotland, will drug use finally be considered a public health issue, as opposed to a criminal justice issue?
What do the Scottish figures show?
- Similar to in previous years, men accounted for over two-thirds of drug-related deaths (69%, 877 deaths) in Scotland in 2019. Whilst lower in number, with women accounting for 31% of such deaths (387 deaths), longer-term analysis which compares the average(s) of two time periods – 2015 to 2019 against 2005 to 2009, shows that the percentage increase in drug-related death has been greater for women, with deaths tripling among women between the two time periods.
- Over two-thirds of deaths were of people between 35 and 54 years old (856 deaths). Whilst this age group have been consistently the most vulnerable to drug-related death, 2019 has seen a 9% increase in deaths of people in this age category compared to 2018. Whilst lower in number overall, with 76 deaths in 2019, the recent figures also show a 19% increase in deaths of young people aged 15-24 years old compared to the previous year.
- Longer term analysis reveals that the percentage increase in number of deaths is highest for those specifically aged 35 to 44 years old. Indeed, the median age of drug-related deaths in Scotland has increased over the past two decades from 28 years old in 1996 - when records began - to 42 years old in 2019.
- The impact of an ageing opioid user population, and the comorbid health conditions that may be more prominent for individuals in this age category, have previously been discussed in relation to drug-related deaths in England and Wales. However, it appears that deaths occurring among those in this cohort do not receive proportionate media coverage, which may in turn link to a lack of proportionate funding for harm reduction and treatment services required so urgently by this cohort. Niamh Eastwood, Executive Director of Release, the UK's centre of expertise on drugs and drugs law, has previously described how “if a 40-year-old man who lives in poverty and deprivation dies, that’s not going to make news. This group is incredibly marginalised and their deaths don’t seem to attract the same attention”.
- Opiates and opioids are named in a large majority of drug fatalities across Scotland. Heroin and morphine, consistently linked to drug-related deaths in Scotland, are now implicated in, or contribute to, over half of all drug-deaths in Scotland (645 deaths, 51% of 2019 deaths). Considering also a large number of deaths linked to methadone, the 2019 data show that one or more opioids/opiates are recorded in 86% of all drug-death incidents (1,092 deaths), which is the highest proportion since records began.
- Benzodiazepines were implicated in, or contributed to, 888 deaths in 2019, 70% of all drug-related deaths recorded in 2019. Whilst ‘street’ benzodiazepines, for example etizolam, were implicated in more than four times as many deaths as their ‘prescribable’ counterparts, for example diazepam, the proportion of deaths linked to one or more type of benzodiazepine was again, higher in 2019 than in any previous year.
- There were also increases in drug-related deaths which named gabapentin and/or pregabalin (438 deaths), cocaine (365 deaths), and amphetamines (51 deaths).
What is also clear, when examining which drugs contribute to drug-related deaths, is the incredible overlap that occurs. Indeed, 94% of all 2019 drug-related deaths in Scotland were of people who took more than one substance.
In addition to a concentration of deaths among people aged 35 to 54, and among men, we also see geographical patterns. Three-quarters of deaths occurred within just five of the 14 regional health board areas in Scotland, with the majority occurring in Greater Glasgow and Clyde. Whilst this area has the largest population, when controlling for population size, Greater Glasgow and Clyde still emerge as having the highest rate of drug-deaths - 0.27 deaths per 1,000 population (average rate across 2015 to 2019), followed by Tayside and Ayrshire & Arran - with rates of 0.21 and 0.20 per 1,000 population respectively. With these areas being among the most socio-economically deprived areas in Scotland, the connection between drug-death and disadvantage is clear.
When comparing Scottish drug deaths to other countries, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has compared the rate of ‘drug-induced’ deaths per million population (of individuals aged 15 to 64) for various countries across Europe. The most recent EMCDDA comparison, which is based on 2018 data, estimates a European average of 22.3 deaths per million. The same EMCDDA report estimates that Scotland has 295 deaths per million population: far higher than any other country included in the analysis, with next closest rate belonging to Sweden, with 81 deaths per million population.
* Dr. Laura Garius joined Release as policy lead in Autumn, 2020. She is a criminologist and obtained her doctorate from Loughborough University. Laura delivered the Drugs and Society module to students at Nottingham Trent University and has researched both alcohol and drug-related harm. She has conducted research with service users as well as with large scale surveys and advocates for harm-reduction approaches, evidence-based drug policy, and social justice.
Please download the full 'Drug-related Deaths in Scotland in 2019' report below: