an overview of drug related deaths in scotland andy rome director figure 8 consultancy services ltd
TRANSCRIPT
An Overview of Drug Related Deaths in Scotland
Andy RomeDirector
Figure 8 Consultancy Services Ltd
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Overview - Knowledge and Action
What do we know? What do we not know?
What are we doing? What could we be doing?
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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%)
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Number of drug related deaths in Scotland 1996-2003
0
50
100
150
200
250
300
350
400
1996 1997 1998 1999 2000 2001 2002 2003 2004
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Knowledge
Why did 317 people die? Why did 51,265 not die?
Why did 317 people die that day?
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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.”
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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)
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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
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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)
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Deaths by category 1996-2003
Drug-related deaths, Scotland, 1996-2003
Year Total Drug abuse Accidental Intentional Assault by Undeterminedpoisoning self-poisoning drugs, etc.
(F11-F16, F19) (X40-X44) (X60-X64) (X85) (Y10-Y14)
1996 244 175 10 41 - 18 1997 224 142 14 42 - 26 1998 249 179 16 32 - 22 1999 291 227 12 19 1 32 2000 292 220 11 34 - 27 2001 332 227 19 34 - 52 2002 382 280 17 30 - 55 2003 317 216 15 40 - 46
Cause of death category (ICD10 codes)
(GROS, 2003)
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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)
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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)
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Research - UK
Shah R, et al (2001) Webb L, et al (2003) Hickman M, et al (2003) Ghodse H, et al (1998)
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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)
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Knowledge - Monitoring
Good national monitoring systems Good analysis of data
– By drug– By Age/Gender– Classification– Locality
Good prevalence data
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Action
Strategies to fill knowledge gaps Strategies to prevent deaths
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Strategies to fill knowledge gaps
National National Investigation into Drug Related
Deaths in Scotland, 2003 STRADA training programme
Local DAAT sub-groups
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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.
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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).
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Local strategic planning
Drug-related deaths, by age and by sex, Scotland, 2003
Total Drug abuse Accidental Intentional Assault by Undeterminedpoisoning self-poisoning drugs, etc.
(F11-F16, F19) (X40-X44) (X60-X64) (X85) (Y10-Y14)
All ages 317 216 15 40 - 46
Under 25 78 56 7 5 - 10 25-34 123 97 2 8 - 16 35-44 80 53 5 9 - 13 45 and over 36 10 1 18 - 7
Males 256 190 12 24 - 30 Females 61 26 3 16 - 16
Cause of death category (ICD10 codes)
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Causes of death by Health Board
Drug-related deaths, by health board area, 2003
Health board Total Drug abuse Accidental Intentional Assault by Undeterminedarea poisoning self-poisoning drugs, etc.
(F11-F16, F19) (X40-X44) (X60-X64) (X85) (Y10-Y14)
Scotland 317 216 15 40 - 46
Argyll & Clyde 27 22 1 1 - 3 Ayrshire & Arran 19 11 - 4 - 4 Borders 2 1 - - 1 Dumfries & Gallow ay 9 7 - 1 - 1 Fife 12 7 - 2 - 3
Forth Valley 12 5 - 1 - 6 Grampian 37 27 3 3 - 4 Greater Glasgow 107 81 7 13 - 6 Highland 7 1 1 2 - 3 Lanarkshire 25 20 2 - 3
Lothian 40 23 2 9 - 6 Orkney - - - - - - Shetland - - - - - - Tayside 19 11 - 2 - 6 Western Isles 1 - 1 - - -
Cause of death category (ICD10 codes)
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Strategies to prevent deaths
National framework Realistic, meaningful goals Local implementation plans sensitive to local
needs
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Sources of information
Drug-related deaths in Scotland in 2003www.gro-scotland.gov.uk
Estimating the National and Local Prevalence of Problematic Drug Misuse in Scotland, 2003
www.drugmisuse.isdscotland.org
All research articleswww.ncbi.nlm.nih.gov