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The 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.

Using 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.

The 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.

The 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.

This research contributes to making unarguable links between entrenched structural inequality and increased drug-related death.

This 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.

While 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.

This article summarises different approaches to defining what constitutes a drug‐related death (DRDs) and how they can be classified. DRDs usually fall into two broad categories: (a) those directly attributable to the consumption of drugs (both illegal and licit) eg. overdose and poisoning, and (b) indirect ‐ those which occur as a consequence of having a drug habit that exposes individuals to the risk of dying in some other way, eg. blood‐borne infections, accidents. Most attention is currently given to direct or ‘acute’ DRDs rather than the long‐term consequences of drug abuse. Problems associated with accurately deriving DRD statistics are outlined. Despite their limitations, such information is essential for identifying issues related to drug use and measuring progress against targets set for reducing DRDs.

This 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.

A qualitative, case-based design focuses on Scottish Government responses to rising drug-related deaths, using publicly available data to produce interpretive critical analysis.

Analysis 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.

In 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).

This 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.

While 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.

The purpose of this paper is to provide a commentary on new information from the Office for National Statistics (ONS) on deaths caused by volatile substance abuse (VSA) in Great Britain which occurred between 2001 and 2016.

Comparing the new study with previous mortality data, the authors consider the strengths and some limitations of the analysis provided by ONS.

By utilising a broader range of codes and collating additional information from death certificates, the new report provides a more comprehensive measure of VSA mortality than was previously available, showing increasing prevalence of deaths. The age profile of people dying is older than in previous studies. Most deaths were associated with inhalation of gases and almost three-quarters of deaths involved volatile substances alone.

Understanding VSA mortality is essential for service planning. It is important that we identify why so many people whose deaths are associated with VSA are not accessing treatment, with particular concern about treatment access for those who only use volatiles. Training to support drug and alcohol and other health service staff to respond to VSA is essential. In future reports, data to identify socioeconomic correlations of VSA deaths would enable targeted responses. Additionally, information on whether deaths occur in long term rather than episodic or one-off users could enable risk reduction education.

This paper shows how data on VSA deaths may inform for policy and service planning.

To determine the mortality of drug users after release from prison in Denmark, a cohort of drug users was identified from two national registers during 1996‐2001: the drug treatment register (T) and the register of viral hepatitis (H). Incarcerations were extracted from the national penal register, vital status from the civil register, and causes of death from the death certificate register and the police register of drug‐related deaths. We identified 15,885 drug users (T: 15,735, H: 896), 62% of the estimated drug‐using population in Denmark. There were 1000 observed deaths, of which 51% were classified as overdose deaths. Mortality in the treatment cohort was 2.4/100 person years (py) (95% C.I. 2.2‐2.5/100 py) compared to the general population expectation of 0.2/100 py. Within the first 2 weeks after release from prison, 26 deaths were observed among 6019 released drug users corresponding to 13/100 py (95% CI 8‐19/100 py). Overdose deaths accounted for 24/26 deaths (92%) in the first two weeks compared to 121/179 (68%) hereafter (p <0.001). We conclude that drug users released from prison are at high risk of overdose death. We suggest that methadone treatment should be evaluated as a way to decrease mortality after release from prison.

This chapter provides a critical exploration of the European Union’s impact on the 2016 United Nations General Assembly Special Session (UNGASS) proceedings and Outcome document. It demonstrates that the ability to produce a European ‘common position’ ahead of the UNGASS debates represents a significant step forward in the ability to ‘speak with one voice’ in the global illicit drug policy arena, and has played an important role in ensuring key issues such as human rights and public health remain on the agenda. In highlights, however, a European failure to engage with issues such as the continuing suitability of the international drug conventions to preside over the current climate of drug policy innovation and experimentation, and the unintended consequences of a ‘war on drugs’ approach. Ultimately, therefore, it argues that these failures will hamper the development of a more progressive and effective global drug policy.

The Swiss drug policy once was very progressive in the 1990s when the harm related to drug use was most visible to the public. Failure of repression opened the room for more innovative harm reduction approaches. In 2008, the four-pillar model including the legal basis for substitution and heroin-assisted treatment of opioid use disorders as well as for other harm reduction facilities was approved by the population that had learned about the success of these measures. Less violence, better health outcomes among people who use drugs and less stigma supported the change of attitudes in the population towards a public health-based approach when dealing with drug use. Switzerland first received heavy criticism for the autonomous policy change at the international level while it is nowadays often cited as best practice example for dealing with people with an opioid use disorder. Otherwise, the country has usually been quiet in drug policy discussions at the UN level. Nevertheless, Switzerland’s reappointment to the Commission on Narcotic Drugs, the central drug policy-making body within the United Nations for a period of four years starting in 2018 is promising, given their unblemished recommendation for human rights-based drug policies including the abolition of the death penalty for drug offences, among other things. Alongside cannabis policy changes at the international level, Switzerland witnessed an unexpected development in cannabis availability and sales. However, the country is still rather conservative with regard to current cannabis policies, although cannabis with less than 1% of THC can be sold legally and the possession of up to 10 g will be followed by a fine only, if at all. Switzerland is open to experiment with new regulations but only if the law allows for that. To conclude, the strong sense of connectedness with the international community may support Switzerland’s next steps towards public health and evidence-based harm reduction.

This study aims to provide data on substance use amongst young people in Scotland to inform policy and practice for an age group who generally do not access specialist alcohol and drug services. The main objectives of the study were to assess the problem severity scores of items from a modified version of the DAST-10 brief screening instrument among respondents; examine correlations between a range of variables in relation to DAST-10 problem severity scores; and explore respondent knowledge of how and where to seek help.

A fixed quantitative design methodology recruited a non-probability sample of 4,501 respondents from an online survey made available by “We are With you” Scotland.

The survey was ethically approved by the School of Education and Social Sciences, University of the West of Scotland. It consisted of 32 questions exploring substances used within the past 12 months, and 12 weeks, and included the DAST-10. We further explored help seeking, and knowledge of support available to respondents.

Substance use patterns were markedly different from people currently known to specialist alcohol and drug services. Over half of respondents were under 25, and 62% report being employed. The most commonly used substances were cannabis and cocaine. One third of respondents recorded substantial or severe problem severity scores and reside in Scottish Local Authorities with high concentrations of socio-economic inequality.

Secure accommodation, stable relationships and being employed are protective factors in relation to reported negative health consequences associated with problem substance use.

Just under one third (27%) of respondents report knowing where to seek help for substance use problems; however, they are unwilling to attend existing specialist alcohol and drug services.

A non-probability sample of the Scottish population has a potential for response bias due to how and what way the survey was made available to respondents. It is acknowledged that while useful as a method of generating drug use data, there are limitations in how recently the substance use occurred, and in relation to the types of substances reported (cannabis, cocaine and ecstasy).

The study provides data to inform wider public health measures in relation to accessing support and addressing societal discrimination associated with the use of substances. The study provides data on service design for young people who do not access specialist alcohol and drug services.

The study informs substance use policy in the Scottish context in relation to a population of young people who use licit and illicit substances. Data contributes to evidence supporting correlations between problematic substance use and socio-economic inequality. Data indicates that existing specialist services require redesign.

The study is the first to be conducted within a Scottish context.