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Article
Publication date: 17 December 2018

Iain McPhee, Barry Sheridan and Steve O’Rawe

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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

Social implications

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.

Originality/value

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.

Details

Drugs and Alcohol Today, vol. 19 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 June 2008

John Corkery

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…

Abstract

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.

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Drugs and Alcohol Today, vol. 8 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 7 January 2019

Victoria Leigh and Sarah MacLean

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…

Abstract

Purpose

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.

Design/methodology/approach

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

Findings

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.

Practical implications

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.

Originality/value

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

Details

Drugs and Alcohol Today, vol. 19 no. 2
Type: Research Article
ISSN: 1745-9265

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Book part
Publication date: 15 October 2018

Abstract

Details

Collapse of the Global Order on Drugs: From UNGASS 2016 to Review 2019
Type: Book
ISBN: 978-1-78756-488-6

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Article
Publication date: 11 December 2009

Christine Goodair

Abstract

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Drugs and Alcohol Today, vol. 9 no. 4
Type: Research Article
ISSN: 1745-9265

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Book part
Publication date: 15 October 2018

Caroline Chatwin

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…

Abstract

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.

Details

Collapse of the Global Order on Drugs: From UNGASS 2016 to Review 2019
Type: Book
ISBN: 978-1-78756-488-6

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Article
Publication date: 1 January 2006

Peer Brehm Christensen, Eva Hammerby, Else Smith and Shelia M. Bird

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…

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Abstract

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.

Details

International Journal of Prisoner Health, vol. 2 no. 1
Type: Research Article
ISSN: 1744-9200

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Book part
Publication date: 15 October 2018

Frank Zobel and Larissa J. Maier

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…

Abstract

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.

Details

Collapse of the Global Order on Drugs: From UNGASS 2016 to Review 2019
Type: Book
ISBN: 978-1-78756-488-6

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Article
Publication date: 11 December 2020

Iain McPhee and Barry Sheridan

In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that…

Abstract

Purpose

In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that socio-economic inequalities were additional risk factors explaining the significant increases in DRD in Scotland. This paper aims to subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP).

Design/methodology/approach

The paper provides a narrative review in the context of the AUDIT Scotland reports “Drug and Alcohol Services in Scotland” from 2009 and follow-up report published in 2019. The authors refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny.

Findings

This analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased DRD.

Research limitations/implications

The authors have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources.

Practical implications

This case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased DRD.

Social implications

Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased DRD within communities in Scotland. The authors conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities.

Originality/value

The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance.

Details

Drugs and Alcohol Today, vol. 20 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 June 2002

John Corkery

Aims This paper examines (a) the relationship between notifications to the Home Office Addicts Index and deaths of notified addicts, and (b) the survival rates of such…

Abstract

Aims This paper examines (a) the relationship between notifications to the Home Office Addicts Index and deaths of notified addicts, and (b) the survival rates of such addicts.Design and participants Data came from the Home Office Addicts Index covering (a) notifications of opiate and cocaine addicts seeking treatment in the UK between 1966 and 1996, and (b) deaths of notified addicts between 1967 and 1996.Measurement Date of first notification; date of death; numbers of notifications in different times.Findings The proportion of addicts dying compared to the number of new notifications 20 years earlier rose from 2 to 7 in 10 between 1988 and 1993. There is constancy in the relationship between numbers of death and new notifications for up to 10 years before death. The proportion of the cumulative notified population dying between 1985 and 1993 remained consistent at 0.6% or 0.7%. The average length of time between first notification and death increased by six months between 1985‐90 and 1991‐96. Whilst the absolute number of deaths rose between 1984 and 1993, the proportion of newly notified addicts dying each year fell from 2.1% to 0.5%.Conclusions An increase in notifications was directly associated with a proportionate increase in addict deaths. One can expect the number of serious‐end drug users who die to increase with time, especially given the continuing role played by opiates ‐ chiefly heroin and methadone ‐ and increasingly cocaine in drug‐related deaths. At the same time, one can expect such individuals to survive for longer periods than did addicts in past decades.

Details

Drugs and Alcohol Today, vol. 2 no. 2
Type: Research Article
ISSN: 1745-9265

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