National drug related death database (Scotland)
Analysis of deaths registered in 2021 and 2022

About this release

This release by Public Health Scotland (PHS) presents information from the National Drug-Related Deaths Database (NDRDD) on Drug-Related Deaths (DRDs) registered in Scotland in 2021 and 2022, with trend data from 2012. The report narrative and main points focus on DRDs registered in the most recently reported year, 2022.

This publication describes the same DRD cohort as the National Records of Scotland's (NRS) Accredited Official Statistics publication. The definition of a DRD is based on the UK-wide definition used by NRS for national reporting. Summary statistics on DRDs registered in 2021 and 2022 were previously published by NRS.

Data from the NDRDD provides detailed information on DRDs in Scotland, providing insights into the lives of those who died and highlighting potential areas for intervention to prevent drug deaths.

Main points

In Scotland, the numbers of DRDs registered annually increased throughout the 2010s, peaking in 2020. Although decreases were recorded in the reported years 2021 and 2022, the number of deaths remains tragically high.

Scotland has a cohort of people with problematic drug use who have multiple complex health and social care needs. Many people who had a DRD shared similar characteristics: they were male, aged over 35, socially deprived, lived alone and had a history of long term and/or injecting opioid use and near fatal overdose.

Among DRDs registered in 2022:

• The average age of people who died was 44 years old (an increase from 39 years in 2012).
• Over half (52%) of the people who died resided in the 20% most deprived neighbourhoods in Scotland (Scottish Index of Multiple Deprivation quintile 1).
• Four out of five people (81%) who had a DRD lived in their own home. Over half (60%) lived alone all of the time.
• 387 children were reported to have lost a parent or parental figure as a result of a DRD.
• Two thirds (65%) of people (73% of those whose death was opioid-related) were in contact with a service (drug treatment, prison or police custody, or discharged from hospital) with the potential to address their problematic drug use or deliver harm reduction interventions in the six months before death.
• Around three in ten (29%) people who died had an been discharged from an inpatient stay in a general acute hospital in the six months before death.
• In the six months prior to death, 54% of people who died had a medical condition recorded (respiratory illness, epilepsy, back pain/injury, and blood borne viruses were most common) and 50% had a recent psychiatric condition (depression and anxiety were most common).
• Over four in ten people (41%) were prescribed an Opioid Substitution Therapy (OST) drug (mainly methadone) at the time of death. The percentage of people who were prescribed an OST at the time of death has increased since 2012 (27%).
• Methadone (an OST medication) was implicated in 47% of DRDs registered in Scotland.
• Etizolam (a 'street' benzodiazepine) implication decreased sharply from 58% in 2021 to 38% in 2022, following international prohibition in 2021. Changes in the overall number of DRDs closely mirrored trends in 'street' benzodiazepine implication, suggesting an association between availability and harms.
• The number of DRDs where cocaine was implicated increased across the time series, to 36% in 2022. Cocaine was implicated in roughly half (49%) of DRDs among people aged under 25 years.

Background

NDRDD information is collated by NHS board data collection coordinators from a range of data sources (e.g. Police Scotland, pathology reports, clinical notes). NHS boards submitted records for 996 deaths registered in 2022 (NRS reported 1,051 deaths) and for 1,317 deaths registered in 2021 (NRS reported 1,330 deaths). Quality and completeness issues associated with this data collection are described fully in the report.

Individual substances are considered to have been implicated in, or potentially contributing to, a drug related death by the examining Pathologist. This decision takes into account a patient's medical and prescribing history, toxicology screen, and a post-mortem examination.

Further information

The next release of this publication will be Summer 2027.