Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

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. We present an overview of what is currently known about drug related deaths (DRDs) in Scotland. We 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
Using quantitative datasets from the National Records of Scotland (NRS) for drug related deaths registered in 2016 and 2017, and datasets 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 highlights the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas, and the national average. Findings indicate 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
The research design was based on secondary data obtained from the National Records of Scotland, 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 datasets 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. The evidence in this paper indicates that increased drug related deaths are insufficiently explained by age, and age related health conditions.