Drug related deaths in the Strathclyde region of Scotland, 1995–1998

Abstract

The misuse of drugs, both illicit and prescribed has increased dramatically in the west of Scotland over the last few decades. Consequently, the number of drug related deaths has risen as a direct result. Since, discrepancies exist between data collected by the Department of Forensic Medicine and Science, University of Glasgow and official statistics, this project, was funded to investigate all known drug related deaths that occurred within the Strathclyde region of Scotland in an effort to improve the accuracy of statistics and the dissemination of information pertaining to them. Changes in medical treatment, legislation and patterns of drug taking were noted and the effects of these on the year-by-year death tolls evaluated.

Introduction

Drug abuse and its consequences are everyday problems encountered globally and Scotland is no exception. The abuse of drugs has a detrimental effect both to the individual misuser and to society as a whole. In 1968, it became statutory for general practitioners (GPs) to notify an individual to the Home Office addicts index if they were known to be addicted to any 1 of 14 specific opiates¹ and/or cocaine. As well as monitoring the extent of drug misuse in the UK, this index acted as an extra source of intelligence to prevent double prescribing occurring [1]. The number of drug addicts notified to the Chief Medical Officer at the Home Office rose from 126 for the whole of Scotland in 1980 to 4516 in 1996 [2]. Given that these figures relate to individuals who have voluntarily presented themselves for treatment, it can be assumed that they are an underestimate. For comparison, there are estimated to be between approximately 12,000–15,000 adults with a serious drug problem in the greater Glasgow area alone. Since mortality is a contingency of an individuals drug abuse, the number of people who died directly as a result of their drug abuse rose dramatically over the above time period.

Trends and patterns of drug use in the west of Scotland have been well documented in the literature [3], [4], [5], [6], [7], [8], [9]. Drug abuse as a problem in the region dates from the early 1980s when black market heroin and the trend of injecting emerged in Edinburgh and Glasgow [10]. Preferences for buprenorphine, heroin and the concurrent use of heroin with benzodiazepines have all existed over certain time scales in the Strathclyde region. Usually, preferences are dictated by availability and cost. For example, initially buprenorphine and temazepam were favoured drugs as a result of widespread availability due to prescribing practices. Changes in legislation led to the availability of these drugs diminishing and the street value increasing. As a result, the popularity of heroin recovered and the scarcity of temazepam led to diazepam being used as a substitute.

During the decade 1983–1993, there has been a considerable expansion in the number and range of services available to drug users in Glasgow. The Glasgow drug problem service was established in 1993, followed by the General Practitioner Drug Misuse Clinic Scheme in 1994 whose objective was to reduce drug related harm to health [11]. The Methadone Maintenance Programme (MMP) was introduced into Glasgow in October 1993 in order to wean addicts off heroin.

This paper reports on the trends and patterns of drug taking as found in the drug related deaths of Strathclyde. In particular, the effects of the MMP, legislation changes and periods of abstinence are discussed.