National Mission on Drugs: Annual Monitoring Report 2023-2024

4. Overarching outcome: Reduce drug deaths and improve lives

4.1 Summary

Overarching outcome: reduce drug deaths and improve lives

• 1,172 people died of a drug death in 2023. Increase of 12% since 2022.
• Drug deaths are lower than at the start of the National Mission but remain at a high level. Measuring progress towards the improving lives aspect of the National Mission is more challenging.

4.2 Background

The aim of the National Mission is to reduce drug deaths and improve the lives of people affected by drugs. The level of harm from drugs in Scotland is high relative to the rest of the UK and Europe and drug deaths are recognised as negatively impacting Scotland’s life expectancy.^[1] Although the challenge is complex and multi-faceted, the number of drug deaths is a key measure of progress against which success of the National Mission will be measured. It is also important to capture whether the lives of those affected by drugs have improved and this is discussed in the data development section of this report.

4.3 Headline metrics

4.3.1 Headline metric: number of drug deaths

There were 1,172 drug deaths^[2],[3] registered in Scotland in 2023 (Figure 2). This was an increase of 12% (121 deaths) compared with 2022 but the second lowest number in the last six years. Most of the increase since 2022 was in males (up 16%, 113 deaths); deaths amongst females increased by 2% (8 deaths). Males were more than twice as likely to have a drug misuse death as females^[4] but this gap between sexes has narrowed over time. Drug deaths increased across most age groups; the largest increases were in the 30-34 years and 40-44 years age bands. The rate of drug deaths in those aged 35-54 years is more than five times the rate for those under 35 years and those aged 55 years and over. Drug death rates increased across the majority of council areas in 2023.

Source: Drug-related deaths in Scotland in 2023, National Records of Scotland, August 2024

The association of deprivation with drug deaths is much greater than with other causes of death. In 2023, people in the most deprived areas of Scotland were more than 15 times as likely to die from drugs compared to people in the least deprived areas. This aspect of drug deaths is considered in more detail in this report as part of Outcome 5 (Quality of life is improved by addressing multiple disadvantage).

Drug deaths in Scotland remain at a high level compared to the rest of the UK, and much more common than they have been in the past. Over the last 20 years, drug poisoning death rates^[5] have increased more rapidly in Scotland than in England and Wales and remain substantially higher in Scotland than in the rest of the UK. In 2023, the drug poisoning mortality rate in Scotland was 25.3 per 100,000 population, compared with 12.9 in Wales and 9.1 in England.^[6],[7]

4.4 Discussion

Drug deaths are lower than at the start of the National Mission but remain at a high level. Measuring progress towards the improving lives aspect of the National Mission is more challenging.

Drug deaths in Scotland remain at a high level, particularly when compared with the rest of the UK. Drug deaths increased in 2023 following a large decrease in the previous year. While drug deaths had generally been increasing since long before the start of the National Mission, 2023 saw the second lowest number in the last six years. More recent Police Scotland management information shows suspected drug deaths have fallen over more recent quarters of 2024 but remain at a high level.^[8]

Polysubstance use continues to drive the majority of harms, with high risk combinations frequently involving cocaine, gabapentinoids, benzodiazepines and / or opioids.^[9] Opiates/opioids remain the most commonly implicated substance type (implicated in 80% of drug deaths in 2023) but deaths involving cocaine have increased markedly over recent years and reached their highest ever level in 2023.^[10] Cocaine is playing an increasing role in harms and became the most commonly detected substance in both post-mortem toxicology and the ASSIST emergency department toxicology project in 2024.^[11] Increasing levels of cocaine injecting and polydrug injecting were also reported in the most recent sweep of the Needle Exchange Surveillance Initiative.^[12]

The harms associated with drug use continue to affect different groups of people in different ways. Drug deaths remain most common amongst those aged 35-54 years, with rates more than five times that for those under 35 years and those aged 55 years and over. Since 2000, the average age of drug deaths has increased from 32 to 45 years. Deprivation continues to be strongly associated with drug deaths, with those in the most deprived areas more than 15 times as likely to die from drugs as those in the least deprived areas. Males remain twice as likely to have a drug death than females, with most of the increase in drug deaths in the past year due to an increase in male deaths.^[13]

A multitude of factors are likely to contribute to individual drug deaths. While robust data exists to measure progress towards reducing drug deaths, it is not possible to assess the extent to which any observed changes in numbers of drug deaths are directly attributable to activities undertaken as part of the National Mission. The PHS evaluation framework report^[14] also acknowledges the limitations of attributing the effect of specific interventions of the National Mission to trends in the number of drug deaths. Without a counterfactual with which to compare the National Mission overall, conclusions cannot be easily drawn about the effectiveness of the National Mission based on changes (in either direction) in drug deaths as they may be a result of other factors.

Measuring the progress on the improving lives aspect of the National Mission is more challenging. The data development section of this report provides a brief discussion exploring where data development would support more complete monitoring of progress.