Mortality rates in Scotland are substantially higher than in England and Wales – the so-called "Scottish effect." New research suggests that loss of life related to problem drug use accounts for a significant portion of the excess death rate.
Official reports of drug-related deaths in Scotland are limited to deaths directly related to the pharmacological effect of an illicit drug, Dr. Michael Bloor and co-investigators explain in their report, published online on July 23 by the British Medical Journal.
To more accurately depict drug-related mortality, Dr. Bloor at the University of Glasgow analyzed data from the Drug Outcomes Research in Scotland (DORIS) study, including "deaths that embrace not just overdoses from illicit drugs but also deaths from blood-borne infections, from violent assaults, from suicides, and from other events associated with drug use." The DORIS cohort of 1033 subjects, ages 15 to 54 years, comprises roughly 1 in 11 of the drug users who entered treatment in Scotland in 2001.
Over 33 months of follow-up, 38 subjects died. Only 22 deaths were officially classified as drug-related. Causes of the remaining 16 deaths included suicide, endocarditis and other infections associated with drug abuse, assaults, alcoholic liver disease, and hypothermia/exposure. The cause of one death was unknown.
The investigators note that four deaths were due to overdoses of paracetamol, amitriptyline, colchicine, and a combination of fluoxetine and propranolol.
The standardized mortality ratio for the DORIS cohort is 1244, Dr. Bloor and his group report, 12 times higher than in the general population of Scotland.
They estimate that 32% of the excess Scottish mortality is related to the greater prevalence of problem drug use in Scotland compared with England.
"Successful public health efforts to reduce the prevalence of problem drug use in Scotland or deaths in Scottish drug users would have a dramatic impact on overall mortality in Scotland," the investigators conclude.
BMJ Online First 2008.
