There were 1,706 male drug poisoning deaths (involving both legal and illegal drugs) registered in 2012, a 4% decrease since 2011
Female drug poisoning deaths have increased every year since 2009, reaching 891 in 2012
The number of male drug misuse deaths (involving illegal drugs) decreased by 9% from 1,192 in 2011 to 1,086 in 2012; female deaths decreased by 1% from 413 in 2011 to 410 in 2012
The highest mortality rate from drug misuse was in 30 to 39-year-olds, at 97.8 and 28.9 deaths per million population for males and females respectively in 2012
The number of deaths involving heroin/morphine fell slightly in 2012 to 579 deaths, but these remain the substances most commonly involved in drug poisoning deaths
The number of deaths involving tramadol have continued to rise, with 175 deaths in 2012 – more than double the number seen in 2008 (83 deaths)
Mortality rates from drug misuse were significantly higher in Wales than in England in 2012, at 45.8 and 25.4 deaths per million population respectively
In England, the North West had the highest mortality rate from drug misuse in 2012 (41.0 deaths per million population)
All figures presented in this bulletin are based on deaths registered in a particular calendar year, and out of the 2,597 drug-related deaths registered in 2012, 1,358 (just over half) occurred in years prior to 2012
This bulletin presents the latest figures from the Office for National Statistics (ONS) on deaths related to drug poisoning (involving both legal and illegal drugs) and drug misuse (involving illegal drugs) in England and Wales for the last five years. Figures from 1993 are available to download, and are discussed in the commentary to provide context to the latest (2012) data.
Figures presented in this bulletin are for deaths registered each year, rather than deaths occurring each year – see the ‘Impact of registration delays on drug-related deaths’ section below for more information. Figures are presented by cause of death, sex, age, substance(s) involved in the death, and area of usual residence of the deceased.
Mortality rates for 2002–11 have been recalculated using revised mid-year population estimates which take account of the 2011 Census. These may differ from previously published figures (see Background note 13).
There were 2,597 drug poisoning deaths (involving both legal and illegal drugs) registered in 2012, and as in previous years, the majority (just over two-thirds) of these deaths were in males. There were 1,706 male deaths from drug poisoning in 2012, a decrease of 4% since 2011, and the lowest since 1995. The equivalent number of female deaths rose to 891, an increase of 1% since 2011, and the highest since 2004.
In 2012 males aged 30 to 39 had the highest mortality rate from drug misuse (97.8 deaths per million population), followed by males aged 40 to 49 (85.9 deaths per million population). The male mortality rates in these two age groups were significantly higher than the rates in all other age groups and much higher than females of any age.
As with males, the highest rates for females were among those aged 30 to 39 and 40 to 49 (28.9 and 28.7 deaths per million respectively), and these rates were significantly higher than the rates in other age groups.
Over half (52%) of all deaths related to drug poisoning involved an opiate drug, and in men aged 30 to 39, nearly two thirds (63%) of drug-related deaths involved an opiate. In 2012, as in previous years, the most commonly mentioned opiates were heroin and/or morphine, which were involved in 579 deaths.
Deaths involving heroin/morphine decreased in 2012, but deaths involving another opiate – tramadol – have continued to rise. There were 175 deaths involving tramadol in 2012 – more than double the number recorded in 2008 (83 deaths). In addition, deaths involving new psychoactive substances (sometimes referred to as ‘legal highs’) such as mephedrone have increased sharply in the last year from 29 deaths in 2011 to 52 deaths in 2012. But the number of deaths from new psychoactive substances are still much lower than the number of deaths from heroin/morphine.
For the first time this bulletin presents analysis of geographical variations in mortality rates from drug misuse. This analysis showed that in 2012 rates were significantly higher in Wales than in England (45.8 and 25.4 deaths per million population respectively). In England, the North West had the highest mortality rate from drug misuse in 2012 (41.0 deaths per million population).Back to table of contents
Drug use and drug dependence are known causes of premature mortality, with drug poisoning accounting for nearly one in eight deaths among people in their 20s and 30s in 2012 (see Background note 7). Drug-related deaths occur in a variety of circumstances, each with different social and policy implications. Consequently, there is considerable political, media and public interest in these figures.
This bulletin covers accidents and suicides involving drug poisonings, as well as deaths from drug abuse and drug dependence, but not other adverse effects of drugs (for example anaphylactic shock). Drug poisoning deaths involve a broad spectrum of substances, including legal and illegal drugs, prescription drugs (either prescribed to the deceased or obtained by other means) and over-the-counter medications. Some of these deaths may also be the result of complications of drug abuse, such as deep vein thrombosis or septicaemia resulting from intravenous drug use, rather than an acute drug overdose.
The figures presented in this bulletin are for deaths registered each year, rather than deaths occurring each year. Almost all drug-related deaths are certified by a coroner, and due to the length of time it takes to hold an inquest, just over half of drug-related deaths registered in 2012 will have actually occurred prior to 2012 – see the ‘Impact of registration delays on drug-related deaths’ section below for more information.Back to table of contents
In December 2010 the Coalition Government launched a new drug strategy entitled 'Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life' (Home Office, 2010). This strategy highlights preventing drug-related deaths as one of the key outcomes that recovery-oriented services should be focused on. In 2011 a new initiative was launched in eight pilot areas in England, trialling payment by results for providers of treatment services for people with drug and/or alcohol problems. The Department of Health is funding a three year independent evaluation of these pilots, which is being led by the University of Manchester.
Patterns of drug use change over time. For instance, in recent years people have been taking new psychoactive substances, including so-called ‘legal highs’. In response to this, the Government’s 2010 drug strategy outlined the introduction of a system of temporary 12-month bans on newly emerging substances. The Advisory Council on the Misuse of Drugs (ACMD) can then evaluate the harm caused by the substance and advise whether there should be a permanent ban.
In February 2013, the Welsh Government published the Substance Misuse Delivery Plan 2013–2015 (Welsh Government, 2013), which included the specific target of ‘reducing the number of substance misuse related deaths and non-fatal overdoses / alcohol poisonings in Wales’. To support this, new proposals to undertake rapid case reviews for both fatal and non-fatal poisonings have been developed and will be formally consulted on next month.Back to table of contents
The figures contained in this statistical bulletin are used by a range of public bodies, such as Public Health England (PHE), the Department of Health (DH) and the Welsh Government to evaluate the effectiveness of various drug strategies.
In April 2013, the key functions of the National Treatment Agency for Substance Misuse were transferred into PHE, and they have linked ONS data on drug-related deaths with data from the National Drug Treatment Monitoring System (NDTMS), to investigate the timing of drug-related deaths in relation to treatment history. This research will also examine risk factors associated with these deaths and carry out area-based comparisons.
The Welsh Government and Public Health Wales are linking ONS data to information on the distribution and coverage of the National Take-Home Naloxone (THN) programme. This will be used to evaluate whether the THN program is having an impact on the number of drug-related deaths in Wales, and also to identify hotspots and areas requiring further focus.
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) combines data for England and Wales from the ONS drug poisoning database with data from Scotland and Northern Ireland to publish UK figures, allowing comparisons to be made with other European countries. The latest EMCDDA report shows that the drug-related mortality rate in the UK was the fourth highest in Europe (EMCDDA, 2013). However, caution should be applied when making international comparisons, because of differences in definitions and the quality of reporting.
ONS drug poisoning data are also used by academic researchers. For example, analysis of this data by the Centre for Suicide Research at the University of Oxford revealed that there was a major reduction in deaths involving co-proxamol following its withdrawal in 2005, with no evidence of an increase in deaths involving other analgesics, apart from oxycodone (Hawton et al, 2012). Updated data on deaths involving co-proxamol and other analgesics are shown in Reference Table 6a.Back to table of contents
Over half (52%) of all deaths related to drug poisoning involved an opiate drug, in fact in men aged 30 to 39, nearly two thirds (63%) of drug-related deaths involved an opiate. In 2012, as in previous years, the most commonly mentioned opiates were heroin and/or morphine, which were involved in 579 deaths (see Background note 8). Although these substances are involved in many drug-related deaths, the mortality rate for males has fallen sharply in recent years, down from 27.7 deaths per million population in 2009 to 15.6 in 2012. This is a 44% fall and the lowest rate since 1997. The female mortality rate for deaths involving heroin/morphine increased slightly between 2011 and 2012 from 4.4 to 5.2 deaths per million population, but was still much lower than the corresponding rate in males.
Evidence suggests that in 2010/11 there was a ‘heroin drought’ in the UK, with reduced availability of heroin persisting in some areas in 2011/12 and 2012/13 (SOCA, 2011, 2012 and 2013). Also, the typical street heroin purity has fallen from 46% in September 2009 to around 15–20% in 2012/13 (SOCA, 2011 and 2013).
Public Health England (2013) report that the number of people starting treatment for heroin and/or crack addiction (including those returning to treatment) fell from 64,288 in 2005-06 to 47,210 in 2011-12. They suggest this is because treatment has helped to shrink the pool of heroin and crack addicts in England. However, evidence from the Crime Survey for England and Wales (Home Office, 2012) suggests generally there has been little variation in heroin use year on year since their measurement began.
A combination of these factors may explain the decline in deaths involving heroin/morphine that has been seen over the last few years.Back to table of contents
In 2012 there were 414 deaths involving methadone (an opiate substance used to treat heroin addiction, which is sometimes abused). The male mortality rate for deaths involving methadone decreased by 16% from 13.4 deaths per million population in 2011 to 11.3 in 2012. The equivalent rate for females decreased by 9% between 2011 and 2012 (from 4.2 to 3.8 to deaths per million population). Despite this fall, the female mortality rate for deaths involving methadone is still the second highest on record.Back to table of contents
There were 139 deaths involving cocaine in 2012. The male mortality rate declined significantly between 2008 and 2011, but then increased again slightly in 2012 to 4.3 deaths per million population in 2012. The equivalent rate in females was lower than for males (0.8 deaths per million population in 2012), and this rate has remained relatively unchanged since 2009 (see Background note 9).Back to table of contents
The number of deaths involving amphetamines increased from 62 deaths in 2011 to 97 in 2012. In addition to amphetamine itself, the amphetamines group includes a variety of substances such as ecstasy, methylamphetamine, paramethoxyamphetamine (PMA) and para-methoxymethamphetamine (PMMA). There were almost four times as many deaths involving ecstasy in 2012 compared with 2010 (31 deaths and eight deaths respectively). In addition, there was a large increase in the number of death certificates mentioning PMA or PMMA. These substances were only involved in one death in 2011, but were involved in 20 in 2012 (a small number of these deaths also mentioned ecstasy). It has been suggested that people may be ingesting PMA/PMMA in the belief that they are taking ecstasy tablets (Frank, 2013). However, there is not enough information recorded on coroner’s death certificates to confirm if this was the case for the deaths registered in 2012.Back to table of contents
Over the past few years a number of new drugs have been controlled under the Misuse of Drugs Act (1971), including synthetic cannabinoid receptor agonists (for example, ‘spice’), gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL), piperazines (benzylpiperazine – BZP and trifluoromethylphenylpiperazine – TFMPP), cathinones such as mephedrone, and pipradrols such as desoxypipradrol. This group of substances are sometimes called legal highs, but most are now controlled under the Misuse of Drugs Act (1971), so will be referred to as new psychoactive substances (NPS) in this report. There is no official definition of NPS, and the drugs included in this category in this bulletin are listed in Background note 11. This grouping may be revised in future years.
Although the number of deaths involving NPS are low compared with the number of deaths from heroin/morphine poisoning, NPS deaths increased sharply in the last year from 29 deaths in 2011 to 52 deaths in 2012 (see Background note 11). In particular, death involving cathinones tripled from six deaths in 2011 to 18 deaths in 2012. This was despite evidence from the Crime Survey for England and Wales suggesting that the proportion of 16 to 59-year-olds using mephedrone in the last year has declined since 2010/11 (Home Office, 2013).Back to table of contents
There were 284 drug poisoning deaths involving benzodiazepines in 2012. Mortality rates in males increased significantly from an all-time low of 4.5 deaths per million population in 2006 to an all-time high of 7.9 deaths per million population in 2011, but fell slightly to 7.3 deaths per million in 2012. Equivalent mortality rates in females were significantly lower than in males at 2.8 deaths per million population in 2012, but have risen slightly since 2011. Diazepam was the most common type of benzodiazepine mentioned on deaths certificates in 2012, and was involved in 207 deaths, the highest number on record.
The increase in deaths involving diazepam is consistent with a recent survey suggesting that there has been a continued increase in the use and availability of illicit benzodiazepines, such as diazepam (Daly, 2012). However, the role of diazepam and other benzodiazepines in drug-related deaths is unclear, as more than 9 out of 10 deaths involving benzodiazepines also mentioned another drug.Back to table of contents
There were 468 deaths involving antidepressants in 2012, up from 393 in 2011. This increase was seen across all classes of antidepressants. Mortality rates were similar in males and females in 2011 (7.8 and 8.5 deaths per million population respectively), and both rose slightly between 2011 and 2012. The female mortality rate was the highest since 1999.
Deaths involving tricyclic antidepressants (TCAs) increased from 200 in 2011 to 233 in 2012, and the majority of these deaths involved amitriptyline (155 deaths in 2012, see Reference Table 6a (303.5 Kb Excel sheet) ). Although TCAs are still involved in more deaths than other types of antidepressants, the number of deaths from TCA poisoning are now much lower than their peak of 497 deaths in 1998.
Deaths involving Selective Serotonin Re-uptake Inhibitors (SSRIs) have been steadily increasing, and reached their highest ever level in 2012 (158 deaths). The majority of these deaths involve the SSRI drug citalopram (101 deaths in 2012). Studies show that SSRIs are less toxic in overdose than TCAs (Hawton et al, 2010), but SSRIs are prescribed more frequently. In the last five years prescriptions for SSRIs have increased more rapidly than prescriptions for TCAs (Health and Social Care Information Centre – HSCIC, 2009 and 2013), which may explain the rise in deaths involving SSRIs.
In 2012 deaths involving other types of antidepressants reached a record high, at 104 deaths. Reference Table 6a shows that in 2012 the majority of these deaths involved venlafaxine or mirtazapine (British National Formulary section 4.3.4, British Medical Association and Royal Pharmaceutical Society, 2013) with only one death involving a Monoamine-Oxidase Inhibitor – MAOI (BNF section 4.3.2). National Institute for Health and Clinical Excellence guidelines (NICE, 2009) suggest that these drugs should not be used as a first-line treatment for depression, and should only be prescribed to people who have not responded to SSRIs. Venlafaxine in particular is associated with a greater risk of death from overdose.
Prescriptions for ‘other antidepressant drugs’ like venlafaxine and mirtazapine (BNF section 4.3.4) accounted for only 17% of all antidepressant prescriptions in 2012. However, prescriptions for this type of antidepressant increased by 60% between 2008 and 2012 (HSCIC, 2009 and 2013), which may partly explain the increase in deaths.Back to table of contents
There were 182 deaths involving paracetamol and its compounds in 2012. The mortality rates for males and females were similar, and both decreased slightly between 2011 and 2012. During this period the male mortality rate decreased from 3.0 to 2.7 deaths per million population (the lowest rate since records began). In females, the equivalent rate went down from 3.6 to 3.2 deaths per million population, but has largely remained stable since 2007.Back to table of contents
A notable trend that has emerged in recent years is the steady increase in the number of deaths mentioning tramadol (a synthetic opioid analgesic). The first recorded death was in 1996, and deaths have risen to an all-time high of 175 deaths in 2012. This increase in deaths may be partly explained by a 35% increase in tramadol prescriptions over the last five years (HSCIC, 2009 and 2013). In addition, the latest ‘Street drug trends survey’ carried out among police forces, drug agencies, frontline treatment services and drug user groups highlighted the continued rise in the recreational use of tramadol and other synthetic opioids (Daly, 2012). Unlike most other opioid analgesics, tramadol is not controlled under the Misuse of Drugs Act 1971. However, the Advisory Council on the Misuse of Drugs (ACMD) have recently advised that tramadol be controlled as a class C substance under the Misuse of Drugs Act 1971, (ACMD, 2013). In response to the ACMD recommendation the Government is running a public consultation to assess the impact of controlling tramadol on the healthcare sector in particular.Back to table of contents
There were 58 deaths mentioning helium in 2012, almost five times higher than the 12 deaths recorded in 2008 (see Background note 12 for further information on helium deaths). Although the number of deaths involving these substances is still relatively small, the large increases are of particular interest to those concerned with suicide prevention, as almost all of these deaths were suicides. The National Suicide Prevention Strategy Advisory Group are considering options to reduce these deaths.Back to table of contents
Figures for Northern Ireland are available from the Northern Ireland Statistics and Research Agency.
Figures for Europe are available from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Figures for other countries may not be comparable with figures presented above for England and Wales, due to differences in data collection methods and in the death registration system.Back to table of contents
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