Table of contents
- Main findings
- Policy context
- Uses made of this data
- Number of deaths from drug-related poisoning
- Number of drug-related deaths by underlying cause
- Number of deaths related to drug misuse
- Mortality rates for all drug-related poisonings and drug misuse
- Age-specific mortality rates for deaths related to drug misuse
- Drug related deaths involving specific substances
- Heroin and morphine
- Amphetamines and ecstasy
- New psychoactive substances (including ‘legal highs’)
- Paracetamol and other analgesics
- Geographical variations in deaths related to drug misuse
- Comparisons with the rest of the UK
- Impact of registration delays on drug-related deaths
- Downloadable reference tables
- Background notes
1. Main findings
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
4. Policy context
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
5. Uses made of this data
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
12. Heroin and morphine
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
15. Amphetamines and ecstasy
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
16. New psychoactive substances (including ‘legal highs’)
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
19. Paracetamol and other analgesics
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
23. Comparisons with the rest of the UK
Figures on drug-related deaths in Scotland are available from National Records of Scotland and the Information Services Division of NHS Scotland.
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
25 .Downloadable reference tables
A back series of data on deaths related to drug poisoning in England and Wales between 1993 and 2012 are available to download in a Microsoft Excel workbook from the ONS website (303.5 Kb Excel sheet).
The workbook contains the following tables:
Table 1: Number of deaths from drug-related poisoning and drug misuse, by sex and country, England and Wales, deaths registered in 1993–2012
Table 2: Number of deaths from drug-related poisoning by sex and underlying cause, England and Wales, deaths registered in 1993–2012
Table 3: Number of deaths related to drug misuse by sex and underlying cause, England and Wales, deaths registered in 1993–2012
Table 4: Number of deaths from drug-related poisoning by sex and age, England and Wales, deaths registered in 1993–2012
Table 5: Number of deaths related to drug misuse by sex and age, England and Wales, deaths registered in 1993–2012
Table 6a: Number of drug-related deaths where selected substances were mentioned on the death certificate, England and Wales, deaths registered in 1993–2012
Table 6b: Number of drug-related deaths where selected substances were mentioned without other drugs, England and Wales, deaths registered in 1993–2012
Table 6c: Number of drug-related deaths where selected substances were mentioned with alcohol, England and Wales, deaths registered in 1993–2012
Table 7: Number of deaths and age-standardised mortality rate for deaths related to drug misuse, by country and region, England and Wales, deaths registered in 1993–2012
Figure 1: Age-standardised mortality rates for deaths related to drug poisoning and drug misuse, by sex, England and Wales, deaths registered in 1993–2012
Figure 2: Age-specific mortality rates for deaths related to drug misuse, males, England and Wales, deaths registered in 1993–2012
Figure 3: Age-specific mortality rates for deaths related to drug misuse, females, England and Wales, deaths registered in 1993–2012
Figure 4: Age-standardised mortality rates for selected substances, males, England and Wales, deaths registered in 1993–2012
Figure 5: Age-standardised mortality rates for selected substances, females, England and Wales, deaths registered in 1993–2012
Figure 6: Average registration delay for all drug poisoning deaths and deaths related to drug misuse, England and Wales, deaths registered in 1993–2012
The Advisory Council on the Misuse of Drugs (2000) Reducing drug related deaths, Home Office: London
The Advisory Council on the Misuse of Drugs (2013) ‘ACMD consideration of tramadol’
British Medical Association and Royal Pharmaceutical Society (2013) ‘British National Formulary 65’, BMJ Group and Pharmaceutical Press
Christophersen O, Rooney C and Kelly S (1998) ‘Drug related deaths: methods and trends’, Population Trends 93, 29–37
Daly (2012) ‘2012 Street Drug Trends Survey’ Druglink November/December 2012
Department of Health (2001) ‘The Government Response to the Advisory Council on the Misuse of Drugs Report into Drug Related Deaths’
The European Monitoring Centre for Drugs and Drug Addiction (2013) ‘Statistical Bulletin 2013: Drug-related deaths and mortality’
Frank (2013) ‘What is PMA’
Hawton K, Bergen H, Simkin S, Cooper J, Waters K, Gunnell D and N Kapur (2010) ‘Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose’, The British Journal of Psychiatry 196, 354-358
Hawton K, Bergen H, Simkin S, Wells C, Kapur N and Gunnell D (2012) ‘Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths: Time-Series Study’, PLOS Medicine
Health and Social Care Information Centre (2009) ‘Prescription Cost Analysis: England 2008’
Health and Social Care Information Centre (2013) ‘Prescription Cost Analysis: England 2012’
Home Office (2010) ‘Drug Strategy 2010 – Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life'
Home Office (2012) 'Drug misuse declared: findings from the 2011 to 2012 Crime Survey for England and Wales'
Home Office (2013) 'Drug misuse: findings from the 2012 to 2013 Crime Survey for England and Wales (CSEW)'
The Misuse of Drugs Act (1971) The Stationery Office Ltd
National Institute for Health and Clinical Excellence – NICE (2009) ‘Quick reference guide: Depression’
National Treatment Agency (2012) ‘Drug treatment in England: the road to recovery’
Office for National Statistics (2002) ‘Report: Deaths related to drug poisoning: results for England and Wales, 1993 to 2000’, Health Statistics Quarterly 13, 76–82
Office for National Statistics (2011) ‘Results of the ICD-10 v2010 bridge coding study, England and Wales, 2009’
Public Health England (2013) ‘Falling drug use: the impact of treatment’
SOCA (2011) ‘Serious Organised Crime Agency Annual Report and Accounts 2010/11 ’
- SOCA (2012) ‘Serious Organised Crime Agency Annual Report and Accounts 2011/12’
SOCA (2013) ‘Serious Organised Crime Agency Annual Report and Accounts 2012/13’
Welsh Government (2013) ‘Substance Misuse Delivery Plan 2013 – 2015’
World Health Organisation – WHO (2010) International Statistical Classification of Diseases and Related Health Problems, volumes 1, 2 and 3 (Tenth Revision). WHO: Geneva
27 .Background notes
Further information about the quality of drug-related deaths data can be found in the Quality and Methodology Information (QMI) paper.
Information about the underlying mortality data, including details on how the data is collected and coded are available in the mortality metadata.
Drug poisoning database
The figures presented in this bulletin have been produced using a special database of deaths related to drug poisoning, which has been developed to facilitate research into these deaths and to aid the identification of specific substances involved. The database is extracted from the national mortality database for England and Wales. Deaths are included if the underlying cause of death is regarded as drug-related, according to the National Statistics definition. More information on this definition and issues relating to the interpretation of drug-related deaths data can be found in Christophersen et al (1998).
Almost all deaths on the drug poisoning database had a coroner’s inquest. For each death the database includes the following information:
- the ICD codes for underlying cause of death and other causes mentioned on the death certificate
- every mention of a substance recorded by the coroner in the cause of death section or elsewhere on the coroner's certificate after inquest (up to seven substances)
- an indicator to show if alcohol is mentioned – this includes a wide variety of scenarios ranging from evidence of alcohol consumption around the time of death (for example an empty vodka bottle found at the scene or alcohol found after toxicology tests) to long-term alcohol abuse and cirrhosis of the liver
- other information recorded at death registration such as age, sex, marital status, occupation and place of usual residence
Definition of a drug-related death
International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes used to define deaths related to drug poisoning
Description ICD-9 Codes ICD-10 Codes Mental and behavioural disorders due to drug use (excluding alcohol and tobacco) 292, 304, 305.2–305.9 F11–F16, F18–F19 Accidental poisoning by drugs, medicaments and biological substances E850–E858 X40–X44 Intentional self-poisoning by drugs, medicaments and biological substances E950.0–E950.5 X60–X64 Assault by drugs, medicaments and biological substances E962.0 X85 Poisoning by drugs, medicaments and biological substances, undetermined intent E980.0–E980.5 Y10–Y14
Download this table International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes used to define deaths related to drug poisoning.xls (53.2 kB)
Definition of a death related to drug misuse
In 2000 the Advisory Council on the Misuse of Drugs published a report called ‘Reducing Drug Related Deaths’. In response to this report’s recommendations on improving the present system for collecting data on drug-related deaths, a technical working group was set up. This group, consisting of experts across government, the devolved administrations, coroners, toxicologists and drugs agencies, proposed a headline indicator for drug misuse deaths as part of the government’s action plan (Department of Health, 2001) to reduce the number of these deaths. This indicator also takes into account the information needs of the European Monitoring Centre for Drugs and Drug Addiction. The baseline year for monitoring deaths related to drug misuse was set as 1999. The definition of the headline indicator using ICD-10 is shown below. The definition using ICD-9 was published in a previous annual report (Office for National Statistics, 2002).
Cause of death categories included in the headline indicator of drug misuse deaths (the relevant ICD-10 codes are given in brackets):
a) Deaths where the underlying cause of death has been coded to one of the following categories of mental and behavioural disorders due to psychoactive substance use (excluding alcohol, tobacco and volatile solvents):
- opioids (F11)
- cannabinoids (F12)
- sedatives or hypnotics (F13)
- cocaine (F14)
- other stimulants, including caffeine (F15)
- hallucinogens (F16)
- multiple drug use and use of other psychoactive substances (F19)
b) Deaths where the underlying cause of death has been coded to one of the following categories and where a drug controlled under the Misuse of Drugs Act 1971, was mentioned on the death certificate:
- Accidental poisoning by drugs, medicaments and biological substances (X40–X44)
- Intentional self-poisoning by drugs, medicaments and biological substances (X60–X64)
- Poisoning by drugs, medicaments and biological substances, undetermined intent (Y10–Y14)
- Assault by drugs, medicaments and biological substances (X85)
- Mental and behavioural disorders due to use of volatile solvents (F18)
Specific rules were adopted for dealing with compound analgesics which contain relatively small quantities of drugs listed under the Misuse of Drugs Act, the major ones being dextropropoxyphene, dihydrocodeine and codeine. Where these drugs are mentioned on a death record, they have been excluded from the drug misuse indicator if they are part of a compound analgesic (such as co-proxamol, co-dydramol or co-codamol) or cold remedy. Dextropropoxyphene has been excluded on all occasions, whether or not paracetamol or a compound analgesic was mentioned. This is because dextropropoxyphene is rarely, if ever, available other than as part of a paracetamol compound. However, codeine or dihydrocodeine mentioned without paracetamol or ibuprofen were included in the indicator. This is because they are routinely available and known to be abused in this form. This approach is the same as that taken by National Records of Scotland (NRS). Drugs controlled under the Misuse of Drugs Act 1971 include class A, B and C drugs.
Revisions to drug misuse
A small number of revisions were made to the to the drug misuse indicator in 2013 and the full back series from 1993 has been revised. Several new psychoactive substances which have been controlled under the Misuse of Drugs Act 1971 in the last few years have been added, and alkyl nitrites have been removed as they were incorrectly being classed as controlled substances. These changes affect no more than two deaths a year.
Deaths among people in their 20s and 30s
Nearly one in eight deaths among people in their 20s and 30s were drug-related. This figure has been calculated from the number of deaths from all drug poisonings of people aged 20 to 39, (1,021 deaths) and the number of deaths from all causes in this age group (8,265 deaths) for England and Wales in 2012. The number of deaths from all causes, by sex and age is available on the ONS website.
Heroin and morphine
Heroin (diamorphine) breaks down in the body into morphine, so either heroin and/or morphine may be detected at post mortem and recorded on the death certificate. Therefore a combined figure for deaths where heroin or morphine was mentioned on the death certificate is included in Table 4.
The figure for cocaine in Table 4 includes deaths where cocaine was taken in the form of crack cocaine. It is not possible to separately identify crack cocaine from other forms of cocaine at post mortem. Other evidence to distinguish the form of cocaine taken is rarely provided on death certificates.
GHB and GBL
The figure for GHB (gamma-hydroxybutyrate) in Reference Table 6a includes deaths where GBL (gamma-butyrolactone) was taken. It is not possible to separately identify GBL and GHB at post mortem as GBL is rapidly converted to GHB when ingested into the human body.
List of drugs included as new psychoactive
There is no official definition new psychoactive substances. The following substances have been included in this group in this bulletin:
- Legal high
- Synthetic cannabinoid
It is likely that this list will be revised in future as new substances emerge.
The number of deaths mentioning helium reported in this statistical bulletin before 2011 are likely to be an underestimate, as some deaths involving helium were assigned an underlying cause of death of hanging, strangulation and suffocation (ICD-10 codes X70 and Y20), and were not included in the drug poisoning database. From 2011 onwards, we have tried to ensure that all deaths mentioning helium are coded to the appropriate poisoning code and not as a suffocation.
Calculation of mortality rates
Mortality rates are presented as deaths per one million population. The mortality rates in Figures 2 and 3 are age-specific rates; and those in Figures 1, 4 and 5 and Table 5 are directly age-standardised to the 1976 European standard population. Age-standardised rates are used to allow comparison between populations which may contain different proportions of people of different ages, including comparisons between males and females and over time. Eurostat, the statistical institute of the European Union, has decided to update the European Standard Population, which is used in the calculation of age-standardised rates. ONS will publish details of the impact of this change on age-standardised rates, and, following user engagement in Summer 2013, the timetable for implementation of the new standard population in relevant publications. ONS is consulting on the implementation of the new European Standard Population between 09 August and 03 October 2013.
Mortality rates are calculated using mid-year population estimates. Rates for 2002–11 have been recalculated using revised mid-year population estimates which take account of the 2011 Census and therefore differ from previously published figures. Analysis shows that rates have been consistently revised down, but these changes were small. The differences tended to be larger at the end of the revision period (2011), than at the beginning (2002) and the biggest change was seen for female drug poisoning deaths in 2010, with rates decreasing from 29.2 to 28.9 deaths per million population (a 1.0% reduction).
Excel workbooks containing the data used to produce Figures 1 to 6 and Tables 1 to 5 are available to download from the ONS website (303.5 Kb Excel sheet) . These tables contain both the mortality rate and the upper and lower confidence limits. These limits form a confidence interval, which is a measure of the statistical precision of an estimate and shows the range of uncertainty around the estimated figure. Calculations based on small numbers of events are often subject to random fluctuations. As a general rule, if the confidence interval around one figure overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two figures. Within this statistical bulletin, a difference which is described as ‘significant’, means ‘statistically significant’, assessed by examining the confidence intervals.
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Calculation of registration delays
Figure 6 presents data on the length of time taken to register a death (also known as the registration delay) for drug-related deaths. This is calculated as the difference between the date each death occurred and the date it was registered, measured in days. Data where the exact date of death was unknown or where either the date of death or date of registration was clearly recorded incorrectly (that is, the death appeared to have been registered before it occurred) were excluded from this analysis. Approximately 0.2% of the data were excluded for these reasons. Analysis showed that the data were positively skewed, and contains some deaths with very long registration delays (for example, more than eight years). Therefore the average registration delay has been presented using the median value, as this is not influenced by extreme values. The median is defined as the value that is halfway through the ordered data set, below and above which there lies an equal number of data values.
Special extracts of data
Special extracts and tabulations of drug poisoning deaths data are available to order (subject to legal frameworks, disclosure control and agreement of costs, where appropriate). Such requests or enquiries should be made to:
Mortality Analysis Team, Life Events and Population Sources Division
Office for National Statistics
Newport NP10 8XG
Tel: +44 (0)1633 455341
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We would welcome feedback on the content, format and relevance of this release. Please send feedback to the postal or email address above.
Plan for mortality outputs
Future changes to mortality outputs are outlined in the plan for mortality outputs available on the ONS website.
A list of the names of those given pre-publication access to the statistics and written commentary is available in this pre-release access list for deaths related to drug poisoning in England and Wales in 2012. The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008.
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Designation can be broadly interpreted to mean that the statistics:
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Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.
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Details of the policy governing the release of new data are available by visiting www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html or from the Media Relations Office email: firstname.lastname@example.org
These National Statistics are produced to high professional standards and released according to the arrangements approved by the UK Statistics Authority.
28 . Methodology
Contact details for this Statistical bulletin
Telephone: +44 (0)1633 455341