In any country, some place has to be the deadliest. In the United Kingdom, that place is Scotland. The key reason is drug abuse, accounts for a third of the deaths behind Scotland's higher mortality rate, according to a study published on bmj.com today.
Traditionally, higher death rates compared to England and Wales have been blamed on the higher levels of deprivation in Scotland. Yet over half the difference between Scottish and English deaths cannot be accounted for by higher levels of deprivation. This puzzling "excess" of Scottish deaths has become referred to as the "Scottish effect."
Professor Bloor and colleagues from the University of Glasgow, analysed how many of these unaccounted-for deaths were the result of drug abuse.
They say that the published data on "drug related deaths" in Scotland is properly and purposely restrictive because only deaths which are a direct result of the pharmacological effect of taking an illegal drug i.e. an overdose, are counted. This, they argue, inadvertently hides a much wider problem of deaths linked to drug taking such as blood borne infections, suicide and violent assaults.
In order to estimate the number of deaths in a population of drug users they matched mortality data from the General Register Office for Scotland with participants in a study on Drug Outcomes Research in Scotland (DORIS). As part of that study, 1033 problem drug users who started a new bout of treatment in one of 33 drug treatment agencies across Scotland were interviewed between 2001 and 2002. They were followed up between 2004 and 2005.
Of those who didn't have follow-up interviews the researchers found 38 had died. Only 22, just over half, of those deaths had been recorded as drug-related. Of the other deaths, six were suicides (including three overdoses from medication such as paracetamol), three were due to an "infection associated with drug abuse", two were due to assaults, one was due to "alcoholic liver disease" and one due to exposure.
Previous work has shown that 1.84% of the Scottish population had a problem with drug abuse, compared to 0.99% in England.
Applying the rate of deaths of drug users in the DORIS study to the wider population of drug users in Scotland, allowed the authors to estimate that 32% of Scotland's excess mortality rate is due to the greater prevalence of problem drug abuse in the country.
Compared to smoking, excess drinking, or lack of exercise, relatively few people have a problem with drug abuse. However, the risk of death is high—drug users in the DORIS study were found to be 12 times as likely to die as someone from the general population.
Professor Bloor and colleagues conclude that successful public health campaigns to reduce the number of people taking drugs "would have a strong impact on overall mortality in both Scotland and England."