Worst figures ever
The annual official drug poisoning figures published this week (3 August 2022) make for predictably grim reading. The data covers 2021, but statistics on drug-related deaths are based on the date of death registration – because of registration delays, around half of these deaths will have occurred in previous years.
The main findings are:
- 4,859 deaths related to drug poisoning were registered in 2021 in England and Wales, equivalent to a rate of 84.4 deaths per million people; this is 6.2% higher than the rate recorded in 2020 (79.5 deaths per million).
- Among males, there were 115.1 drug poisoning deaths registered per million in 2021 (3,275 deaths), compared with 54.1 deaths per million among females (1,584 deaths).
- 3,060 drug poisoning deaths registered in 2021 were identified as drug misuse, accounting for 53.2 deaths per million people.
- Rates of drug misuse death continue to be elevated among those born in the 1970s, often referred to as “Generation X”, with the highest rate in those aged 45 to 49 years.
- Approximately half of all drug poisoning deaths registered in 2021 involved an opiate (45.7%; 2,219 deaths).
- 840 deaths involved cocaine, which is 8.1% more than 2020 and more than seven times the amount recorded a decade ago (112 deaths in 2011).
- The North East continues to have the highest rate of deaths relating to drug poisoning and drug misuse (163.4 deaths per million people and 104.1 per million, respectively); London had the lowest rate for drug poisonings (47.6 deaths per million people), and the East of England had the lowest rate for drug misuse (27.4 per million).
This is the highest number of drug-related deaths since records began in 1993.
The majority of deaths related to drug poisoning are registered following a coroner’s inquest and the text on the coroner’s death certificate is used to code all of the substances involved in the death. The rate of drug poisoning deaths was 81.1% higher in 2021 (84.4 deaths per million) than it was in 2012 (46.6 per million people). The rate has increased every year since 2012 after remaining relatively stable over the preceding two decades.
Drug misuse deaths
Deaths classified as drug misuse must meet either one (or both) of the following conditions:
- The underlying cause is drug abuse or drug dependence,
- Any of the substances involved are controlled under the Misuse of Drugs Act 1971.
Information on the specific drugs involved in a death is not always available, therefore figures on drug
misuse are underestimates. Of the 4,859 registered drug poisoning deaths in 2021, 3,060 were identified as drug misuse. This represents 63.0% of drug poisonings. If we exclude deaths where no information was available on the drug(s) involved (1,219 deaths), then 84.1% of drug poisoning deaths were drug misuse.
In 2021, the highest rate of drug misuse deaths was found in those aged 45 to 49 years, closely followed by those aged 40 to 44 years. They are part of the age cohort often referred to as “Generation X”‘, born between the late sixties and early eighties, who have consistently had the highest rates of drug misuse deaths for the past 25 years.
For deaths registered in 2021, a total of 2,219 drug poisoning deaths involved opiates; this was 1.9% lower than in 2020 (2,263 deaths). Opiates were involved in just under half (45.7%) of drug poisonings registered in 2021, increasing to 61.0% when we exclude deaths that had no drug type recorded on the death certificate.
The accuracy of figures depends on the information provided by the coroner on the death certificate; because of incomplete information, figures for drug misuse and for specific substances are underestimates.
Of the drug poisoning deaths registered in 2021, 25.1% (1,219) had no drug type recorded on the coroner’s death certificate (for example, records only mention “drug overdose” or “multiple drug toxicity”).
Heroin and morphine continued to be the most frequently mentioned opiates with 1,213 drug poisoning deaths mentioning either one of these substances in 2021 (21.1 deaths per million people).
There were 663 deaths involving methadone registered in 2021, which is 28.5% higher than the previous year (516 deaths) and a statistically significantly higher rate than the previous year (11.7 deaths per million in 2021 compared with 9.1 in 2020).
There were 840 deaths involving cocaine registered in 2021, which was 8.1% higher than the previous year (777 deaths) and more than seven times higher than in 2011 (112 deaths). In 2021, males accounted for 76.8% of the deaths involving cocaine (645 males compared with 195 females). Cocaine has consistently been the second most-used drug, after cannabis, in England and Wales over the past decade.
New Psychoactive Substances
There were 258 deaths involving new psychoactive substances registered in 2021, which is 88.3% higher than the previous year (137 deaths) and a statistically significantly higher rate than the previous year (4.5 deaths per million people in 2021 compared with 2.4 in 2020). This rise was driven by an increase in the number of deaths involving benzodiazepine analogues (primarily flubromazolam and etizolam) from 62 deaths in 2020 to 171 deaths in 2021.
Benzos, Pregab & Gapapentin
There have been increasing numbers of deaths involving benzodiazepines (a rise of 13.0% when compared with 2020, from 476 to 538 deaths), pregabalin (a rise of 18.9%, from 344 to 409 deaths) and gabapentin (a rise of 12.7%, from 118 to 133 deaths).
The statisticians suggest a number of reasons for why drug-related deaths have been on an upward trend for the past decade. The reasons are complex and differ by drug type. The overall trend is driven primarily by deaths involving opiates but also by an increase in deaths involving other substances like cocaine.
Across Europe, rates of deaths involving heroin or morphine have been increasing, while the number of new heroin and morphine users has fallen. This indicates higher rates of death among existing long-term drug users.
Possible explanations include that:
- There is an ageing cohort of drug users, likely to be suffering from the effects of long-term drug use and becoming increasingly susceptible to a fatal overdose
- New trends in taking specific drugs, including gabapentinoids and benzodiazepines, alongside heroin or morphine, may increase the risk of an overdose
- There may have been an increase in disengagement or non-compliance with opiate substitute therapy (OST)
- The rise in deaths involving cocaine is likely to be a direct consequence of the increasing prevalence in cocaine use. This increase in cocaine use is also seen across Europe. Both cocaine and heroin have been reported to have high availability in recent years, with low prices and high purity levels.
A recent article by Public health specialist Dr Dan Lewer suggests that another important factor may be the reduction of funding for drug treatment and a focus on discharging clients which led to shorter and less stable periods of treatment, and staff having little time to engage with clients. He notes that research shows that long-term and stable treatment is needed to keep people safe.
These statistical findings do not mask the fact that every data point represents a human being whose life has been cut tragically short and a grieving family and friends whose lives have been changed forever.
Thanks to César Abner Martínez Aguilar for kind permission to use the header image in this post which was previously published on Unsplash.