National Mission on Drugs: annual monitoring report 2022-2023

4. Overarching outcome: Reduce drug deaths and improve lives

4.1 Summary

4.2 Background

The aim of the National Mission is to reduce drug deaths and improve the lives of people affected by drugs. Scotland has one of the highest drug death rates in the developed world and drug deaths are now recognised as one of the biggest contributors to Scotland’s decreasing life expectancy.^[1] Although the challenge is complex and multi-faceted, the number of drug deaths is the key measure of progress against which success of the National Mission will be measured.

4.3 Headline metrics

4.3.1 Headline metric: Number of drug deaths

There were 1,051 drug misuse deaths^[2] registered in Scotland in 2022 (Figure 2). This was 21% (279 deaths) fewer than in 2021. This was the lowest number of drug misuse deaths since 2017 and the largest year on year decrease on record. However, most of the decrease was in males (down 26%, 241 deaths); deaths amongst females fell by 10% (38 deaths). Drug deaths are generally low among people aged 25 and under, however the share of drug deaths in this age group increased slightly from 5% (70 deaths out of a total of 1,339) to 6% (62 deaths out of a total of 1,051) between 2021 and 2022. There was also a mixed picture of trends across the country, with drug misuse deaths falling in two thirds of council areas but increasing or remaining flat elsewhere. Opioids remain the most commonly implicated drug type and cocaine is implicated in an increasing proportion of drug misuse deaths.

Figure 2: Drug deaths fell in 2022 but remain high

Number of drug misuse deaths, 2019-2022

Source: Drug-related deaths in Scotland in 2022, National Records of Scotland, August 2023

The association of deprivation with drug misuse deaths is much greater than with other causes of death. In 2022, people in the most deprived areas of Scotland were almost 16 times more likely to die from drug misuse compared to people in the least deprived areas. This aspect of drug deaths is addressed in more detail as part of the headline metric for outcome 5 (Quality of life is improved by addressing multiple disadvantage).

Despite this recent decrease, drug deaths in Scotland also remain at a high level compared to the rest of the UK, and much more common than they have been in the past. In 2021 (the most recent year for which comparable data are available), the rate of drug poisoning deaths in Scotland was 2.7 times as high as the UK average. There were 3.7 times as many drug misuse deaths in 2022 than in 2000.

4.4 Discussion

Drug deaths are lower than at the start of the National Mission but remain at a high level. Future work could consider the feasibility of capturing monitoring data to inform the ambition to ‘improve lives’.

While the number of drug misuse deaths is lower than at the start of the National Mission it remains at a high level. The fall in drug deaths in 2022 was the largest year on year decrease. However, more recent suspected drug death data^[3],[4] show that, following a downward trend from early 2021 to late 2022, suspected drug deaths have increased over recent quarters. Harms caused by established drugs such as heroin, diazepam, and cocaine continue to exist, but new and emerging drugs such as synthetic opioids^[5] and new benzodiazepines^[6] will likely continue to form a greater part of Scotland’s drugs market and thus pose higher risk to people who use drugs.^[7]

The harms associated with drug use also affect different groups of people in various ways. While males continue to bear the burden of drug mortality, recent trends differ between the sexes and the decrease in drug deaths in 2022 was far greater in males than in females. Males were twice as likely as females to have a drug misuse death in 2022 but this gap has narrowed in recent years (during the early to mid-2000s, males were around four times as likely to have a drug misuse death as females) and drug deaths among females are decreasing at a slower rate compared to males. Drug deaths also continue to be most common among people aged between 35 and 54 years, people from the most deprived areas, and people living in Scotland’s cities.

Finally, while robust data exist to measure progress towards reducing drug deaths, measuring the improving lives aspect of the National Mission is more challenging. Future work could consider the feasibility of capturing monitoring data to inform whether the lives of people affected by drugs – people who use drugs, their families, friends and communities – are improving.