Substance misuse-related poisoning deaths, England and Wales, 1993–2016

Abstract

In recent years there has been an increase in the availability of 'novel psychoactive substances (NPS)' or 'legal highs'. In turn, there is concern as to the risks these compounds pose as compared to those posed by traditionally misused substances such as illicit diamorphine (heroin), methadone, cocaine, and amfetamines. Methods: We reviewed deaths where opiates/opioids, stimulants, hypnosedatives, hallucinogens, or volatile substances were mentioned on the death certificate in England and Wales, 1993-2016 as recorded on the Office for National Statistics drug poisoning deaths database. Deaths were analysed by year of registration of death, age, sex, intent, drug(s) involved, and the presence of alcohol (ethanol). Results: There were 68,347 drug-related deaths in England and Wales (includes both licit and illicit substances), of which 15,457 were either coded as, or had mention of, drug dependent/non-dependent substance abuse on the death certificate. Opioids, particularly diamorphine/morphine and methadone, featured in most deaths. Diamorphine/morphinerelated deaths (17,402) increased from 155 in 1993 to 981 in 2001, and then remained relatively stable until 2010 (791). Thereafter, annual numbers of deaths fell to 579 in 2012, but have since increased to 1,209 (2016). Deaths in the age group 20-29 years declined from 46% (1993), to 13% (2016), whereas in those aged 40-49 years the percentage of deaths increased from 13% (1993) to 33% (2016). Methadone was mentioned in 7,894 deaths (1993-2016). Annual numbers of such deaths increased from 206 to 437, 1993-7, then declined, but have since increased, reaching 413 in 2016. As to age, a similar pattern as to diamorphine/morphine-related deaths is apparent. Annual numbers of deaths involving cocaine

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Are we repeating mistakes of the past? A review of the evidence for esketamine

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