Quality information Further information about the quality of drug-related deaths data can be found in the Quality and Methodology Information (QMI) paper (494.7 Kb Pdf).

Mortality metadata Information about the underlying mortality data, including details on how the data is collected and coded are available in the mortality metadata (2.46 Mb Pdf).

Drug poisoning database The figures presented in this bulletin have been produced using a special database of deaths related to drug poisoning. This 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). (103.5 Kb Pdf). 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 (24.1 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" (The Advisory Council on the Misuse of Drugs, 2000). 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 (723.4 Kb Pdf), 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) halucinogens (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) Notes i. 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.

Deaths among people in their 20s and 30s Around 1 in 7 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, (1,275 deaths) and the number of deaths from all causes in this age group (8,725 deaths) for England and Wales in 2014. The number of deaths from all causes, by sex and age is available on the our 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 1.

Cocaine The figure for cocaine in Table 1 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 substances There is no national statistics definition of new psychoactive substances. The following substances have been included in this group in this bulletin: 1-(benzofuran-5-yl)-N-methylpropan-2-amine 1-(Benzofuran-5-yl)-propan-2-amine 1-(Benzofuran-6-yl)-propan-2-amine 2-(1H-Indol-5-yl)-1-methylethylamine 25B-NBOMe 25C-NBOMe 2-diphenylmethylpyrrolidine 4,4’-DMAR 4-Fluoroephedrine 4-Fluoromethcathinone 4-Methoxymethcathinone 4-Methylamphetamine 4-Methylethcathinone 5-EAPB 5F-AKB-48 AH-7921 Alpha-methyltryptamine APB BZP Cathinone Desoxypipradrol Diphenidine Etizolam Flubromazepam Fluoromethamphetamine Fluoromethcathinone GHB Khat MDDA Mephedrone Methiopropamine Methoxetamine Methoxphenidine Methylenedioxypyrovalerone Methylethcathinone Methylone N-Methyl-3-phenyl-norbornan-2-amine Pyrazolam Synthetic cannabinoid TFMPP It is likely that this list will be revised in future as new substances emerge, and we welcome comments on the grouping.

Calculation of mortality rates Mortality rates are presented as deaths per one million population. The mortality rates in Figure 6 are age-specific rates; and those in Figures 3, 4 and 7 are directly age-standardised to the 2013 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. More information can be found on the our website.

Confidence intervals Excel workbooks containing the data used to produce the figures and tables in this bulletin are available to download from the our website. 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.

Revisions The ONS revisions policy is available on our website.

Calculation of registration delays Figure 10 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 was 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). Enquiries should be made to: Mortality Analysis Team, Life Events and Population Sources Division

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Pre-release access 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 2014. 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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