NEW YORK (Reuters Health) - Mortality rates in Scotland are substantially higher than they are in England and Wales - the so-called "Scottish effect." New research suggests that loss of life related to problem drug use accounts for a significant portion of the higher death rate.
Official reports of drug-related deaths in Scotland are limited to deaths directly related to the pharmacological effect of an illicit drug, Dr. Michael Bloor and co-investigators explain in their report, published online by the British Medical Journal.
To more accurately estimate the drug-related mortality, Bloor at the University of Glasgow and co-investigators analyzed data from the Drug Outcomes Research in Scotland (DORIS) study, including "deaths that embrace not just overdoses from illicit drugs but also deaths from blood-borne infections, from violent assaults, from suicides, and from other events associated with drug use."
The 1,033 study participants, ages 15 to 54 years, comprise roughly 1 in 11 of the drug users who entered treatment in Scotland in 2001.
Over 33 months of follow-up, 38 subjects died. Only 22 deaths were officially classified as drug-related. Causes of the remaining 16 deaths included suicide, endocarditis and other infections associated with drug abuse, assaults, alcoholic liver disease, and hypothermia. The cause of one death was unknown.
The investigators note that four deaths were due to overdoses of paracetamol, amitriptyline, colchicine, and a combination of fluoxetine and propranolol.
The ratio of actual deaths to expected deaths for the DORIS participants was 1244, Bloor and his group report, 12-times higher than in the general population of Scotland.
They also estimate that 32 percent of the excess Scottish mortality is related to the greater prevalence of problem drug use in Scotland compared with England.
"Successful public health efforts to reduce the prevalence of problem drug use in Scotland or deaths in Scottish drug users would have a dramatic impact on overall mortality," the investigators conclude.
SOURCE: British Medical Journal, July 23, 2008.
