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General Register Office

The General Register Office (GRO) registers and codes a death as it receives the death certificate.
There are several things that can hold up the registration and subsequent coding of a drug-related death. For example, if the cause of death is unknown or if the death is drug-related, it must be referred to the coroner. Sometimes it is clear that the death resulted from a drug-related suicide, eg an overdose, or it may have been caused accidentally. The coroner will decide if there should be an inquest or criminal investigation. The criminal investigation would then take precedence over the inquest, which would hold up registration of the death. Also, if a person dies towards the end of the year, his/her death may not be recorded until the following year. This would affect death trends.

There is normally a 12 month time lag before a drug-related death is published in the Registrar General's annual report. This is the length of time it takes for all the inquests to be held and the deaths registered so that coding can occur.

The Annual Report of the Registrar General, 2004 is available at: www.nisra.gov.uk/archive/demography/publications/annual_reports/2004/RG2004.pdf

Difficulties associated with classifying drug-related deaths

There are many difficulties associated with classifying drug deaths, which means that the statistics produced need to be interpreted with caution. One of the key difficulties relates to the definition of drug-related deaths, since deaths involving drugs may occur under a range of different circumstances, with varying social and policy implications. For example, the deceased may be a long-term addict or an occasional recreational user; the drugs involved may be controlled drugs, prescribed substances or a mixture; the death may be due to direct, indirect or long-term effects of drug use, or it may be an accident, suicide or possibly homicide. It is not always possible to make these distinctions from the information available from death registers.

Additional complications arise when quantifying deaths due to specific drugs, as many deaths involve more than one drug, often in combination with alcohol.

UK Focal Point compiles and supplies data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and further information on the definitions of drug-related deaths is available from their website at www.ukfocalpoint.org.uk.

Definitions of drug-related death

All deaths worldwide are recorded using what is known as the International Classification of Disease (ICD) list, where cause of death is placed in various categories. Prior to 1 January 2001, cause of death was recorded using ICD-9 codes. This system has been replaced by ICD-10 coding, which includes an extra 13,000 codes, thus helping to code the reason for death more accurately. Northern Ireland now uses the same codes as England, Wales and Scotland (ICD-10), though Scotland has been coding with ICD-10 since January 2000.

Office for National Statistics and definition of drug-related death

The following figures highlight the number of drug-related deaths as defined by the Office for National Statistics (ONS). This definition considers deaths from drug poisoning using ICD-10 codes. This is a broad definition, covering anything from heroin to aspirin, and volatile substances.

Drug-related deaths for Northern Ireland by gender along with comparisons for Scotland, England and Wales – ONS definition, 1990-2004

UK drug strategy definition of drug-related death

Following a report by the Advisory Council on the Misuse of Drugs (ACMD) in 2000, a technical working group was set up to agree a consistent coding framework for drug-related deaths in England, Wales, Scotland and Northern Ireland.¹ This definition is narrower than the traditional ONS definition. It uses ICD-10 codes but also gives consideration to the status of the drug as outlined in the Misuse of Drugs Act (1971), ie "Deaths where the underlying cause is poisoning, drug abuse or drug dependence and where any of the substances controlled under the Misuse of Drugs Act (1971) are involved".

Specific rules have been adopted for painkillers that may contain small quantities of those drugs listed under the Misuse of Drugs Act, eg dextropropoxyphene, dihydrocodeine and codeine.
Where these drugs are mentioned on a death record, they are excluded from figures relating to drug-related deaths if they are part of a compound, such as a cold remedy. Dextropropoxyphene is always excluded as it is rarely, if ever, available other than as part of a paracetamol compound. However, deaths occurring where the presence of codeine or dihydrocodeine are mentioned, are included within figures relating to drug-related deaths, as these drugs are routinely available and known to be abused.

Drug-related deaths for Northern Ireland and the rest of the UK (UK drug strategy definition), 1994-2004

European Monitoring Centre for Drugs and Drug Addiction General Mortality Register of Drug-Related Deaths definition of drug-related death

The European Monitoring Centre for Drugs and Drug Addiction General Mortality Register of Drug-Related Deaths (EMCDDA DRD) considers the same underlying causes as the UK drug strategy definition, but is even narrower as it includes only deaths due to typical drugs of abuse - eg opiates, cocaine, amphetamines, cannabis and hallucinogens - but excludes psychoactive medicines. Figures for Northern Ireland can be seen in the following table along with the two previous definitions outlined above.

Comparison of Northern Ireland drug-related deaths by definition, 1985-2004

* Figures for Northern Ireland for recent years are subject to upward revision as the outstanding backlog of coroner's inquests dating back several years is reduced.

References

1. The Advisory Council on the Misuse of Drugs. Reducing drug-related deaths. Home Office, 2000.