The Drug crisis in Scotland (also known as the Drug deaths crisis or drug epidemic) is a ongoing crisis regarding mortality rates over drug related/misuse deaths in the country. Drug related deaths started to rise during the 1980s. From 2015 onwards the mortality rate of drug misuse deaths in Scotland has increased rapidly, prompting calls of a 'national emergency' within the country over the crisis. [2] [3] [4] [5]
Drug related (or misuse) mortality rates have begun to rise in Scotland since the 1980s. [6] A variety of factors can be considered to be behind the beginning of the epidemic; Neo-liberal economic restructuring in the 1980s caused parts of large cities in Scotland to go into terminal decline causing income inequality to rise and increased inner city deprivation with the working-class population particularly affected. [7] [8] [6] An additional factor of heroin markets from Afghanistan and Iran becoming more easy to access and smuggle into Europe in the 1980s made the drug more accessible and affordable then ever. [8] In the early-1990s, those born in the late-1970s, termed as the 'Trainspotting generation', began to enter the labour market. High unemployment and especially in deprived areas is generally seen as the hypothesis of increased drug use within this generation, having been exposed to the phenomenon during the 1980s. [7] [6]
Since 2015, mortality rates have dramatically increased, doubling from their previous numbers a decade ago. [7] A factor of this can traced to the more recent ageing of the so called 'Trainspotting generation' [7] (those who grew up in the 1980s and 1990s) which has given rise to increased mortality rates. [8] [9] Funding cuts in 2016 by the Scottish Government reduced drug and alcohol prevention services funding by 20%, however by 2019 this had been restored. [8] Additional reasons may be related to the failings of the UK's drug policy due to drug policy not being a devolved policy issue within Scotland. [8]
Scottish mortality rates to drug misuse and related deaths are the highest in Europe, [10] and higher than the United States. [11] [8] This rate is 3.5 times higher than England and Wales. [7] [10]
City council areas have a higher mortality rate than predominately rural areas. This is especially poignant in Dundee and Glasgow which have the worst drug-misuse mortality rate in the country (two times higher than the national average). [12] In the City of Edinburgh, Drug related deaths have tripled from the 2000-2004 period to 2016-2020. [13]
Traditionally, Opioids have been the main drug and consist of the majority of drug-related deaths in Scotland when a drug can be implicated. However, since 2015, Benzodiazepines, more prominently street Benzodiazepines, cocaine and gabapentin have risen dramatically in implicated drugs. [14] Street Benzodiazepines account for 72% of drug related deaths, in certain areas of Scotland this figure changes. For example, in the City of Dundee this rises to 82% of deaths implicated. [15]
Men have double the mortality rate to drug misuse then women. Approximately 72% of victims to drug misuse were male in 2019 to 28% females. [9]
35-year-olds to 54-year-olds (this consists of two defined age groups) have the highest mortality rate compared to older and younger generations, [8] this accounts for two-thirds of drug-misuse/related deaths. [10] This feature is different to the United States in which opioid overdoses are from younger users. [8]
People who live in the most deprived areas have a 18 times higher mortality rate then those living in the least deprived areas of Scotland. [15] One in five in Scotland live below the poverty threshold, exacerbating the crisis. [9]
Policy proposals to tackle the crisis have been suggested:
40% of drug users in Scotland are currently in treatment. This figure differs from England where it is around 60%. [8]
Benzodiazepines, colloquially called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, insomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and was made available in 1960 by Hoffmann–La Roche, which followed with the development of diazepam (Valium) three years later, in 1963. By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide.
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Temazepam, sold under the brand name Restoril among others, is a medication of the benzodiazepine class which is generally used to treat severe or debilitating insomnia. It is taken by mouth. Temazepam is rapidly absorbed, and significant hypnotic effects begin in less than 30 minutes and can last for up to eight hours. Prescriptions for hypnotics such as temazepam have seen a dramatic decrease since 2010, while anxiolytics such as alprazolam, clonazepam, and lorazepam have increased or remained stable. Temazepam and similar hypnotics, such as triazolam (Halcion) are generally reserved for severe and debilitating insomnia. They have largely been replaced by z-drugs and atypical antidepressants as first line treatment for insomnia.
A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.
Etizolam is a thienodiazepine derivative which is a benzodiazepine analog. The etizolam molecule differs from a benzodiazepine in that the benzene ring has been replaced by a thiophene ring and triazole ring has been fused, making the drug a thienotriazolodiazepine.
Muirhouse is a housing estate in the north of Edinburgh, the capital of Scotland.
A drug-related crime is a crime to possess, manufacture, or distribute drugs classified as having a potential for abuse. Drugs are also related to crime as drug trafficking and drug production are often controlled by drug cartels, organised crime and gangs. Some drug-related crime involves crime against the person such as robbery or sexual assaults.
The health of the Scottish population is, and has been for many years, worse than that of the English. Life expectancy is the lowest in the UK, at 77.1 for men and 81.1 for women, and one of the lowest in the OECD. The gap between Scotland and England has grown since 1980. Some of this is clearly attributable to economic disadvantage, but the differences in health status are more pronounced that would be expected on that basis. It has often been suggested that the Scottish diet is to blame. This is particularly so in Glasgow and the Glasgow effect has been the subject of some academic study.
An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.
Benzodiazepine overdose describes the ingestion of one of the drugs in the benzodiazepine class in quantities greater than are recommended or generally practiced. The most common symptoms of overdose include central nervous system (CNS) depression, impaired balance, ataxia, and slurred speech. Severe symptoms include coma and respiratory depression. Supportive care is the mainstay of treatment of benzodiazepine overdose. There is an antidote, flumazenil, but its use is controversial.
Benzodiazepine use disorder (BUD), also called misuse or abuse, is the use of benzodiazepines without a prescription and/or for recreational purposes, which poses risks of dependence, withdrawal and other long-term effects. Benzodiazepines are one of the more common prescription drugs used recreationally. When used recreationally benzodiazepines are usually administered orally but sometimes they are taken intranasally or intravenously. Recreational use produces effects similar to alcohol intoxication.
The Glasgow effect is a contested term which refers to the lower life expectancy of residents of Glasgow compared to the rest of the United Kingdom and Europe. The phenomenon is defined as an "[e]xcess mortality in the West of Scotland (Glasgow) after controlling for deprivation." Although lower income levels are generally associated with poor health and a shorter lifespan, epidemiologists have argued that poverty alone does not appear to account for the disparity found in Glasgow. Equally deprived areas of the UK such as Liverpool and Manchester have higher life expectancies, and the wealthiest ten percent of the Glasgow population have a lower life expectancy than the same group in other cities. One in four men in Glasgow will die before his sixty-fifth birthday.
Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. It is used to treat opioid use disorder, and reduces the mortality of opioid use disorder by 50%. It relieves cravings to use and withdrawal symptoms. Buprenorphine/naloxone is available for use in two different forms, under the tongue or in the cheek.
There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. It has been called "one of the most devastating public health catastrophes of our time". The opioid epidemic unfolded in three waves. The first wave of the epidemic in the United States began in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The second wave was from an expansion in the heroin market to supply already addicted people. The third wave starting in 2013 was marked by a steep 1,040% increase in the synthetic opioid-involved death rate as synthetic opioids flooded the US market.
In 2017, 2,503 deaths in England and Wales and 934 in Scotland were recorded as “drug misuse”. Deaths from drugs overtook traffic fatalities in the United Kingdom as a leading cause of death in 2008, and the numbers have continued to rise.
A disease of despair is one of three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic prospects are bleak. The three disease types are drug overdose, suicide, and alcoholic liver disease.
The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.
The United States Centers for Disease Control and Prevention has data on drug overdose death rates and totals. Around 1,106,900 US residents died from drug overdoses from 1968 to 2020, around 932,400 from 1999 through 2020 and around 93,700 in 2020. Of every 100,000 people in 2020 in the US, drugs killed 28. Opioids were involved in around 80,400 of the around 109,200 deaths in 2021. Synthetic opioids other than methadone were involved with 70,601 deaths in 2021. Around 111,000 people died in 2022. Around 108,300 in 2023.
Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.
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