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Professor John Robertson OBA
I know we've covered this before, including by reader JB, but I think we need something more short, direct and easy to grasp.
If we accept the published data, there remains a significant gap with drug misuse deaths in Scotland still around twice the level in England and Wales, on average, but the rates are converging fast as they fall in Scotland but climb in England and Wales.
We may however, have reason to doubt the comparability of the rates, with England, and with Europe. More on this below.
In Scotland, in 2024, there were 1,017 drug misuse deaths registered in Scotland, a rate of 184.9 per million population. This is a reduction from 213.1 per million in 2023. There were 271 deaths per million males and 116 deaths per million females in 2024.
https://www.nrscotland.gov.uk/publications/drug-related-deaths-in-scotland-2024/
In England and Wales in 2023 (latest figures) there were 93 per million drug misuse deaths registered. There were 124.3 per million males and 58.8 per million females, climbing from 112 and 41.5 the previous year.
There is, not surprisingly, across England, some variation with 240 males per million dying in the North East of England in 2023, getting close to the Scottish figure of 271 and climbing fast from 197.9 in 2022.
Why might the above data for England and Wales be a significant underestimate?
In August 2023, UK Civil Service researchers revealed that 25.1% of drug-related deaths registered in England and Wales had no information on the specific substances involved and that in most cases a death cannot be called a drug misuse death when no information on the specific substances is known or provided. The equivalent figure in Scotland was only 1.9%. Because of this, figures for drug misuse are underestimates. This means shockingly the ratio per million for England and wales might really be 25.1% higher than the published 93 per million, or around 116 per million much closer to the Scottish rate of 184.9 and closing the gap.
The rate for males in the North East of England would then be 300, surpassing the rate of 271 to 280 in Scotland.
Why might the data for Europe also be a significant underestimate?
As JB has helpfully pointed out, the European Drug Agency in 2023 has reported that not all deaths where a drug was present are counted as drug deaths and consequently ‘overall numbers must be understood as underestimations.’
He concludes:
So no standardised methodology seems to be used to collect drug deaths data across Europe, therefore how many European countries, just like they do in England, are underestimating their statistics, and by how much?
We’ve seen above the figure of a 25% underestimation in England and Wales. While there is no EU figure reported, JB does find the suggestion there that, in Spain only 4 in 5 cases might be reported, so a similar underestimate figure of around 20%.
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