title: Missing targets on drugs-related deaths, and a Scottish paradox.
abstract: The 10-year drug strategy for England and Wales was published in February 2008. It dropped drugs-related deaths (DRDs) as a key performance indicator. Scotland retained a necessary strong focus on DRDs. Scotland's DRDs numbered 1006 in 2000-02 and 1009 in 2003-05. The previous Scottish administration's claim that its number of current injectors had decreased substantially between 2000 and 2003 implied, paradoxically, that their DRD rate would have to have increased. Worse was to come: Scotland's DRDs had increased to 876 in 2006+2007. We analyse UK's DRDs by sex and age-group to reveal temporal trends (2000-02 versus 2003-05 versus 2006+2007) with different public health and epidemiological implications. We also address the above Scottish paradox and assess, by age-group, how consistent Scotland's 876 DRDs in 2006+2007 are with Scottish injectors' DRD rate in 2003-05 of around 1 per 100 injector-years. Public health success in the UK in reducing DRDs at younger ages should not be overshadowed by the late consequence in terms of older-age DRDs of UK's injector epidemics; in the early 1980s in Scotland, and late 1980s in England and Wales. Targets for reducing DRDs should pay heed to UK's injector epidemics.
authors.affiliation: MRC Biostatistics Unit, Medical Research Council, Robinson Way, Cambridge, England G1 1XH, United Kingdom. sheila.bird@mrc-bsu.cam.ac.uk
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Bird
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
authors.forename: Gordon
authors.initials: G
authors.lastname: Hay
authors.forename: Ruth
authors.initials: R
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002423:Cause of Death / Q000639:trends*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000401:mortality*; D014852:Wales / Q000453:epidemiology