title: Mortality related to novel psychoactive substances in Scotland, 2012: an exploratory study.
abstract: BACKGROUND
  The growth of novel psychoactive substances (NPS) over the last decade, both in terms of availability and consumption, is of increasing public health concern. Despite recent increases in related mortality, the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level remain relatively unknown.
  
  
  METHODS
  The Scottish National Drug Related Death Database (NDRDD) collects a wide-range of data relating to the nature and circumstances of individuals who have died a drug-related death (DRD). We conducted exploratory descriptive analysis of DRDs involving NPS recorded by the NDRDD in 2012. Statistical testing of differences between sub-groups was also conducted where appropriate.
  
  
  RESULTS
  In 2012, we found 36 DRDs in Scotland to have NPS recorded within post-mortem toxicology. However, in only 23 of these cases were NPS deemed by the reporting pathologist to be implicated in the actual cause of death. The majority of NPS-implicated DRDs involved Benzodiazepine-type drugs (13), mainly Phenazepam (12). The remaining 10 NPS-implicated deaths featured a range of different Stimulant-type drugs. The majority of these NPS-implicated deaths involved males and consumption of more than one drug was recorded by toxicology in all except one case. NPS-implicated deaths involving Benzodiazepine-type NPS drugs appeared to involve older individuals known to be using drugs for a considerable period of time, many of whom had been in prison at some point in their lives. They also typically involved combinations of opioids and benzodiazepines; no stimulant drugs were co-implicated. Deaths where stimulant-type NPS drugs were implicated appeared to be a younger group in comparison, all consuming two or more Stimulant-type drugs in combination.
  
  
  CONCLUSIONS
  This exploratory study provides an important insight into the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level. It identifies important issues for policy and practice, not least the prominent role of unlicensed benzodiazepines in drug-related mortality, but also the need for a range of harm reduction strategies to prevent future deaths.
authors.affiliation: NHS Health Scotland, Public Health Science Directorate, Meridian Court, Glasgow G2 6QE, Scotland, UK. Electronic address: andrew.mcauley@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: McAuley
authors.affiliation: NHS National Services Scotland, Information Services Division, Gyle Square, Edinburgh EH12 9EB, UK.
authors.forename: Garry
authors.initials: G
authors.lastname: Hecht
authors.affiliation: NHS National Services Scotland, Information Services Division, Gyle Square, Edinburgh EH12 9EB, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Barnsdale
authors.affiliation: NHS National Services Scotland, Information Services Division, Gyle Square, Edinburgh EH12 9EB, UK.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Thomson
authors.affiliation: NHS National Services Scotland, Information Services Division, Gyle Square, Edinburgh EH12 9EB, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Graham
authors.affiliation: NHS Greater Glasgow & Clyde Addiction Services, Glasgow G22 5AP, UK.
authors.forename: Saket
authors.initials: S
authors.lastname: Priyadarshi
authors.affiliation: University of Edinburgh, Centre for Population Health Sciences, Medical School, Teviot Place, Edinburgh EH8 9AG, UK; Muirhouse Group Practice, 1 Muirhouse Avenue, Edinburgh EH4 4PL, UK.
authors.forename: J Roy
authors.initials: JR
authors.lastname: Robertson
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000009:adverse effects; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects; D012606:Scotland / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000401:mortality*
chemical_list: D011619:Psychotropic Drugs; D001569:Benzodiazepines; C017928:phenazepam
keywords: Drugs; Mortality; Novel psychoactive substances; Overdose