1. Drug-related deaths in England: latest data Martin White, Alcohol, Drugs and Tobacco Division, Public Health England

2. Headline figures and notes around data Drug-related deaths in England have increased by 16% between 2012 and 2013, following several years of decreases Drug misuse deaths have increased by 21% (1,492 to 1,812), and account for the large majority of the increase in drug-related deaths ONS have refreshed the drug misuse deaths data series historically to take into account additions to controlled substances (in particular tramadol), but this has little effect on overall trend Main driver of overall increase is a jump in heroin deaths – accounts for 58% of total increase in drug misuse deaths 2Drug-related deaths in England: latest data

3. Headline figures 3Drug-related deaths in England: latest data

4. Opioid deaths 4Drug-related deaths in England: latest data Published data refers to five types of opioid – large increases for three As in previous years, the most mentioned drug on death certificates was heroin – 32% increase in 2013 (579 to 765) – following two years of reduced numbers Significant increase in codeine deaths (from 73 to 130) Tramadol deaths continue to increase – up from 175 in 2012 to 220 in 2013 Deaths where ‘other opiates’ mentioned rose from 172 to 237 – this is likely not to be other opiates in the main but rather unspecified, i.e. just ‘opiate’

5. Opioid deaths 5Drug-related deaths in England: latest data

6. Other substances 6Drug-related deaths in England: latest data Mentions of benzodiazepines on death certificates increased in 2013 by 20% (from 284 to 342) – however benzos usually mentioned with an opioid Cocaine deaths increased by 22% in 2013, following a similar increase in 2012, but following an earlier decline Amphetamine deaths have increased in the last two years, having fallen beforehand – this is mainly explained by increases in MDMA deaths and a series of deaths involving PMA NPS deaths increased slightly in 2013 but remain relatively low – definition includes GBL

7. Other substances 7Drug-related deaths in England: latest data

8. Gender and age 8Drug-related deaths in England: latest data The jump in 2013 is as a result of a jump in drug misuse deaths among men – deaths among women have also increased but this follows a general upward trend

9. Gender and age 9Drug-related deaths in England: latest data Drug misuse deaths in England and Wales have increased in 2013 in all age groups except the oldest and youngest

10. Underlying cause of death 10Drug-related deaths in England: latest data Although intentional self-poisonings classed as drug misuse continue to increase, the jump in 2013 is due to an increase in accidental poisonings

11. Regional variation 11Drug-related deaths in England: latest data All regions saw increases from 2012 to 2013, with the greatest in the South East (statistically significant) and West Midlands and relatively little in the North West

12. Summary and further considerations 12Drug-related deaths in England: latest data Large increase in 2013 – may or may not represent a change in trend but statistically significant (i.e. beyond ‘noise’) Published data from ONS points towards the sudden jump being driven by accidental poisonings, with heroin as the main drug mentioned, among men, replicated across age groups and across regions However, the published data is limited in terms of testing theories about the causes of the increase as we cannot cross-reference between tables or with treatment data For this reason, and also in order to match with treatment data to establish timing of death in relation to treatment, PHE are working with ONS to get row-level data for 2013 – we expect to have this fairly soon