Comparison of Office for National Statistics (ONS) and National Programme on Substance Use Mortality (NPSUM) data suggests that opioid-related deaths in England & Wales have been systematically underestimated

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-08-30 DOI:10.1016/j.drugpo.2025.104976

Shuoqi Chen , David Mais , Caroline S. Copeland

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引用次数: 0

Abstract

Background

In 2023, the Office for National Statistics (ONS) attributed 46.8 % of fatal drug poisonings in England and Wales to opioids. However, this figure likely underrepresents the true scale of opioid-related deaths, as ONS cannot identify opioid involvement when ambiguous causes (e.g., multidrug toxicity) are used. This study used ONS and National Programme on Substance Use Mortality (NPSUM) data to provide a more comprehensive estimate of opioid-related deaths in England and Wales from 2011–2022.

Methods

Deaths were identified as opioid-related by ONS and NPSUM where opioids were explicitly named as a cause. Further cases with ambiguous causes were identified by NPSUM as opioid-related by referring to the accompanying toxicology report.

Findings

ONS has increasingly underestimated opioid-related deaths. In 2011, 574 heroin/morphine-related deaths were identified by ONS; while the estimated number was 813 (95 % CIs 765–866), reflecting a 29 % underestimate. By 2022, the underestimate had extended to 36 % (1264 deaths identified by ONS; estimated number 1980 [95 % CIs 1894–2074]). This correlates with increasing polypharmacy (median number of co-administered drugs: four in 2011, six in 2022, ρ=0.81). Similar trends were observed for other specific opioids for which ONS data were available: methadone, dihydrocodeine, codeine, tramadol, and fentanyl.

Conclusions

Increasing polydrug use in England and Wales is likely leading to the use of ambiguous drug-related causes of death instead of every drug being individually named, resulting in an underestimation of opioid-related deaths. This discrepancy has significant implications for funding, policy and public health initiatives aimed at addressing the UK’s escalating opioid-related death crisis.

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国家统计局（ONS）和国家药物使用死亡率方案（NPSUM）数据的比较表明，英格兰和威尔士与阿片类药物有关的死亡被系统地低估了

2023年，英国国家统计局（ONS）将英格兰和威尔士46.8%的致命药物中毒归咎于阿片类药物。然而，这一数字可能低估了阿片类药物相关死亡的真实规模，因为当使用不明确的原因（例如，多药物毒性）时，国家统计局无法确定阿片类药物的参与。本研究使用了国家统计局和国家物质使用死亡率计划（NPSUM）的数据，对2011-2022年英格兰和威尔士与阿片类药物相关的死亡进行了更全面的估计。方法：由ONS和NPSUM确定与阿片类药物相关的死亡，其中阿片类药物被明确命名为原因。NPSUM通过参考随附的毒理学报告，确定其他原因不明的病例为阿片类药物相关。调查结果越来越低估了阿片类药物相关的死亡。2011年，国家统计局确定了574例与海洛因/吗啡相关的死亡；而估计的数字是813 (95% ci 765-866)，反映了29%的低估。到2022年，被低估的人数已扩大到36%（国家统计局确定的死亡人数为1264人；估计的死亡人数为1980人[95% ci 1894-2074]）。这与多重用药的增加相关（共同用药的中位数：2011年为4种，2022年为6种，ρ=0.81）。其他可获得国家统计局数据的特定阿片类药物也有类似的趋势：美沙酮、二氢可待因、可待因、曲马多和芬太尼。结论：在英格兰和威尔士，越来越多的多种药物使用可能导致使用模棱两可的药物相关死亡原因，而不是每种药物单独命名，导致阿片类药物相关死亡人数被低估。这一差异对旨在解决英国不断升级的阿片类药物相关死亡危机的资金、政策和公共卫生举措产生了重大影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.