By Emily Tweed, with Rebekah Miller and Catriona Matheson

Drug-related deaths have increased significantly in Scotland in recent years. Although men still account for the majority of cases, over the last 10 years the percentage increase in deaths among women has been much greater than among men. This report draws on routine data, published research, conversations with professional stakeholders, and interviews with women with lived experience of problem drug use to examine potential explanations for this phenomenon, and to identify priority areas for future work. The evidence reviewed as part of this project indicates that the observed trend is likely to reflect multiple, interacting causes. Most data sources indicate that the number of women in Scotland with problem drug use is declining, suggesting the increase in deaths is unlikely to be due to an increase in the size of the population at risk. However, some concerns were raised about a potential group of people at risk who may be less likely to be identified through existing routine data sources and by clinical services, particularly older women using prescription drugs: this possibility may merit further investigation. The same data sources indicate that the average age of people who use drugs in Scotland is increasing, and there is some evidence that this trend might be more marked among women than men. Some studies have found that the increase in drug-related death risk associated with increasing age may be more pronounced among women than among men, which may contribute to the rising rates of deaths observed.