An exploratory study of information sources and key findings on UK cocaine-related deaths

Increased numbers of cocaine-related deaths have occurred since the early 1990s in some European countries, including the UK. Cocaine deaths are difficult to define, detect and record as they are multi-factorial. The European Monitoring Centre for Drugs & Drug Addiction (EMCDDA) undertook research to: describe trends in numbers reported to Special Mortality Registries (SMRs) and General Mortality Registers (GMRs); provide information on demographic and drug-use characteristics of cases; and establish how cocaine deaths are identified and classified. A questionnaire was developed and piloted amongst all 30 EMCDDA Focal Point experts/SMRs; 19 (63%) responded. It asked about data availability, case identification and classification. Nine selected countries provided aggregated data. Here the focus is on UK responses. UK GMRs use cause of death and toxicology to identify cocaine-related (Drug-Related Deaths (DRDs). Categorisation is based on International Classification of Diseases (ICD) codes. SMRs use a wider range of information: toxicology, autopsy, evidence and cause of death. UK respondents distinguish cocaine poisonings from other types of deaths. Apart from cocaine itself, the principal metabolites commonly identified/screened for are: benzoylecgonine, ecgonine methyl ester, cocaethylene and ecgonine. The 2000s saw a generally increasing upward trend in such cases, followed by a decline in 2009. The UK recorded about 2700-2900 deaths during 1998-2012. UK SMR data indicate that during 2005-9 around 74% of deaths occurred in the 25-44 years age-group; mean age = 34, range 15-81 years; 84% of cases were male. Cocaine overdoses account typically for about two-thirds of all reported cases. In these, cocaine alone being mentioned/implicated varies considerably but between 1998-2012 it accounted for 23% of cocaine-related deaths in the UK. . Opioids are involved in most cocaine-related overdose cases (UK 58%), often without a further substance. Cocaine-related DRDs are difficult to monitor and are an important feature of drug-related mortality in Europe and the UK. It is important to examine cases ascribed to ‘general medical conditions’, ‘cardiovascular and other issues’, etc. in more detail. More detailed information needs to be recorded and collated.