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The role of substance use in non‐drug related deaths: a cross‐sectional study of drug treatment clients in the North West of England

Aims: (1) To identify all causes of death in a cohort of known problematic drug users; (2) to quantify the number considered drug‐related in accordance with the UK Drug Strategy definition; (3) to identify the possible role of substance use in the residual causes of mortality. Design: Cross‐sectional. Setting: North West of England, UK. Participants: All problematic drug users in contact with structured treatment services in 2003–2004. Measurements: All causes of mortality were identified from death certificates. Mann–Whitney U and chi‐squared tests were used to explore differences in subgroups (alive, drug related deaths (DRD), non‐DRD) by age and sex, respectively. Findings: Of 27,810 individuals, 103 (0.4%) were confirmed dead. Of the 102 for whom cause of death was available, 72 (70.6%) deaths were classified as non‐drug related. In addition to individual causes such as cellulitis, these non‐drug related deaths included 16 from infection (seven from pneumonia), seven from alcohol related liver disorders and seven suicides. Those dying from non‐DRDs were significantly older than those dying of DRD (p = 0.004). Conclusions: A considerable proportion of deaths classified as non‐drug related are the likely result of substance use, particularly through infection.