Trends in Mortality From Novel Psychoactive Substances as “Legal Highs”: Gender Differences in Manner of Death and Implications for Risk Differences for Women

Abstract

IntroductionThis study aimed to examine drug-related deaths in the UK in which novel psychoactive substances (NPS) are an implicated substance, and to focus on female deaths in comparison with male deaths. While male overdoses dominate epidemiological statistics, there is an increase in female drug-related deaths and a narrowing of the gap between gender mortality rates which is to date unexplained.MethodThis study analyzed data from the National Programme for Substance Abuse Deaths (NPSAD) database that records drug-related deaths in the UK from coronial records. A dataset was constructed using parameters to capture all drug-related cases during the period 2007–2017 when NPS were legal and highly available in the UK, in order to capture deaths recorded among both regular and occasional drug users, and to include all cases recorded during that period regardless of NPS status in order to make comparisons. The final dataset comprised 10,159 cases, with 456 NPS-related deaths. Data for NPS and non-NPS were compared, and comparisons were made between cohorts by gender. The dataset also includes coronial narrative notes which allowed a qualitative analysis of NPS female deaths to add contextual explanation.ResultsThe proportion of male NPS deaths is significantly higher than that for female NPS deaths but does not reflect the generalized difference between male and female drug-related mortality of this period studied. Demographic and outcome data by gender difference were significant for all drug-related deaths, but not for NPS-only deaths, indicating a greater homogeneity among NPS deaths by gender. Older women using NPS were more likely to have methadone or diazepam as another drug implicated and have established histories of drug misuse.ConclusionWhere NPS have been used, differences in drug death profiles are less likely to be accounted for by gender than other demographic or behavioral differences more typically found in opiate deaths. The social and health problems of older women may be key characteristics that differentiate female deaths from male deaths. These findings also support evidence of increasing uptake of NPS among older established drug users that adds further risk to polydrug use.

The Use of Premixed Drugs in Commodity Packets in the Population: Prevalence and Correlates Revealed by the 2018 National Survey of Substance Use in Taiwan

“…It is noteworthy that diminishing gender differences have also been reported in the use of other illicit drugs, such as cannabis among the Japanese general population, 15 party drugs among Dutch university students, 17 heroin and opioid analgesics in the United States over the past decade, 31 , 32 and NPS-related deaths in the United Kingdom. 33 Similar trends were also found in problematic alcohol use in Taiwan 34 and other East Asian countries. 35 , 36 Whether changes in gender roles were associated with the phenomenon of gender convergence in various substance uses warrants future investigation.…”

Effects of the Phenethylamine 2-Cl-4,5-MDMA and the Synthetic Cathinone 3,4-MDPHP in Adolescent Rats: Focus on Sex Differences

“…Knowledge of the pharmacological effects of new emerging drugs is, therefore, essential to managing the clinical symptoms of intoxicated patients presenting at emergency centers. Notably, differences started being reported in the use [ 11 ] and effects [ 12 , 13 ] of NPSs in males and females, with women using NPSs in association with illicit and/or over-the-counter drugs more than men [ 14 ]. Preclinical studies confirmed significant sex-dependent differences in the action of novel cathinones [ 15 ] and phenethylamines [ 16 ] on the brain, in line with the vast literature reporting important sex (in animals) and gender (in humans) differences in drug addiction [ 17 ] and in other addictive behaviors [ 18 ].…”