2016年连续第三年看到了苏格兰有史以来记录的毒品相关死亡人数最多。在那年，有867人丧生毒品。这相当于2015年增长23％，是十年前死亡人数的两倍以上（2006年421个）。自1990年代以来，利率一直在上升，相对于西欧其他地区，它们继续为苏格兰总体上更高的死亡率做出贡献。
从1980年代开始，仅与剥夺的关联可以解释这种更高的死亡率。有人提出，这可能是因为1980年代的社会，经济和政治环境造成了延迟的负面影响。确实，我们发现trends in suicide in Scotland, which also rose in the 1990s.
自1960年至1980年左右出生的人确实经历了较高的与毒品有关的死亡风险，自1990年代以来，风险最高的群体是生活在最贫困地区的男性。
我们知道证据that problem drug use is related to social circumstances, with job loss, poverty, Adverse Childhood Experiences and trauma all being factors. We therefore set out to determine whether Scotland’s trend in drug-related deaths could be explained by a group of people who were young adults of working age in Scotland and had been exposed to the changing social, economic and political contexts of the 1980s.
我们的研究今天发表在BMC Public Health, suggests that this is likely to be the case. Those born between around 1960 and 1980 did experience a higher risk of drug-related deaths since the 1990s (when they were working age), and the group at highest risk were males living in the most deprived areas. The impact of this effect can be seen over the years as this group of people get older, carrying their greater risk of drug-related death with them.
我们的发现表明，社会和经济政策的结合导致收入不平等迅速增加，失业率增加，住房不足，就业状况不佳和负面社会环境，对健康产生严重后果，并可能考虑更高的风险这一代人与毒品有关的死亡。
Supporting this group
So, what of the people who were subject to these past policies, who are older now, and who carry an increased risk of drug-related death? It is paramount that they have available to them additional support to take account of the impact that these circumstances have had.
The full impact of the excess mortality in the generation with high drug-related deaths is unlikely to be known for some time. But we know it already represents the deaths of hundreds of people prematurely; half of the current estimated population of 61,500 people in Scotland with drug problems is over 35 years old (considered to be older drug users) and older drug users accounted for almost three quarters (71%) of drug–related deaths in 2016.
As this group of people continues to age, drugs services will need to adapt to their needs.
随着这群人的持续年龄，由于与衰老和吸毒相关的慢性病的合并症变得更加普遍，因此毒品服务将需要适应他们的需求。例如，据估计，长时间有问题的药物使用增加了大约15年的额外生理健康损害。Arecent studyalso found that older people with drug problems report experiencing stigma, loneliness and isolation. These act as barriers to seeking support and accessing services, preventing individuals from addressing the harms they experience.
有必要专门量身定制或适应，以及设计服务，以满足该组的独特医学，心理和社会需求，例如住房，社会保障和支持服务。
What does this mean for current drugs policy for Scotland?
至关重要的是，我们应该从过去学习，并告知当前和未来的政策，以防止进一步的一代人在苏格兰面临与毒品有关的死亡风险更大的风险。
Problem drug use disproportionately affects people who experience socio-economic disadvantage. It is clear that social and economic policy has the potential to either improve, or harm health. On that basis, NHS Health Scotland believes that policy to reduce harm from drug use must take account of the wider things that impact on our health, like housing, work, income and social connectedness – thesocial determinants of health。
这是一种提高健康和减少的方法health inequalitiesfirst, takes a non-punitive harm reduction approach to recovery, offers low-threshold services, tackles associated stigma and responds to individual need as well as addressing broader socio-economic circumstances that increase individuals’ vulnerability to problem drug use.
解决这些更广泛的社会不平等和减少贫困，将有助于在预防药物滥用和减少相关危害方面发挥重要作用。正如研究表明，对于许多没有这样做的社会政策的人来说，预防为时已晚。但是，它还表明，我们可以采取行动来减少伤害并防止该小组中的更多死亡，并采取行动确保未来的社会和经济政策改善了健康，并减少了健康不平等，以防止重复影响。关于1980年代的一代。
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