Deaths related to drug poisoning in England and Wales: 2024 registrations

Deaths related to drug poisoning, 2024 registrations

Statistics on deaths related to drug poisoning are mainly based on the year in which the death was registered. This is because of long delays between the date these deaths occur and the date they are registered and received by the Office for National Statistics (ONS). Registration data relate to the previous year, and occurrence data have a lag of an additional year to allow for inquest times. For example, in this release we have published 2024 registrations and 2023 occurrences.

• In England and Wales, 5,565 deaths related to drug poisoning were registered in 2024, the equivalent of 93.9 deaths per million people, and higher than the rate recorded in 2023 (93.0 deaths per million, 5,448 deaths); the age-standardised mortality rate for deaths related to drug poisoning has risen every year since 2012.

• Among males, there were 128.7 drug-poisoning deaths registered per million in 2024 (3,710 deaths), compared with 60.6 deaths per million among females (1,855 deaths).

• Of drug-poisoning deaths registered in 2024, 3,736 were identified as drug misuse, accounting for 63.1 deaths per million people; rates of drug misuse deaths continue to be elevated among those born in the 1970s, often referred to as "Generation X", with the highest rate in those aged 40 to 49 years.

• Just under half of all drug-poisoning deaths registered in 2024 were confirmed to involve an opiate and opioid (47.1%; 2,621 deaths), while 195 deaths involved a nitazene, which is almost four times higher compared with 2023.

• The North East continues to have the highest rates of deaths relating to drug poisoning and drug misuse (167.6 deaths per million people and 107.1 per million, respectively); East of England had the lowest rates for drug poisoning and drug misuse (66.3 deaths per million people and 40.2 per million, respectively).

• In Wales, there were 417 deaths related to drug poisoning registered in 2024; this is the equivalent of 140.4 deaths per million people, which is higher than the rate recorded in 2023 (129.2 deaths per million, 377 deaths).

Deaths related to drug poisoning, 2023 occurrences

Trends in registrations are influenced by how long it takes coroners to register deaths as well as by genuine increases in drug-poisoning deaths. It is therefore important to consider drug-poisoning death occurrences in contrast to the number of registrations. For comparison with previous years, we have used provisional death registration data for 2025 in our occurrence-based numbers for 2023.

• There were 5,019 deaths related to drug poisoning that occurred in England and Wales in 2023 and were registered by the end of March 2025, which is equivalent to a rate of 85.4 deaths per million people; compared with 4,868 deaths that occurred in 2022 and were registered by the end of March 2024 (83.7 deaths per million people).

For future releases in this series, we will use improved statistical methods to produce occurrence estimates, that will account for the long registration times and allow for reliable comparisons between years. 

Provide feedback on terminology

We are seeking feedback from our users on the terminology we use in our drug-related death statistics. This includes our use of the term "drug misuse death". If you have feedback on this terminology or suggestions for improvement, please contact the ONS Population Health Monitoring group.

England and Wales

In England and Wales in 2024, 5,565 deaths related to drug-poisoning were registered; this is the highest number since records began in 1993 and 2.1% higher than in 2023 (5,448 registered deaths). This equates to a rate of 93.9 deaths per million people, higher than in 2023 (93.0 deaths per million people). The rate has increased every year since 2012. It is now over double the rate recorded in 2012 (46.5 deaths per million).

England

In 2024, 5,129 deaths related to drug poisoning were registered. This equated to a rate of 91.1 deaths per million people, higher than in 2023 (90.8 deaths per million, 5,053 deaths)

Wales

In 2024, 417 deaths related to drug-poisoning were registered. This equates to a rate of 140.4 deaths per million people, higher than in 2023 (129.2 deaths per million, 377 deaths)

Males accounted for two-thirds of registered drug poisonings in 2024 (3,710 male deaths compared with 1,855 female deaths), which is consistent with previous years.

Rates of drug-misuse deaths have continued to increase

Deaths classified as drug misuse must meet one or both of the following conditions:

• the underlying cause is drug abuse or drug dependence

• any of the substances involved are controlled under the Misuse of Drugs Act 1971

This definition of a drug misuse death was established by the Advisory Council on the Misuse of Drugs (ACMD) cross-UK working group in 2000. It is used consistently across UK statistics producers to distinguish these deaths from other categories, such as drug-poisoning or drug-induced deaths.

Information on the specific drugs involved in a death is not always available, therefore figures on drug misuse are often underestimated. The proportion of drug-related deaths for which the Office for National Statistics (ONS) holds no information on the specific substances involved has been increasing over time. As such, caution is advised in the interpretation of these statistics. For more information on the issue of missing data, please see our blog post on the comparability of UK drug-related death statistics.

Of the 5,565 registered drug-poisoning deaths in 2024, 3,736 were identified as drug misuse, accounting for 67.1% of all drug poisonings.

If we exclude the 1,192 deaths where no information was available on the drug or drugs involved, the proportion of drug-poisoning deaths related to drug misuse rises to 85.4%.

The rate of deaths relating to drug misuse in 2024 was 63.1 deaths per million people. Among males, the rate was 91.2 deaths per million, with 2,635 registered deaths. Among females, the rate was 36.2 deaths per million, 1,101 registered deaths.

Drug misuse deaths by age

In 2024, the highest rate of drug misuse deaths was found among those aged 40 to 49 years (146.6 deaths per million people). This group is part of the age cohort often referred to as "Generation X", born between the late 1960s and early 1980s, who have consistently had the highest rates of drug misuse deaths for the past 25 years, as explained in our 2019 article.

The average age at death for drug misuse deaths in 2024 was:

• 45.5 years for males

• 48.5 years for females

The average for males has been steadily increasing since the late 1990s and is now at a historic high, while the average for females remained relatively consistent between 1993 and 2023.

Figure 3: Those aged between 40 to 49 continue to have the highest rate of drug misuse deaths

Age-specific mortality rates for deaths related to drug misuse, by age and sex, England and Wales, registered in 2024

Notes:

1. Age-specific mortality rates per million population.
2. Cause of death was defined using the International Classification of Diseases, Ninth Revision (ICD-9) for the years 1993 to 2000 and Tenth Revision (ICD-10) from 2001 onwards. More details can be found in the Quality and Methodology Information.
3. Figures are for deaths registered, rather than deaths occurring in each calendar year.
4. Figures for England and Wales include deaths of non-residents.
5. Generational categories are inferred from age at death to approximate birth cohorts. Because some age bands span more than one generation, labels reflect the most likely generational group(s) based on typical birth years. These definitions are intended for broad demographic context and may vary by source.

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Drug-poisoning death rates vary across regions. In 2024, most areas experienced increases compared with the previous year, while some saw a decline. In England, the rate of drug-poisoning deaths increased to 91.1 deaths per million, compared with 90.8 deaths per million in 2023. In Wales, the rate increased to 140.4 deaths per million, up from 129.2 deaths per million in 2023. 

Regional drug-poisoning deaths in 2024

The highest drug-poisoning death rate was seen in the North East (167.6 deaths per million and 429 registered deaths). This region has seen the highest rate for the past 12 years.

The lowest rate was seen in the East of England (66.3 deaths per million, 421 registered deaths).

The largest increase in the rate of drug-poisoning deaths was recorded in London, with 76.5 deaths per million and 662 deaths, compared with 58.1 deaths per million and 500 deaths in 2023. This represents an increase of 18.4 deaths per million.

The largest decrease in the rate of drug-poisoning deaths was recorded in the South West, with 83.0 deaths per million and 460 deaths, compared with 95.7 deaths per million and 526 deaths in 2023. This represents a decrease of 12.7 deaths per million.

Figure 4: Rates of drug poisoning deaths have a marked north-south divide

Age-standardised mortality rate for deaths related to drug poisoning, by sex, for countries and regions of England and Wales, registered between 1993 and 2024

Notes:

1. Age-standardised mortality rates per million people, standardised to the 2013 European Standard Population.
2. Cause of death was defined using the International Classification of Diseases, Ninth Revision (ICD-9) for the years 1993 to 2000 and Tenth Revision (ICD-10) from 2001 onwards. More details can be found in the Quality and Methodology Information.
3. Figures are for deaths registered, rather than deaths occurring in each calendar year.
4. Figures are for persons usually resident in each country and region, based on boundaries as of Aug 2025.

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Figures in this section are estimates that are based on analysis of text that appears on the death certificate, which is usually written by the coroner. 

The Office for National Statistics (ONS) does not have access to post-mortem reports or toxicology results, so the accuracy of figures depends on the information provided by the coroner on the death certificate. Because of incomplete information, figures for drug misuse and for specific substances are often underestimates.

In 2024, 1,192 deaths (21.4%) registered in England and Wales had no drug type recorded on the coroner's death certificate. In these cases, the record may only mention general terms such as "drug overdose" or "multiple drug toxicity".

Although the proportion of deaths with no specific substance information has decreased slightly over the past two years, caution is still advised when interpreting these statistics.

However, the overall number of drug-poisoning deaths is considered complete and reliable, as it is based on the ICD-10 coding of the underlying cause of death.

Opiates and opioids in drug-poisoning deaths

In 2024, a total of 2,621 drug-poisoning deaths registered in England and Wales involved opiates and opioids; an increase of 2.7% compared with 2023 (2,551 deaths).

Opiates and opioids were involved in just under half (47.1%) of drug-poisoning in 2024, increasing to 59.9% when we exclude deaths that had no drug type recorded on the death certificate.

Heroin and morphine (often indistinguishable in toxicology testing) continued to be the most frequently mentioned opiates and opioids, with 1,415 drug-poisoning deaths mentioning either one of these substances in 2024 (24.1 deaths per million people).

Nitazenes deaths four times higher than in the previous year

There were 195 deaths involving Nitazenes registered in 2024, following their first appearance in death registrations in 2020. This is almost four times higher than the number registered in 2023 (52 deaths).

Nitazenes are a category of potent new synthetic opioids. As explained in this article from the Pharmaceutical Journal, some are 100 times more potent than heroin and carry a higher risk of overdose.

Cocaine deaths rise for the 13th consecutive year

There were 1,279 deaths involving cocaine registered in 2024, which was 14.4% higher than the previous year (1,118 deaths) and eleven times higher than in 2011 (112 deaths).

Of those whose deaths involved cocaine, in 2024:

• 982 were male (76.8%)

• 297 were female (23.2%)

Cocaine has consistently been the second-most-used drug, after cannabis, in England and Wales over the past decade, as shown in our Drug misuse in England and Wales: year ending March 2024 article.

Figure 6: Drug poisonings involving cocaine continued to increase in 2024

Age-standardised mortality rates for selected substances, by sex, England and Wales, deaths registered between 1993 to 2024

Notes:

1. Age-standardised mortality rates per million people, standardised to the 2013 European Standard Population.
2. Cause of death was defined using the International Classification of Diseases, Ninth Revision (ICD-9) for the years 1993 to 2000 and Tenth Revision (ICD-10) from 2001 onwards. More details can be found in the Quality and Methodology Information.
3. Figures are for deaths registered, rather than deaths occurring in each calendar year.
4. Figures for England and Wales include deaths of non-residents.
5. Rates are not calculated when the number of deaths is fewer than 10.
6. Codeine is not from compound formulation such as co-codamol; paracetamol includes compounds and dextropropoxyphene mentioned without paracetamol (as dextropropoxyphene is very rarely ingested except in combination with paracetamol).

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Of all drug-poisoning deaths in 2024, other significant drugs that were mentioned on the death certificate were:

• Pregabalin, with 617 deaths

• Diazepam, with 302 deaths 

• Amphetamine, with 111 deaths

• Fentanyl, with 60 deaths

• Ketamine, with 60 deaths

Compared with 2023, mentions of most of these substances increased in 2024, with amphetamine remaining unchanged.

Because of the length of time it takes for a drug-poisoning death to be officially registered, there is always a delay in when we can publish data on drug-poisoning death occurrences. Most drug-poisoning deaths are certified by a coroner, usually following an inquest. The median time taken to register a drug-poisoning death in 2024 was 214 days in England and 279 days in Wales.

Data on drug-poisoning death occurrences is continually revised to account for late registrations. The number of occurrences for previous years may therefore not match those previously published.

Figure 7 shows the percentage of drug-poisoning deaths registered each year, broken down by the actual year in which the death occurred. This data shows a growing delay in registration over time, with a decreasing proportion of drug-poisoning deaths registered in a given year also occurring within that same year. Only 37.2% of drug-poisoning deaths registered in 2024 had a date of death in 2024, compared with 61.7% in 2001.

To provide more reliable comparisons between years, for 2023 drug-poisoning death occurrences, we have used provisional registration data to include deaths registered by the end of March 2025. This gives us a minimum of 15 months of death registration data up to a maximum of 27 months for occurrences in 2023. The length of the registration period depends on when the death occurred during the year. Based on death registration data up to the end of March 2025, we are aware of 5,019 drug-poisoning deaths that occurred in 2023 in England and Wales. This is equivalent to a rate of 85.4 drug-poisoning deaths per million people.

Table 1 shows drug-poisoning deaths by year of occurrence, based on all available finalised death registration data (up to the end of 2024). In the table, each occurrence year before 2023 is limited to a registration period within 15 months of the end of the occurrence year. 2023 occurrences are based on registration data to March 2025. For example, we know that 5,136 drug-poisoning deaths occurred in 2022 and were registered by the end of 2024, but we only knew about 4,868 of these, with deaths registered to the end of March 2024. This approach does not account for the increase in registration delays but gives a clearer indication of whether 2023 drug-poisoning death occurrences are higher than previous years or not.

Figure 8 illustrates why it is difficult to look at trends over time when using occurrence data rather than registrations. As more drug-poisoning deaths are registered, the number of occurrences in a year will increase, particularly in recent years. In the chart, we can see that using the latest finalised death registrations (up to the end of 2024) for all years, it appears there was a decrease in the number of drug-poisoning deaths that occurred in 2023 compared with previous years. However, because of registration times, we know that there will likely be more drug-poisoning deaths registered throughout 2025, and subsequent years, that will have occurred in 2023.

To help demonstrate the trend, in Figure 8 we have also plotted drug-poisoning death occurrence rates where the registration period is comparable for all occurrence years. Using the data in this way, we can see that the number of drug-poisoning deaths occurring in 2022 and 2023 has increased slightly, following the increasing trend since 2010.

Most deaths related to drug poisoning in England and Wales are certified by coroners. The length of time it takes to hold an inquest results in a delay between the date a death occurred and the date of registration. This means that more than half of the deaths reported in this bulletin occurred in previous years.

The median registration delay was 214 days in England in 2024 (208 days for drug misuse deaths). This is a slight decrease from 221 days in 2023.

The median registration delay was 279 days in Wales in 2024 (289.5 days for drug misuse). This is a decrease from 309 days in 2023.

Registration delays have gradually increased over time, with the longest delays recorded in 2022 for Wales and in 2023 for England, since the time series began in 1993. In 2024, delays decreased slightly in both countries, compared with the previous year.

Drug poisoning

A death classified as a drug poisoning must have an applicable International Classification of Diseases (ICD) code assigned as the underlying cause of death. This is determined by international coding rules from the condition or conditions reported by the certifier, as recorded on the death certificate. Further information on this definition can be found in Section 10: Data sources and quality.

Drug misuse

Death classified as drug misuse must be a drug poisoning and meet one or both of the following conditions:

• the underlying cause is drug abuse or drug dependence

• any of the substances controlled under the Misuse of Drugs Act 1971 are involved

Further information on this definition can be found in Section 10: Data sources and quality.

Opiates and opioids

Opiates and opioids are drugs that relieve pain by acting on the body's opioid receptors. Opiates are naturally derived from the opium poppy (such as morphine and codeine), while opioids include both natural and synthetic substances (such as heroin, fentanyl, and methadone).

Age-standardised mortality rate

In this article, age-standardised mortality rate refers to a weighted average of the age-specific mortality rates per million people that is standardised to the 2013 European Standard Population. Age-standardised mortality rates allow for differences in the age structure of populations and therefore enable valid comparisons to be made between geographical areas, the sexes, and over time.

Age-specific mortality rate

Age-specific mortality rate is the total number of deaths per million people of a particular age group, used to allow comparisons between specified age groups.

Statistics on mortality are derived from the information provided when deaths are certified and registered. Quality and methodology information (QMI) is available in:

• our Mortality statistics in England and Wales QMI

• our Deaths related to drug poisoning in England and Wales QMI

• our User guide to mortality statistics

Death registrations and occurrences

Most deaths related to drug poisoning in England and Wales are certified by a coroner and cannot be registered until an inquest is complete. This results in a delay between the date the death occurred and the date it is registered and received by the Office for National Statistics (ONS); for example, in 2024, of the deaths related to drug poisoning registered, only 37.2% of the deaths actually occurred in that year.

Currently, we publish deaths related to drug-poisoning statistics on a registration basis, that is, the year in which the death was registered. Death registration records also include the actual date of death; we use this to produce numbers by year of occurrence, which we currently publish in a separate occurrence-based dataset. Registration data relate to the previous year, and the occurrence data have a lag of an additional year to allow for inquest times. For example, in this release we have published 2024 registrations and 2023 occurrences.

We continue to focus the majority of our commentary on registration data because of this, but in response to a recent engagement exercise on ONS suicide statistics, we are presenting some commentary on occurrence based statistics, with a view to broadening this in future.

How we define a drug-poisoning death

Drug-poisoning deaths involve a broad spectrum of substances, including controlled and non-controlled drugs, prescription medicines (either prescribed to the individual or obtained by other means) and over-the-counter medications. As well as deaths from drug abuse and dependence, figures include accidents and suicides involving drug poisonings and complications of drug abuse such as deep vein thrombosis or septicaemia from intravenous drug use. They do not include other adverse effects of drugs, for example, anaphylactic shock or accidents caused by an individual being under the influence of drugs. More details of the drug poisoning definition, including the International Classification of Diseases (ICD) codes used, can be found in our Deaths related to drug poisoning in England and Wales QMI.

A death classified as drug misuse must be a drug poisoning and meet at least one of the following conditions.

The first condition is that the underlying cause is drug abuse or drug dependence. This is defined by ICD-10 as mental and behavioural disorders resulting from the use of:

• opioids (F11)

• cannabinoids (F12)

• sedatives or hypnotics (F13)

• cocaine (F14)

• other stimulants, including caffeine (F15)

• hallucinogens (F16)

• multiple drug use and use of other psychoactive substances (F19)

The second condition is if any of the substances controlled under the Misuse of Drugs Act 1971 are involved; this includes Class A, B and C drugs.

Accredited official statistics

These accredited official statistics were independently reviewed by the Office for Statistics Regulation in February 2013. They comply with the standards of trustworthiness, quality and value in the Code of Practice for Statistics and should be labelled "accredited official statistics".

Populations

Mortality rates are calculated using the number of deaths and our mid-year population estimates.

Comparing with other statistics

Scotland and Northern Ireland each produce their own statistics for deaths related to drug poisoning. These statistics are compiled by the National Records of Scotland (NRS) and the Northern Ireland Statistics and Research Agency (NISRA).

Our drug-poisoning statistics can be used for comparisons across the UK, as our measure offers complete population coverage. Figures for drug misuse and individual substances are not comparable because of differences in data collection methods and in the death registration system. For more information, please see our Comparability of drug-related death statistics across the UK blog post.

User-requested data

Special extracts and tabulations of drug-related deaths data (and other causes of mortality) are available to order for a charge (subject to legal frameworks, disclosure control, and resources and agreement of costs, where appropriate). You can enquire by sending an email to health.data@ons.gov.uk. You can also view our Charging rates.

Strengths

• Deaths related to drug poisonings are compiled using information supplied when deaths are registered, which gives complete population coverage.

• Age-standardised rates allow for differences in the age structure of populations and therefore allow valid comparisons to be made between geographical areas, the sexes and over time.

• Quality assurance procedures have been undertaken throughout all stages of the analysis to minimise the risk of error; in particular, researchers quality assure the automated coding of the coroner's text for each record.

Limitations

• Statistics are based on the year of death registration; because of death registration delays, around half of these deaths will have occurred in previous years.

• The Office for National Statistics (ONS) does not have access to post-mortem reports or toxicology results, so the accuracy of figures depends on the information provided by the coroner on the death certificate; because of incomplete information, figures for drug misuse and for specific substances are undercounts.

• More than half of all drug-poisoning deaths involve more than one drug, and it is not possible in those cases to tell which substance was primarily responsible for the death.

• There is no internationally agreed definition of what constitutes a drug-related death; figures cannot be compared with those produced by other organisations.

• The number of deaths involving new psychoactive substances (NPSs) should be treated with caution because these types of drugs are constantly evolving, and it may not always be possible to identify new substances during post-mortem investigations.

• Local-authority-level rates are aggregated to rolling three-year periods in line with our disclosure control principles and to ensure the robustness of estimates.

Further quality and methodology information

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in our Deaths related to drug poisoning in England and Wales QMI.