Every year, the National Records of Scotland (NRS) publishes a report on “drug-related deaths”. The statistics in this report cover two definitions of drug-related death: ‘drug misuse’ and ‘drug poisoning’.
Following the publication of its most recent report, the NRS asked for feedback on the use of ‘drug misuse’, the importance of consistent terminology across the UK, and any suggested improvements to the term. We would like to respond on behalf of our members.
Here is our response.
Scottish Drugs Forum recognises that the drugs field contains terminology that can be offensive or stigmatising. We believe the Scottish Government and its departments have a responsibility to model appropriate, respectful language — especially in materials that will be used by the media.
We are deeply concerned by the use of “drug misuse” by the National Records of Scotland. In our view, this term is stigmatising and unhelpful, shifting attention away from the realities of poverty, trauma, deprivation and lack of opportunity that underpin problematic drug use.
In the context of the report, “drug misuse deaths” carries a stigmatising connotation that can perpetuate harmful narratives around substance use and those affected by it. It implies personal culpability rather than acknowledging the broader structural, social, and health-related factors that contribute to these deaths. Stigmatisation can have severe consequences, including reinforcing barriers to healthcare access, discouraging people from seeking support, and influencing policy in a way that is punitive rather than health focussed.
Moving Beyond Person-First Language
In 2020, we published ‘Moving Beyond Person-First Language: A Glossary of Contested Terms in Substance Use’. This document is used widely and has been referenced all over the world. It says the following about “drug misuse”:
The terms abuse and misuse are contested being regarded by some people as judgemental, moralistic and inaccurate.
They may be regarded as inaccurate or stigmatising, as people using drugs are not using the product for a purpose for which it was not designed. They are not abusing or misusing the drugs.
An exception may be claimed if people are using pharmaceuticals in ways that goes against advice from the supplier – i.e. a prescriber as opposed to a dealer. However, objection is given to this form of use – for example the abuse of prescribed medicines on the grounds that it is stigmatising and focusses on the behaviour rather than the cause.
These terms may be regarded as derogatory or stigmatising to people with substance problems as they promote the idea that that kind of use is wholly distinct from other people’s use of the same substance which is not always the case.
In ‘Moving Beyond Person-First Language’, we suggest the following alternative terms:
- Drug use
- Problem drug use
The rational for using these terms is:
Drug use can describe any use of any drugs. Where a person’s substance use causes risk or harms to them or to other people, and they persist in use and if it becomes intensive or compulsive, then it is [can be] more accurately be referred to as problem substance use.
Feedback from our members
To inform our response, we consulted:
- People with living and lived experience of using drugs, through our local engagement groups based across Scotland
- The peer editorial board of Buzz Magazine, all of whom have living experience of drug use
- Our members – including people with living and lived experience, family members, and representatives from third and public sector organisations
Across these groups, most participants told us they find the term “drug misuse” stigmatising. Feedback included:
- “I believe ‘misuse’ is an instant stigmatising barrier for people who use drugs, especially when it is used in the context of services and legislation designed to support and help them. The drugs are not being misused and are taken as a response to trauma, adverse childhood experiences, etc.”
- “It suggests wrongdoing or a conscious choice by someone who is living with an addiction.”
- “It implies moral judgment, framing someone’s behaviour as ‘wrong’ rather than focusing on health, support, and harm reduction.”
- “We’re making a judgement right away. They may have a very valid reason for their use and I don’t think we have the authority or right to say what constitutes drug misuse.”
The majority of participants said their preferred term is “drug-related death”:
- “It’s neutral, not loaded with blame.”
- “This is neutral, focused on WHAT happened not WHY it happened.”
- “Drug misuse reminds us of the Misuse of Drugs Act, sounds like an offence or we have committed a crime by dying. Poisoning still doesn’t sound right as it sounds like intentional, who would take poison? Drug related seems the best option and doesn’t over complicate things.”
Summary
We urge the NRS to reconsider its approach and return to the term “drug-related deaths,” which was previously used and is widely regarded as a more appropriate and neutral descriptor. We are also comfortable with: “drug overdose death”, “drug use death” and “drug death”.
While we understand the importance of consistency across UK data and reporting, we also recognise that language is not neutral. The words used to describe drug use and, in particular, drug-related deaths influence how society perceives this public health crisis — and, ultimately, how we respond to it. The use of non-stigmatising language in official reporting aligns with Scotland’s commitment to reducing harm and treating substance use with the dignity and compassion it requires.
Rather than adopting language simply for the sake of UK-wide alignment, we urge the NRS to lead by example by using terminology that is accurate, fair and respectful. Not only would this better fit our nation’s public health and harm reduction approach, it would also give the NRS the opportunity to demonstrate leadership and help shape a more compassionate and evidence-informed conversation across the UK.