Data Insight: What does linked administrative data tell us about mortality risk among people in drug treatment?
Category: Data Insights
9 September 2026
Previous research has shown that people released from prison face an elevated risk of drug-related death, particularly in the weeks immediately following release (Graham et al 2015; Bird et al., 2015). However, it remains unclear whether criminal justice contact itself independently predicts mortality among people in drug treatment, or whether justice involvement reflects broader patterns of social disadvantage, health inequalities and more complex drug use histories. Linked administrative data provides a unique opportunity to investigate these relationships across an entire national cohort.
What we did
This study linked Scotland's national drug treatment records with mortality data to examine the relationship between criminal justice contact and all-cause mortality among people accessing specialist drug treatment. It also explored whether broader social, health, and drug-use characteristics better explained mortality risk, providing new evidence to inform policy, service planning, and future research.
By linking national drug treatment records with mortality data, we examined whether experiences within the justice system or broader social vulnerabilities were more predictive of mortality. Our cohort included 35,331 individuals who accessed Tier 3 or Tier 4 drug treatment services between 2012 and 2015, with mortality followed until 2020.
What we found
The key findings from this work:
• Justice system contact alone was not a significant predictor of mortality.
• People with justice system experience often faced additional vulnerabilities, including homelessness, began using drugs at a younger age, and had a riskier drug use profile.
• Despite these differences in vulnerability, overall mortality was broadly similar (~10%) across the three criminal justice experience groups.
• Mortality was more closely linked to social vulnerabilities, such as housing instability and lack of engagement in employment or education.
• Employment/education disengagement was associated with approximately twice the odds of mortality, but this association varied by criminal justice experience.
• Those in unstable housing experienced 23% higher odds of mortality.
• The relationship between being "drug-free" and mortality varied, suggesting different underlying circumstances across justice groups.
Why it matters
The findings suggest that mortality among people in drug treatment is more influenced by social and structural vulnerabilities than criminal justice contact alone.
This insight is critical because it highlights the limitations of policies focusing solely on justice involvement or overdose prevention. Instead, policies need to address broader conditions like housing stability and employment to effectively reduce preventable deaths. Early intervention through health services and improved continuity of care across systems are crucial for supporting vulnerable populations.
What's next?
•Policy Implementation: Develop and integrate strategies that prioritise stable housing and employment within drug death prevention frameworks.
•Early Intervention: Utilise health service contacts as opportunities for early intervention before individuals engage with the criminal justice system.
•Coordinated Care: Strengthen the coordination between drug treatment, healthcare, housing, social care, and justice services to reduce service gaps and support individuals through transitions.
•Data Utilisation: Enhance linked data capabilities to identify vulnerable populations and target resources effectively, improving early intervention and prevention efforts.
