O'Gorman Aileen, Govenden Stephanie, Matthewson Frances
School of Education & Social Sciences, University of the West of Scotland, Paisley, Scotland, UK.
NHS Highland, Inverness, Scotland, UK.
Nordisk Alkohol Nark. 2025 Sep 9:14550725251370436. doi: 10.1177/14550725251370436.
Social, structural and systemic factors are critical to understanding drug-related deaths among adults. The relevance of these factors to young people is not known. This study explores the life experience, drug using histories and the interactions of a group of young people with agencies and services prior to their death. Our approach seeks to look beyond the immediate cause of death and identify broader contextual factors that may have contributed to a death through a "whole-life view".
The study developed a socio-ecological autopsy approach informed by social autopsy methods and social ecology and risk environment frameworks. Health, social work, police and post-mortem records of the young people were collated and analysed. Summary narratives, chronologies and descriptive statistics were produced using Excel and NVivo.
Twenty-one deaths were identified; almost all were due to multi-drug toxicity, mainly heroin mixed with other substances. Almost all the young people had reported mental health issues such as anxiety, depression and self-harm, and had experinced at least one recorded overdose before they died. Most grew up in precarity and poverty in deprived areas. In their short lives, most of this cohort of young people experienced multiple adversities in childhood and as young adults, particularly in the year preceding their death.
Complex and fragmented services struggled to respond holistically to early signs of difficulties and to the young people's cumulative experience of trauma and adversity, mental ill-health and drug-related harms in the context of prohibition. There is a need for a radical rethink of systems to enable integrated youth-centred approaches that meet the needs of those at risk of drug-related deaths and to address the broader social and structural contexts of drug deaths.
社会、结构和系统因素对于理解成年人与药物相关的死亡至关重要。这些因素与年轻人的相关性尚不清楚。本研究探讨了一组年轻人在死亡前的生活经历、吸毒史以及他们与机构和服务部门的互动情况。我们的方法旨在超越直接死因，通过“全生命周期视角”识别可能导致死亡的更广泛背景因素。
该研究开发了一种社会生态尸检方法，以社会尸检方法以及社会生态和风险环境框架为依据。对这些年轻人的健康、社会工作、警方和验尸记录进行了整理和分析。使用Excel和NVivo生成了总结性叙述、年表和描述性统计数据。
确定了21例死亡案例；几乎所有死亡均由多药中毒导致，主要是海洛因与其他物质混合。几乎所有年轻人都报告过焦虑、抑郁和自我伤害等心理健康问题，并且在死亡前至少有过一次记录在案的用药过量经历。大多数人在贫困地区的不稳定和贫困环境中长大。在他们短暂的生命中，这一群体中的大多数年轻人在童年和青年时期经历了多重逆境，尤其是在死亡前一年。
复杂且分散的服务难以全面应对困难的早期迹象，以及年轻人在禁令背景下累积的创伤、逆境、心理健康问题和与药物相关的伤害经历。有必要对系统进行彻底反思，以实现以青年为中心的综合方法，满足那些面临与药物相关死亡风险的人的需求，并解决药物死亡更广泛的社会和结构背景问题。
