Complex system structures related to drug deaths in Scotland: a network analytic approach to navigating linked administrative data and co-produced system maps

BackgroundDrug-related deaths are rising in many countries, with Scotland having the highest rate in Europe. Understanding the clustering of health conditions, social experiences, and broader social and political factors may enhance policy and intervention design. Systems science methods can help identify action areas for effective interventions. This study aimed to (1) develop a broader understanding of the complex system relating to drug-related deaths in Scotland, and (2) identify potential action areas for interventions.Methods and dataWe conducted a systems-informed intervention development study following steps 1 and 2 of the 6 Steps in Quality Intervention Development framework (6SQuID), which define the problem and clarify modifiable factors. We facilitated co-production workshops using soft systems methods, including critical system heuristics, variable elicitation, multiple perspective diagrams, system mapping, priority setting, and six cohering questions.In parallel, we used Gaussian graphical models to identify co-occurring variables in linked datasets: Public Health Scotland’s National Drug-Related Deaths Database, Prescribing Information System, and Scottish Morbidity Records for inpatient and day case stays in acute (SMR01) and psychiatric (SMR04) hospitals. The linked data included information on 6,608 drug-related deaths in Scotland between 2009 and 2018. Preliminary findings from network analysis were integrated into the workshops for active co-production. We described the structure of the system map and linked data using community detection and network metrics.Results Analysis of the system map found eight subsystems covering direct causes of drug death, life experiences, stigmatising attitudes, treatment services and wider public perspectives. Analysis of the linked data found a further 78 subsystems; 58 related to distinct conditions, eight to co-occurring conditions, and 12 to substance use. Assault, and alcohol treatment and harms were distinct subsystems in the linked data less prominent in the system map. Workshops identified three priority action areas: workforce development, service navigation, and community and connections. Stigma was a leverage point relevant to all actions.ConclusionsPreventing drug-related deaths in Scotland can benefit from a systems science approach. Considering the whole system when prioritising action areas and designing interventions could hold more potential for change. Future policy and practice should consider how systems-informed approaches to death prevention may operate and interact across multiple levels of the social system.