{
  "abstract": "Introduction\n\nMultiple jurisdictions report disproportionately elevated rates of drug-related harm in urban settings, alongside unique treatment needs in rural populations. We examined differences in case characteristics, circumstances of death and implicated drugs among individuals dying from drug-related causes, stratified by rural or urban setting, and determined changes in the proportion of deaths between settings over time.Methods\n\nRetrospective registry-based analysis of coronial records of individuals who died from drug-related causes, submitted to the National Programme on Substance Use Mortality in the UK, 1997-2026. UK Government Rural-Urban Classification methodology dichotomised cases using postcode at date of death.Results\n\nOverall, 39,975 decedents died, 36,350 (90.9%) in urban settings. The urban percentage decreased significantly over the study period from 96.6% in 1999 to 92.3% in 2025 (AAPC -0.34%, 95% CI -0.47% to -0.15%, p = 0.002). Accidental poisoning was the most common direct cause of death in both rural (45.5%) and urban (54.8%) settings, while intentional self-poisoning was more common rurally (17.3% vs. 9.5%). Opioids were the most frequently implicated drug group in both rural (61.1%) and urban (65.4%) settings. The median number of drugs implicated did not differ significantly between settings (both 2, IQR 1-3), but rural decedents had a significantly higher median number of prescribed implicated drugs (1, IQR 0-2 vs. 0, IQR 0-2).Discussion and conclusions\n\nOver three decades, approximately one in 11 UK drug-related deaths occurred rurally. Intentional self-poisoning was substantially more common in rural fatalities, and opioids were the leading implicated drug group across both settings.",
  "abstract_shown": true,
  "affiliations": [
    "National Addiction Centre, King's College London, London, UK.",
    "South London and the Maudsley NHS Foundation Trust, London, UK.",
    "Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.",
    "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.",
    "Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.",
    "Department of Psychiatry, University of Toronto, Toronto, Canada.",
    "Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.",
    "Centre for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.",
    "Program on Substance Abuse and World Health Organization Collaborating Centre, Public Health Agency of Catalonia, Barcelona, Spain.",
    "Faculty of Life Sciences & Medicine, King's College London, London, UK."
  ],
  "article_type": "brief report",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Emmert Roberts",
      "orcid": "0000-0002-4152-5570"
    },
    {
      "affs": [
        2,
        3,
        4,
        5,
        6,
        7,
        8
      ],
      "name": "Jürgen Rehm",
      "orcid": "0000-0001-5665-0385"
    },
    {
      "affs": [
        9
      ],
      "name": "Caroline Copeland",
      "orcid": "0000-0002-4462-1402"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/747g0d2p8fa3c.bib",
  "cited_by": 0,
  "doi": "10.1111/dar.70285",
  "fulltext_url": "https://europepmc.org/articles/PMC13716528",
  "id": "747g0d2p8fa3c",
  "issns": [
    "0959-5236",
    "1465-3362"
  ],
  "landing_url": "https://europepmc.org/article/MED/42950888",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Brief Report"
    ],
    [
      "openalex",
      "2739|Opioid Use Disorder Treatment"
    ]
  ],
  "openalex": "W7224121286",
  "pdf_url": "https://europepmc.org/articles/PMC13716528?pdf=render",
  "pmcid": "PMC13716528",
  "pmid": "42950888",
  "published": "2026-10-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/747g0d2p8fa3c.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:33Z",
      "native_id": "MED:42950888",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42950888"
    },
    {
      "first_seen": "2026-11-01T12:23:27Z",
      "native_id": "PMC13716528",
      "source": "pmc",
      "url": "https://doi.org/10.1111/dar.70285"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Opioid Use Disorder Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "A Comparative Analysis of Deaths Due to Drug-Related Causes Between Rural and Urban Areas in the United Kingdom, 1997-2026.",
  "title_text": "A Comparative Analysis of Deaths Due to Drug-Related Causes Between Rural and Urban Areas in the United Kingdom, 1997-2026.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:23:27Z",
  "url": "https://research.draconitic.com/paper/747g0d2p8fa3c",
  "venue": "Drug and alcohol review",
  "versions": []
}