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Background  Drug-related death (DRD) figures, published by the national performance management framework, are used to monitor the performance of Drug (and Alcohol) Action Teams (D[A]ATs) in England and Wales with respect to reducing DRDs among drug abusers. To date, no investigation has been made into the types of death included in these figures, the demographic and drug profile of those who died, nor the likelihood of individuals included in DRD figures interacting with services designed to assist drug abusers. The aim of this work was to examine the characteristics of deaths classified as drug-related and to explore their applicability to performance-monitor drug-related services. Liverpool was chosen because it was reported by the national DRD monitoring system to have the highest number of DRDs in 2004.    Methods  Information was retrieved from the Liverpool coroner's records and established monitoring systems on individuals reported by the national performance monitoring system as a DRD between 1 st  January 2004 and 30 th  June 2005 (n = 70). Analyses assessed differences between those categorised by the national performance monitoring system as 'drug abusers/dependents' and 'non-drug abusers/dependents' using χ 2 , Fisher's exact test and Mann-Whitney U.    Results  Non-drug abusers were significantly older (median age 53.59 vs. 38.23), had no recent contact with drug-related agencies (cv. 31.6% of abusers who had treatment contact) and had different post mortem drug profiles than drug abusers. A significantly greater proportion of non-drug abusers died from drug toxicity – predominantly through anti-depressants, anti-psychotics and analgesics.    Conclusion  Our findings suggest that the national DRD performance monitoring system includes deaths of people who are not drug abusers – individuals who are not the current focus of drug prevention, treatment or harm minimisation services. This raises concerns regarding the applicability of these figures to performance monitor D(A)ATs. Furthermore, using the more compact definitions used to monitor trends in DRDs across England, Wales and Europe fails to include a proportion of deaths attributable to drug misuse – such as those attributable blood-borne viruses. Current definitions used to monitor DRDs locally, nationally and across Europe fail to capture the true burden of drug-related mortality.

When is a drug-related death not a drug-related death? Implications for current drug-related death policies in the UK and Europe