Characteristics of Drug-Related Deaths Among Individuals Engaged in Sex Work in the United Kingdom, 1997–2023

By Emmert Roberts, Sharmila Parmanand, Caroline Copeland

Individuals engaged in sex work are an understudied population recognised to be at differential risk of experiencing drug-related harms. We aimed to determine the case characteristics, circumstances of death and type of implicated drugs among sex workers dying due to drug-related causes.

Methods

Retrospective cohort study in the United Kingdom using coronial records from the National Programme on Substance Use Mortality, 1997–2023. Information was available on decedent sociodemographics, characteristics of death and implicated drugs.

Results

Nineteen decedents were reported to be sex workers at the time of their death. Overall, decedents were predominantly female (n = 17, 90%) with a mean age of 36.4 years (SD 8.0; range 26–58). Poisoning was the only disease or condition that was certified as a direct, antecedent or contributory cause of death. The mean number of drugs detected at post-mortem was 5.4 (SD 2.5; range 1–10) with multiple drug toxicity implicated in the majority of cases (n = 18, 95%). The most commonly implicated drug groups were opioids (n = 17, 90%) and benzodiazepines (n = 9, 47%). All decedents had a history of substance dependence (n = 19, 100%), with almost a third injecting (n = 6, 32%).

Discussion and Conclusions

There have been low but consistent numbers of drug-related deaths each year where individuals were reported to be sex workers, results likely representing significantly conservative estimates. Polysubstance, opioid and benzodiazepine use are overrepresented within a largely female population with a significant burden of substance dependence. Non-judgmental facilitation of access to evidence-based addiction treatment, in particular for opioid use disorder, should be a priority.

Summary

• International research consistently reports an increased risk of drug-related harm among individuals who are engaged in sex work.

• Over the last two decades in the UK, there have been 19 drug-related deaths where individuals were reported to be sex workers.

• Overall decedents were predominantly female and all had a history of substance dependence. Opioids were implicated in death in the majority of cases.

• Non-judgmental facilitation of access to evidence-based addiction treatment, in particular for opioid use disorder, should be a priority.

• There are likely a substantial number of individuals engaged in sex work where this had either not been established by those submitting coronial evidence, or their sex work status was not deemed pertinent to report. As such, numbers reported are likely to represent significantly conservative estimates.

Drug and Alcohol Review, July 2025