Characteristics of drug‐related deaths among individuals engaged in sex work in the United Kingdom, 1997–2023

Introduction: 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.