Policy and practice briefingsReducing opioid-related deaths

icon deaths

Issues

Mortality directly or indirectly related to use of opioids is a major cause of avoidable premature deaths among European adults. Overall drug-related mortality rates are 1–2 % per year among high-risk opioid users in Europe and drug overdoses account for over 7 000 deaths per annum. Other important causes of death among high-risk opioid users are infections, accidents, violence and suicide.

Key periods of increased risk follow periods of abstinence when tolerance is lost, particularly on leaving prison or abstinence-based treatment.

Response options

These mainly focus on preventing the occurrence of overdoses and on improving the survival of those who overdose.

  • Enrolling and retaining problem opioid users in OST and ensuring continuity between treatment in prisons and the community and at other transition points.
  • Promoting overdose awareness, particularly around key risk periods and other risk factors, such as concurrent alcohol or benzodiazepine use.
  • Ensuring opioid antagonist (naloxone) availability and promoting appropriate use by professionals responding to or intervening in drug overdoses.
  • Education and training of drug users, peers and family members to identify overdoses and intervene with take-home naloxone while waiting for the ambulance to arrive.
  • Provision of drug consumption rooms to support safer injecting.

European picture

  • Around half of opioid-dependent people in Europe are enrolled in OST, but coverage varies widely between countries.
  • Overdose risk information provision is now available in 28 EMCDDA reporting countries.
  • In 2016, there were 78 drug consumption rooms operating in 6 EU countries and Norway. There were also 12 operating in Switzerland.
  • Take-home naloxone programmes existed in ten European countries in 2016.

Summary of the available evidence

Reducing opioid-related deaths

Response option Quality of evidence

Overdose deaths are reduced among opioid users while they are in opioid substitution treatment.

higher quality evidence

There is growing evidence that education and training interventions with take-home naloxone prevent deaths from opioid overdose.

lower quality evidence

Intranasal administration of naloxone is effective in the treatment of opioid overdose.

lower quality evidence

Drug consumption rooms increase safer injecting, reduce blood-borne infections and overdoses and encourage people who inject drugs to engage with care services. These services are furthermore associated with positive effects on public order.

moderate quality evidence

Key

  • speedometer at high High quality evidence — one or more up-to-date systematic reviews that include high-quality primary studies with consistent results. The evidence supports the use of the intervention within the context in which it was evaluated.
  • speedometer at medium Moderate quality evidence — one or more up-to-date reviews that include a number of primary studies of at least moderate quality with generally consistent results. The evidence suggests these interventions are likely to be useful in the context in which they have been evaluated but further evaluations are recommended.
  • speedometer at low Low quality evidence — where there are some high or moderate quality primary studies but no reviews available OR there are reviews giving inconsistent results. The evidence is currently limited, but what there is shows promise. This suggests these interventions may be worth considering, particularly in the context of extending services to address new or unmet needs, but should be evaluated.

Implications for policy and practice

Basics

Core interventions in this area include:

  • Sufficient provision of opioid substitution treatment, with adequate dosage, case management and additional support.
  • Naloxone made available to and used by first responders, such as ambulance staff, paramedics and others who attend overdose incidents.
  • Overdose awareness training to promote less risky use among people who use opioids (such as avoiding injection, mixing drugs and alcohol, not using alone, and fractioning the dose).

Opportunities

  • Establish take-home naloxone programmes to make naloxone widely available to people at high risk of opioid overdose and to their peers, partners and family to enable them to intervene while waiting for the ambulance services to arrive.
  • Improve throughcare between prison and community to prevent drug-related deaths in the first two weeks after prison release, when overdose risk is extraordinarily high.

Gaps

  • Identify and review barriers to the establishment of drug consumption rooms in areas with high numbers of people injecting drugs in public places.
  • Provide enhanced support to those who leave abstinence-based treatment, because their lost opioid tolerance increases the risk of fatal overdose.

Explore all resources in the Best practice portal

Collaborations and partnerships in best practice

logo of the cochrane collaboration  grade logo   grade logo  Health Evidence Network, WHO Europe