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.
- 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
Implications for policy and practice
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).
- 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.
- 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.