Reducing drug-related deaths
Fifteen European countries report that their national drug strategy includes a part dedicated to the reduction of drug-related deaths, that such policies exist at regional level, or that they have a specific action plan for the prevention of drug-related deaths. Austria reports that a strategy paper is being prepared.
Treatment reduces significantly the mortality risk of drug users (Davoli et al., 2007), although risks related to drug tolerance arise when entering or leaving treatment. Studies show that the risk of drug-induced death on relapse after treatment or in the weeks after release from prison is substantially elevated. This led to the publishing of WHO-Europe recommendations regarding overdose prevention in prisons and improved continuity of care after release (WHO, 2010).
Denmark and Norway have recently prioritised buprenorphine in their guidelines for substitution treatment because of its pharmacological safety profile. Spain has recently approved the buprenorphine–naloxone combination for patients in substitution programmes carried out by the national health system, with the aim of reducing drug-induced deaths.
Alongside improving access to drug treatment, other interventions to reduce overdose risks in drug users have been studied. These interventions address personal, situational and drug-use related factors. A recent review of the evidence (Rome et al., 2008) recommended raising awareness among general practitioners of the dangers of multiple prescriptions, in particular of antidepressants. Measures to control the prescription of multiple drugs to substitution clients, and thereby to reduce emergencies involving the use of benzodiazepines, have been taken in Luxembourg.
The provision of information materials is reported as a common intervention to reduce drug-induced deaths in Europe (1). Providing overdose prevention, recognition and response education to drug users and their neighbours, friends and families, as well as to service providers who work with drug users is reported by many countries. The provision of these interventions is, however, often sporadic and limited.
Following an epidemic of fentanyl overdoses, Estonian experts call now for the introduction of overdose prevention programmes in the country. Belgium, the Czech Republic, Estonia and the Netherlands report the operation of early-warning systems that collect and disseminate information about new drugs or dangerous combinations via low-threshold agencies, shelters or treatment facilities. In the Netherlands, a monitoring system for drug-related acute health incidents was tested in 2009 and is now being expanded.
Overdose training combined with a take-home dose of naloxone — which reverses the effects of opioids — is an approach that could save many lives. The intervention targets drug users and their families, the people who could be with a user during an overdose; and is aimed at enabling them to take effective action while awaiting the arrival of emergency services. Studies show that those trained demonstrated improved knowledge of the signs of overdose and increased confidence of using naloxone. In 2009, a project providing packs with a syringe pre-filled with naloxone to 950 family members of drug users started in England. Packs containing one-shot injectors of naloxone are also given, as part of an ongoing study, to opioid users leaving prison in England, Scotland and Wales. Pre-filled syringes are available in Italy via drugs agencies, are used in a trial in Portugal and have been introduced in Bulgaria. The provision of a nasal spray of naloxone has started through a user-led project in Copenhagen.
Supervised drug consumption rooms enable rapid intervention at the first signs of an overdose. Operational data indicate that drug overdoses occurring in these facilities are successfully managed, with no fatal overdoses reported. Providing immediate help also reduces the impact of non-fatal overdose, including irreversible damage to the brain and other vital organs, due to hypoxia (Hedrich et al., 2010).
(1) See Table HSR-8 in the 2009 statistical bulletin.
Davoli, M., Bargagli, A.M., Perucci, C.A. et al. (2007), ‘Risk of fatal overdose during and after specialised drug treatment: the VEdeTTE study, a national multi-site prospective cohort study’, Addiction 102, pp. 1954–9.
Hedrich, D., Kerr, T. and Dubois-Arber, F. (2010), ‘Drug consumption facilities in Europe and beyond’, in Harm reduction: evidence and impacts, EMCDDA Monograph, Rhodes, T. and Hedrich, D. (editors), Publications Office of the European Union, Luxembourg, pp. 305–31.
Rome, A., Shaw, A. and Boyle, K. (2008), Reducing drug users’ risk of overdose, Scottish Government Social Research, Edinburgh.
WHO (2010), Prevention of acute drug-related mortality in prison populations during the immediate post-release period, World Health Organization Europe, Copenhagen.