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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).

 
 

Annual report 2011: the state of the drugs problem in Europe
Drug-related infectious diseases and drug-related deaths

Published: 15 November 2011

Reducing drug-related deaths

Fifteen European countries report that their national drug strategy has a focus on 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. In some of the other countries (Estonia, France, Austria), recent increases in drug-related deaths (partly among younger age groups and integrated users) have raised awareness of the need for improved responses.

Treatment can significantly reduce the mortality risk of drug users, 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.

Due to its pharmacological safety profile, buprenorphine is recommended for opioid maintenance in some countries (1), and a buprenorphine-naloxone combination has obtained marketing authorisation in at least half of the countries (2).

While progress has been made in some European countries towards closing the treatment gap between community and prison (3), disruption of drug treatment, whether due to arrest, imprisonment or discharge, has been identified as increasing overdose risk (Dolan et al., 2005). This has led to the European regional office of the World Health Organization (2010) issuing recommendations on overdose prevention in prison and improved continuity of care after release.

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. Overdose risk information materials, often produced in several languages to reach migrant drug users, are distributed in the majority of countries through specialised drugs agencies and websites, and more recently also through telephone messaging and email. Counselling and safer-use training for drug users, delivered by drug workers or through peer educators, exists in 27 countries but provision of these interventions is often sporadic and limited (4).

Additional responses reported by small numbers of countries include: follow-up of those who have suffered a drug-related emergency (Belgium, Denmark, Luxembourg, Netherlands, Austria); 'early-warning systems' to alert users to dangerous substances (Belgium, Czech Republic, France, Hungary, Portugal, Croatia); and improved controls to prevent multiple drug prescriptions (Luxembourg, United Kingdom). Supervised drug consumption facilities, such as those available in Germany, Spain, Luxembourg, the Netherlands and Norway, provide opportunities for immediate intervention by professionals in cases of overdose, and reduce the health impact of non-fatal overdoses. Evidence for the effect of supervised drug consumption rooms on drug-induced deaths in the community include a recent study carried out in Vancouver, which reported a 35 % reduction in overdose fatalities in the affected community after a supervised injecting facility was opened (Marshall, B. et al., 2011). This result points in the same direction as earlier studies reviewed in a monograph on harm reduction (EMCDDA, 2010).

Overdose training combined with a take-home dose of naloxone - which reverses the effects of opioids, and is widely used in hospitals and emergency medicine - is an intervention that can prevent deaths from opioid overdose. Some European countries report the existence of community-based programmes that prescribe naloxone to drug users at risk of opioid overdose. Naloxone prescribing is accompanied by compulsory training in recognising overdoses, providing basic life-support techniques (e.g. rescue breathing, recovery position), and how to administer naloxone. This intervention targets drug users, their families and peers, and aims to help them to take effective action in overdose situations, while awaiting the arrival of emergency services.

The distribution of naloxone to drug users is reported by Italy (where 40 % of drugs agencies provide the substance), Germany and the United Kingdom (England and Wales). New initiatives are reported by Bulgaria, Denmark and Portugal. In Scotland, provision of 'take-home-naloxone' to all at-risk individuals leaving prison was introduced nationally in 2010, and the government is supporting a national take-home naloxone programme for those deemed to be at risk of opioid overdose and those who may come into contact with them. The effectiveness of naloxone-on-release in reducing overdose deaths in the weeks after release from prison is being evaluated in England by the N-Alive project study, which will perform a randomised controlled trial among 5 600 prisoners.

Footnotes

(1) See treatment guidelines in the Best practice portal.

(2) See Table HSR-1 in the 2011 statistical bulletin.

(3) See chapter 'Responding — an overview' and Table HSR-9 in the 2011 statistical bulletin.

(4) See Table HSR-8 in the 2011 statistical bulletin.

Bibliographic references

Dolan, K.A., Shearer, J., White, B., Zhou, J., Kaldor, J. and Wodak, A.D. (2005), 'Four year follow-up of imprisoned male heroin users and methadone treatment: mortality, re-incarceration and hepatitis C infection', Addiction 100, pp. 820-8.

EMCDDA (2010), Harm reduction: evidence, impacts and challenges, Monograph, Publications Office of the European Union, Luxembourg.

Marshall, B.D.L., Milloy, M.-J., Wood, E., Montaner, J.S.G. and Kerr, T. (2011), 'Reduction of overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study', Lancet 377, pp. 1 429-37.

WHO (2010), Prevention of acute drug-related mortality in prison populations during the immediate post-release period, World Health Organization Europe, Copenhagen.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 28 October 2011