This paper examines the overall number of lives lost due to drug use. All-cause mortality among problem drug users is investigated by means of cohort studies, which link data from death registries to drug treatment records. Building on earlier work, the paper presents data from nine European countries not previously studied using the same methodology. The study finds that the risk of death among problem drug users is typically 10 or more times that among their peers in the general population. The analysis shows that the deaths of problem drug users are overwhelmingly premature and preventable.