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Methods and definitions

Drug-related deaths

The aim of this indicator is to obtain comparable and reliable routine statistics on the number and characteristics of people who die as a consequence of drug use in the EU Member States. This is an important indicator of the health impact of the more severe forms of drug use, and can also be useful for monitoring trends in problem drug use.

Methods and definitions: drug-related deaths

1. EMCDDA definition

“Drug-related death” is a difficult concept. In the EMCDDA report, this term means deaths happening shortly after consumption of one or more psychoactive drugs, and directly related to this consumption. Often these deaths are referred to as “overdoses”, although equivalent concepts are also “deaths directly related to drug use”,“poisonings” or “drug-induced deaths”.

Most national statistics refer to these deaths, which are usually recorded through General Mortality Registries or Special Registries (Forensic or Police).

The EMCDDA has developed a common definition, in agreement with the expert group of national experts (see below summary definition and also the DRD-Standard protocol) focusing on those deaths directly related to consumption of illegal substances (although alcohol or psychoactive medicines are also found frequently in the toxicological analysis).

At present, national statistics are improving in most countries and their definitions are becoming the same, or relatively similar, to the common EMCDDA definition. Some countries still include cases due to psychoactive medicines or non-overdose deaths, generally as a limited proportion (The Methodological Note 1 specifies in detail the definition of drug-related death used in each Member State).

In addition, there are still differences between countries in procedures of recording cases, and in the frequency of post-mortem investigation (including autopsy rates). In some countries information exchange between General Mortality Registries and Special Registries (forensic or police) is insufficient or lacking, which compromise the quality of information.

Direct comparisons between countries in the numbers or rates of drug-related deaths should be made with caution; but if methods are maintained consistently within a country, the trends observed can give valuable insight when interpreted together with other drug indicators.

In addition to deaths directly related to the use of drugs, also deaths indirectly related to drug use (AIDS, accidents, suicides, violence…) should also be taken into account from a public health perspective, although their estimation requires different methodologies and data sources. The EMCDDA Report CT.00.RTX.22 presents an example of methodology to estimate the “total burden of mortality” related to drug use that includes both deaths directly and indirectly related to drugs (Annex 1, pages 47 to 53).

The EMCDDA definition of drug-related deaths

The EMCDDA definition of drug-related death in the Key Indicator “Drug-related deaths and mortality among drug users” refers to those deaths that are caused directly by the consumption of drugs of abuse. These deaths occur generally shortly after the consumption of the substance(s).

In operative terms the cases are selected as follows:

1. The preferred method to estimate the number of deaths is to extract cases from existing General Mortality Registries according to the following criteria,
  • based on the WHO International Classification of Diseases, 9th edition -ICD-9-
Cases will be counted when their underlying cause of death was drug psychoses, drug dependence, nondependent drug abuse, accidental poisoning, suicide and self-inflicted poisoning, and poisoning with undetermined intent.
Cases will be included when the death was due to a standard list of specific drugs: opiates, cocaine, amphetamines and derivatives, cannabis, and hallucinogens.
The precise ICD-9 codes to be selected are the following:
Category of drug-related death
Selected ICD-9 code(s)
Drug psychoses
292
Drug dependence
304.0, 304.2-9

Nondependent drug abuse

305.2-3, 305.5-7, 305.9

Accidental drug poisoning

E850.0, E850.81), E854.1-2, E855.2, andE858.81)

Suicide and self-inflicted drug poisoning

E950.01) , E950.41)

Drug poisoning undetermined intent

E980.01), E980.41)

1) In combination with N-codes (N965.0, and/or N968.5, and/or N969.6, and/or N969.7

This selection was agreed by the EMCDDA Expert Group on Drug-related deaths. It was called “Selection B” for General Mortality Registries based on ICD-9.

  • based on the WHO International Classification of Diseases, 10th edition -ICD-10-

 

Case will be counted when their underlying cause of death was mental and behavioural disorders due to psychoactive substance use (see list of substances below) or poisoning accidental, intentional or undetermined intent (see list of substances below)
  • Harmful use, dependence, and other mental and behavioural disorders due to:
opioids (F11)
cannabinoids (F12)
cocaine (F14)
other stimulants (F15)
hallucinogens (F16)
multiple drug use (F19)
  • Accidental poisoning (X41, X42), intentional poisoning (X61, X62), or poisoning by undetermined intent (Y11, Y12) by:

opium (T40.0),
heroin (T40.1),
other opioids (T40.2),
methadone (T40.3),

other synthetic narcotics (T40.4),
cocaine (T40.5),
other and unspecified narcotics (T40.6),
cannabis (T40.7),
lysergide (T40.8),
other and unspecified psychodysleptics (T40.9),
psychostimulants (T43.6)

The T-codes are to be selected in combination with the respective X-codes and Y-codes.
 
Underlying cause of death
Selected ICD-10 code(s)
Disorders
F11-F12, F14-F16, and F19
Accidental poisoning
X421), X412)
Intentional poisoning
X621), X612)
Poisoning undetermined intent
Y121), Y112)

1) in combination with the T-codes: T40.0-9, 2) in combination with T code: T43.6.

This selection was agreed by the EMCDDA Expert Group on Drug-related deaths. It was called “Selection B” for General Mortality Registries based on ICD-10.
2. An alternative method is to estimate the number of deaths by extracting cases from existing Special Registers (Forensic or police registries). The method based on the Special Registries will be applied in countries where the preferred method cannot be implemented, but also will be used whenever possible as a backup estimate for the General Mortality Registries.

Cases will be counted when the death was due to poisoning by accident, suicide, homicide, or undetermined intent.

Cases will be included when the death was due to opiates, amphetamines, cocaine (or crack), cannabis, hallucinogens, solvents, or synthetic designer drugs like amphetamine derivatives.

The precise groups of deaths are the following:

Category of drug-related death
Selected groups

Poisoning by accident, suicide, homicide, or undetermined intent

Opiates only (excluding methadone only)

Methadone only

Poly-substances including opiates

Poly-substances excluding opiates

Unspecified/unknown

- “poly-substances” should include at least one of the above mentioned substances
- “unspecified/unknown” will be included when it is assumed to include one of the above mentioned substances

This selection was agreed by the EMCDDA group of experts. It was called “Selection D” for Special Registries.

More information on EMCDDA work on drug-related deaths >>

EMCDDA protocol “DRD-Standard Protocol" >>

2. Drug-related deaths: “National Definitions”

Definitions of ‘acute drug-related death’ in EU Member States, as used to report cases for the EMCDDA annual report

It is recommended that for reporting to the EMCDDA, the national definitions are in line with the EMCDDA definition.

Belgium
Case Definition
 

EMCDDA definition for General Mortality Registries (“Selection B” for ICD-9)

 
Technical information

“Selection B” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure

Cases are reported by Health authorities of the French and Flemish Communities that collect death certificates filled by physicians. The National Institute of Statistics centralizes the morbidity statistics of the two communities

Reference

National Institute of Statistics. General Mortality Registry:. Personal communication (Ad-hoc data extraction for REITOX National Focal Point for the 2002 National Report).

Remarks

Since 1998, cases will be selected by ICD-10 codes

 
Bulgaria
Case definition
 

Cases of death which underlying cause of death is Drug Psychosis, Drug Addiction, Drug Abuse, Accidental Poisoning

 
Technical information

The cases are selected according to the ICD-10 codes:

F11-F12, F14-F16, and F19, disorders

X42, X41, accidental poisoning
X62, X61, intentional poisoning

Y12, Y11, Poisoning undetermined intent

 

The combination with T-codes is not possible.

Data collection procedure

Death certificates filled in by family doctors do not specify the substance even if they have reasonable doubts. Deaths occurring in hospitals are followed by toxicological examination.

Reference

Ad hoc data extraction by National Focal Point from General Mortality Registry for the 2006 Reitox National Report

Remarks

There are difference in number of cases obtained from the General Mortality Registry (40) and from police reports (36) in 2005

From 2005 onwards cases are selected by ICD-10 codes

Czech Republic
Case definition
 

Deaths due to poisoning caused by psychoactive substances (drugs of abuse and psychoactive medicines).

 
Technical information

Selection D of EMCDDA standard definition (drugs of abuse) PLUS deaths due to poisonings by psychoactive medicines

Data collection procedure.

Special semiautomatized electronic registry run by National Focal Point and Society of Forensic Medicine and Toxicology.

Reference

Národní monitorovací stredisko pro drogy a drogové závislosti and SSLST CLS JEP (2006) Speciální registr úmrtí spojených s uzíváním drog v r. 2005. Praha: NMS. (Special Mortality Register - Drug-Related Deaths in 2005. Prague: National Monitoring Centre for Drugs and Drug Addiction) Notes: unpublished

Remarks

In 2005, according to the national definition, 156 cases out of a total of 218 were due to psychoactive medicines

 

Since the practice in Czech Republic does not allow to include into the GMR any examination newer than 3 days after the death, this registry is not observed for the purposes of drug epidemiology as appropriate.

Denmark
Case definition

A death is included in the statistics, if the death is caused by poisoning and also non-overdose deaths, such as for example accidents and suicides. The definition includes deaths due to all forms of narcotic substances.

 
OR

A death is included in the statistics, if

(1) the dead is causes by poisoning(or)

(2) there is a strong causal relation between use of drugs and death

Technical information

If no report from autopsy is available, the case is decided on available information of the deceased and circumstances of death.

Data collection procedure

Cases are reported from forensic institutes to the National Commission of Police.

Reference
Remarks

Of the 275 cases based on the national definition, 202 were due to poisonings.

Germany
Case definition
 

Deaths following intentional or unintentional overdose.

Deaths as a result of long-term abuse.

Deaths due to suicide resulting from despair about the circumstances of life or the effects of withdrawal symptoms.

Deaths due to fatal accidents suffered by people under the influence of drugs

 
Technical information
--
Data collection procedure
 

Cases are reported by local police units that are working jointly with the forensic physicians, to the National Police Department, the Federal Criminal Police Office (BKA) that records the information.

Reference

Bundeskriminalamt OA21 (2006). Bundeslagebild Rauschgift 2005. Wiesbaden: Bundekriminalamt.

Remarks

From 1985 through 1990, the figures only refer to the former West Germany (the old Länder).

Since 1991, the figures refer to the reunited Germany, which includes the old and the new Länder.

Estonia
Case Definition
 

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

Technical information

“Selection B” is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure
 
Reference

Drug Situation "Estonia 2006" for the EMCDDA

Remarks
 
Ireland
Case definition
 

Deaths due to drug dependence.

Deaths due to poisoning by opiates and related narcotics.

 

From 2003 onwards,EMCDDA definition for General Mortality Registries (“Selection B” for ICD-9)

 
Technical information

“Selection B” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure

Cases are reported by regional registrars of births and deaths, who collect information from doctors, the police, and coroners, to the General Mortality Register at the Central Statistics Office (CSO).

Reference

General Mortality Register, Vital Statistics, Central Statistics Office

Remarks

The increase between 1995 and 1997 is (partly) due to an increased awareness of the need for more accurate information and reporting.

 

In September 2005, Ireland set up a special register. The first data from this register will be available at the end of 2007. This register will be able to comply with the requirements of EMCDDA selection D

Greece
Case definition
 

EMCDDA standard definition for Special Registries (“Selection D”)

 
In national terms:
Deaths caused by overdose.

Deaths caused by the synergic activity of different drugs.

 
Technical information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure

Cases of sudden death are notified to the police who refer the cases to the forensic department for autopsy and toxicology, which notifies the police of the results. Cases are then reported by local police units to Section C of the Directory of Public Security at the Ministry of Public Order (Hellenic Police). Statistics are reported by the National Anti-Drug Coordinative Unit, National Anti-Drug Intelligence Unit, Joint Secretariat.

Reference
Hellenic Police, 2006.
Remarks

44 additional reported deaths are still being investigated.

Spain
Case definition
 

Deaths due to acute reaction following non-medical use of psychoactive substances

Technical information

From 1985 through 1995: Deaths due to acute reactions following opiate or cocaine consumption.

Since 1996: Deaths due to acute reactions following consumption of any psychoactive drug.

The cases refer to five large cities Barcelona, Bilbao, Madrid, Valencia, and Zaragoza.

Data collection procedure

Cases are reported by medical pathologists for the Mortality Indicator at the Delegación del Gobierno para el Plan Nacional Sobre Drogas (DGPNSD).

Reference 2003

1990 to 1995 State Information System on Drug Abuse (SEIT) Reports.

1996 to 2002 Unpublished reports
Remarks

Deaths due to poisoning by psychoactive medicines are included, but in practice, case definition is an approximation to «Selection D» (only 1 case of difference in 2002)

 

A small breach of trend took place in 1996 due to a change from reporting only on opiate and cocaine cases to all psychoactive substances.

 
France
Case definition
 

Deaths due to overdose in the strictest sense of the term.

Deaths occurring directly and immediately after consumption of drugs.

 
Technical information
--
Data collection procedure
 

After investigations following suspicious death, which generally include an autopsy and a toxicological analysis, cases are reported by the police and the Gendarmerie to the Office Central pour la Répression du Traffic Illicite de Stupéfiants (OCRTIS) at the Ministry of the Interior.

Reference

Office central pour la répression du trafic illicite des stupéfiants (2004) Usage et trafic des produits stupéfiants en France en 2003, OCRTIS, Nanterre

Remarks

Deaths due to poisoning by psychoactive medicines are included but, in practice, case definition is an approximation to «Selection D» (only 11 cases of difference in 2004)

 
Italy
Case definition
 

EMCDDA standard definition for Special Registries (“Selection D”)

 
In national terms:

Deaths directly attributed to drug misuse (acute intoxication, overdose) and reported by local and special police units to the Central Drugs Directorate.

 
Technical Information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure

Cases are reported by local and special police units to the Central Drugs Directorate at the Ministry of the Interior.

Reference

Relazione "Annuale 2005" della Direzione Centrale per i Servizi Antidroga - Ministero dell'Interno

Remarks
--
Cyprus
Case definition
 

EMCDDA standard definition for Special Registries (“Selection D”)

 
Technical information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure
 
Reference
Cyprus NFP, 2006,2006 Annual Report of EKTEPN, published.
Remarks
 
Latvia
Case definition
 

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

 
Technical information

“Selection B” is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure
 
Reference

Health Statistics and Medical Technologies State Agency; Death Cause Database.

Remarks
 
Lithuania
Case definition
 

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

 

Cases codified with X41, X61 and Y11 (with T40 codes) are not included.

 
Technical information

“Selection B” is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure
 
 
Reference

Narkotikų kontrolės depertamento prie Lietuvos Respublikos Vyriausybės metinis pranešimas: 2006 / parengė Narkotikų kontrolės depatramentas prie Lietuvos Respublikos Vyriausybės. - Vilnius, 2006.- P. 207.-ISSN 1822-0576

Remarks

National definition is not officially approved. There are agreement with data providers, that “Drug-related deaths” refers to those deaths that are caused directly by the consumption of drugs of abuse.

 

In 2005 data there is only one case difference between national definition and selection B (coded as X41 and T43.6)

Luxembourg
Case definition
 

Deaths caused by acute/direct reaction to the use of illegally acquired high risk consume (HRC) drugs.

Technical information

Fatal (accidental, intentional or of undetermined intention) intoxication caused by

the use of at least one illicitly acquired drug or

other drug(s) in case the victim has been known as a persistent user of illicitly acquired drugs.

Death is due to the acute pharmacological and or toxicological effects(s) of the consumed substances(s)

Data collection procedure

All suspected deaths require a judicial enquiry, and after forensic evidence from autopsy, cases are reported by the local police to the Special Drug Section (SDU) of the Judicial Police. Data from the General mortality Registry are used for validation purposes.

Reference

Origer,A. (2006): National report on the state of the drugs problem - RELIS2005, NF CES/CRP-Sante Luxembourg.

Remarks
--
Hungary
Case definition
 

EMCDDA standard definition for Special Registries (“Selection D”)

 

Cases of poisoning (where the concentration of the substance is considered to be lethal, based on Clarke’s: Isolation and Identification of Drugs, Pharmaceutical Press, London, 1986.) and cases where there is a casual relationship between the consumption of illegal substance(s) and the death. A toxicological confirmation is required in all cases.

 
Technical information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure
 
 
Reference

National Statistical Data Collection Programme, data corrected by the Institute of Forensic Medicine

Remarks
 
Malta
Case definition
 

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

 
Technical information

“Selection B” is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure
 
Reference

National Mortality Registry - Department of Health Information 2005

Remarks
 
Netherlands
Case definition
 

EMCDDA definition for General Mortality Registries (“Selection B”)

From 1985 through 1995, based on ICD-9

Since 1996, based on ICD-10
 
Technical information

“Selection B” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure

Cases are reported by municipal registrars, who collect information from physicians and coroners, to the Causes of Death Statistics at Statistics Netherlands.

Reference

Causes of death statistics, Statistics Netherlands (CBS)

Remarks

Only persons retrievable in the Dutch population register are included

Austria
Case definition
 

EMCDDA standard definition for Special Registries (“Selection D”)

 
Technical information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure.

Cases are reported by the police and hospitals to the Federal Ministry of Health and Women, which orders and checks the results of forensic examinations.

Reference

Suchtgiftbezogene Todesfälle-Statistik; Federal Ministry of Health and Women

Remarks
 
Poland
Case definition

Cases selected according to ICD 10 – codes: F11-12, F14-16, F19, X42, X62, Y12, X44, X64, Y14

Technical information

The additional T codes are not available. Missing X41, X61 and Y11 (with T43.6) and included X44, X64, Y14 (considered to include relevant cases in Poland).

Data collection procedure
 
Reference

Ad-hoc data extraction from General Mortality Registry for Reitox National Focal Point

Remarks
 
Portugal
Case definition
 

A person whose post-mortem toxicological analysis is positive for any illicit drug of abuse (whatever was the cause of death –overdose, traffic accident…-).

Technical information

The proportion of cases with positive toxicology and information on presumed cause of death suspected to be acute drug-related deaths were: 58% (2005), 51% (2004), 44% (2003), 58% (2002) and 73% (2001)

The cases refer to Lisbon, Oporto and Coimbra regions

Data collection procedure

Cases are reported to the delegations at the three Forensic Institutes of the Ministry of Justice.

Reference

Relatório Anual do IDT - 2005

Remarks

Due to under-reporting in previous Annual Reports, more cases are reported in the Annual Report since 1995.

Romania
Case definition

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

 

Drug-related deaths refers to those deaths that are caused directly by the consumption of drugs of abuse

 
Technical information

“Selection B” is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure
 
Reference

Ad hoc data extraction by National Focal Point from General Mortality Registry for the 2006 Reitox National Report

Remarks

Coverage is only Bucharest and few neighbouring counties.

Slovenia
Case definition

Cases according to the EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10 classification)

 

Deaths due to drug abuse; that means deaths happening during the time drugs is affecting the organism (accidental poisonings, intentional poisonings, poisonings of undetermined intent)

 
Technical Information
 
Data collection procedure

From 2002 onwards cases were obtained by linkage of four different databases: i) General Mortality Registry, ii) Police database, iii) First Treatment Demand database and iv) Toxicology Department at the Institute of Forensic Medicine

 
Reference

Ad-hoc data extraction from General Mortality Registry for Reitox National Focal Point

Remarks

Information of the GMR is completed with Forensic and Toxicology data, with police data and with First Treatment Demand data

Slovakia
Case definition

EMCDDA standard definition for Special Registries (“Selection D”)

 
Technical information

“Selection D” is described in the protocol EMCDDA-DRD Standard, version 3.0 (for Special Registries)

Data collection procedure
 
Reference

Ad-hoc data extraction from the Special Registry

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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: Tuesday, 20 March 2012