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Drug-related deaths and mortality (DRD)

Drug-related deaths and mortality — an overview of the methods and definitions used

Drug-related mortality is a complex phenomenon, which accounts for a considerable percentage of deaths among young people in many European countries. The EMCDDA, in collaboration with national experts, has defined an epidemiological indicator with two components at present: deaths directly caused by illegal drugs (drug-induced deaths) and mortality rates among problem drug users. These two components can fulfil several public health objectives, notably as an indicator of the overall health impact of drug use and the components of this impact, identify particularly risky patterns of use, and potentially identify new risks.

The appropriate implementation of the component ‘deaths directly caused by drugs’ requires the existence of quality information sources: general mortality registries and/or special mortality registries. An EMCDDA protocol establishes common criteria and procedures to extract and report cases from existing registries.

Estimation of ‘mortality rates among drug users’ requires follow-up studies, for which a working protocol has been developed. An updated version will be relased in 2011

The quality of key indicator information depends on the quality of its sources, and will increase with improvement of post-mortem investigations and with full use of this information for death certification and coding.

Purpose of this indicator

The general purpose of the indicator is to improve understanding of the health impact of different forms of drug use and its correlates and determinants, with the aim to inform the development and evaluation of policies and interventions aimed at reducing health problems, in particular mortality, related to drug use.
Data on the number, characteristics and circumstances of people dying directly due to drugs can fulfil several complementary purposes, especially when presented and interpreted alongside other drug indicators.

Some of the more relevant purposes are:

  • to provide information on the health impact of drug use in the community, in particular to highlight and measure the most extreme consequences of drug taking;
  • to identify risky patterns of use (e.g. injection or polydrug use) and risk among the most vulnerable groups of problem drug users;
  • to identify new risks such as those of new substances or combination of substances, or contaminated or adulterated batches;
  • to help to monitor trends in prevalence of specific drug problems with an elevated risk such as injecting heroin use;
  • in combination with other information, to estimate prevalence of problem drug use (multiplier estimation);
  • to help in hypothesis-generating in relation to reasons why rates or characteristics of drug related deaths differ between and within countries.

Mortality among drug users is an important component of the indicator. Critically, mortality studies among cohorts of problem drug users will provide information that is to some extent independent (the overall mortality) of certification or coding practices.

  • Overall mortality is an indicator of the extension of harm associated with different patterns of drug use.
  • Cause-specific mortality can give policy-relevant insight on the components of harm related to problem drug use, which often is not evident from standard sources.
  • Mortality information may also support the interpretation of routine statistics on drug induced deaths (underreporting, codification issues).
  • Mortality studies help to make the link between statistics of drug-induced deaths (number of overdoses) and prevalence estimations of population at risk (e.g. number of opiate injectors).

EMCDDA monitoring standards

The EMCDDA monitoring standards for drug-related deaths (drug-induced deaths) require the collection at national level on the total number of cases of death attributed directly to the use of illegal substances of abuse. In addition, for each reported case, information will be collected on the gender and age-band of the victim and on the substances that caused the death.

The information should be extracted from existing information systems: General Mortality (GMR) or Special Registries (SR). The ideal situation will be to extract information from both systems if they exist in a country, for assessment of consistency and cross validation.

1. EMCDDA case definition of drug-induced death (1)

The EMCDDA definition of drug-related deaths (more precisely, drug-induced deaths) is simple and relatively restrictive. It includes 'people who die directly due to use of illegal substances, although these often occur in combination with other substances such as alcohol or psychoactive medicines. These deaths occur generally shortly after the consumption of the substance.' They are also known as overdoses or poisonings.

2. Operative criteria (1)

The EMCDDA standard protocol transforms this definition into operative criteria for extracting the relevant deaths from both GMR and SR (types of death) in a way that provides the best possible estimation for the number of cases matching this definition. For the GMR, these operative criteria consist of a list of codes from the WHO International Classification of Diseases (ICD) 10th Edition. For the SR they consist of the classes of deaths that should be extracted (only overdoses out of all possible cases recorded in these registries e.g. traffic accidents, violence).

For GMR, the list of ICD-10 codes is known as ‘Selection B’. They include cases where the underlying cause of death (the condition that initiated the process that lead to the death) is: (1) mental and behavioural disorders due to psychoactive substance use (harmful use, dependence, and other mental and behavioural disorders (F codes) due to opioids, cannabinoids, cocaine, other stimulants, hallucinogens or multiple drug use, or (2) poisonings (X and Y codes) that are accidental, intentional or of undetermined intent due to substances under the heading of narcotics (T40-0 to T40-9) or psychostimulants (T43.6).

For the SR, the EMCDDA operative criteria are known as ‘Selection D’. Cases are selected when the death are due to poisoning by accident, suicide, homicide, or undetermined intent by a set of illegal drugs of abuse(1).

At present, national mortality statistics are improving in most countries and their definitions are becoming more comparable, or with small differences, to the common EMCDDA definition (‘Selection B’ and ‘Selection D’). A few countries still include cases due to psychoactive medicines or non-overdose deaths, generally as a limited proportion of the total. (Part 2 of this Methodological note details 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 toxicological investigation. In some countries information exchange between GMR and SR (forensic or police) is insufficient or lacking, which compromise the quality of information. However considerable progress has been obtained during the last years in quality and reliability of information on many Member States.

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.

3. Cases to be extracted from the mortality registries

In operative terms the cases are identified and selected as follows:

3.1 By extraction of the cases from General Mortality Registries according to the following criteria (Selection B)

  • based on the WHO International Classification of Diseases, 9th edition -ICD-9-(2)
  • based on the WHO International Classification of Diseases, 10th edition -ICD-10-

Case are counted when their underlying cause of death is mental and behavioural disorders due to psychoactive substance use (see below) or poisoning (accidental, intentional or by undetermined intent).

  • 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
X42 (1), X41 (2)
Intentional poisoning
X62 (1), X61 (2)
Poisoning undetermined intent
Y12 (1), Y11 (2)

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

Effect of the ICD-10 updates

Several ICD-10 updates for codification of deaths due to drug intoxications were adopted by WHO in 2002 and 2003 by the Heads of WHO Collaborating Centres for International Classifications in Health Care and entered into force in 2006. For the countries that have already implemented these ICD-10 updates some additional combination of codes should be included. They are: X44, X64 and Y14 in combination with main injury codes (T codes) T40.0 through T40.9 and T43.6

Note that X44, X64 and Y14 alone, without combination of T codes, or without the implementation of the updates are not part of the DRD-Standard.

3.2 By extraction of the cases from Special Registers (Forensic or police registries) — Selection D

This method is applied in countries where the previous method cannot be implemented, but also whenever possible as a backup estimate and validation of the numbers derived from the General Mortality Registries. Cases are counted when the death is due to poisoning (by accident, suicide, homicide or of undetermined intent) and when the death is due to opiates, amphetamines, cocaine (or crack), cannabis, hallucinogens, solvents, or synthetic designer drugs like amphetamine derivatives.

The specific groups of deaths to be selected 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 (1) including opiates

Poly-substances excluding opiates

Unspecified/unknown (2)

(1)  'Poly-substances' should include at least one of the above mentioned seven substances or categories of substances.
(2)  'Unspecified/unknown' is used when assumed to include at least one of the above- mentioned substances.

More information on EMCDDA work on drug-related deaths
EMCDDA protocol 'DRD-Standard Protocol'

Definitions of ‘drug-related death’ in EU Member States used to report cases to the EMCDDA

The EMCDDA recommends that for reporting, the national definitions are in line with the DRD-Standards  — Selection B for GMR and Selection D for SR.

 

Belgium
Case Definition

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

Technical information

 

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.

Remarks

Since 1998, cases to be selected by ICD-10 codes. Most recent national data available 1997. No data available from Special Mortality Register.

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

An alternative to Selection B is used, as 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 Reitox National report

Remarks

Data are available through both GMR and SR.

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). National definition is broader than EMCDDA Selection D.

For the purpose of EMCDDA analysis (characteristics, rates, trends), Selection D is used.

Technical information

Selection D of EMCDDA standard definition (drugs of abuse) plus poisonings by psychoactive medicines. These overdoses represent a different category of overdoses (mainly suicide, with a combination with alcohol, with a higher proportion of women and older persons).

Data collection procedure.

Forensic medicine departments sent, special semi-automatised electronic registry run by the national focal point and the Society of Forensic Medicine and Toxicology.

Reference

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

Remarks

Most cases included in the national definition as such are due to psychoactive medicines.

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

Denmark
Case definition EMCDDA definition for General Mortality Registries ('Selection B' for ICD-10 classification)
Technical information

--

Data collection procedure

 

Reference General Mortality Registry (Danish Causes of Death Registry).
Remarks

Until recently, the Danish data used for EMCDDA analysis were based on police information, with a broader case definition than Selection D. It was over inclusive, with some reports of cases of  ‘deaths among drug users’ that were not

The case definition was: A death was included in the statistics, if (1) caused by poisoning (or) (2) there was a strong causal relation between use of drugs and death. The definition was also formulated as: A death is included in the statistics, if caused by poisoning and also non-overdose deaths, e.g. accidents and suicides. The definition includes deaths due to all forms of narcotic substances.

Data are available through both GMR and SR. 

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.
National definition is broader than EMCDDA Selection D.
Technical information The German Police Federal Department (BKA) has implemented new categories to collect information on substitution related deaths. In-depth analyses of toxicological information is available for Berlin, Hamburg, Hesse, Bavaria.
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, 'Rauschfigtkriminalität. Bundeslagebild Rauschgift. Tabellenanghang', Wiesbaden: Bundekriminalamt (Federal Criminal Police Office).

Remarks

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

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

The General Mortality Register (Statistishes Bundeshamt Wiesbaden) is an alternative source of information. Automatic coding procedure was in field trial in 2009 before planned implementation.

Estonia
Case Definition

EMCDDA definition for General Mortality Registries ('Selection B' for ICD-10 classification)

Technical information

 

Data collection procedure  
Reference

 

Remarks

Transfer of the National Death Register to the National Institute for Health Development in 2008.

Ireland
Case definition

From 2007 onwards EMCDDA standard definition for Special Registries ('Selection D').

Technical information

Records have been matched to avoid duplication and to maximise the information available on each case.

Data collection procedure

The database extracts information from four sources: coronial records, deaths among in-patients in acute general hospitals throughout Ireland (Hospital Inpatient Inquiry Scheme [HIPE]), the methadone treatment database (Central Treatment List [CTL]) and the General Mortality Register (GMR). 

Reference

National Drug-Related Deaths Index (NDRDI) uses data from several sources: the Coroners Service, the acute hospital sector through the Hospital In-Patient Enquiry Scheme (HIPE), the Central Treatment List (CTL) and the General Mortality Register (GMR).

Remarks Until 2007, the national definition used was the EMCDDA definition for General Mortality Registries (‘Selection B’ for ICD-10 classification).
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  
Data collection procedure

Cases of sudden death are notified to the police who refer the cases to the forensic department for autopsy and toxicological analysis, 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.
Remarks Alternative source of information: National Statistical Service of Greece. Considerable delay in updating data (data reported for previous years for cases that were still under investigation).
Spain
Case definition

The following codes (ICD-10) were selected from the General Mortality Registry:
F11, F12, F14, F15, F16, F19, X42, X44, X62, Y12 (i.e. Selection B + X44 code).

T codes are not used, and the case definition is therefore an approximation of Selection B.

Technical information Some Autonomous Communities have automatic codification.
Data collection procedure

Every Autonomous Community codifies its own registry and send the data to the National Institute of Statistics.

Reference General Mortality Registry
Remarks

Definition: Although it is not Selection B, the 3 digit codes of the underlying cause of death are the same than in Selection B, wheareas X44 is included because of local expertise — it is known that this code is used mainly for drug overdoses.

Until the previous year, another source of information was used: the Special Registry covering six large cities since 1983 (Barcelona, Bilbao, Madrid, Sevilla, Valencia and Zaragoza).

Cases are reported by medical pathologists for the Mortality Indicator at the Delegación del Gobierno para el Plan Nacional Sobre Drogas (DGPNSD). These special registries collect information on deaths caused by non-medical use of psychoactive drugs, which judge intervention. Information is retrieved by coroners and toxicological analyses. These special registries can produce Selection D.

France
Case definition

The following codes (ICM 10) are selected from the General Mortality Registry:
- F11-F12, F14-F16 and F19; X42 and Y12.

T-Codes are rarely used, and the case definition is therefore an approximation of Selection B.

Technical information F-codes are very frequently used.
Data collection procedure

Codification is based on the death certificate provided by the physician, and data are processed and facilitated by CépiDc/INSERM. Delay in transmitting the toxicological information for the update of the death certificates.

Reference

General Mortality Registry. Alternative sources (i.e. OCRTIS and DRAME) used only, for ad-hoc cross-study of the GMR data.

Remarks

Until 2006, other sources of information were used.

  • Office Central pour la Répression du Traffic Illicite de Stupéfiants (OCRTIS) at the Ministry of the Interior.

The case definition was 'Deaths due to overdose in the strictest sense of the term' or 'Deaths occurring directly and immediately after consumption of drugs' (data are no more published).

  • DRAME (Décès en relation avec l’abus de médicaments et de substances), collecting information from 16 regional forensic institutes. The information on substances involved in the deaths is not available for all DRD cases reported to the EMCDDA, due to the unused T codes.
Italy
Case definition

EMCDDA standard definition for Special Registries ('Selection D')

In national terms:

The Special Register of deaths refers to cases due (on the basis of circumstances and signs which are un equivoque and refer to overdoses and not following toxicological information) directly to the use of illegal psychoactive substances, and, does not include therefore deaths caused indirectly by the taking of drugs (road accidents attributable to driving under the influence of drugs or deaths of drug users due to pathological complications). It does not include cases where police has not been involved.

Technical Information

 

Data collection procedure

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

Reference

DCSA - central Anti-Drug Servcies department. Relazione 'Annuale' della Direzione Centrale per i Servizi Antidroga — Ministero dell'Interno.

Remarks

Alternative source: national Statistics Institute (ISTAT), holding the General Mortalità Registry; Legal Medicine Institute (but partial coverage).

ICD 10 classification was implemented in 2007.

Data are available with a three years' delay.

Cyprus
Case definition

EMCDDA standard definition for Special Registries ('Selection D')

Technical information

All acute deaths are investigated (toxicological analysis carried out in all cases).

Data collection procedure Special register held by the Cyprus police. Information flow from police/forensic pathologist to the National toxicological laboratory police.
Reference Cyprus NFP,  Annual Report of EKTEPN.
Remarks

DRD not previously reported from the GMR (underreporting and difficulties with the completion of the death certificates), but in progress with closer collaboration between the Cyprus Health Monitoring Unit and the NFP since 2008.

According to the NFP, there is no underreporting.

Latvia
Case definition

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

Technical information  
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 in the national defintion.

Technical information

GMR is able to produce Selection B, although national definition slightly differs from it.

Data collection procedure Alternative source of information: Special Mortality Register but no data reported after 2002.
Reference

Narkotiku kontroles depertamento prie Lietuvos Respublikos Vyriausybes metinis pranesimas: 2008/parenge Narkotiku kontroles departamentas prie Lietuvos Respublikos Vyriausybes. — Vilnius.

Remarks

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

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

(a) the use of at least one illicitly acquired drug or

(b) 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.

Reference

National report on the state of the drugs problem — NF CES/CRP-Sante Luxembourg.

Remarks Data from the General mortality Registry are used for validation purposes.
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 Clarkes: 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.

F codes are not used.

Technical information

 

Data collection procedure Only one substance can be indicated in the template for data collection at national leve.
Reference

National Statistical Data Collection Programme, data corrected by the Institute of Forensic Medicine. 2007 data. 2008 National report.

Remarks  
Malta
Case definition

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

Technical information

 

Data collection procedure  
Reference

National Mortality Registry — Department of Health Information.

Remarks  
Netherlands
Case definition

EMCDDA definition for General Mortality Registries ('Selection B').

Technical information

 

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).

Remark

From 1985 until 1995, based on ICD-9. Since 1996, based on ICD-10.

Only persons retrievable in the Dutch population register are included.

Other sources: Netherlands Forensic Institute and the Municipal Health Service in Amsterdam (follows a mortality study on methadone patients, with a known address in Amsterdam, and who were born in the Netherlands or in listed selected countries).
 

Austria
Case definition

EMCDDA standard definition for Special Registries ('Selection D')

Technical information

 

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: F11-12, F14-16, F19, X42, X62, Y12, X44, X64, Y14.

T codes are not available.

Technical information

Differences compared to Selection B: 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 the General Mortality Registry for the Reitox national focal point. Central Statistics Office (GUS)

Remarks

Alternative source of information is the Communal and County Police (in charge of the investigation of every sudden death).

Codes for national definition were chosen in 2005. ICD-10 codes are used since 1997.
 

Portugal
Case definition From 2008 data onwards, Portugal changed the definition used with SR to avoid overestimation (that was due to previously reporting all cases with a positive toxicology, not only Selection D). 2009 data based on SR are provisional due to reporting delay. Data from the GMR are known to underestimate drug-induced deaths.
Technical information  
Data collection procedure

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

Reference

Relatório Anual do IDT

Remarks

 

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  
Data collection procedure Ad hoc data extraction by the national focal point from General Mortality Registry.
Reference

National Institute of Statistics.

National Forensic Institute Mina Minovici.

Remarks Data refer only to Bucharest and several counties in the competence area of the Toxicology Laboratory from Bucharest. Three toxicological laboratories: Bucarest, Lasi, Timisoara.
Slovenia
Case definition

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

Deaths due to drug abuse; i.e. 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 the 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  
Data collection procedure  
Reference Ad-hoc data extraction from the Special Registry, for the NFP Annual report.
Remarks The Special register is recent and was specifically developed with the DRD key indicator implementation. Historical data available since 2004.
Finland
Case definition From 1988 through 1995 (ICD-9, Finnish adaptation), deaths due to identified drugs by: diseases (dependence, harmful use, substance induced brain syndrome accidental poisoning events of undetermined intent). From 1996 onwards, EMCDDA definition for General Mortality Registries ('Selection B' for ICD-10).
Technical information

Three different of statistics on DRD are presented in the National report:

(a) Cause of deaths (EMCDDA criteria for DRD)
(b) Poisoning as the cause of death [minimum estimate]
(c) Chemical findings, based on positive drug findings in forensic autopsies (the drug itself not necessarily being the direct cause or a major indirect cause of death). From the Department of Forensic Medicine, Helsinki University. [maximum estimate]

Data collection procedure Collection and processing of causes of death statistics at Statistics Finland, on the basis of death certificates, with additional information from forensic Toxicology division.
Reference Statistics Finland, Cause of Death Statistics (unpublished data).
Remarks

The Finnish adaptation of ICD-9 did not allow the implementation of 'Selection B' of DRD standard protocol. The breach of trend observed between 1995 and 1996 could be in part due to change from ICD-9 to ICD-10 and to change from the national definition to Selection B.

Data are available through both GMR and SR.

Sweden
Case definition

EMCDDA definition for General Mortality Registries ('Selection B' for ICD-10)

National definition of DRD from the 'National statistics of causes of death' registry include the following ICD-10 codes, registered as either underlying or contributing cause of death:  F 11-F 16, F 18-F 19 T 40.0-T 40.3, T 40.5-T 40.9 T 43.6
O 35.5 P 04.4 Z 50.3 Z 71.5, Z 72.2.

Importantly and however, ICD-10 code T40.4 is not included in either of these definitions. This is due to the extent of poisonings with dextropropoxifen.
 

Technical information  
Data collection procedure Cases are reported by physicians to the Cause of Death Register at Statistics Sweden and are reported and published by the Epidemiological Centre of the National Board of Health and Welfare (NBHW).
Reference National Death Cause Registry (Run by the Epidemiological Centre, at the NBHW).
Remarks In 2003 'national case definition' was adapted to the EMCDDA definition (Selection B) with the exception described.
United Kingdom
Case definition

Two sets of tables submitted to the EMCDDA, based on three definitions of DRD.

(a) EMCDDA definition: Deaths caused directly by the consumption of one or more illegal drugs.

(b) Definition used by the Office of national Statistics (ONS), which a much wider definition including legal drugs and uses (see codes below).

(c) Definition used to measure DRD for the UK Drug Strategy: where the underlying cause of death is drug abuse, drug dependence, or poisonings, where any of the substances scheduled under the Misuse of Drugs Act 1971 (including class A, B and C drugs) are involved.
 

Technical information

England and Wales (E&W), Northern Ireland and Scotland ('ONS standard definition').

Based on ICD-10 Classification, since 2000:

  • F11-F16, F18, F19,
  • X40-X44 (accidental poisoning),
  • X60-X64 (intentional self poisoning),
  • Y85 (assault by drugs, medicaments and biological substances),
  • Y10-Y14 (poisoning undetermined intent).
Data collection procedure

Cases from England and Wales (E&W) are reported to the Office for National Statistics (ONS).

Cases for Northern Ireland (NI) are reported to the NI General Register Office.

Cases for Scotland are reported to the Scottish General Register Office.

Reference

See Health Statistics Quarterly

  • ONS: Published Statistics on DRD in E&W (provides information on death using both ONS and drug strategy definition). 
  • General Register Office for Scotland (GROS)
  • NISRA
  • Np-SAD annual report
Remarks

The UK Drug Strategy definition has been adopted by the GMR across the UK and is a subset of the ONS definition. Over time, it has produced estimates very similar to the EMCDDA Standard 'Selection B'.

Information is also available in the Special Register on drug-related deaths, within the National Programme on Substance Abuse Deaths (NP-SAD). This registry is based on data submitted voluntarily by coroners on inquests into DRD reported by Coroners in E&W, NI, Scotland, Guernsey, Jersey and the Isle of Man, and procurators fiscal in Scotland.
This registry can produce estimates for the EMCDDA Standard 'Selection D'.

Croatia
Case definition

EMCDDA definition for General Mortality Registries (“Selection B” for ICD-10)

Technical information  
Data collection procedure  
Reference

Croatian Central Bureau of Statistics

Remarks  
Turkey
Case definition

EMCDDA standard definition for Special Registries ('Selection D')

Technical information  
Data collection procedure  
Reference

Expert reports of The Council of Forensic Medicine and Turkish National Police

Remarks  
Norway
Case definition

From 2009 (reporting year) onwards, EMCDDA definition for General Mortality Registries ('Selection B' for ICD-10)

Death due to misuse of illegal drugs (Drug dependence or poisoning).
mental and behavioural disorders due to drug use accidental or undetermined poisoning by drugs of abuse.

Until 2009 the national definition was an approximation to 'Selection B' for ICD-10 but excluding 'intentional poisoning' (X61 and X62).

Technical information Up to 1996, cases were selected by ICD-8 and ICD-9 codes (304).
Since 1996, the ICD-10 codes used (underlying causes) are:
F11-F12, F14-16, F19,
X42 and Y12 in combination with T40.0-9,
X41 and Y11 in combination with T43.6.
Data collection procedure Registry of Causes of Death, from Statistics Norway. Data from Statistics Norway are manly based on autopsy reports from the National Institute of Forensic Medicine.
Reference Statistics Norway.
Remarks  

(1) More in Overview of the key indicator, January 2009.

(2) See in more details in the DRD protocol version 3.2 revised in 2010; the codes that were selected when ICD-9 was still in use in some EU countries.

About the EMCDDA

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: Thursday, 14 July 2011