EMCDDA expert meeting on the epidemiological indicator: Drug-related deaths (DRD)

This year particular attention will be given to

• a European project on post mortem toxicology practices across Europe
• Issues with the coding of causes of deaths, and updates of the WHO guidelines
• Heroin related deaths
• Deaths related to synthetic opioids and to prescription opioids
• New psychoactive substances
• Linkage studies and overall mortality among drug users
• Epidemiology and implications of ageing drug users
• Drug consumption rooms and naloxone programmes to reduce overdose deaths

Key EMCDDA resources

• DRD standard protocol 3.2

• WHO. International statistical classification of diseases and related health problems 10th revision Volume 2 Instruction manual Fifth edition. 2016

• LX Addictions DRD EMCDDA Key Epidemiological Indicator

Main topics

The meeting aimed to provide insights into the current situation and trends in drug-induced deaths (overdose) and mortality among drug users in Europe in 2016. It also explored cross-analysis with other indicators of drug use and harms, as well as prevention and treatment responses.

This year the expert meeting focused on important technical and public health issues:

• The latest data, which point to an increase of the number of overdoses in 2016 or most recent year in many countries.
• The drivers and determinants of deaths in selected countries, in the light of multiindicator analysis.
• Changes in opioidsrelated deaths, in the United States and in Europe, with a focus on fentanyls but also on some prescription opioids and new synthetic opioids.
• The analysis of the differences in practices in post mortem toxicology across Europe, and their implications on DRD monitoring.
• Adjustments and updates on the ICD coding, and their implications when extracting and analysing the data from general mortality registries.
• The scaling up of takehome naloxone programmes and health facilities with spaces for supervised drug consumption.
• Public health decisions and developments of national public health policies aiming at reducing overdoses.
• Mortality cohort studies – findings on causes of deaths other than overdoses, and link with the treatment settings and treatment data.
• Ageing highrisk drug users and implications of this demographic change for practices and policies.

Highlights of the 2017 expert meeting

This year, the expert group focused on the monitoring of overdose deaths through data from special mortality registries, on forensic toxicology practices across Europe and on recommendations to improve the quality and comparability of the overdose data available. This 2017 focus balanced the work carried out last year on the analysis of the overdose data from the general mortality registers (GMR), and also the analysis done from the ‘multi-indicator perspective’ ([1]).

Meanwhile, the GMR data were discussed as well, and experts’ opinion on coding and on national statistics were also very valuable. Several experts or countries have revised or completed their data since last year, and this dynamic is very fruitful in improving the overall quality of overdose data across Europe.

Finally, as recommended last year, many presentations of national overdose situations were enriched by cross analysis with other indicators of drug use and harms, such as drug treatment, harm reduction, hospitalisation, seizures/purity data and estimates of high-risk drug users.

Detailed minutes, including provisional data, have been circulated to the national experts and to the national focal points. They are also available on the restricted DRD area.

([1]) See for reference the 2016 DRD summary and also the reports on coding and on cross indicator analysis.