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

dru induced deaths
Source: European Drug Report 2019

On 8-9 November 2018, the EMCDDA brought together more than forty European and international experts for a meeting on the key indicator Drug-related deaths. The meeting provided a space for sharing and discussing new data, studies and experiences at regional, national and European level.

It also aimed to facilitate technical work around the collection and analysis of the different components of this indicator: overdose and toxicological information from special mortality registers; data from the general mortality registers; mortality cohort studies; as well as developments in responses. There were presentations from experts from EU Member States, neighbouring countries and Canada. See main findings and report below.

Meeting topics

This year particular attention was given to:

  • Most recent data reported by the network
  • Post mortem toxicology practices across Europe
  • Most recent trends and analysis of fentanyl-related deaths
  • Deaths related to synthetic opioids and to prescription opioids
  • Stimulant related deaths including cocaine and synthetic cannabinoïds
  • Insights from new and large linkage studies on overall mortality among drug users
  • Drug consumption rooms and naloxone programmes to reduce overdose deaths
  • Alternative and complementary sources: open source information and data from emergency settings

Main findings

At a glance: a summary of key points

Overdose deaths: a very high burden of premature preventable deaths

Over 8 200 deaths involving one or more illicit drugs were reported in 2017 in the European Union. This estimate exceeds 9 400 deaths when Norway and Turkey are included. Males account for four-fifths of the
drug-induced deaths. Most of the deaths were premature, affecting people in their thirties and forties.

Opioids: the main driver of fatal overdoses in Europe

  •  Opioids, often heroin, are involved in between eight and nine out of every 10 drug-induced deaths reported in Europe, although this is not true for all countries.
  • Opioids used in substitution treatment are also commonly found in post-mortem analysis in some countries.
  • Deaths related to medications, such as oxycodone and tramadol, are also reported.
  • Deaths associated with fentanyl, its analogues are probably underestimated, and outbreaks of deaths related to these substances have been reported.

Stimulants and benzodiazepines involved in many deaths

  • Post-mortem toxicology analyses of overdose cases suggest that in most cases, multiple drug toxicity is implicated.
  • Overall, cocaine is reported in an increasing number of deaths. Increased cocaine injection is also reported in several countries.
  • Synthetic cannabinoids were involved in the majority of drug-induced deaths reported in Turkey in 2017.
  • Fake medicines, diverted medicines and new benzodiazepines are related to an increasing proportion of drug-related deaths in some countries. Benzodiazepines are causing particular concern in Scotland (UK), where they were implicated in more than half of the reported drug-related deaths in 2017, with recent increases driven mainly by deaths involving new benzodiazepines such as etizolam.

High overall mortality among drug users

Seven countries reported new data from mortality cohort studies among high-risk drug users:

  • Findings suggest that high-risk drug users are three to seven times more likely to die than their peers of the same age and gender in the general population.
  • The most frequently reported causes of death include overdose, HIV/AIDS, other infections, liver disease, cancer, respiratory disease and cardiovascular disease.
  • The proportion of deaths due to overdose is likely to be underestimated.

Responding to drug-related deaths

  • Coverage and diversity of responses to drug-related deaths vary between and within countries.
  • Updates provided on drug consumption rooms and take-home naloxone programmes indicate the expansion of these responses in countries across Europe in 2018.
  • While the evidence base for their effectiveness is growing, more research is needed on these and other responses.

Implications for public health and for monitoring

  • There is an ongoing need to improve the epidemiology of drug-related deaths — from a toxicology perspective, in particular — in order to get more accurate and informative figures in Europe.
  • Further implementation of cohort and linkage studies is needed and can be attained with relatively little investment.
  • Additional sources of information offer timelier data — important for early identification of threats — and may be triangulated. These include open source information monitoring and data from acute intoxications presented at hospital emergency units.