An overview of the data
Table DRD-0 provides a summary of sources and bibliographic references for each country. Table DRD-106 completes it with detailed methodological characteristics of data collection systems by country, including sources and registers used. One of its more relevant parts is the drug-induced death (DRD) national definition and its compatibility with EMCDDA standard definitions (Selection B — General Mortality Registries — or Selection D — Special Registries). This is presented in a harmonised and more detailed form on the Methods and definitions page.
Table DRD-1 offers summary information for the latest data available on DRD, with gender and age-bands (part (i)), known toxicology and, particularly, a proportion of DRD with opiate found in toxicological analysis (part (ii)) and insight into historical data since 1990, or the closest year (part (iii)).
Table DRD-2 provides numbers of drug-related deaths since 1995, overall (part (i)), broken down by gender (part (ii) and part (iii)), and younger age groups (part (iv)). Several indices (part (v)) are correct for availability of data and can therefore be used for time-trend analysis.
For all countries with available data, Table DRD-3 provides data for the 'Selection B' EMCDDA standard definition and Table DRD-4 provides data for 'Selection D' EMCDDA standard definition (see Methods and definitions). Note: The existence of both sources of information (as it is the case in most Member States and participating countries) helps considerably to cross check their information. For this purpose, the EMCDDA recommends that, when available, data from both GMR and SR are reported.
Figure DRD-5 and Figure DRD-6 show the time-trend of deaths among all cases, cases aged less than 25 years and the time-trend of DRDs by gender.
Table DRD-5 (part (i) and part (ii) provides data on general population mortality by country and based on these, estimates of proportional mortality due to DRD per the entire population, and for several age groups, as well as the estimated mortality due to HIV-AIDS, attributable to injection drug use (part (iii)). Table DRD-108 provides detailed qualitative information on deaths due to specific substances, based on information available through the national reports.
Table DRD-107 provides numbers and indices to gain insight into longer-term historical trends of drug-related deaths, dating back to 1985 (part (i) and part (ii)). Figure DRD-8 shows overall time-trends for all cases of drug-related deaths in Europe since 1985. Figure DRD-11 presents differentiated patterns of evolution of reported drug-induced deaths in some countries, suggesting possible underlying patterns of prevalence of opiate use. Figure DRD-12 highlights more recent changes in numbers (2000 to 2003 and 2003 to 2009/2010) in reported drug-induced deaths.
Figure DRD-2, Figure DRD-3, Figure DRD-4, Figure DRD-9 and Figure DRD-10 show data on the age of the deceased due to drug-related death.
Figure DRD-1 shows a proportion of drug-related death cases with positive opiate toxicology by country, although in many cases other additional substances are found.
Summary points
- 30 countries reported numbers of drug-induced deaths (DRD) according to their national definition that in most cases matched the EMCDDA definition.
- 22/30 countries reported the number of DRD for 2010. Seven countries reported the 2009 figure and one reported 2005 figure.
- Between 1995 and 2010, overall there were between approximately 6 300 to 8 200 DRD (overdoses) reported each year (Table DRD-2 part (i), Table DRD-3 and Table DRD-4).
- Population mortality rates calculated with last year available data was 21 deaths per million inhabitants aged 15 to 64 years on average, but varied widely between countries (see Table DRD-5 part (i)).
- The majority of reported cases were males (8 in 10 cases).
- Most victims were aged between 20 and 40. The mean age of reported victims varies across countries (26 to 44 years) (see Table DRD-1 part (i)). In many of the ‘older’ Member States, an ageing trend has been observed among overdose deaths reported, which could suggest an ‘ageing cohort effect’.
- 24/30 countries specified the proportion of their reported death where a toxicological result was known (see Table DRD-1 part (ii)). In 11 of these countries, opiates accounted for more than 85 % of the reported DRD (see Figure DRD-1).
- In addition to overdoses, the estimated number of HIV–AIDS deaths attributed to injecting drug use was estimated around 1 830 in adults (15–64 years) in Europe in 2009, with almost 90 % of these deaths occurring in Spain, France, Italy and Portugal. This estimation is possibly an underestimate (see Table DRD-5 part (iii)).
- In several countries, methadone was identified in toxicological reports of some deaths, although it is not clear whether methadone was the primary cause of death (see Table DRD-108). However, there is evidence of retention in any treatment being protective against overdose mortality. Studies in different countries showed an increased risk of DRD in people out of treatment, and in people just released from prison.
- Deaths involving cocaine usually show a combination with other drugs (alcohol, opiates and others). In 2011 National reports, around 640 deaths were identified by 16 countries as being cocaine-related, although it is difficult to ascertain the proportion that may have passed unnoticed (e.g. heart problems in youth or middle age adults) (see Table DRD-108).
- Between 2000 and 2003, most EU countries reported a decrease in drug-induced deaths — the total number declined by 23 %. This trend reversed between 2003 and 2009/2010. Preliminary data available for 2010 suggest an overall figure below to that for the previous year. (see Table DRD-2 and Figure DRD-12).
- Deaths indirectly related to drug use (e.g. hepatitis, violence, suicide or accidents) are more difficult to assess, but a study published in 2005 estimated that during the 1990s, 10 to 20 % of mortality of young adults (15–49 years) in some European big cities could be attributed to opiate use, either directly (overdoses) or indirectly (diseases, accidents, suicides).
- Overall mortality is estimated through follow-up (cohort) studies, mainly of persons treated for their heroin or opiate use. Many European countries have conducted cohort studies and most studies show mortality rates in the range of 1–2 % per year among problem drug users. After 10 years, up to 20 % of the participants in a study may have died. Mortality for drug users is roughly 10 to 20 times that of the general population of the same age and gender (see Selected issue on mortality).
- Mortality among other groups of drug users (e.g. regular but integrated cocaine users) is less well known, but it will be increasingly important to measure and monitor it for public health purposes.