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Table DRD-108. Drug-induced deaths: Detailed qualitative national information on deaths due to specific substances in EU Member States (2011 National Reports)

CountryCocaineEcstasyMethadoneBuprenorphineFentanylOthers / Comments
Belgium-----
Bulgaria-----Sofia-city and Sofia-region: of drug-related death cases in 2010, 35 cases were caused by poisoning with narcotic substances.The poisonings are caused mainly by heroin abuse: around 88.6% when used as a single substance, and around 8.6% when used in combination with alcohol. Only one death was ascertained as a result of poisoning by other opioide substances.
Czech RepublicNo cases1 case2 casesNo cases1 case (and in another case small amount of fentanyl in case classified as pervitin overdose)In 2010, 194 fatal overdoses on illicit drugs, inhalants, and psychotropic medication were identified (225 in 2009). Of this number, 55 cases fell under the standard EMCDDA selection D for drug-related deaths, i.e. cases of fatal overdoses on illegal drugs and inhalants (49 in 2009), and 139 cases involved psychotropic pills (176 in 2009).
Denmark (based on The National Commissioner of Police)1 case3 cases44 % of the poisonings (89 out of 204) were caused by methadone or methadone combined with another drug--33 % of the poisonings (67 out of 204) were caused by heroin/morphine or heroin/morphine combined with another drug, whereas 44 % of the poisonings (89 out of 204) were caused by methadone or methadone combined with another drug. Seven of the poisoning cases in 2010 were caused by poisoning with either amphetamine (3) or cocaine (1) or ecstasy and ecstasy-like drugs (3).
Germany 117 cases (90 combined with other substances)8 cases (6 combined with other substances)45 cases Methadone/Polaminode alone 110 cases Methadone/Polaminode plus other drugs4 case of subutex 2 cases of subutex plus other drugs-In the year 2010, a total of 1,237 people died because of the use of illicit drugs which corresponds to a decline of seven percent in comparison with the previous year (1,331).Overdose of heroin (including use of heroin in connection with other drugs) remains with 855 cases the most common cause of death (69%; 2009: 70%; 2008: 66%). The portion of drugrelated deaths in which substitution substances alone or in combination with other drugs were detected, was at 14% (2009: 13%; 2008: 12%). Since 2006, the statistics of the federal criminal police office discriminate in the detected substitution substances between methadone/polamidone and subutex® (buprenorphine). According to the BKA data, the majority of death cases that were attributable to one substitution substance alone happened in connection with methadone/polamidone (N=45; 88%). Among the 116 death cases, in which substitution drugs in combination with other drugs were found, there were also two cases in which buprenorphine was detected.
Estonia----According to the assessment by the Estonian Forensic Science Institute, the majority of them died through using 3-methylfentanyl (Estonian Forensic Science Institute, personal communication, 2011).A total of 101 people died due to using drugs in Estonia in 2010 (this was 133 people in 2009). The majority of persons who died of accidental poisoning were males (89 men, twelve women).The quality of data improved significantly in 2010 and there were only five cases with an unknown substance as the cause of poisoning.
IrelandThe number of deaths where cocaine was implicated, alone or with another drug, decreased again in 2009. In 2008, cocaine was implicated in 58 deaths while in 2009, it was implicated in 52 deaths by poisoning in 2009.----In 2009, the number of deaths owing to poisoning recorded in Ireland by the NDRDI (as per Selection D) decreased slightly, to 203 deaths from 211 in 2008. This is the first decreased in the number of deaths owing to poisoning since 2003. Opiates continued to be associated with the majority of fatal overdoses in 2009, with 180 (88.7%) deaths being associated with opiates alone or with another drug. This percentage is higher than reported for previous years. The number of deaths where cocaine was implicated, alone or with another drug, decreased again in 2009. In 2008, cocaine was implicated in 58 deaths while in 2009, it was implicated in 52 deaths by poisoning in 2009. Of the 203 cases of poisoning recorded in 2009, heroin or unspecified opiates alone accounted for 50 (24.6%) cases. Deaths attributable to polysubstances increased: more than half of all deaths owing to poisoning (125, 61.6%) were attributable to polysubstances, including an opiate, which is higher than reported in previous years.
Greece -----In the year 2010, 153 drug-induced deaths were reported, of which 108 (70.6%)were confirmed with the appropriate toxicological analyses by 15.9.2011. Nine in every 10 drug-induced death cases (90.7%) involved heroin/morphine, while also a 42.6% involved substances other than cannabis or cocaine.
Spain (based on the majority of the great urban areas and many cities of medium size, accounting for about a half of the Spanish population)Cocaine present in 57,8% of cases. Cocaine and no opiates in 16,4% of cases. Cocaine alone in 5,4% of cases. Cocaine alone with alcohol in 4,7% of casesMDMA presente in 0,9% of cases---In 2009, the opiates continue to be the substance identified in the greatest number of deceased individuals (81.0% of the samples), a slight rise having been noted in 2009 compared to 2008 (77.7%). Cocaine continues to be ranked second with regard to the percentage of the total number of deaths in which this substance is identified. However, a slight decline was recorded in 2009 (57.8%) compared to 2008 (60.2%) and 2007 (67%). The data for cocaine shows a drop in the number of deaths in which this substance is identified alone or in combination with other substances (“cocaine alone” and “cocaine and no opiates”). The combination “cocaine alone plus alcohol” has however been increasing considerably since 2007.
France (based on DRAMES)Cocaine alone, or in combination - 32 cases (12,3%) -Methadone alone, or in combination: 58 cases (22,3%)Buprenorphine, alone or in combination: 31 cases (11,9%)-Illegal drugs were the main substances responsible in slightly more than half of the cases (53%) in 2009, substitution treatments in approximately 34% of cases and opiates (excluding substitution) in almost 13% of cases. Overall, opiates were the main cause in 87% of deaths, and cocaine, either alone or combined with other substances, in approximately 12%. The increasing number of overdoses between 2006 and 2009 is explained by an increase in the number of deaths from heroin (+ 44 cases) and methadone (+ 27 cases) overdoses.
Italy 11% attributed to cocaineone case 2% attributed to methadone--374 overdose deaths in 2010. In approximately 44% of deaths recorded in 2010, it was not possible to detect the substance which had allegedly caused the death (we remind the reader that findings were not based on toxicological analyses but on purely circumstantial elements). In 41% of cases, the cause of death could be traced, with reasonable certainty, back to heroin, while in 11% of cases it could be traced back to cocaine, to methadone in 2% of cases and to other substances in the other 2% (these include one death caused by MDMA amphetamine, one by crack, one by hashish and one by barbiturates).
Cyprus-----During the reporting year, 12 drug related deaths were recorded, 9 of which were directly attributed to drug poisoning. Out of 9 cases of overdoses recorded in 2010, 8 cases involved opiates (only opiates: 6 cases; opiates with cocaine: 0 cases; opiates with cannabis: 1 case; opiates with benzodiazepines: 1 case) and 1 cases involved cannabis and butane.
Latvia-----According to GMR data, in 2010 there were 7 deaths recorded directly linked to drug use, or 12 cases less than in 2009. One death was caused by morphine (T40.2); one death was caused by heroin overdose (T40.1); in two cases, by amphetamine/methamphetamine (T43.6), while in three cases, the substance was not specified.
Lithuania2 cases-3 cases where methadone was present in opiate related deaths--According to data of the Institute of Hygiene in 2011, 51 deaths (46 males and 5 females) due to drugs and psychotropic substance use were registered (in 2009– 68 cases), and this level accounts for 0,12 percent of all deaths registered in Lithuania (in 2009 – 0,16 percent). In 2010, the main death cause was intoxication with drugs and psychotropic substances (45 deaths), mostly opiates – 26 deaths cases (of them in 3 cases was found methadone), unknown or non-specified narcotic or psychotropic substance – 17 cases, cocaine – 2 cases.
Luxembourg -----12 cases where reported in 2010. Forensic data show that the most frequently involved substance in overdose cases is heroin, followed by methadone and cocaine. To stress that since 2000, methadone presence in blood samples of overdose victims has been increasing.
HungaryNo casesNo cases2 casesNo casesNo casesIn 2010 17 cases directly related to illicit drug use were reported, which indicates a significant reduction as compared to the previous years (in 2009: 31 cases).
Malta-----During 2010, 5 drug related deaths were reported, while 7 drug related deaths were reported by the Police Special Registry (PSR) in 2009.
Netherlands14 casesIn 2010, there was only one case that was coded to poisoning by psychostimulants (other than cocaine). Whether these fatal intoxication concerned amphetamines, MDMA, or other psychostimulants is not known.---Of the 94 cases in 2010, a total of 45 cases were coded to unspecified substances, compared to 51 cases in the 2009 registration year. Although the specific substances are not known in these cases, a previous inquiry at Statistics Netherlands (CBS) revealed that these cases are mostly related to hard drugs and to polydrug use, and are therefore rightly included in the group of drug-related deaths.
Austria29 % of the cases----In 11% of cases of DRD, the toxicological analyses revealed only illicit substances (one drug or a combination of several drugs). In addition, psychoactive medicines were also found in 53% of cases, in 12% alcohol was detected as well, and in 24%, both substances, i.e., alcohol and psychoactive medicines, were found. As in previous years, fatal poisonings involving opioids clearly predominate. The opioids most often found are morphine and heroin, followed by other opioids and methadone. Cocaine and amphetamines were detected in only 29% and 9% of cases, respectively. The share of persons who had exclusively taken opioids is 8%, which is in line with the long-term trend (2007: 6%; 2008: 8%; 2009: 11%).
Poland-----In cases when a specific type of substance was given as primary cause of the fatal poisoning, the most frequent type of sunstace was opiods-7 individuals
Portugal (data from the special registry INML)Cocaine 50% (26 cases) of the cases (in 54% and 43% of the cases in 2008 and 2009)-The presence of methadone was detected in near 15% (8 cases) of the overdoses in 2010 (4% in 2009 and 9% in 2008).--Concerning the substances detected in these cases of overdose, predominantly opiates in 73% of the cases (82% and 89% of the cases in 2008 and 2009), followed by cocaine 50% of the cases (in 54% and 43% of the cases in 2008 and 2009). The presence of methadone was detected in near 15% of the overdoses in 2010 (4% in 2009and 9% in 2008).
Romania--11 cases--In 2010, 34 cases have been reported at national level (33 in Bucharest, 1 case in Ilfov County) as drug related deaths. All the 34 cases have confirmed by toxicological testing the presence of psychoactive products. Toxicological examination made only at LMNI Bucharest (the other laboratories in the country, including those created in 2010, did not report direct drug related deaths for 2010) revealed the presence of opiates in 26 cases (11 methadone, 14 heroin/morphine and metabolits, 5 tramadole, 1 dextropropoxyphene), benzodiazepine – 15 detections, anti-epileptics – 6 detections, barbiturate – 4 detections, ketamina - 1 detection, anti-psychotics/ anxiolitics/ sedatives - 4 detections. These substances appeared in variable combinations, in 8 cases only one substance was detected (3 heroin, 3 methadone, 1 tramadole 1 case of amphetamine). Alcohol was detected in 4 cases with values of 0.65 g � – 1.1 g �.For the first time hallucinogen substances such as mescaline and phencyclidine – 2 cases.
Slovenia5 cases-6 cases--According to the General Mortality Register, there were 25 direct illicit drug-related deaths in Slovenia in 2010. Somewhat less than half of the poisonings were caused by heroin, which is 23 percent less than in 2009. The number of deaths caused by methadone and other opioids remained the same in both years. Among all drug poisonings, one fifth of deaths were caused by cocaine. Cocaine was not listed as the cause of death in the previous year
Slovakia2009: 2 cases; 2010: no case -2009: 1case methadone/polysubstances; 2010 no case--Forensic medicine workplaces HSA reported 42 cases of deaths directly caused by psychoactive substances in 2010, i.e. by 14 cases (25%) less than in 2009. In 22 cases (52%), it was due to overdose of commonly available medicine, in 20 cases due to overdose of illegal drugs and solvents. Opiates and opiods and their combinations with different substances were identified in 12 cases, which converts to 60% of cases of overdose of illegal drugs and solvents or 29% of the total number of cases of the so-called direct death. Amongst psychoactivey medicine, benzodiazepines were identified in 9 cases (41%), which converts to 21% of all reported cases.
Finland-----
Sweden------
United Kingdom180 mentions9 mentions503 mentions --There were 1,930 deaths in 2010, a decrease of 7.7% since 2009 (n=2,092). As in the past 10 years, most deaths continue to be linked with the use of opiates, primarily heroin/morphine (n=1,061) and, to a lesser extent, methadone. There has been a sharp fall in ecstasy mentions between 2009 and 2010 (72%) and cocaine mentions have also fallen by around a quarter in that time, although they remain at around twice the level of 2000 (n=88). The ONS reported six death registrations in England and Wales involving mephedrone in 2010.
Croatia--38 cases--Opiate overdose accounted for the cause of death of 61 persons, i.e. 40.1% of all deaths. Toxicological analysis in 2010 showed an increase in methadone intoxication - 38 deaths or 62.3% of the total number of overdoses were deaths caused by methadone intoxication. The reasons of the rise in methadone intoxications can be found in illegal methadone use, easy availability, treatment overdose, inadequate use or reduced opiate tolerance.
Turkey15 cases were substance was found 1 case2 cases (methadone only)--The number of direct drug-related death cases which was 153 in 2009, decreased to 126 with 17.6% in 2010. As in the previous years the causes of death for most cases were overdose drug use or poly-drug use. In 88.9 % of the cases (112) at least one substance that was a opioid was detected and in 11.1 % of the cases (14) a substances that was not a opioid was detected (solvents in 7 cases, cocaine in 4 cases and methamphetamine in 3 cases).The most common substances that were used in combination with opioids were benzodiazepine derivatives (23), cannabis (11) and cocaine (11). As a difference from previous years both methamphetamine and amphetamine were detected in 5 cases and only methamphetamine was detected in 1 case. Only one Ecstasy (MDMA/MDA)-related death case was observed.
Norway--39 deaths were recorded with methadone poisoning as the underlying cause --Concerning the 285 drug-related deaths in 2009 that were recorded by Statistics Norway, 255 deaths involved opioids with or without additional drugs (Figure 7), 137 were deaths due to heroin (X42, X44, X62, X64 + T401), 39 deaths were recorded with methadone poisoning as the underlying cause (X42, X44, X62 + T403), and 61 with other opioids, either as poisoning or dependency (X42, X44, X62, X64 + T402, F112). The remaining 48 deaths broke down as follows: 18 other synthetic narcotics (X42, X44, X64 + T404), four other/unspecified psychodysleptics (X42 + T409), seven psychostimulants (X41, X44, X61 + T436), three unspecified narcotics (X42, X44 + T406), 16 dependence other stimulants and dependence multiple/other (F152,F192), and no deaths from cocaine (X44 + T405).
 

Sources:

Reitox national reports 2011. Textual information extracted from national reports, based on different national sources (GMR, SR and others)

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