Drug-related deaths (DRD)

• Methods and definitions

Overview of the data

Table DRD-6 provides very detailed methodological characteristics of data collection systems by country. One of its more relevant parts is the case definition per country and its compatibility with EMCDDA standard definitions. This is presented in harmonised form in "Methods and Definitions", part 2, pp. 4 to 14. Table DRD-0 provides data sources and bibliographic references by country according to each country's national definition.

Tables DRD-1 and DRD-2 provide data by country on drug-related deaths according to each respective national definition, which in most countries currently correspond with EMCDDA standard definitions (Selection B or D). While Table DRD-1 offers summary information for the latest data (part (i)), % opiate in toxicological analysis (part (ii)) and insight into historical data for 1990 or closest year (part (iii)), Table DRD-2 provides time-trend data on the number of drug-related deaths (part i), their breakdown by gender (parts (ii) and (iii)), data on younger age groups (part iv) and several indices (part v) which correct for availability of data and can therefore be used for time-trend analysis.

Table DRD-3 provides data for the EMCDDA standard definition 'selection B' for General Mortality Registries (see Methods and Definitions) for all countries with available data for this selection. Note: some countries can provide both 'selection B' and 'selection D' data and may prefer to use one or the other, whichever best reflects their national context. Table DRD-4 provides data for 'selection D' EMCDDA standard definition for Special Registries (see Methods and Definitions) for all countries with available data for this selection. See also Table DRD-3.

Figures DRD-5 and DRD-6 show the time-trend of deaths among all cases and cases aged under 25 years and the time-trend of DRDs by gender. These figures indicate differentiated patterns in the evolution of mortality by age and gender.

Table DRD-7 provides numbers and indices to gain insight into longer-term historical trends of drug-related deaths, dating back to 1985. Figures DRD-8, DRD-11 and DRD-12 provide analysis of time-trends for all cases of acute drug-related deaths. Figure DRD-8 aims to present a long term perspective in Europe since 1985, to help clarify the implications of more recent trends. Figure DRD- 11 presents differentiated patterns of evolution of acute drug deaths in some countries, suggesting possible underlying patterns of prevalence of opiate use. Figure DRD-12 highlights more recent proportional changes in acute drug deaths.

Table DRD-5 (part (i) and part (ii)) provides data on general population mortality by country and based on these, proportional mortality due to drug-related deaths per the entire population, as well as for several age groups. Figures DRD-2, DRD-3, DRD-4, DRD-9 and DRD-10 show data on age of decease due to drug-related death. Figure DRD-1 shows proportion of drug-related death cases with positive opiate toxicology by country, although in many cases other additional substances are found.

Summary points

• Between 1990 and 2004, Member States reported between 6 500 to over 9 000 acute drug-related deaths (overdoses) each year, adding up to more than 122 000 deaths during this period as a minimum estimate (See Table DRD-2 (i), Table DRD-3 and Table DRD-4).
• Mortality rates varied widely between countries, with most countries ranging from 3- 5 to over 50 deaths per million inhabitants (with an average of 18.3 – see Table DRD-5 part (i)).
• In addition to overdoses, AIDS deaths related to injecting drug use and intravenous drug (IVD) use accounted for almost 1 400 deaths in 2003 in Europe, although this figure is possibly an underestimate.
• Other 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 or indirectly.
• Mortality related to other forms of drug use should be added to this burden, although at present its quantification is very difficult (e.g. cardiovascular problems related to cocaine use), and further work is needed on this issue.
• Opioids are present in most cases of 'acute drug-related deaths', due to illegal substances identified and reported in the EU (range 46-100%, see Figure DRD-1).
• Opiate overdose (with or without other substances) is one of the leading causes of death among young people in Europe, in particular in some countries (proportional mortality).
• The majority of overdose victims are men (60 to 100%). Most victims are aged between 20 and 40 years old, with the mean age in the mid thirties (range between 23 and 43 years) (See Table DRD-1 part (i)).
• In many of the "older" Member States, an ageing trend has been observed among overdose deaths, suggesting an 'ageing cohort effect'.
• Several countries reported the presence of methadone in a substantial proportion of drug-related deaths in their 2006 Reitox reports, although in some cases it is not clear if methadone was the primary cause of death. Some countries, present a substantial number of methadone deaths, but in others a clear decrease of methadone mortality has been observed, in terms of rates per people in treatment.
• Fentanyl and buprenorphine deaths are unusual, except for buprenorphine in Finland, where a substantial number of fatalities have been reported, mainly in combination with alcohol and benzodiazepines.
• It is considered that cocaine deaths are more difficult to identify than opiate deaths, as they constitute multifactor deaths, and occur rarely from pharmacological toxicity itself.
• In Europe, deaths involving cocaine usually show a presence of other substances (alcohol, opiates and others). In 2006 National Reports (similarly to 2005 Reports), over 400 deaths were identified by countries as being cocaine-related, although it is difficult to ascertain the proportion that may have passed unnoticed.
• Since 2000, many EU countries have reported decreases in the numbers of drug-related deaths. The European average decrease was 6% in 2001, 14% in 2002 and 5% in 2003 (see Table DRD-2).
• However, this overall EU decreasing trend halted in 2004 and 2005 (partial data). Between 2000 and 2003, 19 countries reported decreases in the number of drug deaths, but between 2003 and 2004/2005, increases were observed in 14 of the 23 countries where comparison was possible (see Figure DRD-12).
• In addition to overdoses, problem drug users have a high overall mortality, due to AIDS and other diseases (e.g. cirrhosis), violence, suicide and accidents, and is estimated through follow-up (cohort) studies, mainly of persons treated for their opiate use. Mortality among other forms of drug use is less well known, but it will be increasingly important for public health purposes, for instance among regular but integrated cocaine users.

Page last updated: Tuesday, 20 March 2012