Drug-related deaths and mortality (DRD)

• Overview
• Tables
• Graphs
• Methods and definitions

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-related 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: 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.

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. These figures indicate differentiated patterns in the evolution of mortality by age and gender.

Table DRD-5 (part (i) and part (ii)) provides data on general population mortality by country and based on these, proportional mortality due to DRD per the entire population, and for several age groups, as well as the estimated mortality due to AIDS, attributable to injection drug use (part (iii)). Table DRD-108 provides detailed qualitative information on deaths due to specific substances.

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 acute drug-related deaths in Europe since 1985. 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 changes in numbers (2000 to 2003 and 2003 to 2006/2007) in acute drug 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

• All 30 countries (27 Member States, Croatia, Turkey and Norway), reported numbers of drug-related deaths (DRD) according to their national definition that in most cases matched the EMCDDA definition.
• Only 18/30 countries reported the number of DRD for 2007. Ten countries reported the 2006 figure and two reported 2005 or earlier.
• Between 1995 and 2006, overall there were between approximately 6 400 to 8 500 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 (3 to 85 DRD per million inhabitants)  (see Table DRD-5 part (i)).
• The majority of cases were males (83 %).
• Most victims were aged between 20 and 40. The mean age of reported victims was 34 years but this varies across countries (21 to 46 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’.
• 23/30 countries specified the proportion of their reported death where a toxicological result was known. In these, just over 85 % of the reported deaths had a toxicology result reported.
• Overall, where a toxicological result was known, opiates (i.e. heroin, mainly) were present in 4/5 reported DRD.
• In 11 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 more than 2 100 in adults (15–64 years) in Europe in 2006, with almost all cases in four countries. This estimation is possibly an underestimate (see Table DRD-5).
• 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, in different countries there was evidence of a decrease in the numbers of deaths in which methadone was recorded, whereas the number of people treated increased a lot; and 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 2008 National reports, around 500 deaths were identified by 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).
• Over the 2000–03 period, most EU countries reported decreases in the numbers of reported drug-related deaths, followed by a rebound, in the 2003–07 period. Although some countries that significantly contribute to the reported numbers (i.e. the UK, Spain, France, Denmark, Sweden, and Norway) could not report 2007 data, levels are expected to be sustained in 2007. Compared to 2000, 16 EU countries reported decreased numbers of drug-related deaths in 2006 (or 2005 when data not available) and seven countries reported increased numbers (see Table DRD-2 and Figure DRD-12) (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).
• In addition to overdoses, problem drug users have a high overall mortality, due to HIV–AIDS and other diseases, violence, suicide and accidents. Overall mortality is estimated through follow-up (cohort) studies, mainly of persons treated for their heroin or opiate use.
• 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.