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 2007/2008) 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
- 28 countries reported numbers of drug-induced deaths (DRD) according to their national definition that in most cases matched the EMCDDA definition.
- Only 20/30 countries reported the number of DRD for 2008. Seven countries reported the 2007 figure and one reported 2006 figure. For Portugal data has not been included this year due to major discrepancies existing in previous years between figures from the General Mortality Register and the Special Register (reporting all cases with a positive toxicology, not only Selection D). Ongoing work is conducted by Portugal to harmonise data reporting with EMCDDA Selection D, and to make data available in next reporting year.
- Between 1995 and 2007, 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 (2 to 85 DRD per million inhabitants) (see Table DRD-5 part (i)).
- The majority of reported cases were males (81 %).
- Most victims were aged between 20 and 40. The mean age of reported victims was 34 years but this varies across countries (25 to 47 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’.
- 20/30 countries specified the proportion of their reported death where a toxicological result was known. In these, over 85 % of the reported deaths had a toxicology result reported.
- In 18 countries out of 20 providing data in 2008, opioids accounted for more than three quarter of all cases (77–100 %)
- 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 around 2 100 in adults (15–64 years) in Europe in 2007, with 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, 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 2009 National reports, around 1 000 deaths were identified by 15 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).
- There are signs of cocaine being detected in increasing numbers of reported drug-induced deaths, but due to the lack of comparability in the available data, it is difficult to describe the European trend.
- 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 2007 with an overall increase of 11 % in reported deaths. Preliminary data available for 2008 suggest an overall figure at least equal to that for the previous year, with increases reported by 11 out of 18 countries where a comparison was possible. (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.
- 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.