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Table DRD-106. Methodological features of drug-induced deaths reported by National Reitox Focal Points (Based on national definitions - Reitox Standard Table 5)
| Country | Geographical Area | Year | Bibliographic Reference / Source of information | Source General Mortality Registry | Source Special Registry | Case_Definition (National) | Explain_Difference with EMCDDA Standard | Double count control | Underreporting_explanation | Other_Sources existing in the country | Remarks about National Definition |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Belgium | National | 2005 | Belgian National Institute of Statistics: General Mortality Register | Yes | : | EMCDDA definition for General Mortality Registers (Selection B-ICD-10) | There is no difference between the national definition and Selection B | Yes | : | No | : |
| Bulgaria | National | 2010 | National Statistical Institute | Yes | : | Coding of DRD causes is according to ICD-10. Data are processed by the main cause of death. Three-digits code is used. The cases are selected according to the ICD-10 codes: F11-F12, F14-F16, F19, X41, X42, X61, X62, Y11, Y12. | Three-digits code (ICD-10) is used when coding the death cause. For this reason the combination with T-codes is not possible. | Yes | An estimation on the level of underestimated reporting has not been done. | No | : |
| Czech Republic | National. | 2010 | Narodni monitorovaci stredisko pro drogy a drogove zavislosti and SSLST CLS JEP (2011) Specialni registr umrti spojenych s uzivanim drog (Special Mortality Register - Drug-Related Deaths) | No | Special semiautomatized electronic registry run by National Focal Point and Society of Forensic Medicine and Toxicology. 1998-2001 aggregated reporting forms from all (13) forensic medicine departments were used. In 2002 partly eletronic/database reporting started. In 2003-2010, data were fully delivered electronically from all 13 forensic medicine departments. | Poisoning caused by psychoactive substances except alcohol: Selection D of EMCDDA standard definition + poisoning caused by psychoactive medicines = causes 18-23 of SMR standard. | National definition is broader than EMCDDA Selection D. It covers poisoning caused by psychoactive substances except alcohol: Selection D of EMCDDA standard definition + poisoning caused by psychoactive medicines = causes 18-23 of SMR standard. | Yes | : | No | : |
| Denmark | 95,5 % | 2009 | The Danish General Mortality Registry | Yes | : | The national case defintion is equal to the selection B | There is no difference between the national definition and EMCDDA Selection B. | Yes | For the year 2009 we only covered approximately 96,6 pct. of all death cases in our GMR-register. Since we know that for sure from another register we estimated a total number of cases of 228. Since we do not have the detailed information of those "missing" cases, the total number of cases is only 215 in table 2.1.11, 2.1.12 and 2.1.13. The data for 2010 are expected to be finished at the end of 2011 | Yes | : |
| Germany | national | 2010 | Bundeskriminalamt (2011). Rauschgiftkriminalitaet - Bundeslagebild 2010 - Tabellenanhang. Wiesbaden: Bundeskriminalamt. | No | Federal Criminal Police Office (Bundeskriminalamt) | Deaths following intentional or unintentional overdose./ Deaths as a result of long-term abuse./ Deaths as a result of suicide resulting from despair about the circumstances of life or the effects of withdrawal symptoms./ Deaths as a result of fatal accidents suffered by people under the influence of drugs. | National definition is broader than EMCDDA Selection D (see 2.2.6) | Yes | unknown | Yes | question 2.1.8.: in 19 cases the gender is unknown |
| Estonia | National (whole country) | 2010 | Estonian Causes of Death Registry; National Institute for Health Development | Yes | : | National definition is Selection B | There is no difference between the national definition and EMCDDA Selection B definition | Yes | : | Yes | : |
| Ireland | National | 2009 | Drug-Related Deaths and Deaths Among Drug Users in Ireland 1998 to 2007,with an update of 2008 data is available at: http://www.hrb.ie/health-information-in-house-research/alcohol-drugs/ndrdi/ndrdi-publications/ | No | The Irish National Drug-Related Deaths Index (NDRDI) is an epidemiological database which records cases of death by drug and alcohol poisoning, and deaths among drug users and those who are alcohol dependent. | The Irish definition includes the EMCDDA Selection D Protocol exactly. | The Irish definition includes the EMCDDA Selection D Protocol exactly.However the SR also includes cases that do not fit Selection D, but are not submitted to the EMCDDA. These are alcohol releated deaths,and other prescription medication deaths only. | Yes | The SR included all available data sources for DRD and are crossed matched to exclude duplicate. This provides the most complete census possible in Ireland. However no studies have been carried out to determine under reporting. | No | All relevant national sources of information are included in the data sources providing data to the SR |
| Greece | National | 2010 | Hellenic Police, 2010 | No | Police | Same as EMCDDA definition (Selection D) | No difference | Yes | Not available | Yes | 2005 data:6 additional reported deaths are still being investigated 2006 data:13 additional reported deaths are still being investigated 2007 data:40 additional reported deaths are still being investigated 2008 data:69 additional reported deaths are still being investigated 2009 data:151 additional reported deaths are still being investigated 2010 data:41 additional reported deaths are still being investigated Question 2.1.10: Age distribution: ≤20 years:5 cases, 21-30 years:36 cases, >=31 years:67 cases. We have not been provided with the information of sex by age groups and with the information of question 2.1.12 |
| Spain | Whole country | 2009 | Unpublished data | Yes | : | "Deaths due to acute reaction following non-medical use of illicit drugs. The following codes were selected from the General Registry: F11, F12, F14, F15, F16, F19, X42, X44, X62, Y12 (ICD-10)" | To obtain the number of DRD, X44 has been added to Selection B | Yes | Probably very low | Yes | : |
| France | National | 2009 | Special extraction perfomed by the GMR at our request | Yes | : | Selection B used here. | National definition excludes deaths related to the misuse of opioid medications prescribed as painkillers. | Yes | Under-reporting assessed by cross-comparision of two sources (pessults published) and three sources (results awaiting publication).A cohort study was lauunched in 2010 although it shall NOT be used to determine or correct under-reporting. | Yes | Please note that the Selection B here applied includes false positive cases, i.e. individuals officially dying of DRD that would be not classified as drug users (mainly elderly - 65 or more - unwillingly misusing painkillers prescribed within a medical frame). Note that when restricted to 15-64 year old, the number of DRD falls down to 322 cases (266 males, 56 females). |
| Italy | National | 2010 | Annual Report from the Ministry of the Interior - Central Directorate for Anti-Drug Services | No | Reports from law enforcement services to the Central Directorate of Anti-Drug Services of the Ministry of Interior | Death directly attributed to drug misuse (acute intoxication, overdose) and reported by local and special police units to the Central Directorate of Anti-Drug Services of the Ministry of Interior. Selection D | the national case definition is equal to the EMCDDA Selection D | Yes | : | Yes | At present data from the GMR are only available with a three year delay (2003). Istat is moving from ICD9 to ICD10 system |
| Cyprus | National. | 2010 | Special Registry and National Focal Point, 2011. | No | Special Registry is held by the Cyprus NFP. Every acute death is being investigated by the Police (Drug Law Enforcement Unit), with the following information flow direction: Police-forensic pathologist-National Toxicological Laboratory-Police-NFP. | Deaths due to drug poisoning (selection D). | The National Definition is the same as the EMCDDA's standard definition (selection D). | Yes | Cross-comparison of different sources. | No | : |
| Latvia | National level but only a few centres/institutions providing updates (e.g. if new information on cause of deaths is gathered) to the initial data provided . | 2010 | Death Causes Database | Yes | : | National case definition is equal to the EMCDDA DRD Protocol v3 Selection B; ICD-10 codes of X41,X42,X44,X61,X62,X64,Y11,Y12,Y14 with a combination of T40.0-T40.9 and/or T43.6 are used for selecting DRD cases. In the coding F11-F16 or F18-F19 are not used in General Mortality Register in Latvia. | No differences. | Yes | 1) Cohort studies conducted in Latvia suggest there are rather many ill-defined causes of death for young adults, e.g. deaths due to cardiovascular problems, reported each year. It is unknown how much it influences the results. 2) Additionally decreased funding might influence the number of deceased, which are being sent to forensic laboratories. 3) Due to limited technical possibilities forensic laboratories are sometimes not able to assess, which drugs were involved in some of the death. | Yes | : |
| Lithuania | All country. | 2010 | Narkotiku, tabako ir alkoholio kontroles depertamento metinis pranesimas: 2011 / parenge Narkotiku, tabako ir alkoholio kontroles depertamentas. - Vilnius, 2011. | Yes | : | National definition is not officially approved. There are agreement with data providers, that Drug-related deaths refers to those deaths that are caused directly by the consumption of drugs of abuse and aims ICD-10 code: F11; F12; F14; F15; F16; F19 ; X42; X62; Y12. | National definition aims ICD-10 code: F11; F12; F14; F15; F16; F19 ; X42; X62; Y12 but not include cases with ICD codes X41, X61, Y11 with T40 codes. GMR is able to produce Selection B, although national definition slightly differs from it. National focal point receive full data from GMR and can calculate number of drug related death cases also using standart EMCDDA DRD definition for Selection B (ICD-10), adding to National definition missing cases with ICD codes X41, X61, Y11 with T40 codes. | Yes | : | No | : |
| Luxembourg | 100% | 2010 | Register of Drugs Unit (Judicial Police) & National Toxicological Laboratory (LNS) | No | Special Register of Drugs Unit (Judicial Police), cross-checked with forensic information source provided by the National Toxicological Lab (LNS). | Deaths caused by accute/direct reaction to the use of illegally acquired high risk drugs. | See question 2.2.5 | Yes | 0% | No | : |
| Hungary | National coverage. | 2010 | National Centre for Addictions - Mortality module of the reporting system of the National Centre for Addictions (OAC) relating to illicit drug use | No | The data collection system was launched in November 2009. Data providers are the Institutes of Forensic Medicine and the Departments of Forensic Medicine of Medical Universities. A unique identification code is assgined to each case (same as in the TDI) and an online questionnaire is filled in including questions on the circumsatnces of the death as well, that is fully compliant to the EMCDDA's DRD 3.2 protocol. | Cases of poisoning (where the concentration of the substance is considered to be lethal, based on Clarke's: Isolation and Identification of Drugs, Pharmaceutical Press, London, 1986.) and cases where there is a casual relationship between the consumption of illegal substance(s) and the death. A toxicological confirmation is required in all cases. It is equal to Selection D. | There is no difference between the national definition and EMCDDA Selection D. | Yes | No information. | Yes | : |
| Malta | National | 2010 | Malta General Mortality Registry | Yes | : | SUICIDE, LONGTERM ABUSE, ACCIDENTAL, UNDETERMINED INTENT. There is no difference between the national definition and selection B. | there is no difference between the national definition and selection B. | Yes | Under reporting is low. | Yes | : |
| Netherlands | National | 2010 | Causes of Death Statistics, held by Statistics Netherlands (CBS). | Yes | : | The EMCDDA definition, that is Selection B, is also the national definition. | The EMCDDA definition is also the national definition. | Yes | Validations from cohort data show that the level of underreporting will only be modest. | Yes | With regard to 2.1.9: please notice that the mean ages have been estimated by the number of cases within the age groups from 15 up to including 64 years. |
| Austria | all of Austria | 2010 | Suchtgiftbezogene Todesfaelle-Statistik | No | Since 2005 the NFP is in charge of the data analysis for the Special Register. | all overdoses according A 1 to A 4 + A 6 (see the DRD Standard, version 3.0) = Selection D = national definition | national definition is equal to selection D | Yes | : | Yes | : |
| Poland | Whole country | 2009 | Glowny Urzad Statystyczny | Yes | : | Cases selected according to ICD 10 codes: F11-12, F14-16, F19, X42, X62, Y12, X44, X64, Y14. | An additional T code are not available. In comparison with EMCDDA standard definition selection B there where missing X49, X69 and Y19. | Yes | It is not easy to assess. Not only underestimation is possible but also overestimation due to lack of additional codes. | No | : |
| Portugal | National | 2010 | Relatório Anual sobre a situação do País em Matéria de Drogas e Toxicodependências - 2010, IDT,I.P./Source: National Institute of Forensic Medicine (INML, IP)/ Ministry of Justice | No | National Institute of Forensic Medicine (INML,IP)/ Ministry of Justice. See information on Questions 4.1.14 and 4.1.16 | National case definition of drug-related death is the same as the EMCDDA definition - Selection D | The national case definition is equal to the EMCDDA ( Selection D) | Yes | In the moment, concerning 2010 data, we only know the cause of death for 65% of the cases with positive toxicological results. Since these deaths require forensic investigation and dificulties in collecting this information remain, wether due to the delay in completing the final report or to access it, 2010 data will be updated next year. | Yes | : |
| Romania | National | 2010 | National Forensic institute | No | The SR is set up at the level of all forensic services and regional institutes, and the National Forensic Institute “Mina Minovici” Bucharest, which covers the entire territory. Since the drug-related deaths are cases that include a "traumatic" component (including a chemical component) in the chain of death causes, according to the law in all these cases the forensic autopsy is compulsory. The data extraction pool is represented by the entire forensic casuistry, from which the DRD files are extracted. The centralization is based on internal protocols of the forensic network, including standard reporting bulletins, with the data processing at the level of the National Forensic Institute. Considering the fact that every case involves a judiciary analysis and the corresponding evidence, the informational contribution is maximized and it is allowed to take over data by including also the results of the toxicology tests – carried out in such cases – with those evidenced by the investigation, including the adjustm | same definition as EMDDA selection D | There is no difference between the national definition and Selection D | Yes | : | : | Is an obvious discrepancy between the level or drug mortality in Bucharest and the rest of the country. Possible explanations include misinterpretation of the law (to declare a forensic case in all drug related deaths) inexperience of forensic pathologist with this kind of cases, financial limits that reduce requires for toxicological analyses. |
| Slovenia | national coverage | 2010 | National Institute of Public Health: General Mortality Registry. | Yes | : | "Same as the EMCDDA (Selection B =1" | No difference. | Yes | : | No | : |
| Slovakia | Whole country | 2010 | Health Care Surveillance Authority | No | Special registry is a database of Institute of Forensic Medicine where reports from all workplaces are concentrated. | Selection D | No difference | Yes | : | Yes | GMR is not used since there are many difficulties related to methodology, data processing and cleaning. Furthermore, from the Special Registry all cases reported are with known toxikology. |
| Finland | Nationwide | 2010 | Cause of death statistics, Statistics Finland. Unpublished data. | Yes | Special registry is the Forensic Toxicology Unit of Helsinki University | National case definition is equal to the EMCDDA's Selection B. | There is no difference between the national definition and the EMCDDA standard definition. | Yes | No | Yes | : |
| Sweden | All Swedish residents | 2009 | The Swedish Causes of Death Registry | Yes | : | National definition includes both contributing and underlying causes. National definition of drug-related deaths from the "National statistics of causes of death" registry include the following ICD-10 codes, registered as either underlying or contributing cause of death: F 11-F 16, F 18-F 19 T 40.0-T 40.3, T 40.5-T 40.9 T 43.6 O 35.5 P 04.4 Z 50.3 Z 71.5, Z 72.2. The EMCDDA DRD-standard, version 3.1, Selection B: ICD codes were extracted according to the guidelines. Importantly and However, ICD-10 code T40.4 is not included in EITHER of these definitions. This is due to the extent of poisonings with dextropropoxifen. | The Swedish national definition includes both underlying and contributing causes. EMCDDA DRD-standard, version 3.1, Selection B: ICD codes extracted according to the guidelines. However,ICD-10 code T40.4 is not included. This is due to the extent of poisonings with dextropropoxifen. | Yes | : | Yes | : |
| UK (DSD) | UNITED KINGDOM | 2010 | ONS. (2011). Deaths related to drug poisoning in England and Wales, 2010. Statistical Bulletin. 22 August 2011. Newport, Gwent: Office for National Statistics Available with accompanying spreadsheets at: http://www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/2010/stb-deaths-related-to-drug-poisoning-2010.html GROS. (2011). Drug-Related Deaths in Scotland in 2010. Edinburgh: General Register Office (Scotland). 9 August 2011. Available at: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/drug-related/index.html NISRA. (2011). Drug-Related Deaths and Deaths due to Drug Misuse registered in Northern Ireland (2000-2010). 29 July 2011. Belfast: Northern Ireland Statistics & Research Agency. Available at: http://www.nisra.gov.uk/archive/demography/publications/drug_deaths/Drug_Tables_10.xls | Yes | : | ICD10 F11-F16, F19, X40-X44, X60-X64, X85, Y10-Y14 (see remarks below) | Deaths where the underlying cause is poisoning, drug abuse or drug dependence and where any of the substances scheduled under the Misuse of Drugs Act 1971 were involved. This definition has been adopted by the GMRs across the UK. Full details of the appropriate ICD 9 codes are given in Griffiths et al (2002), and ICD 10 codes in Jackson (2002). It should be noted that the way in which this definition has been operationalised means that where compound analgesics containing relatively small quantities of controlled drugs (chiefly dextropropoxyphene, dihydrocodeine and codeine) are mentioned on a death certificate - and there are no references to other controlled drugs - these cases are ignored. | Yes | : | Yes | Data not currently available from np-SAD due to lack of time and staff. The Programme has not received any funding from the Department of Health (England) since July 2010. It is unclear whether there will be any or not. In the meantime, the Programme Manager is trying to keep things 'ticking over' on an unpaid voluntary basis with some help from volunteers. |
| Croatia | National | 2010 | Croatian Central Bureau of Statistics | Yes | : | National definition is equal to the EMCDDA. F11-F12, F14-F16, F19, X42/T40.0-9, X41/T43.6, X62/T40.0-9, X61/T43.6, Y12/T40.0-9, Y11/T43.6, X44/T40.0-9, X64/T40.0-9, Y14/T40.0-9, X44/T43.6, X64/T43.6, Y14/T43.6 | There is no difference between the national definition and EMCDDA Selection B. | Yes | : | Yes | : |
| Turkey | Whole Country | 2010 | Expert Reports of The Council of Forensic Medicine and Turkish National Police, Gendarmerie | No | The Council of Forensic Medicine and Turkish National Police, Gendarmerie | EMCDDA Selection D Intoxication (Drug-related deaths refers to those deaths that are caused directly by the consumption of drugs of abuse) | There is not any difference between national and EMCDDA defination. Data provided here inculude the deaths due to overdose useage and drug related deaths and it does not inculude the deaths because of the indirect drug useage. Selection D is equal to the national defination. | Yes | : | No | : |
| Norway | National | 2009 | Statistics, Norway. | Yes | : | National definition is the same as EMCCDA standard definition, Selection B, ICD 10. | No difference. | Yes | : | No | : |
Notes:
See Drug related deaths – methods and definitions.
See also 'General notes for interpreting data' on the Explanatory notes and help page.
Sources:
Reitox national focal points