Drug-related deaths and mortality in Europe

Background

Drug use, in particular high-risk drug use, is one of the major causes of avoidable mortality in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide. Drug-related deaths (DRD) is one of the five key epidemiological indicators (KI) of the European monitoring centre for drugs and drugs Addiction (EMCDDA). This poster is part of a set of five posters on the EMCDDA key epidemiological indicators.

Objectives

The DRD indicator aims to improve the understanding of the health impact of different forms of drug use, by monitoring data on the numbers and trends, characteristics and circumstances of deaths related to drug use. It can fulfil several complementary purposes, especially when interpreted alongside other drug indicators.

Methods

The information is collected in the 28 European Member States, Norway and Turkey. The indicator has two components: monitoring of drug-induced deaths (‘overdose’), through general and special mortality registers (police, forensic institutions), based on ICD codes and criteria of the DRD EMCDDA protocol; and also monitoring of mortality among cohorts of drug users. A system to assess the data quality of the indicators has been established in agreement with the national experts.

Results

The Europe estimate for 2017 is a minimum of 9502 deaths overall. The average overdose mortality rate is estimated at 22.6 deaths per million population aged 15-64 (35.9 cases per million in males and 9.3 cases per million females). The mean age at death is 39.5, with 9% of victims younger than 25 years and 5% older than 64. Between 2012 and 2017, overdose deaths in the European Union increased in all age categories above 30 years reflecting the ageing nature of Europe’s opioid-using population, Drug overdose continues to be the main cause of death among high-risk drug users. Opioids, including primarily heroin and its metabolites, but also substances used for opioid substitution treatments, and fentanyls are present in most cases, often in combination with other drugs.

Conclusions

Differences exist between countries in the availability and nature of post-mortem investigations, certification and coding practices. The implication of NPS, among which synthetic opioids, is likely underestimated. Caution is required when interpreting the EU total, for a number of reasons, including systematic under-reporting in some countries and registration delays. More focus is now placed on improving availability of toxicological information and on polydrug use, including the implication of prescription medicine. Cohort studies need to explore further neglected causes of deaths including hepatitis but also HIV infection, suicide, cardio-vascular, pulmonary causes and violence.