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TECHNICAL REPORT Drug-Related Deaths and Mortality in Europe Update from the EMCDDA Expert Network

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TECHNICAL REPORT Drug-Related Deaths and Mortality in Europe Update from the EMCDDA Expert Network TECHNICAL REPORT Drug-related deaths and mortality in Europe Update from the EMCDDA expert network May 2021 I Legal notice This publication of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is protected by copyright. The EMCDDA accepts no responsibility or liability for any consequences arising from the use of the data contained in this document. The contents of this publication do not necessarily reflect the official opinions of the EMCDDA’s partners, any EU Member State or any agency orinstitution of the European Union. PDF ISBN 978-92-9497-605-5 doi: 10.2810/777564 TD-02-21-591-EN-N Luxembourg: Publications Office of the European Union, 2021 © European Monitoring Centre for Drugs and Drug Addiction, 2021 Reproduction is authorised provided the source is acknowledged. Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2021), Drug-related deaths and mortality in Europe: update from the EMCDDA expert network, Technical report, Publications Office of the European Union, Luxembourg. About this report This report provides an update on drug-related deaths in Europe based primarily on presentations and discussions held at the 2019 meeting of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) expert network on drug-related deaths. The meeting brought together experts and representatives from over 40 countries and provided a platform for discussing new trends in and analyses of drug-induced deaths in Europe and beyond and responses to them. About the EMCDDA The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the central source and confirmed authority on drug-related issues in Europe. For over 25 years, it has been collecting, analysing and disseminating scientifically sound information on drugs and drug addiction and their consequences, providing its audiences with an evidence-based picture of the drug phenomenon at European level. The EMCDDA’s publications are a prime source of information for a wide range of audiences including policymakers and their advisors; professionals and researchers working in the drugs field; and, more broadly, the media and general public. Based in Lisbon, the EMCDDA is one of the decentralised agencies of the European Union. Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal Tel. +351 211210200 [email protected] I www.emcdda.europa.eu twitter.com/emcdda I facebook.com/emcdda Acknowledgements The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is grateful to the members of the drug-related deaths network for their collaboration on this publication and for their work in this area throughout the year, and also to the external participants in the expert meeting on drug-related deaths. The national experts on drug-related deaths for Europe are Judith Anzenberger, Peter Blanckaert, Vasil Atanasov, Marijan Erceg, Katerina Liveri, Blanka Nechanská, Claudia Ranneries, Gleb Denissov, Pirkko Kriikku, Anne-Claire Brisacier, Axel Heinemann, Chara Spiliopoulou, Anna Péterfi, Suzi Lyons, Roberta Crialesi, Linda Veisberga, Lina Jurgelaitiene, Michel Yegles, Kathleen England, Guus Cruts, Thomas Clausen, Janusz Sierosławski, Małgorzata Dalmata, Mário João Dias, Maria dos Anjos Campos, Madalina Martis, Jozef Šidlo, Mateja Jandl, Begona Brime Beteta, Mimmi Eriksson Tinghög, Bülent Şam and Martin White. The national experts from the Instrument for Pre- Accession Assistance countries and Switzerland are Zana Bruçi, Aleksandar Stankov, Avdi Smajljaj, Naim Muja, Ivana Čurović, Dalibor Nedić, Miroslav Milić, Verena Maag and Andrea Oestreich. The invited external experts are Amanda Roxburgh, Christopher Jones, Elina Kotovirta, Kari Grasaasen, Andrew McAuley and Sabrina Molinaro. Statement regarding the United Kingdom This report covers a reference period until 2019. The United Kingdom had left the European Union as of 1 February 2020. Unless stated otherwise, for the purpose of this report, the term ‘Member States’ includes the United Kingdom. EMCDDA authors: Isabelle Giraudon, Federica Mathis, Dagmar Hedrich, Julian Vicente and André Noor Contents Acknowledgements ................................................................................................................ 3 Introduction to and aim of this report ...................................................................................... 5 Overdose deaths in Europe: an overview ............................................................................... 7 Demographic characteristics of drug-related fatalities in Europe ...................................... 9 Heroin-related deaths in selected European countries ................................................... 11 Cocaine-related deaths in selected European countries ................................................ 17 Special focus: a European overview of deaths related to new psychoactive substances ...... 20 Fentanyl and fentanyl analogues ................................................................................... 25 Etizolam: concern around new benzodiazepines in Scotland ......................................... 25 Responding to drug-related deaths ...................................................................................... 27 Drug consumption rooms ............................................................................................... 28 Take-home naloxone programmes ................................................................................ 29 References .......................................................................................................................... 31 TECHNICAL REPORT | Drug-related deaths and mortality in Europe: update from the EMCDDA expert network At a glance: a summary of key points Overdose deaths: a very high burden of preventable premature deaths • Over 8 300 deaths involving one or more illicit drugs were reported in 2018 in the European Union. This estimate rises to over 9 200 deaths when Norway and Turkey are included. Men account for three quarters of drug-induced deaths. Most of the deaths were very premature, affecting people in their thirties and forties. Multiple drug toxicity is implicated in most cases. Opioids: the main driver of fatal overdoses in Europe • Opioids, often heroin, or opioid substitution treatment medicines, such as methadone and buprenorphine, are involved in 80-90 % of drug-related deaths overall, although differences between countries exist. • Deaths associated with fentanyl and its analogues might be underestimated in some countries. Fentanyl-related deaths decreased markedly in Estonia and Sweden in 2018. New psychoactive substances: stimulants and benzodiazepines involved in many deaths • Most new psychoactive substance-related deaths are reported in the United Kingdom and in Turkey (where synthetic cannabinoids largely dominate). Fake and diverted medicines and new benzodiazepines are involved in an increasing proportion of drug-related deaths. Highlights and concerns • When information on post-mortem investigation is available it shows that the proportion of drug- related deaths involving ‘other opioids’ is increasing in some countries, while the proportion involving heroin is decreasing. • Cocaine was reported to be involved in an increasing number of deaths in 2018, mainly associated with heroin or other opioids. • Mortality rates due to overdose are higher in Scotland than in the rest of the United Kingdom or in other European countries or the United States. Most deaths in Scotland are related to heroin, other opioids and benzodiazepines (etizolam in particular was implicated in more than half of the deaths in 2018). Implications for public health and for monitoring • There are still major limitations and gaps in the monitoring of drug-related deaths. Special mortality registers are a key source of information, in particular on polydrug use patterns and on prescription opioids and other medicines implicated in deaths. • Further triangulation of drug-related deaths and other opioid indicators is needed to consolidate estimates of the number of deaths. Responding to drug-related deaths • While the coverage and diversity of responses to drug-related deaths vary between and within countries, drug consumption rooms and take-home naloxone programmes expanded across Europe in 2019. The evidence base for their effectiveness is growing. However, more research is needed on the population impact of these and other responses. Introduction to and aim of this report This report provides an update on drug-related deaths in Europe (EMCDDA, 2019a, 2019b). It is primarily based on presentations and discussions held at the annual 2-day meeting of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) expert network on drug-related deaths in Lisbon on 21 and 22 October 2019 (EMCDDA, 2019b). The meeting brought together experts and representatives from over 40 countries and provided a platform 5 TECHNICAL REPORT | Drug-related deaths and mortality in Europe: update from the EMCDDA expert network for discussing new trends in and analyses of drug-induced deaths in Europe and beyond and responses to them. Drug-related mortality is a complex phenomenon. The EMCDDA has defined a drug-related death and mortality (DRD) epidemiological indicator, which has two complementary components: (i) national, population-based statistics on deaths directly attributable to the use of drugs (drug-induced deaths, also known as poisonings or overdoses); and (ii) estimations of the overall and cause-specific mortality
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