Overview of drug-induced deaths in Europe - What does the data tell us? João Matias, Isabelle Giraudon, Julián Vicente EMCDDA expert group on the key-indicator Drug-related deaths and mortality among drug users 12-13 November 2012
Overall situation Between 10 000 and 20 000 opioid users die each year Main causes: overdose, infectious disease, trauma, suicide About 7 000 reported overdose deaths in 2010 (decrease compared with 2009) mainly opioids, males, polydrug use Provisional data for 2011: suggest a further decrease 2
Drug-induced deaths in Europe In the period 1995 2010, between 6 300 and 8 400 drug-induced deaths were reported each year in Europe Most fatal overdoses are associated with opioids (typically over 85 %) Around 650 cocaine-related deaths were reported by 16 countries (decreases in most member states) Following an overall falling trend in drug-induced deaths between 2000 and 2003, subsequent data show an increase. Peaked reached in 2008 From 2009 onwards there is a general decreasing trend 3
Overdoses reported ~ 6 500 fatal overdoses reported in 2011 ~80 males Mean age ~38 years Mostly polydrug overdoses with alcohol 22 countries show a decrease Mainly opioids heroin 10/23 countries with info available have 80% or more of their cases related to opioids 4
Factors associated with drug-induced deaths Not being in drug treatment waiting list, dropped out Injecting Simultaneous use of alcohol, BZD, other drugs Poor mental health Homelessness Previous overdose Using drugs alone Time immediately after release from prison or discharge from drug treatment 5
Mortality rates due to drug-induced deaths among all adults 120 90 60 EU average 20 per million 30 0 6 Mortality rate per m illion Romania (N =34) Hungary (N=17) Turkey (N =126) Latvia (N=7) Slovakia (N =20) Bulgaria (N =41) Portugal (N =52) CZ (N=55) Poland (N =247) Netherlands (N =94) France (N=365) Italy (N =374) Spain (N=442) Belgium (N =105) Slovenia (N =25) Cyprus (N=9) Greece (N=108) Malta (N=5) Lithuania (N =51) Germany (N =1237) C roatia (N=73) Austria (N=170) Luxembourg (N =12) Sweden (N =267) Finland (N =156) UK (DSD) (N=2334) Denmark (N=222) Ireland (N =203) Norway (N=285) Estonia (N=101)
Proportion of drug-induced deaths that show presence of opioids for the most recent year reported 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 7 Estonia (2011) (n=123) Ireland (2010) (n=164) Belgium (2008) (n=146) France (2010) (n=392) Slovenia (2011) (n=24) Czech Republic (2011) (n=27) Latvia (2011) (n=11) Lithuania (2011) (n=45) Hungary (2011) (n=14) Romania (2011) (n=15) Cyprus (2011) (n=8) Malta (2011) (n=4) Slovakia (2011) (n=16) Norway (2010) (n=248) Italy (2011) (n=362) Turkey (2011) (n=104) Luxembourg (2011) (n=6) Greece (2011) (n=20) Uk (2011) (n=2250) Portugal (2011) (n=19) Sweden (2011) (n=239) Croatia (2012) (n=59) Austria (2011) (n=201)
% of overdoses that show presence of opioids 100.0 90.0 80.0 70.0 60.0 Mixed/ unknown (3) % without opiates % opiate 50.0 40.0 30.0 20.0 10.0 0.0 8 Belgium (2005) (N=105) Czech Republic (2010) (N=55) Denmark (2009) (N=222) Estonia (2010) (N=101) Ireland (2009) (N=203) France (2009) (N=365) Italy (2010) (N=374) Cyprus (2010) (N=9) Latvia (2010) (N=7) Lithuania (2010) (N=51) Luxembourg (2010) (N=12) Hungary (2010) (N=17) Malta (2010) (N=5) Austria (2010) (N=170) Portugal (2010) (N=52) Romania (2010) (N=34) Slovenia (2010) (N=25) Slovakia (2010) (N=20) Finland (2010) (N=156) Sweden (2009) (N=267) Croatia (2010) (N=73) Turkey (2010) (N=126) Norway (2009) (N=285)
Proportion of drug-induced deaths occurring under the age of 25 years 35.0 30.0 25.0 Overall 10% of all deaths under 25 20.0 15.0 10.0 5.0 0.0 9 % Slovakia (2011) Croatia (2012) Spain (2010) Portugal (2011) Netherlands (2011) Denmark (2010) Germany (2011) Uk (2011) France (2010) Norway (2010) Italy (2011) Czech Republic (2011) Belgium (2008) Cyprus (2011) Slovenia (2011) Estonia (2011) Sweden (2011) Finland (2009) Poland (2010) Lithuania (2011) Luxembourg (2011) Latvia (2011) Bulgaria (2011) Romania (2011) Ireland (2010) Turkey (2011) Malta (2011) Hungary (2011) Austria (2011)
Proportion of overdose deaths over 40 years Lithuania (2011) Hungary (2011) Romania (2011) Cyprus (2011) Bulgaria (2011) Latvia (2011) Estonia (2011) Germany (2011) Luxembourg (2011) Czech Republic (2011) Slovakia (2011) Croatia (2012) Ireland (2010) Austria (2011) Turkey (2011) Malta (2011) Slovenia (2011) Lithuania (2011) Hungary (2011) Romania (2011) Cyprus (2011) Bulgaria (2011) Latvia (2011) Estonia (2011) Netherlands (2011) Sweden (2011) Norway (2010) Spain (2010) Portugal (2011) France (2010) Poland (2010) Italy (2011) Belgium (2008) Finland (2009) Denmark (2010) Uk (2011) Germany (2011) Luxembourg (2011) Czech Republic (2011) Slovakia (2011) Croatia (2012) Ireland (2010) Austria (2011) Turkey (2011) Malta (2011) Slovenia (2011) Denmark (2010) Netherlands (2011) Sweden (2011) Norway (2010) Spain (2010) Portugal (2011) Uk (2011) France (2010) Poland (2010) Italy (2011) Belgium (2008) Finland (2009) 0.0 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 % 10
Age pyramids of overdose cases Germany 2010 (n=1237) Female >=65 Male 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15-50 0 50 100 150 200 Number of deaths reported Estonia 2010 (n=101) Female Male 60-64 50-54 40-44 30-34 20-24 <15-10 0 10 20 30 40 50 Number of deaths reported Age-band Ireland 2009 (n=203) >=65 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15-25 -5 15 35 >=65 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 <15 Numbers of deaths reported Norway 2010 (n=285) Female Male -15-5 5 15 25 35 Number of deaths reported Female Male 11
Trends and patterns of drug-induced deaths Clear decrease between 2000 and 2003 in the EU Different patterns in national trends In 2008, 18 reporting countries showed a rise New data (2012) suggest a possible decline (22/30 countries) 12
Drug-induced deaths: change 2000 to 2003 2000/2001: -3% 2001/2002: -14% 2002/2003: -7% 2003/2009: + 20% 13
Drug-induced deaths: change 2003 to 2009/10 2003/2009: + 20% 14
Indexed time series of patterns of drug-induced deaths in different countries and in the EU as a whole, 1985 to 2010 15
Indexed time series of patterns of drug-induced deaths in different countries and in the EU as a whole, 1985 to 2010 16
Indexed time series of patterns of drug-induced deaths in different countries and in the EU as a whole, 1985 to 2010 17
Trends in mean age of drug-induced deaths in some of the EU-15 Member States, 1990 to 2010 18
100 90 80 70 60 50 40 30 20 10 0 Toxicological findings (based on Standard Table 5 Section 4) % Opiates % Cocaine % Amphetamines % Ecstasy 19 Czech Republic (2011) Ireland (2010) Greece (2011) Spain (2010) France (2010) Cyprus (2011) Lithuania (2011) Hungary (2011) Austria (2011) Portugal (2011) Romania (2011) Slovenia (2011) Finland (2009) Norway (2010)
Possible reasons for the sustained numbers of DRD Difficult to explain as Indication of decreases in injecting drug use Increases in the number of opioid users in contact with treatment and harm-reduction services Ageing cohort of more vulnerable problem opioid users Polydrug use and other high-risk behaviours Increase in the number of relapsing opioid users leaving prison or treatment 20
Interpreting the numbers of drug-induced deaths May be influenced by Prevalence and patterns of drug use (polydrug, injecting drug use ) Age and co-morbidities of drug users Availability of treatment and emergency services Quality of the data collection and reporting 21
The annual report package drug situation > publications Country overviews Annual report Drugnet Europe Selected issues Statistical bulletin /events/2012/annual-report 22