Trends in overdose deaths from drug misuse in Europe: what do the data tell us?

Abstract

Europe: what do the data tell us?During the 1990s the number of drug-related deaths (acute poisonings) in the United Kingdom increased rapidly. Between 1993 and 2000 the number of deaths doubled from 864 to 1662 [1,2], precipitating the recognition that reducing drug misuse deaths was a public health priority [3]. The UK Advisory Council on the Misuse of Drugs recommended the creation of a new surveillance indicator to follow overdose trends, which was incorporated into the government's drugs strategy. A target was set to reduce deaths related to drug misuse by 20% by 2004 compared to a 1999 baseline [4]. As more than three-quarters of drug-related poisonings in the United Kingdom are opiate-related, expanding drug treatment options, especially methadone maintenance for problem opiate users, was seen as a critical overdose prevention measure [5]. UK and European indicators of drug-related deaths include deaths certified as due to drug use or misuse and include acute poisonings (overdose deaths) based on routine mortality statistics; the indicators exclude other deaths that may have been caused directly or indirectly by drug use but which cannot be attributed readily to drug use within routine statistics (such as infections, other injuries or chronic diseases) [1].Early signs were very encouraging. Between 2001 and 2004, the government investment in specialist drug treatment doubled to over £250 million annually [6]. The volume of methadone prescriptions increased markedly, and there was a drop in the estimated number of deaths per 1000 patient-years treated with methadone [7]. The number of drug misuse deaths fell from 2001, and by 2003 the reduction in drug-related deaths had almost reached the target. However, in 2004 and 2005 there were sharp increases in drug misuse deaths, due largely to heroin overdose, meaning the government's target was not met [8,9].The European context is presented in Fig. 1, which compares trends in overdose deaths in selected European countries with similar population sizes [10]. The figure shows drug misuse deaths per million population from 1993 to 2005 for England and Wales, Italy, Germany and Spain (Madrid, Barcelona, Valencia, Bilbao, Seville and Zaragoza only) based on routine mortality statistics. The drug-poisoning mortality rate in these six Spanish cities probably overestimates the rate for Spain overall, but is likely to provide an accurate representation of trends over time.By 2004/05 the drug misuse mortality rates in England and Wales was one of the highest in Europe. However, case definition and data extraction from mortality statistics varies between countries despite there being a common European definition [11], which may explain, in part, the difference in the size of the mortality rates between countries. There have been no changes in the compilation of statistics over time. More illuminating, therefore, and a salutary reminder to policy makers in England and Wales, is the difference in trends over time. In none of the other selected European countries did the ove...

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A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013

“…The historical progression of mortality rates of DRD in Europe is characterized by a rapid increase in rates between 1990 and 2000 precipitating nations to adopt drug treatment policies that treated drug misuse as a serious and chronic medical problem. Many nations adopted advisory councils on misuse of drugs and surveillance indicators were devised to monitor trends in DRDs [12]. Although overall rates of DRD have declined in Europe, there is considerable variation in trends of mortality rates of DRD in countries throughout Europe that is fueled by heroin use, misuse of prescription opioid analgesic medications and synthetic opioids [13–15].…”