Deaths due to substances other than opiates

Deaths due to overdose of cocaine, amphetamine or ecstasy in the absence of opiates are infrequent in Europe. However, several countries (Spain, France, Italy, the Netherlands and the United Kingdom) have reported national or local increases in the number of victims in whom cocaine was found, generally in addition to other substances, although information is reported in heterogeneous ways. Some countries (e.g. Spain and Portugal) reported the frequent presence of cocaine in the victims of opiate overdose. In addition, cocaine may contribute to death from cardiovascular disease and such deaths may pass unnoticed.

Although deaths associated with ecstasy use arouse considerable public concern, they are relatively rare compared with deaths associated with opiates use, despite the fact that ecstasy use is far more common. The number of cases in which toxicology findings for ecstasy are positive has increased as ecstasy use has become more popular, but, frequently, other substances are also present, and it is not clear whether death can be attributed solely to ecstasy. Short- and long-term risks associated with ecstasy use need to be assessed more accurately. Although adverse reactions to ecstasy appear to be unpredictable, some deaths could be prevented by the adoption of relatively simple measures (e.g. supply of water) in dance clubs, as well as by improved health education.

Although deaths associated with abuse of volatile substances generally attract less attention, in countries where information is available the numbers of such deaths are far from negligible. For instance, in the United Kingdom over the period 1992–2000, such deaths amounted to 64–85 cases per year, with most victims being very young (Field-Smith et al., 2002). The collection of information about such deaths should be improved in other countries.

Research clearly shows that substitution treatment reduces the risk of overdose mortality among programme participants. However, in several EU countries and cities, methadone has been detected in a significant number of victims of drug-related deaths. Several studies have found that death is more likely to be associated with use of illicit rather than prescribed methadone, while other studies have found a higher risk during the initial phases of methadone substitution. These findings suggest that there is a need to assure quality standards of substitution programmes.