Reducing drug-related deaths

Around 8 000 acute drug-related deaths are recorded each year throughout the EU and Norway, mostly involving young people. The burden of drug-related deaths for society becomes even more apparent if represented in terms of ‘years of life lost’ (76). Thus, the burden due to drug-related deaths in England and Wales in 1995 was 70 % of that due to deaths in road traffic accidents (ACMD, 2000).

Findings indicate a considerable potential to reduce the number of deaths through medical and educational approaches (77). Increased availability of substitution treatment, which has a substantial protective effect on mortality (WHO, 1998), has been found to be correlated with reductions in overdose deaths in France and Spain, though decreasing rates of drug injecting in Spain may also have made an important contribution (EMCDDA, 2002a). Educational programmes for drug users to identify risks, recognise overdose signs and respond correctly have yielded positive effects by increasing drug users’ competence to help when witnessing an overdose.

Local strategies to reduce overdose deaths in Oslo, Copenhagen, Amsterdam and Frankfurt have been the topic of a study that found that, although existing levels and patterns of drug use set limits on what can be achieved, local policies on responses can help reduce the number of deaths (Reinås et al., 2002).

A reduction in drug-related deaths, which is a key objective in target 2 of the EU drugs strategy (2000–04), is increasingly being taken seriously as an achievable goal. It is identified as a priority in the new national drug strategies of Germany, Greece, Ireland, Luxembourg, Portugal, Finland and the United Kingdom. Local strategies to reduce overdose deaths are also reported (Table 11 OL).

Information resources on overdose prevention are available in most countries. Training in basic resuscitation methods for drug users is offered by drugs and health services, though geographical coverage of these first aid courses is often limited to major urban centres (Table 11 OL).

Distribution of an opiate antagonist, naloxone, is one measure taken in some countries with the aim of reducing heroin overdoses (Sporer, 2003). In Italy, a significant number of Unità de Strada (street drugs services) provide drug users with naloxone, which can be administered as an interim emergency measure while awaiting medical help. A pilot study in Berlin of combined first aid training and naloxone distribution found increased competence to react adequately in drug emergencies and medically justified use of the antagonist in the large majority of cases (93 %) (Dettmer, 2002). The same study also pointed to the relevance of naloxone for emergencies occurring in domestic settings.

Overdose deaths in public places have been of particular concern in European cities with large open drugs scenes. In some German and Spanish cities, supervised consumption facilities have been introduced, targeting the often marginalised populations of open drug scenes. Supervised consumption rooms are also to be found in the Netherlands. Among other services, they provide immediate emergency care in cases of overdose. A study of consumption rooms in Germany (Poschadel et al., 2003) found that they contributed significantly to a reduction in drug-related deaths at city level and improved access to further health and treatment services for problem drug users who are not reached by other services.

(76) Years of life lost: based on the age to which any individual would be expected to live if he or she had not died as a result of drug use (ACMD, 2000, p. 56).

(77) Toxicological aspects, social and personal correlates and risks, and the circumstances under which deaths and non-fatal overdoses occur and prevention strategies have been researched, e.g. Varescon-Pousson et al. (1997), Hariga et al. (1998), Seaman et al. (1998), Víllalbi and Brugal (1999), ACMD (2000), Ferrari et al. (2001), Lepère et al. (2001), Brugal et al. (2002), Buster (2002), Kraus and Püschel (2002), Origer and Delucci (2002) and Pant and Dettmer (2002).