Emerging concerns and threats (FAQ drug overdose deaths in Europe)
What are the emerging concerns and threats?
This year, three concerns and potential threats are highlighted: the outbreaks of deaths linked to highly potent synthetic opioids – nitazenes mainly – in Estonia and Latvia, in particular; deaths associated with the co-use of drugs and medicines; and the high and increasing proportion of drug-induced deaths with cocaine involved in some countries.
This page is part of the Frequently asked questions (FAQ): drug overdose deaths in Europe.
Are nitazenes and other new synthetic opioids increasing overdose deaths in the Baltic countries?
Of particular concern is the recent appearance of the nitazene opioids, which were involved in localised poisoning outbreaks in France and Ireland during 2023. In provisional data from Estonia, the drugs were identified in almost half of the drug-induced deaths (56 of 117, 48 %) in 2023. This compares with 32 of 82 drug-induced deaths (39 %) in 2022. In Latvia, provisional data point to a doubling in the number of drug-induced deaths, from 63 in 2022 to 130 in 2023, with nitazenes identified in 38 (29 %) of these cases. See also recent papers by Giraudon et al. (2024) and Killeen et al. (2024).
More information on this topic can be found in the drug-related deaths section of the 2024 European Drug Report.
What is the role of medicines in deaths associated with polydrug use?
In 2022, in some countries, benzodiazepines were detected in a large proportion of overdose deaths, including in over half of the cases in most countries with recent data available. Few countries report information on the involvement of pregabalin in drug-induced deaths. Several countries reported an increase in the number of deaths with pregabalin mentioned: Denmark (from 48 deaths in 2021 to 58 in 2022), Austria (from 37 in 2021 to 54 in 2022), Spain (from 41 in 2020 to 81 in 2021), and Türkiye (from 5 in 2021 to 25 in 2022).
More information on this topic can be found in the drug-related deaths section of the 2024 European Drug Report.
Is cocaine playing a greater role in drug-induced deaths?
Opioids, usually in combination with other substances, remain the group of substances most commonly implicated in drug-induced deaths. Opioids other than heroin, including methadone and, to a lesser extent, buprenorphine, pain-relief medicines containing opioids, and other synthetic opioids are associated with a substantial share of overdose deaths in some countries. However, evidence suggests that cocaine use and associated harms may be increasing in Europe (EMCDDA, 2022), and the drug is increasingly mentioned in the post-mortem findings of drug-induced deaths in Europe. Among 19 European countries providing data for 2021 and 2022, cocaine, mostly in the presence of opioids, was involved in 996 (23 %) overdose deaths in 2022 (807 or 20 % in 2021). Deaths involving cocaine are now also being reported in countries where they were previously less common, such as Denmark, the Netherlands, Austria and Slovenia. Cocaine was involved in 52 % of the overdose deaths in Spain (477 of the 910 cases with information available) in 2021 and in 67 % of the overdose deaths in Portugal (46 of 69 cases) in 2022. In France, cocaine was involved in 39 % (259 of the 662 deaths with information available) of the cases in 2021. This is an increase from 23 % (130 of 567 deaths with information available) in 2020, suggesting that cocaine is contributing to the overall increase in the number of overdose deaths in the country.
More information on this topic can be found in the drug-related deaths section of the 2024 European Drug Report.
Resources and references
Consult the methodological information and list of references on the Frequently asked questions (FAQ): drug overdose deaths in Europe main page.