Emerging concerns and threats (FAQ drug-induced deaths in Europe)
What are the emerging concerns and threats?
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-induced deaths in Europe.
Is the increase in the use of nitazenes and other new synthetic opioids driving the increasing drug-induced deaths in the Baltic countries (Estonia and Latvia)?
Of particular concern is the appearance of the nitazene opioids, which were involved in localised poisoning outbreaks across Europe in 2023 and 2024. Clusters of deaths and acute toxicity linked to nitazenes have been reported in 2023 in France and in 2024 in Germany. In Sweden, over 30 deaths associated with metonitazene were reported from January 2023 to September 2024, more than 1 per month on average, before declining in the autumn of 2024. In Norway, 34 nitazene-related deaths (mainly metonitazene) were registered between June 2023 and August 2024, more than 2 per month on average, before the incidence sharply declined from September 2024.
In Estonia, the overall number of drug-induced deaths rose from 82 cases in 2022 to 119 in 2023, representing a drug-induced mortality rate of 135 per million population (in the 15-64 age class), six times the EU average. Nitazenes, mostly metonitazene and protonitazene, were implicated in over half (52%) of these deaths. In Latvia, both the national statistics and the forensic registers provisionally reported an increase in the overall number of drug-induced deaths, from 63 in 2022 to 154 in 2023, representing a drug-induced mortality rate of 130 per million population (in the 15-64 age class), more than five times (5.3) the EU average. Nitazenes were identified in 101 (66%) of these cases. In Estonia and in Latvia, the increase in the use of nitazenes has been driving the increase in the number of drug-induced deaths. Multi-layered monitoring systems and signal detection tools suggest that nitazene deaths in these two countries might have passed the peak (Giraudon, 2025).
See also recent papers: Giraudon et al. (2024); Giraudon et al. (2025); Killeen et al. (2024).
More information on this topic can be found in the drug-related deaths section of the 2025 European Drug Report.
What is the role of medicines in deaths associated with polydrug use?
Most drug-induced deaths involved polysubstance use, as illustrated by the graphic ‘Distribution of the cases with heroin mentioned in Austria, Slovenia and Norway in 2023’.
In 2023, in some countries, benzodiazepines were detected in a large proportion of overdose deaths, including in over a third of the cases in most countries with recent data available. Alcohol was mentioned in drug-induced deaths in more than 20% of the cases in at least 6 countries (see the graphic ‘Proportion of drug-induced deaths with mention of alcohol and benzodiazepines’).
More information on this topic can be found in the drug-related deaths section of the 2025 European Drug Report.
Is cocaine more frequently reported in drug-induced deaths?
Cocaine use and associated harms have been increasing in Europe (EMCDDA and Europol, 2022), and the drug is increasingly mentioned in the post-mortem findings of drug-induced deaths in some countries. Among the 20 European countries providing data for both years, cocaine was involved in approximately one quarter (1051 or 26%) of the drug-induced deaths in 2023 (956 or 27% in 2022). Deaths involving cocaine are now also being reported in countries where they were previously less common, such as Denmark, Cyprus, the Netherlands, Slovenia and Finland. Cocaine was involved in 30% of the drug-induced deaths in Germany (2023), in 65% of cases in Portugal (2023) and in 60% in Spain (2022). In Spain, this is an increase from the 52% of drug-induced deaths with cocaine involved in 2021. Evidence of polysubstance use was common in cocaine-related deaths in Spain, with opioids present in most cases, alcohol in more than a third (38%) and benzodiazepines in more than half (56%). Cocaine has contributed to the increase in drug-induced deaths in Spain (Gine et al., 2025).
Although only 20 countries provided data on drug-induced deaths for both years 2022 and 2023, the available data show that more than a quarter of the drug-induced deaths involved cocaine, and that the number of drug-induced deaths associated with cocaine has increased overall in 2023 compared with 2022 (by 10%). In some countries in the south of Europe, cocaine is reported in higher proportions of drug-induced deaths than in the rest of the European countries, and the number of drug-induced deaths with cocaine involved is increasing
Resources and references
Consult the methodological information and list of references on the Frequently asked questions (FAQ): drug-induced deaths in Europe main page.