Overdose situation (FAQ drug overdose deaths in Europe)
Introduction
This section presents the definitions used across Europe. It also presents the most recent data available, together with graphics and maps on the number and the rates of drug-induced deaths in Europe.
This page is part of the Frequently asked questions (FAQ): drug overdose deaths in Europe.
What is a drug-induced death?
Overdose or drug-induced deaths are monitored by the EUDA under the ‘Drug-related deaths and mortality (DRD)’ epidemiological indicator. This has two complementary components:
- drug-induced deaths: regular national, population-based statistics on deaths directly attributable to the use of drugs (also known as poisonings or overdoses) (1);
- drug-related mortality: estimations of the overall and cause-specific mortality among people who use drugs, based on follow-up longitudinal ad-hoc studies.
Case definition
For the purpose of the EUDA regular national statistics, drug-induced deaths are those ‘happening shortly after consumption of one or more illicit psychoactive drugs and directly related to this consumption, although they may often happen when such substances are taken in combination with other substances, such as alcohol or psychoactive medicines’.
Exclusion criteria
Deaths for which a drug has been found in the toxicological analysis but in which this drug did not have a causal or determinant role in the death are not included in the EUDA statistics. This may happen when a toxicological analysis is undertaken in certain investigations (e.g. traffic accidents, suicides and violence). Deaths that are indirectly related to drug use are also excluded from the regular national statistics of ‘drug-induced’ or ‘overdose’ deaths (e.g. deaths related to HIV/AIDS acquired through injecting drugs).
More information
More information is presented in the Methodology — FAQ drug overdose deaths in Europe, and also in the methods pages of the EUDA Statistical Bulletin, and in the European DRD protocol (EMCDDA, 2010). The protocol establishes harmonised criteria to collect data and report figures, based on the information available in different mortality registries, at the end point of the chain of certification/ascertainment procedures.
(1) In many publications and documents, the term ‘drug-related deaths’ is used, although strictly speaking this term may include deaths indirectly caused by drug use.
How many people die from drug overdoses each year in the European Union, Norway and Türkiye?
It is estimated that at least 6 400 overdose deaths occurred in the European Union in 2022. This rises to an estimated around 7 000 deaths if Norway and Türkiye are included. These overall numbers must be understood as underestimations, as there are limitations to drug-induced deaths data, particularly to European cumulative totals. Data for 2022 are not available for all countries, and for those cases (11 of the 27 EU countries), the most recent available data may be used to estimate the overall EU figure.
What is the most recent year for which data on overdose deaths are available?
In 18 of the 29 countries (EU, Norway and Türkiye) 2022 data from the preferred source are available. For the other countries, the most recent data are from 2021 for Denmark, Hungary, Malta, Poland, Portugal, Slovakia and Spain; from 2020 for Belgium, Greece and Ireland; from 2017 for France.
Are the numbers of drug-induced deaths and estimated mortality rates similar between countries?
Germany, Spain and Sweden together account for almost half (49 %) of the estimated number of drug-induced deaths among people aged 15-64 in 2022 in the European Union. This finding is influenced partly by the size of the at-risk populations in these countries, but also by under-reporting in certain other countries. Following these three countries, the next highest numbers of deaths among people aged 15-64 were reported by Ireland, Norway, the Netherlands and Italy (see the figure below).
For France, the latest data are for the year 2017, when 417 cases were reported. No age breakdown is available.
Mortality rates due to overdose are typically 3 to 4 times higher among males compared with females. Among males, the highest mortality rates are often among those aged 25-44. Overdose mortality rates in this age group are higher than for the male general population overall (adults aged 15-64 years).
Click on a country for more detailed information.
The estimated mortality rates must be interpreted with caution. Methodological differences should be considered when comparing between countries (see Methodology — FAQ drug overdose deaths in Europe).
In some countries the data were not fully available for some years or age-bands. For more information see the drug-induced deaths section of the 2024 Statistical Bulletin.
There are also differences within countries, with some regions and cities much more affected than others.
Is the drug-induced deaths rate (deaths/population) similar between countries?
The mortality rate due to drug overdose in the European Union in 2022 is estimated to be 22.5 deaths per million of the population aged 15-64 years, but this varies between countries. The estimated rate varies from 2 to 97 deaths per million; 9 countries have less than half the EU average and 7 have more than twice the EU average (see the trend chart and map below).
Comparisons between countries should be made with caution, however, because of under-reporting in some countries (see Methodology — FAQ drug overdose deaths in Europe).
In some countries the data were not fully available for some years or age-bands. For more information see the drug-induced deaths section of the 2024 Statistical Bulletin.
Note: For Germany, from the year 2021, the data fully comply with the European protocol defining cases to be extracted from special mortality registers, such as those of police and forensic services. Comparable data for the previous years are not available. For this series and graph, the previous years were filled in with the first available datapoint (2021) in order to avoid mixing different data series with different methods. However, it should be noted that drug-induced deaths, according to the national definition, have increased in Germany since 2011.
Is the sex difference in drug-induced deaths similar between countries?
The majority of drug-induced deaths in Europe (77 %) are among males. The distribution of drug-induced deaths between males and females varies between countries, with the proportion of deaths among males being higher in the south and east of Europe, compared with the north and west of Europe (see the figure below). This difference between the sexes might be related to a range of factors, including the proportion of males among people who are using drugs, the level of drug use behaviour risk (e.g. the higher risk of deaths associated with polydrug use, drinking alcohol or with injecting drugs compared to other routes of administration). These varied between countries. Nevertheless, overall, overdose mortality rates are higher for males than for females. Overdose mortality rates also differ between age groups, and sex and age differences vary by country. Some countries in the north of Europe report higher rates of overdose deaths among older women compared to young women. Some cases among women aged 65-74 years and more may involve the use of prescription medicines such as opioids and benzodiazepines. Most countries report higher rates of overdose deaths among younger males compared to males aged 45 years or more. Mortality rates allow comparisons to be made between the sexes and between age groups, in order to identify what segments of the population are most at risk and should be targeted for overdose prevention.
Figure 1.6. Proportion of males among drug-related deaths in the European Union, Norway and Türkiye, 2022
How has the distribution of drug-induced deaths among age groups changed in recent years?
Overdose deaths in the European Union have been increasing since 2012, overall and among teenagers and all age categories above 35 (see the figure below), with the 69 % increase among the 50-64 age group particularly high (by 43 % among females and by 101 % among males). This reflects the ageing nature of Europe’s opioid-using population in most countries.
In 2022, the overall mean age at death due to overdose was 48 years for females and 43 years for males. A noticeable shift in the age distribution for both females and males has been observed over the past decade (see the figure below).
Figure 1.7 Distribution of drug-induced deaths reported in the European Union in 2012 and 2022 or most recent year, by age band
Is the age distribution of drug-induced deaths similar between countries?
There are differences between countries in the age distribution of drug-induced deaths (see the bar chart below). Countries in the west of Europe tend to have an older age profile among overdose deaths than countries in the east (see the maps below). This mirrors, in part, the ageing populations of opioid users (including ageing users of illicit opioids, typically heroin; and also in some countries, people using prescription opioids, such as oxycodone) in western countries.
Figure 1.8. Distribution of drug-induced deaths reported in 2022, or most recent year, by age group and country
Fgure 1.9. Proportion of drug-induced deaths among older (40+ years) people in the European Union, Norway and Türkiye, 2022 (or most recent data available)
Figure 1.10. Proportion of drug-induced deaths among younger (under 30 years) people in the European Union, Norway and Türkiye, 2022 (or most recent data available)
What substances are involved in drug-induced deaths?
Opioids, including heroin and its metabolites, often in combination with other substances, are present in the majority of fatal overdoses reported in Europe. In most drug-induced deaths, more than one substance is detected, indicating polydrug use (2).
Overall, opioids are involved in 74 % of cases reported in the European Union, with large differences across countries (see the map below). Countries where opioids are involved in more than 8 in 10 overdose deaths are located mainly in the north and west of Europe (Denmark, Estonia, Finland, Ireland, Lithuania, Luxembourg, Norway, Sweden), but also include Austria, Bulgaria, Croatia and Romania.
In some countries, no or limited post-mortem toxicology data are reported. Furthermore, in several countries, some cases are reported with ‘unknown or unspecified’ toxicology, in particular when there are several drugs involved. Most of these cases involve at least one opioid. The proportion of cases with opioids involved shown here is a minimum estimate.
In Cyprus, Czechia, Hungary, Slovakia and Türkiye, less than half of the cases involved opioids. Although limited information is reported in some countries, most cases appear to involve polydrug drug use (2).
Figure 1.11. Proportion of drug-induced deaths with opioids involved in the European Union, Norway and Türkiye, 2022
Note: Data are for 2022 or most recent year available. Although information on toxicology is not available for data reported through the general mortality registers (preferred source) in France, Portugal, Poland and Spain, data from the alternative source (forensic special mortality registers) suggest that most drug-induced deaths in these countries involved opioids. Data from the general mortality register are shown for France. However, data were available for only 31 of 417 cases reported in 2017.
Stimulants such as cocaine, MDMA, amphetamines and synthetic cathinones are implicated in overdose deaths in Europe, although their significance varies by country. More information is available for some countries in the latest European Drug Report (EMCDDA, 2024).
A review of MDMA-related deaths showed that against a background of ‘increased purity and availability of MDMA’, deaths related to the drug increased in Australia, Finland, Portugal and Türkiye between 2011 and 2017 (Roxburgh et al., 2021).
Deaths associated with new psychoactive substances are a cause of concern. A review published in 2021, and based on the reports to the EUDA of drug-induced deaths from the EU countries as well as Norway, Türkiye and the United Kingdom, found that in 2017, 1 in 6 drug-induced deaths in these countries involved new psychoactive substances, and the proportion and numbers increased from 2016 levels (López-Pelayo et al., 2021). However, three quarters of the cases were concentrated in only two countries and involved a small number of substances. In 2016 and 2017, 73 % and 77 % of the cases were concentrated in the United Kingdom and Türkiye, related mainly to etizolam – a ‘new benzodiazepine’ – generally used together with opioids and synthetic cannabinoids, respectively. In Türkiye, there has been a decrease in the number of drug-induced deaths from the peak reached in 2017.
(2) ‘Polydrug use’ is a term to describe the use of more than one drug or type of drug by an individual, either at the same time or sequentially. It encompasses use of both illicit drugs and legal substances, such as alcohol and medicines (EMCDDA, 2021).
Where have numbers of drug-induced deaths increased over the last 10 years?
Data on fatal overdoses, especially the European cumulative total, must be interpreted with caution. Among the reasons for this are systematic under-reporting in some countries, differences in the ways toxicological examinations are conducted and registration processes that can result in reporting delays. Annual estimates therefore represent a provisional value.
Country numbers and trends vary across Europe, but they should also be interpreted with caution. The section below presents selected countries. Countries from the southeast and from the north of Europe are presented separately (as indicated in the map below).
Figure 1.12. Countries included in the south-east and north of Europe for this trend analysis
The south-east of Europe
Compared with 2012, the number of drug-induced deaths has increased in 7 out of 8 countries in the southeast of Europe (see the figure below). Bulgaria, however, observed a slight decrease in the number of drug-induced deaths over this period. This trend needs to be analysed with caution as Bulgaria reports that there is some underestimation of the number of the drug-induced deaths. In Türkiye, the peak of drug-induced deaths observed in 2016-2017 was mainly related to deaths involving synthetic cannabinoids. These drugs were often found together with stimulants (amphetamines, cocaine, MDMA) and other drugs, including heroin. Most drug-induced deaths during this outbreak occurred among young males in their twenties and early thirties.
Figure 1.13. Indexed trends in the number of deaths in selected countries in the south-east of Europe, 2013-2022
2013 = 100
Note: Other countries in the south-east of Europe, with 5 cases reported in 2022 or the last year with available data, are not represented (Cyprus and Malta). When a national data point was missing for the computation of the European index trend, it was replaced by the value of the preceding year.
The north of Europe
The largest increases in 2022 – or the last year with available data – compared to 2012 are reported in Finland, Latvia, the Netherlands, and Sweden (see the figure below). In these countries, overdose deaths are mostly related to opioids and polydrug use. In Sweden, part of the peak in the number of deaths reported in 2015-2017 was due to an increase in the number of deaths associated with fentanyl. In Lithuania, most of the increase observed in the same period was due to deaths associated with opioids.
In Estonia, an outbreak of drug-induced deaths, which peaked in 2011-2012, was associated with fentanyl and fentanyl derivatives. After years of police intervention, along with the implementation of treatment and new harm reduction measures (namely take-home naloxone programmes), the country observed a marked reduction in overdose deaths in the period up to 2019, to levels well below those reported 10 years previously. More recent data suggest a large increase in the number of deaths in 2023 (see What are the emerging concerns and threats?). The Netherlands reported the largest increase in 2022 compared to 2012. Most of the deaths were related to opioids, although limited information is available on the drugs identified.
Figure 1.14. Indexed trends in the number of deaths in selected countries in the north of Europe, 2013-2022 (2013 = 100)
Note: When a national data point was missing for the computation of the European index trend, it was replaced by the value of the preceding year.
Resources and references
Consult the methodological information and list of references on the Frequently asked questions (FAQ): drug overdose deaths in Europe main page.
Source data
The data used to generate infographics and charts on this page may be found below.
| Substance | Color |
|---|---|
| Females (15-24) | #92c020 |
| Females (25-44) | #b0cf61 |
| Females (45-64) | #c7dc8c |
| Females (65-74) | #dde9b7 |
| Males (15-24) | #dc5c31 |
| Males (25-44) | #f49d7f |
| Males (45-64) | #f8af94 |
| Males (65-74) | #fcc6b2 |