Preventing overdose deaths (FAQ drug overdose deaths in Europe)
Introduction
The use of illicit drugs is a recognised contributor to the global burden of disease. Interventions designed to reduce this burden include prevention activities, intended to reduce or slow the rate at which drug use may be initiated, and the offer of treatment to those who have developed drug problems. A complementary set of approaches goes under the general heading of harm reduction. There is a range of evidence-based and integrated interventions available to reduce the risk of overdoses, including fatal overdoses. This section presents strategies, recent best practice guidelines in hospital settings, the current state of implementation of several services and responses in Europe; and the directions for improvement identified during an investigation of the circumstances around the deaths of young persons aged less that 25 in Finland in 2023.
This page is part of the Frequently asked questions (FAQ): drug overdose deaths in Europe.
How can overdose deaths be prevented?
A multifaceted response is needed to prevent overdose deaths, as there is no single or simple intervention that will make a large impact alone. This section briefly lists the most important interventions, and provides links to resources in this area.
Strategies to reduce drug-related deaths may include:
- high coverage of opioid agonist treatment for those with opioid use problems;
- promotion of quality in the care and treatment and implementation of interventions supported by evidence;
- provision of harm reduction interventions;
- provision of specialised drug treatment, including opioid agonist treatment, in prisons;
- development of a national overdose prevention policy, supported by long-term commitment from policymakers and funding for treatment services;
- reinforcement of the collaboration between different stakeholders in the treatment services for substance use disorders;
- interventions to reduce demand and use for drugs, particularly opioids;
- promotion of safer drug taking, such as switching from injection to a less harmful route of administration, not taking drugs alone, and not combining drugs, as well as taking lower doses, if tolerance may be lost;
- beyond the prevention of overdose, provision of integrated healthcare services, including HIV, hepatitis C and hepatitis B treatment to people who are using drugs.
For more information on measures to reduce the risk of overdose and prevent deaths, see the EUDA publication Opioid-related deaths: health and social responses.
The latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more is available in the European Drug Report 2024.
How should emergency departments assess and treat adults presenting with acute opioid toxicity?
Best practice guidelines have been published in 2024 regarding the assessment and management of acute opioid toxicity in adults in the emergency departments (Blundell et al., 2024). There are four key recommendations:
- In acute opioid toxicity, naloxone administration should be aimed at reversing respiratory depression and maintaining airway protective reflexes rather than full reversal of unconsciousness.
- Adverse effects from naloxone are more likely to occur when excessive doses of naloxone are used.
- Generally, patients should be observed for at least 4 hours after the last dose of naloxone and for at least 6 hours after the suspected time of opioid use. The length of the observation period may need to be adjusted from this standard depending on the duration of the effect of the opioids taken.
- The treatment of patients who have experienced a non-fatal overdose provides a valuable opportunity to provide brief intervention, onward referral to drug liaison services and to promote engagement with community services.
What is the level of implementation of harm reduction interventions?
Figure 2.1. Number of European countries implementing harm reduction interventions, up to 2023
Implementation at any level, including pilot projects, is included.
What does a study in Finland tell us about improving overdose prevention for young people?
The data on drug mortality are indicative of an ageing opioid-using cohort in Europe as illustrated by the two-thirds increase in the number of drug-induced deaths among 50- to 64-year-olds between 2012 and 2022. Despite public perceptions that drug overdoses are a problem that impacts mostly on young people, cases of mortality linked to drug consumption are typically found among males aged 40 or older.
However, there are some concerns about increasing numbers of deaths among young persons in some European countries. A recent investigation highlighted the risk factors identified in the life trajectories of 79 young people under 25 years of age who died of a drug overdose in 2023 in Finland (Safety Investigation Authority, 2024). The conclusions about the risk factors, circumstances of death and the direction for improvement included the following:
- The current range of services available to young drug users is not a good match to their needs. The service system lacks clear operating models for referring young drug users to services at the right time. Young people are not getting the help they need.
- There are not enough services for young people who suffer from both mental health problems and problem drug use at the same time.
- Polydrug use is common. Accidental drug poisonings are rarely caused by a single substance. Mixing medications can also lead to fatal respiratory depression even at therapeutic doses.
- Problem drug use is often not outwardly visible, and drug use is common. Identifying the issue is difficult, as drug users tend to hide their habit. Young drug users fear the potential consequences of getting caught using drugs. The threshold for seeking help is high.
- The service system is failing to identify, reduce and control the risks associated with transitions in young problem drug users’ lives.
- Society lacks the ability and tools to properly engage young drug users in schools and promote the continuation of their studies.
- Although the law permits the imposition of involuntary substance abuse treatment, these powers are rarely exercised in practice even in life-threatening cases. The threshold for resorting to involuntary treatment as a way to break the cycle of problem drug use is high.
- Teachers and other staff in comprehensive schools, upper secondary schools and vocational schools do not always know about, or otherwise fail to observe, their statutory obligation to report drug use or suspected drug use among adolescents.
- The various operators involved in the service system are not capable of forming a full picture of the totality of young problem drug users’ circumstances. The more service providers are involved, the more important it is to ensure the continuity and coordination of the provision of timely and appropriate help to these young people.
- Even repeated accidental drug poisonings that require hospital treatment are not identified or flagged as risk factors despite their being potentially an indicator of a life-threatening problem. There are no harmonised procedures for post-poisoning follow-up and treatment.
It should be noted that as this study was done in only one country, the findings might not be generalisable to other countries.
What interventions are available in prisons?
People in prison are substantially more likely to have used drugs, to use drugs regularly and to experience drug-related problems than their peers in the community. For those receiving treatment prior to incarceration, the availability of interventions and the possibility of continuation of care in prison are important. Data provided by the 27 EU countries, Norway and Türkiye on the harm reduction and treatment interventions available in prisons in 2022 show that continuity of opioid agonist treatment was available in most of the countries (27 out of 29). Initiation of agonist treatment in prison was possible in 26 countries, and measures to ensure continuation of opioid agonist treatment on return to the community were available in 20 countries. In 2022, needle and syringe programmes were available in prisons in 3 countries and take-home naloxone was available in 7 countries (compared to 3 countries in 2021) (European Drug Report 2024).
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.