Frequently asked questions (FAQ): drug overdose deaths in Europe

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Page last updated: 31 August 2023

Introduction

This page provides answers to the questions most often asked about drug overdose deaths in Europe. Also known as drug-induced deaths, they are deaths directly attributable to the use of illicit drugs. The information presented here is based on the latest data from the Member States of the European Union (1) and the EMCDDA affiliates Norway and Türkiye. It draws on contributions from specialists from these countries, as well as on information provided by European countries in the annual reporting exercise to the agency. 

The latest European Drug Report (EMCDDA, 2023) estimated that over 6 100 deaths involving one or more illicit drugs were reported in 2021  in the European Union. This estimate rises to more than 6 600 deaths when Norway and Türkiye are included. Men accounted for four out of five drug-induced deaths. The numbers are provisional and are an underestimate, due to reporting delays and other limitations in reporting capacity apparent in some countries.

All of these deaths were premature, predominantly affecting people in their thirties and forties.

Opioids, often heroin, were involved in three quarters of the drug-induced deaths reported in Europe, although this is not true for all countries. Opioids used in agonist treatment can also be found in post mortem analyses in some countries. Deaths related to medications, such as oxycodone and tramadol, are also reported. Deaths associated with fentanyl and its analogues are rarely reported and might be underestimated in some countries. Deaths related to stimulants such as cocaine and amphetamines have been reported in recent years in several countries. Most deaths involve polydrug use.

(1) The United Kingdom left the European Union on 31 January 2020 and is not included in the overall analysis presented here.

Aim and objectives

This page aims to raise awareness on the nature and scale of the drug overdose deaths problem in Europe. This topic does not receive sufficient attention, despite the high number of lives lost, the dramatic consequences for families and communities and the fact that all of these deaths are, in principle, preventable and avoidable. Enhancing the monitoring and responses to drug-related deaths are also a priority of the European Union Drugs Action Plan 2020-25. These pages pull together the most recent epidemiological data and highlight the gaps in the information available in this area across Europe.

We are publishing this page to mark International Overdose Awareness Day on 31 August 2023.

What this page contains

This page contains up-to-date information on overdose deaths in Europe, focusing on selected recent concerns and threats, the demographics (who is dying) and the time trends in the overdose situation. It also summarises the common situations that increase the risk of overdose (risk factors for overdose) and presents the current state of play of prevention of overdose deaths in Europe. Finally, background information is given on the methodology, the sources of information and their limitations, together with references and links to resources.

Questions

Main concerns and threats

Outbreak of deaths linked to new synthetic opioids in the Baltic countries

Preliminary 2022 data from Estonia indicate that the number of drug-induced deaths involving new synthetic opioids doubled to 79 deaths (39 in 2021). The share of deaths related to new synthetic opioids involving benzimidazoles increased from 10 % (4/37) in 2021 (isotonitazene) to 37 % (29/79) in 2022 (protonitazene, metonitazene and isotonitazene) (Harm reduction – the current situation in Europe (European Drug Report 2023)) .

Deaths associated with polydrug use and medicines

In 2021, the proportion of overdose deaths involving benzodiazepines increased in a number of countries in which data were available, although the numbers were sometimes small. In some countries and where data exist, benzodiazepines are detected in a relatively large share of overdose deaths, including in over half of cases in Denmark (120), Luxembourg (4), Austria (119), Portugal (43) and Finland (127). Few countries report information on the involvement of pregabalin in drug-induced deaths. Among those that do, Finland reported an increase from 63 deaths in 2020 to 90 in 2021 (Harm reduction – the current situation in Europe (European Drug Report 2023)).

Overdose situation

What is a drug-induced death?

Overdose or drug-induced deaths are monitored by the EMCDDA 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). In many publications and documents, the term ‘drug-related deaths’ is used, although strictly speaking this term is more inclusive);
  • drug-related mortality: estimations of the overall and cause-specific mortality among high-risk drug users, based on follow-up longitudinal ad-hoc studies.

Case definition

For the purpose of the EMCDDA 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 EMCDDA 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 drugs 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 section at the end of this document, and also in the methods pages of the EMCDDA Statistical Bulletin, and in the EMCDDA 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.

How many people die every year in Europe?

It is estimated that at least 6 100 overdose deaths occurred in the European Union in 2021. This rises to an estimated 6 600 deaths if Norway and Türkiye are included, representing a slight increase compared with the 2020 figure of about 6 400. These overall numbers must be understood as underestimations, as there are limitations to drug-induced deaths data, particularly to European cumulative totals. Data for 2021 are not available for all countries, and for those cases (8 of the 29 countries in the EU, Norway and Türkiye), the most recent available data may be used to estimate the overall European figures.

What is the most recent data available on overdose?

In 21 of the 29 countries (EU, Norway and Türkiye) the 2021 data from the preferred source is available. The year of the most recent data available for the other countries is 2020 in Denmark, Spain, Poland and Portugal; 2019 in Belgium and Greece; 2017 in France and Ireland.

Year of most recent overdose data

The data for this graphic are available in the source data section.

Are the numbers of drug-induced deaths and the estimated mortality rates similar across different countries

Germany, Spain, France and Sweden together account for over half (52 %) of the European total number of drug-related deaths in 2021. This relates partly to the size of the at-risk populations in these countries, but also to under-reporting in certain other countries. Following Germany, Spain, France and Sweden , the next highest numbers of deaths were reported by, Italy, Finland and Türkiye (see figure below).

The estimated mortality rates must be interpreted with caution. Methodological differences should be considered when comparing between countries (see methodology section below).

There are also differences within countries, with some regions and cities much more affected than others.

Drug-induced deaths in the European Union, Norway and Türkiye: total number among adults aged 15-64 years if available, otherwise all ages, 2021

(1) No age breakdown was available in 2021 for Germany, France and Malta.

The data for this graphic are available in the source data section.

Is the drug-induced deaths rate (deaths/population) similar across countries?

The mortality rate due to drug overdoses in Europe in 2021 was estimated to be 16 deaths per million in the population aged 15-64 years, but this varied across countries, with higher rates observed in countries in the north and east of Europe (see map and trend chart below).

Comparisons between countries should be made with caution though because of under-reporting in some countries (see the section on methods).

Drug-induced mortality rates per million among adults (15-64): selected trends

The data for this graphic are available in the source data section.

Drug-induced mortality rates per million among adults (15-64), females, males and total.
 

Note: For Germany, the mortality rate was computed based on the most recent data (2017) for which a breakdown by age was available.

The data for this graphic are available in the source data section.

Are there differences between the genders across countries? 

Men represent overall the majority of drug-induced deaths in Europe (74 %). The current distribution of drug-induced deaths between men and women varies between countries, with the proportion of male deaths higher in the south and east of Europe, compared with the north and west of Europe (see figure below). This difference might relate to a range of factors including the proportion of men among people who are using drugs, and varying drug use patterns by gender across regions. Besides differences in gender distribution, there are different age-distributions of the cases of drug-induced deaths across Europe; with some countries in the north of Europe reporting deaths among older women (including those who have died from use of prescription pills), while some countries in the south of Europe report high numbers of deaths among younger men using illicit drugs (see the section below on age differences).

Proportion of males among drug-related deaths in the European Union, Norway and Türkiye, 2021

Note: The total number of cases is low in some countries (fewer than 20 cases reported in Bulgaria, Cyprus, Latvia, Luxembourg and Malta). For Germany, the proportion was computed based on the most recent data with gender breakdown (2021). 

The data for this graphic are available in the source data section.

Mortality rates were higher among men compared to women.

How has the distribution of drug-induced deaths among age groups changed in recent years?

Comparing the number of deaths over a longer time period, overdose deaths in the European Union have been increasing since 2012, overall and among teenagers and all age categories above 35 (see figure below), with the 69 % increase among the 50-64 age group particularly high (by 31% among women and by 86% among men). This reflects the ageing nature of Europe’s opioid-using population in most countries. It is important because older high-risk drug users may be at the greatest risk of drug overdose death.

In 2021, the overall mean age at death due to overdose was 48 years for women and 42 years for men. See also the trends by sex in the figure ‘Number of drug-induced deaths reported in the European Union in 2012 and 2021, or the most recent year, by age band’ in the EDR 2023.

Distribution of drug-induced deaths reported in the European Union in 2012 and 2021, or most recent year, by age band

The data for this graphic are available in the source data section.

Is the age distribution of drug-induced deaths similar across different countries?

There are differences between countries in the age distribution of drug-induced deaths (see 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 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.

Distribution of drug-induced deaths reported in 2021, or most recent year, by age group and by country

The data for this graphic are available in the source data section.

Proportion of drug-induced deaths among older (40+ years) people in the European Union, Norway and Türkiye, 2021 (or most recent data available)

The data for this graphic are available in the source data section.

Proportion of drug-induced deaths among younger (under 30 years) people in the European Union, Norway and Türkiye, 2021 (or most recent data available)

The data for this graphic are available in the source data section.

What substances are involved in drug-induced deaths?

Opioids, mainly heroin or 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 map below). More than 8 in 10 overdose deaths involved opioids in countries in the north of Europe (Denmark, Ireland, Norway, Finland and Sweden), as well as in Austria, Bulgaria, Croatia, Greece, and Romania.

The proportion of deaths with opioids involved differed between males and females in some countries. In Latvia, Belgium, Portugal, Bulgaria and Lithuania, the proportion of deaths with opioids involved among females was more than 20 points above the proportion reported in males.

In some countries, no or limited data are reported on the post mortem toxicology findings. 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 an opioid. The proportion of cases with opioids involved shown here is a minimum estimate.

In Belgium, Czechia, Hungary, Latvia, Lithuania, Malta, Slovenia and Türkiye, less than half of cases involved opioids. Although limited information is reported in some countries, most cases appear to involve polydrug drug use. Detailed information on toxicology findings is available in few countries: in Türkiye, the substances most often involved in overdose deaths are mainly synthetic cannabinoids, MDMA and amphetamines; in Hungary, the substances most often involved in overdose deaths are new psychoactive substances; and in Czechia, most cases involve amphetamines. Seven countries reported 26 deaths with synthetic cathinones involved in 2021, mainly in Austria (7 cases), Hungary (7 cases) and Finland (6 cases).

Proportion of drug-induced deaths with opioids involved in the European Union, Norway and Türkiye, 2021 (or most recent data available)
 

Note: Although information on toxicology is not available for data reported through the general mortality registers (preferred source) in France, Spain, Portugal and Poland, 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 is showed for France. However, data was available for only 31 of 417 cases reported in 2017.

The data for this graphic are available in the source data section.

Stimulants such as cocaine, MDMA, amphetamines and 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, 2023), and a recent report points to an increase in the number of deaths related to cocaine (EMCDDA, 2018).

A recent review of MDMA-related deaths in Australia and Europe showed an increase of the numbers of these deaths in Australia and all the three European countries (Finland, Portugal and Türkiye) participating in the study (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 EMCDDA of drug-induced deaths from the EU countries as well as Norway, Türkiye and the United Kingdom, found that in 2017, one in six drug-related 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 together with opioids and synthetic cannabinoids respectively. In Türkiye, there has been a decrease in the number of deaths after the peak reached in 2017. To fully understand the public health implications of new psychoactive substances, further monitoring of drug-induced deaths linked to these substances and their distribution in Europe is needed.

(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 (Harm reduction – the current situation in Europe (European Drug Report 2023).

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).

Countries included in the ‘southeast’ and ‘north’ of Europe for this trend analysis

The data for this graphic are available in the source data section.

The southeast of Europe

Compared with 2012, the number of drug-related deaths has increased in seven out of eight countries in the southeast of Europe (see figure below). Only in Bulgaria, the number of drug-related deaths has slightly decreased. This trend needs to be analysed with caution as Bulgaria reports that there is some underestimation of the number of the drug-related deaths. In Türkiye, the peak of drug-related deaths observed in 2016-17 was mainly related to deaths involving synthetic cannabinoids. These drugs were often found together with stimulants (MDMA, amphetamines, cocaine) and other drugs including heroin. Most deaths during this outbreak occurred among young males in their twenties and early thirties.

The recent increase observed in Slovenia relates to deaths involving opioids and cocaine mainly. The increase in Hungary relates largely to deaths involving new psychoactive substances and non-cocaine stimulants. An outbreak of deaths related to synthetic cannabinoids was reported in the summer of 2020.

Indexed trends in the number of deaths in selected countries in the south east of Europe, 2012-2021

2012 = 100

Note: Other countries in the southeast of Europe, with fewer than 15 cases reported in 2020 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 data for this graphic are available in the source data section.

North of Europe

The largest increases in 2021 – or the last year with available data – compared to 2012 are reported in the Netherlands, Latvia, Sweden and Finland (see 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 overdose deaths, which peaked in 2011-12, 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 last 3 years, to levels well below those reported 10 years ago. More recent data suggest a large increase in the number of deaths in 2022 and early 2023 (see section above on ‘Emerging concerns and threats’). The Netherlands reported the largest increase compared to 2012. Most deaths where related to opioids, although limited information is available on the drugs identified.

Indexed trends in the number of deaths in selected countries in the north of Europe, 2012-2021 (2012 = 100)

2012 = 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.

The data for this graphic are available in the source data section.

Risk factors for overdose deaths

What are the common situations that increase the risk of overdose?

There are individual, situational and organisational risk factors for overdoses and they can be modified to reduce fatal outcomes (Frisher et al., 2012).

Individual and situational factors include the type of drugs used, the route of administration, the use of several drugs together, age and decreased tolerance to opioids and other drugs.

The type of substance used, the route of administration and the health of the user all have an impact on the risk of overdose. Most overdose deaths are linked to the use of opioids, primarily the injection of heroin or synthetic opioids, while polydrug use is also very common, including the combination of heroin or other opioids with other central nervous system depressants, such as alcohol or benzodiazepines, which bears particularly high risks. Using/injecting alone is also a risk factor for overdose death.

A number of environmental factors increase the risk of drug overdose death, including, in the case of opioid users, lack of access to and disruption of treatment provision or discontinuity of treatment and care. In certain situations, for example following detoxification or discharge from drug-free treatment, the tolerance of drug users to opioids is greatly reduced and, as a result, they are at a particularly high risk of overdosing if they resume use. For these same reasons, an inadequate access to treatment while in prison and, thereafter, an inadequate continuity of care between prison and community life has also been identified as an important environmental risk factor (Degenhardt et al., 2014; WHO Regional Office for Europe, 2010; Zlodre and Fazel, 2012). In a cohort study in England, differences in the risk of fatal opioid poisoning were identified, which were dependent on the type of treatment received: opioid users who received only psychological support appeared to be at a greater risk than those who received opioid-agonist pharmacotherapy (opioid agonist treatment) (Pierce et al., 2016). This adds to the body of evidence that supports enrolling and retaining high-risk opioid users in opioid agonist treatment (see the EMCDDA Best practice portal), access to harm reduction interventions and continuity between treatment in prisons and the community and at other transition points (see also in the recently published EMCDDA Insights on prison and drugs (EMCDDA, 2021b)).

What interventions are available in prisons in particular?

EMCDDA data on harm reduction and treatment interventions available in prisons in 2021 show that continuity of opioid agonist treatment was available in all EU Member States, apart from Slovakia, as well as in Türkiye and Norway. Initiation of agonist treatment in prison was not allowed in 6 countries. Needle and syringe programmes were available in prisons in 3 countries and take-home naloxone was available in 4 countries (Harm reduction – the current situation in Europe (European Drug Report 2023).

Preventing overdose deaths

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 more detailed resources in this area.

Strategies to reduce drug-related deaths can include in particular the following:

  • provision of large-scale opioid agonist treatment;
  • promotion of quality in the care in treatment and implementation of interventions supported by evidence;
  • provision of harm-reduction interventions (Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies);
  • provision of 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/use for drugs, particularly opioids;
  • promotion of safer drug taking, such as switching from injection to inhaling opioids, 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 health care services, including hepatitis C treatment to people who are using drugs.

For more information on measures to reduce the risk of overdose and prevent deaths, see the miniguide on Opioid-related deaths: health and social responses and the EMCDDA Best practice portal.

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 on the European Drug Report 2023.

What is the level of implementation of harm reduction interventions?

Number of European countries implementing harm reduction interventions, up to 2022
 

Implementation at any level, including pilot projects, is included.

The data for this graphic are available in the source data section.

Methodology

The national focal points and their experts in the 27 EU Member States, Norway and Türkiye report data annually to the EMCDDA through standard tables and workbooks. The annual Statistical Bulletin contains the most recent available data on the drug situation in Europe provided by the Member States, Norway and Türkiye. These data sets underpin the analysis presented in the European Drug Report.

Where do the data come from?

There are two kinds of mortality registers from which cases of drug-related deaths can be retrieved and reported: general mortality registers and special mortality registers.

  • General mortality registers: These are usually maintained by national statistical offices or health departments. They are based on the mandatory death certificates issued for all deaths by a certifying doctor. In cases of deaths with legal intervention, the certifying person is usually a forensic doctor or a coroner. These registers are limited, as often they do not have specific information on which drugs were consumed. Limitations are also due to the use of broad categories such as ‘other synthetic opioids’ and ‘other opioids’ in the coding of the cause of death in these registers. 
  • Special mortality registers: These are ideally developed specifically for drug mortality monitoring through a combination of different sources (e.g. forensic, police and other sources), which allows a high degree of detection of drug-induced deaths in a country. Alternatively, these registers are included in and maintained by existing information systems of police or medico-legal institutions (e.g. forensics institutes, coroners) for all unnatural deaths that required investigation.

What cases are included?

The European definition of drug-induced deaths is translated into a set of codes and criteria to allow the extraction of the relevant cases from mortality registers.

The extraction of cases from general mortality registers is explained in detail in the DRD methods page of the Statistical Bulletin. Cases are counted when their underlying cause of death is mental and behavioural disorders due to psychoactive substance use or poisoning (accidental, intentional or by undetermined intent) (EMCDDA, 2010).

What sources of information are used in different countries?

Most countries report data from both sources (general and special registers – see map below), which allows triangulation and validation of the data.

While the trends are usually consistent between both sources (as can be seen in the Statistical Bulletin), there can be discrepancies between the general mortality register and the special mortality register data in some countries. This can be because the coding of the causes of deaths in the general mortality register is not sufficiently sensitive, or because the data reported from the special register do not cover the whole country.

Depending on the certification and coding procedures in the registries and also on the flux of information between the special and the general mortality registries, there are reporting delays in some countries. The most recent data are from 2021 in 21 countries, 2020 in four countries, 2019 in two countries, 2017 in two countries and 2016 in one country (see Table 1).

Sources used by the countries to report drug-induced deaths to the EMCDDA, 2021 (or most recent data available)

The data for this graphic are available in the source data section.

What is the preferred source of data chosen by the countries to show the details of the cases in EMCDDA publications?

When both sources are available, the countries are asked to choose which is more valid and which should be taken as the reference for the EMCDDA Statistical Bulletin. The data from the selected source are then used to compute the European figures and European trends.

Meanwhile, at national level, figures from both sources (the selected source or ‘national definition’ and the other source) are given in the Statistical Bulletin.

Eighteen countries indicated that the general mortality register was their preferred source, while 11 preferred the special register (see map below). Twelve countries report data from both sources.

In the Statistical Bulletin, when the EMCDDA definition is fully applied, the cases extracted from the general mortality register are shown under the category EMCDDA definition for the general mortality registers and those extracted from the special mortality registers are shown under the category EMCDDA definition for the special mortality registers.

Sources preferred by the countries to report drug-induced deaths to the EMCDDA, 2021 (or most recent data available)

The data for this graphic are available in the source data section.

Are the data comparable among countries?

The differences in drug-induced death rates across regions may be explained by several factors including the different size of the population at risk, different drug taking and risk-taking patterns – including injecting drugs – different practices among drug users, and also different age-distribution and health status among drug users. There are also differences in access to health care, drug treatment and harm-reduction interventions.

Besides these, there are varying rates of post mortem examinations, varying quality in the data available about toxicology and mortality, and varying practices in coding of cause of death, including the use of ‘unknown cause of death’. These are some known influential factors that might impact on the comparability of the data.

In particular, there are differences between (and within) countries with regard to the identification and certification of the cause of death, and the classification and reporting of the number of drug-induced deaths.

This relates to:

  • the quality and frequency of post mortem investigations,
  • the availability of this information for the determination and codification of the cause of death,
  • the classification system used,
  • the quality of classification,
  • the coverage and quality of the overall reporting system.

Countries also have different levels of forensic laboratory capacity and different standard procedures for post mortem toxicological investigations of suspected drug-induced deaths (EMCDDA, 2019a, 2019b; Leifman, 2017; Millar, 2017). These factors have an impact on the sensitivity of analyses and hence on the comparability of the data within and across countries.

Caution is thus advised when interpreting and comparing data on drug-induced deaths over time and between countries.

Insights into the differences in post mortem toxicology investigations have been published recently (EMCDDA, 2019a).

How do we measure the overall and the cause-specific mortality rates related to drug use?

Monitoring overall mortality among high-risk drug users is the second component of the DRD epidemiological indicator. The overall or ‘all-cause’ mortality among high-risk drug users is investigated by means of cohort studies, which link records from death registers with records of individuals – typically from treatment registers – who are or have been using drugs (see the EMCDDA guidelines for carrying out, analysing and reporting key figures (EMCDDA, 2012)). In this way, it is possible to check the vital status of the individuals who enrolled in treatment at some point. Follow-up cohort studies also allow measurements of behaviour over time, for example the duration of treatment and interruptions, if any.

Mortality cohort studies measure the overdose mortality risk among drug users. This risk can, in turn, be applied in the estimated population of high-risk drug users in countries, in combination with the reported number of drug-induced deaths. Overdose mortality rates from cohorts can allow researchers to estimate the ‘expected’ number of overdose deaths in countries and can help cross-validate the reported number of overdoses in the national statistics (3).

The provisional findings of a mapping conducted in 2021 suggest that, for the majority of countries, there are some recent data based on cohort studies. More information is also available from the previous review of cohorts published by the EMCDDA (2015) and from the EDR 2023.

Mortality cohort studies among people using drugs in Europe: countries with studies conducted within the last 10 years or earlier. July 2021 – provisional findings

The data for this graphic are available in the source data section.

(3) More information on the methods was presented during the annual DRD expert meeting in 2019 (Vicente and Giraudon, 2019).

Resources and references

For further methodological information and the most recent EMCDDA data in this area consult the Statistical Bulletin 2023 – methods and definitions for overdose deaths.

The European network of drug-related deaths experts supports the EMCDDA’s work on the DRD key epidemiological indicator. The network meets each year to share and discuss new data, studies and experiences at regional, national and European level.

Details of the 2022 meeting (meeting report) are available on the EMCDDA website.

The findings of the 2019 meeting were published recently (EMCDDA, 2021c).

All EMCDDA publications are available online at https://www.emcdda.europa.eu/publications.

References

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D. J., Gibson, A., et al. (2014), ‘The impact of opioid substitution therapy on mortality post-release from prison: Retrospective data linkage study’, Addiction 109(8), pp. 1306-1317.

EMCDDA (2010), Drug-related deaths (DRD) standard protocol, version 3.2, EMCDDA, Lisbon.

EMCDDA (2012), Mortality among drug users: guidelines for carrying out, analysing and reporting key figures, EMCDDA, Lisbon.

EMCDDA (2015), Mortality among drug users in Europe: new and old challenges for public health, Publications Office of the European Union, Luxembourg.

EMCDDA (2018), Recent changes in Europe’s cocaine market: results from an EMCDDA trendspotter study, Publications Office of the European Union, Luxembourg.

EMCDDA (2019a), An analysis of post-mortem toxicology practices in drug-related death cases in Europe, Technical report, Publications Office of the European Union, Luxembourg.

EMCDDA (2019b), Drug-related deaths and mortality in Europe: update from the EMCDDA expert network, Rapid Communication, Publications Office of the European Union, Luxembourg.

EMCDDA (2023), European drug report 2023: trends and developments, Publications Office of the European Union, Luxembourg.

EMCDDA (2021b), Prison and drugs in Europe: current and future challenges, Insights, Publications Office of the European Union, Luxembourg.

EMCDDA (2021c), Drug-related deaths and mortality in Europe: update from the EMCDDA expert network, Technical Report, Publications Office of the European Union, Luxembourg.

Frisher, M. Baldacchino, A., Crome, I. and Bloor, R. (2012), Preventing opioid overdoses in Europe: a critical assessment of known risk factors and preventative measures, EMCDDA, Lisbon.

Leifman, H. (2017), Drug-related deaths in Sweden: estimations of trends, effects of changes in recording practices and studies of drug patterns, Centralförbundet för alkohol- och narkotikaupplysning, Stockholm.

López-Pelayo, H., Vicente, V., Gallegos, A., McAuley, A., Büyük, Y., White, M. and Giraudon, I. (2021), ‘Mortality involving new psychoactive substances across Europe, 2016-2017’, Emerging Trends in Drugs, Addictions and Health 1, 100016.

Millar, T. and McAuley, A. (2017), EMCDDA assessment of drug-induced death data and contextual information in selected countries, EMCDDA, Lisbon.

Pierce, M., Bird, S. M., Hickman, M., Marsden, J., Dunn, G., Jones, A. and Millar, T. (2016), ‘Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England’, Addiction 111(2), pp. 298-308.

Roxburgh, A., Sam, B., Kriikku, P., Mounteney, J., Castanera, A., Dias, M. and Giraudon, I. (2021), ‘Trends in MDMA-related mortality across four countries’, Addiction, doi:10.1111/add.15493.

Vicente, J. and Giraudon, I. (2019), ‘Improving DRD information: multi-indicator coherence analysis (multi-country analysis)’, presentation in Session 5 of the 2019 EMCDDA annual meeting on drug-related deaths, EMCDDA, Lisbon 21-22 October 2019 (available at https://www.emcdda.europa.eu/meetings/2019/drd#section2).

WHO Regional Office for Europe (2010), Prevention of acute drug-related mortality in prison populations during the immediate post-release period, WHO, Copenhagen.

Zlodre, J. and Fazel, S. (2012), ‘All-cause and external mortality in released prisoners: systematic review and meta-analysis’, American Journal of Public Health 102(12), pp. e67-e75.

Recommended citation

European Monitoring Centre for Drugs and Drug Addiction (2023), Frequently asked questions (FAQ): drug overdose deaths in Europe,https://www.emcdda.europa.eu/publications/topic-overviews/content/faq-d….

Source data

List of tables

Table A. Year of most recent overdose data
Country Country code Year
Austria AT 2021
Belgium BE 2019
Bulgaria BG 2021
Croatia HR 2021
Cyprus CY 2021
Czechia CZ 2021
Denmark DK 2020
Estonia EE 2021
Finland FI 2021
France FR 2018 or earlier
Germany DE 2021
Greece EL 2019
Hungary HU 2021
Ireland IE 2018 or earlier
Italy IT 2021
Latvia LV 2021
Lithuania LT 2021
Luxembourg LU 2021
Malta MT 2021
Netherlands NL 2021
Norway NO 2021
Poland PL 2020
Portugal PT 2020
Romania RO 2021
Slovakia SK 2021
Slovenia SI 2021
Spain ES 2020
Sweden SE 2021
Türkiye TR 2021
Table 1. Drug-induced deaths in the European Union, Norway and Türkiye: total number among adults aged 15-64 years if available, otherwise all ages, 2021
Country Year Number of deaths (all ages) Number of deaths (15-64 years) Number of deaths (15-64 years if available, otherwise all ages) Deaths per million (15-64 years)
Germany (1) 2021 1826   1826  
Spain 2020 774 585 585 19
France (1) 2017 417   417  
Sweden 2021 450 410 410 64
Italy 2021 293 288 288 8
Finland 2021 287 271 271 79
Türkiye 2021 270 269 269 5
Netherlands 2021 298 262 262 23
Austria 2021 235 234 234 39
Greece 2019 230 229 229 34
Ireland 2017 235 227 227 73
Norway 2021 241 222 222 63
Poland 2020 229 187 187 7
Denmark 2020 197 164 164 44
Belgium 2019 168 149 149 20
Croatia 2021 77 74 74 28
Lithuania 2021 62 61 61 34
Slovenia 2021 65 60 60 44
Portugal 2020 63 58 58 9
Czechia 2021 64 53 53 8
Hungary 2021 42 41 41 6
Estonia 2021 39 34 34 40
Romania 2021 30 30 30 2
Slovakia 2021 28 27 27 7
Bulgaria 2021 20 18 18 4
Latvia 2021 17 17 17 14
Cyprus 2021 10 10 10 17
Luxembourg 2021 5 5 5 11
Malta (1) 2021 5   5  

(1) No age breakdown was available in 2019 for Germany, therefore all cases are counted instead of only those aged 15-64 years.

Table 2. Drug-induced mortality rates per million among adults (15-64): selected trends
Country 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Austria 33 35 28 24 21 26 28 26 31 33 32 39
Croatia 25 21 16 17 21 19 20 23 30 37 37 28
Denmark 64 76 61 58 63 50 62 53 43 44 44  
Estonia 112 138 192 127 113 102 132 130 43 30 38 40
Finland 42 53 58 54 47 43 53 55 72 65 72 79
Norway 74 77 70 68 76 82 75 66 77 73 85 63
Slovenia 18 17 18 20 20 22 29 32 41 51 46 44
Sweden 56 57 65 72 96 103 90 94 84 79 73 64
EU27+2 14 14 13 14 15 17 17 19 16 15 15 16

(1) No age breakdown was available for Germany. 

Table 3. Drug-induced mortality rates per million among adults (15-64)
Country Year Females Males Total Deaths per million - Females (category) Deaths per million - Males (category) Deaths per million - Total (category)
Austria 2021 12 67 39 10-40 >40 10-40
Belgium 2019 7 33 20 <10 10-40 10-40
Bulgaria 2021 0 8 4 <10 <10 <10
Croatia 2021 9 48 28 <10 >40 10-40
Cyprus 2021 0 34 17 <10 10-40 10-40
Czechia 2021 5 11 8 <10 10-40 <10
Denmark 2020 22 66 44 10-40 >40 >40
Estonia 2021 14 66 40 10-40 >40 10-40
Finland 2021 38 120 79 10-40 >40 >40
France 2016 3 16 9 <10 10-40 <10
Germany 2017 6 35 21 <10 10-40 10-40
Greece 2019 8 60 34 <10 >40 10-40
Hungary 2021 3 9 6 <10 <10 <10
Ireland 2017 41 105 73 >40 >40 >40
Italy 2021 2 14 8 <10 10-40 <10
Latvia 2021 2 27 14 <10 10-40 10-40
Lithuania 2021 4 63 34 <10 >40 10-40
Luxembourg 2021 5 18 11 <10 10-40 10-40
Malta 2018 0 18 9 <10 10-40 <10
Netherlands 2021 9 37 23 <10 10-40 10-40
Norway 2021 39 87 63 10-40 >40 >40
Poland 2020 4 11 7 <10 10-40 <10
Portugal 2020 1 18 9 <10 10-40 <10
Romania 2021 0 4 2 <10 <10 <10
Slovakia 2021 3 12 7 <10 10-40 <10
Slovenia 2021 9 76 44 <10 >40 >40
Spain 2020 6 31 19 <10 10-40 10-40
Sweden 2021 38 88 64 10-40 >40 >40
Türkiye 2021 1 9 5 <10 <10 <10

Note: No age break down available in Germany.

Table 4. Proportion of males among drug-related deaths in the European Union, Norway and Türkiye, 2021
Country Year Proportion Proportion (categories) Total cases
Austria 2021 85 75-85 235
Belgium 2019 77 75-85 168
Bulgaria 2021 90 >85 20
Croatia 2021 84 75-85 77
Cyprus 2021 100 >85 10
Czechia 2021 67 <75 64
Denmark 2020 71 <75 197
Estonia 2021 74 <75 39
Finland 2021 75 75-85 287
France 2017 74 <75 417
Germany 2021 83 75-85 1826
Greece 2019 89 >85 230
Hungary 2021 71 <75 42
Ireland 2017 70 <75 235
Italy 2021 90 >85 293
Latvia 2021 94 >85 17
Lithuania 2021 92 >85 62
Luxembourg 2021 80 75-85 5
Malta 2021 100 >85 5
Netherlands 2021 77 75-85 298
Norway 2021 67 <75 241
Poland 2020 68 <75 229
Portugal 2020 94 >85 63
Romania 2021 93 >85 30
Slovakia 2021 79 75-85 28
Slovenia 2021 85 75-85 65
Spain 2020 72 <75 774
Sweden 2021 69 <75 450
Türkiye 2021 91 >85 270

Note: The total number of cases is low in some countries (fewer than 20 cases reported in Bulgaria, Cyprus, Latvia, Luxembourg and Malta). No age and gender breakdown was reported for Germany in 2019.

Table 5. Distribution of drug-induced deaths reported in 2012 and in 2020, or most recent year, by age group
Age 2012 2021
15-19 84 129
20-24 337 309
25-29 597 457
30-34 729 613
35-39 607 759
40-44 525 673
45-49 447 591
50-54 258 411
55-59 184 298
60-64 83 180
65+ 147 311
Table 6. Distribution of drug-induced deaths reported in 2021, or most recent year, by age group and by country
Country Year Females <30 Females 30-39 Females 40+ Males <30 Males 30-39 Males 40+ Total <30 Total 30-39 Total 40+
Austria 2021 16 8 11 74 58 68 90 66 79
Belgium 2019 5 4 30 16 36 77 21 40 107
Bulgaria 2021 0 1 1 3 8 7 3 9 8
Croatia 2021 0 4 8 5 21 39 5 25 47
Cyprus 2021 0 0 0 1 3 6 1 3 6
Czechia 2021 1 5 15 7 9 27 8 14 42
Denmark 2020 5 6 46 26 28 86 31 34 132
Estonia 2021 4 1 5 10 8 11 14 9 16
Finland 2021 23 19 30 77 55 83 100 74 113
France 2016 7 16 81 42 111 208 49 127 289
Germany 2017             206 423 496
Greece 2019 5 5 16 23 76 105 28 81 121
Hungary 2021 3 2 7 10 11 9 13 13 16
Ireland 2017 6 24 40 31 56 78 37 80 118
Italy 2021 5 14 11 35 57 171 40 71 182
Latvia 2021 0 1 0 5 7 4 5 8 4
Lithuania 2021 0 3 2 2 23 32 2 26 34
Luxembourg 2021 0 1 0 0 0 4 0 1 4
Malta 2018             0 3 0
Netherlands 2021 11 8 49 36 34 160 47 42 209
Norway 2021 10 10 59 32 39 91 42 49 150
Poland 2020 12 9 52 51 40 65 63 49 117
Portugal 2020 0 0 4 5 12 41 5 12 45
Romania 2021 0 1 1 2 18 8 2 19 9
Slovakia 2021 2 3 1 9 6 7 11 9 8
Slovenia 2021 1 1 8 6 18 31 7 19 39
Spain 2020 7 21 185 45 125 391 52 146 576
Sweden 2021 21 22 97 88 96 126 109 118 223
Türkiye 2021 16 3 6 99 79 66 115 82 72
Table 7. Proportion of drug-induced deaths among older (40+ years) people in the European Union, Norway and Türkiye, 2020 (or most recent data available)
Country Year Proportion Proportion (categories)
Austria 2021 34 30-50%
Belgium 2019 64 >60%
Bulgaria 2021 40 30-50%
Croatia 2021 61 >60%
Cyprus 2021 60 >50-60%
Czechia 2021 66 >60%
Denmark 2020 67 >60%
Estonia 2021 41 30-50%
Finland 2021 39 30-50%
France 2016 62 >60%
Germany 2017 44 30-50%
Greece 2019 53 >50-60%
Hungary 2021 38 30-50%
Ireland 2017 50 30-50%
Italy 2021 62 >60%
Latvia 2021 24 <30%
Lithuania 2021 55 >50-60%
Luxembourg 2021 80 >60%
Malta 2018 0 <30%
Netherlands 2021 70 >60%
Norway 2021 62 >60%
Poland 2020 51 >50-60%
Portugal 2020 73 >60%
Romania 2021 30 30-50%
Slovakia 2021 29 <30%
Slovenia 2021 60 >50-60%
Spain 2020 74 >60%
Sweden 2021 50 30-50%
Türkiye 2021 27 <30%
Table 8. Proportion of drug-induced deaths among older (40+ years) people in the European Union, Norway and Türkiye, 2021 (or most recent data available)
Country Year Proportion Proportion (categories)
Austria 2021 38 >30%
Belgium 2019 12 <15%
Bulgaria 2021 15 15-25%
Croatia 2021 6 <15%
Cyprus 2021 10 <15%
Czechia 2021 12 <15%
Denmark 2020 16 15-25%
Estonia 2021 36 >30%
Finland 2021 35 >30%
France 2016 11 <15%
Germany 2017 18 15-25%
Greece 2019 12 <15%
Hungary 2021 31 >30%
Ireland 2017 16 15-25%
Italy 2021 14 <15%
Latvia 2021 29 >25-30%
Lithuania 2021 3 <15%
Luxembourg 2021 0 <15%
Malta 2018 0 <15%
Netherlands 2021 16 15-25%
Norway 2021 17 15-25%
Poland 2020 28 >25-30%
Portugal 2020 8 <15%
Romania 2021 7 <15%
Slovakia 2021 39 >30%
Slovenia 2021 11 <15%
Spain 2020 7 <15%
Sweden 2021 24 15-25%
Türkiye 2021 43 >30%
Table 9. Proportion of drug-induced deaths with opioids involved in the European Union, Norway and Türkiye, 2020 (or most recent data available)
Country Year Type of register Females Males Total Proportion (categories) among females Proportion (categories) among males Proportion (categories) among total
Latvia 2021 General register 100 29 38 >80% <50 <50
Belgium 2019 General register 80 41 49 50-80% <50 <50
Portugal 2015 General register 88 61 66 >80% 50-80% 50-80%
Bulgaria 2021 General register 100 78 82 >80% 50-80% >80%
Lithuania 2021 General register 100 79 80 >80% 50-80% 50-80%
Slovenia 2021 General register 88 68 71 >80% 50-80% 50-80%
Romania 2021 Special register 100 86 87 >80% >80% >80%
Hungary 2021 Special register 50 37 40 50-80% <50 <50
Slovakia 2021 Special register 50 41 43 50-80% <50 <50
Sweden 2021 General register 94 86 88 >80% >80% >80%
Czechia 2021 Special register 33 26 28 <50 <50 <50
Croatia 2021 General register 90 85 86 >80% >80% >80%
Ireland 2017 Special register 89 87 87 >80% >80% >80%
Denmark 2020 General register 96 97 96 >80% >80% >80%
Estonia 2021 General register 67 70 67 50-80% 50-80% 50-80%
Türkiye 2021 Special register 32 36 36 <50 <50 <50
Finland 2021 General register 83 89 88 >80% >80% >80%
Austria 2021 Special register 75 88 86 50-80% >80% >80%
Italy 2021 Special register 57 71 70 50-80% 50-80% 50-80%
Greece 2019 General register 69 85 83 50-80% >80% >80%
France 2017 General register 50 78 74 50-80% 50-80% 50-80%
Luxembourg 2021 Special register 0 100 80 <50 >80% 50-80%
Norway 2021 General register     84     >80%
Table 10. Indexed trends in the number of deaths in selected countries in the south east of Europe, 2011-2020 (2011 = 100)
Country 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Bulgaria 100 70 50 57 73 60 80 37 80 67
Croatia 100 98 120 110 114 133 173 198 202 157
Greece 100 82 77 124 99 111 120 100    
Hungary 100 129 96 104 121 138 138 179 200 175
Romania 100 107 118 75 68 114 93 161 118 107
Slovakia 100 104 50 104 77 73 123 131 142 108
Slovenia 100 108 108 123 154 181 227 285 269 250
Türkiye 100 143 307 364 568 581 406 211 194 167
EU27+2 100 103 114 124 135 135 128 128 136 139

Note: Other countries in the southeast Europe, with fewer than 15 cases reported in 2019 or last year with available data, are not represented (Bulgaria, 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.

Table 11. Indexed trends in the number of deaths in selected countries in the north of Europe, 2011-2020 (2011 = 100)
Country 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Denmark 100 94 105 81 104 98 75 82 80  
Estonia 100 65 58 52 67 65 23 16 19 23
Finland 100 94 83 78 91 94 123 110 121 135
Ireland 100 122 122 128 119 127        
Latvia 100 65 88 106 106 129 118 71 124 100
Lithuania 100 77 124 164 156 119 84 74 67 89
Luxembourg 100 138 100 150 62 100 50 100 75 62
Netherlands 100 122 104 167 199 222 190 214 250 253
Norway 100 95 108 117 115 100 116 112 132 98
Sweden 100 112 147 157 141 150 136 129 122 105
EU27+2 100 103 114 124 135 135 128 128 136 139

Note: other countries in the north of Europe, with fewer than 15 cases reported in 2019 or last year with available data are not represented (Luxembourg and Latvia). 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.

Table 12. Sources used by the countries to report drug-induced deaths to the EMCDDA, 2020 (or most recent data available)
Country Year Available sources
Austria 2021 Both
Belgium 2019 General register
Bulgaria 2021 Both
Croatia 2021 General register
Cyprus 2021 Special register
Czechia 2020/2021 Both
Denmark 2020/2021 Both
Estonia 2021 General register
Finland 2021 Both
France 2017/2020 Both
Germany 2021 Special register
Greece 2019/2021 Both
Hungary 2021 Both
Ireland 2017 Special register
Italy 2021 Special register
Latvia 2021 Both
Lithuania 2021 General register
Luxembourg 2021 Special register
Malta 2021 Both
Netherlands 2021 General register
Norway 2021 General register
Poland 2020 General register
Portugal 2020/2021 Both
Romania 2021 Special register
Slovakia 2021 Special register
Slovenia 2021 General register
Spain 2020 Both
Sweden 2021 General register
Türkiye 2021 Special register
Table 13. Sources preferred by the countries to report drug-induced deaths to the EMCDDA, 2020 (or most recent data available)
Country Year Preferred source
Austria 2021 Special register
Belgium 2019 General register
Bulgaria 2021 General register
Croatia 2021 General register
Cyprus 2021 Special register
Czechia 2020/2021 Special register
Denmark 2020/2021 General register
Estonia 2021 General register
Finland 2021 General register
France 2017/2020 General register
Germany 2021 Special register
Greece 2019/2021 General register
Hungary 2021 Special register
Ireland 2017 Special register
Italy 2021 Special register
Latvia 2021 General register
Lithuania 2021 General register
Luxembourg 2021 Special register
Malta 2021 General register
Netherlands 2021 General register
Norway 2021 General register
Poland 2020 General register
Portugal 2020/2021 General register
Romania 2021 Special register
Slovakia 2021 Special register
Slovenia 2021 General register
Spain 2020 General register
Sweden 2021 General register
Türkiye 2021 Special register
Table 14. Mortality cohort studies among people using drugs in Europe: countries with studies conducted within the last 10 years or earlier. June 2021 – provisional findings
Country Last study
Belgium Within the last 10 years
Bulgaria Within the last 10 years
Croatia Within the last 10 years
Cyprus None
Czechia Within the last 10 years
Denmark Within the last 10 years
Estonia None
Finland Within the last 10 years
France Within the last 10 years
Germany Within the last 10 years
Greece None
Hungary None
Ireland Within the last 10 years
Italy Within the last 10 years
Latvia Within the last 10 years
Lithuania Within the last 10 years
Luxembourg Within the last 10 years
Malta None
Netherlands Within the last 10 years
Poland Within the last 10 years
Portugal Within the last 10 years
Romania More than 10 years
Slovakia Within the last 10 years
Slovenia Within the last 10 years
Spain Within the last 10 years
Sweden Within the last 10 years
Türkiye None
Norway Within the last 10 years
Table 15. Countries included in the ‘southeast’ and ‘north’ of Europe for this trend analysis
Country Region
Bulgaria Southeast
Croatia Southeast
Cyprus Southeast
Denmark North
Estonia North
Finland North
Greece Southeast
Hungary Southeast
Ireland North
Latvia North
Lithuania North
Luxembourg North
Malta Southeast
Netherlands North
Norway North
Romania Southeast
Slovakia Southeast
Slovenia Southeast
Sweden North
Türkiye Southeast
Table 16. Number of European countries implementing harm reduction interventions, up to 2022
Year Drug checking Drug consumption rooms Methadone maintenance treatment Needle and syringe programmes Take-home naloxone
1967     1    
1968     2    
1969          
1970     3    
1971          
1972          
1973          
1974     4    
1975     5    
1976          
1977     6    
1978          
1979          
1980          
1981          
1982          
1983          
1984       2  
1985       3  
1986       6  
1987     8 7  
1988       8  
1989     9 11  
1990     11 13  
1991     12    
1992 1   15 14  
1993     16 16  
1994     17 19  
1995     20 21  
1996 2   22    
1997 5   23 25  
1998     26 26  
1999          
2000       27  
2001 7   27    
2002          
2003          
2004          
2005          
2006          
2007       28  
2008          
2009          
2010         1
2011          
2012          
2013         2
2014 8       4
2015   1     6
2016 9 2     7
2017   6     9
2018 10 8     11
2019   9     13
2020 12       15
2021          
2022 12 10 27 28 16

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