1. Overdose deaths: diverging trends among heterogeneous groups of victims
Isabelle Giraudon
Lisbon, 25 October 2017
Lisbon Addictions 2017 – Structured session 25 – Take-home naloxone: taking drug users seriously

2. Drug-induced deaths in Europe
Trend continue cette année avec 500 DC de plus - au moins
Plusieurs pays concernés – des drivers probablement différents
Heroin back
Ageing users in the NL Scot E&W
Lithuania??? Des jeunes aussi
Turkey : heroin mais aussi de la MDMA des stimulants et des synthetic cannabinoids identifiées dans beaucoup de cas - en augmentation
* Source July 2017 EMCDDA European Drug report

3. Drug-induced deaths mortality rates in Europe
Gradient nord sud très clair
En partie du au niveau ++ d’autopsie, codage linking between registres ‘forensic’ et linking meilleur au nord
Mais aussi prevalence of heroin use, injection - maxi dans plusieurs de ces pays
Des tendances divergentes
Concern mainly in the UK, SE – driven by heroin but not only?
20 deaths /million population aged (32 for males and 8 for females)
North/south gradient
Various trends

4. Drug-induced deaths mortality rates in Europe
Gradient nord sud très clair
En partie du au niveau ++ d’autopsie, codage linking between registres ‘forensic’ et linking meilleur au nord
Mais aussi prevalence of heroin use, injection - maxi dans plusieurs de ces pays
Des tendances divergentes
Concern mainly in the UK, SE – driven by heroin but not only?
20 deaths /million population aged (32 for males and 8 for females)
North to south gradient
Various trends

5. Almost 310,00 people have died from an opioid overdose since 1999
RISE IN OPIOID DEATHS
Overlapping, Entangled but Distinct Epidemics
US mortality rates (X 5)
Any opioid deaths
104/million population
Almost 310,00 people have died from an opioid overdose since 1999
Heroin
European average
All drug-induced deaths
20 deaths /million population
Not suggesting situation in Europe will develop in the same way
SOURCE: National Vital Statistics System Mortality File.
Adapted from Jan Losby, CDC, invited at the Drug-related deaths expert meeting, Lisbon, Sept 2017

6. Proportion of drug-induced deaths cases in Europe with opioids involved (2017 EMCDDA report)
With opiates Country Year Definition Males Females Total Austria * 2015 Selection D Belgium 2013 Selection B Bulgaria * 2015 Selection B Croatia 2015 Selection B Cyprus 2015 Selection D Czech Republic 2015 Selection D Denmark 2014 Selection B Estonia 2015 Selection B Finland 2015 Selection B France 2013 Selection B Germany 2015 Other (Specific Definition) 798 Greece 2015 Selection D Hungary 2015 Selection D Ireland 2014 Selection D Italy 2015 Selection D Latvia 2015 Selection B Lithuania 2015 Other (Specific Definition) Luxembourg 2015 Other (Specific Definition) Malta 2015 Selection B Netherlands 2015 Selection B Norway * 2014 Selection B Poland 2014 Other (Specific Definition) Portugal 2015 Selection D Romania 2015 Selection D Slovakia 2015 Selection D Slovenia 2015 Selection B Spain 2014 Other (Specific Definition) Sweden 2015 Selection B Turkey 2015 Selection D United Kingdom * 2014 Selection B
5 countries with no data
14/25 data based on General mortality registers

7. Proportion of drug-induced deaths cases in Europe with opioids involved (2017 EMCDDA report)
Pervitin
With opiates Country Year Definition Males Females Total Austria * 2015 Selection D Belgium 2013 Selection B Bulgaria * 2015 Selection B Croatia 2015 Selection B Cyprus 2015 Selection D Czech Republic 2015 Selection D Denmark 2014 Selection B Estonia 2015 Selection B Finland 2015 Selection B France 2013 Selection B Germany 2015 Other (Specific Definition) 798 Greece 2015 Selection D Hungary 2015 Selection D Ireland 2014 Selection D Italy 2015 Selection D Latvia 2015 Selection B Lithuania 2015 Other (Specific Definition) Luxembourg 2015 Other (Specific Definition) Malta 2015 Selection B Netherlands 2015 Selection B Norway * 2014 Selection B Poland 2014 Other (Specific Definition) Portugal 2015 Selection D Romania 2015 Selection D Slovakia 2015 Selection D Slovenia 2015 Selection B Spain 2014 Other (Specific Definition) Sweden 2015 Selection B Turkey 2015 Selection D United Kingdom * 2014 Selection B
In Scotland 88 with opioid /opiates -55% with heroin
5 countries with no data
14/25 data based on General mortality registers

8. 630 000 receive opioid substitution treatment in 2015
1.3 million high risk opioid users in Europe Estimated coverage of opioid substitution treatment
receive opioid substitution treatment in 2015
The primary treatment for opioid dependence is substitution treatment, typically combined with psychosocial interventions.
Of the 1.3 million estimated opioid users in Europe, an estimated 660 000 opioid users received substitution treatment in the European Union in 2014 (683 000 including Norway and Turkey), and numbers have fallen by around 50 000 since 2010.
These estimates would suggest that overall at least 50 % receive substitution treatment. However, this estimate must be treated with caution for methodological reasons and there are considerable national differences.
Methadone is the most commonly prescribed opioid substitution drug, received by over two-thirds (70 %) of substitution clients. A further 28 % of clients are treated with buprenorphine-based medications, which is the principal substitution drug in seven countries. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being received by an estimated 2 % of substitution clients in Europe.

9. Challenges ahead - old problems and new problems
Heroin use and misused OST are still there
Fentanyls and other new synthetic opioids emerging

10. Timeline of an outbreak seen in terms of serious adverse events
1st seizure in may and reported in sept
Already assess in the UN system so we do not do a Joint report
Often characterised by clusters
We contribute to the EU mechanism only
Now assessed by the UN -

11. Pictures courtesy of Police Scotland.
Cas: U-47700
Pictures courtesy of Police Scotland.
U is an opioid analgesic 7.5 fold more potent than morphine (in animal models)
first appearance : Oct 2014 (SE). Since then seizures at street- level AND borders (inc. 1 Kg Spain – delivery from China)
serious adverse events: 4 deaths (EU), 15 (USA)
Seizure Scotland: SOLD AS DIAZEPAM (2,600 tablets)
1 Kg fentanyl = 4,000 lethal doses
The tablets were either white, round and bearing an interlocked “MA” logo (made to look like diazepam commercialised by M&A Pharmachem); or were yellow, round and bearing a “5” logo (made to look like diazepam tablets commercialised by Actavis)

12. Different situations with regards to opioid related deaths
Various substances
Various coverage of responses in place
Diverse populations at risk

13. Conclusions for action
More than 8400 lives lost to drug overdose last year in Europe
Likely more (plus 700? 800? this year)
Most deaths related to opioids
All these deaths are premature and preventable

14. Thank you