1. Monitoring drug related overdose and mortality in Europe Dr. Eva Keller

2. Importance of Mortality Mortality directly or indirectly related to drug use is one of the main cause of death among young people in Europe Yearly approximatelly 7-9000 death occours in connection with drug use

3. DRD and Mortality indicator Core component –Population statistics –DRD indicator –Characteristics of people who die directly due to use illicit drugs –GMR, SR

4. Second component Estimation of overall and cause-specific mortality based on mortality cohort studies in connection with treatment centers Death indirectly related mortality (Infectious diseases, accidents, suicide etc.)

5. Problems Typology of death Methodological challenges Death certificate Difference in investigation of death Weather further statistics based on death investigation result or not.

6. EMCDDA definition of DRD “those deaths that are caused directly by the consumption of drugs of abuse. These deaths occur shortly after the consumption of the substance(s)” “In addition to deaths directly related to the use of drugs, also deaths indirectly related to drug use (AIDS, accidents, suicides, violence…) should also be taken in account”

7. Factors influencing DRD Law –legal system Determination of cause of death Scene investigation Autopsy Data collection system Toxicology in ER, hospitals Coding

8. Factors influencing DRD Law –legal system –Anglosax –Continental Coroner-medical examiner-forensic expert- police

9. Factors influencing DRD Determination of cause of death –Examination of the dead body to determine the nature of death Physician, GP Ambulance doctor Medical examiner

11. Factors influencing DRD Scene investigation –Data collection –Surroundings –Shame in the family

12. Factors influencing DRD Autopsy –To be or not to be –Money –International autopsy protocoll –Toxicology

13. Autopsy rate versus number of poisoning

15. Mortality due to drug-induced deaths among all adults (15 to 64 years) in European countries EMCDDA

16. Drug related death in Hungary and in Budapest 1996-2008 25% 38% 94% 38% 79% 80% 118%34% 89%61% 96%92%

17. DRD in Budapest

18. Drug types in accidental OD cases

19. Pure heroin cc and DRD

20. Age distribution

21. Trends in mean age of drug-induced deaths in some of the EU-15 Member States, 1990 to 2006 EMCDDA

22. Infectious diseases 1% 99% 64% 36% 93% 7% 95% 5%

23. EMCDDA

24. Data collection system National statistic office/GMR Forensic Institute/SR National focal points/SR

25. Toxicology in ER, hospitals Direct – Indirect cause of death Synthetic drugs and cocaine Importance of toxicology –Live –Death

26. Coding ICD-9-ICD-10 Automatic coding versus manual Coding before toxicology

27. Summery-conclusion To improve understanding drug related death and mortality To develope and improve policies and intervention To provide information on health issues to health authorities and policy makers

28. Thank you for your attention! Eva Keller M.D. PhD Semmelweis University Department of Forensic & Insurance Medicine Budapest, Hungary keller_e@yahoo.com

29. Mean age of drug-induced deaths in EU Member States, last year with available data EMCDDA