Isabelle Giraudon, Federica Mathis, Julian Vicente Setting the scene of drug-related deaths in Europe: rebound and shifts? A diverse picture Isabelle Giraudon, Federica Mathis, Julian Vicente Lisbon, 26 October 2017

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

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 3

Most recent trends - provisional figures suggest an overall increase this year Decrease Sweden Denmark Cyprus Finland Czech Republic Lithuania Italy Increase UK Germany Spain The Netherlands Estonia Turkey Portugal Norway Slovenia Croatia Stable and or with most recent data back in 2014

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 15-64 (32 for males and 8 for females) North/south gradient Various trends

Toxicology - % of cases with opioids With opiates Country Year Definition Males Females Total Austria * 2015 Selection D 85 28 113 Belgium 2013 Selection B 25 19 44 Bulgaria * 2015 Selection B 7 2 9 Croatia 2015 Selection B 32 4 36 Cyprus 2015 Selection D 7 1 8 Czech Republic 2015 Selection D 14 6 20 Denmark 2014 Selection B 145 63 208 Estonia 2015 Selection B 66 11 77 Finland 2015 Selection B 103 34 137 France 2013 Selection B 101 67 168 Germany 2015 Other (Specific Definition) 798 Greece 2015 Selection D Hungary 2015 Selection D 10 2 12 Ireland 2014 Selection D 131 40 171 Italy 2015 Selection D 83 21 104 Latvia 2015 Selection B 7 2 9 Lithuania 2015 Other (Specific Definition) 96 6 102 Luxembourg 2015 Other (Specific Definition) 9 2 11 Malta 2015 Selection B 7 1 8 Netherlands 2015 Selection B 43 21 64 Norway * 2014 Selection B 175 56 231 Poland 2014 Other (Specific Definition) Portugal 2015 Selection D 23 6 29 Romania 2015 Selection D 15 2 17 Slovakia 2015 Selection D 20 4 24 Slovenia 2015 Selection B Spain 2014 Other (Specific Definition) Sweden 2015 Selection B 416 152 568 Turkey 2015 Selection D 292 25 317 United Kingdom * 2014 Selection B 1662 642 2304 5 countries with no data - 14/25 data based on General mortality register Overall 4/5 cases with opioids, but country variations

Age distribution of overdose deaths in Europe – 2006

Age distribution of overdose deaths in Europe – 2006 and 2014

Age distribution of overdose deaths in Europe – 2006, 2014 and 2015 (n=8440)

Age distribution of drug-induced deaths 2006-2015, UK

Suède

Suède Hommes 2011-2015 .triplement des cas< 30ans

1.3 million ‘High-risk opioid users’ in Europe 630 000 receive opioid substitution treatment in 2015 National variation in coverage 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.

Emerging opioid NPS Augmentation de la ‘file active’ - un marché très dynamique et innovant Diversification des produits mais aussi des formes: spray, buvards, spray nasals - des implictaions de santé importantes du fait de risque de diffusion à un public plus novice, plus dans un contexte d’experimentation, de festif Augmentation des quantites et des saisies Des millions de doses potentielles Montée en charge progressive Nombre cumulé 570 Emergence des nouveaux cannabinoides de synthese en 2009 Les plus fréquentes nouvelles substances ajoutées sont maintenant cannabinoides de synthese et cathinones Puis en 2012, premiers opioids de synthese. 4 nouveaux en 2015 plus 5 déja en 2016 - 3 fluoro fentanyl reported recently by FR – one of the first country

Conclusions and introduction to the speakers More than 8400 lives lost in 2015 Preliminary data suggest an overall increase for 2016 Comparisons between countries need caution We need to consider the context (demographics, rates, populations at risk, level of risk among those exposed, responses available, market, NPS, improved data quality) Illustration and discussion with the next speakers

Enhanced assessment of drug-induced deaths data in Europe – 2015-2017 http://www.emcdda.europa.eu/publications/technical-reports/assessment-drug-induced-death-data_en

Thank you Contact Isabelle.giraudon@emcdda.europa.eu Acknowledgments : to all the Drug-Related Deaths national experts and National focal points