Prescription Drugs

opioids

Nordic Alcohol Policy Report is beginning to broaden its scope by adding chapters also on different drugs. Although the Nordic countries are often seen as ideal in practically every global ranking of quality of life and social equality, the number of drug-related deaths in these countries is among the highest in Europe. Together with Baltic countries. 
Opioids, including heroin, methadone and buprenorphine, account for the majority of fatal overdoses in these countries.
The following page provides a summary of the main comparative data, and more detailed reports can be found from each country report.

Why comparing death rates between different countries is problematic

 

Decriminalisation of Drugs report (The Swedish Drug Policy Centre, 2020)

Comparing death rates between different countries is more problematic and more complex than usually comes out in discussions on the subject. The EMCDDA itself says that any comparison between countries must be made with caution “since it is underreported in some countries”. In a technical report, EMCDDA has also identified significant differences between countries in a number of areas: 

  • The number and quality of post-mortem examinations and forensic analyses carried out. Procedures vary for when a post-mortem and forensic analysis is to be carried out.

  • Availability of information to the medical doctor determining the cause of death.

  • Different classification systems are used, and the quality of the classifications is considered to vary.

  • The standard of available laboratory equipment varies

In the case of Portugal and Sweden, the differences in the way in which deaths are collated and reported appear to be so vast that comparisons between the countries become meaningless in practice. Most people argue that the differences in method vary widely across Europe in general. Is Sweden really at the top in the EU when it comes to drug mortality? Nobody knows for sure.

EMCDDA - Overdose deaths, TRENDS

Source: EMCDDA

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Sweden: In 2016 Sweden updated data since 2001 in order to include T40.4 cases.

National definitions usually refer to acute deaths directly related to drug consumption ("overdoses", "poisonings" or "drug-induced"). Note that, in a few countries, the figures might include also a limited number of cases of deaths indirectly related to drug use (e.g. accidents with positive toxicology). Note in addition that in some countries, statistics published at national level may differ from those presented here, owing to differences of case definition used at national level.

Comparisons between countries must be made with caution, because mortality rates and trends are influenced by factors such as practices of reporting, recording information and coding overdose cases that may vary across countries and time.

EMCDDA - Overdose deaths, Current situation > Toxicology > With opiates

The EMCDDA drug-related deaths (DRD) indicator focuses on deaths directly caused by illegal drugs (drug-induced deaths) and mortality among drug users.

The EMCDDA encourages countries to both harmonise their data collection and reporting. Nevertheless, differences in the availability of autopsies and in coding practices between countries will influence the interpretation and comparability of the results.

The number of drug-induced deaths provides one perspective on the drug situation and should be considered within the broader range of information available. Cross-referencing between data-sets provides both additional insights and a check of validity. The DRD indicator also considers mortality amongst drug users derived from cohort studies.

Learn more about EMCDDA methods and definitions

* Percentage of patients whose main drug was opioid from all entrants.

Sweden: Data for clients entering treatment refer only to hospital-based and specialised outpatient care facilities.

EMCDDA - Treatment demand > Current situation

Treatment demand > Current situation > Drug > All entrants > Opioids

Opioid substitution treatment > All clients

Legal framework > Initiation OST

Notes: 'Y' indicates whether a specific provider is involved in initiating opioid substitution treatment.

Specialized medical doctors' refers to specifically trained or accredited office-based medical doctors or general practitioners practicing outside specialised drug treatment centres.

'Any medical doctor' refers to office-based medical doctors practicing outside specialised drug treatment centres.

Where a specific provider is not allowed to initiate a specific treatment, the table entry is left empty. Exception for Sweden for which data were not available 

Needle and syringe programmes > Sites > Fixed

NSP (Needle and syringe programmes) site: The term ‘site’ is used to describe physically distinct outlets where syringes can be obtained for free or in exchange against used ones.

Norway: is based on a harm reduction equipment survey in Norwegian municipalities. This was carried out for the third time in 2019 with a response rate of 73%. 77 municipalities reported syringe delivery. 77 municipalities reported syringe delivery. Around 77 municipalities reported fixed NSP-locations. Due to the fact that not all of the municipalities who reported syringe delivery stated the type of NSP, this number should be treated as an estimate. Despite the high number of participating municipalities, some cities/villages with an NSP site are not represented in the survey.

Needle and syringe programmes > Sites > Outreach

Norway: The information provided is based on 2018 year's reporting (2017-data). Out of the 77 municipalities reporting syringe delivery in the survey, 18 reported outreach syringe provision. Due to some inconsistency in the reporting of type of NSP, this number should still be treated as a rough estimate.