Abstract
The European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, publishes statistics for overdose deaths giving a European mean number, and ranking nations in a national ‘league table' for overdose deaths. The interpretation of differing national levels of mortality is more problematic and more complex than is usually recognised. Different systems are used to compile mortality data and this causes problems for cross-national comparisons. Addiction behaviour can only be properly understood within its specific social and environmental ecology. Risk factors for overdose, such as the type of drug consumed, and the route of administration, are known to differ across countries. This paper describes problems associated with ranking and suggests how mortality data might be used in high-level countries aiming at reduction in the number of overdose deaths.
References
1.
EMCDDA: The State of the Drugs Problem in Europe. Annual Report 2008. Luxembourg, Office for Official Publications of the European Communities, 2008.
2.
EMCDDA: The State of the Drugs Problem in Europe. Annual Report 2009. Luxembourg, Publications Office of the European Union, 2009.
3.
EMCDDA: The State of the Drugs Problem in Europe. Annual Report 2010. Luxembourg, Publications Office of the European Union, 2010.
4.
EMCDDA: Drug-Related Deaths and Mortality - An Overview of the Methods and Definitions Used. Luxembourg, Publications Office of the European Union, 2009.
5.
Gossop M, Stewart D, Treacy S, Marsden J: A prospective study of mortality among drug misusers during a 4-year period after seeking treatment. Addiction 2002;97:39-47.
6.
Jauncey ME, Taylor LK, Degenhardt LJ: The definition of opioid-related deaths in Australia: implications for surveillance and policy. Drug Alcohol Rev 2005;24:401-409.
7.
Waal H: Mortality related to drug use: a comprehensive approach and public health implications; in Hordvin O (ed): The Drug Situation in Norway 2010. Annual Report to the European Monitoring Centre for Drugs and Drug Addiction - EMCDDA. Oslo, SIRUS Norwegian Institute for Alcohol and Drug Research, 2010, pp 66-76.
8.
Janssen E: Estimating the levels of acute drug-related deaths in France, 2001-2002: a simple technique to measure bias in overdoses recording. J Substance Use 2010;15:105-112.
9.
Janssen E: Drug-related deaths in France. A critical view (in French). Rev Epidemiol Sante Publique 2009;57:126-129.
10.
Ødegård E, Amundsen EJ, Kielland KB: Fatal overdoses and deaths by other causes in a cohort of Norwegian drug abusers - a competing risk approach. Drug Alcohol Depend 2007;89:176-182.
11.
EMCDDA: Statistical Bulletin Table DRD-5. Mortality due to Drug-Induced Deaths in European Countries, in All Adults and Adults aged 15 to 39 Years (Total and Males): Parts II & III. Luxembourg, Publications Office of the European Union, 2010.
12.
Mezzelani P, Quaglio GL, Venturini L, Lugoboni F, Friedman SR, Des Jarlais DC: A multicentre study on the causes of death among Italian injecting drug users. AIDS has overtaken overdose as the principal cause of death. AIDS Care 1998;10:61-67.
13.
EMCDDA: Mortality Related to Drug Use in Europe; Public Health Implications. Lisbon, EMCDDA, 2011.
14.
European Commission: Eurostat-Statistics-Population and Social Conditions: Public Health/Causes of Deaths/Standardised Death Rate. Brussels, European Commission, 2010.
15.
Auriacombe M, Franques P, Tignol J: Deaths attributable to methadone versus buprenorphine in France. JAMA 2001;285:45.
16.
Clausen T, Anchersen K, Waal H: Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend 2008;94:151-157.
17.
Gossop M, Marsden J, Stewart D, Lehmann P, Edwards C, Wilson A, et al: Substance use, health and social problems of service users at 54 drug treatment agencies. Intake data from the National Treatment Outcome Research Study. Br J Psychiatry 1998;173:166-171.
18.
Langendam MW, van Brussel GH, Coutinho RA, van Ameijden EJ: The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health 2001;91[:]774-780.
19.
Preti A, Miotto P, De CM: Deaths by unintentional illicit drug overdose in Italy, 1984-2000. Drug Alcohol Depend 2002;66:275-282.
20.
Best D, Man LH, Zador D, Bird S, Strang J, Aston M: Overdosing on opiates. Part I: Causes. Drug Alcohol Find 2000;4:1-20.
21.
Gossop M, Marsden J, Stewart D, Treacy S: Routes of drug administration and multiple drug misuse: regional variations among clients seeking treatment at programmes throughout England. Addiction 2000;95:1197-1206.
22.
Darke S, Zador D: Fatal heroin ‘overdose': a review. Addiction 1996;91:1765-1772.
23.
EMCDDA: Statistical Bulletin Figure PDU-2. Estimates of the Prevalence of Injecting Drug Use (Rate per 1,000 Population Aged 15 to 64), 2003 to 2008 - Last Study Available. Luxembourg, Publications Office of the European Union, 2010.
24.
EMCDDA: Trends in Injecting Drug Use in Europe. Special Issues. Luxembourg, Publications Office of the European Union, 2010.
25.
Robertson R, Richardson A: Heroin injecting and the introduction of HIV/AIDS into a Scottish city. J R Soc Med 2007;100:491-494.
26.
Weinberg D: On the embodiment of addiction. Body Soc 2002;8:1-19.
27.
Weinberg D: Sociological perspectives on addiction. Sociol Compass 2011;5/4:298-310.
28.
Wiessing L, Klempova D, Hedrich D, Montanari L, Gyarmathy VA: Injecting drug use in Europe: stable or declining. Euro Surveill 2010;15:1-2.
29.
De la Fuente L, Barrio G, Royuela L, Bravo MJ: The transition from injecting to smoking heroin in three Spanish cities. The Spanish Group for the Study of the Route of Heroin Administration. Addiction 1997;92:1749-1763.
30.
Stoltenbergutvalget: Rapport om narkotika. Oslo, Helse- og omsorgsdepartementet (Ministry of Health), 2010.
31.
Haraldsen M: Why there has been an excess of overdoses in Norway since 1990? Heroin Addict Relat Clin Probl 2010;12:37-40.
32.
Teige B: Whose deaths should be included? Choices and consequences for mortality rates; in Waal H (ed): Patterns on the European Drug Scene. Oslo, National Institute of Alcohol and Drug Research, 1998, pp 155-162.
33.
Cruts G, Buster M, Vicente J, Deerenberg I, Van LM: Estimating the total mortality among problem drug users. Subst Use Misuse 2008;43:733-747.
34.
Caplehorn JR, Dalton MS, Haldar F, Petrenas AM, Nisbet JG: Methadone maintenance and addicts' risk of fatal heroin overdose. Subst Use Misuse 1996;31:177-196.
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2013
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