Worldwide, overdose is the leading cause of avoidable death among people who inject drugs. It accounts for nearly half of all deaths among people who inject heroin, exceeding HIV and other disease-related deaths (UNODC, 2017). More than 9 000 lives were reported to be lost to drug overdoses in Europe (28 EU Member States, Norway and Turkey) in 2017, the latest reporting year, and this is an underestimate. The number of drug-related deaths in Europe has been rising for 5 years (EMCDDA, 2019a). Reducing drug-related deaths therefore remains a major challenge for European public health policy.

The groups most likely to experience an overdose are people with an opioid dependency and those who inject them. It has been found that overdose deaths are more likely to occur in specific situations, for example the period shortly after prison release, hospital discharge or completing a course of residential detoxification or recovery treatment. Other risk factors for opioid overdose include using opioids in combination with other central nervous system depressants, such as alcohol or benzodiazepines, and using them unaccompanied. The type of opioid used also plays a role. In some countries (in particular the United States and Canada), overdose risks have substantially increased because of the circulation of fentanyl-laced drugs. The high potency of even small amounts of fentanyl, a synthetic opioid, in combination with its unknown concentration in drug mixtures, presents an elevated risk of overdose (see Spotlight: Fentanyl).

In recent years, several documents addressing the prevention of drug-related deaths have been issued by international organisations, and reducing premature mortality is a target under Sustainable Development Goal 3.