This miniguide is one of a larger set, which together comprise Health and social responses to drug problems: a European guide 2021. It provides an overview of the most important aspects to consider when planning or delivering health and social responses to opioid-related deaths, and reviews the availability and effectiveness of the responses. It also considers implications for policy and practice.

Key issues
Mortality directly or indirectly related to the use of opioids is a major cause of avoidable premature deaths among adults in Europe, with drug-related mortality rates estimated at around 1–2 % per year among people who inject opioids. Overall, opioids are detected in more than three quarters of fatal overdoses in Europe. The risk of dying from an opioid overdose increases following periods of abstinence when tolerance is lost, in particular on release from prison or on leaving abstinence-based treatment.

Suicide, accidents and complications from infections also contribute to the excess mortality observed in this group. Studies have also shown that people who use opioids may suffer from higher-than-expected rates of certain non-communicable diseases, including some cancers and cardiovascular problems. An association between opioid-related problems and other substance use issues, such as smoking or high levels of alcohol use, may partly explain this observation. 

Evidence and responses
Approaches taken to reduce opioid-related deaths include interventions that focus on preventing the occurrence of overdoses and those that aim to improve the survival chances of people who do overdose.

• Opioid agonist treatment (1): Enrolling and retaining people who use opioids in effective treatment reduces opioid-related deaths.
• Naloxone: The opioid antagonist naloxone can reverse the potentially fatal effect of an opioid overdose. Several interventions seek to ensure the availability of naloxone and promote appropriate use by peers and professionals responding to or intervening in drug overdoses.
• Extended-release naltrexone implants: Although their effectiveness in reducing overdose deaths remains uncertain, they may be useful to prevent relapse in opioid-dependent individuals.
• Continuity of care: Ensuring continuity in health and drug services during transitions between prison and the community is important as evidence shows that people who use opioids are particularly vulnerable to overdose in the first weeks after release.
• Overdose risk awareness: Awareness raising among people who use opioids is particularly important with respect to key risks, including concurrent alcohol or benzodiazepine use.
• Drug consumption rooms: Current evidence is insufficient to assess their impact on overdose deaths, but there is an indication that this intervention may support safer injecting behaviour.

In addition, a number of policies and interventions may contribute to reducing people’s vulnerability to overdose. These include, for example, the provision of outreach and low-threshold services that lower access barriers for those seeking help, and integrated overdose prevention policies.

[For the full guide, click this link to the EMCDDA website; and 
click here to view the EMCDDA webinar on drug-related deaths, December 2021]