monitoring drug related overdose and mortality in europe dr. eva keller
TRANSCRIPT
Monitoring drug related overdose
and mortality in Europe
Dr. Eva Keller
Importance of Mortality
• Mortality directly or indirectly related to drug use is one of the main cause of death among young people in Europe
• Yearly approximatelly 7-9000 death occours in connection with drug use
DRD and Mortality indicator
• Core component– Population statistics– DRD indicator– Characteristics of people who die directly
due to use illicit drugs– GMR, SR
Second component
• Estimation of overall and cause-specific mortality based on mortality cohort studies in connection with treatment centers
• Death indirectly related mortality (Infectious diseases, accidents, suicide etc.)
Problems
• Typology of death
• Methodological challenges
• Death certificate
• Difference in investigation of death
• Weather further statistics based on death investigation result or not.
EMCDDA definition of DRD
“those deaths that are caused directly by the consumption of drugs of abuse. These deaths occur shortly after the consumption of the substance(s)”
“In addition to deaths directly related to the use of drugs, also deaths indirectly related to drug use (AIDS, accidents, suicides, violence…) should also be taken in account”
Factors influencing DRD
• Law –legal system
• Determination of cause of death
• Scene investigation
• Autopsy
• Data collection system
• Toxicology in ER, hospitals
• Coding
Factors influencing DRD
• Law –legal system– Anglosax– Continental
• Coroner-medical examiner-forensic expert-police
Factors influencing DRD
• Determination of cause of death– Examination of the dead body to determine
the nature of death• Physician, GP• Ambulance doctor• Medical examiner
Death case
Examination of dead body
Natural cause of death Unnatural cause of death
Well known cause of death
Unknown cause of death
Medico-legal investigation
Suspicion of crime
Criminal procedure
Scene investigation
No crime
State administration procedure
Transplantation
Pathologist
Pathological autopsy
Cause of death ~~~ Death certification ~~~ Permission to dispose of body
G. P.
Funeral
Forensic autopsy Forensic autopsy
Factors influencing DRD
• Scene investigation– Data collection– Surroundings– Shame in the family
Factors influencing DRD
• Autopsy– To be or not to be– Money– International autopsy protocoll– Toxicology
Autopsy rate versus number of poisoning
0
20
40
60
80
100
120
pois.old pois.all Bp.autopsy SE.autopsy
Autopsy rate versus number of poisoning
0
20
40
60
80
100
120
pois.old pois.all SE.autopsy
Mortality due to drug-induced deaths among all adults (15 to 64 years) in European countries
0
10
20
30
40
50
60
70
80
90
100
Hungary
Slo
vakia
Bulg
aria
Czech R
epublic
Fra
nce
Pola
nd
Neth
erlands
Latv
ia
Italy
Rom
ania
Belg
ium
Cypru
s
Spain
Sw
eden
Gre
ece
Germ
any
Malta
Lithuania
Slo
venia
Port
ugal
Austr
ia
Fin
land
Irela
nd
United K
ingdom
(D
SD
)
Norw
ay
Denm
ark
Luxem
bourg
Esto
nia
EMCDDA
Drug related death in Hungary and in Budapest 1996-2008
0
10
20
30
40
50
60
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Hungary Budapest
25%38%
94%
38%
79%80%
118% 34%
89% 61%
96% 92%
DRD in Budapest
0
10
20
30
40
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Drug types in accidental OD cases
0
10
20
30
40
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
amphetamine cocain MDMA butane inhalant opiate
0
20
40
60
80
100
120
1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
min drd max
Pure heroin cc and DRD
Age distribution
0%
20%
40%
60%
80%
100%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
less 20 20-29 30-39 40-49 over 50
Trends in mean age of drug-induced deaths in some of the EU-15 Member States, 1990 to 2006
15
20
25
30
35
40
45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
DE
IE
ES
IT
LU
NL
AT
PT
FI
SE
UK (DSD)
NO
EMCDDA
EMCDDA
Infectious diseases
HIV HCV lues HBV (HBsAg)
pozitív
negatív
1%
99% 64%
36%
93%
7%
95%
5%
EMCDDA
0
10
20
30
40
50
60
70
80
90
100
Hun
gary
Slo
vakia
Bulg
aria
Cze
ch R
epub
lic
Fra
nce
Pola
nd
Net
her
lands
Latv
ia
Italy
Rom
ania
Belg
ium
Cyp
rus
Spai
n
Sw
eden
Gre
ece
Ger
man
y
Mal
ta
Lith
uan
ia
Slo
venia
Port
ugal
Aust
ria
Fin
land
Irela
nd
Uni
ted
Kin
gdom
(D
SD
)
Nor
way
Den
mar
k
Luxem
bour
g
Esto
nia
Rate AIDS —IDU/million population 15–64(1)Rate DRD/million population 15–64
Data collection system
• National statistic office/GMR
• Forensic Institute/SR
• National focal points/SR
Toxicology in ER, hospitals
• Direct – Indirect cause of death
• Synthetic drugs and cocaine
• Importance of toxicology – Live– Death
Coding
• ICD-9-ICD-10
• Automatic coding versus manual
• Coding before toxicology
Summery-conclusion
• To improve understanding drug related death and mortality
• To develope and improve policies and intervention
• To provide information on health issues to health authorities and policy makers
Thank you for your attention!
Eva Keller M.D. PhDSemmelweis University Department of Forensic & Insurance Medicine
Budapest, Hungary
Mean age of drug-induced deaths in EU Member States, last year with available data
0
5
10
15
20
25
30
35
40
45
50
Rom
ania
(2006)
Esto
nia
(2006)
Latv
ia (
2006)
Cypru
s (
2006)
Malta
(2006)
Bulg
aria (
2006)
Austr
ia (
2006)
Lith
uania
(2006)
Hungary
(2006)
Czech R
epublic
(2006)
Luxem
bourg
(2006)
Port
ugal (
2006)
Slo
venia
(2005)
Irela
nd (
2004)
Belg
ium
(1997)
Germ
any (
2006)
Italy
(2006)
Norw
ay (
2005)
Slo
vakia
(2006)
Sw
eden (
2004)
Unite
d K
ingdom
(D
SD
) (2
005)
Fin
land (
2006)
Neth
erlands (
2006)
Denm
ark
(2005)
Pola
nd (
2005)
Fra
nce (
2005)
Mean
ag
e i
n y
ears
EMCDDA