Overdose continues to claim thousands of lives in Europe. In the run-up to International Overdose Awareness Day (31 August) (1), the EUDA has updated its resource ‘Frequently asked questions (FAQs): drug-induced deaths in Europe’. The resource highlights the scale of the problem and points to cocaine, new synthetic opioids (nitazenes) and polysubstance use as growing concerns. Drawing on the latest data from the 27 EU Member States, Norway and Türkiye, the FAQs answer the questions most often asked about overdose deaths in Europe.
Across the EU, overdose remains one of the leading preventable causes of death among people who use drugs. In 2023, over 7 500 people in the EU lost their lives to overdose, rising to around 8 100 when Türkiye and Norway are included. Four in five victims were men, most in their late thirties or early forties. Opioids were involved in over two-thirds of Europe’s drug-induced deaths, although national patterns vary. Drugs linked to these cases included heroin, opioids prescribed in agonist treatment (e.g. methadone) and a variety of synthetic opioids. Deaths involving fentanyl and its derivatives remained stable in 2023 (153 cases, compared with 159 in 2022), with some associated to diverted medicines rather than illicit fentanyl.
Cocaine frequently reported in overdose deaths
In the 20 countries that provided data for both 2022 and 2023, over a quarter of the drug-induced deaths involved cocaine, with overall numbers in these countries rising from 956 in 2022 to 1 051 in 2023. In some countries, cocaine is reported in higher proportions of drug-induced deaths than in the rest of Europe. Cocaine was involved in 65% of drug-induced deaths in Portugal (2023), 60 % in Spain (2022) and 30% in Germany (2023). Evidence of polysubstance use is common, with opioids present in many cocaine-related deaths.
Nitazenes fuel rise in overdoses in some countries
The FAQs draw particular attention to nitazene opioids, which have been involved in localised poisoning outbreaks across Europe. In Estonia, drug-induced deaths jumped from 82 cases in 2022 to 119 in 2023, representing a drug-induced mortality rate of 135 per million population (adults 15-64 years), six times the EU average (22). Nitazenes, mostly metonitazene and protonitazene, were implicated in over half (52 %) of these deaths. Latvia saw an even steeper rise, from 63 deaths in 2022 to 154 in 2023, representing a drug-induced mortality rate of 130 per million population (adults 15-64 years), almost six times the EU average. Nitazenes were present in two-thirds (66 %) of the cases. Multi-layered monitoring systems and signal detection tools suggest that nitazene deaths in these two countries might have passed the peak (2). However, deaths and acute toxicity linked to nitazenes have also been reported in several other countries, including France, Germany, Sweden and Norway.
Role of medicines in polydrug use deaths
Polysubstance use remains the rule rather than the exception in drug-induced deaths. In 2023, benzodiazepines were detected in over a third of the cases in most of the countries reporting post-mortem findings on drug-induced deaths cases. Alcohol was mentioned in more than 20 % of cases in at least six countries. Deaths involving opioid medications, such as oxycodone and tramadol, also feature in several national reports.
Wider risks and responses
The FAQs stress that overdose deaths are shaped by many factors — from the type of drug and how it is used, to interruptions in treatment or reduced tolerance (e.g. after release from prison). Suicidal intent is reported more often among female drug-induced deaths compared to males, underlining the need for gender-sensitive prevention. On the response side, the resource reviews how overdose prevention services are currently implemented in Europe, both in communities and in prisons. It also highlights best practice guidelines in hospital settings and health and social responses to opioids related-deaths (3).
Preventing overdose deaths is a priority under the EU Drugs Strategy and Action Plan 2021–25. This commitment is central to the work of the EUDA. Measures include tailoring interventions for high-risk groups, scaling up naloxone availability and use and expanding the provision of evidence-based treatment.
The digital FAQs include maps, downloadable data, graphics, and country-level data, providing policymakers, practitioners and the public with an accessible overview of current trends and responses to drug-related deaths in Europe.
