Drug-induced deaths – the current situation in Europe (European Drug Report 2025)

Estimating the mortality attributable to drug use is critical for understanding the public health impact of drug use and how this may be changing over time. On this page, you can find the latest analysis of drug-induced deaths in Europe, including key data on overdose deaths, substances implicated and more. 

This page is part of the European Drug Report 2025, the EUDA’s annual overview of the drug situation in Europe.

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Last update: 5 June 2025

Improving responses to drug-related mortality requires better insight into factors driving trends

Estimating the mortality attributable to drug use is critical for understanding the public health impact of drug use and how this may be changing over time. Understanding the factors driving trends in this area is also likely to be key for the development of effective responses. However, despite improvements over the last decade, there are still important limitations in the information currently available to us, and this hampers the development of both policies and responses.

The term drug-induced deaths is used for an indicator that is intended to capture those deaths that are directly attributable to the consumption of drugs, sometimes referred to as drug overdose deaths. It should be noted that estimates of drug-induced deaths only represent a share of the overall mortality associated with drug use, as this measure does not include mortality from motor vehicle and other accidents, violence, suicides by means other than drug poisoning or chronic disease, where drug use may have played a role. A need exists, therefore, through cohort studies and other approaches, to extend our understanding in these other important areas of drug-related mortality.

Despite these limitations, an assessment of drug-induced deaths is still a key measure for understanding the harm that the use of illicit drugs can cause, but it is also a challenging one to interpret for methodological and data availability and quality issues. This is particularly true when interpreting recent trends in drug-induced deaths, where data for the most recent reporting year (2023) are available for only 21 of the 29 countries covered by this indicator, and estimated values must therefore be calculated if an overall EU estimate is to be derived. Given the speed at which new drug threats can emerge, improving the timeliness and completeness of data in this area is an important priority for the future.

It should also be noted that, for methodological reasons, the numbers of drug-induced deaths identified are likely to represent minimum estimates; that reporting capacity varies between countries, meaning that national comparisons need to be made with caution. In addition, a lack of detailed toxicological information in some countries currently means that our overall understanding of the role different drugs play in driving rates of drug-induced deaths over time is limited. The lack of detailed toxicological information can also hamper an understanding of the role played by different drugs when used in combination. As the majority of fatal overdoses involve the use of more than one substance, and as drug consumption patterns are becoming ever more complex, there is also a growing need to improve our understanding of how changes in patterns of polysubstance use are impacting on mortality. The EUDA’s creation has strengthened the capacity for rapid threat assessment, early warning and the issuing of alerts, and support measures to improve routine reporting capacity in this area. Importantly, the EUDA will coordinate a network of forensic and toxicological laboratories, increasing the analytical capacity available to monitor how different drugs and drug combinations are impacting on trends in mortality.

Polysubstance use patterns are linked to most drug-induced mortality

For the year 2023, the number of reported drug-induced deaths increased slightly in some EU Member States and fell in others. The provisional overall estimate of almost 7500 drug-induced deaths in 2023 represents a slight increase on the revised 2022 numbers, but this figure should be interpreted with caution, as a number of countries with large populations have yet to provide data, and estimated values are used to compute this provisional total. The largest increases in the number of drug-induced deaths in 2023 were reported by Germany, Latvia, Finland, Norway and Türkiye.

The available information highlights that opioids, usually in combination with other substances, remain the group of substances most commonly implicated in drug-induced deaths. Overall, trends in deaths where opioids are implicated appear stable, but the proportion of deaths in older age groups is increasing. It is estimated that heroin was involved in slightly fewer deaths in 2023, around 1200 (1300 in 2022) in the European Union, a minimum estimate based on data from 18 EU Member States with data available for both years. Heroin remains the drug commonly identified as involved in opioid-related deaths in some western European countries. However, the data available suggest heroin is now present in the majority of overdose deaths in only a few countries, and both other opioids and other drugs are now playing an important role. Opioids other than heroin, including methadone and, to a lesser extent, buprenorphine, pain-relief medicines containing opioids, and other synthetic opioids, are associated with a substantial share of overdose deaths in some countries.

Although detailed toxicological information is not available on all death cases, the information that does exist suggests that polysubstance toxicity is the norm. Where detailed toxicological information is available, it usually reports the presence of multiple substances. While many countries report individual drugs identified in post-mortem toxicology, few countries report how these drugs are combined and the number of deaths related to drug mixtures. An analysis of mortality case data from Austria, Slovenia and Norway in 2023 reveals a more detailed picture, for example, indicating that most drug-induced deaths were associated with multiple substances. Opioids remained the most frequently mentioned group of drugs detected overall, and some deaths related to opioids involved heroin. Heroin was rarely identified alone or with alcohol only, and most heroin-related cases involved different combinations of substances (Figure 11.1). Alcohol, either alone with heroin or in combination with other substances, was also frequently identified, as well as benzodiazepines. In Denmark, Austria, Slovenia and Finland, benzodiazepines were associated with more than half of the drug-induced deaths in 2023.

The data on drug mortality are also indicative of an ageing opioid-using cohort in Europe, with most cases of mortality linked to drug consumption typically found among males aged 40 or older. This is also illustrated by the more than two-fold increase in the number of drug-induced deaths among 50- to 64-year-olds between 2013 and 2023.

The available data also suggest that deaths where stimulants are implicated are rising in some countries, although with important caveats here. Stimulant deaths are likely to be particularly prone to under-reporting, and stimulants are often implicated in deaths where other drugs, including opioids, are also found to be present. There is also some information to suggest that stimulants appear to be more commonly implicated in deaths reported among younger age cohorts.

Overdoses and deaths related to synthetic opioids remain a concern

Potent synthetic opioids, such as the fentanyl derivative carfentanil and nitazene opioids, have been associated with some outbreaks of fatal and non-fatal poisonings in Europe. However, with the exception of some Baltic countries, these drugs do not currently figure prominently in the routine data available at EU level. Nonetheless, developments in this area are worrying because of the potential of these substances to impact negatively on public health in Europe in the future.

Nitazene opioids were involved in localised poisoning outbreaks in Ireland in 2023 and 2024 and in France during 2023. In Ireland, nitazenes were mis-sold as heroin in 2023 and as benzodiazepines in 2024, resulting in inadvertent consumption and multiple overdoses (see New psychoactive substances – the current situation in Europe). Clusters of deaths and acute toxicity linked to nitazenes have been reported in 2023 in France and in 2024 in Germany. In Sweden, over 30 deaths associated with metonitazene were reported from January 2023 to September 2024, more than 1 per month on average, before declining in the autumn of 2024. In Norway, 35 nitazene-related deaths (mainly metonitazene) were registered between June 2023 and August 2024, more than 2 per month on average, before the incidence sharply declined from September 2024. Metonitazene has been found in fake prescription tablets. Actions undertaken during 2024 included media warnings, national warnings, increased access to naloxone, prioritisation of nitazenes in narcotics classification, and increased police efforts targeting online sellers. Due to their high potency and novelty, there are concerns that nitazene opioids may not be routinely detected in procedures commonly used for post-mortem toxicology. This raises the possibility that the number of deaths reported could be an underestimate. Some evidence of this exists from countries in the Baltic area, where improvements in testing methods have resulted in an increase in the detection of these substances. In Estonia, the number of drug-induced deaths rose from 82 cases in 2022 to 119 in 2023, representing a drug-induced mortality rate of 135 per million population (in the 15-64 age class), six times the EU average. Nitazenes, mostly metonitazene and protonitazene, were implicated in over half (52 %) of these deaths. In Latvia, both the national statistics and the forensic registers provisionally reported an increase in the overall number of drug-induced deaths, from 63 in 2022 to 154 in 2023, representing a drug-induced mortality rate of 130 per million population (in the 15-64 age class), more than five times (5.3) the EU average. Nitazenes were identified in 101 (66 %) of these cases, driving the increase. Although systematic testing for nitazenes was not possible in 2022, there was a dramatic rise in the number of acute drug toxicological presentations involving opioids (from around 2400 in 2022 to over 4000 in 2023). Anecdotal reports from clinical staff suggesting that greater doses of naloxone were required raise concerns that synthetic opioids may have been involved. Since 2019, at least 21 countries have reported the presence of nitazenes to the Early Warning System on new psychoactive substances, which is now monitoring 22 different nitazenes.

Interventions needed to target deliberate self-harm from poisonings

Determining the intention of a person who has died from a drug overdose can be difficult. Many overdose deaths are reported as accidental, and others have an undetermined intent. However, in some countries, more information is available on intention, and a relatively high proportion of reported overdose deaths (1 in 8 overall) were classified as intentional in 2022 and 2023 (that is, with a suicidal intent). In all EU Member States, except Malta, and in Norway, the most recent available data show that the proportion of overdose deaths with a suicidal intent was higher among women. In the Netherlands and Sweden in 2022-2023, more than a third of the reported overdose deaths among women were classified as having a suicidal intent. In the same period, in Denmark, Hungary, Poland, Slovenia and Finland, a suicidal intent was recorded for one fifth or more of the overdose deaths among females. These findings indicate the need for interventions that target deliberate self-harm and suicidal intent among people who use drugs, and especially to recognise the risk that females may experience in this context.

Services scale-up required to prevent opioid overdoses and deaths

Responses aimed at reducing opioid-related deaths include interventions geared towards preventing overdoses from happening in the first place and those that focus on preventing death when overdoses do occur (Figure 11.2). Changes in both the population of people who inject opioids and the types of substances they are using create new and greater challenges for interventions designed to reduce overdose deaths. These include the challenge to develop differentiated programmes to target the needs of different groups and to configure services to the needs of different age cohorts. Enrolment in opioid agonist treatment is strongly evidenced as a protective factor against opioid overdose and some other causes of death, yet coverage and access issues still exist in many EU Member States, where provision is below levels recommended by the World Health Organization with respect to estimated needs.

The evidence is also growing that the increasing availability of opioid antagonists can play an important role in preventing fatal opioid overdoses. However, again, the extent to which this approach is available varies between and within countries. The implementation of naloxone programmes, including pilot projects, to prevent overdose deaths was reported by 15 European countries up to 2023. Changing consumption patterns and the availability of various formulations of both injectable and nasal spray naloxone may require services to review delivery protocols to ensure appropriate access and use of available products. Overdoses involving potent synthetic opioids, such as nitazenes or fentanyl derivatives, can present challenges for overdose reversal. In clinical settings, 2024 guidelines confirm that the initial management of acute opioid toxicity remains unchanged, with titrated administration of naloxone continuing to be the recommended approach. In community settings, including take-home naloxone programmes, more than one dose may be required. In such cases, guidance advises bystanders to administer doses stepwise, assessing the person’s response between administrations and providing rescue breathing or cardiopulmonary resuscitation if necessary. This highlights the value of training people who may witness or respond to an overdose in first aid, including the correct use of naloxone. Available 2023 data from 6 EU Member States and Norway indicate that several thousand individuals have been trained in correctly administering the medication. However, coverage and access issues still exist in some countries where this intervention is implemented, and more information on training, provision and use of naloxone is needed at national and local level to support the deployment of this life-saving medication. Implementation in additional European countries continued to progress in 2024: Croatia, Luxembourg and Finland started the piloting of take-home naloxone programmes.

In some countries, drug consumption rooms are also provided in part as a response to reducing overdose mortality. These facilities are now operational in 13 EU Member States and Norway (see Harm reduction – the current situation in Europe). Where multicultural and new immigrant populations are present, increased own-language harm reduction messaging is desirable for high-risk drug users. For more information on health and social responses to prevent opioid-related deaths, see the EUDA’s miniguide.

Key data and trends

Mortality rates due to overdose

• The mortality rate due to overdoses in the European Union in 2023 is estimated at 24.7 deaths per million population aged 15 to 64.
• The mortality rates due to overdose are typically 3 to 4 times higher among males compared with females (Figure 11.3), with men aged 25 to 39 the most affected. Overdose mortality rates in this age group can be considerably higher than for the male population aged 15 to 64 (adults). For example, in Sweden, the overdose mortality rate for men aged 25 to 39 was 117 deaths per million in 2023, compared with 89 deaths per million adult men in the country. In Estonia, the comparable figures were 264 deaths per million men aged 25 to 39 and 209 deaths per million adult men.

Overdose deaths

It is estimated that at least 7459 overdose deaths involving drugs occurred in the European Union in 2023 (7145 in 2022). This is a minimum estimate, as some countries report that their monitoring system is missing some cases. For example, a cross-validation of the 2022 data from the different registers (general and special registers) in Spain suggested that, when based solely on the general register, only 4 out of 5 cases might be reported. In Germany and Italy, the mortality register only contains cases that have come to the attention of the police. Thus cases outside of police focus may be under-reported. However, the extent of the underestimation is unknown.

Various populations are affected across Europe

• In Finland, drug-induced deaths among people under the age of 25 have remained high, accounting for 29 % (91 out of 310 deaths) of all drug poisoning deaths in 2023; this age group represented 25 % (63 out of 256 deaths) of the drug-induced deaths reported in 2023 in Austria, 22 % (2 out of 9 deaths) in Luxembourg, and 20 % (6 out of 30 deaths) in Hungary.
• The number of overdose deaths reported in the European Union among those aged 50 to 64 is estimated to have more than doubled between 2013 and 2023 overall, increasing by 76 % among women (from 184 to 323 deaths) and by 159 % among men (from 422 to 1094 deaths) (Figure 11.4).

Established and new substances associated with drug-induced deaths

• Opioids, including heroin and its metabolites, often in combination with other substances, were estimated to be present in 7 out of 10 cases of fatal overdose that occurred in the European Union in 2023 (Figure 11.5 and Figure 11.6). Multiple drugs are commonly found in the toxicology reports of drug-induced deaths.

• Heroin was present in the majority of overdose deaths in a relatively small number of EU Member States, namely Austria (heroin or morphine) (66 %), Luxembourg (heroin or morphine) (56 %), Slovenia (51 %) and Bulgaria (50 %). Heroin has been reported in approximately two fifths to one fifth of overdose deaths in Italy (45 %), Germany (37 %), France (34 % in 2022), Portugal (34 %), Croatia (29 %), Romania (28 %), Türkiye (20 %), Spain (20 % in 2022) and Norway (21 %). In 2023, heroin was reported in fewer than 1 in 5 overdose deaths in Czechia, Estonia, Cyprus, Latvia, Lithuania, Hungary, Malta, Slovakia, Finland and Sweden.
• Among 20 EU Member States providing data for 2022 and 2023, cocaine, mostly in the presence of opioids, was involved in 1051 (26 %) overdose deaths in 2023 (956 or 27 % in 2022).
• Deaths involving cocaine are now also being reported in countries where they were previously less common, such as Denmark, Cyprus, the Netherlands, Slovenia and Finland.
• Cocaine was involved in 30 % of the overdose deaths in Germany and in 65 % of the overdose deaths in Portugal in 2023.
• Stimulants other than cocaine, including amphetamine and methamphetamine, are involved in many deaths, often alongside opioids. Out of 19 countries with post-mortem data available for 2023, 17 reported deaths where non-cocaine stimulants were involved. The highest numbers of deaths involving non-cocaine stimulants were reported by Germany (490 cases), Türkiye (228), Sweden (75), Norway (64), Denmark (61), Finland (49), Latvia (41), Estonia (32) and Austria (30). Beyond these drug-induced deaths, other stimulant-related deaths, such as those associated with cardiovascular problems, may go undetected.
• In 2023, cathinones were reported in drug-induced deaths in 7 countries. In Hungary, 12 of the 30 deaths reported in 2023 involved cathinones. In Finland, 12 out of 253 deaths involved cathinones, while smaller numbers of cathinone-related deaths were reported in Lithuania, Austria, Romania, Slovenia and Slovakia.
• In 7 of the 18 countries with post-mortem toxicological data available for 2023, around 1 in 4 drug-induced deaths involved methadone. The opioid agonist medicine was mentioned in 30 % or more of cases with known toxicology reported in Luxembourg (56 %), Romania (40 %), Croatia (38 %), Estonia (37 %), Portugal (36 %), Bulgaria (35 %) and Germany (31 %). There is little information available on whether the medicines were prescribed, misused or acquired on the black market. However, the mention of the drug does not mean that it was the cause of the poisoning, as overdoses often involve polysubstance use with other opioids, alcohol and other medicines such as benzodiazepines.
• In 2023, buprenorphine was identified in 58 % (147) of the drug-induced deaths reported in Finland and in 16 % (73) of cases in Sweden. In all other countries with available data, buprenorphine was reported in less than 5 % of fatal overdose cases or was not reported at all.
• Tramadol, an opioid medicine used to treat moderate to severe pain, was involved in about 5 % (173) of reported overdose deaths in 13 European countries in 2023. However, it was involved in 35 % of the 136 deaths reported by the French registry of medicine misuse-related deaths in 2022, suggesting that improving surveillance and toxicological investigation might increase the detection of deaths associated with opioid-containing medicines. Morphine, oxycodone and fentanyl were involved in 25 %, 20 % and 4 % of the deaths, respectively, reported in 2022 in the registry of medicine misuse-related deaths.
• Available data from 16 EU Member States indicate that the number of deaths related to fentanyl and fentanyl derivatives remained relatively stable, with the drugs being linked to 153 overdose deaths in 2023 (159 in 2022). Germany reported the largest number of fentanyl-related deaths (70). Some of these fatalities might be associated with diverted fentanyl medicines rather than illicit fentanyl. The other cases reported in 2023 were in Sweden (15), Denmark (10), Austria (7), Estonia (7) and Finland (6).
• In 2023, data from Estonia and Latvia indicate that the number of drug-induced deaths involving new synthetic opioids further increased. The most prominent nitazenes detected in Estonia in 2023 were protonitazene (40 of 119 cases) and metonitazene (32 of 119, 27 %).
• In countries with data available for 2023, oxycodone was reported as being involved in 151 drug-induced deaths in 8 countries: Sweden (88), Finland (26), Denmark (24), Estonia (7), Austria (3), Lithuania (1), Luxembourg (1), Portugal (1).
• Consuming opioids in combination with benzodiazepines increases the risk of overdose. In 2023, benzodiazepines, together with other substances, primarily opioids, were detected in the majority of overdose deaths in Denmark, Austria, Slovenia and Finland.
• Few countries report information on the involvement of pregabalin or gabapentin in drug-induced deaths. Among those that do, Finland reported 87 deaths in 2023 (87 in 2022). Two countries reported an increase in the number of deaths with pregabalin or gabapentin mentioned: Denmark (from 58 deaths in 2022 to 60 in 2023), Austria (from 54 in 2022 to 71 in 2023).
• Deaths linked to synthetic cannabinoids increased to 61 in Türkiye in 2023 (8 in 2022).
• Seven countries with available data reported 39 deaths with synthetic cathinones involved in 2023: Finland (12), Hungary (12), Lithuania (6), Slovenia (4), Austria (2), Romania (2), Slovakia (1).

All-cause drug-related mortality

• A 2024 Norwegian cohort study analysed post-release mortality among 92 000 people released from prisons between 2010 and 2022. Mental health disorders and opioid use disorders were strongly associated with an increased risk of post-release mortality. The study showed a reduction in both all-cause and overdose mortality during the first 6 months after release among people who were enrolled in opioid agonist treatment.
• In 2023, opioid agonist treatment could be continued from the community to prison in 28 out of the 29 countries reporting to the EUDA, could be initiated in 24 countries and continued after prison in 23 countries (see Harm reduction – the current situation in Europe).

Additional detailed information can be found in the EUDA’s Opioid-related deaths: health and social responses and EUDA answers key questions on overdose deaths.

Source data

The complete set of source data for the European Drug Report 2025, including metadata and methodological notes, is available in our data catalogue.

A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.