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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.
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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
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
Mortality due to drug-induced deaths among all adults (15 to 64 years) in European countries EMCDDA
Drug related death in Hungary and in Budapest 1996-2008 80% 79% 94% 96% 92% 38% 38% 89% 61% 25% 118% 34%
Trends in mean age of drug-induced deaths in some of the EU-15 Member States, 1990 to 2006 EMCDDA EMCDDA
Infectious diseases 99% 64% 93% 95% 1% 36% 7% 5%
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. PhD Semmelweis University Department of Forensic & Insurance Medicine Budapest, Hungary keller_e@yahoo.com
Mean age of drug-induced deaths in EU Member States, last year with available data EMCDDA