Preventing drug-related deaths — risks and responses
Most overdose deaths in Europe are linked to the use of opioids (heroin or synthetic opioids), although cocaine, other stimulant drugs and medicines also play a role. In a new online resource, Prevention of drug-related deaths in Europe,the agency provides an overview on the issue and the risk factors involved.
Fatal overdoses are most likely to occur in specific situations, such as lost or reduced tolerance to opioids shortly after prison release, hospital discharge, interruption of treatment or completing a course of residential detoxification. Using opioids with other substances (e.g. alcohol, benzodiazepines and other medicines) also increases the risks of death, as does the lack of, or inadequate, response by those witnessing an overdose.
The EMCDDA illustrates how overdose prevention can be addressed on three levels: reducing vulnerability to overdose (e.g. accessible treatment and services); reducing the risk of overdose (e.g. retention in opioid substitution treatment, prison aftercare and overdose risk assessments); and reducing the likelihood of fatal outcomes (e.g. take-home naloxone policies and supervision of drug consumption) (see Figure 1). Currently, 87 supervised drug consumption facilities exist in 8 EU member states, Norway and Switzerland providing a safer drug-using environment (1).
Take-home naloxone can save lives — a first overview of programmes
Many people overdose in the presence of their partners or peers, therefore empowering friends, family and other bystanders to act effectively, before emergency services arrive at the scene, can save lives. While naloxone — a medicine used to reverse opioid toxicity — has been used in hospitals for over 40 years, it is also now available in the community in many countries (2). The EMCDDA has launched its first overview of Take-home naloxone (THN) programmes in Europe.
The new online resource describes how these programmes developed and became more common over the past decade (see timeline). Providing naloxone and training in emergency response to those likely to witness an overdose is set out as an overdose prevention measure in the EU Action Plan on Drugs 2017–2020 and THN programmes are now expanding. In 2019, 11 EU member states and Norway report running such programmes (see map and national fact sheets) or allowing access to the medicine without a prescription (3). Since 2016, pharmacists in a majority of US states have been able to give out naloxone on the basis of a standing order (and do not require a patient-specific prescription). Prescription-free distribution is now permitted in several other countries worldwide, including Australia, Canada, Italy, the UK and France.
Practical solutions have been found to allow non-medical personnel to receive and administer injectable naloxone and enable the distribution of the medication to the homes of potential bystanders. Some countries now make the emergency medication available without a prescription to, or have lifted prescription regulations for, specific establishments or those registered as formally trained. The resource summarises the different products used in THN programmes, including naloxone nasal spray, authorised in 2017 by the European Commission for marketing in all EU countries.
Drug overdose deaths in Europe — frequently asked questions
Where have drug-related deaths increased most over the last 10 years? Are women and men affected equally? What are the current concerns in Europe? These are some of the questions answered in new Frequently asked questions (FAQs): drug overdose deaths in Europe published on the EMCDDA website. These present the overdose situation and trends as well as a range of maps and graphics. ‘Focus’ sections highlight overdose trends in Scotland — currently the country with the highest overdose mortality rate per capita in Europe — and illicitly manufactured fentanyl and its derivatives, involved in large numbers of deaths in some countries, including Sweden (which saw a peak in 2017) and Estonia.
In Scotland, a country with a high prevalence of high-risk drug use, a record 1 187 drug-related deaths were reported in 2018 (up 27% from 2017). Scotland’s drug-death rate among adults (15–64 years) is higher than those reported for all the EU countries. Most cases in Scotland are associated with opioids (9 in 10) and benzodiazepines (7 in 10), but almost all (85%) involve more than one drug. Recent increases are primarily seen in 35–44 and 45–54 year-olds. Other northern European countries (e.g. Estonia, Sweden, Norway) also have high overdose mortality rates (in some countries, there may be under-reporting).
The EMCDDA monitors closely alerts on harms related to fentanyl and its derivatives due to the very high toxicity of these substances and their potential to result in large clusters of incidents and deaths. In 2017, following reports that fentanyl or carfentanil introduced into the heroin supply in the north of England had caused a number of deaths, public health authorities issued warnings on the harms related to these heroin mixtures and advised on naloxone dosing regimes in the event of an overdose.
EMCDDA Director Alexis Goosdeel said: "Overdose deaths are preventable. We know from research that many of those who die have been struggling and living on the margins of society for years. We know that those who overdose once are at a very high risk of overdosing again. And we know that effective preventive and response measures exist that would allow us to avoid many deaths. Bystanders must also be empowered to save lives and prevent irreversible organ damage with effective medication."
Through its Strategy 2025, the EMCDDA is committed to contributing to a healthier Europe. While opioids are involved in the vast majority of overdose fatalities, other substances (e.g. cocaine, benzodiazepines, synthetic cannabinoids) also contribute to the overdose burden and should not be neglected. The resources released today contribute to a better understanding of drug overdoses and responses to them in Europe to support sound policymaking in this area.
Spanish Police seize first ever narco-submarine made in Europe
The Spanish National Police (Policía Nacional), in close co-operation with Europol and law enforcement from five other countries, have seized in the city of Málaga the first ever half-submersible vessel being built on European territory. Similar vessels captured in the past have always been of Latin American manufacture.
The seizure was made in the framework of Operation FERRO, a high-level law enforcement operation against an organized crime group involved in large-scale drugs trafficking.
Over 300 police officers carried out this operation in Spain, supported by the National Police of Colombia (Policía Nacional de Colombia), the Dutch National Police (Politie), the Portuguese Judicial Police (Polícia Judiciária), the UK National Crime Agency and the U.S. Customs and Border Protection, with international activity coordinated by Europol.
Results of Operation FERRO
- 47 house searches carried out in the Spanish cities of Tarragona (6), Barcelona (11), Gerona (3), Málaga (11), Castellón (4), Valencia (2), Murcia (7), Cádiz (1), Granada (1) and Badajoz (1);
- 52 individuals arrested;
- 2 boats seized: one semi-submersible vessel in Málaga and one speedboat worth over €300 000 in the province of Murcia;
- Over 3 tonnes of cocaine seized, alongside 700 kilos of hashish and over €100 000 in cash.
Operation FERRO was carried out in several phases
Phase one: Investigators identified an organised crime group, composed of Spanish, Colombian and Dominican nationals, involved in large-scale trafficking of cocaine, hashish and marijuana. The criminals were operating from Spain, specifically Cataluña. Between April to December 2020, a number of important cocaine seizures linked to this criminal group were made in Colombia. A total of 2 900 kilos of cocaine were seized.
Phase two: In November 2020, police officers in Spain arrested the leader of this criminal network in Tarragona, alongside 13 of his accomplices.
Phase three: In February of this year, another branch of this organised crime group was targeted. Four individuals were arrested in Tarragona and a shipment of 583 kilos of hashish on its way to France and Italy seized. House searches were also carried out in Málaga, on the occasion of which the half-submersible vessel was found in a warehouse. The boat – the first ever of its kind seized on European soil, was still in construction when it was found. The craft was 9 meters long and could have been able to transport up to 2 tonnes of drugs.
Phase four: One of the main targets was arrested in February at the El Prat airport in Barcelona as he was trying to flee to the Netherlands. As a result of this arrest, a warehouse was searched Barcelona which led to the seizure of 300 kilos of cocaine.
Phase five: A clandestine drug laboratory was discovered in Barcelona next to an indoor cannabis plantation with over 1 150 plants. A 15-meter long speedboat belonging to this criminal network and loaded with 7 000 litres of gasoline was also seized in the region of Murcia.
Phase six: At the end of February, the remaining members of the criminal network were arrested. Some 6 000 litres of drug precursors were also seized, destined for a clandestine laboratory in Murcia.
Europol’s EU Drugs Unit co-ordinated the intense international activity from the onset of this Investigation. Its team of specialists facilitated the exchange of information between the different countries involved and analysed the operational data to identify the main targets.
Fight against drugs: Commission initiates ban on two new harmful psychoactive substances
The Commission is proposing to ban two new psychoactive substances across the European Union: MDMB-4en-PINACA and 4F-MDMB-BICA. The two substances are synthetic cannabinoids showing life-threatening toxicity. They have been available in the EU since at least 2017 and March 2020 respectively. Both substances are being sold online both in small and wholesale amounts, mainly as a finished product ready for consumption, for instance in smoking mixtures, e-liquids or impregnated on paper. 21 deaths associated with 4F-MDMB-BICA were reported in one Member State between May and August 2020. The decision to ban these substances is based on a risk assessment conducted by the EU's drug agency, the European Monitoring Centre for Drugs and Drug Addiction. The Agency's initial and technical reports are available online. This is the second time the Commission initiates a ban under the revised EU rules on psychoactive substances, after having done so for isotonitazene in September 2020. The European Parliament and the Council will now have two months to scrutinise the delegated act before it enters into force. Once in force, EU Member States will have six months to enact the ban into national law.
Demystifying the drug menace: Insights from convicted drug sellers
Recent and ongoing issue pertaining to narcotic drug usage and drug selling in Indian Film Industry has caught the attention of entire South East Asia. One recent report written by Gan in American Journal of Preventive Medicine indicates that the cost of drug abuse is more than $740 billion annually, writes Indian Institute of Management-Rohtak Director Professor Dheeraj Sharma.
Substance abuse results in additional burden on healthcare costs, crimes, and lost productivity. In last decade, India has witnessed several instances of increased availability of drugs and increased number of arrest, trials, and conviction under the Indian Narcotic Drugs and Psychotropic Substances Act.
Given the paucity of studies related to illegal drugs and drugs selling in India, an effort was undertaken by the author with his research team that was involved in jail related projects from 2011 to 2016 in various states, to examine the issue of illegal drugs and drugs selling from the perspective of those either convicted of such offenses. Data for the survey were collected from convicted drug peddlers across three states in India – Punjab, Gujarat, and Delhi.
They were repeatedly assured that their responses for this survey shall remain anonymous and confidential. Data were collected by a team of research associates trained in the local language of the state. Brislin protocol using back translation was followed to translate the questionnaire. A total of 872 responses were collected across the three states in India. All these 872 were convicted under Indian Narcotic Drugs and Psychotropic Substances Act. The participation for the survey was voluntary.
The results indicated many counter-intuitive insights. First, 78.10% of drug peddlers reported that they used to consume drugs and selling of drugs was limited to those amongst their friends and family. Of these, around 56.54% of respondents became drug peddlers as a result of being a regular drug user. A majority of the respondents (86.70%) argued that they were trapped into drug trafficking by their drug suppliers with whom they had frequent interaction owing their consumption habits. The survey questionnaire also included questions on understanding the nature of the drug trade. 77.06% of the respondents asserted that drugs are not indigenous and most of the drugs are brought from other countries. 81.88% also reported that the drugs they used to sell were routed to India from other foreign countries.
The peddlers were also asked to give inputs relating to the country they think the drugs are infiltrated in India. Majority of the drug peddlers (83.94%) reported that the drugs are infiltrated in India from Pakistan. This was followed by Nepal (5.05%), and Afghanistan (4.24%). The detailed distribution of the countries is shown in the graph below. Similarly, we also asked them to report how drug suppliers operate and were asked to rank them based on the frequency of the method used.
For our analysis, we considered the mean ratings of all the respondents to rank the modus operandi of drug peddlers in India. The results show that cross border transactions are the most common form of operation. This is followed by tourists, Illegal, college students, and business people. The most favorable place to sell drugs according to the respondents were (ranked from best to worst): 1 = Pubs and Bars, 2 = Restaurants and hotels, 3 = Colleges and Universities, 4 = Drug rehab centers, 5 = schools.
The drug peddlers were also asked questions pertaining to the profitability of the drug trade. Almost the majority of the respondents reported that on an average a profit of more than 10 lakhs is reaped from selling drugs worth INR 1 lakh. It demonstrates that the drug trade has a profitability of more than 1000 percentage. Lastly, two questions pertaining to the society and drugs were also asked. More than 85% of the respondents (86.12%) believed that music that promotes drugs has increased the drug consumption among the youth.
They contended that consumption of drugs was accompanied by music that talked about drug use and absurdity of life. On a similar note, 79.36 percent believed that Bollywood movies that glorify drugs has resulted in an increased intention to consume drugs. Specifically, the respondents reported that almost all of their clients and they themselves were trying to imitate some actor/actress from Bollywood and that drugs would result in them feeling confident about themselves. On measurement scale for self-esteem, most respondents reported very low self-esteem (scale of 1 to 7 average score was 2.4).
The study does provide some insights from the perspective of those convicted in the illegal drug related cases. Consequently, it may be useful to counsel individual at early age, particularly in schools about the menace of drug abuse. Also, health facilities and provision of rehabilitation must be strengthened. Given that some Bollywood movies play a role in glorification of consumption and trade of illegal drugs, akin to the warning that is delayed for cigarette smoking in movies, there needs to be similar warning when characters are shown consuming drugs.
In other words, the viewers should warned of penalties that arise from consumption and trade of drugs. More specifically, random drug tests in institutions could be instituted. Also, given that majority of the drugs are infiltrated from neighboring countries, the border deterrence could be enhanced. Further, college students and pubs are the most common target consumer segment for drug peddlers. Hence, the administrators of academic institutions should take appropriate measures and test for drug abuse.
Also, pubs should be regulated. Finally, given that drugs are a lucrative trade, it is likely to see more prevalence in places where there is wealth. Hence, metropolitan cities need to develop special units or strengthen the existing special units for dealing with illegal drug cases.
The views expressed in this article are those of the author alone and do not reflect the opinions of EU Reporter.
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