Methods and definitions

1. EMCDDA definition

‘Drug-related death’ is the term used by the EMCDDA to refer to deaths happening shortly after consumption of one or more psychoactive drugs, and directly related to this consumption. Often these deaths are referred as ‘overdoses’, although equivalent concepts are also ‘deaths directly related to drug use’, ‘poisonings’ or ‘drug-induced deaths’.

Most national statistics refer to these deaths, which are usually recorded through general mortality registries or special registries (forensic or police).

The EMCDDA has developed a common definition, in agreement with national experts (see below summary definition and also the DRD-Standard protocol) focusing on those deaths directly related to consumption of illegal substances (although alcohol or psychoactive medicines are also found frequently in the toxicological analysis).

At present, national statistics are improving in most countries and their definitions are becoming the same, or relatively similar, to the common EMCDDA definition. Some countries still include cases due to psychoactive medicines or non-overdose deaths, generally as a limited proportion (Drug-related deaths: ‚National definitions‘ specifies in detail the definition of drug-related death used in each Member State).

In addition, there are still differences between countries in procedures of recording cases, and in the frequency of post-mortem investigation (including autopsy rates). In some countries information exchange between general mortality registries and special registries (forensic or police) is insufficient or lacking, which compromise the quality of information.

Direct comparisons between countries in the numbers or rates of drug-related deaths should be made with caution; but if methods are maintained consistently within a country, the trends observed can give valuable insight when interpreted together with other drug indicators.

In addition to deaths directly related to the use of drugs, also deaths indirectly related to drug use (e.g. AIDS, accidents, suicides, violence) should also be taken into account from a public health perspective, although their estimation requires different methodologies and data sources. The EMCDDA Report CT.00.RTX.22 presents an example of methodology to estimate the ‘total burden of mortality’ related to drug use that includes both deaths directly and indirectly related to drugs (Annex 1, pages 47 to 53).

The EMCDDA definition of drug-related deaths

The EMCDDA definition of drug-related death in the Key Indicator ‘Drug-related deaths and mortality among drug users’ refers to those deaths that are caused directly by the consumption of drugs of abuse. These deaths occur generally shortly after the consumption of the substance(s).

The cases are selected as follows:

  1. The preferred method to estimate the number of deaths is to extract cases from existing general mortality registries according to the following criteria:

based on the WHO International Classification of Diseases, 9th edition -ICD-9-

Cases will be counted when their underlying cause of death was drugs psychoses, drug dependence, nondependent drug abuse, accidental poisoning, suicide and self-inflicted poisoning, and poisoning with undetermined intent.

Cases will be included when the death was due to a standard list of specific drugs: opiates, cocaine, amphetamines and derivates, cannabis, and hallucinogens.

The precise ICD-9 codes to be selected are the following:

Category of drug-related death

Selected ICD-9 code(s)

Drug psychoses

292

Drug dependence

304.0, 304.2-9

Nondependent drug abuse

305.2-3, 305.5-7, 305.9

Accidental drug poisoning

E850.0, E850.8 (1), E854.1-2, E855.2, and E858.8 (1)

Suicide and self-inflicted drug poisoning

E950.0 (1) , E950.4 (1)

Drug poisoning undetermined intent

E980.0 (1), E980.4 (1)

(1) In combination with N-codes (N965.0, and/or N968.5, and/or N969.6, and/or N969.7

This selection was agreed by the EMCDDA expert group on drug-related deaths. It was called ‘Selection B’ for general mortality registries based on ICD-9.

based on the WHO International Classification of Diseases, 10th edition -ICD-10-

Case will be counted when their underlying cause of death was mental and behavioural disorders due to psychoactive substance use (see list of substances below) or poisoning accidental, intentional or undetermined intent (see list of substances below)

  • Harmful use, dependence, and other mental and behavioural disorders due to:

    • opioids (F11)

    • cannabinoids (F12)

    • cocaine (F14)

    • other stimulants (F15)

    • hallucinogens (F16)

    • multiple drug use (F19)

  • Accidental poisoning (X41, X42), intentional poisoning (X61, X62), or poisoning by undetermined intent (Y11, Y12) by:

    • opium (T40.0)

    • heroin (T40.1)

    • other opioids (T40.2)

    • methadone (T40.3)

    • other synthetic narcotics (T40.4)

    • cocaine (T40.5)

    • other and unspecified narcotics (T40.6)

    • cannabis (T40.7)

    • lysergide (T40.8)

    • other and unspecified psychodysleptics (T40.9)

    • psychostimulants (T43.6)

The T-codes are to be selected in combination with the respective X-codes and Y-codes.

Underlying cause of death

Selected ICD-10 code(s)

Disorders

F11-F12, F14-F16, and F19

Accidental poisoning

X42 (1), X41 (2)

Intentional poisoning

X62 (1), X61 (2)

Poisoning undetermined intent

Y12 (1), Y11 (2)

(1) in combination with the T-codes: T40.0-9

(2) in combination with T code: T43.6.

This selection was agreed by the EMCDDA expert group on drug-related deaths. It was called ‘Selection B’ for general mortality registries based on ICD-10.

  1. An alternative method is to estimate the number of deaths by extracting cases from existing special registers (forensic or police registries). The method based on the special registries will be applied in countries where the preferred method cannot be implemented, but also will be used whenever possible as a backup estimate for the general mortality registries.

Cases will be counted when the death was due to poisoning by accident, suicide, homicide, or undetermined intent.

Cases will be included when the death was due to opiates, amphetamines, cocaine (or crack), cannabis, hallucinogens, solvents, or synthetic designer drugs like amphetamine derivates.

The precise groups of deaths are the following:

Category of drug-related death

Selected groups

Poisoning by accident, suicide, homicide, or undetermined intent

Opiates only (excluding methadone only)

Methadone only

Poly-substances including opiates

Poly-substances excluding opiates

Unspecified/unknown

– ‘poly-substances’ should include at least one of the above mentioned substances

– ‘unspecified/unknown’ will be included when it is assumed to include one of the above mentioned substances

This selection was agreed by the EMCDDA group of experts. It was called ‘Selection D’ for special registries

For more information on EMCDDA work on drug-related deaths see:

http://www.emcdda.eu.int/?nnodeid=1419.

For the EMCDDA protocol ‘DRD-Standard Protocol’ see:

http://www.emcdda.eu.int/?nnodeid=1837.

2. Drug-related deaths: ‘National definitions’

Definitions of ‘acute drug-related death’ in EU Member States, as used to report cases for the EMCDDA annual report

(It is recommended that for reporting to the EMCDDA, the national definitions are in line with the EMCDDA definition)

Austria

Case definition

EMCDDA standard definition for special registries (‘Selection D’)

Technical information

‘Selection D’ is described in the protocol EMCDDA-DRD Standard, version 3.0 (for special registries)

Data collection procedure

Cases are reported by the police and hospitals to the Federal Ministry of Health and Women, which orders and checks the results of forensic examinations.

Reference

Suchtgiftbezogene Todesfälle-Statistik; Federal Ministry of Health and Women

Remarks

Belgium

Case Definition

EMCDDA definition for general mortality registries(‘Selection B’ for ICD-9)

Technical information

‘Selection B’ is described in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Cases are reported by health authorities of the French and Flemish Communities that collect death certificates filled by physicians. The National Institute of Statistics centralises the morbidity statistics of the two communities

Reference

National Institute of Statistics. General mortality registry: personal communication (ad-hoc data extraction for REITOX national focal point for the 2002 National Report).

Remarks

Since 1998, cases will be selected by ICD-10 codes

Denmark

Case definition

A death is included in the statistics, if the death is caused by poisoning and also non-overdose deaths, such as for example accidents and suicides. The definition includes deaths due to all forms of narcotic substances.

OR

A death is included in the statistics, if

(1) the dead is causes by poisoning (or)

(2) there is a strong causal relation between use of drugs and death

Technical information

If no report from autopsy is available, the case is decided on available information of the deceased and circumstances of death.

Data collection procedure

Cases are reported from forensic institutes to the National Commission of Police.

Reference

www.politi.dk

Remarks

Finland

Case definition

From 1988 through 1995 (ICD-9, Finnish adaptation), deaths due to identified drugs by:

  • Diseases (dependence, harmful use, substance induced brain syndrome);

  • accidental poisoning;

  • events of undetermined intent.

From 1996 onwards, EMCDDA definition for general mortality registries(‘Selection B’ for ICD-10)

Technical information

From 1988 through 1995 cases selected by ICD-9 (Finnish adaptation. See Finnish National Report 2003, Appendix 7)

From 1996 onwards, ‘Selection B’ for ICD10, which is described in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Collection and processing of causes of death statistics at Statistics Finland.

Reference

STAKES. General mortality registry. Personal communication (Ad-hoc data extraction for REITOX national focal point for the 2004 National Report)

Remarks

The Finnish adaptation of ICD-9 did not allow the implementation of ‘Selection B’ of DRD standard protocol. For these reason, Selection B is only available from 1996 onwards, where ICD-10 was implemented.

The breach of trends observed between 1995 and 1996 could be in part due to change from ICD-9 to ICD-10 and to change from national definition to Selection B

France

Case definition

  • Deaths due to overdose in the strictest sense of the term.

  • Deaths occurring directly and immediately after consumption of drugs.

Technical information

Data collection procedure

After investigations following suspicious death, which generally include an autopsy and a toxicological analysis, cases are reported by the police and the Gendarmerie to the Office Central pour la Répression du Traffic Illicite de Stupéfiants (OCRTIS) at the Ministry of the Interior.

Reference

Office central pour la répression du trafic illicite des stupéfiants (2004) Usage et trafic des produits stupéfiants en France en 2003, OCRTIS, Nanterre

Remarks

Deaths due to poisoning by psychoactive medicines are included but, in practice, case definition is an approximation to ‘Selection D’ (only 10 cases of difference in 2003)

Germany

Case definition

  • Deaths following intentional or unintentional overdose.

  • Deaths as a result of long-term abuse.

  • Deaths due to suicide resulting from despair about the circumstances of life or the effects of withdrawal symptoms.

  • Deaths due to fatal accidents suffered by people under the influence of drugs

Technical information

Data collection procedure

Cases are reported by local police units that are working jointly with the forensic physicians, to the National Police Department, the Federal Criminal Police Office (BKA) that records the information.

Reference

Bundeskriminalamt OA21 (2004). Bundeslagebild Rauschgift 2003. Wiesbaden: Bundekriminalamt

Remarks

  • From 1985 through 1990, the figures only refer to the former West Germany (the old Länder).

Since 1991, the figures refer to the reunited Germany, which includes the old and the new Länder.

Greece

Case definition

EMCDDA standard definition for special registries (‘Selection D’)

In national terms:

  • Deaths caused by overdose.

  • Deaths caused by the synergic activity of different drugs.

Technical information

‘Selection D’ is described in the protocol EMCDDA-DRD Standard, version 3.0 (for special registries)

Data collection procedure

Cases of sudden death are notified to the police who refer the cases to the forensic department for autopsy and toxicology, which notifies the police of the results. Cases are then reported by local police units to Section C of the Directory of Public Security at the Ministry of Public Order (Hellenic Police). Statistics are reported by the National Anti-Drug Co-ordinative Unit, National Anti-Drug Intelligence Unit, Joint Secretariat.

Reference

Hellenic Police, 2004. Reference for 2003 data: http://www.ydt.gr

Remarks

Ireland

Case definition

  • Deaths due to drug dependence.

  • Deaths due to poisoning by opiates and related narcotics.

Technical information

Cases selected by ICD-9 codes

– 304 (drug dependence)

– 965.0 (poisoning by opiates and related narcotics)

Data collection procedure

Cases are reported by regional registrars of births and deaths, who collect information from doctors, the police, and coroners, to the general mortality register at the Central Statistics Office (CSO).

Reference

Central Statistics Office, Vital Statistics Section

Remarks

The increase between 1995 and 1997 is (partly) due to an increased awareness of the need for more accurate information and reporting.

Italy

Case definition

EMCDDA standard definition for special registries (‘Selection D’)

In national terms:

Deaths directly attributed to drug misuse (acute intoxication, overdose) and reported by local and special police units to the Central Drugs Directorate.

Technical Information

‘Selection D’ is described in the protocol EMCDDA-DRD Standard, version 3.0 (for special registries

Data collection procedure

Cases are reported by local and special police units to the Central Drugs Directorate at the Ministry of the Interior.

Reference

Relazione Annuale 2003. Direzione Centrale per i Servizi Antidroga (DCSA), Ministero dell’Interno

Remarks

Luxembourg

Case definition

Deaths caused by acute/direct reaction to the use of illegally acquired high risk consume (HRC) drugs.

Technical information

Fatal (accidental, intentional or of undetermined intention) intoxication caused by

the use of at least one illicitly acquired drug or

other drug(s) in case the victim has been known as a persistent user of illicitly acquired drugs.

Death is due to the acute pharmacological and or toxicological effects(s) of the consumed substances(s)

Data collection procedure

All suspected deaths require a judicial enquiry, and after forensic evidence from autopsy, cases are reported by the local police to the special drug section (SDU) of the judicial police.

Reference

Origer, A.(in press). National report on the state of the drugs problem -RELIS 2003. NFP – CRP-Santé. Luxembourg

Remarks

Netherlands

Case definition

EMCDDA definition for general mortality registries(‘Selection B’)

From 1985 through 1995, based on ICD-9

Since 1996, based on ICD-10

Technical information

‘Selection B’ is described in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Cases are reported by municipal registrars, who collect information from physicians and coroners, to the causes of death statistics at Statistics Netherlands.

Reference

Causes of death statistics, Statistics Netherlands

Remarks

Only persons retrievable in the Dutch population register are included

Norway

Case definition

Death due to misuse of illegal drugs (Drug dependence or poisoning).

mental and behavioural disorders due to drug use

accidental or undetermined poisoning by drugs of abuse

Technical information

  • Up to 1996, cases were selected by ICD-8 and ICD-9 codes (304).

  • Since 1996, the ICD-10 codes used (underlying causes) are:

F11-F12, F14-16, F19,

X42 and Y12 in combination with T40.0-9

X41 and Y11 in combination with T43.6.

Data collection procedure

Registry of causes of death, from Statistics Norway. Data from Statistics Norway are manly based on autopsy reports from the National Institute of Forensic medicine.

Reference

Statistics Norway

Remarks

National definition is an approximation to ‘Selection B’ for ICD-10 but excluding ‘intentional poisoning’ (X61 and X62)

Portugal

Case definition

A person whose post-mortem toxicological analysis is positive for any illicit drug of abuse (whatever was the cause of death.

Technical information

  • The proportion of cases with positive toxicology and information on presumed cause of death suspected to be acute drug-related deaths were: 44 % (2003), 58 % (2002) and 73 % (2001)

  • The cases refer to Lisbon, Oporto and Coimbra regions

Data collection procedure

Cases are reported to the delegations at the three forensic institutes of the Ministry of Justice.

Reference 2003

Relatório Anual do IDT- 2003. Lisboa

Remarks

Due to under-reporting in previous annual reports, more cases are reported in the annual report since 1995.

Spain

Case definition

Deaths due to acute reaction following non-medical use of psychoactive substances

Technical information

  • From 1985 through 1995: Deaths due to acute reactions following opiate or cocaine consumption.

  • Since 1996: Deaths due to acute reactions following consumption of any psychoactive drug.

  • The cases refer to five large cities Barcelona, Bilbao, Madrid, Valencia, and Zaragoza.

Data collection procedure

Cases are reported by medical pathologists for the Mortality Indicator at the Delegación del Gobierno para el Plan Nacional Sobre Drogas (DGPNSD).

Reference 2003

1990 to 1995 State Information System on Drug Abuse (SEIT) Reports.

1996 to 2002 Unpublished reports

Remarks

Deaths due to poisoning by psychoactive medicines are included, but in practice, case definition is an approximation to ‘Selection D’ (only 1 case of difference in 2002)

A small breach of trend took place in 1996 due to a change from reporting only on opiate and cocaine cases to all psychoactive substances.

Sweden

Case definition

EMCDDA definition for general mortality registries(‘Selection B’ for ICD-10)

Cases codified with T40.4 are excluded (in Sweden are mainly due to dextropropoxifen poisonings)

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Cases are reported by physicians to the cause of death register at Statistics Sweden and are reported and published by the Epidemiological Centre of the National Board of Health and Welfare (NBHW).

Reference

National Death Cause Registry (Run by the Epidemiological Centre, at the NBHW)

Remarks

In 2003 ‘national case definition’ was adapted to the EMCDDA definition (Selection B) with the exception described

United Kingdom

Case definition

  • Deaths due to drug dependence.

  • Deaths due to nondependent abuse.

  • Deaths due to accidental, suicidal, or undetermined poisonings.

Technical information

  • England and Wales, Northern Ireland and Scotland (‘ONS standard definition’)

Based on ICD-9 Classification:

292 (Drug psychoses),

304 (Drug dependence),

305.2 – 9 (Non-dependent abuse of drugs),

E850 – E858 (Accidental poisoning by solid or liquid substances – drugs, medicaments, and biologicals),

E950.0 – 5 (Suicide and self-inflicted poisoning by solid or liquid substances – drugs and medicaments),

E980.0 – 5 (Poisoning by solid or liquid substances, undetermined whether accidentally or purposely inflicted – drugs and medicaments),

E962.0 (Assault by poisoning – drugs and medicaments).

Scotland (From 2000) and England & Wales and N Ireland (From 2001) (‘ONS standard definition’

Based on ICD-10 Classification:

F11-F16, F18, F19,

X40-X44 (accidental poisoning),

X60-X64 (intentional self poisoning),

Y85 (assault by drugs, medicaments and biological substances),

Y10-Y14 (poisoning undetermined intent).

Data collection procedure

Cases from England and Wales are reported to the Office for National Statistics (ONS), cases for Northern Ireland are reported to the General Register Office (Northern Ireland) and cases for Scotland are reported to the General Register Office (Scotland).

Reference 2003

See Health Statistics Quarterly, Nos 5, 7, 9, 11, 13, 17 & 21, ONS 2000, 2001, 2002, 2003 & 2004

Remarks

Drug Strategy Definition

Recently it has been developed an additional national definition that in this reports is referred as ‘UK Drug Strategy Definition’.

The UK Drug Strategy Definition is a more restrictive extract from the ONS description that focuses on drugs controlled under the Misuse of Drugs Act of 1971. Drugs controlled by the Misuse of Drugs Act include class A, B and C drugs.

A description of this definition is given in the Annexed Box 1) ‘UK Drug Strategy Definition’.

This definition produces estimates approximated to the EMCDDA Standard ‘Selection B’.

Figures reported on the basis of this definition are presented separately in Table DRD-2 part (ii).

National Programme on Substance Abuse Deaths (np-SAD)

In addition, in the UK there is a special registry on drug-related deaths within the National Programme on Substance Abuse Deaths (np-SAD). This registry is based on data submitted voluntarily by coroners.

This registry can produce estimates for the EMCDDA Standard ‘Selection D’.

A description of this special registry is given in the Annexed Box (2) ‘UK np-SAD’.

Notes:

1) ICD-9, ICD-10 = International Classification of Diseases, edition 9, edition 10, established by the World Health Organisation (WHO).

2) In some countries, traditional definitions of ‘drug-related deaths’ used at national level are different from those presented here and may also include cases related to medicines, or some other deaths indirectly related to drug use (e.g. diseases, accidents).

(1) Annexed Box ‘UK Drug Strategy Definition’

UK Drug Strategy definition

Extract from ONS description (based on ICD-9)

A) Deaths where the underlying cause of death has been coded to the following categories:

Drug psychoses (292);

Drug dependence (304.0 -.5 and 304.7-.9);

Nondependent abuse (305.2 -.9)

B) Deaths coded to the following categories and where a drug controlled under the Misuse of Drugs Act 1971 was mentioned on the death record:

– Accidental poisoning by drugs, medicaments and biologicals (E850-E858);

– Undetermined whether accidentally or purposely inflicted (E980.0-E980.5);

– Assault by poisoning – drugs and medicaments (E962.0)

– Dependence on other drugs (304.6).

Notes:

1. Deaths coded to opiate abuse which resulted from the injection of contaminated heroin have been included in the indicator. This is opposite to the approach taken in Scotland, where these deaths have been excluded for 2000.

2. Specific rules were adopted for dealing with compound analgesics which contain relatively small quantities of drugs listed under the Misuse of Drugs Act, the major ones being dextropropoxyphene, dihydrocodeine and codeine. Where these drugs are present on a death record, they have been ignored if they are part of a compound analgesic (such as co-proxamol, co-dydramol or co-codamol) or cold remedy. Dextropropoxyphene has been ignored on all occasions. However, codeine or dihydrocodeine mentioned alone were included in the indicator.

3. Drugs controlled under the Misuse of Drugs Act 1971 include class A, B and C drugs.

Extract from ONS description (based on ICD-10)

a) deaths where the underlying cause of death was

F11; F12; F13; F14; F15; F16; and F19.

b) deaths coded to the following categories and where a drug listed under the Misuse of Drugs Act (1971) was known to be present in the body at the time of death:

accidental poisoning (X40 – X44);

intentional self-poisoning by drugs, medicaments and biological substances (X60 – X64);

assault by drugs, medicaments and biological substances (X85); and

event of undetermined intent, poisoning (Y10 – Y14)

Notes

Deaths excluded:

deaths coded to F10 (alcohol), F17 (tobacco) and F18 (volatile substances);

deaths coded to drug abuse which were caused by secondary infections and related complications

deaths from AIDS where the risk factor was believed to be the sharing of needles;

deaths from road traffic and other accidents which occurred under the influence of drugs; and

deaths where a drug listed under the Misuse of Drugs Act was present because it was part of a compound analgesic or cold remedy: examples are: Co-proxamol Co-dydramol and co-codamol. Dextropropoxyphene has been ignored on all occasions. However, deaths involving codeine or dihydrocodeine alone have been included.

(2) Annexed Box ‘National Programme Substance Abuse Deaths’

Special registry np-SAD

The National Programme on Substance Abuse Deaths (np-SAD), based in the Department of Addictive Behaviour and Psychological Medicine at St George’s Hospital Medical School in London, collects data from inquests held on drug-related deaths submitted voluntarily by coroners.

The electronic database’s current coverage is about four-fifths of all coroners’ jurisdictions in England and Wales. Recently coverage was extended to Scotland and Northern Ireland.

A ‚case‘ is defined as a drug-related death where any of the following criteria are met at an inquest or fatal accident inquiry:

one or more psychoactive substances directly implicated in death;

history of dependence or abuse of psychoactive drugs; or

presence of controlled drugs at post-mortem.

New Member States and candidate countries

Note:

Reported separately in this edition of the statistical bulletin to highlight the developments of these countries.

Czech Republic

Case definition

Deaths due to poisoning caused by psychoactive substances (drugs of abuse and psychoactive medicines).

Technical information

Selection D of EMCDDA standard definition (drugs of abuse) PLUS deaths due to poisonings by psychoactive medicines

Data collection procedure.

Special semiautomated electronic registry run by national focal point and Society of Forensic Medicine and Toxicology.

Reference

Special mortality register – drug-related deaths in 2003. Prague: National Monitoring Centre for Drugs and Drug Addiction. Unpublished

Remarks

In 2003, according to the national definition, 167 cases out of a total of 222 were due to psychoactive medicines

Since the practice in Czech Republic does not allow to include into the GMR any examination newer than 3 days after the death, this registry is not observed for the purposes of drug epidemiology as appropriate.

Estonia

Case Definition

Cases according to the EMCDDA definition for general mortality registries(‘Selection B’ for ICD-9 classification):

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks

Cyprus

Case definition

The EMCDDA standard definition for special registries (‘Selection D’) will be used.

Technical information

Data collection procedure

Reference 2003

Remarks

Not information provided yet.

Latvia

Case definition

Cases according to the EMCDDA definition for general mortality registries(‘Selection B’ for ICD-9 classification)

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Reference

Ad hoc data extraction from Forensic Medical Institute 2003

Remarks

Lithuania

Case definition

Cases according to the EMCDDA definition for general mortality registries(‘Selection B’ for ICD-9 classification):

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks

Hungary

Case definition

Cases according to the EMCDDA definition for general mortality registries(‘Selection B’ for ICD-9 classification

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for General Mortality Registries)

Data collection procedure

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks

Malta

Case definition

Cases according to the EMCDDA definition for general mortality registries(‘Selection B’ for ICD-10 classification)

Technical information

‘Selection B’ is described in detail in the protocol EMCDDA-DRD Standard, version 3.0 (for general mortality registries)

Data collection procedure

Reference

Dept of Health Information. Malta National Mortality Registry

Remarks

Poland

Case definition

Technical information

Data collection procedure

Reference

Remarks

Slovenia

Case definition

Deaths due to drug abuse; that means deaths happening during the time drugs is affecting the organism (accidental poisonings, intentional poisonings, poisonings of undetermined intent)

Technical Information

National definition takes into account the ICD-10 codes of the EMCDDA definition, but without exact implementation of Selection B or selection D

Data collection procedure

From 2002 onwards cases were obtained by linkage of four different databases: i) general mortality registry, ii) police database, iii) first treatment demand database and iv) toxicology department at the Institute of forensic medicine

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks

Information of the GMR is completed with forensic and toxicology data, with police data and with first treatment demand data

Slovakia

Case definition

Technical information

Data collection procedure

Reference 2003

Remarks

Bulgaria

Case definition

Cases of death which underlying cause of death is drug psychosis, drug addiction, drug abuse, accidental poisoning

Technical information

The cases are selected according to the ICD-9 codes

292, drug psychosis

304, drug dependence

305, drug abuse

E854, accidental poisoning with other psychrotropic substances

E939, psychotropic substances

Data collection procedure

Death certificates filled in by family doctors do not specify the substance even if they have reasonable doubts. Deaths occurring in hospitals are followed by toxicological examination.

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks

– ICD-10 will be implemented in 2003

– There are difference in number of cases obtained from the general mortality registry (15) and from police reports (56) in 2003

Romania

Case definition

Drug-related deaths refers to those deaths that are caused directly by the consumption of drugs of abuse

Technical information

Cases extracted according to codes X62 in combination to T40.1

Data collection procedure

Reference

Ad hoc data extraction by national focal point from general mortality registry for the 2004 Reitox National Report

Remarks