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There is an international crisis of drug overdose. Over the last twenty years drug overdose deaths have increased significantly in many parts of the world. Each year a record number of deaths are reported, predominantly driven by the misuse of opioids, often in combination with other drugs including benzodiazepines, stimulants and alcohol.
In 2021, an estimated 296 million people – one in every 17 people aged 15-64 – had used a drug in the past 12 months, a 23 per cent increase from 2011.
Opioids account for two-thirds (69 per cent) of drug overdose deaths. The estimated number of people using opioids globally has doubled from 26-36 million people in 2010 to 61.3 million in 2020. There are currently multiple ongoing opioid overdose epidemics in the world; one is driven by the increased presence of the synthetic opioid fentanyl in the United States and Canada, while another in North Africa, West Africa, the Near and Middle East and South-West Asia is due to the non-medical use of the synthetic opioid tramadol.
Some of the new drugs available today – most notably synthetic opioids and amphetamine-type stimulants – are more dangerous than their counterparts were 20 or even 10 years ago. There were 1,235 new psychoactive substances reported in 142 countries and territories between 2013 and 2023. Opioids are the fastest-growing and most harmful group of new psychoactive substances – there were 88 different types recorded globally in 2021, an increase from just one in 2009.
Beyond a few countries and regions, most notably North America, the European Union, United Kingdom, Australia and New Zealand, reliable data on fatal and non-fatal overdose do not exist or are at best questionable. In many low-resource countries, deaths caused by overdose are not reliably recorded, instead being classified as heart attacks or respiratory failure. This occurs for many reasons; among the important contributors are widespread stigma about drug use, fear of police harassment, political pressure, and inconsistent or inadequate coronial systems. The illegal nature of drugs and profound stigma associated with drug use leaves an overwhelming reluctance in many parts of the world to acknowledge let alone report on drug related deaths.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
UNODC (2023). World Drug Report 2023
In 2023, provisional data from the Centres for Disease Control and Prevention yielded an estimate of 105,303 drug overdose deaths in the United States, an decrease of 2 per cent from 2022. Two-thirds of these deaths involved synthetic opioids, primarily fentanyl.
The United States reported an age-adjusted mortality rate of 32.4 per 100,000 population, for the 15–64-year age bracket for 2021.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
National Centre for Health Statistics (2023)
There were 7,525 apparent opioid toxicity deaths in Canada in 2022, representing a rate of 19.3 deaths per 100,000 population. This rate increased from January-June 2023 to a rate of 21.2 per 100,000 population.
A majority of deaths occurred in British Columbia, Alberta, and Ontario; high rates were also observed within other regions.
In 2022, fentanyl was responsible for 81 per cent of opioid-overdose deaths in Canada. Of the accidental stimulant toxicity deaths during the year, 62 percent involved cocaine, while 55 percent involved methamphetamines.
Source:
Government of Canada (2022). Health Infobase.
The World Health Organisation reports that use, abuse, dependence, and overdose attributed to tramadol have in recent years emerged as serious public health concerns in countries across several regions, but most notably in Africa and Middle Eastern countries.
It is projected that the number of people using drugs by 2030 will rise by 11 per cent globally, and by as much as 40 per cent in Africa.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
UNODC (2023) World Drug Report.
In 2021, there were 2,231 drug-induced deaths in Australia, a rate of 8.5 deaths per 100,000 people. This equates to 66,792 years of life lost to drug-induced deaths, with an average of 32 years of life lost per drug-induced death. The number of all drug-induced deaths surpassed the road toll in 2008 and has continued to rise in the years since. For Australians aged 30-39, drug-induced deaths were the second-leading cause of death behind suicide in 2020.
Source:
Penington Institute (2023). Australia’s Annual Overdose Report.
In 2014, the UNODC estimated that there were 49,000 drug-related deaths in China. However, Chinese media reports estimate the number of drug users at 14 million, suggesting the rate of drug-related mortality could be much higher than reported.
A 2022 document from the Office of China National Narcotics Control Commission dismisses the issue, claiming that the situation of drug abuse continues to improve and that drug abuse in China has been curbed.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
Sui-Lee Wee, ‘Drug abuse cost China $80 billion last year as it clocked 49,000 drug related deaths’, Insider June 24, 2015.
Office of China National Narcotics Control Commission (2020). Drug Situation in China (2022), p. 3.
In 2022, 4,907 deaths related to drug poisoning were registered in England and Wales (equivalent to a rate of 84.4 deaths per million people). This is similar to the rate recorded in 2021 (84.0 deaths per million people, 4,859 deaths). This rate has increased every year since 2012.
In 2022, the number of deaths due to cocaine in England and Wales increased for the 11th consecutive year. There were 857 deaths involving cocaine registered in 2022, which was 2 per cent higher than the previous year. By contrast, 46% of all drug-poisoning deaths in 2022 involved an opiate (2,261 deaths).
The Office for National Statistics reported that there were 241 deaths registered in England and Wales in 2022 where new psychoactive substances were mentioned on the death certificate.
Sources:
Deaths related to drug poisoning in England and Wales QMI.
Office of National Statistics (2021). Deaths related to drug poisoning in England and Wales: 2022 registrations, p. 2.
Stimulants are the second most reported category of drug consumed across Europe. In 2021, the number of deaths involving stimulants other than cocaine decreased to 477 (from 512 in 2020) in at least 19 countries. Germany (348 cases), turkey (184 cases), Finland (49 cases), Norway (47 cases), Austria (41 cases), Sweden (36) and Denmark (35) reported the highest numbers. Amphetamine,
Opioids were estimated to be preset in three quarters (74%) of fatal overdoses in the European Union, often in combination with other drugs, suggesting that poly drug toxicity remains an ongoing issue.
A European project monitoring cases involving medical treatment for non-fatal overdoses found 6.2 per cent of cases related to new psychoactive substances in 2014–2017. While deaths related directly to the use of new psychoactive substances do occur, they were rare in the countries that were able to provide relevant data.
Deaths involving synthetic cannabinoids declined in two of the three reported countries: 16 in Hungary in 2021 (24 in 2020) and 46 in Turkey (49 in 2020). In 2021, seven counties reported 26 deaths with synthetic cathinones, with highest numbers in Austria (7); Hungary (7); Finland (6).
Sources:
Penington Institute (2022). Global Overdose Snapshot.
EMCDDA (2022). European Drug Report 2023, p. 39.
1,051 people lost their lives to a drug-related death in Scotland in 2021, a decrease of 21% (279 deaths) from 2021 and the lowest number since 2017. The rate of drug-related deaths in was 27.1 deaths per 100,00 people which almost three times (2.7 times) higher than the rest of the United Kingdom.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
National Records of Scotland (2022). Drug Related Deaths in Scotland 2022, p. 3.
In 2020, there were 345 drug related deaths in New Zealand, an increase of 12% compared to 2019. Cases are considered drug-related where the death was due to external causes, and where drugs made a contribution to death. The national rate of drug-related deaths was 7.2 deaths per 100,000 population. In 2020, 83.3 per cent of opioid-related deaths involved the opioid as a primary contributor to death. Poly-substance use was recorded in most cases in the five years from 2017-2021. Combinations of more than one depressant was a characteristic of 281 deaths in this period.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
NCIS Fact Sheet (2023) Drug-related deaths in New Zealand in 2020.
New Zealand Drug Foundation (2022) Report: Fatal overdose in Aotearoa 2017-2021.
Northern Ireland recorded 154 drug-related deaths and 127 drug misuse deaths in 2022. There was a general downward trend in both registered deaths (213 in 2021) and drug misuse deaths (175 in 2021). However, the three-year average for drug-related and drug misuse deaths has been steadily increasing since 2012. In 2020-2022 the rate of drug-related deaths was 10.5 per 100,000 population and 8.3 deaths per 100,000 population for drug misuse deaths
Sources:
Northern Ireland Statistics and Research Agency (2024). Drug-related and drug-misuse deaths in Northern Ireland, 2022, p. 2.
In 2019, there were 57 drug-induced deaths in Serbia, equating to 8.21 deaths per million people. In 2018 there were 47 drug-induced deaths. Drug Policy Network South-East Europe emphasised controversies and questions regarding the reliability of the data.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
Republic of Serbia, Office for Combating Drugs, Presentation of the analysis, Drug-induced deaths in Serbia 2008-2019, March 2021, Presentation to Drug Policy Network South-East Europe.
South and Central America and the Caribbean have the highest proportion of people worldwide who are in drug treatment due to the use of cocaine, which is often consumed in smokable forms that are cheap and frequently toxic.
In Mexico, amphetamines have become the most frequently detected drug in the deceased. The dominance of methamphetamine use, as compared with the use of other amphetamines, is illustrated by the 29,680 methamphetamine users in drug treatment in 2020, compared with only 727 amphetamine users in treatment. This represents a 218 per cent increase in the number of clients in drug treatment with amphetamine type stimulant as their primary drug compared to 2013.
There are also reports of new psychoactive substances – sometimes containing fentanyl – circulating in party and street markets in Colombia, Argentina, Uruguay, and Chile.
However, whilst drug use is seen as a significant and growing problem in South America, there is little reliable information available to determine the extent of harms caused from drug use. In Colombia, for instance, different government agencies have reported widely varying and contradictory numbers of fatal opioid overdoses.
Sources:
Penington Institute (2022). Global Overdose Snapshot.
Pacurucu-Castillo, S.F, Ordóñez-Mancheno J. M et al. (2019). ‘World Opioid and Substance Use Epidemic: A Latin American Perspective’. Psych Res Clin Pract, 1, pp. 2–38.
65 ATS Corporation (2021). ‘How many deaths are there from opioid overdose in Colombia? We do not know’. ATS Corporation.
In 2021, there were 565 deaths related to substance use and poisoning. This was a 4.1% decrease from 2020 (589 deaths), however reported statistics may be inaccurate due to current armed conflict in Ukraine which may result in changes to drug markets. 422 deaths were classified as accidental overdose. Opioid-related overdoses totalled 307 deaths.
Sources:
EMCDDA (2023), Report on the Drug and Alcohol Situation in Ukraine for 2023 (based on 2012 data), Kyiv 2023, p. 17.
UNODC (2022) Conflict in Ukraine: Key evidence on drug demand and supply.
