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Overdose is a global health issue – let’s treat it like one
Drug overdose is an international crisis. Over the last 20 years drug overdose deaths have increased significantly in many parts of the world, predominantly driven by the effects of opioids, often in combination with other drugs including benzodiazepines, stimulants and alcohol. The proliferation of dangerous novel substances has heightened the public health risk faced by countries around the globe.
In 2022, an estimated 292 million people – 5.6 per cent of the population aged 15-64 – had used a drug in the past 12 months, a 20 per cent increase from 2012. While cannabis remains the most used drug worldwide, opioids account for over two-thirds (69 per cent) of drug overdose deaths. According to the United Nations Office on Drugs and Crime (UNODC), the estimated number of people using opioids globally has doubled from 26-36 million people in 2010 to 61.3 million in 2020.
The opioid overdose epidemic takes different forms in different areas of the world. The most well publicized crisis is driven by the dominance of the synthetic opioid fentanyl in the opioid supply in the United States and Canada. In North Africa, West Africa, the Near and Middle East and South-West Asia, opioid harms are driven by use of the synthetic opioid tramadol. Between January 2016 and June 2024, Canada reported 49,105 overdose deaths. Notably, while US overdose rates remain very high by historical standards, unprecedented declines in overdose rates have recently been reported: provisional data for the period from October 2023 to September 2024 indicate 87,000 deaths, the fewest deaths in any 12-month period since June 2020.
Some widely available drugs – most notably synthetic opioids and certain types of amphetamine-type stimulants – are more dangerous than their counterparts were 20 or even 10 years ago. The UNODC Early Warning Advisory on New Psychoactive Substances reported 1,342 new psychoactive substances in 151 countries and territories between 2013 and 2025. Opioids are the fastest growing and most harmful group of new psychoactive substances: 88 different types were recorded globally in 2021, an increase from just one in 2009.
While fentanyl and its analogues continue to cause thousands of fatalities, detections of nitazenes, a class of synthetic opioids that can be even more powerful, have increased in the last five years. Since 2021, Europe has reported a higher number of new unique nitazenes than fentanyl analogues.
Beyond a few regions and countries, most notably North America, the European Union, United Kingdom, Australia and New Zealand, data on fatal and non-fatal overdose do not exist or may be unreliable. In many low-resource countries, deaths caused by overdose may be classified as heart attacks or respiratory failure for reasons including 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 (2024). World Drug Report 2024.
Drug trends are always changing – our response must change too
Comprehensive and reliable data on drug use and drug overdose deaths in Africa is extremely limited. The World Health Organisation reports that use, abuse, dependence, and overdose attributed to the synthetic opioid tramadol have emerged as serious public health concerns in countries across several regions, especially in Africa and Middle Eastern countries. Non-prescribed use of tramadol is prevalent in North, West, and Central Africa, where it is often illicitly manufactured and more potent than prescribed versions, thereby raising health risks. Between 2012 and 2017 South Africa reported a 3.9 per cent increase on admissions for opioid use disorder treatment. In 2023, the UNODC projected that the number of people using drugs by 2030 will rise by 11 per cent globally, but by as much as 40 per cent in Africa.
Sources:
Nadine Harker, Warren Covelé Lucas et al. (2020). ‘Is South Africa being spared the global opioid crisis? A review of trends in drug treatment demand for heroin, nyaope and codeine-related medicine in South Africa (2012-2017)’. International Journal of Drug Policy, 83, pp. 2-8.
UNODC (2023). People first: stop stigma and discrimination, strengthen prevention.
UNODC (2024). World Drug Report 2024.
In 2022, there were 2,356 drug-induced deaths in Australia, representing 69,815 years of life lost and an average of 31 years of life lost per drug-induced death. Since 2002, the population of Australia has increased by 20.4 per cent while the number of unintentional drug-induced deaths has increased by 108 per cent. For Australian men aged 30-39, drug-induced deaths were the second-leading cause of death in 2022; for women aged 30-39, drugs were third, behind only suicide and breast cancer. Among Indigenous Australians, in 2022 the rate of unintentional drug-induced deaths was 23.3 per 100,000 population, compared with 6.1 per 100,000 population for non-Indigenous people. Nationwide, opioids continue to be the most common drug type detected in unintentional drug-induced deaths.
Source:
Penington Institute (2024). Australia’s Annual Overdose Report.
Between January 2016 and June 2024 Canada reported a total of 49,105 apparent opioid toxicity deaths. In the first six months of 2024, there were 3,787 apparent opioid toxicity deaths in Canada, and 1,599 apparent stimulant toxicity deaths reported. Preliminary full year data for 2024 show that the number of drug-induced deaths in British Columbia were down by 13 per cent compared to 2023.
Most deaths (84 per cent) occurred in British Columbia, Alberta, and Ontario. Men accounted for 72 per cent of opioid-overdose deaths reported in 2024.
In 2024, fentanyl was responsible for 75 per cent of opioid-overdose deaths in Canada, which represents an increase of 32 per cent since 2016. Of all opioid-overdose deaths, 65 per cent also involved a stimulant.
Source:
Government of Canada (2024). Health Infobase.
John Snowdon. (2022). ‘Drug overdose death rates in different countries: Who should be alarmed?’. Australasian Psychiatry, 30, pp. 26-30.
The Canadian Press and Times Colonist, ‘Drug deaths in B.C. dropped 13 per cent in 2024, hitting four-year low’, February 4, 2025.
The Chinese government reported at least 49,000 drug-related deaths in 2014, while estimating the number of people who use drugs at 14 million. A 2023 document from the Office of China National Narcotics Control Commission claimed a 20 per cent decrease in people registered in mandatory drug treatment programs compared to 2022. The report identified methamphetamine as the most common drug used by this group (455,000 people), followed by heroin (305,000 people) and ketamine (30,000 people). The Commission’s report highlights the emergence of new types of drugs and substitutes amid post-COVID cost increases for heroin and methamphetamine.
Sources:
Office of China National Narcotics Control Commission (2024). China Drug Situation Report 2023.
Sui-Lee Wee, ‘Drug abuse cost China $80 billion last year as it clocked 49,000 drug related deaths’, Insider June 24, 2015.
In 2023, 5,448 deaths related to drug poisoning were registered in England and Wales (equivalent to a rate of 9.3 deaths per 100,000 people). This is higher than the rate recorded in 2022 (4,907 deaths, or 8.4 deaths per 100,000 people). This rate has increased every year since 2012, and 2023 was the year with the highest number of overdose deaths recorded since record-keeping started in 1993.
In 2023, the number of deaths due to cocaine in England and Wales increased for the 12th consecutive year. There were 1,118 deaths involving cocaine registered in 2023, which was 30.5 per cent higher than the previous year. In comparison, 46.8 per cent of all drug-poisoning deaths in 2023 involved an opiate (2,551 deaths).
The Office for Health Improvement and Disparities and the National Crime Agency reported that between 1 June 2023 and 31 May 2024 there were 179 deaths confirmed to have involved one or more nitazenes.
Sources:
Office for Health Improvement and Disparities (2024). Deaths linked to potent synthetic opioids.
Office of National Statistics (2024). Deaths related to drug poisoning in England and Wales: 2023 registrations.
As of 2022, 21 of the 27 countries in the European Union officially report on drug-induced deaths. The European Union Drugs Agency (EUDA) estimates that, at a minimum, there were 6,392 drug-induced deaths in 2022. The European Union-wide mortality rate in 2022 was 2.25 deaths per 100,000 population aged 15 to 64.
Opioids were estimated to be present in three-quarters (74 per cent) of fatal overdoses in the European Union, often in combination with other drugs, underscoring the ongoing challenge of poly-drug toxicity. An estimated 1,800 deaths in 2022 deaths involved heroin, with Germany (728), Spain (173), France (142), Austria (127), and Italy (127) reporting the highest numbers.
According to the European Union Drugs Agency (EUDA), stimulants are the second most-reported category of drug consumed across Europe. Deaths involving cocaine rose throughout the European Union, including in France (23 per cent increase from 2020 to 2021) Austria, Slovenia, Spain, Portugal and the Netherlands. Overdose deaths caused by non-cocaine stimulants such as amphetamine and methamphetamine were also reported, led by Germany (476), Turkey (186), Latvia (62), Estonia (33) and Austria (32).
A European project monitoring cases involving medical treatment for non-fatal overdoses found that 6.2 per cent of overdose cases in 2014–2017 related to new psychoactive substances (NPS). While deaths related directly to the use of NPS do occur, they were rare in the countries that were able to provide relevant data. However, the emergence of nitazenes and other potent synthetic opioids has increased mortality linked to new substances; preliminary data from 2023 showed that 5 countries reported the presence of nitazenes in at least 150 overdose deaths.
Potent synthetic opioids have been reported in both fatal and non-fatal overdose clusters (e.g., Ireland and France in 2023), but data for potent synthetic opioids is not part of the routine data collected in the European Union. Provisional data from Estonia shows that potent synthetic opioids were identified in 48 per cent of all drug-induced deaths in 2023.
Sources:
EUDA (previously EMCDDA) (2024). European Drug Report 2024: Trends and Developments.
According to governmental figures released in 2021, between 2017 and 2019 there were 2,324 drug-induced deaths in India. Two nationwide drug surveys have been conducted in India, once in 2014 and again in 2019. The surveys suggested that drug use in India is increasing, with rising cocaine use and an increase in reported opioid use from 0.7 per cent in 2014 to almost 2 per cent in 2019; heroin was the most common opioid used.
Sources:
Ajit Avasthi, Abhishek Ghosh, ‘Drug misuse in India: Where do we stand and where to go from here?’, Indian J Med Res, June 2019.
Ministry of Justice & Empowerment (2021). Deaths Due to Drug Abuse.
Official statistics from Latin America and the Caribbean indicate relatively low rates of drug-induced deaths compared with other regions. However, a lack of reliable information about the extent of harms caused by drug use makes it difficult to assess the full extent of drug-related harms in the region. In Colombia, for instance, different government agencies have reported widely varying and contradictory numbers of fatal opioid overdoses.
In 2019, Honduras (1.6 deaths per 100,000 population) and Guatemala (1.4 deaths per 100,000 population) were the countries reporting the highest drug-related death rates. Even though rates increased in the region between 2000 and 2019, rates reported are on average far lower than the Organisation for Economic Co-operation and Development country average (5.8 deaths per 100,000 population, compared to an average of 0.4 deaths per 100,000 population for all Latin and Caribbean countries). However, the difference may be partly attributed to the quality and quantity of the data reported.
In Mexico, between 2010 and 2017 there were 757 overdose deaths reported due to illicit drug use. Of those, 514 cases were attributed to multiple drugs, in 54 cases opioids were reported as the main cause of death and 39 cases were attributed to cocaine.
There are also reports of increasing presence of the NPS known as 2C-B (often sold as ‘pink cocaine’ or ‘tusi’), particularly in party and street markets. Many products sold as tusi do not contain 2C-B but do contain combinations of other NPS. In 2019, these compounds were reported in 7 Latin America and the Caribbean countries, compared to no such reports in 2015.
Sources:
65 ATS Corporation (2021). ‘How many deaths are there from opioid overdose in Colombia? We do not know’. ATS Corporation.
CONACID (2019). Informe Sobre la Situación del Consumo de Drogas en México y su Atención Integral 2019, pp. 61-62
COPOLAD (2024). Colombia tackles harm reduction with the support of the European Union.
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.
OECD (2023). Health at a Glance: Latin America and the Caribbean 2023, pp.128 – 129
UNODC (2021). Synthetic Drugs and New Psychoactive Substances in Latin America and the Caribbean 2021. pp. 25
The New Zealand Drug Foundations reports that between 2016 and 2023 there were 1,179 accidental drug overdose deaths in New Zealand (this figure includes accidental overdoses only, not including intentional self-harm). Provisional estimates for 2023 show that there were 188 overdose deaths, an increase of 32 deaths compared to 2022. Between 2016 and 2023, the drug types linked to the highest total numbers of reported fatal overdoses were opioids (516), benzodiazepines (141), stimulants (76), and synthetic cannabinoids (65). While opioids remain the drug type responsible for the greatest number of overdoses, overdoses involving benzodiazepines have steadily increased since 2016. Stimulants were reported in 22.5 per cent of all closed overdose cases.
Sources:
New Zealand Drug Foundation (2024). Drug Overdoses in Aotearoa.
The rate of drug-related deaths in the Nordic countries has been increasing and is higher than the European average. In 2022 death rates among people who use drugs in Nordic countries were:
Compared to 2017, the rate increased in all Nordic countries except Sweden, where the rate decreased to 5.91 from 6.46. In 2022 opioids were the main cause of death in 73 to 89 per cent of all drug-induced deaths. Heroin/morphine was the most common opioid involved in deaths in Sweden and Norway . In Norway, the number of heroin/morphine related deaths increased (from 69 in 2017 to 104 in 2022, while in Sweden heroin/morphine related deaths decreased from 110 in 2017 to 83 in 2022. In Denmark, the most common opioid involved in overdoses was methadone (73 deaths); this represents a gradual decrease since 2007 (116 deaths). In Finland, buprenorphine was the most common opioid involved in overdose deaths, increasing from 48 in 2017 to 103 in 2022. The most common opioid involved in overdoses in Iceland was oxycodone (10 deaths), with other opioids contributing to fewer than 5 deaths each.
While NPS were detected in all countries, the frequency of detecting NPS in overdoses remained low. The largest variety of NPS were in Finland (11) and Sweden (17), but the only NPS recorded in greater than 5 per cent of overdoses was a cathinone called alpha-PHP, which accounted for 6.3 per cent of overdose deaths in Finland.
Sources:
EUDA (2024). European Drug Report 2024: Trends and Developments.
Pirkko Kriikku, Hilde Marie E. Evardsen, Gunilla Thelander et al., ‘Fatal poisonings in Nordic countries in 2022 among people who use drugs’, Forensic Science International: Reports, July 2025
Northern Ireland recorded 169 drug-related deaths in 2023, representing a 47 per cent increase in the number of drug-related deaths in the previous 10 years. The three-year rolling average decreased after a steady increase to 2021, falling from 207 deaths in 2021 to 179 deaths in 2023.
Opioids were the most common drug involved, contributing to 103 deaths in 2023, while benzodiazepines were the next most common, contributing to 95 drug-related deaths.
Poly-drug combinations were recorded in 74.6 per cent of drug-related deaths 2023, compared to 53 per cent in 2013.
Sources:
Northern Ireland Statistics and Research Agency (2025). Drug-related and drug-misuse deaths in Northern Ireland, 2023.
1,172 people lost their lives to a drug-related death in Scotland in 2023, an increase of 12 per cent from 2022. While the total was the second-lowest number of drug-related deaths recorded in the last six years, the rate of drug-related deaths in 2023 remained 4.2 times higher than in 2000. Glasgow City and Dundee City are the areas with the highest rates of frug-related deaths. Opioids were registered in 80 per cent of all deaths, and 88 per cent of all drug-induced deaths were classified as unintentional.
Sources:
National Records of Scotland (2024). Drug-related deaths in Scotland in 2023.
Due to military operations in Ukraine, compilation of statistical information on the population has been suspended since 2023.
In 2021, there were 565 deaths related to substance use, representing a 4.1 per cent decrease from 2020 (589 deaths); 422 deaths were classified as accidental overdose. Opioid-related overdoses totaled 307 deaths, representing a more than three-fold increase since 2017 (90 deaths).
Sources:
EUDA (2023). National Report on Drug and Alcohol Situation in Ukraine, 2023 (based on data 2022), p.17
EUDA (2024). Drug Situation in Ukraine (based on 2023 data), p.47.
UNODC (2022) Conflict in Ukraine: Key evidence on drug demand and supply.
In 2024, data from the Centers for Disease Control and Prevention yielded an estimate of 80,391 drug overdose deaths in the United States, a decrease of 26.9 per cent from the 110,037 deaths in 2023. This is the lowest number of projected deaths since 2019.
Almost all states experienced decreases in total overdoses in 2024, with only South Dakota and Nevada registering small increases compared to 2023.
Overdose deaths from opioids – mainly fentanyl – decreased in 2024, but they still account for almost 68 per cent of all overdose fatalities. Deaths involving cocaine and psychostimulants also decreased in 2024 compared to 2023 (51,630 in 2024 compared to 67,929 in 2023).
Sources:
National Center for Health Statistics (2024). U.S. Overdose Deaths Decrease in 2023, First Time Since 2018.
US Centers for Disease Control and Prevention (2025) U.S. Overdose Deaths Decrease Almost 27% in 2024
In 2022, there were 59 overdoses in Serbia, with the majority (52) involving opioids. The actual figure is likely to be higher, as reporting does not cover the entire country. In Albania 36 drug-induced deaths were recorded, and 12 each in Kosovo and North Macedonia; the Drug Policy Network South-East Europe emphasised controversies and questions regarding the reliability of the data. These are likely underestimates due to limited toxicology testing facilities. Most drug-related deaths reported in the Western Balkans were associated with opioids, mainly heroin and methadone. Cocaine-related deaths have been reported in Albania and North Macedonia.
Sources:
EUDA (2024). Cooperation with the Western Balkans: first national drug datasheets unveiled.
EUDA (2022). Drug-related health and security threats in Western Balkans.
EUDA (2023). National Drug Situation Overview 2023 (Montenegro).