Fatal overdoses –
The Danish perspective
Christian Tjagvad SERAF
International Overdose Awareness Day 31. August 2015
The ten countries in Europe
reporting the
highest overdose death rates
EMCDDA, European Drug Report 2015
Heroin-related deaths among overdose deaths in the Nordic countries, 1997-2012
0 10 20 30 40 50 60 70 80 90 100
1997 2002 2007 2012
Percentage of overdose deaths, %
Year
Denmark Norway Sweden
Simonsen et al, Forensic Science International, 2015
Methadone-related deaths among overdose deaths in the Nordic countries, 1997-2012
0 10 20 30 40 50 60 70 80 90 100
1997 2002 2007 2012
Percentage of overdose deaths, %
Year
Denmark Norway Sweden
Simonsen et al, Forensic Science International, 2015
Study including overdose deaths in three municipalities, 2008-2011:
• Copenhagen
• Aarhus
• Odense
Heroin- and methadone-related deaths among overdose deaths in three Danish municipalities, N=182
30 40 50 60 70 80 90
Percentage of overdose deaths, %
Odense Aarhus Copenhagen
Extent of less restrictive availability of opioid maintenance treatment
6-MAM/heroin Methadone
Prescribed and non-prescribed methadone in methadone-related deaths
0 % 10 % 20 % 30 % 40 % 50 % 60 % 70 % 80 % 90 % 100 %
Denmark;
2008-2012;
N=130
Norway;
2000-2006;
N=312
Sweden;
2003-2010;
N=306
Zurich, Switzerland;
1998-2007;
N=146
West Virginia, USA;
2004;
N=61
Percentage of overdose deaths
Non-
prescribed methadone Prescribed methadone
Bernard, Forensic Science International, 2012 Wikner, Drug and Alcohol Review, 2014
Laberke, Int J Legal Med, 2010 Weimer, J Addict Med., 2011
Co-detections in overdose deaths with prescribed and non-prescribed methadone, N=130 and N=95
0 10 20 30 40 50 60 70 80 90 100
Benzodiazepines, total
Heroin*
Percentage of overdose deaths, % Prescribed methadone Non-
prescribed methadone
0 10 20 30 40 50 60 70 80 90 100
Prescribed benzodiazepines*
Non-prescribed benzodiazepines*
Percentage of overdose deaths with detection of benzodiazepines, %
* p value < 0.05
Overdose deaths with prescribed methadone, by prescribed daily dose, N=80
Methadone daily dose: < 60mg
Methadone daily dose : 60-120mg
Methadone daily dose : > 120mg N=7 (8.8%) N=38 (47.5%) N=35 (43.8%)
• Individuals with methadone dose within recommended limits: N=38 (47.5%)
• Individuals with methadone dose outside recommended limits:N=42 (52.5%)
Co-detections in overdose deaths with prescribed methadone, N=80 and N=63
0 10 20 30 40 50 60 70 80 90 100
Supervised intake*
Benzodiazepines, total
Percentage of overdose deaths, % Methadone dose within recommended limits
Methadone dose outside recommended limits
* p value < 0.05
0 10 20 30 40 50 60 70 80 90 100
Prescribed benzodiazepines*
Non-prescribed benzodiazepines*
Percentage of overdose deaths with detection of benzodiazepines, %
Methadone-related deaths among overdose deaths in the Nordic countries, 1997-2012
0 10 20 30 40 50 60 70 80 90 100
1997 2002 2007 2012
Percentage of overdose deaths, %
Year
Denmark Norway Sweden
Simonsen et al, Forensic Science International, 2015
Rates of death associated with heroin
and prescription opioids in USA, 2002–2013
Dart et al, New England Journal of Medicine, 2015
