The Netherlands Drug Situation 2010 - Trimbos-instituut

6.3 Drug-related deaths and mortality among drug usersIn the Netherlands, statistics on drug-related deaths, among others, are available fromthe General Mortality Register (GMR), or Causes of Death Statistics, held by StatisticsNetherlands (CBS). In this register the causes of death are classified according to theInternational Classification of Diseases, Injuries and Causes of Death (ICD). The 10thedition of the ICD has been in use since 1996. The register has national coverage, but instandard form only includes deceased residents of the Netherlands who were registeredat a municipal register. However, data on drug-related deaths among non-residents areavailable from an additional database.The General Mortality Register (GMR) specifically provides data on acute mortality dueto drug use, that is poisoning by drugs, or drug 'overdose'. These are the cases in whichdeath is directly related to drugs. The GMR data do not make a distinction between experimentaland habitual drug users, and are not suitable for tracing deaths due to rare toxicologicalsubstances like various synthetic drugs. Nonetheless, the registered cases canbe selected according to the EMCDDA standard definition of acute drug-related death(EMCDDA 2009), as reported for the Netherlands in the Standard TablesST5_2010_NL_01 and ST6_2010_NL_01. Information on drug-related mortality fromother sources is given in chapter 12.Overall trendFigure 6.3.1 shows the number of cases recorded from 1996 through 2009 according tothe EMCDDA selection of ICD-codes. The figure only includes cases from residents thatwere registered at a municipal register. Among non-residents, an additional 28 caseswere registered in 2009 in a separate archive (Van Zeijl, Statistics Netherlands (CBS),personal communication, 10-08-2010). The total number of recorded drug-related deathsamong residents increased between 1996 and 2001, thereafter showed a rather whimsicaltrend, but in 2009 almost returned at the level of 2001. The total number decreased in2002 and 2003, rose in 2004, declined until 2007, and finally rose again between 2007and 2009.Of the 139 cases in 2009, a total of 51 cases were coded to unspecified substances,compared to 58 cases in the 2008 registration year. Although the specific substances arenot known in these cases, a previous inquiry at Statistics Netherlands (CBS) revealedthat these cases are mostly related to hard drugs and to polydrugs, and are thereforerightly included in the group of drug-related deaths. From 1996 up to including 2009, thenumber of unspecified cases ranged from 18 in 1996 to 58 in 2008.Despite fluctuations over the years, the total number of drug-related deaths in the Netherlandshas remained relatively low. This might be explained by a low number of problemdrug users, prevention measures among the drug users, and protective factors, such asthe nationwide availability of methadone-maintenance treatment and the low rate of injectingdrug use (Van Laar et al. 2006). There are, however, some indications that not allcases of drug-related deaths are recognised in the Dutch GMR (De Zwart et al. 2001),although the level of underreporting is probably rather low (Cruts et al. 2008).Opiates and cocaineCases of "opiates" and "cocaine" refer to cases in which these substances were explicitlystated as the primary cause of death on the death certificate. Between 1996 and 2001,opiate intoxications were the most common causes of drug-related death recorded96