Opioid-related mortality remains one of the most pressing public health challenges across Europe, accounting for three-quarters of all fatal drug overdoses. Furthermore, research demonstrates that these tragic losses are largely preventable through evidence-based interventions that address both the occurrence of overdoses and survival outcomes when they happen.

The Scale of the Crisis

Each year, mortality rates among people who inject opioids reach 1-2%, representing five to ten times the death rate of their peers in the general population. In addition to overdose, complications from infections, accidents, violence and suicide contribute to this devastating toll. Moreover, with Europe’s opioid-using population ageing, the urgency for comprehensive prevention strategies has never been greater.

Proven Approaches for Preventing Opioid Overdose Deaths

Opioid Agonist Treatment: A Lifeline

The evidence is unequivocal: enrolling and retaining individuals in opioid agonist treatment dramatically reduces mortality. In fact, research shows that people receiving methadone or buprenorphine face less than one-third the death rate of those not in treatment. Consequently, this makes treatment retention a cornerstone of any strategy aimed at reducing opioid-related mortality.

However, particular vigilance is required during the first four weeks of treatment and the four weeks following treatment exit, when overdose risk peaks significantly.

Naloxone: The Overdose Antidote

Naloxone, an opioid antagonist that reverses potentially fatal overdoses, has transformed emergency responses. Therefore, the World Health Organization recommends making naloxone available to anyone likely to witness an overdose, including peers, family members and frontline workers.

Similarly, take-home naloxone programmes, which combine training on overdose recognition with distribution of naloxone kits, have demonstrated clear effectiveness in preventing opioid overdose deaths. Additionally, these initiatives extend beyond traditional first responders to reach people who use drugs, their loved ones, homeless shelter staff and prison officers.

Meanwhile, studies comparing intranasal and injectable naloxone confirm both methods work effectively, with nasal sprays offering easier handling for laypeople responding to emergencies.

Critical Transitions Require Enhanced Support

The period immediately following prison release represents an exceptionally dangerous time. Specifically, former inmates with opioid use history face markedly elevated overdose risk during their first month of freedom, when tolerance has diminished during incarceration.

Therefore, preventing opioid overdose deaths in this vulnerable population requires proactive planning. For instance, Scottish programmes distributing naloxone to prisoners upon release have achieved significant reductions in opioid-related mortality within the first month post-release. Similarly, ensuring continuity of care through planned referrals to community treatment services proves equally vital.

Drug Consumption Rooms: Supervised Safety

Approximately one-third of European Union countries operate supervised drug consumption facilities, where trained staff can intervene immediately if overdoses occur on-site. Although challenging to evaluate rigorously, current evidence suggests these facilities contribute to reducing opioid-related mortality at the local level whilst also decreasing injecting risk behaviours.

Furthermore, these spaces serve marginalised individuals who inject drugs in risky street conditions, linking them with treatment, health and social services whilst preventing immediate harm.

Reducing Vulnerability Through Comprehensive Care

Beyond direct interventions, reducing opioid-related mortality requires addressing broader vulnerabilities. Accordingly, integrated approaches that coordinate housing programmes, employment support and anti-stigma initiatives create environments where individuals feel safe seeking help.

In addition, overdose awareness training equips people who use opioids with knowledge about key risks, including the dangers of concurrent alcohol or benzodiazepine use. Meanwhile, low-threshold services that minimise access barriers encourage engagement before crises occur.

The European Landscape

Current coverage of life-saving interventions varies considerably across Europe. Although all EU member states provide opioid agonist treatment, only an estimated 50% of people who use opioids receive it, with significant variation between countries.

Encouragingly, over one-third of European countries now offer naloxone training and distribution programmes, with numbers growing as legal pathways expand. Moreover, information on overdose risk reaches populations through increasingly diverse communication channels, including materials in multiple languages for migrant communities.

Nevertheless, gaps remain. Indeed, only a limited number of countries have adopted specific overdose prevention strategies, and barriers continue preventing the establishment of consumption facilities in areas with high rates of public drug injection.

Emerging Technologies

Innovation continues advancing prevention efforts. For example, new mobile applications allow individuals injecting alone to log in before use, with automatic alerts to emergency services if they fail to confirm safety at regular intervals. As a result, these e-health tools represent promising additions to traditional harm reduction approaches.

A Call for Comprehensive Action

The evidence is clear: preventing opioid overdose deaths requires multi-faceted strategies combining treatment retention, naloxone availability, continuity of care, awareness raising and supportive environments. Notably, European countries implementing comprehensive approaches grounded in evidence are successfully reducing preventable deaths.

Furthermore, as synthetic opioids and new psychoactive substances continue emerging on illicit markets, maintaining surveillance capabilities and responding rapidly to threats becomes increasingly critical. Consequently, investment in toxicological analysis and early warning systems enables timely public health alerts that save lives.

Every opioid-related death represents a preventable tragedy. Ultimately, with proven interventions available, the responsibility lies in ensuring adequate resources, policy support and coordinated implementation across communities throughout Europe.

Source: EUDA