Drug-related deaths and twelve suggestions for a more sustainable future: the Finnish context

Most drug-related deaths in Finland are accidental, unintentional, and preventable overdose deaths in which a person dies from the combined use of opioids with other substances. This is mainly caused by the use of long-acting buprenorphine combined with alcohol and, in most cases, benzodiazepines.

Death due to opioid overdose is a leading contributor to premature and preventable death among the Finnish adult population. The annual number of drug overdose deaths exceeds, for example, the number of road traffic deaths and fatal drownings. Most road traffic deaths and drownings are preventable, and in Finland, ambitious and goal-oriented work is being done to prevent those deaths. There is a vision zero in traffic safety, and the goal is that no one should die in a road traffic accident. Campaigns are also actively carried out to prevent drowning deaths, such as “Wise on the waters,” in which the goal is simple: that no person would not drown. Equally ambitious work should also be done to prevent drug-related deaths, especially since drug overdose victims can be detected and saved when effective means are known and used.

Drug-related deaths in Finland, Norway and Sweden

In Finland, people don’t generally die due to one-time use or experimentation of drugs. On the contrary, there is often long-standing, problematic, and risky use behind the cause of unintentional overdose death, even among young people. The situation in Finland is significantly different than in the other Nordic (and European) countries, where overdose occurs mainly after using a fast-acting opioid, usually heroin. In Finland, deaths often occur due to the interaction of the long-acting opioid (mainly buprenorphine) combined with other substances, usually several hours after the dose. Due to buprenorphine’s action mechanism, death often happens while the person is sleeping, so all methods for preventing drug-related deaths used in other countries, such as drug consumption rooms, cannot be applied directly in Finland, and there’s a need for specific Finnish model to prevent deaths.

In Norway, the total number of drug overdose deaths in 2022 was 321. That is 74 more deaths than in 2021, but 10 deaths less than the peak year 2020. The number of fatalities has fluctuated around an average of 280 deaths per year and has been relatively stable as the number of deaths has not increased. However, the drug overdose-related deaths trend has not decreased over the past 10 to 20 years.

The number of drug-related deaths is also at a high level in Sweden. A positive development was seen in 2021 when fatalities decreased for several years. But, according to the latest statistics, the number of deaths in 2022 has increased again and was 519.

Methodological differences

Because of the statistical and methodological differences, direct comparisons between countries in statistics should be made with caution. However, the comparison between Nordic countries is possible and reliable because of the high quality of forensic toxicology in our countries. Despite the methodological differences between different European countries, drug-related deaths are at a high level and a significant problem in all Nordic countries.

Although Finland is, unlike the rest of Europe, a Subutex country, other opioids, such as oxycodone and tramadol, have also caused deaths, and there is an urgent need for improvement in the prevention of drug-related deaths. While Sweden represents the strictest drug policy and Finland has its dual-track policy, Norway is one step forward despite the Norwegian parliament rejecting the government’s bill proposing the decriminalization of illicit drug use.

The New Finnish model

Based on international experience and research, effective methods are known to prevent drug deaths. Still, not all of them suit Finland’s current drug use culture, where the combined use of long-acting opioids and sedatives is causing most of the deaths. The Finnish Expert Group for Preventing Drug-related Deaths (HEAR) has collected methods and proposals applicable to Finland. The practices and measures contain researched information and the views of various experts, examples, and estimates on how to stop and reduce the increase in drug-related deaths.

The outcome of the work done by the expert group was published in September 2023. The publication contains background information, methods, and proposals for action to prevent drug-related deaths. The publication assesses twelve themes and techniques that could be used in order to avoid drug-related deaths in Finland:

1. opioid substitution treatment and other substance use services
2. needle and syringe exchange and health advice services for people who use drugs
3. drug consumption room (harm reduction center)
4. take-home naloxone and related first-aid training
5. lowering the threshold for calling 112
6. information exchange
7. campaigns
8. strengthening cooperation with the police
9. reducing stigma
10. wearable technology
11. drug-checking services
12. decriminalization of drug use

As many methods as possible must be available and accessible to people who use drugs, and all forms of treatment are needed: preventive, medical, non-medical, outpatient treatment, inpatient treatment, long-term inpatient rehabilitation, support services (such as day activity centers and outreach work), and harm reduction measures.

Drug-related deaths must be prevented so that recovery can also be possible. More efforts must also be made to reduce the stigma towards people who use drugs and toward their services under the priorities of the substance abuse and addiction strategy. Negative attitudes towards people who use drugs have considerable effects on their well-being and health and their willingness to seek support and help. The threshold for seeking treatment must be lowered, as many drug-related deaths occur outside the service system. As for technological innovations, new promising innovations are being developed in the US and Canada to prevent drug-related deaths, for example, an activity bracelet that detects overdose, which development work should be promoted in Finland as a complementary effort alongside the other suggested measures.

Over the last decade, the drug market has been changing constantly, the trend being an increase in the availability of new potent synthetic drugs. Of these substances, drug-related deaths are mainly caused by illegally manufactured synthetic opioids. Finland should be better prepared than at present because the drug situation can change quickly. Urgent actions and concrete responses are required to prevent drug-related deaths in Finland.

The article is written by

Inari Viskari, specialist & Sanna Kailanto, senior specialist at the Finnish Institute for Health and Welfare

on the request of PopNAD.