Overdose prevention in Europe – where are we and what’s next?

With a devastating surge in overdose deaths globally, Correlation – European Harm Reduction Network (C-EHRN), recently held a webinar to discuss findings related to overdose prevention in its third ‘Civil Society Monitoring of Harm Reduction in Europe‘ report.

The webinar was moderated by C-EHRN’s Katrin Schiffer and discussed the report, which gives a voice to the civil society organisations on the ground across Europe and features data from more than 100 organisations and individuals across 34 European cities and multiple countries. 

“The findings show that most overdose victims were using alone, mixing drugs, had no access to Naloxone, drug consumption rooms or drug checking,” explained Rafaela Rigoni, C-EHRN. “There were also more overdoses within the homeless and prison populations.”

While there have been some positive movements since the last report – such as opioid agonist therapy (OAT) being widely available in almost all places except some locations in Russia, there is still much work to be done. 

Naloxone must be made available to everyone 

In Greece, naloxone was troublingly still classified as a medical intervention until recently, and could only be used by medical personnel. A change to the law means that outreach workers from state-based organisations can now use naxolone, which is vital for stopping overdoses.

“But it still can’t be used by outreach workers at NGOs,” says Marios Aztemis from Positive Voice, Greece. “Or, to peers, people who use drugs, or their family and friends. There is a desperate need for an awareness campaign to change this and make naloxone accessible.”

There is also a need to educate people on the dangers of mixing drugs and using alone.

Listen to the community and act on the insights

In many places, the lag between what’s actually happening on the street and actionable, government-approved data is a concern. 

“It is very difficult to get timely and efficient data on overdose deaths and this means that policies are often based on information that is out of date,” says Aljona Kurbatova from TAI in Estonia. “For example, you might hear about a new synthetic opioid from the community, but you have to wait months for toxicology reports before being able to act.”

It’s a similar story elsewhere, with data in Greece also compromised, with many overdose deaths recorded as something else (like heart failure), to limit shame and stigma.

Decriminalisation could stop people from using alone

Despite a surge in harm reduction services like drug consumption rooms, and the introduction of drug checking, Germany has seen its highest rate of overdose deaths in 20 years, and equates to 1/3rd of European drug-related deaths.

Like elsewhere, majority of those who overdose are doing so because they are using untested drugs, alone. Stigma, shame and discrimination play a key part of the reason people use alone and do not access the harm reduction services available to them. 

“It’s disappointing that the increase in harm reduction services has not stopped the overdose deaths,” says Dirk Schaeffer, Deutsche AIDS-Hilfe e.V. “But that’s because we also need to look seriously at decriminalisation to ensure people aren’t hiding their use at home alone. Only when we look at both of these will we bring down the number of deaths.”

Is safe supply the answer?

Adriana Curado, Grupo de Ativistas em Tratamentos (GAT), agreed with Dirk but believes that decriminalisation still won’t go far enough to stop the rise of overdose deaths. “Harm reduction is not enough,” she says. “But neither is decriminalisation. What we need is regulation of the market and safe supply.”

Curado argues that until this happens, people won’t know what’s in their drugs and will rely on drug-checking services that are not always available. Plus, the market will remain in the hands of criminals.

Overdose prevention guidelines

The report provided some suggested overdose prevention guidelines for Europe, including:

  • The provision of take-home naloxone
  • Low-threshold access to OAT (current challenges include limited opening hours, high threshold requirements (documents, urine testing, abstinence, insurance/cost etc), age restrictions, lack of prescribers, waiting lists etc)
  • Continuous training for overdose prevention
  • Overdose prevention for non-opioids such as stimulants and synthetic cannabinoids
  • Provision of first aid training
  • Provision of Drug Consumption Rooms (DCRs) 
  • Overdose risk assessment and screening


For Estonia’s Aljona Kurbatova, the report was useful but highlighted one thing:

“This report is a confirmation that we have been unable to yet deliver the work that needs to be done.”

A rallying call to keep going, we hope to see the various recommendations in action soon. 


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