T2023-S1 Accidental drug-related deaths among young people in Finland in 2023

The Safety Investigation Authority, Finland conducted a themed investigation to ascertain what kinds of direct and indirect factors leading to death can be identified behind the accidental drug-related deaths of young people. The investigation involved collating the basic facts of all accidental drug-related deaths among young people under the age of 25 years in 2023. The investigation sample (N = 96) was based on the police’s investigation notices and information received from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare. All cases in which the death was initially attributed to an accidental drug poisoning were included in the sample. Detailed case studies were conducted on 15 of the deaths included in the sample. Violent deaths were excluded.

There were a total of 79 deaths attributed to an accidental drug poisoning in 2023. The preliminary data indicated 147 cases in which the deceased had a history of drug or psychoactive medication use. The study showed that drug-related deaths among young people are most often caused by a combination of opioids and benzodiazepines. More than 80 per cent of the cases showed signs of simultaneous use of both groups of substances. The most frequently encountered substances were buprenorphine and alprazolam. Mixing opioids and central nervous system depressants can lead to fatal respiratory depression even at low doses.

A total of 78 per cent of the deceased were male and 22 per cent were female. The average age of the deceased was 20.9 years. Two of the deceased were under 18 years old. In most cases the drugs had been consumed by mouth, but some of the deceased had also used drugs nasally. Less than half of the deceased (45%) showed signs of intravenous drug use. There was little evidence of alcohol use. Approximately one in four of the deceased had previously suffered a non-fatal drug or medication poisoning. Three cases occurred during the year that involved two young people under the age of 25 years dying simultaneously. The sample only included a few individuals who may have had a foreign background.

A total of 18 wellbeing services counties (including City of Helsinki) reported accidental drug-related deaths in 2023, and almost all the fatal drug or medication poisonings had occurred in large towns or cities. The majority of the deaths took place in the young person’s home or in another private residence. Many of the deaths had occurred during sleep, often in the early hours of the morning, although there was even distribution across all times of day. The average time it had taken to notice the death was 22 hours, and the median time was 12 hours. There were more deaths in the summer and autumn.

The risks associated with poly-drug use are poorly known. The current range of services available to young drug users is not a good match to their needs. The service system lacks clear operating models for referring young drug users to services, and they are not getting the help they need at the right time. Accessing the appropriate services is especially difficult for problem drug users who also have mental health issues. The more service providers are involved, the more important it is to ensure the continuity and coordination of the provision of timely and appropriate help to these youngsters.

There is also no national standard for the provision of treatment guidance by the police and no operating model or service pathway for supporting young drug users. Effective treatment guidance requires cooperation between the police and health and social services as well as service providers to whom the youngsters can be referred. Making the emergency call promptly is critical in an accidental drug poisoning situation. If the seriousness of the situation is misjudged based on the emergency call, the risk assessment leads to an inadequate response and potentially a delay in getting help. There are also issues with the coordination of young drug users’ pharmacotherapy.

The Safety Investigation Authority recommends the following:

1. The Ministry of Social Affairs and Health and the Finnish Institute for Health and Welfare review the services available for young problem drug users, build a nationally harmonised service bundle specifically targeted at problem drug users under 18 years of age and between 18 and 25 years of age and ensure that service pathways work as intended in practice.
2. The Ministry of Social Affairs and Health reform child welfare services so that the complex service needs of young drug users are appropriately catered for in both non-residential and substitute care.
3. The Ministry of Social Affairs and Health investigate the role of after-care placements in the lives of care leavers who use drugs in reducing drug-related deaths and improve after-care on that basis.
4. The Ministry of Social Affairs and Health, the Finnish Medicines Agency and the Finnish Institute for Health and Welfare investigate what measures are needed to improve the safety of the pharmacotherapy of young drug users as well as coordination.
5. The Ministry of Social Affairs and Health and the National Police Board develop a nationally harmonised treatment guidance system for young drug users and reform existing practices.
6. The Ministry of Social Affairs and Health and the Ministry of Education and Culture engage other operators and public authorities in coordinated multi-channel awareness raising campaigns that resonate with drug users.
7. The Ministry of Social Affairs and Health ensure that efforts to prevent drug-related deaths among young people incorporate appropriate technological solutions to detect life-threatening drug poisoning situations.
8. The Emergency Response Centre Agency and pre-hospital emergency care units of the collaborative areas for health care and social welfare ensure that incidents involving accidental drug poisonings are dealt with in a way that gives the emergency dispatcher enough information about the situation to determine the correct urgency classification and incident code.