Trends in Fatal Poisoning Among Drug Users in France From 2011 to 2021
Authors: Revol Bruno , Willeman Théo , Manceau Marc , Dumestre-Toulet Véronique , Gaulier Jean-Michel , Fouilhé Sam-Laï Nathalie , Eysseric-Guérin Hélène ,   Compagnie Nationale des Biologistes et Analystes Experts (CNBAE) and the French Addictovigilance Network (FAN), Abbara Chadi , Allorge Delphine , Alvarez Jean-Claude , Ameline Alice , Aquizerate Aurélie , Barret Anne , Berland Emilie , Bertin Célian , Besnard Thierry , Bevalot Fabien , Billet-Chatenay Camille , Bouquet Emilie , Bourgine Joanna , Brunet Bertrand , Caous Anne-Sylvie , Cesbron Alexandre , Chaouachi Leila , Chevallier Cécile , Cheze Marjorie , Citterio-Quentin Antony , Collon-Fabie Philippe , Dailly Eric , Daveluy Amélie , Deffontaine Grégory , Delage Martine , Delavenne Xavier , Descamps Florence , Descoeur Juliette , Deslandes Guillaume , Deveaux Marc , Devos Bernadette , Doche Christophe , Eiden Céline , Fouley Aurélie , Gaillard Yvan , Gambier Nicolas , Ganière Catherine , Goullé Jean-Pierre , Guerard Pascal , Hoizey Guillaume , Humbert Luc , Imbert Laurent , Kergueris Marie-France , Kintz Pascal , Klinzig Florian , Labat-Deveaux Laurence , Lacarelle Bruno , Lacroix Christian , Lamiable Denis , Lavit Michel , Le Boisselier Reynald , Le Bouil Anne , Le Meur Catherine , Lefeuvre Sandrine , Lelièvre Bénédicte , Lelong-Boulouard Véronique , Lemaire-Hurtel Anne-Sophie , Lima-Tournebize Juliana , Loilier Magalie , Lopez Vincent , Martin-Molins Claire , Marty Hélène , Mathieu Olivier , Mathieu-Daudé Jean-Claude , Mauras Yves , Milan Nathalie , Moal Aurélie , Morel Isabelle , Mura Patrick , Pelissier-Alicot Anne-Laure , Pépin Gilbert , Perrin Martine , Peyre Anne , Pineau Alain , Pok Rop , Ragoucy-Sengler Catherine , Rayer Raphaël , Roman Emilie , Roussel Carine , Roussin Anne , Sabini Sandrine , Saussereau Elodie , Scala-Bertola Julien , Sibille Pauline , Spadari Michel , Titier Karine , Turcant Alain , Vacher Pierrick , Venisse Nicolas , Vieira Ophélie , Visinoni Pascale 
Published: August 2023

Importance

The DRAMES (Décès en Relation avec l’Abus de Médicaments Et de Substances) register is a database of drug-related deaths with the aim of identifying the psychoactive substances associated with and estimating the trends in these deaths. Our novel approach is based on the collection of data on all deaths for which toxicology experts have performed analyses.

Objective

To describe drug-related deaths in France and report trends over an 11-year period.

Design, Setting, and Participants

This case series used a national register to assess 4460 drug-related deaths that occurred from 2011 to 2021 in France. Data analyses were performed from January 1, 2012, to December 31, 2022.

Main Outcomes and Measures

Demographic characteristics; medical and substance abuse history; forensic autopsy findings; and toxicology reports.

Results

Among the 4460 deceased individuals (mean [SD] age, 37.8 [10.5] years), the mortality rate was highest among men (sex ratio, 4.4:1). Of the deaths involving a single or predominant drug, the legal substitution product, methadone, was the leading cause of death during the entire study period, ahead of heroin—44.7% and 35.9% for methadone vs 15.8% and 21.8% for heroin in 2011 and 2021, respectively. Between 2011 and 2021, most of the drug-related deaths shifted from licit to illicit drugs, and statistically significant variations were found for buprenorphine, cocaine, heroin, methadone, and other licit opioids. Deaths related to polydrug use increased from 23.2% in 2011 to 30.6% in 2021. In this context, opioids remained associated with most deaths, with at least 1 opioid being involved in approximately 9 of 10 cases (85.9%) in 2021. However, the main trend was the dramatic increase in drug combinations with cocaine, from less than one-third of cases in 2011 (30.8%) to more than half in 2021 (57.8%).

Conclusions and Relevance

This case series assessment of 4460 drug-related deaths found that opioids used alone or in combination were the main contributor to drug-related deaths, despite having a lower prevalence than other drugs. This finding is similar to that of other countries; however, in France licit methadone was the leading cause of opioid-related deaths (ahead of heroin) during the study period. Deaths associated with use of cannabis, new psychoactive substances, and stimulants (including amphetamine-type stimulants and cocaine, especially in combination) have increased and should be closely monitored.