Drugs – Fatal poisonings and drug-related deaths

Number of fatal poisonings almost tripled over the last 25 years

Although poisonings are the most common accidental cause of death among working age adults in Finland, the total number of fatal poisonings has decreased significantly over the past two decades. 

The decline is mainly explained by a reduction in fatal alcohol poisonings. The decrease in suicides in Finland has also contributed to the overall decline in fatal poisonings. 
In contrast, the number of drug-related poisoning deaths has nearly tripled since the early 2000s, and the proportion of individuals under 25 years of age is among the highest in Europe.

Finland, other Nordic countries and the Baltic states have more drug-related deaths per capita than EU countries on average, partly due to polydrug use and more dangerous administration routes such as injection.

Fatal drug poisonings among young people have increased worryingly in recent years. The annual numbers fluctuate considerably, so long term trends are more reliable indicators. 

Fatal drug poisoning in this context refers to overdose deaths caused by illicit drugs or pharmaceuticals used for intoxication. The European Union Drugs Agency (EUDA) has defined criteria for which fatal poisonings are classified as drug poisonings in European reporting. In Finland, official cause-of-death statistics are produced by Statistics Finland, which applies another EUDA definition that differs slightly from the one used here.

The total number of all fatal poisonings has decreased

The total number of fatal poisonings has declined to less than half during the 2000s. The highest number of poisoning deaths occurred in 2006 – a total of 1,228. In 2024, there were altogether 567 fatal poisonings.

A fatal poisoning refers to a death directly caused by a toxic substance or combination of substances entering the body in excessive amounts. Causes may include alcohol, medications, illicit drugs, carbon monoxide, chemicals or natural toxins.

A fatal poisoning may be classified as an accident, where the individual unintentionally consumed too much alcohol or drugs, or as a suicide, in which the poisoning was intentional. Homicides committed by poisoning are rare in Finland, with only about 0–3 cases per year.

Many accidental poisoning deaths are linked to substance misuse, whereas victims of suicide by poisoning are relatively seldom substance abusers.

Buprenorphine is responsible for the highest number of fatal poisonings

Year after year, the opioid medication buprenorphine causes the highest number of fatal poisonings in Finland. 

Buprenorphine is used for pain management and opioid substitution therapy and is safe when used correctly. However, misuse – such as intravenous administration and concurrent use with other central nervous system depressants – may cause life-threatening respiratory depression that results in dozens of premature deaths annually.

In addition to buprenorphine, other opioids play a significant role in poisoning deaths. Tramadol, oxycodone and fentanyl each cause several fatal poisonings every year, often in combination with other psychoactive substances. 

In suicides by poisoning, substances detected include certain antipsychotics, antidepressants and sleeping medications. The painkiller paracetamol also causes multiple poisoning deaths annually.

The number of fatal alcohol poisonings has decreased

Fatal alcohol poisonings in Finland have decreased dramatically over the past 15 years, particularly among individuals under 45 years of age. 

In this age group, the number of deaths is now only about one quarter of what it was in the 1980s and 1990s.

Findings of illicit/abused drugs in post-mortem cases

Even if death was not directly caused by drugs or other intoxicants, drug findings may still be present in the deceased, such as a cannabis metabolite or small amounts of amphetamine.

The cause of death may then be unrelated to drugs, in which case drugs are listed on the death certificate as contributing factors. Sometimes the detected substance is considered irrelevant to the death.

The number of findings of amphetamine, cannabis and buprenorphine have increased in post-mortem cases throughout the 2000s. Heroin was still detected relatively frequently in the early 2000s but has since been largely replaced by buprenorphine as the primary abused opioid. Cocaine findings have increased somewhat in recent years but still remain relatively uncommon.

Statistical description

Forensic toxicological analyses related to medico-legal cause-of-death investigations in Finland are carried out centrally at THL’s Forensic Chemistry Unit in Helsinki. In 2024, medico-legal autopsies were performed in about 13% of all deaths in Finland, and in 76% of these cases a forensic toxicology examination was conducted.

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