Preparing Europe for drug-poisoning outbreaks: lessons from evidence and public health guidance

Background

Drug-related poisoning outbreaks have increased in scale and severity in Europe and globally, placing growing pressure on public health systems. Despite repeated incidents, preparedness and response remain fragmented across jurisdictions.

Methods

Two systematic reviews were conducted to support the development of a European public health emergency preparedness and response framework for drug-related poisoning outbreaks. The first synthesized scientific and grey literature on outbreak causes, detection, management, monitoring and response. The second reviewed international public health guidance addressing preparedness, response and recovery phases specific to drug-related poisonings. Both reviews followed PRISMA guidelines and incorporated health equity, human rights, gender, age and broader political, economic, social, technological, legislative and environmental perspectives.

Results

Recurrent outbreak drivers included rapid drug market changes, increased potency, mis‑selling and adulteration, and delayed incident recognition. Evidence highlighted the importance of syndromic surveillance, poison centre data, emergency departments, drug checking services and community reporting for early detection. Public health guidance showed substantial variation in preparedness, with limited drug‑specific protocols, unclear governance and inconsistent integration of harm reduction and risk communication. Gaps were identified in cross‑sector coordination, workforce preparedness and mechanisms for learning from past outbreaks.

Conclusions

Integrating scientific evidence with public health guidance provides a structured basis for strengthening preparedness and response. A shared framework can enhance early detection, coordinated action and post‑outbreak learning, supporting more timely and equitable protection of populations at risk.

Acknowledgements: This work was supported by the European Union Drugs Agency (EUDA).

Key messages

• Strengthens Europe’s readiness for drug-related poisoning outbreaks by synthesizing scientific evidence and public health guidance into a unified approach for early detection and coordinated response.

• Supports more timely, coordinated and equitable public health responses to drug-related poisoning outbreaks by identifying gaps, best practices and core preparedness needs across Europe.