Trends of the use and abuse of illicit drugs in Europe


    This report contains a comprehensive overview and summary of Europe’s illicit drug situation and the measures being taken to tackle it.

    It provides insights into key trends, responses and policies, together with in-depth analyses including psychosocial interventions, drug consumption facilities, misuse of benzodiazepines and heroin trafficking routes. The statistical data reported here relate to 2013 (or the most recent year available).

    What are the main findings of this report?

      It is estimated that almost a quarter of the adult population in the European Union have tried illicit drugs at some point in their lives and that almost 1 % of European adults are daily or almost daily cannabis users. Around three-quarters of these are aged between 15 and 34 years, and over three-quarters are male.

      Opioid deaths linked to their use reach 10 000 and 20 000 per year, drug overdose being the main cause of death. Overall, opioid users are at least 10 times more likely to die than their peers of the same age and gender. HIV-related mortality is one of the best documented indirect causes of death among drug users. The most recent estimate suggests that about 1 700 people died of HIV/AIDS attributable to injecting drug use in Europe in 2010, but this number is decreasing each year.

      The main findings of this analysis of the illicit drug problem in Europe point to a situation where long term patterns and trends continue, but the European drug markets continue to change and evolve rapidly. This is illustrated by the fact that, in 2014, over a hundred new psychoactive substances were detected, and risk assessments were conducted on six new drugs — both of these numbers are record high.

      Despite improvements in the monitoring of acute drug related health effects, the limited capacity in this area continues to restrict our view of the public health consequences related not just to new psychoactive substances but, more generally, to contemporary drug consumption patterns.

      Health and social responses to the challenges posed by new drugs have been piecemeal and slow to emerge, but are now gathering momentum. These include a wide range of efforts mirroring the full spectrum of responses to established illicit substances, from drug education and training activities, to user-led consumer protection interventions on the Internet, and needle and syringe exchange programmes based in low-threshold services.

      What is the situation of cannabis use?

        Two main cannabis products are found on the European drugs market: herbal cannabis (marijuana) and cannabis resin (hashish). Herbal cannabis consumed in Europe is both cultivated domestically and trafficked from external countries. Most cannabis resin is imported by sea or by air from Morocco. The recent emergence of over 130 different synthetic cannabinoid products in recent years has added a new dimension to the cannabis market. Most of these substances appear to be manufactured in China. After being shipped in powder form to Europe, the chemicals are typically added to plant material and packaged for sale as ‘legal high’ products. From studies in accident and emergency settings, evidence is emerging of increasing cases of acute health problems associated with these high-potency cannabis products. Against a background of their greater availability, improvements are clearly now required in the monitoring of acute health problems associated with the use of these drugs.

        Considerable diversity exists between countries in sentencing practices for cannabis-related supply offences, with national experts indicating that penalties for a first-time offence of supplying one kilogram of cannabis may range from less than 1 year to 10 years in prison.

        Cannabis is the most commonly seized drug accounting for 80 % of reported seizures. Cannabis use or possession for personal use accounts for over 60 % of all reported drug law offences in Europe and is reflecting its relatively high prevalence of use1. In 2013, about two-thirds of all seizures in the European Union were reported by just two countries, Spain and the United Kingdom. In addition, the production and trafficking of this drug is recognised as an area of growing importance for law enforcement efforts due to the increased involvement of organised crime.

        While initiatives being undertaken in the Americas on the regulated sale of cannabis and cannabis products are generating international interest and debate, in Europe, discussion on cannabis remains largely focused on the potential health costs associated with this drug.

        The availability of treatment for cannabis users appears also to be changing, probably in response to a greater awareness of the need for services and in some countries, of a treatment capacity becoming available due to a decline in demand for services for other types of drug use. New data show the growing importance of cannabis within drug treatment systems in Europe, with an increase in the number of treatment demands for cannabis-related problems.

        This increase needs to be understood in the context of service provision and referral practice. For example, in some countries, directive referrals from the criminal justice system account for a high proportion of treatment entrants. The data are also influenced by differing national definitions and practices in respect to what constitutes treatment for cannabis-related disorders, which can range from a brief intervention session delivered online to admission to residential care. Irrespective of treatment type, for cannabis-related problems the evidence supports also psychosocial interventions.

        What about the cases of heroin and cocaïne uses?

          Heroin is the most common opioid on the European drug market. Other opioids seized by law enforcement agencies in European countries in 2013 included opium and the medicinal products morphine, methadone, buprenorphine, fentanyl and tramadol. Some medicinal opioids may have been diverted from pharmaceutical supplies, while other opioids are manufactured specifically for the illicit market. The United Nations estimates suggest a substantial increase in opium production in Afghanistan, the country supplying most of the heroin consumed in Europe. A potential knock-on effect in availability is therefore possible, and it is worrying that estimates of the purity of heroin available in Europe are on the rise, resulting in a higher level of the active substance tetrahydrocannabinol, which could lead to more overdoses.

          Worryingly, 14 new synthetic opioids have been reported since 2005, among which are several highly potent uncontrolled fentanyls. Alongside recent declines in the number of heroin seizures, decreases were also observed in indexed trends for price and supply offences. Some countries have expressed concern about possible increased availability.

          Problems related to heroin still account for a large share of the drug-related health and social costs in Europe, although recent trends in this area have been relatively positive. Recent data continue to show declining treatment demand and heroin-related harms, but a number of market indicators raise concern. In some countries where purity increases have been observed, overdose deaths have also increased in recent data. It is unclear if these increases are linked, but this question warrants research attention.

          Cocaine , in Europe, is available in two forms, the most common of which is cocaine powder and less commonly available is crack cocaine, a smokeable form of the drug. The drug is produced almost exclusively in Bolivia, Colombia and Peru, and is transported to Europe by both air and sea routes. Decreases in cocaine use are observable in the most recent data; of the countries that have produced surveys since 2012, eight reported lower estimates and three reported higher estimates than in the previous comparable survey. In 2013, the number of seizures and the volume seized are at levels considerably lower than the peak values reached in 2006 and 2008. Indexed trends for cocaine-related offences show an increase since 2006. Meanwhile, over 800 deaths associated with cocaine use were reported in Europe in 2013.

          How is the situation relative to heroin consumption and addiction evolving in Europe?

            The long-term picture shows clear improvement overall and illustrates the impact that providing the appropriate services can have. Historically, a main driver for drug policy and responses in respect to heroin, particularly injecting use, was the need to reduce HIV risk behaviour and transmission. There is an overall stagnation in demand for heroin, driven in a large part by both a decline in recruitment into heroin use and the enrolment of many of those with heroin problems into treatment services. Injecting as the main route of administration has declined from 28 % in 2006 to 20 % in 2013.

            In addition to the therapeutic benefits of treatment provision, Europe’s overall high rate of treatment coverage, estimated at 50 % of cases or more, is likely to make the European Union a smaller and potentially less attractive market for those supplying this drug.

            Formulating effective responses to reduce overdose deaths remains a key policy challenge in Europe. Recent outbreaks and the situation in a few European countries underline the need for continued vigilance and ensuring that service provision levels are adequate. It remains that the misuse of benzodiazepines in combination with opioids is associated with elevated risk of drug overdose.

            Efforts also are still needed to address the relatively high rates of hepatitis C infection still found among injecting drug users. Here, new and effective treatments are becoming available, although treatment costs are high.

            Developments in this area include the introduction of targeted strategies, the provision of naloxone programmes and prevention initiatives targeting high-risk groups. Some countries have a long-established practice of providing ‘supervised drug consumption rooms’, with the intention of engaging with hard-to-reach drug users and reducing drug-related harms, including overdose deaths. Nonetheless, The EMCDDA report notes, however, that in some countries, and with support at European level, efforts are being made to improve the situation.

            As heroin dependence is a chronic condition, a specific issue is that the services provided need to adapt to the needs of an ageing cohort, and provision of an appropriate health and social service response for this group is therefore a growing challenge for drug services. A history of poor health, bad living conditions, tobacco and alcohol use, and age-related deterioration of the immune system make these users quite susceptible to a range of chronic health problems. Among these are cardiovascular and lung problems resulting from chronic tobacco use and injecting drug use and long-term use of other substances, including alcohol or misuse of benzodiazepines among high-risk drug users.

            What is the evolution of the « heroin market » in Europe?

              The clandestine nature of the drug market means that any analysis of its dynamics must be made with caution. Nonetheless, evidence is emerging of innovation in the supply of heroin to markets in Europe, and potential for a resurgence of the drug exists. Signs of change in heroin supply include detection of heroin processing laboratories in Europe — not seen before — as well as evidence of adaptation in heroin trafficking routes and in the modus operandi of criminal groups. The transit of heroin from Pakistan and Afghanistan into Europe through Africa continues to cause concern. Seizure data also point strongly to the role that Turkey plays as a geographical gateway for drugs being shipped into and out of the European Union, and heroin seizures in that country have partially recovered from a low point recorded in 2011.

              What about the prevalence of the new psychoactive substances?

                Public and policy concern about the use of new psychoactive substances has grown considerably in a short time. While the use of new psychoactive substances appears to be limited overall, the pace of emergence of both the variety and the quantity of new drugs identified on the drug market continue to increase. In 2014, 101 new psychoactive substances were detected, and it is noticeable how the new drugs coming onto the market, mainly synthetic cannabinoids, stimulants, hallucinogens and opioids, mirror the established substances. An unprecedented formal risk assessments of six of these new drugs were conducted in 2014 showing the importance of keeping a focus on the substances that may cause particular harm. This achievement was helped by the improved availability of information on both hospital emergencies and toxicology.

                To avoid controls, many new products are often mislabelled, for example as ‘research chemicals’, with disclaimers stating “product not intended for human consumption’. These products are marketed through online retailers and specialised shops, and increasingly they are offered through the same channels used for the supply of illicit substances. The Internet has also been an important driver for the development of the market for new psychoactive substances, both directly, through online stores, and indirectly, by allowing producers easy access to research and pharmaceutical data and by providing potential consumers with a forum for information exchange.

                Studies show that the use of new psychoactive substances occurs among groups as diverse as school students, party-goers, psychonauts, prisoners and injecting drug users. The motivations for use are diverse and include factors such as legal status, availability and cost, as well as the desire to avoid detection and user preferences for particular pharmacological properties. There is also evidence to suggest that new psychoactive substances have functioned as market substitutes at times of low availability and poor quality of established illicit drugs such as MDMA and cocaine.

                It will be interesting to see whether the increases now being observed in the potency and purity of established drugs will have implications for the consumption of new psychoactive substances. Estimation in this area is challenging for methodological reasons, and to date national estimates have been difficult to compare, while acknowledging that the recent Flash Eurobarometer on young people and drugs would suggest that lifetime use of new psychoactive substances remains at low levels among young people in most countries.

                What is the situation for amphetamine, ecstasy and other psychoactive substances?

                  • Amphetamine and methamphetamine are both manufactured in Europe for the domestic market, although some is also manufactured for export, principally to the Middle East and the Far East, respectively. Some methamphetamine production is centred on Lithuania while production based on ephedrine and pseudoephedrine is centred on the Czech Republic, although some is also occurring in Slovakia and now Germany. More than half of the total quantity of amphetamine seized was accounted for by Germany, the Netherlands and the United Kingdom. After a period of relative stability, there was an increase in the quantity of amphetamine seized in 2013, and there are indications that methamphetamine use is diffusing to other countries and new populations.
                  • Ecstasy is the common name of the synthetic substance MDMA , which is chemically related to amphetamines, but differs to some extent in its effects. Ecstasy tablets have historically been the main MDMA product on the market, although they may often contain a range of MDMA-like substances and unrelated chemicals.

                  Problems associated with use of this drug include acute hyperthermia, increased heart rate and multi-organ failure, and long-term use has been linked with liver and heart problems. Deaths associated with this drug remain relatively rare. Production of MDMA in Europe appears to be concentrated around the Netherlands and Belgium. About 4.8 million MDMA tablets were seized in the European Union in 2013. A recent upturn is also evident in indexed trends of MDMA-related offences.

                  • Synthetic cathinones such as mephedrone, pentedrone and MDPV3 were first introduced as new psychoactive substances, not controlled under drug laws, and have become a fixture on the illicit drug market in some European countries. Cathinones are used in similar ways to, and often interchangeably with, other stimulants such as amphetamine and MDMA.
                  • LSD4, ketamine, GHB (gamma-hydroxybutyrate) and hallucinogenic mushrooms are among the other psychoactive substances with hallucinogenic, anaesthetic and depressant properties that are used in Europe. There is growing recognition of the health problems related to these substances, for example, damage to the bladder associated with long-term ketamine use. Loss of consciousness, withdrawal syndrome and dependence are risks linked to use of GHB.

                  Is the illicit drug market competition leading to more potent products?

                    This year’s round of data collection found evidence of purity or potency (expressed, in the case of cannabis,as the level of the active substance tetrahydrocannabinol) increases in the medium or short term for all the most commonly used drugs in Europe. The reasons for this are likely to be complex, but appear to include both technical innovation and market competition. In the case of cannabis, where domestically produced, high-potency herbal products have taken an increasing market share in recent years, the data now point to an increase in the potency of imported resin, which is likely to be associated with changes in production practices. Innovation in the market and increased purity are also evident in the case of MDMA.

                    Over the last year, an alert warning of health risks has been issued linked to the consumption of very high purity MDMA products. In addition, alerts have also been issued about tablets sold as ecstasy, but containing PMMA5, sometimes in combination with MDMA. The pharmacology of this drug makes it particularly worrying from a public health point of view. Indeed, after a period in which tablets sold as ‘ecstasy’ had a reputation among consumers for poor quality and product adulteration, which was supported by forensic evidence, high-purity MDMA powder and tablets are now more commonly available. The introduction of high-purity powder or crystal MDMA appears to be a deliberate strategy for differentiating this form of MDMA and making it more attractive to consumers. Similarly, high-dose tablets with distinctive shapes and logos are appearing, presumably with the same marketing objective.

                    For MDMA, and synthetic substances in general, product quality and supply are largely driven by the availability of precursor chemicals in relation to innovative production practices. It has also been suggested that, in some countries, the availability of new psychoactive substances may offer direct competition to lower-quality, and relatively more expensive, established drugs.

                    Is the combination of sexual and drug risk-taking behaviour a growing area of concern?

                      Some drug-taking behaviours are linked to socio-cultural factors and in some large European cities, concerns exist about the spread of stimulant injection among small groups of men who have sex with men. Practices involving the so-called slamming of methamphetamine, cathinones and other substances in the context of ‘chem-sex’ parties have implications for both HIV transmission and sexual health services.

                      This phenomenon runs contrary to the overall European trend in injecting drug use, which is declining in most populations, and underlines a general need to increase the attention given to the link between drugs and sexual risk-taking behaviour and highlights a need for joined-up responses in this area of growing concern.

                      Is Internet and its applications playing an increasing role in illicit drug markets?

                        Reflecting developments elsewhere, both new psychoactive substances and established drugs are being offered for sale on the surface and deep web, although the extent to which this occurs is unknown. Bearing in mind that in most other fields of commerce, consumer activity is moving from physical to online marketplaces, online drug markets may become an important area for focusing monitoring activity in the future. Another development relates to drug supply and the sharing of drugs or drug experiences via social media, including mobile apps. This area remains both poorly understood and difficult to monitor.

                        In parallel, there is also a growing trend for both drug and sexual health services to use the Internet and applications as platforms for delivering services. Information provision on drugs, prevention programmes and outreach services are, in varying degrees, relocating from physical spaces to virtual environments with many drug treatment programmes now accessible to both new and existing target groups.

                        These developments are also a challenging area for drug control policies, as developments can occur rapidly, such as the introduction of new marketplaces and cryptocurrencies. Existing regulatory models will need to be adapted to perform in a global and virtual context.

                        What is done to improve the fight against illicit drug uses?

                          Evaluation of drug strategies and action plans has been conducted in many countries with the aim to assess the changes in the overall drug situation as well as the level of implementation achieved. Prevention of drug use and drug-related problems among young people is a key policy objective and is one of the pillars of the European Drugs Strategy 2013–20. Drug prevention encompasses a wide range of approaches. Eight countries adopted national strategies and action plans that cover both licit and illicit drugs. More attention is being paid to the development of targeted education and prevention activities, as well as training and awareness raising activities for professionals.

                          Regarding the emergence of new psychoactive substances in European countries, initial responses have been predominantly regulatory in nature, focused on tackling their supply by using legislative tools. New EU legislation was introduced in 2013 to strengthen controls over the trade in some drug precursors, both within the European Union and between Member States and third countries.

                          Targeted interventions also can facilitate access to treatment and ensure that the needs of different groups are met. The available information suggests that this kind of approach is currently most commonly available to young drug users, those referred from the criminal justice system, and pregnant women.

                          An estimated 700 000 opioid users received substitution treatment in the European Union in 2013, and a slight downtrend has been observed since 2011. In many countries a majority of opioid users are, or have been, in contact with treatment services. At national level, however, large differences still exist in coverage rates. Data for the period 2009–12 show a decline in public spending on health in most countries, compared with the pre-recession period 2005–07, with reductions of more than 10 percentage points in many European countries, at constant prices.

                          Programmes for homeless drug users, older drug users, and lesbian, gay, bisexual and transgender drug users were less frequently available, despite many countries reporting that there was a need for this kind of provision.

                          1 Cocaine ranks second overall, with more than double the number of seizures reported for either amphetamines or heroin. The number of ecstasy seizures is relatively low.
                          2 3,4-méthylenedioxy-methamphetamine.
                          3 Methylenedioxypyrovalerone.
                          4 Lysergic acid diethylamide.
                          5 PMMA is the 4-methoxy analog of methamphetamine

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