Trends of the use and abuse of illicit drugs in Europe

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 regular (daily or almost daily) cannabis users.

Opioid drugs cause the most deaths, in the range of 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. However, the view of the public health consequences related not just to new psychoactive substances but, more generally, to contemporary drug consumption patterns remains limited. HIV-related mortality is one of the best documented indirect causes of death among drug users.

The European drug markets continue to change and evolve rapidly : in 2014, over a hundred new psychoactive substances were detected.

Health and social responses include a wide range of efforts established for illicit substances, from drug education and training activities, to user-led consumer protection interventions on the Internet.

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). In addition of those, there has been a recent emergence in recent years of over 130 different synthetic cannabinoid products manufactured in China that have added a new dimension to the cannabis market. These chemicals are typically added to plant material and packaged for sale as ‘legal high’ products and increasing cases of acute health problems are associated with these high-potency cannabis products. There is an increase in the number of treatment demands for cannabis-related problems and the evidence also supports psychosocial interventions.

Considerable diversity exists between countries in sentencing practices for cannabis-related supply offences, and cannabis is the most commonly seized drug accounting for 80 % of seizures with an increased involvement of organised crime. In Europe, discussion on cannabis remains largely focused on the potential health costs associated with this drug.

What about the cases of heroin and cocaïne uses?

Heroin is the most common opioid on the European drug market even if there is an overall stagnation in demand. 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. Worryingly, 14 new synthetic opioids have been reported since 2005 and in some countries where purity increases have been observed ; overdose deaths have also increased in recent data.

In terms of treatment, the long-term picture shows clear improvement overall and illustrates the impact that providing the appropriate services can have. Formulating effective responses to reduce overdose deaths remains a key policy challenge in Europe. Other challenges include the misuse of benzodiazepines in combination with opioids, the relatively high rates of hepatitis C infection, and adapting to an ageing cohort.

Cocaine , in Europe, is available in two forms produced almost exclusively in Bolivia, Colombia and Peru, the most common of which is cocaine powder, and less commonly available is crack cocaine, a smokeable form of the drug. Decreases in cocaine use are observable in the most recent data. Meanwhile, over 800 deaths associated with cocaine use were reported in the European Union in 2013.

What is the situation for amphetamines, ecstasy and other stimulants like GHB?

• The quantity of amphetamine seized increased in 2013 after a period of relative stability. Acute effects linked to amphetamines use include cardiovascular, pulmonary, neurological and mental health problems.
• Ecstasy tablets have historically been the main MDMA (3,4-méthylenedioxy-methamphetamine) product on the market. 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.
• Synthetic cathinones, first introduced as new psychoactive substances often interchangeably with, other stimulants are not controlled under drug laws and have become a fixture on the illicit drug market in some European countries.
• LSD, hallucinogenic mushrooms, ketaminea and GHB are among the other psychoactive substances with hallucinogenic, anaesthetic and depressant properties presenting health problems including damage to the bladder. Loss of consciousness, withdrawal syndrome and dependence are specific risks linked to use of GHB².

Are there new developments on the drug market?

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 for the first time, mainly synthetic cannabinoids, stimulants, hallucinogens and opioids that mirror the effects of established substances.

The purity and consecutive potency (expressed as the level of the active substance tetrahydrocannabinol or THC in the case of cannabis) of all the most commonly used drugs in Europe is increasing, possibly for both technical innovation and market competition reasons. Very high purity MDMA products in particular are worrying, making it more attractive to consumers, and an alert warning of health risks has been issued. 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.

The internet is playing an increasing role on the drug market. Drugs are being offered online, experiences are shared through social media, but increasingly health services are also offering information and help online.

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

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. 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 highlights a need for joined-up responses in this area.

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

The prevention of drug use and drug-related problems among young people is one of the pillars of the European Drugs Strategy 2013–20. National strategies and action plans that cover both licit and illicit drugs have been adopted by eight countries. Increasingly, however, more attention is being paid to the development of targeted education and prevention activities, as well as training and awareness raising activities for professionals. The Internet is also increasingly important as a platform for the provision of information and counselling.

Targeted interventions should facilitate access to treatment and ensure that the needs of different groups are met in particuar young drug users, those referred from the criminal justice system and pregnant women. In 2013, an estimated 700 000 opioid users received substitution treatment in the European Union.

Targeted programmes for users of other vulnerable demographics, such as homeless, older, or LGBTQ people were less frequently available, despite many countries reporting that there was a need for this kind of provision.

² Gamma hydroxybutyrate