EUROPEAN REPORT ON DRUGS 2023: MAIN POINTS
Greater diversity of supply and use of drugs creates new challenges for drug policy and healthcare in Europe. This is one of the problems highlighted today by the EU Agency for Drugs (European Monitoring Centre for Drugs and Drug Addiction, EMCDDA) when issuing its European Drug Report 2023: Trends and Developments in Brussels (1). The report provides the latest overview of the drug situation in Europe, examining key trends and emerging threats.
The availability of drugs remains high for all types of substances and the scale and complexity of illicit drug production in Europe continues to increase. People who use drugs are now exposed to a larger range of psychoactive substances, often with high efficiency and purity. As they can be sold in the form of similar looking powders or tablets, consumers may not know what they are taking. The report underlines the need for effective risk reporting strategies to alert consumers to health damage associated with new substances, drug interactions and high-efficiency products.
The analysis covers a wide range of illicit drugs, from opioids and stimulants to new cannabis products and dissociative drugs (e.g. ketamine). It also provides up-to-date information on new psychoactive substances (NPSs) which continue to pose a threat to public health in Europe. In 2022, 41 new medicines were first reported through the EU Early Warning System (EWS), increasing the total number of NPS monitored by the EMCDDA to 930.
The report underlines the need to improve forensic and toxicological data in order to better understand the threats arising from new and strong synthetics, drug mixtures, modified substances, changing drug markets and patterns of use. As part of its new mandate in 2024, the Agency will launch a European network of forensic and toxicological laboratories to strengthen capacity in this area (2).
Head of the EMCDDA Alexis Goosdeel Says: "This year's report strongly reminds us that problems with illicit drugs can be encountered throughout our society. To sum it up, wherever, whatever, whoever, Illegal drugs are currently widely available and new active substances are still emerging. Almost everything that has psychoactive properties, often mislabelled or mixed, can appear on the drug market. This is why illegal drugs can affect everyone, whether directly through use or indirectly, through their impact on families, communities, institutions and businesses. At the same time, they increasingly expose our citizens to drug-related violence and its consequences. Today, we highlight the challenges posed by stimulants, synthetic drugs and new cannabis products. It is very important that we step up forensic and toxicological testing in order to better detect emerging threats and protect public health. We also need to invest more in services, which must now meet more diverse and complex needs.
Development of a new cannabis policy in a complex market
The scope of policies on hemp in Europe is gradually expanding and currently includes not only the control of illegal hemp, but also the regulation of cannabis and cannabinoids for therapeutic and other purposes (e.g. cosmetics, foodstuffs).
Currently, five EU Member States (Czech Republic, Germany, Luxembourg, Malta and the Netherlands) plus Switzerland are introducing or planning to introduce new approaches to regulating the supply of cannabis for recreational purposes. These changes outlined in the report underline the need to invest in monitoring and evaluation in order to fully understand their impact on public health and safety (3).
Cannabis remains the most commonly used illicit drug in Europe. Last year, it is estimated that around 8% (22.6 million) of European adults (15-64 years) used cannabis. In 2021, the quantity of cannabis resin (816 tonnes) and plant cannabis (256 tonnes) seized in the EU reached the highest level in the last ten years, indicating the high availability of the drug. It is estimated that in Europe 97 000 clients have entered some form of drug treatment in 2021 due to problems related to cannabis use.
New cannabis products pose a threat to public health. Some products sold on the illegal market, such as natural cannabis, may be mixed with strong synthetic cannabinoids, thus creating a risk of poisoning. Highly effective extracts and edible substances are associated with acute poisoning in hospital emergency reception departments.
In 2022, hexahydrocannabinol (HHC) became the first semisynthetic cannabinoid reported in the EU . This substance has been identified in two thirds of the Member States and in some EU countries, it is sold as a "legal'" alternative to cannabis (4). Since October 2022, HHC has been subject to intensive monitoring under the EU's Early Warning System (EWS) to better understand the potential risks for Europe.
Record cocaine seizures and growing concerns about the use of synthetic stimulants
Trafficking large volumes of cocaine via European sea ports in commercial containers currently leads to high availability of this drug. There are concerns that this situation may contribute to increased cocaine use, harm to health and drug crime. In 2021, EU Member States seized record 303 tonnes of cocaine. Belgium (96 tonnes), the Netherlands (72 tonnes) and Spain (49 tonnes) seized almost 75% of the total quantity seized. Preliminary data for 2022 show that the amount of cocaine seized in Antwerp, the second largest seaport in Europe, increased from 91 tonnes in 2021 to 110 tonnes. Evidence suggests that organised crime groups are also increasingly targeting smaller ports in other EU countries as well as those bordering the EU. . Illegal cocaine production in the EU is becoming increasingly important, with 34 cocaine laboratories being abolished in 2021 (23 in 2020), some of which were large-scale.
Cocaine is the most commonly used illegal stimulant drug in Europe, which last year has been used by around 1.3% (3.7 million) of European adults (15-64 years). In 2021, this was the most common substance associated with acute poisoning symptoms in hospital emergency departments, which was mentioned in 27% of cases. There are also some indications that cocaine injection and crack use are becoming more common among marginalised groups in some countries, which requires an extension of harm reduction measures. It is estimated that 7 500 crack treatment records were registered in 2021.
The wider variety of synthetic stimulants currently available on the illegal market increases the risks to public health. In the past, amphetamine was the most commonly used synthetic stimulant in Europe. However, there are indications that both methamphetamine and synthetic cathinones currently contribute to overall stimuli problems in Europe more strongly than in the past.
The report also states that stimulants are now more often injected, sometimes in combination with heroin or other opioids. Understanding the harm associated with changing injecting patterns of drug use will be key to proposing interventions that reduce the harm associated with this behaviour.
Potential health risks of less known substances
Ketamine, which is used as an anaesthetic and painkiller in medicine, has become a more widespread recreational drug in some environments. It is commonly snorted and sometimes added to other mixtures of medicines, including MDMA powders and tablets. Long-term users of ketamine may have health problems (e.g. bladder damage).
The increase in recreational use of nitrous oxide (the so-called gas of laughter) in some parts of Europe raises health concerns. A recent survey by the EMCDDA (5) highlighted the risks associated with this drug, which now appears to be more accessible, cheaper and more popular among some young people. These risks may include poisoning, burns and lung injuries and in some cases prolonged use nerve damage. There is a strong argument for dealing with drug prevention and harm reduction services in their work. Regulatory approaches to the sale and use of this substance vary from country to country.
Today's report also addresses the growing interest in the therapeutic potential of psychedelic substances. Although there is promising research into the potential of these substances in treating various mental disorders, the report highlights the risk of unregulated programmes operating within the EU and elsewhere. Growing interest in this topic can encourage greater experimental use of these substances without medical support, potentially threatening some vulnerable individuals.
Opioid problems in Europe are developing
Heroin remains the most commonly used illicit opioid in Europe, but in some areas there are also growing concerns about the use of synthetic opioids. Many synthetic opioids are very effective and present a risk of poisoning and death. Only small quantities are needed to produce thousands of doses, making organised criminal groups potentially more lucrative.
New uncontrolled synthetic opioids continue to emerge on the European drug market, with a total of 74 opioids identified since 2009. In recent years, most newly identified opioid substances have been reported to the EWS by highly effective benzimidazole (nitazene) opioids. Compared to North America, new synthetic opioids (e.g. fentanyl derivatives and rivetenes) currently play a relatively small role in the overall European drug market, although they represent a significant problem in some countries.
New synthetic opioids (including benzimidazoles and fentanyl derivatives) are associated with an increase in overdose deaths in the Baltic countries. New synthetic opioids have been found in mixtures containing benzodiazepines and sedatives for xylazine in Estonia. These combinations, known as -benzo-dopa- and -tranq-dopa-, have been associated with deaths due to overdose in North America. The report states: ... although problems in this area are currently relatively limited, this group of substances poses a threat with a potential for a greater impact on European health and safety in the future.
The availability of heroin still seems to be high today. The amount of heroin seized by EU Member States has more than doubled to 9.5 tonnes in 2021, while Turkey seized record 27.2 tonnes. Almost all heroin consumed in Europe comes from Afghanistan, where the Taliban announced a ban on opium poppy growing in April 2022. Although it is too early to say how the ban will affect the European heroin market, there is concern that any lack of availability of this drug could be linked to an increase in the supply and demand of synthetic opioids.
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Chairman of the EMCDDA's Management Board Franz Pietsch concluded: Today's report is an important resource for obtaining a strategic overview of the European drug situation and its implications for public health and safety. The publication of the report comes at a crucial time, as the EMCDDA is preparing for a new mandate and a new future. We look forward to implementing this promising new mission, where the Agency will expand its monitoring capacity, strengthen the EU's readiness and help develop competences for better drug interventions."
(1) See https://www.emcdda.europa.eu/event/2023/06/launch-event-european-drug-report-2023 en. Report describing the drug situation by the end of 2022, based on 2021 data and, where available, 2022. (2) In 2024, the EMCDDA will become the European Union Agency for Drugs (EUDA), with an extended mandate. (3) https://www.emcdda.europa.eu/publications/faq/cannabis-laws-europe-questions-and-answers-for-policymaking en (4) https://www.emcdda.europa.eu/news/2023/new-cannabinoid-hhhc-spotlight-market-evolves en (5) https://www.emcdda.europa.eu/news/2022/11/no-laughing-matter-new-report-shows-rise-recreational-use-nitrous-oxide en