EMCDDA Full Report 2024

European Drug Report 2024: Trends and Developments
European Drug Report 2024:

Trends and Developments
This PDF was generated automatically on 11/06/2024 from the web page located at this address:
https://emcdda.europa.eu/publications/european-drug-report/2024. Some errors may have
occurred during this process. For the authoritative and most recent version, we recommend
consulting the web page.
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Table of contents
Understanding Europe’s drug situation in 2024 – key developments (European Drug

Report 2024)
Drug supply, production and precursors – the current situation in Europe (European
Drug Report 2024)
Cannabis – the current situation in Europe (European Drug Report 2024)
Cocaine – the current situation in Europe (European Drug Report 2024)
Synthetic stimulants – the current situation in Europe (European Drug Report 2024)
MDMA – the current situation in Europe (European Drug Report 2024)
Heroin and other opioids – the current situation in Europe (European Drug Report
2024)
Other drugs – the current situation in Europe (European Drug Report 2024)
New psychoactive substances – the current situation in Europe (European Drug

Report 2024)
Injecting drug use in Europe – the current situation (European Drug Report 2024)
Drug-related infectious diseases – the current situation in Europe (European Drug

Report 2024)
Drug-induced deaths – the current situation in Europe (European Drug Report 2024)
Opioid agonist treatment – the current situation in Europe (European Drug Report
2024)
Harm reduction – the current situation in Europe (European Drug Report 2024)
List of figures (European Drug Report 2024)
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The European Drug Report 2024: Trends and Developments presents the EMCDDA’s latest analysis
of the drug situation in Europe. Focusing on illicit drug use, related harms and drug supply, the
report provides a comprehensive set of national data across these themes, as well as on specialist
drug treatment and key harm reduction interventions.
Introductory note
This report is based on information provided to the EMCDDA by the EU Member States, the
candidate country Türkiye, and Norway, in an annual reporting process.
The purpose of the current report is to provide an overview and summary of the European drug
situation up to the end of 2023. All grouping, aggregates and labels therefore reflect the situation
based on the available data in 2023 in respect to the composition of the European Union and the
countries participating in EMCDDA reporting exercises. However, not all data will cover the full
period. Due to the time needed to compile and submit data, many of the annual national data sets
included here are from the reference year January to December 2022. Analysis of trends is based
only on those countries providing sufficient data to describe changes over the period specified. The
reader should also be aware that monitoring patterns and trends in a hidden and stigmatised
behaviour such as drug use is both practically and methodologically challenging. For this reason,
multiple sources of data are used for the purposes of analysis in this report. Although considerable
improvements can be noted, both nationally and in respect to what is possible to achieve in a
European-level analysis, the methodological difficulties in this area must be acknowledged. Caution
is therefore required in interpretation, in particular when countries are compared on any single
measure. Caveats relating to the data are to be found in the online Statistical Bulletin, which
contains detailed information on methodology, qualifications on analysis and comments on the
limitations in the information set available. Information is also available there on the methods and
data used for European-level estimates, where interpolation may be used.
Content
The drug situation in Europe up to 2024
This page draws on the latest data available to provide an overview of the current situation and
emerging drug issues affecting Europe, with a focus on the year up to the end of 2023. The analysis
presented here highlights some developments that may have important implications for drug policy
and practitioners in Europe.The drug situation in Europe up to 2024
Drug supply, production and precursors

Analysis of the supply-related indicators for commonly used illicit drugs in the European Union
suggests that availability remains high across all substance types. On this page, you can find an
overview of drug supply in Europe based on the latest data, supported by the latest time trends in
drug seizures and drug law offences, together with 2022 data on drug production and precursor
seizures.Drug supply, production and precursors – the current situation in Europe
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Cannabis
Cannabis remains by far the most commonly consumed illicit drug in Europe. On this page, you can
find the latest analysis of the drug situation for cannabis in Europe, including prevalence of use,
treatment demand, seizures, price and purity, harms and more. Cannabis – the current situation in
Europe
Cocaine
Cocaine is, after cannabis, the second most commonly used illicit drug in Europe, although
prevalence levels and patterns of use differ considerably between countries. On this page, you can
find the latest analysis of the drug situation for cocaine in Europe, including prevalence of use,
treatment demand, seizures, price and purity, harms and more.Cocaine – the current situation in
Europe
Synthetic stimulants
Amphetamine, methamphetamine and, more recently, synthetic cathinones are all synthetic central
nervous system stimulants available on the drug market in Europe. On this page, you can find the
latest analysis of the drug situation for synthetic stimulants in Europe, including prevalence of use,
treatment demand, seizures, price and purity, harms and moreSynthetic stimulants – the current
situation in Europe
MDMA
MDMA is a synthetic drug chemically related to the amphetamines, but with somewhat different
effects. In Europe, MDMA use has generally been associated with episodic patterns of consumption
in the context of nightlife and entertainment settings. On this page, you can find the latest analysis
of the drug situation for MDMA in Europe, including prevalence of use, seizures, price and purity and
more. MDMA – the current situation in Europe
Heroin and other opioids

Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large share of the
health burden attributed to illicit drug consumption. Europe’s opioid problem, however, continues to
evolve in ways that are likely to have important implications for how we address issues in this
area. On this page, you can find the latest analysis of the drug situation for heroin and other opioids
in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and
more. Heroin and other opioids – the current situation in Europe
New psychoactive substances

The market for new psychoactive substances is characterised by the large number of substances
that have emerged, with new ones being detected each year. On this page, you can find an overview
of the drug situation for new psychoactive substances in Europe, supported by information from the
EU Early Warning System on seizures and substances detected for the first time in Europe. New
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substances covered include synthetic and semi-synthetic cannabinoids, synthetic cathinones, new
synthetic opioids and nitazenes. New psychoactive substances – the current situation in Europe
Other drugs
Alongside the more well-known substances available on illicit drug markets, a number of other
substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in
Europe: these include LSD, hallucinogenic mushrooms, ketamine, GHB and nitrous oxide. On this
page, you can find the latest analysis of the situation regarding these substances in Europe,
including seizures, prevalence and patterns of use, treatment entry, harms and more.Other drugs –
the current situation in Europe
Injecting drug use

Despite a continued decline in injecting drug use over the past decade in the European Union, this
behaviour is still responsible for a disproportionate level of both acute and chronic health harms
associated with the consumption of illicit drugs. On this page, you can find the latest analysis of
injecting drug use in Europe, including key data on prevalence at national level and among clients
entering specialist treatment, as well as insights from studies on syringe residue analysis and more.
Injecting drug use – the current situation in Europe
Drug-related infectious diseases

People who inject drugs are at risk of contracting infections through the sharing of drug use
paraphernalia. On this page, you can find the latest analysis of drug-related infectious diseases in
Europe, including key data on infections with HIV and hepatitis B and C viruses.Drug-related
infectious diseases – the current situation in Europe
Drug-induced deaths
Estimating the mortality attributable to drug use is critical for understanding the public health
impact of drug use and how this may be changing over time. On this page, you can find the latest
analysis of drug-induced deaths in Europe, including key data on overdose deaths, substances
implicated and more. Drug-induced deaths – the current situation in Europe
Opioid agonist treatment

Opioid users represent the largest group undergoing specialised drug treatment, mainly in the form
of opioid agonist treatment. On this page, you can find the latest analysis of the provision of opioid
agonist treatment in Europe, including key data on coverage, the number of people in treatment,
pathways to treatment and more.Opioid agonist treatment – the current situation in Europe
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Harm reduction
Harm reduction encompasses interventions, programmes and policies that seek to reduce the
health, social and economic harms of drug use to individuals, communities and societies. On this
page, you can find the latest analysis of harm reduction interventions in Europe, including key data
on opioid agonist treatment, naloxone programmes, drug consumption rooms and more. Harm
reduction – the current situation in Europe
PDF version of full report

The European Drug Report 2024 was designed as a digital-first product, structured by modules, and
optimised for online reading. Within each chapter, you may download a PDF version of the page.
However, for convenience we are also making available here a PDF version of the full report (all
modules and annex tables combined). Please note that, some errors may have occurred during
the transformation process.
Download full PDF version of the European Drug Report 2024 (available shortly)
Data visualisations and list of figures

A list of all figures available in the report is available.
A selection of data visualisations from the report will be made available shortly.
Annex tables
These tables, produced specifically for the European Drug Report, provide national data for
estimates of drug use prevalence including problem opioid use, substitution treatment, total number
in treatment, treatment entry, injecting drug use, drug-induced deaths, drug-related infectious
diseases, syringe distribution and drug seizures. The data are drawn from and are a subset of the
EMCDDA Statistical Bulletin 2024, where notes and meta-data are available. The years to which
data refer are indicated. In addition, for some indicators, these data tables also provide total values
for EU as well as for EMCDDA reporting countries, 'EU+2' (EU Member States, Türkiye and Norway).
European Drug Report 2024 annex tables
Source data
Links to all source data used in the report for by data visualisations may be found at the bottom of
each chapter, as well as, in most cases, beneath each graphic.The entire source data set for the
report, including data for tables which appear within the report, may be found using the link below.
All data is is fully compatible with the Creative Commons Attribution 4.0 International (CC BY 4.0)
licence.
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Complete set of source data for the European Drug Report 2024
Acknowledgements
The EMCDDA would like to thank the following for their help in producing this report:
the heads of the Reitox national focal points and their staff;
the Early Warning System correspondents of the Reitox national focal points and experts from
their national early warning system network;
the services and experts within each Member State that collected the raw data for this report;
the members of the Management Board and the Scientific Committee of the EMCDDA;
the European Parliament, the Council of the European Union — in particular its Horizontal
Working Party on Drugs — and the European Commission;
the European Centre for Disease Prevention and Control (ECDC), the European Medicines
Agency (EMA) and Europol;
the Pompidou Group of the Council of Europe, the United Nations Office on Drugs and Crime
(UNODC), the WHO Regional Office for Europe, Interpol, the World Customs Organisation (WCO)
, the European School Survey Project on Alcohol and Other Drugs (ESPAD), the Sewage Analysis
Core Group Europe (SCORE), the European Drug Emergencies Network (Euro-DEN Plus), the
European Syringe Collection and Analysis Project Enterprise (ESCAPE) network, the European
Network of Drug Consumption Rooms (ENDCR) and the Trans-European Drug Information
network (TEDI).
Reitox national focal points

Reitox is the European information network on drugs and drug addiction. The network is
comprised of national focal points in the EU Member States, the candidate country Türkiye,
Norway and at the European Commission. Under the responsibility of their governments, the
focal points are the national authorities providing drug information to the EMCDDA.
About this page

Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2024),
European Drug Report 2024: Trends and Developments,
https://www.emcdda.europa.eu/publications/european-drug-report/2024_en
Identifiers:
HTML: TD-AT-24-001-EN-Q ISBN: 978-92-9497-975-9 DOI: 10.2810/91693
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Understanding Europe’s drug

situation in 2024 – key
developments (European Drug
Report 2024)
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The EMCDDA’s latest analysis of the European drug

phenomenon reveals a drug market that is both resilient and
influenced by developments taking place at the global level.
The continuing health and security problems presented by
established and newer illicit drugs, and increasingly the
interplay between them, create a challenging policy context
for the shaping and implementation of effective responses.
The European Drug Report 2024 provides a snapshot of the
drug situation in Europe based on the latest data available.
This introductory section provides a brief analytical
commentary on some of the important issues that are
currently featuring on Europe’s drug policy agenda.
This page is part of the European Drug Report 2024, the

EMCDDA's annual overview of the drug situation in Europe.
Last update: 11 June 2024
EVERYWHERE, EVERYTHING, EVERYONE

Responding to Europe’s evolving drug problems
A central message from the 2024 European Drug Report's analysis is that the impact of the use of
illicit drugs is now seen almost everywhere in our society. Almost everything with psychoactive
properties has the potential to be used as a drug. This means that everyone, whether directly or
indirectly, can be affected by illicit drug use and the problems associated with it.
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Everywhere
Today, drug issues have an impact almost everywhere.
Domestically, they are manifest in and exacerbate other
complex policy problems, such as homelessness, the
management of psychiatric disorders and youth criminality.
We are also observing greater levels of violence and
corruption driven by the drug market in some countries.
Internationally, drug problems are growing in many low- and
middle-income countries, undermining governance and
development, and adding to the already considerable public
health and security challenges many countries face.
Everything
Increasingly, we are observing that almost everything with
psychoactive properties can appear on the drug market,
often mislabelled or in mixtures, leaving consumers
potentially unaware of what they are using, increasing
health risks and creating new law-enforcement and
regulatory challenges.
Everyone
The impact of the developments we are seeing means that
everyone is in some way likely to be impacted by illicit drug
use, the operation of the drug market and the problems
associated with it. Directly, we see this in those who develop
problems and need treatment or other services. Indirectly,
we see it in the recruitment into criminality of vulnerable
young people, the strain on health budgets, and the social
costs for communities that feel unsafe or where institutions
or businesses are undermined by corruption or criminal
practices.
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The European Union Drugs Agency – providing Europe with

greater capacity to respond effectively to a more complex and
rapidly changing drug phenomenon
Since the EMCDDA’s foundation in 1993, the extent and nature of
the drug phenomenon has changed significantly. To address
the new challenges posed by contemporary drug issues, the
agency’s mandate has been revised, and on 2 July 2024 the
European Monitoring Centre for Drugs and Drug Addiction will be
transformed into the European Union Drugs Agency (EUDA).
The EUDA will support the European Union and its Member
States through improving and extending our monitoring of drug
use and drug-related problems, increasing our preparedness to identify and respond to new threats
and investing in competence development. These actions will contribute to the delivery of better
interventions in both the health and security areas.
The EUDA will provide services across four overlapping areas: anticipating new and future
challenges; identifying and issuing alerts on emerging risks and drug-related threats; assessing
needs and available responses; and assisting stakeholders by evaluating and disseminating new
knowledge and best practice.
The collection, analysis and dissemination of data will remain key tasks for the EUDA and be
complemented by new competences. These include a greater investment in understanding and
responding to problems arising from polydrug use and strengthening analytical capacity through the
establishment of a new network of forensic and toxicological laboratories. The EUDA will develop a
new European drug alert system to extend the current work of our Early Warning System on new
psychoactive substances and complement this with new health and security threat-assessment
capabilities. Greater investment will also be given to identifying research gaps and needs, and
regular foresight and scanning exercises will help increase EU preparedness to respond to future
challenges in the drug area. The EUDA will continue to work in close partnership with the Reitox
network of national drug focal points, whose role will be reinforced. Support will be provided for the
evaluation and development of evidence-based policies, and the agency will be in a position to
invest more in supporting EU-level policy needs in its activities. The agency will also be able to do
more to develop and promote evidence-based interventions and best practice, play a stronger
international role and support the European Union in drug policy at the multilateral level.
The drug situation in Europe in 2024 – an overview

High availability of wider range of often more potent substances
Analysis of supply-related indicators for commonly used illicit
drugs in the European Union suggests that availability remains
high across nearly all substance types. In addition, the information
available suggests that the market is now characterised by the
widespread availability of a broader range of drugs than in the
past, with substances often available at high potency or purity or
in new forms, mixtures or combinations. These include novel
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substances, where both consumer and scientific knowledge about the health risks may be limited.
There is a growing diversity in the forms in which substances can be available on the market and, in
some cases, such as cannabis for example, the routes of administration by which they may be
consumed, with edibles and various forms of vaping technologies appearing. These developments
increase concerns that the risks associated with some substances may be growing. In particular,
people who use drugs may be placed at greater risk of experiencing health problems, including
potentially fatal poisoning, through consuming, possibly unknowingly, higher-potency or more-novel
substances.
Targeting of commercial infrastructure is linked to high drug

availability
For substances trafficked into the European Union, an important
driver of increased availability is the ability of criminal groups to
exploit the opportunities provided by modern commercial
transportation infrastructure. Almost 70 % of the drug seizures by
customs authorities happen in the European Union’s ports, with
large-volume seizures of drugs, particularly cocaine, detected in
intermodal shipping containers. For example, in 2023 Spain
reported its largest ever seizure of cocaine in a single
shipment, with 9.5 tonnes of the drug concealed in bananas
originating from Ecuador. Large ports in Belgium and the Netherlands are also routinely targeted by
trafficking organisations, and there are concerns that smaller ports elsewhere in Europe are now
increasingly coming under threat.
The methods used by crime groups operating in this area have become increasingly sophisticated
with well-documented instances of infiltration of supply chains and exploitation of key staff through
intimidation and corruption. In response to this, the 2023 EU Roadmap Against Drug Trafficking
includes measures to strengthen customs risk-management and the detection of trafficked drugs
and precursor chemicals. This includes supporting the deployment of advanced container-scanning
equipment and increasing the interoperability of EU customs information systems. The
Roadmap also supports the newly established European Ports Alliance, a public-private partnership,
which includes actions to increase the resilience of Europe’s key logistical centres to drug trafficking
and infiltration by organised criminal groups.
Policy concerns grow about drug-related violence and the

exploitation of minors
Concerns are growing that as a consequence of high drug
availability, large-volume trafficking and competition between
criminal groups in Europe, some countries are experiencing an
increase in violence and other forms of criminality linked to the
operation of the drug market. Historically, the greatest burden of
violent crime associated with the drug market has been borne by
producer and transit countries outside of the European Union, and
this remains the case. However, in Europe, particularly in
countries where large volumes of drugs are known to enter or be
produced, levels of violence associated with the drug trade appear to be increasing. Accompanying
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this, concerns are also growing about the recruitment and exploitation of juveniles by criminal
networks involved in the illicit drugs trade. This is reflected in the increasing priority given to
countering these threats by law enforcement agencies. Currently, monitoring trends and
developments in drug-related crime at the European level is challenging. In response, the EMCDDA
has been investing in improving monitoring tools in this area, an example of which can be seen in
recent work to develop an indicator of drug-related homicides. The EUDA, working in close
partnership with Europol and the European Commission, will invest more in this area in the future,
as sound information is likely to be a prerequisite for the design of effective intervention strategies
to counter the violence, corruption and criminal exploitation increasingly associated with the
operation of some contemporary European drug markets.
Polydrug consumption and drug mis-selling increase risks to

health
Polydrug use is the use of two or more psychoactive
substances, licit or illicit, simultaneously or sequentially. A related
issue is that substances may be sold that contain one or more
drugs other than the one the purchaser was expecting, either in a
mixture with the substance they intended to purchase or as a
replacement for it. This means that consumers may be unaware of
what substance or substances they are actually consuming. Using
drugs in combination can increase the risk of health problems and
complicate the delivery of effective interventions, an issue for example in responding to acute
poisoning.
A key message of this year’s European Drug Report is that polydrug consumption is common among
those consuming psychoactive substances, and using drugs in this way can increase the risks of
incurring serious health problems. Challenges in this area also appear to be growing. This is partly
due to increased market integration of established illicit drugs and new psychoactive substances,
and partly to the wider availability and use of synthetic substances. Concerns in this area include
cannabis products adulterated with synthetic cannabinoids, products sold as MDMA but sometimes
containing synthetic cathinones as adulterants, and the appearance of highly potent synthetic
opioids mixed with or mis-sold as other substances. It is also important to note that the combined
use of alcohol with illicit drugs can also increase health risks, for example when alcohol is taken in
combination with cocaine, opioids or new or ‘street’ benzodiazepines.
Forensic, toxicological and innovative new data sources are

needed
One of the challenges facing drug surveillance in 2024 is to gain a
deeper understanding of what drugs are actually being consumed
and in what combinations. Enhancing the monitoring of patterns
of polydrug use and increasing our understanding of what
constitutes effective interventions in this area will therefore be
priorities for the future work of the EUDA. Improving the sources
of toxicological and forensic data and the information they provide
will be a key component in achieving a better understanding of
what substances are being sold on the market and which drugs or drug combinations are
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particularly associated with harm. In addition, the EUDA will continue to invest in developing new
data sources that can provide a more detailed picture of drug consumption patterns, such as data
from drug testing services or syringe monitoring studies. For example, multiple substances are
commonly detected in used syringes collected at syringe exchange sites, often including stimulants
and opioids, suggesting that these drug classes are commonly used together in European cities.
Addressing a more diverse and complex set of needs

Supporting the implementation of evidence-based substance use
prevention
Substance use prevention aims to stop or delay the use of
psychoactive drugs. It also may help those who have started to
use substances to avoid the development of drug use disorders.
However, not all approaches utilised in this area have been found
to be effective, and interest in the identification and
implementation of evidence-based prevention programmes has
been increasing. Achieving this objective is now supported by the
establishment of prevention programme registries, training
initiatives and the development of quality standards. The European Prevention Curriculum is
designed to improve the overall effectiveness of prevention efforts. More than 25 EU Member States
and neighbouring countries now have national European Prevention Curriculum trainers. Prevention
efforts are also supported by Xchange, a European online registry of evaluated prevention
interventions. Despite the availability of high-quality tools to help identify programmes that are likely
to be effective, in many countries there is still either a lack of investment in drug prevention work or
evidence that resources are not being used efficiently by investing in programmes that lack robust
evidence of effectiveness.
Greater diversity of substances injected increases health risks

Ensuring an effective and comprehensive response for people
who inject drugs in Europe remains a key issue for policy and
practice if drug-related harm is to be reduced. Challenges in this
area are becoming more complex, however, as data reported here
highlight the increasing diversity of substances being injected in
Europe and that this diversity can be associated with a greater
risk.
People who inject drugs are often at greater risk of harms, such as
contracting blood-borne infections or dying from drug overdose, than those who use other routes of
administration. Injecting drug use can also exacerbate pre-existing health problems or cause
abscesses, septicaemia and nerve damage. Although injecting drug use has continued to decline in
Europe over the past decade, it still accounts for a disproportionate share of both the acute and
chronic harms to health resulting from substance use.
Historically, heroin has been the main drug associated with injecting in Europe, but syringe residue
data reported here illustrate how variable and complex injecting patterns have become. A wide
range of drugs, including amphetamines, cocaine, synthetic cathinones, opioid agonist medications,
other medicines and various new psychoactive substances, are now being detected in syringe
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residues, often in combination, potentially increasing the risk of overdose. Syringe monitoring
studies support other data suggesting that stimulant injecting, in particular, has become more
common among people who inject drugs. This is a concern, as stimulant injecting has been
associated both with more frequent injecting and a number of local outbreaks of HIV reported in
Europe over the last decade. Local HIV outbreaks linked to stimulant injecting continue to be
reported in the most recent data, including an outbreak in Monza, Italy, in 2022.
Harm reduction approaches are now seen as fundamental to reducing HIV transmission among
people who inject drugs, particularly the provision of sterile injecting equipment, including
distribution both in prisons and through pharmacies. Again, however, our analysis indicates that
coverage and access to free needle and syringe programmes remain inadequate in many EU
countries.
HIV notifications return to pre-pandemic levels

While new HIV infections related to injecting drug use have been
declining in the European Union over the long term, more than
half of the countries reporting data saw an increase in new HIV
notifications in 2022 compared with 2021. In 2022, the number of
new HIV notifications linked to injecting drug use in the European
Union increased to 968, compared with 662 in the previous year,
returning to a level similar to that observed in 2019. This increase
may in part reflect increased rates of HIV testing following the
lifting of COVID-19-related restrictions and the return of health services, including HIV testing, to
pre-pandemic functioning. Another possible contributory factor is the movement of people living
with a known HIV diagnosis between European countries following the Russian invasion of Ukraine.
Regardless of its cause, this finding deserves further investigation, as any change in the long-term
downward trend observed in this data set would be a concern. Moreover, although the European
Union compares favourably with many other regions of the world, the 38 % reduction in HIV
notifications since 2010 falls short of the World Health Organization’s (WHO) target of a
75 % reduction, indicating that more needs to be done to eliminate drug-related HIV transmission in
Europe.
Signs that ketamine is increasingly available and may be causing

harm
Part of the mission for the new EUDA will be to extend our
monitoring capacity to more-novel substances that currently are
not sufficiently visible within the data sets used for routine drug
monitoring. A good example of this is ketamine, where the
evidence that exists is limited but does suggest that this drug is
likely to be consistently available in some national drug markets
and may have become an established drug of choice in some
settings. However, despite anecdotal evidence that ketamine is
widely used by some groups of young people, we lack a good understanding of the patterns of use of
this substance.
While not necessarily representative at European level, the quantity of ketamine seized and reported
to the EU Early Warning System on new psychoactive substances has varied over time, but has
remained at relatively high levels recently, with reported seizures increasing from just under 1 tonne
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in 2021 to 2.8 tonnes in 2022. Most of the ketamine seized in Europe is believed to originate from
India, but Pakistan and China may also be source countries for this substance.
Ketamine may be used alone or in combination with other substances. In 2022, data from hospital
emergency departments participating in the Euro-DEN Plus network reported that cocaine was the
substance most often reported in combination with ketamine in acute toxicity presentations.
Ketamine is commonly snorted, but can also be injected, and has been linked to various dose-
dependent acute and chronic harms, including neurological and cardiovascular toxicity, mental
health problems and urological complications, such as bladder damage from intensive use or the
presence of adulterants. Currently, our understanding of the extent that this drug is associated with
significant harm in Europe remains limited, and there is a strong case for improving the monitoring
of ketamine use and any related harms.
‘Pink cocaine’: an example of new synthetic drug mixtures

appearing on the EU market
Ketamine may also be added to other drug mixtures, including
MDMA powders and tablets, potentially increasing the risk of
inadvertent consumption. Mixtures sold as ‘pink cocaine’ can also
contain ketamine. This product appears in parts of the EU drug
market, but has a longer history in Latin America, where it has
often been reported to contain the substance 2CB, which is
reflected in its alternative street name ‘tucibi’. In Europe, however,
a range of synthetic substances, including ketamine and MDMA,
have been found in this brightly coloured, distinctive product. In
many respects, pink cocaine is an example of the more sophisticated marketing of synthetic
substances to consumers, who are likely to have very little understanding of what chemicals they are
actually consuming.
Europe’s response to cannabis

A need to better understand what responses are most effective for
treating cannabis-related problems
Cannabis remains the most commonly used illicit drug in the
European Union, with the prevalence of use about five times that
of the nearest other substance (Figure At a glance). Cannabis use
is associated with a range of physical and mental health
problems; with early initiation, regular and long-term use and
high-dose use all thought to increase the risks. There
remains, however, a need to understand better the types of
problems experienced by cannabis users, as well as what might
constitute appropriate referral pathways and effective treatment options for those seeking help for
their cannabis use. Cannabis accounts for more than one third of all reported admissions to drug
treatment in Europe. This finding is difficult to interpret, in part because of the wide variety of
interventions provided to cannabis users, which may include brief interventions or directive referrals
from the criminal justice system. Further work is needed to understand better the types of services
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offered to people with cannabis problems. However, the information that does exist suggests that
psychosocial treatments, such as cognitive behavioural therapy, are commonly offered and that e-
health interventions are becoming increasingly available.
Evaluating the risk of harm associated with cannabis use is complicated by the apparently
increasing range of cannabis-based products potentially available to consumers, which can include
edibles, various forms of vaping technologies, high-potency products and various derivatives of the
drug. This diversity may have implications for the risk of an individual experiencing problems with
their cannabis use, but these are poorly understood. This remains therefore an area that requires
greater research and regulatory attention.
Monitoring and evaluation are key to assessing the impact of

cannabis policy changes
Some EU Member States have changed, or are considering
changing, their approach to the regulation of recreational
cannabis use, creating the possibility of greater access to the drug
for some consumers or under certain conditions. In December
2021, Malta legislated to permit home growing and cannabis use
in private, alongside non-profit communal growing clubs. In July
2023, Luxembourg legislated to permit home growing and use in private, and in February 2024,
Germany legislated to allow home growing and non-profit cannabis growing clubs. Czechia has also
announced plans for a regulated and taxed distribution system.
The cultivation, sale and possession of cannabis remain criminal offences in the Netherlands.
However, the sale of small quantities of cannabis to adults (aged over 18) in ‘coffeeshops’ has been
tolerated for decades. One of the policy objectives for this tolerance was to separate the cannabis
market from the market for other drugs. A concern with this approach is that cannabis sold in
coffeeshops is supplied from the illegal market, and criminal groups therefore benefit from this
trade. To address this issue, the Netherlands is piloting a closed cannabis supply chain model,
where cannabis sold in coffeeshops is produced in regulated facilities.
In Europe and elsewhere, the current dynamic public and policy debate on how cannabis should be
regulated is likely to continue. The large commercial markets for this drug that exist in North
America and elsewhere are already driving innovation, and are probably indirectly influencing the
wider range of cannabis products now available on the European market. It is unclear what direction
future European policies will take. What is clear, however, is that any policy development in this area
should be accompanied by an assessment of the impact of any changes introduced. This sort of
evaluation will depend on the existence of good baseline data; underlining again the need to
improve our monitoring of current patterns of use of Europe’s most commonly consumed illicit drug.
Changing cannabis markets create new challenges for drug

policies
The diversity of cannabis products available in Europe is
increasing. This is true for the illicit drug market. It is also true for
the consumer market, where products are appearing that contain
low levels of THC, or other substances that may be derived from
the cannabis plant such as CBD, or both. On the illicit drug
market, the availability of high-potency extracts and edibles is of
- 17 -
particular concern and has been linked to acute toxicity presentations in hospital emergency
departments. In addition, there are concerns that some products sold on the illicit market as
cannabis may be adulterated with potent synthetic cannabinoids.
Some semi-synthetic cannabinoids have also appeared recently on the commercial market in parts
of Europe. Probably the most commonly encountered semi-synthetic cannabinoid is
hexahydrocannabinol (HHC), but also more recently hexahydrocannabiphorol (HHC-P) and
tetrahydrocannabiphorol (THCP) have become commercially available in some EU Member States.
These substances have been sold as purportedly ‘legal’ alternatives to cannabis, adding to the
regulatory challenges in this area. While knowledge of the effects of HHC in humans is limited,
concerns have been raised as studies have emerged, including some reports of links to psychosis.
There have also been reports of intoxication among children caused by consuming edibles
containing HHC.
Cocaine and synthetic stimulants now play a greater

role in Europe’s drug problems
For the sixth year running, record quantities of cocaine seized in
Europe
Record quantities of cocaine were again seized by EU Member
States in 2022, amounting to at least 323 tonnes. European
seizures now exceed those made by the United States, historically
a country considered to be among the largest markets for this
drug. Cocaine enters Europe by various routes, but the trafficking
of large volumes of cocaine through Europe’s seaports in
intermodal commercial shipping containers remains a significant
factor in its high availability.
The trafficking of illicit drugs is highly dynamic and quickly adapts to geopolitical developments,
regional conflicts and changes in trade routes. Developments in Colombia, Brazil and Ecuador are all
thought to have contributed to the increase observed in cocaine trafficked to the European Union. As
interdiction measures have been scaled up at major known entry points for the drug, traffickers
increasingly appear to be targeting smaller ports in other EU countries and countries bordering the
European Union, where deterrent measures may be less intensively applied. Some northern
European countries, including Sweden and Norway, reported record cocaine seizures at seaports in
2023, suggesting that all entry points to the European Union have now become vulnerable.
Cocaine production sites in Europe reveal how trafficking groups

are innovating to avoid detection
The regular detection of large-scale cocaine processing
laboratories across Europe, particularly in Belgium, Spain and
the Netherlands, reveal how transnational criminal networks from
both sides of the Atlantic are working together to develop new
methods to traffic cocaine into Europe. This can be seen in the
use of specialised equipment and the involvement of chemists
with expertise in cocaine concealment and processing. Cocaine
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processing in Europe usually involves the secondary extraction of cocaine that has been
incorporated into other materials in order to reduce the risk of detection when it is included in
commercial shipments of legitimate goods. These trafficking methods range from the simple
impregnation of cocaine into a material, to more sophisticated chemical concealments, where the
drug is incorporated into a variety of plastics, polymers or metal complexes.
In addition, coca paste and cocaine base, are also now being trafficked into Europe, with the final
stages of processing into cocaine hydrochloride being completed in clandestine laboratories. The
reasons for this are not known, but it has been suggested that it may be a response to the relative
scarcity of cocaine-processing chemicals in Latin America and the economic advantage of
controlling the final stages of the production process in Europe.
Impact of high cocaine availability on public health becoming

more visible
Cocaine is, after cannabis, the second most commonly used illicit
drug in Europe. There are increasing signs that the continued high
availability of this drug is having a growing negative impact on
public health in Europe. Although there is considerable
geographical heterogeneity observable in the data, overall cocaine
is the second most frequently reported illicit drug, both by first-
time entrants to drug treatment services and in the more limited
information available on acute drug toxicity presentations to
hospital emergency departments. European drug checking services, although not nationally
representative, note that cocaine was the most common substance they screened in 2022. The
available toxicological data suggest that the drug was involved in about one fifth of drug overdose
deaths in 2022, often in association with other substances. Moreover, as cocaine use can aggravate
underlying cardiovascular problems, a major cause of death in Europe, it is likely that the overall
contribution of this drug to mortality is not sufficiently recognised.
Cocaine residues in municipal wastewater also increased in two thirds of cities with data for 2023
and 2022. This, together with other information, suggests that as cocaine has become increasingly
available, so too has its geographical and social distribution. Of particular concern is that, in some
countries, cocaine use appears to be increasing among more marginalised groups. This contrasts
with the public perception of the drug as being more commonly used by socially integrated and
affluent people. Smoking and injecting cocaine are both associated with greater health problems
than nasal insufflation, and it is therefore worrying that cocaine injection and the use of crack
cocaine are reported to be growing in a number of countries. Smokable crack cocaine is a form of
the drug that is associated with more problematic patterns of use and use by more marginalised
groups. As noted elsewhere in this report, the injection of cocaine has been linked to a number of
localised HIV outbreaks in Europe in recent years.
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Europe remains a significant producer of synthetic drugs

While monitoring illicit activity is always challenging, the
information available suggests that the scale and complexity of
illicit drug production within Europe is continuing to grow. In
2022, hundreds of synthetic drug production facilities were
reported as having been dismantled in the European Union. These
facilities were producing a variety of substances, including
amphetamine, methamphetamine, synthetic cathinones and
MDMA. Facilities for the final stages of heroin production were
also detected. In addition, the regular detection of separate sites for cocaine production, extraction,
cutting and packaging in recent years suggests that secondary cocaine production is now well-
established in parts of Europe, facilitating the use of innovative methods of chemical concealment
and trafficking of this drug into Europe.
Innovation in production processes is also suggested by recent seizures of chemicals that can be
used to produce the precursor chemicals needed to manufacture amphetamine, methamphetamine
and MDMA, thereby circumventing the controls in place to reduce the availability of these drugs.
A challenge in this area is that the use of a more diverse set of chemicals and the introduction of
new routes of chemical synthesis mean that customs, law enforcement and existing regulations can
struggle to keep pace with market developments. Moreover, where illicit synthetic drug production
takes place, there is a growing awareness of the risks to public health and the environment from the
dumping or disposal of the often large volumes of hazardous substances used in the drug
production process.
Methamphetamine production and trafficking highlight the

potential for increased use in Europe
Globally, methamphetamine problems appear to be growing, and
this synthetic stimulant is making a major contribution to drug-
related harms in many parts of the world. In Europe, with the
notable exception of a few countries, methamphetamine is a
relatively uncommonly used stimulant. However, drug trends are
increasingly dynamic and can change rapidly. It is a worry,
therefore, that some signals exist that methamphetamine
use may be spreading to more countries, even if overall levels of
use remain low. An additional concern is the continuing evidence
of production in Europe. Although the number of
methamphetamine production sites dismantled slightly declined
in 2022, these overall numbers fluctuate from year to year, as
they largely reflect numerous small-scale ‘kitchen-labs’. Low-
volume methamphetamine production for local consumption is a
long-standing phenomenon in parts of Europe, such as Czechia,
with established populations using this drug. More recently,
however, there is increasing evidence of the existence of larger-scale facilities, often located
elsewhere in Europe, that have produced this drug in large volumes for export to non-EU markets.
Seizures of glycidic derivatives of BMK, a precursor used for large-scale methamphetamine

production, increased significantly in 2022, while new alternative chemicals from which BMK can be
- 20 -
made were also seized. In addition, large volumes of tartaric acid continued to be seized. Tartaric
acid is used in the production of the potent and sought-after form of methamphetamine (d-
methamphetamine, used for ‘crystal meth’). Taken together this information suggests that large-
scale production of methamphetamine is now established in the European
Union. Currently, production on this scale appears to be mainly for export to non-EU markets. This is
a concern in itself, but it also poses a risk that the use of this drug could become more common in
the European Union, should market conditions become conducive to this.
Synthetic cathinones represent a growing challenge

The dynamic nature of the European drug market is highlighted by
increased reports of the production and use of synthetic
cathinones, a class of drugs relatively new to Europe. Data
reported here continue to indicate the large-volume trafficking of
synthetic cathinones into Europe from source countries such as
India. At the same time, there is increasing evidence of production
in the European Union, most notably in Poland. The size and scale
of the production sites reported as dismantled by law
enforcement agencies varies from relatively small-scale ‘kitchen-scale’ laboratories to facilities
capable of producing large quantities of these substances. Given the volumes of precursor
chemicals now seized and the interception of unregulated alternative chemicals, it appears likely
that large-scale production for both European and external markets is now taking place.
Developments in the opioid area create new

challenges for both drug policies and response
models
Presence of multiple substances in most opioid deaths deserves
greater recognition
The observation that drug consumption patterns are becoming
both more dynamic and more complex comes under the spotlight
again in our analysis of drug-induced deaths, sometimes referred
to as ‘overdose deaths’. Opioids remain the group of substances
most commonly implicated, but they are often found in
combination with other substances, highlighting how patterns of
polydrug use are an important driver of drug-related harms in
Europe. Benzodiazepines, alcohol or cocaine, for example, are all
often reported alongside opioids in the available toxicology data, and it is likely that the co-
consumption of these different drug classes is an important, but not always sufficiently
recognised, factor for understanding and responding to drug-related mortality.
At EU level, recent trends in deaths where opioids are implicated appear stable, but the proportion of
deaths in older age groups is increasing. It is estimated that heroin was involved in more than 1 800
deaths in 2022 in the European Union, and it remains the drug most commonly identified in opioid-
related deaths in some western European countries. However, the data available suggest that
heroin is now present in the majority of overdose deaths in only a minority of countries, with other
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opioids and other drugs playing a more important role. Overall, the situation appears more
heterogeneous than in the past, with opioids other than heroin, including methadone and, to a lesser
extent, buprenorphine, pain-relief medicines containing opioids and other, more-novel, synthetic
opioids being associated with a substantial share of overdose deaths in some countries.
The available data suggest that deaths where stimulants are implicated are rising in some countries.
However, interpreting these data is difficult, both because stimulant-related deaths are likely to be
particularly prone to under-reporting, and because stimulants are often implicated in deaths where
other drugs, including opioids, are also found to be present.
Concern is growing that highly potent synthetic opioids pose a

significant threat to public health
Deaths associated with the use of opioids are an important public
health concern in Europe, but they currently represent only a small
fraction of the number of deaths associated with this class of
drugs reported in North America. Both the United States and
Canada have been experiencing a public health emergency driven
by synthetic opioids, principally derivatives of fentanyl. The
situation in Europe is very different. Although some under-
reporting is likely, fentanyl derivatives were only linked to 163
deaths in 2022. These fatalities also include deaths associated with fentanyl diverted from medical
use rather than obtained from the illicit market.
Despite this difference in scale, concerns are growing that highly potent synthetic opioids are
increasingly appearing on the European drug market and are causing harm. Moreover, even if the
North American context is different, it does provide a warning on how rapidly trends in opioid use
can develop, with dramatic implications for public health. It is therefore worrying that 81 new
synthetic opioids have been reported to the EU Early Warning System since 2009, with 7 new
substances appearing in 2023. Six of these were highly potent nitazene opioids. Nitazenes were first
reported to the EMCDDA around 2019. Since then, 16 nitazenes have been identified in Europe,
with the majority of countries having detected one of these substances on their territory.
Appearance of nitazene opioids already associated with harm in

some countries
Nitazenes have been sold in preparations that resemble street
heroin, or online as ‘synthetic heroin’, and have also appeared in
tablets mis-sold as medicinal opioids or other medicines. There
are also reports of smoking mixtures adulterated with nitazenes.
These drugs have been linked to an increase in drug-induced
deaths in Estonia and Latvia in 2023, where they now account for
a significant share of overdose deaths. Localised poisoning
outbreaks have also been reported in Ireland and France in 2023.
In Ireland, nitazenes were mis-sold as heroin, resulting in multiple
overdoses, and were also linked to overdoses in two prisons in 2024. Outside the European Union,
nitazenes have been linked to drug overdoses in Australia, North America and the United Kingdom.
These drugs do not currently figure prominently in the routine data available at EU level. However,
due to their high potency and novelty, there are concerns that nitazene opioids may not be routinely
- 22 -
detected in procedures commonly used for post-mortem toxicology. This raises the possibility that
the number of deaths or non-fatal poisonings attributed to these substances could be an
underestimate.
These developments are occurring in the context of other recent signals of worrying changes to the
opioid market in Europe. These include the emergence in 2021 of ‘tranq-dope’, in which synthetic
opioids are mixed with the animal sedative and analgesic xylazine, and ‘benzo-dope’ in 2022, in
which synthetic opioids are mixed with new benzodiazepines (such as bromazolam). Such mixtures
are commonly found in parts of North America, where they have been associated with a range of
health concerns.
New challenges for policy, practice and research

The emergence of novel and highly potent synthetic opioids
creates new challenges for drug policy and practice. It also
highlights important knowledge gaps requiring research scrutiny.
Many of these substances are not subject to drug control when
they first appear. In this respect, Europe is fortunate to have put in
place, through its Early Warning System, a fast-track mechanism
for drug identification, risk assessment and control. It is vital,
however, that Member States support this mechanism with
appropriate national measures. Currently, most new synthetic
opioids appear to be supplied from Asian countries. Consequently, multilateral follow-up is likely to
be important. Some production of fentanyl derivatives is known to take place in Europe, but thus far
this has been limited. However, the technical barriers to the production of these substances are
relatively low, and it is therefore imperative to consider what may constitute effective measures to
prevent the possibility of the large-scale production of these drugs within the European Union.
Recent experience within the European Union has demonstrated how the sudden emergence of
potent synthetic opioids can result in multiple poisonings occurring over a short period, with the
potential to overwhelm local services. Resilience in this area can be increased by having in place a
multiagency rapid response plan, which includes an effective risk communication component in
order to alert both those at risk and frontline services. Furthermore, response models in this area
need to be expanded in recognition that, as these substances have been sold as or in mixtures with
other substances, the population at risk is not necessarily restricted to those with a history of
consuming opioids. The capacity to rapidly identify the presence of highly potent opioids on local
drug markets will also be important. A critical requirement of response models in this area will be
ensuring that adequate supplies of the opioid antagonist naloxone are available to frontline
workers, such as police, ambulance and low-threshold service providers, and they are enabled to
administer this drug when it is needed. Finally, our evidence base in Europe for what constitutes
effective responses to opioid problems has been built largely on our historical experience of
responding to heroin problems. Research is therefore urgently required to assess the extent to
which our current response models may require adjustment in order to remain fit for purpose in the
context of the availability of more-novel and highly potent opioids, especially if these substances
appear in mixtures with other drugs such as xylazine.
- 23 -
Could a decline in heroin availability lead to a larger market for

synthetic opioids?
In April 2022, the Taliban announced a ban on opium poppy
cultivation. A similar, albeit short-lived, ban in 2001 saw the
introduction of replacement substances, including stimulants and
synthetic opioids, into the European market. These changes were
short-lived in most countries, but long-term changes in the opioid
market were observed in a small number of countries. Given that
Afghanistan is the main source of heroin consumed in Europe, the
latest opium ban has prompted speculation that it could result in
a future heroin shortage, which might lead to increased supply of
synthetic opioids and their use in Europe.
The United Nations Office on Drugs and Crime (UNODC) estimates that opium production fell by
95 % in 2023. While there is considerable uncertainty in this area, evidence suggests that a
substantial inventory of opium remains in Afghanistan. This may help explain why we have not
observed evidence of any disruption of heroin flows towards the European Union. However, some
market adjustments may have occurred in response to a reported increase in opium prices in
Afghanistan. At the time of writing, it is too early to say if the current ban on opium production will be
sustained over time. Nevertheless, it would be prudent to prepare for a possible heroin shortage in
late 2024 or 2025. An immediate response would include ensuring that sufficient drug treatment
places were available to those seeking help with managing their opioid use. It would also be
important to monitor closely whether changes in heroin supply were having an impact on the
availability or use of other substances. Substances to be considered include potent synthetic
opioids, but also more established substances such as stimulants.
Could Myanmar replace Afghanistan as a source of heroin for

Europe?
Myanmar has historically been a notable source of opium and
heroin, though generally not for European markets. Heroin from
Myanmar is thought to be trafficked to various countries in Asia
and Oceania. After a period of decline, there have been reports of
increased opium cultivation over the last 3 years. The UNODC
estimates that Myanmar produced 1 080 tonnes of opium in
2023, up 36 % on 2022, but still much lower than the quantities
produced in Afghanistan in recent years. Given the potential value
to traffickers of this crop when converted to heroin, and the increasing maritime trade flows
between South-East Asia and Europe, there is a potential risk that a portion could be diverted to
service profitable markets in Europe in the future. Monitoring of any appearance of heroin from this
region is merited therefore, but remains challenging given the security context in Myanmar, which
has been embroiled in civil war since 2021. However, in the short to medium term, it appears that
heroin produced in this region is unlikely to replace the volumes of heroin up to now supplied to the
European market from Afghanistan.
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At a glance
At a glance – estimates of drug use in the European Union
Cannabis Cocaine
Adults (15-64) Adults (15-64)
Last year use Lifetime use Last year use Lifetime use
22.8 million 85.4 million 4.0 million 15.4 million

8.0 % 29.9 % 1.4 % 5.4 %
Young adults (15-34) Young adults (15-34)

Last year use National estimates of use Last year use National estimates of use
in last year (%) in last year (%)
15.1 million 2.5 million

15 % 2.5 %
MDMA Amphetamines
Adults (15-64) Adults (15-64)
Last year use Lifetime use Last year use Lifetime use
2.9 million 12.3 million 2.3 million 10.3 million

1% 4.3 % 0.8 % 3.6 %
Young adults (15-34) Young adults (15-34)

Last year use National estimates of use Last year use National estimates of use
in last year (%) in last year (%)
2.2 million 1.5 million

2.2 % 1.5 %
- 25 -
Heroin and other opioids
High-risk Drug Fatal

opioid users treatment overdoses
requests
Opioids were
860 000 Principal drug in
24 % found in 74 % of 74 %
about 24 % of all fatal overdoses
513 000 drug treatment
opioid users requests in the
received agonist European Union
treatment in
2022
Source data
The data used to generate infographics and charts on this page may be found below.
- 26 -
Drug supply, production and

precursors – the current
situation in Europe (European
Drug Report 2024)
- 27 -
Analysis of the supply-related indicators for commonly used

illicit drugs in the European Union suggests that availability
remains high across all substance types. On this page, you
can find an overview of drug supply in Europe based on the
latest data, supported by the latest time trends in drug
seizures and drug law offences, together with 2022 data on
drug production and precursor seizures.

High drug availability fuelled by large-volume

imports and production within the European Union
Drug availability within the European Union
Analysis of supply-related indicators for illicit drugs in the European Union suggests that availability
remains high across all substance types. In addition, the market is characterised by the widespread
availability of a broader range of drugs, often available at high potency or purity, potentially
increasing risks to health. These include novel substances, where both consumer and scientific
knowledge about the health risks may be limited. There is also a growing diversity in the forms in
which substances may be available on the market and, in some cases, such as cannabis, the routes
of administration (e.g. vaping, edibles) by which they may be consumed. Together, these
developments increase concerns that there is a potential for the greater use of illicit substances
overall, and that the risks associated with some substances may be growing, especially among
vulnerable users such as people experiencing social and economic marginalisation and deprivation.
In particular, there are worries that people who use drugs may be at greater risk of adverse health
outcomes, including poisonings and deaths, through consuming, possibly unknowingly, high-purity
and potency drugs, especially more-novel substances.
Globalisation in the operational methods used by organised crime groups appears to be an

important facilitator of high drug availability in Europe. There is closer involvement of European drug
producers and traffickers with international criminal networks, resulting in more resilience in the
flows of illicit drugs into and out of the European Union. Various countries in South America, West
and South Asia and North Africa remain important source areas for illicit drugs entering Europe,
while China and India remain important source countries for new psychoactive substances, with
India now more important for some substances, such as synthetic cathinones. Drug precursors and
related chemicals are also often reported to be sourced from China.
Large seizures of drugs, particularly cocaine, in intermodal shipping containers have continued to be
detected in the last few years. For example, in 2023 Spain reported its largest seizure to date of
9.5 tonnes of cocaine in a single shipment concealed in bananas that originated in Ecuador (
Figure 1.1). The drug trafficking operations of organised crime groups increasingly target legitimate
commercial infrastructure involved in global trade. Documented instances show infiltration of
supply chains and exploitation of key staff through intimidation and corruption. Moreover, there are
- 28 -
increasing concerns regarding the recruitment and exploitation of juveniles by criminal networks in
the illicit drug trade. This is reflected in the priority given to countering these threats by law
enforcement agencies. More generally, and particularly in countries where large volumes of drugs
are known to enter or be produced in Europe, there is growing recognition of the need to do more to
counter the violence, corruption and criminal exploitation practices associated with drug market
operations.
Figure 1.1. ‘Operation Nano’, 9.5 tonnes of cocaine seized in August 2023 at the Port of Algeciras
(Cadiz), Spain
The dynamics of the production and trafficking of illicit drugs internationally adapt in response to
geopolitical developments, regional conflicts and changes in trade routes. Developments in recent
years in Colombia, Brazil and Ecuador have, for example, contributed to the increased availability of
cocaine for trafficking to the European Union by organised crime groups, simultaneously using
multiple modi operandi (Figure 1.2) in an attempt to evade detection. The United Nations Office on
Drugs and Crime has estimated a 95 % drop in opium cultivation in 2023 in Afghanistan following
the Taliban’s opium ban. While it is too early to determine the full impact of this situation on
European drug markets, it is likely to affect the availability of heroin in Europe in the coming years,
with concerns being raised around its replacement with other drugs, such as highly potent synthetic
opioids or stimulants. At the same time, conflicts in Ukraine and the Middle East appear to be having
an impact on the trafficking routes used by criminals to move illicit drugs to Europe.
- 29 -
Figure 1.2. Example range of drug trafficking methods previously reported by law enforcement in
Europe
Almost 70 % of the drug seizures by customs authorities happen in the European Union’s ports.
Complementing the EU Drugs Strategy and Action Plan 2021-25, the 2023 EU Roadmap Against
Drug Trafficking contains measures to enhance customs risk management and the detection of
trafficked drugs and precursors. This includes enhancing the interoperability of customs information
systems among EU Member States and supporting the deployment of advanced container-scanning
equipment. It also supports the newly established European Ports Alliance, a public-private
partnership approach, designed to increase the resilience of Europe’s key logistical centres against
drug trafficking and infiltration by organised crime groups. It will aim to support the implementation
of best practices and recommendations from the 2023 Schengen Thematic Evaluation on drug
trafficking in ports. This will include not only tackling drug trafficking into Europe, but downstream
disruption of trafficking by law enforcement on rail and road networks.
Organised crime groups attempt to evade legislative and customs controls restricting the use of
chemicals widely used in legitimate industries by creating alternative chemicals. In response, the EU
Roadmap supports making EU legislative scheduling to control precursors more rapid to match the
pace of criminal innovation by extending it to cover known derivatives and related chemicals that
can be converted into or substituted for established drug precursors. The EMCDDA’s revised
mandate will see it transformed into the European Union Drugs Agency, playing a greater role in
supporting the European Commission in the monitoring, scheduling and threat assessment of
- 30 -
precursors. The EU Roadmap also seeks to tackle the issue of alternative chemicals by supporting
the equipment needs of customs laboratories. Information exchange with countries where
precursors are sourced will be enhanced, including, for example, through the EU-China Joint Follow-
up Group on Precursors. The European Commission is also a member of the United States-led
Global Coalition to Address Synthetic Drug Threats, which targets precursors, including those
required to manufacture new synthetic opioids, through collaboration on priority actions.
Drug production within the European Union

These policy developments are taking place at a time when Europe remains an important production
region for various illicit drugs. Cannabis produced in the European Union is generally for EU
consumption, and many thousands of cannabis cultivation sites are reported as dismantled each
year in EU Member States. Synthetic drugs, such as MDMA and amphetamines, are also produced
in the European Union and may be trafficked to non-EU markets. Reports indicate that the hundreds
of illicit drug production facilities dismantled in the European Union produced a variety of
substances ranging from amphetamine, methamphetamine, synthetic cathinones and MDMA to
cocaine and heroin. Although it can be difficult to determine, in some cases, a single laboratory may
have been producing multiple substances, such as various synthetic stimulants that have similar
chemical and equipment manufacturing requirements. It is difficult to estimate the production
capacity of individual dismantled laboratories. Overall, this means that while it is possible to
determine that the production of various illicit drugs takes place in Europe, commenting on the total
number of facilities, trends or changes in capacity remains problematic. While large-scale
methamphetamine and amphetamine laboratories are reported, many are small-scale, hence larger
numbers are reported and these fluctuate annually. While the majority of dismantled MDMA
production sites were reported by the Netherlands and Spain, some Member States that usually
dismantle large numbers of facilities did not report information for 2022. The detection of separate
facilities for cocaine production, extraction, cutting and packaging in recent years suggests that
cocaine production is now well-established in Europe and that innovative methods are being used to
facilitate the entry of this drug into Europe.
Innovation in production processes is also evident from some recent seizures of chemicals that can
be used to manufacture the precursor chemicals needed to produce amphetamine,
methamphetamine and MDMA, thereby circumventing the controls in place to reduce the availability
of these drugs. Large seizures of precursors in 2022 suggest that the production of synthetic
cathinones remains significant, particularly in Poland. The size and scale of the production sites
reported as dismantled by law enforcement varies from ‘kitchen-scale’ laboratories to higher-
throughput facilities operated by multiple ‘cooks’, which produce several dozens of kilograms of
finished product per batch in special reactors. In smaller sites, production appears to be destined
mostly for local markets and, occasionally, for sale on the darknet. Although information is very
limited, larger production sites also appear to supply local markets and occasionally the finished
product is exported outside Europe.
The use of a wider set of chemicals to create both new substances and different synthesis
processes for more established drugs presents a complex challenge for customs, law enforcement
and legal regulation. Illicit synthetic drug production within the European Union for export and local
markets remains a source of risks to public health, both to people consuming the potentially
hazardous substances and from the environmental damage their production can have locally.
- 31 -
Key data and trends

Drug supply trends
Indexed trends, overall, show that the quantities of all drugs seized in the European Union
increased between 2012 and 2022, particularly in the past 5 years, although there has been
some fluctuation in the quantities of amphetamine and methamphetamine seized in the last 3
years (Figure 1.3).
Between 2012 and 2022, the largest increases have been for cocaine (+376 %),
methamphetamine (+293 %), herbal cannabis (+184 %), heroin (+91 %), MDMA (+71 %), and
amphetamine (+74 %). The small increase observed for cannabis resin (+5 %) reflects the 52 %
decrease reported by Spain for 2022, likely related to shifting drug trafficking routes. Sizeable
consumer markets for these drugs exist in Europe. However, it is likely that increases in quantities
seized reflect, at least partially, the larger role played by Europe as a place of production, export
and transit for these drugs.
Figure 1.3. Drug seizures in the European Union – quantity of drugs seized, indexed trends
(2012 = 100)
The indexed trends presented reflect relative changes in drug seizures over a 10-year period but give no indication of the actual
amounts.
MDMA tablets were converted to mass-equivalents by assuming a mass of 0.25 grams MDMA per tablet.
Interpreting trends in drug seizures is complicated by the fact that they are influenced by policing
and law enforcement strategies and priorities, the success or otherwise of trafficking groups to
- 32 -
avoid detection, and any underlying change in availability and use.
An estimated 1 million seizures were reported in 2022 in the European Union, with cannabis
products being the most frequently seized, accounting for 71 % of the number of all seizures (
Figure 1.4 and Figure 1.5).
Figure 1.4. Drug seizures in the European Union – number of reported drug seizures,
breakdown by drug, 2022 (percent)
- 33 -
Figure 1.5a. Drug seizures in the European Figure 1.5b. Drug seizures in the European
Union – number of seizures in 2022 Union – quantity seized in 2022 (tonnes)
Data for seizures related to the main controlled drugs; not MDMA tablets were converted to mass-equivalents by
included are other seizure categories, including new assuming a mass of 0.25 grams MDMA per tablet.
psychoactive substances, medicines, hypnotics and
sedatives, and seizures of unknown or unspecified
substances.
In terms of numbers, fewer seizures were made in 2022 than in 2012 of cannabis resin (−18 %),
herbal cannabis (−23 %) and heroin (−28 %) (Figure 1.6). This may reflect changes in policing
practices, consumption patterns or drug availability.
The largest increases observed in the number of seizures between 2012 and 2022 were for
methamphetamine (+180 %), MDMA (+60 %), cocaine (+26 %) and amphetamine (+5 %).
- 34 -
Figure 1.6. Drug seizures in the European Union – number of drug seizures, indexed trends
(2012 = 100)
Drug law offences trends

In 2022, an estimated 1.5 million drug law offences were reported in the European Union, an
increase of 26 % since 2012. More than three quarters of these offences (77 % or 1.2 million)
relate to use or possession for personal use.
Of the estimated 1.5 million drug law offences, the drug mentioned in the offence is reported in
just under 1 million offences, of which 809 000 were for possession or use, 177 000 were for
supply-related offences and 3 000 were for other types of offence (Figure 1.7). Definitions of
what constitutes a supply-related offence may vary between countries.
With approximately 609 000 reported offences in 2022, cannabis accounted for more than three
quarters of the use or possession offences (75 %), for which the drug is known, and just over half
or 98 000 of the drug supply offences (56 %). The predominance of cannabis in both supply and
possession offences reflects the level of demand for the drug; it also attests to the policy
importance of this drug.
Both drug possession and drug supply offences remain at higher levels than in 2012 for all drugs
apart from heroin (Figure 1.8 and Figure 1.9).
- 35 -
Figure 1.7. Drug law offences – number of offences, supply and use/possession, 2022
Data for offences for which the drug involved has been reported.
Figure 1.8. Drug law offences – possession/use offences, indexed trends (2012 = 100)
- 36 -
Figure 1.9. Drug law offences – supply offences, indexed trends (2012 = 100)
EU production and precursors data for 2022

Cannabis: EU Member States reported 98 000 seizures of cannabis plants, amounting to
3.5 million individual plants and 6.5 tonnes in 2022 (4.3 million plants and 32.5 tonnes in
2021). In 2022, almost 5 700 illicit cannabis cultivation were dismantled in 14 EU Member
States, according to data obtained from open sources and national partners.
Heroin: Two heroin production sites were dismantled in the Netherlands in 2022 (3 in 2021).
Only three seizures of the heroin precursor chemical acetic anhydride, amounting to 141 litres
(5 730 litres in 2021), were reported by Germany, Spain and Poland. Worldwide, seizures of
acetic anhydride have been declining substantially since 2019. This may indicate a decline in
attempts at diverting and trafficking the substance, or a shift to alternative trafficking routes.
Cocaine: In 2022, at least 39 sites related to cocaine production were dismantled in the
European Union (34 in 2021). In spite of a decrease in the quantity of potassium permanganate
seized in 2022 (173 kilograms) compared with 2021 (1 100 kilograms), it is likely that the large-
scale processing of cocaine hydrochloride from imported intermediary products continues to take
place in the European Union. For example, a cocaine processing laboratory dismantled in Spain in
2023 was reported to have a daily output capacity of 200 kilograms of the drug. In addition, some
large seizures have been reported of unusual substances containing cocaine that must be
extracted by chemical means, indicating that processing continues to be a significant problem in
Europe. For example, in 2022, chemically concealed cocaine was detected in a shipment in
22 tonnes of sugar in France and in 100 kilograms of coal, part of a larger load of coal shipped to
Croatia.
- 37 -
Amphetamine: In 2022, 7 EU Member States reported dismantling 108 amphetamine

laboratories (119 in 2021): the Netherlands (39), Belgium (35), Poland (22), Spain (5),
Sweden (5), Croatia (1) and Romania (1).
Methamphetamine: Nine EU Member States reported dismantling 242 methamphetamine

laboratories in 2022 (224 in 2021): Czechia (202), the Netherlands (14), Bulgaria (12),
Belgium (6), Poland (4), Greece (1), Spain (1), Slovenia (1) and Sweden (1). Seizures of the
precursors needed to synthesise methamphetamine via the ‘ephedrine method’ (ephedrine and
pseudoephedrine) amounting to 352 kilograms (both powders and tablets) were reported by 15
EU Member States in 2022 (723 kilograms by 15 EU Member States in 2021).
Methamphetamine can also be produced using BMK as a starting material (BMK is also used to
produce amphetamine). In 2022, 1 329 litres of BMK (close to 5 100 litres in 2021) and
26.6 tonnes of substances (10.5 tonnes in 2021) that can be used to produce BMK were seized
in Europe. These seizures included 25.6 tonnes of glycidic derivatives of BMK (736 kilograms in
2021), 379 kilograms of MAPA (close to 9.7 tonnes in 2021) and over 500 kilograms of APAA and
APAAN (50 kilograms of APAA in 2021). Two new alternative chemicals that can also be used to
make BMK, DEPAPD and DEPAPD enolate, were reported in Europe (and worldwide) for the first
time in 2022, seized in relatively small amounts. In addition, seizures of tartaric acid, a chemical
that allows the retrieval of the most potent and sought-after form of methamphetamine (d-
methamphetamine, used for ‘crystal meth’) from mixtures produced by BMK methods, reached
2.6 tonnes in 2022 (4.5 tonnes in 2021) and were reported by Belgium, Germany and the
Netherlands. This suggests that large-scale production of d-methamphetamine continues to take
place in Europe. The increased quantities of methamphetamine precursors and related
chemicals seized in Europe reflects the globally significant capacity of synthetic drug producing
groups in the European Union.
MDMA: In 2022, six EU Member States reported dismantling 48 MDMA laboratories (25 in
2021). Belgium reported 27 MDMA laboratories in 2022 (8 in 2021), with the Netherlands
reporting 13, Spain reporting 5 and France, Poland and Sweden reporting 1 each. Seizures of
MDMA precursors increased to 20.5 tonnes in 2022 (7.1 tonnes in 2021). Seizures of the MDMA
precursor PMK and its glycidic derivatives surpassed 19.9 tonnes in 2022 (2.6 tonnes in 2021).
Other alternative chemicals were also reported: MAMDPA was seized in smaller amounts in 2022
(37 kilograms versus 4.5 tonnes in 2021). These reports of increased seizures of MDMA
precursors, combined with information about MDMA exports, may reflect an increase in the
production of the drug for global markets and a general rebound following a decline related to the
COVID-19 pandemic.
Cathinones: In 2022, 29 synthetic cathinone production sites, some of which were large-scale,
were dismantled in the European Union (15 in 2021): 23 in Poland (12 in 2021) and 6 in the
Netherlands (2 in 2021). Seizures of synthetic cathinone precursors amounted to 558 kilograms
in 2022 (555 kilograms in 2021), mainly in Poland (355 kilograms). A shipment of 1 tonne of the
4-CMC precursor 1-(4-chlorophenyl)propan-1-one was stopped in France, originating from China
and en route to Poland.
Synthetic opioids: In 2023, Latvian police reported dismantling a site equipped to produce
fentanyl and seizing nearly 2 kilograms of the drug, as well as 2.7 kilograms of fentanyl precursor
NPP at the same premises. Also in 2023, Latvian police reported dismantling an illicit methadone
laboratory.
Dumping sites: In 2022, Belgium (41) and the Netherlands (153) accounted for the 194 dumping
sites for drug production waste and equipment reported in the European Union (234 in 2021).
- 38 -
The EMCDDA and Europol’s EU Drug Markets: In-depth analysis provides detailed information on
the production and trafficking of illicit drugs.
- 39 -
Summary of seizures of EU scheduled precursors and non-scheduled chemicals used for selected
drugs produced in the European Union, 2022
Precursors associated with MDMA production
Substance Quantity seized
Glycidic derivatives of PMK (kilograms) 14182
Helional (litres) 5
MAMDPA (kilograms) 37
Nitro-PMK (kilograms) <1
Piperonal (kilograms) <1
PMK (litres) 3883
Safrole (litres) 436
Precursors associated with amphetamine and methamphetamine production
AIBN (kilograms) 20
Ammonium formate (litres) 19
APAA (kilograms) 11
APAAN (kilograms) 500
Benzaldehyde (kilograms) 482
Benzylcyanide (kilograms) 3
BMK (litres) 1329
DEPAPD (litres) 13
DEPAPD enolate (kilograms) 100
Ephedrine (kilograms) 312
Formamide (kilograms) 9943
Formic acid (litres) 10432
Glycidic derivatives of BMK (kilograms) 25567
Iodine (kilograms) 75
MAPA (kilograms) 379
Nitroethane (litres) 1
- 40 -
Phenyl-2-nitropropene (kilograms) 4
Phenethylamine (kilograms) 34
Phenylacetic acid (kilograms) 25
Pseudoephedrine (kilograms) 40
Red phosphorus (kilograms) 108
Tartaric acid (kilograms) 2574
Precursors associated with heroin production
Acetic anhydride (litres) 141
Precursors associated with cathinones production
2-Bromo-4-chloropropiophenone (kilograms) 234
2-Bromo-4-methylpropiophenone (kilograms) 324
Chemicals associated with cocaine processing
Calcium chloride (kilograms) 2040
Potassium permanganate (kilograms) 173
Ethyl acetate (litres) 10491
Source data
- 41 -
Cannabis – the current situation

in Europe (European Drug
Report 2024)
- 42 -
Cannabis remains by far the most commonly consumed illicit

drug in Europe. On this page, you can find the latest analysis
of the drug situation for cannabis in Europe, including
prevalence of use, treatment demand, seizures, price and
potency, harms and more.

Understanding the policy and practice implications

of changes in Europe’s cannabis market remains a
priority
Cannabis remains by far the most commonly consumed illicit drug in Europe. National surveys of
cannabis use would suggest that, overall, an estimated 8 % of European adults (22.8 million aged 15
to 64) have used cannabis in the last year. However, both the level of use and trends in use reported
in recent national data appear heterogeneous (see Prevalence and patterns of cannabis use, below).
At the same time, there is an ongoing debate on how best to respond to the use of this drug, with
some countries modifying their regulatory approach. We are also seeing significant developments in
the cannabis market. Taken together, this all means that there remains a pressing need to
understand better the potential harms associated with different patterns of cannabis consumption
and the implications this raises for policy and practice.
There is a need to better understand what responses are effective

Around 1.3 % of adults in the European Union (3.7 million people) are estimated to be daily or
almost daily users of cannabis, and this is the group most likely to experience problems associated
with this drug. Cannabis use can cause or exacerbate a range of physical and mental health
problems, including chronic respiratory symptoms, cannabis dependence and psychotic symptoms.
In addition, studies have found that regular cannabis use can be associated with poorer educational
achievement and an increased risk of involvement with the criminal justice system. Problems are
most associated with early onset of use, high-potency products and more regular and long-term
patterns of use.
There remains, however, a need to understand better the kinds of problems experienced by
cannabis users, as well as what are appropriate referral pathways and effective treatment options
for those with cannabis-related problems. Cannabis is reported to be responsible for more than one
third of all drug treatment admissions in Europe. This finding is difficult to interpret, in part because
of the wide variety of interventions provided to cannabis users, which may include brief interventions
or directive referrals from the criminal justice system. Further work is needed to understand better
the kind of services offered to those with cannabis problems. However, the information that does
exist would suggest that psychosocial treatments, such as cognitive behavioural therapy, are
commonly offered and that e-health (online) interventions appear to be increasingly available.
- 43 -
Evaluating the risk of harm in this area is complicated by the apparently increasing range of
cannabis-based products potentially available to consumers, which can include edibles, high-
potency products and various derivatives. This diversity can have implications for the risk of an
individual experiencing problems with their cannabis use and is therefore an area that requires
greater research and regulatory attention.
Overall, the number of people reported as entering treatment for cannabis problems for the first
time remained relatively stable until 2019, before declining during the pandemic, and not returning
to pre-pandemic levels in most EU Member States by 2022 (see Treatment entry for cannabis use,
below). A caveat here is that data quality and coverage issues mean that this observation must be
interpreted with caution.
Seizures indicate that trafficking routes may be diversifying

Seizures of cannabis products overall continued to be at historically high levels in 2022, indicating
the high availability of this drug (see Cannabis market data, below). However, the total quantity of
cannabis resin seized in the European Union dropped significantly, largely due to a decrease in
seizures reported by Spain. It is possible that this may reflect an adaptation in supply routes by
those involved in trafficking cannabis resin from North Africa to Europe as a response to anti-
trafficking measures taken by Spanish authorities. In this context, it is also interesting to note that
since 2019 the volume of herbal cannabis seized has increased significantly in Spain. In 2022,
Spain accounted for 69 % of all resin seized, 47 % of all herbal cannabis seized, and 81 % of the
total number of cannabis plants reported seized in the European Union, underlining the significant
role played by Spain, both as a transit country for cannabis trafficking and as a production area.
However, it is important to note that significant cannabis production also takes place elsewhere in
the European Union. Recent large seizures highlight the role Spain continues to play as a transit
country for resin intended for the European market. In 2023, for example, Spanish authorities seized
22 tonnes of cannabis resin concealed in fake tomato packaging suspected of being destined for
trafficking to France (see Figure 2.1).
Figure 2.1. Operation ‘Cabalgata/Califa-Trucks’ – Spanish authorities seize 22 tonnes of cannabis

resin concealed in fake tomato packaging
Credit: Guardia Civil and Policía Nacional.
- 44 -
Although new products and forms of this drug are available, herbal cannabis and cannabis resin
remain the most commonly available forms. While the quantities of cannabis resin seized in the
European Union are greater than those of herbal cannabis, this is thought to reflect the greater
vulnerability of cannabis resin to interdiction measures in cross-border trafficking, rather than
availability or use. The information available suggests that herbal cannabis is the more commonly
available form of the drug in most countries. Herbal cannabis may be grown near to its intended
consumer market, and this may reduce the risk of detection. The potency of seized cannabis resin
continued to increase in 2022, with the average resin sample now containing just under 25 % THC.
This is very high by historical standards, potentially creating elevated health risks, particularly when
associated with early onset of use. In contrast, the average potency of seized herbal cannabis has
hovered at around 10 % THC for some years.
Some worrying new developments in the detection of cannabis seizures entering Europe may
indicate that trafficking routes are diversifying and creating a growing challenge for interdiction
efforts. These include, for example, the seizure of 4 tonnes of cannabis resin originating from
Pakistan in the port of Antwerp, Belgium. Moreover, this is evidence that Morocco is not the only
source of resin for the European cannabis market. Some EU Member States reported the trafficking
of cannabis through postal systems and, increasingly, through commercial air travel, sometimes
linked to the United States and Canada. There are indications that larger quantities of herbal
cannabis may be shipped from North America via maritime routes. This, alongside the appearance
of new forms of the drug, raises concerns that developments in regulated cannabis markets outside
Europe may increasingly have implications for the availability of this drug within the European Union
in the future.
Changing cannabis markets create new challenges for drug

policies
The diversity of cannabis products available in Europe is increasing. This is true for the illicit drug
market. It is also true for the consumer market, where products are appearing that contain low levels
of THC, or other substances that may be derived from the cannabis plant such as CBD, or both. On
the illicit drug market, the availability of high-potency extracts and edibles is of particular concern
and has been linked to acute drug-toxicity presentations in hospital emergency departments. In
addition, there are concerns that some products sold on the illicit market as cannabis may be
adulterated with potent synthetic cannabinoids. For more information on these synthetic
cannabinoids, see New psychoactive substances – the current situation in Europe.
Some semi-synthetic cannabinoids have also appeared recently on the commercial market in parts
of Europe. These are substances thought to be produced from cannabidiol extracted from low-THC
cannabis (hemp), not controlled under the international drug conventions. Probably the most
commonly encountered semi-synthetic cannabinoid is hexahydrocannabinol (HHC), but also more
recently hexahydrocannabiphorol (HHC-P) and tetrahydrocannabiphorol (THCP) have become
commercially available in some EU Member States. These substances have been sold as
purportedly ‘legal’ alternatives to cannabis, adding to the regulatory challenges in this area. While
knowledge of the effects of HHC in humans is limited, concerns have been raised as studies have
emerged, including some reports of links to psychosis. Between June 2022 and February 2024,
Czechia’s Toxicology Information Centre recorded over 170 consultations on HHC. Many of the
cases involved young people, including children, who had consumed edibles, such as gummy bears.
HHC has been listed as a controlled drug in at least 18 EU Member States as of April 2024.
The European policy approach to cannabis is also becoming more diverse, as some EU Member
States are considering or changing their policy approach to recreational cannabis use, creating
- 45 -
various forms of access to cannabis resin and herb products. In December 2021, Malta legislated for
home growing and cannabis use in private, alongside non-profit communal growing clubs. In July
2023, Luxembourg legislated to permit home growing and use in private, and in February 2024,
Germany legislated to allow home growing and non-profit cannabis growing clubs. Czechia has also
announced plans for a regulated and taxed distribution system. In addition, non-EU Switzerland has
started to authorise pilot trials of sales or other distribution systems for specific residents in certain
cities.
The Netherlands is also reviewing its approach in this area. The cultivation, sale and possession of
cannabis remain criminal offences in the Netherlands. However, the sale of small quantities of
cannabis, up to 5 grams, to people over the age of 18 in ‘coffeeshops’ that meet certain criteria has
been tolerated for decades, with one of the policy objectives stated as separating cannabis
consumers from the market for other substances. A concern with this approach is that cannabis is
still necessarily supplied from the illegal market, and criminal groups therefore benefit from this
trade. To address this issue, the Netherlands is piloting a model for a closed cannabis supply chain
in 10 municipalities, with cannabis produced in regulated premises being made available for sale in
cannabis coffeeshops.
More detailed information about national legislative approaches to cannabis can be found in the
EMCDDA’s 2023 Cannabis laws in Europe: questions and answers for policymaking.
Key data and trends
Prevalence and patterns of cannabis use

Based on the most recent surveys (Figure 2.2), last year cannabis use among the EU population
aged 15 to 34 is estimated at 15.0 % (15.1 million), with males being typically twice as likely to
report use as females. Among 15- to 24-year-olds, an estimated 18.6 % (8.8 million) used
cannabis in the last year, and 9.7 % (4.6 million) used the drug in the last month. It is estimated
that around 1.3 % (3.7 million) of adults (aged 15 to 64) are daily or almost daily cannabis users
(that is, using the drug on 20 days or more in the last month). Among 15- to 34-year-olds, an
estimated 2.0 % (2.0 million) are daily or almost daily cannabis users. Around three quarters of
adult users (aged 15 to 64) are male and the majority (54 %) are under 35.
Trends in cannabis use at the national level appear mixed. Of the countries that have produced
surveys since 2021 and reported confidence intervals, 3 reported higher estimates, 8 were stable
and 2 reported a decrease compared with the previous comparable survey.
The 2021 European Web Survey on Drugs found that herbal cannabis was used by 95 % of
respondents who used cannabis in the last 12 months, compared with 32 % for resin, 25 % for
edibles and 17 % for extracts. This data source also indicates that consumers may be commonly
using more than one form of this drug.
- 46 -
Figure 2.2. Prevalence of cannabis use in Europe

This data explorer enables you to view our data on the prevalence of cannabis use by recall
period and age range. You can access data by country by clicking on the map or selecting a
country from the dropdown menu.
Recall period Age
Last month Last year Lifetime Young adults (15-34) All adults (15-64)
Country
Notes
Prevalence data presented here are based on general population surveys submitted to the EMCDDA by national focal points. For
the latest data and detailed methodological information please see the Statistical Bulletin 2024: Prevalence of drug use.
Graphics showing the most recent data for a country are based on studies carried out between 2013 and 2023.
Prevalence estimates for the general population: age ranges are 18-64 and 18-34 for Germany, Greece, France, Italy and
Hungary; 16-64 and 16-34 for Denmark, Estonia and Norway; 18-65 for Malta; 17-34 for Sweden.
In 2023, of the 51 cities with comparable data, 20 reported an annual increase in the cannabis
metabolite THC-COOH in wastewater samples, while 15 reported a decrease (Figure 2.3).
- 47 -
Figure 2.3. Cannabis residues in wastewater in selected European cities: most recent data
Red = increase | Green = decrease | Yellow = stable, with respect to previous value | Blue = no
previous data
Mean daily amounts of THC-COOH in milligrams per 1000 population. In most cities, sampling was carried out over a week
between March and May 2023. Taking into account statistical errors, values that differ less than 10 % from the previous value are
considered stable in this figure. Source: Sewage Analysis Core Group Europe (SCORE) For the complete data set and analysis,
see Wastewater analysis and drugs – a European multi-city study.
Treatment entry for cannabis use

In Europe an estimated 92 000 clients entered specialist drug treatment for problems related to
cannabis use (36 % of all treatment demands) in 2022, with about 58 000 entering for the first
time. Cannabis was the main problem drug most frequently cited by new treatment clients,
accounting for 43 % of all first-time treatment entrants in Europe (Figure 2.4).
- 48 -
Figure 2.4. Users entering treatment for cannabis in Europe
Gender breakdown: all treatment entrants Mean age: all treatment entrants
Client status – number of clients Frequency of use in the last month (%): all treatment
entrants
Mean use: 4.3 days per week
Trends in first-time entrants
- 49 -
Apart from the trends, data are for all treatment entrants with cannabis as the primary drug – 2022 or the most recent year
available.
Trends in first-time entrants are based on 25 countries. Only countries with data for at least 5 of the 6 years are included in the
trends analysis. Missing values are interpolated from adjacent years. Because of disruptions to services due to COVID-19, data
for 2020, 2021 and 2022 should be interpreted with caution. Missing data were imputed with values from the previous year for
Spain and France (2022) and Germany (2019).
Hospital presentations
Where national data are available, cannabis is involved in a large proportion of drug-related
emergency presentations to hospital services in some countries. In Spain in 2021, the drug was
involved in 44 % of the cases (over 2 700 out of 6 200) reported in a regular study conducted over
one week in 16 of the 19 autonomous communities. In Germany in 2021, cannabis was involved
in 17 % of the cases (over 1 700 out of 10 200) of acute intoxication and poisoning presenting to
hospitals.
Cannabis was the most frequently reported substance by the Euro-DEN Plus hospital network in
2022. It was involved in 29 % of acute drug-toxicity presentations (25 % in 2021). Usually it was
reported in the presence of other substances, reflecting the fact that many of those presenting
with drug toxicity may have consumed multiple substances.
Cannabis market data

In 2022, EU Member States reported 243 000 seizures of cannabis resin amounting to
468 tonnes (816 tonnes in 2021) and 234 000 seizures of herbal cannabis amounting to
265 tonnes (256 tonnes in 2021) (see Figure 2.5). Due to a decrease of 52 % reported by Spain
(673 tonnes in 2021 to 325 tonnes in 2022), the overall quantity of cannabis resin seized in the
European Union decreased by 43 %. In addition, Türkiye reported 15 700 seizures of cannabis
resin, amounting to 29.3 tonnes, and 57 400 seizures of herbal cannabis, amounting to
42.5 tonnes.
- 50 -
Approximately 609 000 cannabis use or possession offences were reported in the European
Union in 2022 (566 000 in 2021), alongside 98 000 supply offences (100 000 in 2021).
In 2022, the average THC content of cannabis resin in the European Union was 24.8 %, more
than twice that of herbal cannabis, at 10.1 %. Indexed trends show that the average THC content
of resin has doubled in the last 10 years, and continues to rise, whereas that of herbal cannabis
has been generally stable for most of that time. It should be noted that samples of both forms of
the drug can vary considerably.
- 51 -
Figure 2.5a. Cannabis resin market in Europe
Geographical coverage (selected graphs)
EU EU+2
Resin: Number of seizures, EU Resin: Price retail (EUR/g) (EU)
Resin: Price wholesale (EUR/kg) (EU)

Resin: Quantity seized (tonnes), EU
Resin: Potency retail (% THC) (EU)
Resin: Trends in number of seizures (x 1000), EU
Resin: Indexed trends, retail (2011=100)

(EU)
Resin: Trends in quantity seized (tonnes)
EU+2 refers to EU Member States, Norway and Türkiye.
Price and potency: mean national values – minimum, maximum and interquartile range. Countries vary by indicator.
- 52 -
Figure 2.5b. Herbal cannabis market in Europe
EU EU+2
Herbal: Number of seizures, EU Herbal: Price retail (EUR/g) (EU)
Herbal: Price wholesale (EUR/kg) (EU)

Herbal: Quantity seized (tonnes), EU
Herbal: Potency retail (% THC) (EU)
Herbal: Trends in number of seizures (x 1000), EU
Herbal: Indexed trends, retail (2011=100)

(EU)
Herbal: Trends in quantity seized (tonnes)
Price and potency: mean national values – minimum, maximum and interquartile range. Countries vary by indicator.
Additional detailed information on cannabis can be found in the joint EMCDDA-Europe EU Drug
Market: Cannabis – In-depth analysis and the EMCDDA’s Cannabis: health and social responses.
- 53 -
Source data
- 54 -
Cocaine – the current situation

in Europe (European Drug
Report 2024)
- 55 -
Cocaine is, after cannabis, the second most commonly used

illicit drug in Europe, although prevalence levels and patterns
of use differ considerably between countries. On this page,
you can find the latest analysis of the drug situation for
cocaine in Europe, including prevalence of use, treatment
demand, seizures, price and purity, harms and more.

Growing evidence of the health and social costs of

high cocaine availability
Cocaine is, after cannabis, the second most commonly used illicit drug in Europe. Although
prevalence levels and patterns of use differ considerably between countries (see Prevalence and
patterns of cocaine use), the availability of this drug has been increasing for a number of years.
Equally, concern has been growing that the health and social costs associated with this drug are
rising significantly. The use of cocaine can result in dependent and compulsive patterns of use and
is associated with a number of adverse health consequences, which can include agitation,
psychosis, tachycardia, hypertension, arrhythmia, chest pain due to acute coronary syndrome and
stroke. Chronic cocaine use is associated with an increased risk of coronary artery disease,
cardiomyopathy and stroke. Cocaine and synthetic stimulants can induce or precipitate psychotic
states, such as stimulant-induced psychosis. Longer and heavier use of stimulants delays recovery
and worsens the prognosis for recovery. Among those using the drug, the combined use of cocaine
and alcohol is common. The presence of the two substances in the body creates cocaethylene in the
liver, which is associated with greater health risks. The management of psychiatric comorbidity
among people with drug use problems remains challenging, as integrated treatment and mental
health service responses are often lacking. A recent review of mortality among people with regular or
problematic cocaine use found that the risk of death by suicide, accidental injury, homicide and
AIDS-related mortality were all elevated when compared with non-cocaine using peers.
Cocaine is usually available in two forms in Europe. The most common is cocaine powder (the salt
form) and less commonly available is crack cocaine (a smokable freebase form). Cocaine is
produced from the coca plant, grown in South America. It enters Europe through various routes, but
the trafficking of large volumes of cocaine through Europe’s seaports in intermodal commercial
shipping containers appears a significant factor in the current high availability of this substance. In
countries with large container ports known to be utilised for cocaine importation, rising levels of
drug-related crime, including the corruption of staff along supply chains, intimidation and violence,
have been observed. Elsewhere, there are concerns that competition within the cocaine market,
both at the wholesale and retail levels, is now an important driver of drug-related crime, including
gang-related violence and homicides in some countries. At the same time, cocaine use, and crack
cocaine use in particular, appears to be becoming more common, especially among some
marginalised communities. Taken together, this means that the growing availability and use of
cocaine in Europe is resulting in greater costs, both in terms of its impact on public health and
- 56 -
because of the criminality and violence associated with the cocaine market.
Signs of increased cocaine trafficking and innovative approaches

to avoid detection
In 2022, for the sixth year in a row, EU Member States reported a record amount of cocaine seized,
amounting to 323 tonnes. Belgium, Spain and the Netherlands remain the countries reporting the
highest volumes of seizures, reflecting their importance as entry points for cocaine trafficked to
Europe. In 2023, the quantity of cocaine seized in Antwerp, Europe’s second-largest seaport, rose to
116 tonnes from 110 tonnes in 2022. The volume of cocaine seized in Antwerp has increased
annually since 2016. In 2023, Spain reported its largest ever seizure of cocaine (9.5 tonnes) in a
single shipment, concealed in bananas originating from Ecuador (see Figure 3.1).
Figure 3.1. ‘Operation Nano’, 9.5 tonnes of cocaine seized in August 2023 at the Port of Algeciras
(Cadiz), Spain
The trafficking of illicit drugs is highly dynamic and quick to adapt to geopolitical developments,
regional conflicts and changes in commercial trade routes. In this context, developments in
Colombia, Brazil and Ecuador are all thought to have contributed to the increase observed in cocaine
trafficked to the European Union by organised crime groups (see the European Drug Market Report:
Cocaine for an in-depth analysis). In addition to the use of commercial containers, a range of other
methods are now used, often in combination, to evade detection (see Figure 3.2).
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Figure 3.2. Example range of drug trafficking methods previously reported by law enforcement in
Europe
As interdiction measures have been scaled up at major known entry points for the drug, it appears
that cocaine traffickers are increasingly targeting smaller ports in other EU countries and countries
bordering the European Union, which may be more vulnerable to drug trafficking activities. Some
northern European countries, including Sweden and Norway, reported record cocaine seizures at
seaports in 2023. Together, these developments may help explain the fact that despite the large
seizures, reported cocaine purity at the retail level remains high by historical standards and its price
is stable. It is now well-established that the illicit processing of cocaine products takes place in
several EU Member States, with 39 cocaine laboratories reported to have been dismantled in 2022.
Cocaine processing in Europe usually involves the secondary extraction of cocaine that has been
incorporated into other materials (e.g. chemically concealed in plastics), creating challenges for its
detection in commercial shipments. Some relatively large-scale facilities have been detected
recently. For example, a cocaine processing laboratory dismantled in Spain in 2023 was reported to
have a daily output capacity of 200 kilograms of the drug (see Figure 3.3).
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Figure 3.3. Operation ‘Mourente’, a large-scale cocaine base paste processing laboratory
dismantled by Spanish authorities in 2023
Impact of cocaine availability on public health increasingly visible

For a number of practical and methodological reasons cocaine-related health problems can be
challenging to monitor, but there are increasing signals that the high availability of this drug is
having a growing negative impact on public health in Europe. Cocaine is the second most frequently
reported illicit drug, both by first-time treatment entrants and in the available data on acute drug-
toxicity presentations to sentinel hospital emergency departments. European drug checking
services, although not nationally representative, reported that cocaine was the most common
substance they screened in 2022. The available data also suggest that the drug was involved in
about a fifth of drug overdose deaths in 2022. As cocaine use can aggravate underlying
cardiovascular problems, it is likely that the overall contribution this drug makes to mortality in
Europe is not sufficiently recognised.
Cocaine residues in municipal wastewater also increased in two thirds of cities with data for 2023
and 2022. This, together with other information, suggests that as cocaine has become increasingly
available, so too has its geographical and social distribution. Of particular concern is that cocaine
use appears to be becoming more common in more marginalised groups in some countries. Both
the smoking and injection of cocaine are associated with greater health problems, and it is therefore
worrying that cocaine injection and the use of crack cocaine are reported in a growing number of
countries. Stimulants such as cocaine are associated with a higher frequency of injection and have
been involved in localised HIV outbreaks among people who inject drugs in 7 European cities over
the last decade (see Injecting drug use in Europe – the current situation).
Treating people with problems associated with their cocaine use is challenging, whether they are
clients that are more socially integrated and involved in casual or episodic use of powder cocaine, or
more marginalised groups injecting the drug or smoking crack cocaine. Most of the chronic harms
related to the use of stimulants such as cocaine are associated with intensive, high-dose or long-
term consumption. Acute problems can also affect people who use stimulants experimentally, but
they are likely to be less common when the stimulant use is infrequent and low-dose. Although our
understanding of what constitutes effective treatment for stimulant problems is growing, it remains
relatively limited. The current evidence available is indicative of the use of psychosocial
interventions, including cognitive behavioural therapy and contingency management. Currently,
there is insufficient evidence to strongly support any pharmacological treatment, although some
potentially useful new pharmacotherapies are in development. Treating cocaine problems among
more marginalised groups can be particularly challenging, as clients may also be experiencing
problems with a range of other drugs, including opioids or alcohol. For injecting cocaine and
smoking crack, existing harm reduction responses, to a large extent those originally developed for
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opioid problems, are likely to be appropriate to reduce route-specific harms. However, further work is
needed to develop more comprehensive interventions, and greater investment is needed to ensure
services are appropriate to the growing needs observed in this area in some countries.
Key data and trends
Prevalence and patterns of cocaine use

In the European Union, surveys indicate that almost 2.5 million 15- to 34-year-olds (2.5 % of this
age group) used cocaine in the last year (see Figure 3.4). Of the 13 European countries that have
conducted surveys since 2021 and provided confidence intervals, 5 reported higher estimates
than their previous comparable survey and 8 reported a stable trend.
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Figure 3.4. Prevalence of cocaine use in Europe

This data explorer enables you to view our data on the prevalence of cocaine use by recall
Recall period Age
Country
Notes
Cocaine residues in municipal wastewater increased in 49 out of 72 cities with data for both
2023 and 2022, while 13 cities reported no change and 10 cities reported a decrease (see Figure
3.5).
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Figure 3.5. Cocaine residues in wastewater in selected European cities, 2023
previous data
Mean daily amounts of benzoylecgonine in milligrams per 1000 population. Sampling was carried out over a week between
March and May 2023. Taking into account statistical errors, values that differ less than 10 % from the previous value are
considered stable in this figure. Source: Sewage Analysis Core Group Europe (SCORE) For the complete data set and analysis,
Analysis of 1 849 used syringes by the ESCAPE network of 12 cities in 11 EU Member States
between 2021 and 2022 found that, overall, a third of syringes contained residues of two or more
drug categories, indicating frequent polydrug use or re-use of injecting paraphernalia. The most
frequent combination was a mixture of a stimulant and an opioid. Cocaine was detected in over
50 % of syringes analysed in Athens, Cologne, Dublin and Thessaloniki, with a mixture of cocaine
and heroin being the most frequent combination found.
Treatment entry for cocaine use

Cocaine was the second most common problem drug among people entering specialist drug
treatment for the first time in their lives, cited by an estimated 29 000 clients or 21 % of all first-
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time entrants (see Figure 3.6).
The latest European data reveal a time lag of 13 years between first cocaine use, on average at
the age of 22, and first treatment for cocaine-related problems, on average at the age of 35.
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Figure 3.6. Cocaine users entering treatment
Client status — number of clients Frequency of use in the last month (%): all treatment
entrants
Mean use 3.3 days per week
Trends in first-time treatment entrants Route of administration (%): all treatment

entrants
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Apart from the trends, data are for all treatment entrants with cocaine as the primary drug – 2022 or the most recent year
available.
Trends in first-time entrants are based on 25 countries. Only countries with data for at least 5 of the 6 years are included in the
trends analysis. Missing values are interpolated from adjacent years. Because of disruptions to services due to COVID-19, data
for 2020, 2021 and 2022 should be interpreted with caution. Missing data were imputed with values from the previous year for
Spain and France (2022) and Germany (2019).
Harms related to cocaine use

Cocaine was the second most common substance reported by Euro-DEN Plus sentinel hospitals
in 2022, mentioned in 28 % (1 739) of acute drug-toxicity presentations. Where recorded, most
presentations were associated with co-ingestion of alcohol.
Among the 19 European countries providing data for both years, cocaine, mostly in the presence
of opioids, was involved in 996 (23 %) drug-induced deaths in 2022 (807 or 20 % in 2021).
In Spain, cocaine was involved in more than half (52 %) of the drug-induced deaths reported in
2021. In France, the forensic network reported that the number of drug-induced deaths involving
cocaine doubled from 130 cases (22 % of all drug-induced deaths) in 2020 to 259 cases (39 %)
in 2021.
Crack cocaine
Just 6 EU countries accounted for 90 % of the estimated 8 100 crack-related treatment entries in
2022 (7 500 in 2021), of which 3 000 were first-time entrants. A caveat here is that the term
‘crack’ may not be used consistently by all countries.
The number of first-time treatment entrants with crack cocaine as primary drug increased by
about 42 %, from 1 900 clients in 2017 to 2 750 clients in 2022.
Data from drug consumption rooms in Lisbon and Porto, Portugal, and in Paris, France, in 2022
indicate that crack cocaine, either alone or with heroin, accounted for a significant proportion of
the drug consumption episodes facilitated. In both countries, half of all crack cocaine
consumptions involved smoking and the other half involved injecting crack, alone or with heroin.
No crack cocaine use was reported by drug consumption rooms in Barcelona, Athens or Bergen in
2022.
A 2021 analysis of municipal wastewater in 13 European cities, by the EU-funded EUSEME

project, found crack residues in all cities on all sampling days, with the highest loads reported in
Amsterdam and Antwerp.
Cocaine market data

In 2022, EU Member States reported 84 000 cocaine seizures, amounting to 323 tonnes (up
from 303 tonnes in 2021); a record amount for the sixth year in a row. Belgium (111 tonnes), the
Netherlands (51.5 tonnes) and Spain (58.3 tonnes) accounted for 68 % of the total quantity
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seized (see Figure 3.7).
The average purity of cocaine at the retail level ranged from 52 % to 83 % across Europe in 2022,
with half of the countries reporting an average purity between 64 % and 76 %. While the price of
cocaine at retail level has remained stable over the past decade, cocaine purity has been on an
upward trend, and in 2022 reached a level 45 % higher than the index year of 2012 (Figure 3.7).
In 2022, EU Member States reported dismantling 39 sites related to cocaine production (34 in
2021). In spite of a decrease in seizures of the essential chemical potassium permanganate in
2022 (173 kilograms) compared with 2021 (1 100 kilograms), it is likely that the large-scale
processing of cocaine hydrochloride from imported intermediary products continues to take
place in the European Union. For example, in 2023, a cocaine processing laboratory dismantled
in Spain was reported to have an estimated daily output capacity of 200 kilograms. In addition,
some large seizures of unusual substances containing cocaine that must be chemically extracted
have been reported, suggesting that secondary extraction of cocaine occurs at significant levels
in Europe. For example, in 2022, chemically concealed cocaine was detected in a shipment of
22 tonnes of sugar in France and in 100 kilograms of coal, part of a larger load of coal shipped to
Croatia.
In 2022, cocaine was cited in 85 800 use or possession offences, about 10 % of all such offences
for which the drug is known, continuing the upward trend observed over the previous 6 years.
After cannabis, cocaine was the second most frequently cited drug in offences related to use or
possession.
Among the 18 drug checking services across 8 EU countries that reported testing more than 10
samples, cocaine emerged as the substance most commonly detected by 5 services during the
first half of 2022 and by 4 services during the first half of 2023. Over the same period, the purity
of cocaine samples analysed by the 18 drug checking services remained high. In the first half of
2022, 50 % of the samples tested exhibited a purity ranging from 80 % to 100 %. By the first half
of 2023, this equivalent share was 55 %.
Detailed information on cocaine can be found in the joint EMCDDA-Europol EU Drug Market:
Cocaine and the EMCDDA’s Stimulants: health and social responses.
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Figure 3.7. Cocaine market in Europe
EU EU+2
Cocaine: Number of seizures, EU Cocaine: Price retail (EUR/g) (EU)
Cocaine: Price wholesale (EUR/kg) (EU)

Cocaine: Quantity seized (tonnes), EU
Cocaine: Purity (%) (EU)

Cocaine: Trends in number of seizures (x 1000)
Cocaine: Indexed trends: retail (2011 = 100)

(EU)
Cocaine: Trends in quantity seized (tonnes)
EU + 2 refers to EU Member States, Norway and Türkiye.
Price and purity: mean national values – minimum, maximum and interquartile range. Countries vary
by indicator.
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Source data
- 68 -
Synthetic stimulants – the

current situation in Europe
(European Drug Report 2024)
- 69 -
Amphetamine, methamphetamine and, more recently,

synthetic cathinones are all synthetic central nervous system
stimulants available on the drug market in Europe. On this
page, you can find the latest analysis of the drug situation for
synthetic stimulants in Europe, including prevalence of use,
treatment demand, seizures, price and purity, harms and
more.

Diversity in the availability and use of stimulants

Amphetamine, methamphetamine and synthetic cathinones are all synthetic central nervous system
stimulants available on Europe’s illicit drug market. Historically, amphetamine use has always been
the most common, with the availability and use of methamphetamine and synthetic cathinones
being more limited in most countries. There are, however, signals that patterns of synthetic
stimulant availability and use are diversifying. Part of the context for this is that trends in synthetic
drug production can be extremely dynamic, and consumers may view different stimulants as
functionally similar and be amenable to trying new products based on their availability in the market.
There are therefore concerns about increased threats to health and social problems that may be
associated with the more widespread availability and use of these substances. At the same time,
current information tools are generally not sufficiently well-developed to track trends in use or
related problems associated with changing patterns of synthetic stimulant use, meaning that we
can be slow to detect important changes in this area. Improving our ability to monitor and respond
more rapidly to developments in the use of synthetic drugs in general therefore remains a priority.
Understanding stimulant-related risks to health

Methamphetamine and synthetic cathinones are chemically similar to amphetamine, but are not
necessarily equivalent in respect to the risk they pose to public health. The more widespread use of
synthetic cathinones, for example, is a relatively new development, and we currently lack a robust
evidence base to understand the potential health risks of this phenomenon or what might constitute
appropriate interventions. Methamphetamine is available in high-purity forms that are smokable,
and there are particular health concerns associated with the use of this drug by this mode of
administration. All of these substances may also be available in similar-looking powders or pills,
meaning consumers may be unaware of what particular stimulant or mixture of substances they
may be consuming. Reports from drug checking services in several EU Member States between
2022 and 2023, and also to the EU Early Warning System, indicate that synthetic cathinones may
also be found in MDMA products, reflecting mis-selling and adulteration. This means that forensic
and toxicological analysis is particularly important for understanding both consumption trends and
the scale and nature of any associated adverse health outcomes.
A more general concern is that all of the stimulants discussed here are also, to some extent,
associated with behaviours that can represent health risks. These risks include overdoses, acute
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and chronic mental health problems and infectious diseases. Problematic and intensive patterns of
stimulant use, such as the combination of high-risk drug taking and risky sexual behaviours, known
as ‘chemsex’, have also been documented in some populations. There are also particular concerns
about the injecting of stimulants, which has been associated with a higher risk of HIV transmission.
This could be explained by more frequent use, sharing of injecting material and risky sexual
behaviours among people who inject stimulants.
In the last decade, 7 European cities, across 6 countries, have reported localised HIV outbreaks
associated with stimulant injecting, mainly among marginalised people who inject drugs involved in
open drug scenes (see Drug-related infectious diseases – the current situation in Europe). Syringe
residue analysis conducted by the ESCAPE network between 2022 and 2023 confirms the presence
of stimulants, such as amphetamine and synthetic cathinones, in many injecting drug scenes.
Reports from the Euro-DEN Plus network of sentinel hospitals across Europe in 2022 highlight the
continued presence of synthetic stimulants in acute drug-toxicity presentations to emergency
departments.
Methamphetamine production and trafficking highlights potential

for increased use in Europe
While methamphetamine is a less commonly used synthetic stimulant and is less visible in available
data, signals continue to emerge that its production is increasing in Europe. Historically, the use of
this drug has been most commonly observed in Czechia and Slovakia and, more recently, some
neighbouring countries. Now, however, it is present in more countries, although the overall
prevalence of use appears to remain low in most countries. While not representative of the general
population, data from wastewater analysis indicate that 15 of the 67 European cities with data for
2022 and 2023 saw an increase in the methamphetamine residues detected.
Available data on the production and trafficking of these stimulants reveal the changing dynamics of
the illicit stimulant trade. There were 108 dismantled amphetamine production laboratories
reported in the European Union in 2022 (119 in 2021). Following a decline from a peak in 2020
(22.3 tonnes), the quantity of the drug seized in the European Union remained stable at about
7 tonnes between 2021 and 2022. It has been suggested that this fall in the quantities seized may
be indicative of a decline in production, possibly resulting from producers switching to other
stimulants, such as methamphetamine, which can be highly profitable when trafficked to non-EU
markets. Recent data show the quantity of methamphetamine seized in the European Union has
remained relatively stable between 2021 and 2022 at about 1.4 tonnes, following a decline from a
peak in 2019 (2.3 tonnes) due to large importations from Mexico. The number of methamphetamine
production sites reported as dismantled slightly declined in 2022, likely reflecting that, while large-
capacity sites are found, most are small-scale, with the number of detections fluctuating annually.
The quantity of seized glycidic derivatives of BMK, the precursor used for large-scale
methamphetamine production, increased in 2022, while new alternative chemicals to make BMK
were also seized (see Synthetic stimulants market data, below). The increased quantities of
methamphetamine precursors and related chemicals seized in Europe reflect the globally significant
capacity of synthetic drug producing groups in the region, with the drug still predominantly exported
to non-EU markets. Data availability issues mean that caution is needed in interpreting the
information available, and more work is needed to track production trends and analyse their
implications for both public health and security. Türkiye has reported seizing a record quantity of
methamphetamine in 2022 (almost 16 tonnes). Among the reasons for this is a potential increase in
trafficking of methamphetamine from Afghanistan along established heroin trafficking routes
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towards Europe. Challenges remain in better understanding methamphetamine trafficking flows

and the changes taking place in Afghanistan; and this drug has also been the target of recent
measures taken by the Taliban to reduce drug production in the country.
Synthetic cathinones pose a growing challenge

Reports indicate that synthetic cathinones are increasingly trafficked to Europe from India in large
shipments. At the same time, they are also produced in Europe, notably in Poland, where
23 laboratories were reported as dismantled in 2022, and 355 kilograms of precursors were seized.
Given the volumes of precursor chemicals seized and the interception of unregulated alternative
chemicals, it appears likely that large-scale production for both the European and other markets
may be taking place.
In summary, as the use of illicit stimulants can lead to a range of health problems, these substances
continue to represent a challenge for monitoring efforts, policymakers and service providers in
Europe. More frequent injecting associated with stimulant use and the potentially much more severe
health complications from injecting and smoking methamphetamine mean that any increase in
consumption, especially among vulnerable groups, could represent a growing challenge for harm
reduction and emergency health services.
Key data and trends

Prevalence and patterns of synthetic stimulants use
Surveys conducted by 24 EU countries between 2017 and 2023, which group amphetamine and
methamphetamine together, suggest that 1.5 million young adults (15 to 34) used
amphetamines during the last year (1.5 % of this age group). Of the 12 European countries that
have conducted surveys since 2020 and provided confidence intervals, 2 reported higher
estimates than their previous comparable survey and 10 reported a stable trend (see Figure 4.1
for most recent survey data).
Estimates of high-risk methamphetamine use vary between countries, ranging from 0.37 per
1 000 population (corresponding to 225 high-risk users) in Cyprus to 5.22 per 1 000 (34 700
high-risk users) in Czechia, with 2.9 per 1 000 (10 624 high-risk users) in Slovakia.
In the 2021 European Web Survey on Drugs, a non-representative survey of people who use
drugs, 4 % of respondents reported having used synthetic cathinones in the last 12 months.
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Figure 4.1. Prevalence of amphetamines use in Europe
Recall period Age
Country
Of the 65 cities with data on amphetamine residues in municipal wastewater for 2022 and 2023,
26 reported an increase, 13 a stable situation and 26 a decrease (Figure 4.2).
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Figure 4.2. Amphetamine residues in wastewater in selected European cities: changes

between 2022 and 2023
previous data
Mean daily amounts of amphetamine in milligrams per 1000 population. Sampling was carried out over a week between March
and May 2023. Taking into account statistical errors, values that differ less than 10 % from the previous value are considered
stable in this figure. Source: Sewage Analysis Core Group Europe (SCORE). For the complete data set and analysis, see
Wastewater analysis and drugs – a European multi-city study.
Of the 67 cities that have data on methamphetamine residues in municipal wastewater for 2022
and 2023, 15 reported an increase, 13 a stable situation and 39 a decrease (Figure 4.3).
- 74 -
Figure 4.3. Methamphetamine residues in wastewater in selected European cities: changes

previous data
Mean daily amounts of methamphetamine in milligrams per 1000 population. Sampling was carried out over a week between
March and April 2023. Taking into account statistical errors, values that differ less than 10 % from the previous value are
considered stable in this figure. Source: Sewage Analysis Core Group Europe (SCORE). For the complete data set and analysis,
Treatment entry for use of synthetic stimulants

Almost 10 000 clients are estimated to have entered specialised drug treatment in Europe in
2022 reporting amphetamine as their primary drug, approximately half of them (4 800) being
first-time clients (Figure 4.4).
In 2022 or the most recent year available, amphetamine or methamphetamine clients accounted
for at least 15 % of first-time treatment entrants in Bulgaria, Czechia, Estonia, Latvia, Poland,
Slovakia, Finland and Türkiye.
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Figure 4.4. Amphetamine users entering treatment in Europe
entrants
Amphetamine. Entrants for this substance as a share of all

first-time treatment entrants
- 76 -
Route of administration: all treatment

entrants (%)
Data are for all treatment entrants with amphetamine as the primary drug – 2022 or the most recent year available. Data for first-
time entrants are for 2022 or the most recent year available: Czechia, 2020, Spain, France, Finland, Romania, 2021; Netherlands,
2015. Data for Sweden and Norway relate to clients citing stimulants other than cocaine as primary drug.
Treatment entrants citing methamphetamine as their main problem drug are concentrated in
Czechia, Germany, Slovakia and Türkiye, which together accounted for 92 % of the estimated
12 000 methamphetamine clients entering treatment in 2022, 6 400 of whom were first-time
clients (Figure 4.5). In addition, drug consumption facilities in Athens and Barcelona observed an
increase in the number of clients reporting methamphetamine smoking in the second half of
2022.
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Figure 4.5. Metamphetamine users entering treatment in Europe
entrants
Methamphetamine. Entrants for this substance as a share of

all first-time treatment entrants
- 78 -
Route of administration: all treatment

entrants (%)
Data for client characteristics are for all treatment entrants with methamphetamine as the primary drug – 2022 or the most
recent year available. Data for first-time entrants are for 2022 or the most recent year available: Czechia 2020, Spain, France,
Finland, Romania 2021; Netherlands, 2015.
Available data from countries that report treatment entrants for synthetic cathinones show an
increase from 457 clients in 2016 to 1 207 clients in 2022, 90 % of whom are accounted for by
France (416 clients, 2021 data), Poland (306 clients), Spain (225 clients, 2021 data) and
Belgium (145 clients) (Figure 4.6). The share of synthetic cathinones entrants among all
treatment entrants with stimulants other than cocaine as their primary drug increased to 8 % in
2022, from 4 % in 2016.
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Figure 4.6. Synthetic cathinone users entering treatment in Europe
entrants
Trends in all treatment entrants Route of administration: all treatment

entrants (%)
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Data on entrants into treatment are for 2022 or the most recent year available. Trends in treatment entrants are based on 22
countries. Only countries with data for at least 5 of the 6 years are included in the trends graph. Missing data were imputed with
values from the previous year for Spain and France (2022) and Germany (2019). Because of disruptions to services due to
COVID-19, data for 2020, 2021 and 2022 should be interpreted with caution
Injecting use of synthetic stimulants

Injecting is reported as a common route of administration by those entering treatment with
amphetamine as their primary drug in a number of countries, including Finland (78 %), Estonia
(71 %) Sweden (65 %) and Latvia (42 %).
About 6 % of amphetamine clients entering drug treatment in Europe in 2022, or the most recent
year available, reported injecting as the main route of administration, while 68 % reported
sniffing, 9 % reported smoking and 17 % reported oral consumption of the drug. Four countries,
Belgium, Germany, Poland and Spain, accounted for 65 % of the treatment entrants.
between 2021 and 2022 found that overall, a third of syringes contained residues of two or more
drug categories. The most frequent combination was a stimulant and an opioid. Synthetic
cathinones were found in used syringes collected in Paris (89 %), Budapest (34 %), Helsinki
(23 %) and Tallinn (19 %). The synthetic cathinones 3-MMC and 3-CMC were detected in Paris,
Dublin (3-MMC only) and Prague (3-CMC only).
Harms related to use of synthetic stimulants

In 2022, amphetamine was the fifth most common substance reported by 20 Euro-DEN Plus
hospitals located in 15 EU countries and Norway. It was present in 9 % (566) of acute drug-
toxicity presentations.
Methamphetamine was the twelfth most common substance reported by 18 Euro-DEN Plus
hospitals in 2022, present in 2.1 % (135) of acute drug-toxicity presentations (2.6 % in 2021).
In 2022, the synthetic cathinone 3-MMC was involved in 38 acute drug-toxicity presentations in 6
Euro-DEN Plus hospitals (68 in 2021 in 5 hospitals).
Of the 20 countries with post-mortem data available for 2022, 18 reported 1 030 drug-induced
deaths where amphetamines were involved (1 073 in 2021 in 23 countries) – post-mortem
findings group amphetamine and methamphetamine together.
In the 6 EU countries reporting drug-induced deaths involving synthetic cathinones for both
years, the number of cases increased from 18 in 2021 to 27 in 2022.
Synthetic stimulants market data

In 2022, EU Member States reported 31 000 seizures of amphetamine, amounting to 7.1 tonnes
(7 tonnes in 2021) (Figure 4.7). Türkiye seized almost 6 tonnes (3.5 tonnes in 2021), including
almost 24 million tablets described as ‘captagon’ (13.8 million in 2021). The average purity of
amphetamine at retail level has increased markedly over the past decade (+97 %), while the
average price has decreased (−27 %).
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Figure 4.7. Amphetamine market in Europe
EU EU+2
Number of seizures, EU Price retail (EUR/g) (EU)
Price wholesale (EUR/kg) (EU)

Quantity seized (tonnes), EU
Purity retail (%) (EU)
Trends in number of seizures, EU
Indexed trends: price and purity, retail

(2012=100) (EU)
Trends in quantity seized (tonnes)
Price and purity: mean national values – minimum, maximum and interquartile range. Countries vary by indicator.
- 82 -
EU Member States reported 9 900 seizures of methamphetamine amounting to 1.4 tonnes in

2022 (1.2 tonnes in 2021) (Figure 4.8). Türkiye reported 77 700 seizures of methamphetamine in
2022, amounting to 15.8 tonnes and 383 litres (5.5 tonnes in 2021). The large increase in the
quantities seized by Türkiye may indicate increased methamphetamine trafficking along
established heroin trafficking routes to Europe from Afghanistan via Türkiye. Over the past
decade, the average purity of methamphetamine has risen slightly, while the price has remained
relatively stable, although declining in recent years.
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Figure 4.8. Methamphetamine market in Europe
EU EU+2
Number of seizures, EU Price retail (EUR/g) (EU)
Purity retail (%) (EU)

Quantity seized (tonnes), EU
Indexed trends: purity, retail (2012=100)

(EU)
Trends in number of seizures, EU
Trends in quantity seized (tonnes)
- 84 -
About 87 % of the total quantity of new psychoactive substances reported as seized by EU

Member States in 2022 in all forms, or 26.5 tonnes (4.5 tonnes in 2021), were synthetic
cathinones. The main substances were 3-CMC (63 %), 3-MMC (9 %), 2-MMC (5 %) and N-
ethylnorpentedrone (3 %). The very large quantities of cathinones found in some individual
seizures, mostly trafficked from India, suggest that these substances have the potential to play a
bigger role in Europe’s stimulant market.
In 2022, 7 EU Member States reported dismantling 108 amphetamine laboratories (119 in

2021): the Netherlands (39), Belgium (35), Poland (22), Spain (5), Sweden (5), Croatia (1) and
Romania (1).
Nine EU Member States reported dismantling 242 methamphetamine laboratories in 2022 (224
in 2021): Czechia (202), the Netherlands (14), Bulgaria (12), Belgium (6), Poland (4), Greece (1),
Spain (1), Slovenia (1) and Sweden (1).
Seizures of the precursors required to synthesise methamphetamine via the ‘ephedrine method’
(ephedrine and pseudoephedrine) amounting to 352 kilograms (both powders and tablets) were
reported by 15 EU Member States in 2022 (723 kilograms by 15 EU Member States in 2021).
Methamphetamine can also be produced using BMK as a starting material, which may also be
used to produce amphetamine. In 2022, 1 329 litres of BMK (close to 5 100 litres in 2021) and
26.6 tonnes of substances that can be used to produce BMK were seized in Europe. These
seizures included 25.6 tonnes of glycidic derivatives of BMK (736 kilograms in 2021),
379 kilograms of MAPA (close to 9.7 tonnes in 2021) and over 500 kilograms of APAA and
APAAN (50 kilograms of APAA in 2021). Two new alternative chemicals that can also be used to
make BMK, DEPAPD and DEPAPD enolate, were reported in Europe (and worldwide) for the first
time in 2022 and seized in relatively small amounts. In addition, seizures of tartaric acid, a
chemical that allows the retrieval of the most potent and sought-after form of methamphetamine
(d-methamphetamine, used for ‘crystal meth’) from mixtures produced by BMK methods, were
reported by Belgium, Germany and the Netherlands, amounting to 2.6 tonnes in 2022 (4.5 tonnes
in 2021). This suggests that large-scale production of d-methamphetamine continues to take
place in Europe.
In 2022, 29 synthetic cathinone production sites, some of which were large-scale, were
dismantled in the European Union (16 in 2021): 23 in Poland (12 in 2021) and 6 in the
Netherlands (2 in 2021).
Seizures of synthetic cathinone precursors amounted to 558 kilograms in 2022 (555 in 2021),
most of which were seized in Poland (355 kilograms, 311 kilograms in 2021). One shipment of
1 tonne of the 4-CMC precursor 4-chloropropiophenone was stopped in France, originating from
China and headed for Poland.
While not representative of national drug markets, over 66 % of amphetamine samples screened
by European drug checking services in the first half of 2023 contained a psychoactive adulterant.
Caffeine was the psychoactive adulterant most commonly found in amphetamine samples
analysed by drug checking services. Other stimulants and hallucinogens were also commonly
found as adulterants.
In 2022 and 2023, reports to the EU Early Warning System suggested the possibility of synthetic
cathinones increasingly being mis-sold as MDMA or used to adulterate MDMA. Although the
extent of this problem is unknown, drug checking services in 11 EU Member States have
detected synthetic cathinones in MDMA products, albeit infrequently. The affected products
included ecstasy tablets, crystals and powders, typically containing 4-CMC (clephedrone), 3-
MMC, 3-CMC, 4-MMC (mephedrone) and dipentylone.
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Detailed information on synthetic stimulants can be found in the joint EMCDDA-Europol EU Drug
Markets: In-depth analysis and the EMCDDA's Stimulants: health and social responses.
Source data
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MDMA – the current situation in

Europe (European Drug Report
2024)
- 87 -
MDMA is a synthetic drug chemically related to the

amphetamines, but with somewhat different effects. In
Europe, MDMA use has generally been associated with
episodic patterns of consumption in the context of nightlife
and entertainment settings. On this page, you can find the
latest analysis of the drug situation for MDMA in Europe,
including prevalence of use, seizures, price and purity and
more.

Signs of increasing MDMA production in Europe;

strong products still creating health risks
MDMA is a synthetic drug chemically related to the amphetamines, but with somewhat different
effects. In Europe, MDMA use has generally been associated with episodic patterns of consumption
in the context of nightlife and entertainment settings. Survey data indicate that MDMA is the second
most commonly used illicit stimulant in Europe, after cocaine. The use of the drug appeared to
decline temporarily during the early phases of the COVID-19 pandemic but bounced back when
social distancing measures were lifted. The most recently available data would suggest that the
current situation is relatively stable in terms of annual consumption, although the national situation
is relatively heterogeneous and there are some possible signs of a slight increase in use in some
countries. Almost two thirds of the European cities reporting wastewater analysis found an increase
in MDMA residues between 2022 and 2023.
European production for a global MDMA market

MDMA production is known to take place within Europe, both for domestic consumption and for
export to non-EU markets. Europe is recognised as an important global supply source for this
substance, with most MDMA production thought to be concentrated in or around the Netherlands.
Monitoring trends in illicit drug production is always challenging but there are now some possible
indications to suggest increasing levels of MDMA production within Europe, following a recent
period in which production volumes are thought to have declined. The number of MDMA
laboratories dismantled in the European Union rose to 48 in 2022 (25 in 2021), while seizures of the
internationally controlled precursor chemical PMK (piperonyl methyl ketone) and its glycidic
derivatives for manufacturing MDMA increased markedly in 2022, to 19.9 tonnes (2.6 tonnes in
2021). Alternative chemicals were also seized in notable quantities in 2022. These reports of
increased seizures of MDMA precursors and alternative chemicals, combined with information
about MDMA exports, may reflect an increase in the production of the drug for global markets and a
general rebound following a decline related to the COVID-19 pandemic. However, not all recent data
suggest this. In 2022, the quantity of MDMA tablets seized in the European Union declined by nearly
a third, while the quantity of MDMA powder seized declined slightly. The MDMA content of tablets
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and the purity of powders continued to decline in 2022 from a pre-pandemic peak in 2019, with
declines in the MDMA content of ecstasy tablets observed in recent years in some important source
countries, most notably the Netherlands.
MDMA product strength remains a concern

Despite indications that the MDMA content of ecstasy tablets is decreasing, with a typical MDMA
content of 140 to 157 milligrams, the overall strength of tablets available on the retail market
remains high by historical standards. The availability of higher-strength products potentially
increases the risk of adverse health outcomes associated with the consumption of this substance.
MDMA tablets are typically available in many designs, often colourful replications of brand logos.
Alongside powders and tablets, more-novel MDMA products, such as edibles (candies, gelatines
and lollipops), have been reported to have become available in recent years in some countries, for
example, Belgium and Czechia. As with cannabis edibles, these products pose difficulties in
regulating intended dosage and increase the risk of inadvertent consumption, especially a concern if
they are consumed by minors.
The use of MDMA is rarely cited as a reason for entering drug treatment in Europe, but acute
poisonings and deaths are sometimes associated with the consumption of this substance. Some
countries, including Germany, reported small numbers of drug-induced deaths involving MDMA in
2022, while Türkiye remains the only country reporting larger numbers. The reasons for this are not
clear. The use of MDMA therefore continues to represent an important issue for prevention and
harm reduction messaging and interventions. Measures typically undertaken in this area include risk
communications about high-strength products and safer use guidelines, as well as providing drop-in
services and, in some countries, pill testing services, where consumers can have the composition of
their substances analysed.
While it is difficult to generalise due to limitations in national and European coverage, the available
information from drug checking services suggests that MDMA products are generally less subject to
adulteration than other illicit drugs they screened in 2022. This does occur, however, as illustrated
by the occasional detection of synthetic cathinones in MDMA tablets. Such drug mixtures, which
have been reported to the EU Early Warning System as being mis-sold as MDMA to consumers, may
also increase the risk to consumers of experiencing unexpected adverse effects and potential harm.
Additional detailed information about MDMA can be found in the joint EMCDDA-Europol EU Drug
Markets: In-depth analysis and the EMCDDA's Stimulants: health and social responses.
Key data and trends

Prevalence of MDMA use
Surveys conducted by 26 EU countries between 2015 and 2023 suggest that 2.2 million young
adults (aged 15 to 34) used MDMA in the last year (2.2 % of this age group), with 2.3 %
(1.1 million) of those aged 15 to 24 years estimated to have used MDMA in the last year (for
survey data, see Figure 5.1).
Of the 13 European countries that undertook surveys since 2021 and provided confidence
intervals, 4 reported higher estimates than their previous comparable survey and 9 reported
stable estimates.
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Figure 5.1. Prevalence of MDMA ('ecstasy') use in Europe

This data explorer enables you to view our data on the prevalence of MDMA use by recall
Recall period Age
Last month Last year Lifetime Young adults (15-34) All adults (15-64) Country
Notes
Of the 69 cities that have data on MDMA residues in municipal wastewater for 2022 and 2023,
42 reported an increase, 11 a stable situation and 16 a decrease (Figure 5.2). All of the 10 cities
with data for both years had higher MDMA mass loads in 2023 than in 2011.
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Figure 5.2. MDMA residues detected in wastewater in selected European cities: most recent
data
previous data
Mean daily amounts of MDMA in milligrams per 1000 population. Sampling was carried out over a week in March and May 2023.
Taking into account statistical errors, values that differ less than 10 % from the previous value are considered stable in this
figure. Source: Sewage Analysis Core Group Europe (SCORE) For the complete data set and analysis, see Wastewater analysis
and drugs – a European multi-city study.
Deaths and hospital presentations related to MDMA

MDMA is reported in small numbers of drug-induced deaths, and in most countries less than 1 in
20 cases involve the drug. For example, in Germany, MDMA was mentioned in 1 in 25 fatal
overdoses in 2022, with most of the cases involving multiple drugs. Türkiye is an outlier, with
MDMA identified in almost 1 in 5 drug-induced deaths (46 out of 246 in 2022). The majority of
drug-induced deaths in Türkiye are among younger people, predominantly males, and are more
likely to involve stimulant drugs rather than opioids, compared with the European Union and
Norway.
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MDMA was the sixth most frequently reported drug by Euro-DEN Plus hospitals in 2022. The
drug was reported by 19 sentinel centres in 2022 and was involved in an estimated 4.7 % of
presentations (median) across the 23 centres that reported data for that year. Alcohol was co-
used in most reported cases. The drugs most commonly found in association with MDMA were
cocaine and cannabis, and in some centres also GHB/GBL, amphetamine and synthetic
cathinones.
In 2022, the share of acute drug-toxicity presentations involving MDMA increased as compared
to other substances and the previous year (or MDMA was reported for the first time) in 10 of the
Euro-DEN hospitals. In 5 hospitals, this share decreased and in 4 it remained stable.
Only in the sentinel hospitals in Belgium, France and the Netherlands, was MDMA involved in
more than 1 in 10 presentations.
In half of the Euro-DEN hospitals in 2022, at least 3 out of 4 presentations with MDMA were
among males, at least 4 in 10 were among young people aged less than 25 years, and MDMA was
the sole drug reported for less than 3 % of the MDMA-related presentations. Alcohol was co-
ingested in at least 2 out of 3 cases, and cocaine and amphetamine were the drugs most
commonly reported in presentations with MDMA involved.
MDMA market data

In 2022, EU Member States reported 14 500 seizures of MDMA (10 000 in 2021), amounting to
1.2 tonnes of MDMA powder (1.6 tonnes in 2021) and 2.5 million MDMA tablets (3.5 million in
2021). Türkiye seized 5 million MDMA tablets in 2022 (7.6 million in 2021) (Figure 5.3).
In 2022, 6 EU Member States reported dismantling 48 MDMA laboratories (25 in 2021). Belgium
reported 27 MDMA laboratories in 2022 (8 in 2021), with the Netherlands reporting 13, Spain
reporting 5 and France, Poland and Sweden reporting 1 each.
Seizures of MDMA precursors increased to 20.5 tonnes in 2022 (7.1 tonnes in 2021). Seizures of
the MDMA precursor PMK and its glycidic derivatives of 19.9 tonnes were reported in 2022
(2.6 tonnes in 2021). Seizures of alternative chemicals for the production of MDMA were also
reported: MAMDPA was seized in smaller amounts in 2022 (37 kilograms, compared with
4.5 tonnes in 2021).
While high by historical standards, the average MDMA content in tablets continued to decline in
2022 from a peak in 2019; the purity of powders was stable compared with 2021. MDMA tablets
seized in Europe contained on average between 140 and 157 milligrams of MDMA (161-
173 milligrams in 2021), and the average purity of seized MDMA powders ranged from 46 % to
100 % (42-100 % in 2021), with half the countries reporting values in the range 66-87 % (69-
85 % in 2021). The Netherlands, however, reported a lower average MDMA content of ecstasy
tablets (130 milligrams per tablet).
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Figure 5.3. MDMA market in Europe
EU EU+2
Number of seizures, EU Price retail (EUR/tablet) (EU)
Quantity seized (million tablets), EU Price retail (EUR/g powder) (EU)
Quantity seized (tonnes), EU Price wholesale (EUR/1000 tablets) (EU)
Trends in the number of MDMA seizures (all forms), MDMA content retail (mg/tablet) (EU)
EU
Trends in the quantity of MDMA seized Tablets Purity powder retail (% MDMA) (EU)
- 93 -
Trends in the quantity of MDMA seized Indexed trends: price and MDMA content, retail
Powder/crystal (tonnes) (2011=100)
In the first half of 2023, the average MDMA tablet tested by drug checking services in 18 cities in
10 EU Member States contained 134 milligrams of the drug (139 milligrams in the same period
of 2022). The average purity of MDMA powder reported was 80 % (78 % in first half of 2022) (
Figure 5.4).
In 2023, a total of 1 541 samples sold as MDMA were tested for psychoactive adulterants by 12
drug checking services in 9 EU Member States. MDMA was the sole psychoactive substance in
1 325 samples, while the remaining 216 samples contained at least one other psychoactive
substance. Synthetic cathinones were the most frequently detected of these, representing 44 %
of all detected psychoactive adulterants in samples sold as MDMA (Figure 5.5). Synthetic
cathinones were reported by services in 9 Member States (compared with 4 in 2022), with all 12
services reporting the detection of these substances in at least one MDMA sample. The synthetic
cathinones most frequently detected in MDMA products in 2023 were 3-CMC, 4-CMC, 3-FEA, 3-
MMC and dipentylone.
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Figure 5.4a. Purity of MDMA powder samples submitted to drug checking services in 2022
and 2023 (percent)
Figure 5.4b. Content of MDMA tablet samples submitted to drug checking services in 2022
and 2023 (percent)
Source: Trans-European Drug Information (TEDI). Data from drug checking services in 18 cities (10 EU countries), collected
between January and June of 2022 and 2023. Only cities that submitted 10 or more samples were included.
- 95 -
Figure 5.5. Psychoactive adulterants detected in samples sold as MDMA to users and tested
in 12 European drug checking services in 2023
Total number of detected adulterants was 226.
Source data
- 96 -
Heroin and other opioids – the

- 97 -
Heroin remains Europe’s most commonly used illicit opioid

and is responsible for a large share of the health burden
attributed to illicit drug consumption. Europe’s opioid
problem, however, continues to evolve in ways that are likely
to have important implications for how we address issues in
this area. On this page, you can find the latest analysis of the
drug situation for heroin and other opioids in Europe,
including prevalence of use, treatment demand, seizures,
price and purity, harms and more.

Being prepared for possible changes in opioid

availability and use
Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large share of the
health burden attributed to illicit drug consumption. Europe’s opioid problem, however, continues to
evolve in ways that are likely to have important implications for how we address issues in this area.
Data on entry to drug treatment and other indicators show that Europe’s cohort of heroin users is
ageing, with little current evidence to suggest significant new recruitment into this behaviour.
Between 2010 and 2022, the mean age of all clients entering specialist drug treatment for heroin
use and for those doing so for the first time increased, as did the proportion of older clients (see
Figure 6.1 and Figure 6.2). Changes in the characteristics of those seeking help increasingly mean
that services must respond to the needs of clients presenting with an increasingly complex range of
health and social support needs. As well as directly responding to drug-related problems, these
include the need to provide care and support to prevent or treat age-related illness and a
corresponding requirement to establish effective multi-agency partnerships and referral pathways
with general health and social support services.
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Figure 6.1. Age distribution of all clients entering treatment with heroin as their primary
drug, 2010 and 2022
Based on data from 19 EU countries and Türkiye.
Figure 6.2. Age distribution of never previously treated clients entering treatment with
heroin as their primary drug, 2010 and 2022
Based on data from 20 EU countries and Türkiye.
While heroin continues to be involved in many opioid-related deaths (see Drug-induced deaths – the
current situation in Europe), the number of countries in which this is the case has decreased; at the
same time, other opioids have become more prominent. In addition, although heroin remained the
most commonly reported opioid in acute drug toxicity presentations at Euro-DEN sentinel hospitals
in 2022, in some cities other opioids – often those used for opioid agonist treatment, but also in
some locations, medicines containing opioids used for pain relief or potent new synthetic opioids –
have now overtaken heroin as a driver of presentations. While this data set is not nationally
representative, it provides a window on how opioid problems may be changing at the local level. This
data also needs to be interpreted with care, as some changes in this area appear to reflect the
positive impact of long-term policies to reduce the demand for heroin, discourage new initiation and
provide adequate and effective treatment responses. Nonetheless, greater attention may now be
- 99 -
merited on measures to reduce the risk that opioids intended for therapeutic use may be diverted
onto the illicit market. An important caveat here is that the pursuit of this objective should not create
additional barriers to the provision of effective treatment for those with opioid problems. Moreover, it
must be recognised that access to opioid agonist treatment remains inadequate in many countries.
Changes in the route of administration of heroin have also been observed. Among presentations to
treatment services, injecting among both first-time and previously treated heroin clients has
decreased over the last decade (see Figure 6.3 and Injecting drug use in Europe – the current
situation). This change could reflect the influence of various factors, including the impact of harm
reduction and prevention efforts and changes in drug availability that may affect patterns of use.
Only 18 % of new clients entering treatment for heroin-related problems now report injection as their
main route of administration. This development is important, as injecting drug use is particularly
associated with a range of negative health outcomes. Less positively, as discussed elsewhere in this
report, overall, people who inject drugs appear to be injecting a wider range of substances, with
stimulants in particular being more commonly reported.
- 100 -
Figure 6.3. Trends in the main route of administration of clients entering treatment with
heroin as primary drug, by treatment status
Treatment status
First-time
Treatment status
Previously treated
- 101 -
'Other routes' includes eat/drink, sniff and unspecified main routes of administration. Due to COVID-19 restrictions within
specialist drug treatment services, data for 2020, 2021 and 2022 should be interpreted with caution. Trends are based on the 19
EU Member States providing data over the period; only those with data for at least 9 of the 10 years are included. Missing values
are interpolated from adjacent years. Dashed lines refer to the COVID-19 pandemic period.
Possible signs of change in Europe’s heroin market

The United Nations Office on Drugs and Crime has estimated a 95 % drop in opium cultivation in
2023 in Afghanistan following the Taliban’s opium ban. While it is too early to determine the full
impact of this development on European drug markets, if sustained, it is likely to affect the
availability of heroin in Europe in the coming years. The most recent aggregate data presented here
are from 2022 and predate this development. These show a slight decrease in the overall quantity of
heroin seized in the European Union. In addition, substantial decreases in heroin seizures were
noted in Bulgaria and Türkiye, key countries on the heroin trafficking routes (see Heroin and other
opioids market data below). Also in 2022, a slight decline can be observed in indexed trends in
retail-level prices, with purity estimates slightly rising. At the same time, conflicts in Ukraine and the
Middle East may affect the routes used by criminals to traffic illicit drugs to Europe. The EMCDDA’s
current assessment of the most recent data would be to cautiously conclude that, as yet, there are
no strong signals of an impact on flows of heroin trafficked towards European markets, although
increases in opium prices in Afghanistan may have possibly had an impact in some areas on price
and purity. More generally, it is thought that stocks of opium existing within Afghanistan and the
relatively high value of the European market would make supplies to Europe somewhat resilient in
the short to medium term. Nonetheless, should the ban be sustained and rigorously enforced, we
would expect to see an impact on the availability of heroin in the future. It is also possible that we
might also see in the future some more limited supply of this drug to Europe from other producing
regions in South-East Asia. It is therefore prudent to consider now what might be the implications of
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any changes in this area for drug polices and responses in order to be better prepared to mitigate
any possible adverse consequences. One important implication would be the need to ensure the
adequate availability of drug treatment provision for those seeking help, as disruptions to the illicit
opioid market could increase demands in this area. A second implication would be the need to
monitor and respond appropriately to reduce any possible additional harms that might result if other
substances are used as substitutes for heroin. Experience suggests that these may include not only
other opioids but also other drug classes, including stimulants such as cocaine or synthetic
cathinones.
Could we see greater availability and use of new synthetic opioids

or other drug classes?
Currently, synthetic opioids play a relatively small role in the drug market in Europe overall, but they
are a significant problem in some countries, and there are signals that they could have the potential
to play a larger role in Europe’s drug problems in the future.
In 2023, new synthetic opioids were detected by the EU Early Warning System on new psychoactive
substances in at least 16 EU Member States, Norway and Türkiye (see New psychoactive
substances – the current situation in Europe). In the same year, outbreaks of poisonings and
overdoses involving nitazene opioids were reported in 5 countries. There were also reports of
nitazene opioids being mis-sold as heroin in Ireland and France.
An increase in the availability of synthetic opioids and of associated harms, including drug-related
deaths was reported in 2022 by some northern and Baltic countries, with preliminary 2023 data
from some countries confirming this trend. Historically, concerns in this area have been focused on
fentanyl derivatives, such as the highly potent carfentanil, which continues to be seized in some EU
countries. However, in the last few years, the nitazenes, highly potent opioids derived from 2-benzyl
benzimidazole, have be detected in Europe. The most commonly identified nitazenes include
protonitazene, metonitazene and isotonitazene. In 2022, 14 countries reported seizures of nitazenes
to the Early Warning System, amounting to 3 kilograms. These substances are discussed in more
detail in New psychoactive substances – the current situation in Europe.
There has also been speculation that if the availability of heroin in Europe is reduced as a result of
the Taliban’s ban on opium production in Afghanistan, this could create the conditions for greater
availability and use of synthetic opioids. Given the potential negative consequences of this, Europe
needs to improve its preparedness for the harm reduction and other challenges that such a market
shift could bring.
Concerns in this area include the adulteration of heroin with new synthetic opioids, the mis-selling of
new synthetic opioids and, in an extreme scenario, the replacement of heroin by new synthetic
opioids. Such developments could increase the risk of overdose and drug-related death among
opioid consumers. It is of note in this context that North America has seen a dramatic increase in
opioid-related mortality in recent years, driven by potent synthetic opioids, principally fentanyl
derivatives. However, based on previous examples of shocks to the heroin market, it is also possible
that stimulants such as cocaine and synthetic cathinones may also have the potential to be used as
replacement substances for heroin. It is therefore of concern that, as noted elsewhere in this report,
the use of cocaine, and crack cocaine in particular, appears to be increasing among more
marginalised groups and spreading to more countries.
While increased polydrug use and substance-switching are likely outcomes of any reduction in
heroin availability, a key means to pre-empt this scenario would be to expand rapid access to opioid
agonist treatment and related supports, as well as needle and syringe programmes. It also remains
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important to develop sufficient access to naloxone to prevent overdoses and drug-related deaths.
Most supplies of new synthetic opioids, such as nitazenes, are believed to originate in China and to
be trafficked to Europe. However, some limited synthetic opioid production is known to have
occurred within Europe, and it is not impossible to imagine that existing illicit synthetic drug
production capacity could potentially be used for the production of synthetic opioids, should market
conditions become favourable.
For a more detailed insight into the dynamics of heroin supply in the European Union, see the 2024
EMCDDA-Europol EU Drug Market: Heroin and other opioids – In-depth analysis.
Key data and trends

Prevalence of opioid use
It is estimated that 0.3 % of the EU adult population, or around 860 000 people, used opioids in
2022 (950 000 in 2021). This apparent decrease, compared to previous years, is mainly due to a
change in the indirect statistical method used to estimate the population of people who use
heroin in Italy.
Treatment entry for use of heroin and other opioids

Opioid use was reported as the main reason for entering specialist drug treatment by 63 000
clients in 2022, representing 25 % of all those entering drug treatment in Europe. Heroin was the
primary drug for 12 000 (64 %) of the 19 000 first-time entrants who reported a specific opioid as
their main problem drug (see Figure 6.4). Another 2 400 first-time opioid clients did not specify
their primary drug.
Due to service disruptions during the COVID-19 pandemic, treatment entry data for 2020-2022
should be interpreted with caution. Nevertheless, the data suggest that the long-term downward
trend in the number of people entering treatment for heroin use has continued (Figure 6.4).
The latest European data reveal a time lag of 14 years between first heroin use, on average at the
age of 23, and first treatment for heroin-related problems, on average at the age of 37.
National data from 26 EU Member States show that an estimated 508 000 clients received opioid
agonist treatment in 2022 (506 000 in 2021).
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Figure 6.4. Users entering treatment for heroin in Europe
entrants
Mean use: 4.7 days per week
Trends in first-time treatment entrants Route of administration (%): all treatment

entrants
- 105 -
Apart from trends, data are for all treatment entrants with heroin as the primary drug – 2022 or the most recent year available.
Trends in first-time entrants are based on 25 countries. Data for Germany are for entrants with ‘opioids’ as primary drug. Only
countries with data for at least 5 of the 6 years are included in the trends analysis. Missing values are interpolated from adjacent
years. Because of disruptions to services due to COVID-19, data for 2020, 2021 and 2022 should be interpreted with caution.
Missing data were imputed with values from the previous year for Spain and France (2022) and Germany (2019).
Harms related to opioid use

In 2022, heroin remained the third most frequently reported drug in acute drug toxicity
presentations in Euro-DEN Plus hospitals, accounting for 16 % of all reported cases. A small
number of centres accounted for many of the reports received by the sentinel network. Heroin
was found in 19 of the 23 European hospitals participating in 2022 (see Figure 6.5). Half of the
participating hospitals reported that 4.3 % or more of their presentations involved heroin in 2022.
Heroin was reported in more than a fifth of the drug-related presentations at centres in Drogheda
and Dublin (Ireland), Ljubljana (Slovenia) and one of the two centres in Oslo (Norway). Most
presentations with heroin involved were among men aged 25 to 45 years: in 6 of the 19 centres in
2022, no cases were aged less than 25 years. In half of the centres, women represented 19 % or
less of the presentations with heroin involved. Depending on the centre, the other drugs most
commonly reported in these presentations were benzodiazepines, cocaine and amphetamine.
Opioids were found in an estimated 74 % of fatal overdoses reported in the European Union. This
finding is based on toxicological data submitted between 2015 and 2022, in which opioids were
identified in 3 305 out of a total of 4 439 deaths. It should be noted that multiple drugs are
commonly found in toxicology reports from suspected drug-induced deaths.
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Figure 6.5a. Proportion of acute drug toxicity presentations with heroin involved in 2022, Euro-
DEN Plus
Figure 6.5b. Trends in the proportion of presentations with heroin involved, selected hospitals
- 107 -
Data source: Euro-DEN. For the complete data set and analysis, see European Drug Emergencies
Network (Euro-DEN Plus): data and analysis.
Heroin and other opioids market data

EU Member States reported 19 000 heroin seizures amounting to 8.0 tonnes in 2022 (9.5 tonnes
in 2021). The Netherlands (2.6 tonnes), France (1.4 tonnes), Belgium (1.3 tonnes), Italy
(0.6 tonnes) and Bulgaria (0.3 tonnes) reported large quantities. Türkiye seized 8 tonnes of heroin
in 2022 (22.2 tonnes in 2021).
Following an increase in heroin seizures in 2021 (to 9.5 tonnes), the quantity seized by EU
Member States fell by 16 % to 8.0 tonnes in 2022. Türkiye reported a more marked decrease in
the quantity seized in 2022 (to 8.0 tonnes, or −64 %, compared with 22.2 tonnes in 2021) (
Figure 6.6). Bulgaria reported a 71 % reduction in the quantity seized in 2022 (to 0.3 tonnes)
compared with 2021 (1.2 tonnes).
The average purity of brown heroin at the retail level ranged from 5.4 % to 41.7 % in 2022, with
half of the countries reporting an average purity between 14.4 % and 25.0 %. Indexed trends
indicate the average purity of brown heroin rose by 44 % between 2012 and 2022, while its price
dropped by 24 %. A slight decline in heroin’s average price and a slight rise in its purity are
observable in the most recent data (Figure 6.6).
Available data show that almost 13 600 seizures of opioids other than heroin were reported in
2022, amounting to almost 1.2 tonnes, 216 litres and over 2 million tablets (including tramadol,
buprenorphine, oxycodone, morphine, methadone, codeine and nitazene opioids) (Table 6.1). A
total of 3.5 kilograms of nitazene analogues was reported as seized in 2022 by Estonia, Latvia,
Poland and Sweden. In the same year, reports of seized quantities of fentanyl and carfentanil in
the European Union amounted to 9.2 kilograms (2.7 kilograms of fentanyl seized by two countries
and 6.5 kilograms of carfentanil seized by 14 countries), 168 litres of fentanyl (in one seizure in
- 108 -
Bulgaria) and 8 435 tablets (fentanyl).
An increase in fake medicines containing nitazenes was reported to the EU Early Warning
System, with 430 tablets or capsules reported in 2022 (189 in 2021). In 2023, Portugal seized
5 752 fake oxycodone tablets containing N-desethyl isotonitazene, while Sweden seized 3 100
fake Oxycontin (oxycodone) tablets containing metonitazene. In 2024, Finnish police reported a
seizure of 1 000 fake Subutex (buprenorphine) tablets containing metonitazene.
Approximately 22 400 offences for heroin use or possession were reported in 2022.
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Figure 6.6. Heroin market in Europe
EU EU+2
Heroin: Number of seizures, EU Heroin base, retail price (EUR/g) (EU)
Heroin hydrochloride, retail price (EUR/g)

(EU)
Heroin: Quantity seized (tonnes), EU
Heroin base, wholesale price (EUR/g)

(EU)
Heroin: Trends in number of seizures (x 1000) EU
Heroin hydrochloride, wholesale price

(EUR/g) (EU)
Heroin base, purity (%) (EU)
Heroin: Trends in quantity seized (tonnes)
Heroin hydrochloride, purity (%) (EU)
Indexed trends: retail (2012=100) (EU)
Indexed trends show the price and purity of brown heroin base: national mean values – minimum, maximum and interquartile
range. Countries covered vary by indicator.
- 110 -
Table 6.1. Other opioids: number of seizures and quantities seized, 2022
Number of Weight
Substance Countries Tablets Litres Patches
seizures (kilograms)
Tramadol 13 4185 0.1 958094 1.7
Buprenorphine 17 4578 3.4 918819 0.001 21
Methadone 19 1136 17.3 76447 43.8
Morphine 16 761 2.8 11259 1.3
Oxycodone 15 894 1.3 76342 0.5
Opium 17 826 1116.4 298 0.02
Codeine/dihydrocodeine 14 390 26.4 13384 0.4
Fentanyl 14 177 2.7 8435 168.2 1521
Carfentanil 2 273 6.5 0.17
Nitazenes 4 350 3.5 108 0.44
Source data
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Other drugs – the current

Drug Report 2024)
- 112 -
Alongside the more well-known substances available on illicit

drug markets, a number of other substances with
hallucinogenic, anaesthetic, dissociative or depressant
properties are used in Europe: these include LSD (lysergic
acid diethylamide), hallucinogenic mushrooms, ketamine,
GHB (gamma-hydroxybutyrate) and nitrous oxide. On this
page, you can find the latest analysis of the situation
regarding these substances in Europe, including seizures,
prevalence and patterns of use, treatment entry, harms and
more.

Need for greater investment in monitoring the use of

less well-known substances
Alongside the more well-known substances available on illicit drug markets, a number of other
substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in
Europe: these include LSD (lysergic acid diethylamide), hallucinogenic mushrooms, ketamine, GHB
(gamma-hydroxybutyrate) and nitrous oxide. Some of these substances appear to have become
well-established in some countries, cities or specific populations, although overall their relative
prevalence may remain low in comparison to some other better-known drug classes. However, for a
variety of methodological and historical reasons, our current monitoring approaches often perform
poorly in identifying patterns and trends in the use of less well-known substances. This makes it
difficult to comment with confidence on the prevalence of use or recent trends, or on the extent to
which these drugs are associated with health or social problems. The information available
suggests, however, that in some countries, subgroups or settings, the use of these sorts of
substances has become more common. As patterns of drug use can change rapidly and many of the
drug-related problems we face are increasingly influenced by the co-consumption of multiple
substances, there is a strong argument for increasing investment in the surveillance of substances
with hallucinogenic, anaesthetic, dissociative or depressant properties.
Signs that ketamine is increasingly available and more prominent

in Europe’s drug problems
Ketamine accounted for 9 % of the quantity of new psychoactive substances seized in the European
Union in 2022. The quantity of ketamine seized and reported to the EU Early Warning System on
new psychoactive substances has varied over time, but has remained at relatively high levels in
recent years, tripling from just under a tonne in 2021 to 2.8 tonnes in 2022. Seizures were reported
by 17 countries in both years, with both Denmark and the Netherlands reporting large seizures, and
these two countries together accounted for two thirds of the overall quantity of ketamine seized in
2022. Most of the ketamine seized in Europe is thought to originate from India, but there is some
evidence that the drug may also be sourced from Pakistan and China. Available information
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suggests that production of the drug in Europe remains limited.
Overall, there is evidence to suggest that ketamine is likely to be consistently available in some
national drug markets and may have become an established drug of choice in some settings. It is
also reported to be used in combination with other substances, such as stimulants. In Ireland, for
example, the intentional mixing of cocaine and ketamine has been identified at music festivals, as
have ketamine-related medical incidents during 2022 and 2023. In 2022, Euro-DEN sentinel
hospital emergency departments in Europe reported that cocaine was the substance most often
reported in combination with ketamine in acute toxicity presentations. Ketamine is commonly
snorted, but can also be injected, and has been linked to various dose-dependent acute and chronic
harms, including neurological and cardiovascular toxicity, mental health problems, such as
depression, and urological complications, such as bladder damage from intensive use or the
presence of adulterants.
Ketamine may also be added to other drug mixtures, including MDMA powders and tablets,
potentially making inadvertent consumption an issue. Ketamine has also been found in mixtures
sold as ‘pink cocaine’ or ‘tucibi’, which are more likely to contain ketamine and other synthetic drugs,
such as amphetamines or MDMA. In contrast to some other parts of the world, mixtures sold as pink
cocaine are less likely to contain the synthetic drug 2C-B, which has historically been associated
with this product. At least 10 countries reported the detection of pink cocaine to the EU Early
Warning System’s database on new drugs, with most of the cases reported by Spain. It is also
interesting to note that while the overall figure remains low, both the quantity of 2C-B seized and the
number of countries reporting seizures increased in 2022, with 14 countries reporting seizures
amounting to just under 6 kilograms of this drug.
The number of clients reported to receive treatment for problems related to ketamine use remains
low. However, it has risen from around 240 cases reported in 2018 to 600 in 2022. Moreover, this
data set is not likely to capture all those having health problems with this drug. For example, those
who have developed urological problems may be poorly represented.
More EU countries control access to nitrous oxide

Nitrous oxide, commonly known as laughing gas, has been linked to various health problems,
including poisonings, burns and lung injuries and, in some cases of prolonged exposure,
neurotoxicity from vitamin B12 deficiency. There is, however, a debate on the extent to which this
substance is associated with negative health risks, especially among episodic users, although given
its apparent growing popularity among young people, this is clearly an important area for further
research and monitoring. In some European cities, discarded nitrous oxide gas canisters have
become a relatively common sight, and the disposal of the smaller stainless steel canisters has been
identified as a drug-litter issue in some countries. A 2022 EMCDDA review identified a number of
EU Member States, including Denmark, Ireland, France, Lithuania, the Netherlands and Portugal,
that observed signs of an increase in the availability and recreational or episodic use of nitrous
oxide. The drug has become more accessible and cheaper, available online and with the increased
availability of larger gas canisters aimed at recreational use. However, high-volume cylinders may
also increase the risk of lung damage, due to the higher pressure of their contents and, in general,
inhaling directly from gas bottles is reported to be associated with a greater risk of harm. Nitrous
oxide has various commercial uses, for example, it is used by the catering industry. Regulatory
approaches to the sale and use of this substance vary between countries, with the gas legally
available for sale in some countries. Several EU countries, including Denmark, France, Lithuania, the
Netherlands and Portugal have restricted the availability of nitrous oxide in recent years. There is
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limited evaluative information about the effectiveness of legislative or other approaches to

restricting access to nitrous oxide.
New benzodiazepines continue to appear on Europe’s illicit drug

market
Non-controlled and new benzodiazepines also continued to be available in some European countries
but, again, current monitoring approaches make it difficult to comment on the scale of their use,
although signals exist that these substances may have important consequences for health,
especially when consumed in combination with other drugs. They are often very cheap and may be
used by young people in combination with alcohol, sometimes resulting in potentially serious health
reactions or aberrant behaviour. These substances have also been linked to overdose deaths among
people who use opioids. A lack of toxicological information means the role that benzodiazepines
play in opioid-related deaths is not sufficiently understood. A total of 36 new benzodiazepines were
notified to the EU Early Warning System between 2007 and 2023 (Figure 8.1), with 23 of these
appearing on the drug market in 2022 in 19 EU countries and Norway.
Mixtures containing new benzodiazepines and opioids, known as ‘benzo-dope’, have been linked to
increases in overdose deaths in Canada and the United States. So far, seizures of benzo-dope have
been reported by Estonia and Latvia. In both countries, the same mixtures have also been identified
in residues analysed from used syringes.
Figure 8.1. Number of formal notifications of benzodiazepines reported to the EU Early Warning
System, 2005-2023
Potential therapeutic uses of psychedelics: an increasing focus of

medical research
Both clinical and public interest has been growing in the therapeutic use of some novel substances,
particularly psychedelic substances, but also dissociative drugs such as ketamine. At the same time,
a growing number of clinical studies, both internationally and in Europe, are exploring the potential
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of a range of psychedelic substances to treat different mental health conditions.
The evidence base in this area is growing rapidly, and some studies have produced evidence to
support the view that some substances may have value in the treatment of specific neuropsychiatric
disorders, such as post-traumatic stress disorder or treatment-resistant depression and major
depressive disorder. However, the interpretation of the results is complicated by a range of
methodological issues, and generalisation remains difficult as much of the research in this area
remains at an early stage.
Nonetheless, these developments have received considerable media attention, raising concerns that
this may encourage greater experimental use of a range of potent psychoactive substances without
appropriate medical support, potentially putting vulnerable individuals at risk of suffering adverse
consequences. At the same time, there are signs of unregulated programmes being operated in the
European Union and elsewhere, in which the use of psychedelic substances is included as part of a
wellness, therapeutic or spiritually oriented intervention. Strengthening monitoring in this area will
be important, as a growth of unlicensed therapeutic uses of psychedelics may adversely affect
vulnerable individuals with pre-existing mental health conditions.
Key data and trends

Prevalence and patterns of use of other drugs
Among young adults (aged 15 to 34), recent national surveys show last year prevalence
estimates for both LSD and hallucinogenic mushrooms equal to or less than 1 %. Exceptions for
hallucinogenic mushrooms include Czechia (4.4 % in 2022), Finland (2.7 % in 2022), the
Netherlands (2.2 % in 2022), Estonia (1.6 % in 2018, 16-34), Denmark (1.7 % in 2023, 16-34)
and Germany (1.1 % in 2021). Exceptions for LSD include Czechia (3.5 in 2022), Ireland (2.4 % in
2019), Estonia (1.7 % in 2018, 16-34), Latvia (1.4 % in 2020), Finland (1.3 % in 2022) and
Denmark (1.1 % in 2023).
Among respondents to the European Web Survey on Drugs, a non-representative survey of

people who use drugs, 20 % of those who had used drugs within the last 12 months had used
LSD, while 13 % had used ketamine.
Recent estimates of last year prevalence of ketamine use among young adults (15-34) range
from 0.8 % in Romania (2019) to 0.9 % in Denmark (2023, 16-34). The Netherlands reported that
ketamine use has increased among young people in nightlife settings.
In 2023, generally very low levels of ketamine residues in municipal wastewater were reported by
22 cities in 16 EU Member States, with the highest mass loads being detected in cities in
Belgium, Germany, Spain, France and the Netherlands (Figure 8.2). Among the 22 cities with
data for 2022 and 2023, 12 showed an increase (of at least 10 %), 8 were relatively stable and 2
showed a decrease.
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Figure 8.2. Ketamine residues detected in wastewater in selected European cities, 2023
previous data
Mean daily amounts of ketamine in milligrams per 1000 population. Sampling was carried out over a week in March and April
2023. Taking into account statistical errors, values that differ less than 10 % from the previous value are considered stable in this
figure.
Source: Sewage Analysis Core Group Europe (SCORE). For the complete data set and analysis, see Wastewater analysis and
drugs – a European multi-city study.
Treatment entry for ketamine use

Increases were observed in the number of clients entering treatment for problems related to
ketamine use in Belgium, Germany and Italy in 2022 and Spain in 2021 (most recent data), with
the overall number rising from 179 in 2018 to an estimated 534 clients in 2022 in these
countries.
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Harms related to use of other drugs

GHB/GBL (gamma-hydroxybutyric acid/gamma-butyrolactone) was the fourth most common
drug reported by Euro-DEN Plus hospitals in 2022. Overall, it was reported by 16 emergency
departments in 11 EU Member States and Norway in 2022 and was involved in an estimated
3.7 % of presentations (median) across the 23 participating emergency departments in 17 EU
Member States and Norway that reported 2022 data.
Ketamine was the eighth most common drug reported by Euro-DEN Plus hospitals in 2022.
Overall, it was reported by 18 centres in 12 EU Member States and Norway in 2022 and was
involved in an estimated 2.3 % of presentations (median) across the 23 centres that reported
2022 data. In 2022, half of the cases were aged between 25 and 45 years, most were males,
presented to the emergency services during weekdays, and had also consumed alcohol. In most
centres, cocaine was the substance most often reported as used in combination with ketamine.
Cannabis and stimulants, including amphetamine and MDMA, were also reported in the acute
drug-toxicity presentations with ketamine involved, potentially indicating a diversity of use
patterns and possible inadvertent consumption. One in 40 ketamine-related presentations was
admitted to intensive care.
Nitrous oxide was reported in acute drug-toxicity presentations to emergency services of 6 out of
23 sentinel hospitals in 2022. Most cases were younger than 25 years, males and presented
during weekdays. A minority of the presentations involved alcohol, and cannabis was the drug
most commonly reported in the cases of polydrug use toxicity.
LSD was reported by 15 centres in 12 of the 17 participating EU Member States and Norway in
2022 and was involved in an estimated 0.7 % of presentations (median) across the 23 centres.
Three quarters of the presentations were in males and 4 out of 10 were younger than 25 years.
One in 3 LSD-related presentations was admitted to intensive care.
Market data for other drugs

Seizures of hallucinogenic and dissociative drugs are not consistently monitored across Europe.
Different EMCDDA monitoring systems provide the limited information available, which is
incomplete, divergent and difficult to generalise.
In 2022, 1 700 seizures of LSD (lysergic acid diethylamide), amounting to 99 700 units and
2.1 kilograms were reported in Europe (Table 8.1). Twenty-three countries reported 1 439
seizures of hallucinogenic mushrooms, amounting to 143 kilograms. Sixteen countries reported
207 seizures of DMT (dimethyltryptamine), amounting to 754 kilograms, mainly in Türkiye
(710 kilograms) and Italy (19 kilograms).
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Table 8.1a. Number of seizures and quantity seized of other drugs, EU+2
Quantity Quantity Quantity

Drug Countries Number
(kg) (litres) (tablets/units/blotters)
2C-B 14 569 5.7 64586
LSD 24 1665 2.1 99687
DMT 16 207 754.4 6.1 8453
Hallucinogenic
23 1439 143 3588
mushrooms
GHB 17 1011 6.5 166.5
GBL 16 488 106.9 599.9
Clophedrone 15 1269 132.3
Clephedrone 14 153 15.5
Table 8.1b. Number of seizures and quantity seized of other drugs, EU
Quantity Quantity Quantity

Drug Number
(kg) (litres) (tablets/units/blotters)
2C-B 569 5.7 64586
LSD 1330 2 94026
DMT 205 45 6.1 8453
Hallucinogenic
1434 143 3588
mushrooms
GHB 621 6.5 62.3
GBL 471 106.9 481.6
Clophedrone 1269 132.3
Clephedrone 153 15.5
In 2022, ketamine seizures reported to the EU Early Warning System amounted to 2.8 tonnes, up
from 0.87 tonnes in 2021. Seizures of ketamine have fluctuated at levels above 0.5 tonnes since
2017 (Figure 8.3), while the number of ketamine seizures has doubled (Figure 8.4).
No ketamine laboratories were reported as dismantled in 2022. Given ketamine’s common use in
veterinary medicine as an anaesthetic, the theft and diversion of the drug from legitimate
purposes remains a problematic issue.
Ketamine was submitted for testing to drug checking services in 11 cities in 4 EU countries in the
first half of 2023, with an average purity of 83 % (in the same period, in 2022, the average purity
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was 80 %). Detected adulterants generally included stimulants (cocaine, amphetamines, MDMA,
synthetic cathinones) or dissociative drugs (2-(2-fluorophenyl)-2-(methylamino)cyclohexan-1-
one).
Figure 8.3. Seizures of ketamine powder in the European Union: total quantity (kilograms), 2006-
2022
Figure 8.4. Seizures of ketamine powder in the European Union: total number, 2006-2022
An increasing number of samples of mixtures containing ketamine, MDMA and cocaine have
been reported to the EU Early Warning System on new psychoactive substances since about
2018, mostly by Spain. Some of these appear to be sold as ‘pink cocaine’ or ‘tucibi’, with people
consuming it potentially unaware they may be consuming ketamine.
In 2022, 14 EU countries reported 569 seizures of the psychedelic drug 2C-B, amounting to
64 600 tablets or units and 5.7 kilograms. Open-source monitoring indicates that it is sometimes
added to mixtures sold as pink cocaine in Europe and elsewhere, alongside MDMA powder and
ketamine, which may or may not contain cocaine.
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Seventeen European countries reported 1 500 seizures of GHB (gamma-hydroxybutyrate) or its

precursor GBL (gamma-butyrolactone), amounting to 114 kilograms and around 800 litres. GBL
has many industrial purposes, making the data challenging to interpret.
In 2022, EU Member States reported 752 seizures of new benzodiazepines to the EU Early
Warning System, representing approximately 3 % of the total number of seizures of new
psychoactive substances. Of the 36 new benzodiazepines ever reported to the Early Warning
System, 23 were detected in drug seizures in 19 EU countries and Norway in 2022.
Source data
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New psychoactive substances –

the current situation in Europe
- 122 -
The market for new psychoactive substances is

characterised by the large number of substances that have
emerged, with new ones being detected each year. On this
page, you can find an overview of the drug situation for new
psychoactive substances in Europe, supported by
information from the EU Early Warning System on seizures
and substances detected for the first time in Europe. New
substances covered include synthetic and semi-synthetic
cannabinoids, synthetic cathinones, new synthetic opioids
and nitazenes.

Appearance of potent new substances and

inadvertent consumption raising health concerns
The market for new psychoactive substances is characterised by the large number of substances
that have emerged, with new ones being detected each year. The term ‘new psychoactive
substances’ covers a broad range of substances that are not controlled by international drug control
conventions, although some of them may be subject to national regulatory measures. In 2022, EU
Member States seized a record 30.7 tonnes of new psychoactive substances (see Seizures of new
psychoactive substances, below).
The most recent data shows that drug producers continue to create new substances to avoid legal
controls, although the rate at which new psychoactive substances are now entering the market
appears to be slowing. Between 2016 and 2022, typically around 50 new psychoactive substances
appeared on the market for the first time each year; this fell to 26 in 2023. In addition, around 400
previously reported new substances are detected on the market each year.
In general, the risks to health of these novel compounds are usually unknown, although some clearly
pose an acute risk to consumers of experiencing serious or even fatal poisonings or other health
problems. Over time, legislative controls and other regulatory measures taken in Europe and non-EU
source countries appear to have contributed to a reduction in the number of new derivatives of some
drug types, particularly those that have been specifically targeted, such as fentanyl. Other
substances, however, designed to evade generic definitions in legislation, continue to emerge, with
China and India remaining important source countries for these substances or the precursors that
are required to produce them.
Cannabis consumers risk inadvertent exposure to synthetic

cannabinoids
The 9 new cannabinoids detected, 4 of which are semi-synthetic cannabinoids, accounted for
approximately one third of the new substances first reported to the EU Early Warning System in
2023 (see New psychoactive substances reported, below).
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The continuing emergence of new substances in this area adds to concerns that consumers of
cannabis may be at risk of inadvertent exposure to synthetic cannabinoids. Adulterated cannabis
may appear similar to unadulterated cannabis and can be mis-sold as cannabis to unsuspecting
consumers. It is therefore possible that such adulterated products are more widely available but
often go undetected.
Synthetic cannabinoids are often highly potent substances, and adulterated products carry
poisoning risks. An additional concern is that cannabis edibles (foods, often in the form of sweets
that are typically infused with cannabis extract) have become more available on the illicit market in
Europe since 2021. In addition to the risks posed by these products due to their THC content and
the possibility that they may be mistaken for legitimate commercial products, especially by children,
there are concerns that some of these products contain synthetic cannabinoids. Since 2019, at least
5 countries have reported the identification of edibles containing synthetic cannabinoids in the form
of sweets (jelly ‘gummies’). Cases of severe poisonings after the ingestion of sweets infused with
synthetic cannabinoids have been recorded in the European Union.
Synthetic cannabinoids also sometimes appear in samples of other drugs. In May 2023, for
example, an unusual and unexpected outbreak of non-fatal poisonings involving more than 20
people was reported in Paris, France, caused by heroin adulterated with synthetic cannabinoids.
Around the same time, in April 2023, Lithuania reported the seizure of a similar adulterated heroin
sample.
Health risks from HHC and other semi-synthetic cannabinoids

remain poorly understood
New regulatory challenges and concerns have emerged about the potential for interaction between
the commercialisation of cannabis derivatives and the recreational drug market. In 2022, semi-
synthetic cannabinoids, not controlled under international drug laws, started to appear on the
European drug market for the first time. The first was HHC (hexahydrocannabinol), which was
identified in May 2022 and had been reported by 23 EU Member States and Norway by December
2023. HHC has been listed as a controlled drug in at least 18 EU Member States, as of March 2024.
Five other semi-synthetic cannabinoids, HHC acetate, hexahydrocannabiphorol,
tetrahydrocannabidiol, tetrahydrocannabiphorol and hexahydrocannabihexol, have also been
identified on the European drug market. It appears likely that these substances are being produced
from cannabidiol extracted from low-THC cannabis. Initially, semi-synthetic cannabinoids were
trafficked from the United States. However, there are now signs that they are also being produced in
Europe. Marketed online and in shops as ‘legal’ replacements for cannabis, they include hemp
sprayed or mixed with HHC, which looks and smells like cannabis, as well as vapes and edibles. The
effects of HHC in humans have not been sufficiently studied, but anecdotal consumer reports
suggest they may be subjectively similar to those of cannabis. Some of the products available,
however, are in forms that may deliver high doses, raising concerns about the possibility of adverse
health effects. More research is needed on the implications of consuming these substances,
especially at higher doses, and currently a lack of robust monitoring data makes the availability, and
any risks associated from the use of these substances, difficult to assess.
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Synthetic cathinones becoming more significant in Europe’s

stimulant market
Synthetic cathinones have appeared and become established as replacements for stimulants such
as amphetamine in some parts of Europe.
In 2022, large quantities of cathinones such as 3-CMC and 3-MMC, mostly trafficked from India,
continued to be seized in Europe, indicative of the important role these drugs now play in some
countries. This is a cause for concern, compounded by information suggesting that cathinones are
also now increasingly being produced in Europe. Cathinones are also sold alongside or as other
drugs, potentially increasing the risk of harm. In 2022 and 2023, the EU Early Warning System noted
an increase in reports of synthetic cathinones mis-sold as MDMA or used to adulterate MDMA.
Nitazenes: a new and growing threat to health

New synthetic opioids are often highly potent, meaning a small amount can be sufficient to produce
a large number of typical street doses and can pose an increased risk of life-threatening poisoning.
In North America, the synthetic opioid fentanyl has been the major driver of a public health
emergency characterised by high levels of mortality. Although these drugs have not figured
prominently in the European drug problem to date, there are now concerns that risks in this area are
growing. New synthetic opioids have been linked to drug-induced deaths in Europe with recent
reports from Estonia, Latvia and Lithuania indicating that these substances now account for a
significant share of overdose deaths in these countries. At least 163 deaths were associated with
fentanyl and fentanyl derivatives in Europe in 2022. Many of these were associated with fentanyl
diverted from medical use as opposed to fentanyl produced for the illicit drug market.
Seven new synthetic opioids were formally notified in 2023 to the EU Early Warning System, with 6
of them belonging to the highly potent group of benzimidazole (nitazene) opioids. This is the highest
number of nitazene opioids notified in a single year. Since 2019, at least 20 EU countries have now
reported the presence of a nitazene. The nitazene opioids appear to have emerged following control
measures, introduced both in producer countries and elsewhere, to reduce the availability of
fentanyl derivatives. Preliminary reporting from 2023 suggests an increase in deaths linked to
nitazenes in Estonia and Latvia. In addition, localised outbreaks of poisonings caused by nitazenes
mis-sold as heroin were reported in Ireland and France.
There are also some reports that suggest an increase in the detection of fake medicines containing
nitazene opioids. The appearance of nitazenes has also been accompanied by other developments
in the market, where new synthetic opioids are found in combination with other substances. These
include the emergence in 2021 of ‘tranq-dope’, in which new synthetic opioids are mixed with the
animal sedative and analgesic xylazine, and ‘benzo-dope’ in 2022, in which new synthetic opioids
are mixed with new benzodiazepines (such as bromazolam).
The European opioid market may also be affected by developments elsewhere. Of particular note in
this context is the recent ban on opium poppy cultivation in Afghanistan, which appears to have
resulted in a dramatic reduction in opium production. While it is still too early to be definitive, this
may result in a reduced supply of heroin to Europe. Should this happen, a concern exists that new
synthetic opioids could be among the replacement drugs for heroin, potentially increasing the risks
associated with opioid use.
More generally, the appearance of highly potent synthetic opioids requires us to review if the current
approaches used to prevent, treat and reduce the harm of opioid-related problems remain fit for
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purpose. For example, it has been suggested that approaches to providing the opioid antagonist
naloxone need to be reviewed, as models of care may need to be adapted to more effectively
respond to those who have consumed new synthetic opioids or mixtures that contain new synthetic
opioids and other substances.
Key data and trends

New psychoactive substances reported
At the end of 2023, the EMCDDA was monitoring over 950 new psychoactive substances, 26 of
which were first reported in Europe in 2023 (Figure 7.1 and Table 7.1).
Approximately 400 new psychoactive substances were detected in seizures in 2022 (Figure 7.2).
In 2023, the EU Early Warning System received reports of 9 new cannabinoids, bringing the total
number being monitored to 254.
Since 2009, a total of 81 new opioids have been identified on the European drug market, with 7
new substances notified in 2023 (1 in 2022, 6 in 2021), 6 of which were highly potent nitazene
opioids, which can, in some cases, be hundreds of times more potent than heroin. To date, 16
nitazenes have been identified in Europe (Figure 7.3).
Figure 7.1. Number of new psychoactive substances reported for the first time to the EU
Early Warning System, by category, 2005-2023
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Table 7.1. Notifications of new psychoactive substances under the terms of Regulation (EC) no
1920/2006 (as amended) and Council Framework Decision 2004/757/JHA (as amended) – 2023
Date of
EMCDDA
Common name IUPAC name formal Country
classification
notification
N-ethyl-2-[2-[(4-
isopropoxyphenyl)methyl]-5-
N-desethyl isotonitazene Opioids 22/12/2023 Portugal
nitro-benzimidazol-1-
yl]ethanamine
2-[2-[(4-ethoxyphenyl)methyl]-
N-desethyl etonitazene 5-nitro-benzimidazol-1-yl]-N- Opioids 21/12/2023 Sweden
ethyl-ethanamine
(Adamantan-1-yl)(3-pentyl-2-
thioxo-2,3-dihydro-1H-
A-PBITMO Cannabinoids 18/12/2023 Germany
benzo[d]imidazol-1-
yl)methanone
2-[2,5-dimethoxy-4-
2C-T (methylsulfanyl)phenyl]ethan- Phenethylamines 14/12/2023 Austria
1-amine
2-(4-methoxybenzyl)-5-nitro-1-
Metonitazepyne (2-(pyrrolidin-1-yl)ethyl)-1H- Opioids 23/10/2023 Sweden
benzo[d]imidazole
3-hexyl-6,6,9-trimethyl-
Hexahydrocannabihexol 6a,7,8,9,10,10a-
Cannabinoids 18/09/2023 Sweden
(HHCH) hexahydrobenzo[c]chromen-1-
ol
3-heptyl-6a,7,8,10a-tetrahydro-
Tetrahydrocannabiphorol
6,6,9-trimethyl-6H- Cannabinoids 13/09/2023 Belgium
(THCP)
dibenzo[b,d]pyran-1-ol
5-nitro-2-[(4-
propoxyphenyl)methyl]-1-(2-
Protonitazepyne Opioids 31/07/2023 Slovenia
pyrrolidin-1-
ylethyl)benzimidazole
N,N-diethyl-7-methyl-4-
(thiophene-2-carbonyl)-
1T-LSD 4,6,6a,7,8,9- Others 14/07/2023 Germany
hexahydroindolo[4,3-
fg]quinoline-9-carboxamide
1-naphthyl 4-methyl-3-
NMDMSB Cannabinoids 03/07/2023 Hungary
(dimethylsulfamoyl)-benzoate
1-(3-methylphenyl)-2-
3'-Me-PVP Cathinones 08/06/2023 Sweden
(pyrrolidin-1-yl)pentan-1-one
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Date of
EMCDDA
classification
notification
N-(2-phenylpropan-2-yl)-1-(3-
CUMYL-3TMS-PRINACA (trimethylsilyl)propyl)-1H- Cannabinoids 30/05/2023 Sweden
indazole-3-carboxamide
2-[(butan-2-yl)amino]-1-
N-sec-butyl-pentedrone Cathinones 17/05/2023 France
phenylpentan-1-one
methyl 2-(1-butyl-1H-indazole-
MDMB-BINACA 3-carboxamido)-3,3- Cannabinoids 11/05/2023 Sweden
dimethylbutanoate
6-(4-chlorophenyl)-1-methyl-
4'-Chloro
4H-[1,2,4]triazolo[4,3- Benzodiazepines 24/04/2023 Ireland
deschloroalprazolam
a][1,4]benzodiazepine
2-(2-isopropyl-5-
Tetrahydrocannabidiol
methylcyclohexyl)-5- Cannabinoids 03/04/2023 Sweden
(H4-CBD)
pentylbenzene-1,3-diol
N-(1-amino-3,3-dimethyl-1-
oxobutan-2-yl)-1-(3-
ADMB-3TMS-PRINACA Cannabinoids 31/03/2023 Germany
(trimethylsilyl)propyl)-1H-
indazole-3-carboxamide
1-[2-(3,4-dimethoxyphenyl)-1-
N-pyrrolidinyl-3,4-DMA Phenethylamines 23/03/2023 Ireland
methylethyl]-pyrrolidine
1-(1,3-benzodioxol-5-yl)-2-
N-cyclohexyl butylone Cathinones 14/03/2023 Spain
(cyclohexylamino)butan-1-one
N-(1-(2-fluorophenethyl)-3-
2’-Fluoro-2-fluoro-3-
methylpiperidin-4-yl)-N-(2- Opioids 03/03/2023 Germany
methylfentanyl
fluorophenyl)propionamide
2-{2-[(2,3-dihydro-1-
benzofuran-5-yl)methyl]-5-
Ethyleneoxynitazene Opioids 24/02/2023 Estonia
nitro-1H-benzimidazol-1-yl}-
N,N-diethylethan-1-amine
1-(methylamino)-1-(3-
Iso-3-MMC Others 15/02/2023 Austria
methylphenyl)propan-2-one
2-[(4-ethoxyphenyl)methyl]-
Etomethazene N,N-diethyl-5-methyl-1H- Opioids 19/01/2023 Sweden
benzimidazole-1-ethanamine
2-(2-bromo-3,4,5-
2-Bromomescaline Phenethylamines 12/01/2023 Austria
trimethoxyphenyl)ethanamine
2-(2,6-dibromo-3,4,5-
2,6-Dibromomescaline Phenethylamines 12/01/2023 Austria
trimethoxyphenyl)ethanamine
- 128 -
Date of
EMCDDA
classification
notification
3-Heptyl-6a,7,8,9,10,10a-
Hexahydrocannabiphorol
hexahydro-6,6,9-trimethyl-6H- Cannabinoids 06/01/2023 Slovenia
(HHC-P)
dibenzo[b,d]pyran-1-ol
Figure 7.2. Number of new psychoactive substances reported each year following their first
detection in the European Union, by category, 2005-2022
- 129 -
Figure 7.3. Number of new opioids reported for the first time to the EU Early Warning
System, 2009-2023
Seizures of new psychoactive substances

In 2022, 24 countries reported seizing 281 kilograms (385 kilograms in 2021) of synthetic
cannabinoids as herbal material. Low-THC herbal cannabis products accounted for around 30 %
of these seized materials, amounting to 76 kilograms (242 kilograms in 2021), reported by 10
countries. The samples were variously reported as ‘hemp’ or ‘cannabis’ or containing THC, CBD
or CBG.
In 2022, EU Member States accounted for almost 26 390 of the 38 860 seizures of new
psychoactive substances reported in the European Union, Norway and Türkiye, amounting to
30.7 of the 31.8 tonnes seized (Figure 7.4). The increase was driven by a small number of large
seizures of cathinones (3-CMC, 3-MMC, 2-MMC) and ketamine (Figure 7.5). In addition,
1 472 litres of liquids containing new psychoactive substances were seized, mainly GBL
(1 115 litres) and HHC (96 litres).
In 2022, just 5 substances accounted for over 90 % of the quantity of new psychoactive
substances seized in EU countries: 4 cathinones (3-CMC, 3-MMC, 2-MMC and N-
ethylnorpentedrone, amounting to 24.8 tonnes) and ketamine (2.8 tonnes, up from 0.87 tonnes in
2021) (Figure 7.5).
In 2022, 749 seizures of new opioids were reported to the EU Early Warning System, with 40 %
containing carfentanil and 22 % containing tramadol. A total of 16.6 kilograms of material was
seized, with 50 % (8.2 kilograms) containing carfentanil and 31 % (5.2 kilograms) containing
tramadol. Most of the seizures occurred in northern Europe, with Estonia, Latvia, Lithuania,
Sweden and Finland reporting 87 % of the seizures and 67 % (11.1 kilograms) of the quantity
seized.
- 130 -
Figure 7.4a. Seizures of new psychoactive substances in the European Union: number of
seizures, 2005-2022
Figure 7.4b. Seizures of new psychoactive substances in the European Union: quantity
seized, 2005-2022 (kg)
- 131 -
Figure 7.5. Seizures of new psychoactive substances in the European Union: percentage of
total quantity seized, by substance, 2022
Based on all physical forms expressed in kilograms.
Prevalence of new psychoactive substances use

National estimates of last year use of new psychoactive substances (excluding ketamine and
GHB) among young adults (aged 15 to 34) range from 0.1 % in Latvia and Norway to 5.1 % in
Romania. Among 15- to 16-year-old schoolchildren, the most recent European survey (see
ESPAD), carried out in 2019, estimated that lifetime use of new psychoactive substances ranged
from 0.9 % to 6.6 %, with lifetime use ranging from 1.1 % to 5.2 % for synthetic cannabinoids and
0.2 % to 2.5 % for synthetic cathinones.
- 132 -
Abbreviations
Abbreviations of chemical names used on this page
Abbreviation Chemical name
2-MMC 2-methylmethcathinone
3-CMC 3-chloromethcathinone
3-MMC 3-methylmethcathinone
4-CMC 4-chloromethcathinone, clephedrone
4-MMC 4-methylmethcathinone, mephedrone
CBD cannabidiol
CBG cannabigerol
GHB gamma hydroxybutyrate
GBL gamma-butyrolactone
HHC hexahydrocannabinol
THC tetrahydrocannabinol
Source data
- 133 -
Injecting drug use in Europe –

the current situation (European
Drug Report 2024)
- 134 -
Despite a continued decline in injecting drug use over the

past decade in the European Union, this behaviour is still
responsible for a disproportionate level of both acute and
chronic health harms associated with the consumption of
illicit drugs. On this page, you can find the latest analysis of
injecting drug use in Europe, including key data on
prevalence at national level and among clients entering
specialist treatment, as well as insights from studies on
syringe residue analysis and more.

Variety of substances now injected causing serious

health harms
Despite a continued decline in injecting drug use over the past decade in the European Union, this
behaviour is still responsible for a disproportionate level of both acute and chronic health harms
associated with the consumption of illicit drugs. Half a million Europeans are estimated to have
injected an illicit drug in the last year. This underlines the scale of the ongoing challenges in this area
and the fact that reducing the harm associated with injecting drug use remains an important public
health priority.
People who inject drugs are at greater risk of contracting blood-borne infections or dying from a drug
overdose. Injecting can also exacerbate other pre-existing health problems or be a cause of
abscesses, septicaemia and nerve damage. Historically, heroin has been the main drug associated
with injecting in Europe, but this has been changing in recent years. Increasingly today, other drugs,
including amphetamines, cocaine, synthetic cathinones, opioid agonist medications and other
medicines and various new psychoactive substances, are also injected, either alone or in
combination. While it is known that there is considerable variation in injecting between countries,
recent studies of syringe residues also reveal that there can also be considerable variation in the
drugs injected between different sites within a country. Multiple substances are commonly detected
in syringe residues, often including both stimulant and opioid drugs, and polydrug use can increase
the risk of a drug overdose. Recognising the complexity of injecting drug use in Europe and the
significance of polydrug use in this context is therefore likely to have important implications both for
understanding the harms associated with this mode of administration and for designing
interventions to reduce them.
Injecting stimulant drugs such as cocaine and synthetic cathinones tends to be more associated
with high-frequency injecting patterns of use, and has been associated with local HIV outbreaks in
the last decade in Europe. Methamphetamine injecting carries similar risks. This is a concern, as
there are a number of signals that stimulant injecting is becoming a more common behaviour among
people who inject drugs. In addition, people who inject drugs may use stimulants as replacement
substances, when opioids such as heroin are scarce.
- 135 -
There are multiple long-term risks linked to injecting dissolved medicine tablets and capsules, and
also crack cocaine, including vascular damage and infective endocarditis and other bacterial
infections. An additional concern is raised by the availability of highly potent synthetic opioids, such
as fentanyl and its derivatives, which can cause rapid onset of life-threatening respiratory
depression leading to fatal overdoses, and these risks are likely to be elevated when such
substances are injected. The highly potent benzimidazole opioids (nitazenes), which can be more
potent than fentanyl, were involved in three localised poisoning outbreaks in France (1) and Ireland
(2) in 2023, where consumption of nitazenes mis-sold as heroin resulted in multiple overdoses (see
also New psychoactive substances – the current situation in Europe).
In addition to the provision of drug treatment, harm reduction interventions, such as the provision of
sterile injecting equipment, remain among the most common public health measures targeting the
risks associated with injecting drugs. Although, by international standards, such interventions are
relatively well developed in Europe, it is also clear that some EU Member States face challenges in
providing sufficient coverage and access to harm reduction and drug treatment interventions for
people who inject drugs. For example, the coverage of needle and syringe programmes is low in
Bulgaria, Italy, Cyprus, Hungary and Romania in comparison with other EU Member States with
comparable estimates of injecting drug use. Moreover, historically the need to reduce the risk of
acquiring blood-borne infectious diseases has been a primary focus of many interventions in this
area. This concern remains important, but there is now greater recognition that more also needs to
be done to reduce overdose deaths and the broader range of health harms associated with injecting
drug use. Forensic and toxicological analysis of drug batches suspected of containing highly potent
substances (e.g. nitazenes), combined with rapid risk communication, is an important part of the
overall approach to overdose prevention and needs to be scaled up. Other interventions targeting
these outcomes, including take-home naloxone and drug consumption rooms, are generally less
well developed, and therefore this remains an important area for investment and service
development.
Changing patterns of drug injecting, an increasing diversity of substances and the adequacy of the
type and level of existing responses remain key issues for both frontline responders and
policymakers in the European Union. As the subgroups of people who inject drugs change, now
encompassing primarily opioid and stimulant-based open drug scenes involving marginalised
people who inject drugs, as well the use of substances such as methamphetamine and cathinones
in some settings and subgroups, responding effectively to the risk posed by drug injecting has
become a more urgent and complex challenge.
Key data and trends

Prevalence of injecting drug use
Only 18 countries have estimates of the prevalence of injecting drug use since 2015, where they
range from under 0.1 per 1 000 population aged 15 to 64 in the Netherlands, to over 10 per 1 000
in Estonia. Opioids are reported as the main injected drugs in the majority (19) of the 22
countries for which data are available for clients entering treatment in 2022.
Adjusting population estimates of high-risk opioid and stimulant users for the proportion of drug
treatment entrants reporting injecting provides a prevalence estimate of injecting drug use of 1.8
per 1 000 population aged 15 to 64 years. This suggests there were an estimated 504 000
people who inject drugs in the European Union in 2022 or 512 000 if Norway is included (Figure
9.1).
- 136 -
Figure 9.1a. Estimated number of people who inject drugs, by country

Number of people who inject drugs
Figure 9.1b. Estimated prevalence of people who inject drugs (per 1000 people)
Prevalence of people who inject drugs (per 1 000 population)
Based on the latest data available from each country.
- 137 -
Injecting drug use among clients entering specialised treatment

Among first-time clients entering specialised drug treatment in 2022, or most recent year
available, with heroin as their primary drug, 18 % (down from 37 % in 2013) reported injecting as
their main route of administration. In this group, levels of injecting vary between countries, from
less than 10 % in Belgium, Spain, France and Portugal to 60 % or more in Bulgaria, Czechia,
Estonia, Latvia, Lithuania, Romania and Slovakia.
Available data indicate that injecting is reported as the main route of administration by less than
1 % of first-time cocaine clients, 2 % of first-time amphetamine clients and 16 % of first-time
methamphetamine clients. It should be noted that Czechia and Slovakia account for more than
90 % of methamphetamine first-time entrants who reported injecting as their main route of
administration.
Considering the four main injected drugs together, injecting as the main route of administration
among first-time entrants to treatment in Europe has declined from 10 % in 2017 to 7 % in 2022 (
Figure 9.2).
Figure 9.2. Trends in injecting among first-time treatment entrants with heroin, cocaine,
amphetamine or methamphetamine as primary drug: percentage reporting injecting as main
route of administration
Trends in injecting among first-time treatment entrants are based on 22 countries with data for at least 5 of the 6 years (missing
values were interpolated from adjacent years), and one country for which the final 2 years were extrapolated.
Syringe residue analysis

between 2021 and 2022 detected 54 psychoactive substances. These data are not nationally
- 138 -
representative and therefore should be understood as indicative of a diversity at local-level in

drug use dynamics, rather than reflecting the overall national situations.
Heroin was still the most commonly detected drug in 5 out of the 12 participating cities, but
stimulants, mostly cocaine, were found in syringes in all cities. They were found in a high
proportion (over 50 %) of the syringes sampled in Athens (cocaine), Cologne (cocaine), Dublin
(cocaine), Thessaloniki (cocaine), Prague (methamphetamine), Oslo (amphetamine), Tallinn
(amphetamine) and Paris (synthetic cathinones) (Figure 9.3).
Injection of diverted opioid agonist medications was common in some cities, with buprenorphine
detected in more than 30 % of the syringes in Helsinki, Prague and Thessaloniki and methadone
detected in more than 30 % of the syringes in Dublin, Riga and Vilnius. Benzodiazepines were
also detected, albeit to a lesser extent (in more than 5 % of the syringes in Helsinki, Dublin and
Tallinn). Carfentanil was commonly found in syringes in Vilnius (92 %) and Riga (29 %). Another
potent synthetic opioid, isotonitazene, was detected in 10 % and 26 % of syringes from Tallinn
and Riga, respectively. Xylazine, a potent veterinary tranquilliser, was detected in 25 out of 194
syringes (13 %) in Riga, where it was found in the presence of isotonitazene or metonitazene in
all 25 syringes and together with carfentanil in 3 syringes.
Overall, a third of the syringes contained residues of two or more drug categories, indicating
frequent polydrug use or re-use of injecting paraphernalia. The most frequent combination was a
mixture of a stimulant and an opioid.
Preliminary data on syringe residue analysis for 2023 confirm existing trends. In Tallinn, the
potent synthetic opioid protonitazene was found in half of the syringes (77 of 154), suggesting
nitazenes are continuously available on the local drug market. While no nitazenes were detected
in the 155 syringes analysed in Dublin, heroin was observed in 150 (97 %) and cocaine in 139
(90 %), reflecting polydrug use or the re-use of syringes, or both. In Budapest, of the 147 syringes
analysed, cathinones were found in 101 (69 %) and amphetamine in 35 (24 %), while heroin was
detected in 22 (15 %), indicating a greater role for synthetic stimulants in the local drug market.
Reflecting a different consumption dynamic, of the 159 syringes analysed in Split, methadone
was found in 132 (83 %), while cocaine was detected in 67 (44 %), with amphetamine observed
in 41 (24 %). Lastly, in Helsinki, out of the 163 syringes analysed, detections of buprenorphine
and amphetamine remained high, while benzodiazepines, mostly alprazolam, were found in 60
syringes (37 %).
- 139 -
Figure 9.3. Percentage of used syringes tested positive by drug category, by city, 2022
Location of cities participating in ESCAPE syringe

analysis project
Dublin Oslo
Helsinki Tallinn
Riga Vilnius
Cologne
- 140 -
Prague
Paris Budapest
Thessaloniki Athens
Data source: ESCAPE project. For the complete data set and analysis, see ESCAPE: data explorer, analysis and key findings.
Source data
- 141 -
Drug-related infectious diseases

– the current situation in Europe
- 142 -
People who inject drugs are at risk of contracting infections

through the sharing of drug use paraphernalia. On this page,
you can find the latest analysis of drug-related infectious
diseases in Europe, including key data on infections with HIV
and hepatitis B and C viruses.

Rebound in HIV notifications to pre-pandemic levels

highlights service development needs
People who inject drugs are at risk of contracting infections such as viral hepatitis B and C (HBV and
HCV, respectively) and the human immunodeficiency virus (HIV) through the sharing of drug use
paraphernalia. These infections can cause chronic diseases that may result in severe health-related
harms, including death. While the long-term trend in new HIV infections related to injecting drug use
has been declining in the European Union, more than half of the reporting countries saw an increase
in new HIV notifications in 2022 compared with 2021 (Figure 10.1). The increase observed in 2022
may, in part at least, reflect increased rates of HIV testing following the lifting of COVID-19-related
restrictions on movement and the return to pre-pandemic functioning of health services (including
HIV testing). Another possible contributory factor is the increased movement of people living with a
known HIV diagnosis in European countries following the Russian invasion of Ukraine. Thus, these
data need to be interpreted with caution, as they are not necessarily indicative of an increase in
rates of new infections. Nor do they necessarily put into question the long-term decline in HIV
notifications. Nevertheless, the decline of 38 % noted since 2010 falls short of the World Health
Organization’s (WHO) target of a 75 % reduction, suggesting increased efforts are still needed in
this area.
- 143 -
Figure 10.1. New HIV notifications linked to injecting drug use in the European Union, 2009
to 2022
Source: ECDC.
It is also important to note the role that stimulants now appear to play in respect to HIV infections
related to injecting drug use. The injection of stimulants, alone or in combination with opioids, has
been associated with most HIV outbreaks documented in Europe in the past decade, and local HIV
outbreaks linked to stimulant injecting continue to be reported, with an example of an ongoing
outbreak that was still active in 2022 reported in Monza, Italy (Figure 10.2). The increased
availability of cocaine on the European drugs market and its injection is a cause for concern, as it
may lead to more HIV outbreaks.
- 144 -
Figure 10.2. Most-recent HIV outbreaks in Europe among people who inject drugs: number of
cases and the associated injected substance, 2014 to 2022
Location of most-recent HIV outbreaks and

associated substance
Cologne Dublin
Helsinki
Lithuania (prisons) Luxembourg (national)
Bavaria
An additional concern is that, in 2022, over 40 % of new HIV diagnoses linked to injecting drug use in
the European Union were diagnosed late. Patients with a late HIV diagnosis are at increased risk of
HIV-related morbidity and mortality and may have a poorer response to antiretroviral treatment.
Voluntary and confidential infectious disease testing of people who inject drugs is a prerequisite for
linkage to care and treatment provision.
- 145 -
By 2022, no EMCDDA reporting country had yet reached all 95-95-95 WHO targets for the
continuum of care among people who inject drugs living with HIV. These targets aim to have 95 % of
people living with HIV tested, 95 % of these people on antiretroviral therapy and 95 % of those
achieving viral suppression by 2030. Overall, among people living with HIV, those who inject drugs
are less likely to be diagnosed, linked to care and achieve viral suppression. This implies a greater
risk of HIV-related morbidity and mortality, as well as the possibility of more onward transmission.
Recent guidance from the EMCDDA and ECDC on the prevention and control of infectious diseases
among people who inject drugs supports the implementation of tailored community-based testing
services. This includes testing outside formal healthcare settings, for example in outreach services,
and highlights how a more integrated approach to testing and linkage to care is an effective way to
reduce this persistent health inequity. Harm reduction approaches are now seen as fundamental to
reducing HIV transmission among people who inject drugs, particularly the provision of sterile
injecting equipment, including in prisons and through pharmacies. However, coverage and access to
free needle and syringe provision remain insufficient in many countries, with only 5 of the 17
countries with available data achieving the WHO service provision targets in 2022 (Figure 10.3).
Obtaining secure funding for harm reduction services working with people who inject drugs can be
challenging in some countries. For example, non-governmental organisations in Bulgaria and
Romania have experienced funding and procurement difficulties in recent years, leading to a
reduction in provision. In Sofia, during the period of reduced syringe provision, HIV prevalence rates
from routine diagnostic tests conducted in drug treatment centres increased, reaching 15 % in
2022, reflecting the risk of increased infections when service levels are inadequate.
Figure 10.3. Number of sterile syringes distributed per person who inject drugs per year,
2022 or latest data
- 146 -
Norway on track to eliminate HCV as a public health threat among

people who inject drugs
In Europe, people who inject drugs also have a high burden of chronic viral hepatitis, and injecting
drug use remains the most common risk factor for new HCV diagnoses. A recent study found that at
least 36 % of the overall chronic HCV prevalence in the EU Member States, Norway and Iceland is
associated with injecting drug use. There is also evidence that harm reduction services, such as
needle and syringe programmes, as well as the provision of opioid agonist treatment, can reduce the
risk of HCV transmission. As noted earlier, the coverage of and access to these interventions vary
considerably between European countries (Figure 10.4). In addressing the harms associated with
HCV infection, it is important to identify individuals who remain chronically infected with the virus,
as they are at risk of cirrhosis and cancer, and can transmit the virus to others through the sharing of
any injecting paraphernalia that has been in contact with their blood. However, barriers to the uptake
of HCV testing and treatment exist in many countries and may result in many HCV infections not
being diagnosed and treated.
- 147 -
Figure 10.4. Availability of needle syringe programmes in Europe at regional level, 2022 or
the most recent year available
Data are at NUTS levels 2 or 3. For information on NUTS (nomenclature of territorial units for
statistics) visit the Eurostat website. The lack of data at NUTS levels 2 or 3 does not mean
that the intervention is not available within a country.
Time trends in the prevalence of active HCV infection among people who inject drugs are useful for
monitoring the impact of prevention and treatment. The EMCDDA monitors national progress
through its elimination barometer. Among the countries reporting to the EMCDDA, only Norway has
evidence that they have achieved an 80 % reduction in viraemic HCV prevalence among people who
inject drugs between 2015 and 2021, which is needed to achieve the Sustainable Development
Goal 3.3 on HCV elimination by 2030. The prevalence of active HCV infection, as measured by HCV-
RNA in a large seroprevalence study among people who inject drugs and use harm reduction
services in Oslo, decreased by more than 80 % between 2015 (46 %) and 2022 (8.9 %). A similar
trend in prevalence of active infections was observed in Bergen and Stavanger, while modelling
- 148 -
work suggests incidence among people who inject drugs has decreased by 79 % at the national level
over the same period.
Responding to interactions between high-risk drug-taking and

sexual behaviours requires multi-agency partnerships
The use of illicit stimulants and other drugs to facilitate group sexual encounters, sometimes of an
extended duration, among men who have sex with men is known as chemsex. The drugs associated
with this practice include synthetic stimulants, depressants and dissociatives, and both high-risk
drug-taking and high-risk sexual behaviours may take place in some settings, making this an
important area for outreach and harm reduction. High-risk consumption of some of these drugs,
including injecting drug use, places people at risk of infectious diseases, acute drug toxicity and
other health problems. People using drugs in this way often do not present as clients in drug
treatment clinics but may be in contact with other services, including sexual health services.
Providing effective harm reduction responses for people engaged in these high-risk behaviours
remains a challenge, and the development of tailored interventions is needed. In Europe, treatment
services for drug and sexual health problems are usually funded separately, have different eligibility
criteria and are rarely co-located. This makes it difficult to provide integrated care for people
exposed to the dual risks of unprotected sex and high-risk drug use in the context of sexualised drug
use.
Greater investment still needed to meet global targets

EU policymakers have made a commitment to the WHO global health sector strategies to end AIDS
and the epidemics of viral hepatitis and sexually transmitted infections by 2030. Achieving these
objectives, however, still requires increased investment in harm reduction services, testing and
linkage to treatment, as the provision in many countries remains insufficient. Greater efforts are
therefore needed to prevent future outbreaks and reduce transmission, thereby reducing the burden
of disease associated with HIV, HCV, HBV and other infections among people who inject drugs.
Key data and trends

HIV/AIDS
In 2022, the number of new HIV notifications linked to injecting drug use in the European Union
increased to 968, compared with 662 the previous year (Figure 10.5).
The share of new HIV cases related to injecting drug use also increased between 2021 and 2022:
from 4.8 % to 5.9 % of new cases with a known route of transmission. In 2022, the share of new
HIV cases related to injecting drug use was greater than 10 % in Latvia (25 %), Finland (21 %),
Luxembourg (19 %), Greece (15 %), Lithuania (14 %), Germany (11 %) and Norway (11 %).
In 2022, 165 new AIDS diagnoses related to injecting drug use were notified in the European
Union.
Delayed diagnosis and treatment initiation among marginalised populations was a prominent
characteristic of the latest HIV cluster detected in the European Union. Situated in the Lombardy
region of Italy, it involved 20 analytically linked infections acquired between 2006 and 2022
- 149 -
traced back to the same HIV strain showing resistance-associated mutations.
Figure 10.5. Drug-related infectious diseases
HIV and AIDS HCV and HBV

New HIV cases attributable to injecting drug HCV antibody prevalence among people who
use: 968 inject drugs 2021/2022
As a share of all new HIV cases (percent)

17 % to 72 %
in 9 countries
Countries with national data
New AIDS cases attributable to injecting drug

use: 165
As a share of all new AIDS cases (percent)
Trends in drug-related HIV: EU and selected

countries
Cases per million population
HCV active infections among people who
inject drugs 2021/22
6 % to 54 %
in subnational samples in 6 countries
HBV active infections, national data

for 2021/22
an average of 3.1 % (0.4-5.3 %)
among people who inject drugs
HCV and HBV

Five European countries have recent prevalence estimates of active HCV infection among people
who inject drugs and access drug services. The prevalence of active HCV infection derived from
seroprevalence studies ranged from just under 9 % (Oslo, 2022) to 27 % (Bavaria, 2022), while
results from routine HCV diagnostic tests ranged from 15 % (Belgium, 2019) to 59 % (Austria,
2020) and 62 % (Sweden, 2014) (Figure 10.6).
- 150 -
Snapshots of HCV diagnosis and treatment in several European countries provide insight into
linkages to care. In 2022, data from treatment programmes in Greece indicated that of the 26 %
of people who inject drugs who tested positive for HCV-RNA, 85 % reported being prescribed
treatment, and 54 % of those who had a diagnosis of HCV completed treatment. In Norway, a
yearly seroprevalence study conducted among ever-injectors attending drug services in Oslo
found a significant decrease in HCV-RNA prevalence between 2015 (46 %) and 2022 (8.9 %),
reflecting the impact of prevention and treatment measures.
In 2023, people who inject drugs were reported to face clinical or financial restrictions in
accessing direct-acting antiviral HCV treatment in 5 EU Member States.
Estimates for HBV infection (as measured by the presence of the hepatitis B surface antigen),
derived from the latest seroprevalence studies among people who inject drugs, ranged from
0.4 % (Czechia, 2022) to 5.3 % (Spain, 2021).
In 2023, there were 20 EU Member States with a viral hepatitis policy that included people who
inject drugs. Integrating testing and treatment for HCV, HBV and HIV into harm reduction, drug
treatment and prison health services is key to achieving the continuum of care targets for people
who inject drugs.
Figure 10.6. Prevalence of active HCV infection among people who inject drugs, by country,
2022 or latest available data
Low evidence | Moderate evidence
Source data
- 151 -
Drug-induced deaths – the

- 152 -
Estimating the mortality attributable to drug use is critical for

understanding the public health impact of drug use and how
this may be changing over time. On this page, you can find
the latest analysis of drug-induced deaths in Europe,
including key data on overdose deaths, substances
implicated and more.

Improving our understanding of drug-related

mortality is a key requirement for developing
effective responses
Estimating the mortality attributable to drug use is critical for understanding the public health
impact of drug use and how this may be changing over time. Understanding the factors driving
trends in this area is also likely to be key for the development of effective responses. However,
despite improvements over the last decade, there are still important limitations in the information
currently available to us, and this hampers the development of both policies and responses.
The term drug-induced deaths is used for an indicator that is intended to capture those deaths that
are directly attributable to the consumption of drugs, sometimes referred to as drug overdose
deaths. It should be noted that estimates of drug-induced deaths only represent a share of the
overall mortality associated with drug use, as this measure does not include mortality from motor
vehicle and other accidents, violence, suicides by means other than drug poisoning or chronic
disease, where drug use may have played a role. A need exists therefore, through cohort studies and
other approaches, to extend our understanding in these other important areas of drug-related
mortality.
Despite these limitations, an assessment of drug-induced deaths is still a key measure for
understanding the harm that the use of illicit drugs can cause, but it is also a challenging one to
interpret for methodological and data availability and quality issues. This is particularly true when
interpreting recent trends in drug-induced deaths, where data for the most recent reporting year
(2022) are available for only 21 of the 29 countries covered by this indicator, and estimated values
must therefore be calculated if an overall EU estimate is to be derived. Given the speed at which
new drug threats can emerge, improving the timeliness and completeness of data in this area is an
important priority for the future.
It should also be noted that, for methodological reasons, the numbers of drug-induced deaths
identified are likely to represent minimum estimates; that reporting capacity varies between
countries, meaning that national comparisons need to made with caution. In addition, a lack of
detailed toxicological information in some countries currently means that our overall understanding
of the role different drugs play in driving rates of drug-induced deaths over time is limited. The lack
of detailed toxicological information can also hamper an understanding of the role played by
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different drugs when used in combination. As the majority of fatal overdoses involve the use of more
than one substance, and as drug consumption patterns are becoming ever more complex, there is
also therefore a growing need to improve our understanding of how changes in patterns of polydrug
use are impacting on mortality. A positive development in this area is that the launch of the new
European Union Drugs Agency (EUDA) in 2024 will strengthen the capacity for rapid threat
assessment, early warning and the issuing of alerts, and support measures to improve routine
reporting capacity in this area. Importantly, the new agency will also coordinate a new network of
forensic and toxicological laboratories, increasing the analytical capacity available to monitor how
different drugs and drug combinations are impacting on trends in mortality.
While opioids are often present, most drug-induced deaths are

associated with the consumption of multiple substances
For the year 2022, the number of reported drug-induced deaths increased slightly in some EU
countries and fell in others. The provisional overall estimate of about 6 400 drug-induced deaths in
2022 represents a slight increase on 2021, but this figure should not be over-interpreted, as a
number of countries with large populations have yet to provide data, and estimated values have
necessarily been used to compute this provisional total.
Although detailed toxicological information is not available on all death cases, the information that
does exist suggests polydrug toxicity is the norm, and where detailed toxicological information is
available, it usually reports the presence of multiple substances.
The available information highlights that opioids, usually in combination with other substances,
remain the group of substances most commonly implicated in drug-induced deaths. Overall, trends
in deaths where opioids are implicated appear stable, but the proportion of deaths in older age
groups is increasing. It is estimated that heroin was involved in more than 1 800 deaths in the
European Union, and heroin remains the drug commonly identified as involved in opioid-related
deaths in some western European countries. However, the data available suggest heroin is now
present in the majority of overdose deaths in only a few countries, and both other opioids and other
drugs are now playing a more important role. Opioids other than heroin, including methadone and, to
a lesser extent, buprenorphine, pain-relief medicines containing opioids, and other synthetic opioids
are associated with a substantial share of overdose deaths in some countries.
The data on drug mortality are also indicative of an ageing opioid-using cohort in Europe as
illustrated by the two-thirds increase in the number of drug-induced deaths among 50- to 64-year-
olds between 2012 and 2022. Despite public perceptions that drug overdoses are a problem that
impacts mostly on young people, cases of mortality linked to drug consumption are typically found
among males aged 40 or older.
The available data also suggest the deaths where stimulants are implicated are rising in some
countries, although with important caveats here. Stimulant deaths are likely to be particularly prone
to under-reporting, and stimulants are often implicated in deaths where other drugs, including
opioids, are also found to be present. There is also some information to suggest that stimulants
appear to be more commonly implicated in deaths reported among younger age cohorts.
Concerns growing about deaths linked to synthetic opioids

Potent synthetic opioids, such as the fentanyl derivative carfentanil and nitazene opioids, some of
which are significantly more potent than fentanyl, have been associated with some outbreaks of
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fatal and non-fatal poisonings. However, with the exception of some Baltic countries, these drugs do
not currently figure prominently in the routine data available at EU level. Nonetheless, developments
in this area are worrying because of the potential of these substances to impact negatively on public
health in Europe in the future.
Of particular concern in this area is the recent appearance of the nitazene opioids, which were
involved in localised poisoning outbreaks in Ireland and France during 2023. In Ireland, nitazenes
were mis-sold as heroin resulting in inadvertent consumption and multiple overdoses (see New
psychoactive substances – the current situation in Europe). Due to their high potency and novelty,
there are concerns that nitazene opioids may not be routinely detected in procedures commonly
used for post-mortem toxicology. This raises the possibility that the number of deaths reported
could be an underestimate. Some evidence of this exists from countries in the Baltic area, where
improvements in testing methods have resulted in an increase in the detection of these substances.
In provisional data from Estonia, the drugs were identified in almost half the drug-induced deaths
(56 of 117, 48 %) in 2023. This compares with 32 of 82 drug-induced deaths (39 %) in 2022. In
Latvia, both the national statistics and the forensic registers provisionally reported a doubling in the
overall number of drug-induced deaths, from 63 in 2022 to 130 in 2023, with nitazenes identified in
38 (29 %) of these cases. Although systematic testing for nitazenes was not possible in 2022, there
was a dramatic rise in the number of acute drug toxicological presentations involving opioids (from
1 936 in 2021 to 2 357 in 2022). Anecdotal reports from clinical staff suggesting that greater doses
of naloxone were required raise concerns that synthetic opioids may have been involved.
Another source of information on drug mortality is provided by deaths reported to the Early Warning
System on new psychoactive substances. At least 150 cases of deaths with confirmed exposure to
nitazenes have been reported to this mechanism from 5 countries during 2023. However, this figure
includes cases where the cause of death has not been confirmed.
The challenges of responding to deliberate self-poisonings

Determining the intention of a person who has died from a drug overdose can be difficult. Many
overdose deaths are reported as accidental, and others have an undetermined intent. However, in
some countries more information is available on intention, and a relatively high proportion of
reported overdose deaths (1 in 6 overall) were classified as intentional (that is, with a suicidal
intent). In all countries in the European Union, Norway and Türkiye, the most recent available data
show that the proportion of overdose deaths with a suicidal intent was higher among women. In a
few countries (Hungary, Netherlands, Slovenia, Sweden), more than a third of the reported overdose
deaths among women were classified as having a suicidal intent. In Bulgaria, Poland and Finland, a
suicidal intent was recorded for more than a quarter of the overdose deaths among females
reported in 2022. These findings indicate the need for interventions that target deliberate self-harm
and suicidal intent among people who use drugs, and especially to recognise the disproportional risk
that females may experience in this context.
Preventing opioid-related overdoses and deaths remains difficult

Responses aimed at reducing opioid-related deaths include interventions geared towards
preventing overdoses from happening in the first place and those that focus on preventing death
when overdoses do occur (see Figure 11.1). Changes in both the population of people who inject
opioids and the types of substances they are using create new and greater challenges for
interventions designed to reduce overdose deaths. These include the challenge to develop
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differentiated programmes to target the needs of different groups and, particularly, to be sensitive to
the necessity to configure services to be appropriate to the needs of different age cohorts.
Enrolment in opioid agonist treatment is strongly evidenced as a protective factor against opioid
overdose and some other causes of death, yet coverage and access issues still exist in many
countries.
Figure 11.1. Interventions to prevent opioid-related deaths, by intended aim and evidence of
benefit
Notes: Interventions where there is evidence of benefit and where we can have a high or reasonable confidence in the available evidence,
are highlighted in a bolder frame. Much of the current evidence on interventions listed in this figure is either emerging or deemed
insufficient, in part because of the practical and methodological difficulties of conducting research, especially in developing randomised
controlled trials (see Spotlight on... Understanding and using evidence) and also because service delivery models often differ
considerably.
The evidence is also growing that the increasing availability of opioid antagonists can play an
important role in preventing fatal opioid overdoses. However, again, the extent to which this
approach is available varies between and within countries. The implementation of naloxone
programmes, including pilot projects, to prevent overdose deaths was reported by 16 European
countries up to 2022. Changing consumption patterns also require services to review current
delivery protocols. Overdoses involving potent synthetic opioids may require, for example, the
administration of multiple doses of naloxone to reverse the opioid effects. In some countries, drug
consumption rooms are also provided in part as a response to reducing overdose mortality. These
facilities are now operational in 10 EU countries and Norway (see Harm reduction – the current
situation in Europe). Where multicultural and new immigrant populations are present, increased
own-language harm reduction messaging is desirable for high-risk drug users. For more information
on the health and social responses to prevent opioid-related deaths see the EMCDDA’s recent
miniguide.
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Key data and trends

Mortality rates due to overdose
The mortality rate due to overdoses in the European Union in 2022 is estimated at 22.5 deaths
per million population aged 15 to 64.
The mortality rates due to overdose are typically 3 to 4 times higher among males compared with
females (Figure 11.2), with men aged 25 to 39 the most affected. Overdose mortality rates in this
age group can be considerably higher than for the male population aged 15 to 64 (adults). For
example, in Sweden, the overdose mortality rate for men aged 25 to 39 was 122 deaths per
million in 2022, compared with 73 deaths per million adult men in the country. In Estonia, the
comparable figures were 197 deaths per million men aged 25 to 39 and 62 deaths per million
adult men; and in Ireland, the mortality rate was 183 deaths per million men aged 25 to 39
compared with 85 deaths per million among all adult men.
Men aged 40 to 59 are those most affected by overdose mortality in a number of European
countries, including Denmark, Spain, Italy, the Netherlands, Portugal and Norway.
Figure 11.2. Proportion of males among drug-induced deaths in the European Union, Norway
and Türkiye in 2022, or most recent year (percent)
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Overdose deaths
It is estimated that at least 6 392 overdose deaths involving drugs occurred in the European Union in
2022 (6 166 in 2021). This is a minimum estimate as some countries report that their monitoring
system is missing some cases. For example, a cross-validation of the 2022 data from the different
registers in Spain suggested that only 4 out of 5 cases might be reported. In Germany, the mortality
register only contains cases that have come to the attention of the police. Thus cases outside of
police focus may be under-reported. However, the extent of the underestimation is unknown.
Opioids, including heroin and its metabolites, often in combination with other substances, were
estimated to be present in three quarters (74 %) of the fatal overdoses reported in the European
Union in 2022 (see Figure 11.3 and Figure 11.4). It should be noted that multiple drugs are
commonly found in toxicology reports from drug-induced deaths.
Figure 11.3a. Drug-induced deaths
Gender breakdown (percent) Mean age at death (years)
Deaths with opioids present (percent) Number of deaths
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Figure 11.3b. Drug-induced deaths in the European Union: age at death, 2022 or most recent
available data (percent)
Figure 11.3c. Trends in drug-induced deaths in the European Union, Norway and Türkiye
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Figure 11.3d. Age distribution (percent) of drug-induced deaths reported in the European
Union, Norway and Türkiye in 2022 or the most recent year
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Figure 11.4. Proportion of drug-induced deaths cases with opioids mentioned, 2022 or most
recent available data
Although information on toxicology is not available for data reported through the general mortality registers (preferred source) in
Spain and Poland, available data from the alternative source (forensic special mortality registers) suggest that most drug-
induced deaths in these countries involved opioids.
The data available have limitations with respect to quality and coverage. Nevertheless, the
information available suggests that heroin remains involved in large numbers of deaths in some
western European countries: over 728 cases in Germany, 222 in Spain, 173 in France, 142 in
Austria (heroin or morphine), 127 in Italy and 104 in Sweden. Overall, it is estimated that more
than 1 800 deaths involved heroin in the European Union.
Heroin was present in the majority of overdose deaths in a relatively small number of EU
countries, namely Austria (heroin or morphine) (77 %) and Italy (57 %). Heroin has been reported
in approximately two fifths to one fifth of overdose deaths in Portugal (42 %), Slovenia (42 %),
Romania (41 %), Türkiye (35 %), France (26 % in 2021), Denmark (24 %), Spain (24 % in 2021),
Norway (22 %) and Sweden (21 %). In 2022, heroin was reported in fewer than 1 in 6 overdose
deaths in Estonia, Latvia, Lithuania and Finland.
In preliminary data subject to further updating, 5 countries reported the presence of nitazenes in
at least 150 deaths in 2023: Estonia (56), Latvia (76), Finland (8), Sweden (1) and Norway (13).
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Among 19 European countries providing data for 2021 and 2022, cocaine, mostly in the presence
of opioids, was involved in 996 (23 %) overdose deaths in 2022 (807 or 20 % in 2021).
Deaths involving cocaine are now also being reported in countries where they were previously
less common, such as Denmark, the Netherlands, Austria and Slovenia. Cocaine was involved in
52 % of the overdose deaths in Spain (477 of the 910 cases with information available) in 2021
and in 67 % of the overdose deaths in Portugal (46 of 69 cases) in 2022.
In France, cocaine was involved in 39 % (259 of the 662 deaths with information available) of the
cases in 2021. This is an increase from 23 % (130 of 567 deaths with information available) in
2020, suggesting that cocaine is contributing to the overall increase in the number of overdose
deaths in the country.
Stimulants other than cocaine, including amphetamine and methamphetamine, are involved in
many deaths, often alongside opioids. Out of 20 countries with post-mortem data available for
2022, 18 reported deaths where non-cocaine stimulants were involved. The highest numbers of
deaths involving non-cocaine stimulants were reported by Germany (476 cases), Türkiye (186),
Denmark (68), Norway (63), Latvia (62), Finland (34), Estonia (33) and Austria (32). While the
numbers reported by the countries may vary from year to year, the total numbers of such cases
for the 16 countries that reported comparable data in all three years were 496 in 2020, 462 in
2021 and 492 in 2022. Beyond these drug-induced deaths, other stimulant-related deaths, such
as those associated with cardiovascular problems, may go undetected.
The number of overdose deaths reported in the European Union among those aged 50 to 64 is
estimated to have increased by 69 % between 2012 and 2022 (by 43 % among women and by
101 % among men) (Figure 11.5).
Figure 11.5. Number of drug-induced deaths reported in the European Union in 2012 and
2022, or the most recent year, by age band
Females Males
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Opioid agonist treatment – the

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Opioid users represent the largest group undergoing

specialist drug treatment, mainly in the form of opioid
agonist treatment. On this page, you can find the latest
analysis of the provision of opioid agonist treatment in
Europe, including key data on coverage, the number of
people in treatment, pathways to treatment and more.

EMCDDA's annual overview of the drug situation in
Europe.
Treating opioid-related problems still consumes

most treatment resources
While there is now greater heterogeneity in the characteristics of those seeking help for drug
problems, due to the long-term nature of opioid agonist treatment, those receiving it still
probably account for the greatest share of the resources invested in drug treatment services
in most countries. An estimated 1.7 million people received treatment for problems related to
the use of illicit drugs in the European Union in 2022 (2.0 million, including Norway and
Türkiye). Specialist drug treatment encompasses a range of medical (including
pharmacological), psychological, social and behavioural approaches to stop or reduce drug
use and injecting. Generally, the majority will receive some form of opioid agonist treatment,
which is the main pharmacological treatment approach and is typically combined with
psychosocial interventions. The available evidence supports this approach, with positive
outcomes found with respect to treatment retention, illicit opioid use, reported risk behaviour,
drug-related harms and mortality. Recent guidance from the EMCDDA and ECDC on the
prevention and control of infectious diseases among people who inject drugs recommends
the provision of opioid agonist treatment in both community and prison settings to prevent
transmission of HCV and HIV and to help reduce injecting risk behaviour and injecting
frequency. The guidance also recommends the provision of sterile injecting equipment
alongside opioid agonist treatment to maximise the coverage and effectiveness of the
interventions among people who inject opioids.
There remain, however, important differences between countries in the settings and form in
which treatment is provided and the extent to which the availability of opioid agonist
treatment is sufficient to meet the needs of those requiring this form of care. The provision of
opioid agonist treatment is still clearly insufficient in some countries (see Key data and trends
, below). The relative importance of outpatient and inpatient provision within national
treatment systems also varies greatly between countries. Almost a fifth of drug treatment in
Europe is provided in inpatient settings, mainly hospital-based residential centres (e.g.
psychiatric hospitals), but this can also include therapeutic communities and, in some
countries, specialist residential treatment centres in prisons. Overall, however, opioid agonist
treatment is more commonly provided in outpatient settings. These can include specialist
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drug treatment centres, low-threshold agencies, and primary healthcare centres, which can
include general practitioners’ surgeries.
The available data suggest that the provision of opioid agonist treatment did not drop
significantly during the COVID-19 pandemic, when public health-based restrictions on
movement were in place. During that period, however, service delivery models may have been
adapted. Examples of this include increased use of telemedicine and less restrictive
approaches to providing take-home doses. There is also some information to suggest that
access to care for new clients seeking opioid agonist treatment may have been disrupted
temporarily during the pandemic period.
Meeting the more complex needs of an ageing

cohort of opioid treatment clients
The long-term nature of opioid problems is underlined by the data available on the
characteristics of those receiving opioid agonist treatment. The data also indicate that
Europe’s cohort of those who have had problems with heroin is ageing. This is illustrated by
the fact that almost 70 % of clients in opioid agonist treatment are now aged 40 or older,
while less than 10 % are under 30 years old. This has important implications for service
delivery, with services having to address a more complex set of healthcare needs in a
population that is becoming ever more vulnerable. An important consideration here is the
need to ensure the existence of effective referral pathways to more generic services offering
treatment for other conditions associated with the ageing process. This is becoming
increasingly necessary in order to support older opioid treatment clients in need of geriatric
care due to the long-term effects of illicit drug use, but also tobacco and alcohol use, on their
physical health. The treatment of this marginalised group also needs to respond to a complex
and often long-established set of problems related to mental health issues, social isolation,
employment and housing. The development of integrated, multidisciplinary and age-
specialised care services for this group will remain an important consideration in policy and
provision as the demographics of opioid use in Europe continue to change.
Polydrug use and the appearance of highly potent new synthetic opioids on local drug
markets can increase the risks from opioid use, especially for older people and those with
complex healthcare needs. Where highly potent opioids have become an established feature
of drug markets, more research is needed to determine if adaptations are needed to ensure
that current approaches to providing opioid agonist treatment remain optimal. In addition, as
noted elsewhere in this report, should we see the reduced availability of heroin on the
European market, this may increase the demand for care in this area.
More information on health and social responses to opioid use, including among older people,
can be found in the EMCDDA’s Health and social responses to drug problems: A European
guide.
Key data and trends
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Number of people in treatment

A comparison with current estimates of the number of high-risk opioid users in Europe
would suggest that, overall, opioid agonist treatment was received by about half of the
number of high-risk opioid users in the European Union in 2022, an estimated 513 000
(526 000 including Norway and Türkiye) (Figure 12.1). However, there are differences
between countries. In those countries where data from 2011 or 2012 are available for
comparison, there was generally an increase in coverage. Levels of provision, however,
remain low and insufficient in some countries estimated to have significant numbers of
high-risk opioid users, such as Latvia, Lithuania, Poland, Romania and Slovakia (Figure
12.2).
Figure 12.1. Clients in opioid agonist treatment
Number in treatment Gender breakdown Trends in the number in opioid agonist

(percent) treatment
Age distribution Treatment duration (months)
Type of medication
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Trends in the number of opioid agonist clients are based on 26 countries. Only countries with data for at least 7 of the
10 years are included in the trends graph. Missing values are interpolated from adjacent years. Data for age distribution
are based on 16 countries representing 28 % (141 164) of all registered clients in the European Union. Data for gender
are based on 17 countries representing 18 % (93 612) of all registered clients. Data for treatment duration are based on
7 countries representing 7 % of all registered clients (34 300).
Distribution of OAT clients by type of medication: SROM is slow-release oral morphine and DHC is dihydrocodeine.
Figure 12.2a. Coverage of opioid agonist treatment (percent) in 2022 or the most
recent year
Figure 12.2b. Coverage of opioid agonist treatment (percent) in 2011/12
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Coverage is defined as the share of high-risk opioid users receiving the intervention. Data are displayed as point
estimates and uncertainty intervals.
Data from countries that consistently reported on clients receiving opioid agonist
treatment between 2010 and 2022 show an overall stable trend in treatment levels during
this period, with little fluctuation in the number of clients receiving this treatment. The
reasons for this stability vary. In countries with high treatment provision, it may reflect the
often chronic, relapsing nature of opioid dependence and the need for treatment over a
prolonged period; in others (e.g. Latvia), it may reflect the low capacity of treatment
systems.
At the onset of the COVID-19 pandemic, EU Member States sought to ensure continued
access to opioid agonist treatment for people engaged in high-risk drug use. Comparing
treatment data between 2019 and 2022 indicates that the number of clients remained
stable, with only Croatia and Hungary reporting a decrease greater than 10 % of their
opioid agonist treatment population during this period. These reductions may be partly due
to decreased access to treatment during the pandemic.
In some countries, the number of people receiving opioid agonist treatment has increased,
reflecting increased treatment provision, with 11 countries reporting an increase between
2016 and 2022, including Denmark (37 %), Poland (54 %), Romania (17 %) and Sweden
(21 %).
Pathways to treatment
Client pathways through drug treatment are often characterised by the use of different
services, multiple entries and varying lengths of stay. Self-referral continues to be the most
common route into specialist drug treatment for opioid clients. This form of referral, which
also includes referral by family members or friends, accounted for about two thirds (66 %)
of those with primary opioid problems entering specialist drug treatment in Europe in
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2022. Almost one fifth (23 %) of clients were referred by health, education and social
services, including other drug treatment centres, while 7 % were referred by the criminal
justice system.
Opioid agonist medications

The provision of more than one opioid agonist treatment medication in 2022 is reported by
26 countries. Methadone is the most commonly prescribed medication, received by more
than half (56 %) of opioid agonist treatment clients across Europe. Another 35 % are
treated with medications based on buprenorphine, which is the principal medication
reported to be used in 8 countries. Other substances, such as slow-release morphine or
diacetylmorphine (heroin), are more rarely prescribed, being received by almost 10 % of
opioid agonist clients in Europe, with 5 countries reporting some provision of heroin-
assisted treatment, if pilot projects are included (Figure 12.3).
Figure 12.3. Number of European countries implementing opioid agonist treatment, up

to 2023
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Implementation at any level, including pilot projects, is included.
Alternative treatment options

Although less common than opioid agonist treatment, alternative treatment options for
opioid users are available in all European countries. In the 11 countries for which data are
available, between 5 % and 47 % of all opioid users in treatment receive interventions not
classified as opioid agonist treatment, such as medically assisted detoxification and
outpatient or inpatient abstinence-oriented interventions.
Source data
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Harm reduction – the current

Drug Report 2024)
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Harm reduction encompasses interventions,

programmes and policies that seek to reduce the health,
social and economic harms of drug use to individuals,
communities and societies. On this page, you can find
the latest analysis of harm reduction interventions in
Europe, including key data on opioid agonist treatment,
naloxone programmes, drug consumption rooms and
more.

Europe.
Evolving drug problems pose a broader set of

challenges for harm reduction
The use of illicit drugs is a recognised contributor to the global burden of disease.
Interventions designed to reduce this burden include prevention activities, intended to reduce
or slow the rate at which drug use may be initiated, and the offer of treatment to those who
have developed drug problems. A complementary set of approaches goes under the general
heading of harm reduction. Here the emphasis is on working non-judgementally with people
who use drugs in order to reduce the risks associated with behaviours that are mostly
associated with adverse health outcomes, and more generally to promote health and well-
being. Probably the best known of these is the provision of sterile injecting equipment to
people who inject drugs, with the aim of reducing the risk of contracting an infectious disease.
Over time these sorts of approaches appear to have contributed to the relatively low rate, by
international standards, of new HIV infections now associated with injecting drug use in
Europe. Over the last decade, as patterns of drug use have changed and the characteristics of
those who use drugs have also evolved, to some extent, harm reduction interventions have
also needed to adapt to address a broader set of health outcomes and risk behaviours.
Prominent among these are reducing the risk of drug overdose and addressing the often-
considerable and complex health and social problems faced by people who use drugs in more
marginalised and socially excluded populations.
A spectrum of responses is needed to reduce changing drug-

related harms
Chronic and acute health problems are associated with the use of illicit drugs, and these can
be compounded by factors such as the properties of the substances, the route of
administration, individual vulnerability and the social context in which drugs are consumed.
Chronic problems include dependence and drug-related infectious disease, while there is a
range of acute harms, of which drug overdose is perhaps the best documented. Although
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relatively rare at the population level, the use of opioids still accounts for much of the
morbidity and mortality associated with drug use. Injecting drug use also increases risks.
Correspondingly, working with opioid users and those who inject drugs has been historically
an important target for harm reduction interventions and also the area where service delivery
models are most developed and evaluated.
Reflecting this, some harm reduction services have become increasingly integrated into the
mainstream of healthcare provision for people who use drugs in Europe over the last three
decades. Initially, the focus was on expanding access to opioid agonist treatment and needle
and syringe programmes as a part of the response to high-risk drug use, primarily targeting
injecting use of heroin and the HIV/AIDS epidemic. Recent joint EMCDDA-ECDC guidance on
the prevention and control of infectious diseases among people who inject drugs
recommends providing opioid agonist treatment to prevent hepatitis C and HIV, as well as to
reduce injecting risk behaviours and injecting frequency, in both the community and prison
settings. The guidelines also recommend the provision of sterile injecting equipment
alongside opioid agonist treatment to maximise the coverage and effectiveness of the
interventions among people who inject opioids.
In the last three decades, approaches to harm reduction have been broadened in some EU
countries to encompass other responses, including drug consumption rooms and take-home
naloxone programmes intended to reduce fatal overdoses (Figure 13.1). Interventions to
reduce opioid-related deaths include those aimed at preventing overdoses from occurring and
those aimed at preventing death when an overdose does occur (Figure 13.2).
Figure 13.1. Number of European countries implementing harm reduction

interventions, up to 2023
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benefit
- 174 -
Note: Interventions where there is evidence of benefit and where we can have high or reasonable confidence in the available
evidence are highlighted in a bolder frame. Much of the current evidence on interventions listed in this figure is either emerging
or deemed insufficient, in part because of the practical and methodological difficulties of conducting research, especially in
developing randomised controlled trials (see Spotlight on... Understanding and using evidence) and also because service delivery
models often differ considerably.
In some countries, there are drug checking facilities, which have been established with the
aim of enabling people to understand better what substances the illicit drugs they have
bought contain. Tablets, for example, purchased as MDMA, may also contain adulterants and
other drugs, such as synthetic cathinones. With many synthetic stimulants and new
psychoactive substances now available on the illicit market in similar looking powders or pills,
consumers may be increasingly at risk of being unaware of what particular stimulant or
mixture of substances they may be consuming.
The increasing integration of the markets for new psychoactive substances and illicit drugs is
creating new public health challenges, such as herbal cannabis mixed with synthetic
cannabinoids, stimulants mixed with cathinones and ketamine or new synthetic opioids
mixed with or mis-sold as heroin. As poisoning events can evolve rapidly, understanding what
constitutes the delivery of effective of risk communication has become more important.
Although the range of services provided may differ, all drug checking services undertake
some form of health risk communication activity, often by issuing alerts on analysed drug
products and sharing data with other stakeholders. The aim is to prevent or reduce harm at
the level of the individual (the person submitting the substance for checking) and of the
population (others who may be exposed to the same substance). Future steps in this field
may include moves towards harmonisation and the building of consensus among European
drug checking services on the determination of criteria and thresholds for when and how to
issue alerts, as well as the adoption of evidence-based standard operating procedures for
health risk communication. These issues are explored in a recent manual developed by the
EMCDDA and the Trans-European Drug Information project on health risk communication
strategies.
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Some of these interventions remain controversial for reasons that include their legal status
and the evolving nature of their evidence base. Coverage of these newer interventions
therefore remains uneven within and between countries, and where they do exist, they are
often most commonly found only in large cities. Overall, coverage and access to harm
reduction services more generally, including those service models that are long-established
and relatively well evidenced, varies considerably between EU countries, and in some
countries remains inadequate in comparison to estimated needs.
Increasing preparedness to reduce the harm from potent

synthetic drugs and unintentional consumption
Potent synthetic substances have a growing potential to cause drug-related harms in Europe,
as inadvertent consumption of these substances in powders or mixtures sold as other drugs
can lead to poisonings and deaths. This, together with more complex patterns of polydrug
consumption, adds to the already considerable challenges of developing effective responses
to reduce drug overdose deaths and drug-related poisonings. An example of this growing
complexity, albeit currently on a relatively small scale, was seen in Estonia in 2022, where
mixtures were identified containing new synthetic opioids and new benzodiazepines and also
the tranquilliser xylazine. Known respectively as ‘benzo-dope’ and ‘tranq-dope’, these sorts of
mixtures have been linked to increases in overdose deaths and other negative health-related
outcomes in the United States and Canada. More recently, the highly potent benzimidazole
opioids (nitazenes), which are more potent than fentanyl, have also been involved in localised
poisoning outbreaks in parts of Europe (see also New psychoactive substances – the current
situation in Europe).
During a recent outbreak in Ireland, a rapid risk communication exercise was undertaken, with
the support of low-threshold services, which included leaflet drops to open drug scenes and
distribution of information on social media and news platforms. This is an example of how
services may need to respond both more rapidly and more intensively to outbreaks of drug
poisoning than in the past (Figure 13.3). The presence of such mixtures and mis-sold
substances on the market highlights the need to review current approaches to the delivery of
some harm reduction interventions. For example, the distribution and administration of the
opioid antagonist naloxone may need to be reviewed in the context of these mixtures and
mis-sold substances.
Figure 13.3. Example of a rapid risk communication issued in Ireland, 2024
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More generally, given possible developments in the synthetic opioid market, it would be
prudent to review current plans to prepare for and respond to any possible increase in the
availability and use of synthetic opioids or in the harm associated with these substances. This
could include enhancing toxicological analysis capabilities, alert messaging and frontline
responder preparedness. Where drug consumption rooms are operational, the possible
benefits and risks from also providing drug checking services may be an issue for
consideration. Most drug consumption rooms in Canada, for example, offer drug checking for
fentanyl. This is currently uncommon in the European Union, but a consumption room in
Copenhagen has recently started providing this service, and other pilot projects are reported
to be in development elsewhere in Europe.
Stimulant-related harms linked to different patterns of use

Reducing the risks associated with injecting drug use has always been an important target for
harm reduction interventions, and the service models are relatively well developed and
evidenced. However, even in this area, changes in drug consumption are creating new
challenges for effective service delivery. In the last decade, there have been HIV outbreaks
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associated with the injection of illicit synthetic stimulants in 7 European cities, across 6 EU
countries. A potentially increased frequency of injection is associated with stimulant use
compared with heroin use, while crushing and dissolving crack cocaine and other tablets for
injection also brings with it additional health risks. These consumption patterns raise
questions regarding, for example, the type and adequacy of needles and syringes provided to
people in street-based open drug scenes, which now are typically characterised by polydrug
use. An additional concern exists that service restrictions during COVID-19 lockdowns
adversely impacted on testing for drug-related infections, such as HIV and HCV, and on
conduits to care among more vulnerable and marginalised populations of people who use
drugs, including those experiencing homelessness.
Synthetic stimulants and various other substances are consumed to facilitate and enhance
sex in the context of sexualised drug use by various groups, but mainly among men who have
sex with men, when it is known as ‘chemsex’. While this definition is imprecise, it is usually
used to refer to settings or events where both high-risk drug taking and high-risk sexual
behaviour may occur. The drugs involved can range from stimulants, such as
methamphetamine, cocaine and synthetic cathinones, to alcohol, depressants such as
GHB/GBL and dissociatives such as ketamine. While it is difficult to estimate the prevalence
of chemsex, information from research studies suggests it is an issue that is present, albeit at
a small scale and among specific subgroups of people who use drugs, across Europe.
Engaging with and providing effective harm reduction responses for people engaged in these
forms of high-risk behaviours remains a challenge, and the development of tailored harm-
reduction interventions is likely to be needed. Also likely to be needed in this area are strong
multi-agency partnerships between those providing sexual health services and those services
providing drug-related harm reduction.
New challenges and opportunities to reduce harm

Despite cannabis being Europe’s most commonly consumed illicit drug, an argument can be
made that it is also an area in which harm reduction advice and interventions are often
lacking. Cannabis users in Europe commonly smoke the drug with tobacco, and an
undeveloped area for the development of harm reduction approaches is the consideration of
what might constitute effective inventions to reduce smoking-related harm in this group. More
generally, as the types and forms of cannabis products available in Europe continue to
change, so too have considerations about the implications this has for harm reduction
responses. Overall, cannabis products, both resin and herbal, are now of a higher potency –
they contain more THC – than they were historically, and high-potency cannabis products are
associated with more acute and chronic harms. In addition, the diversity of product types has
expanded, with edibles, e-liquids and extracts all now available. These changes create new
potential challenges to identify what constitutes effective harm reduction interventions and
opportunities to implement them to reduce harm.
Cannabis is not the only area in which harm reduction approaches have the potential to play a
greater role. As noted elsewhere in this year’s European Drug Report, there are also signs of
increasing consumer interest in less commonly known substances, including dissociative
drugs and psychedelics such as nitrous oxide and ketamine. These substances do have the
potential to cause possible harm, and some patterns of use are likely to increase the risk of
adverse consequences occurring, creating potential opportunities for harm reduction
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approaches.
While some harm reduction responses remain controversial in some countries in Europe, the
overall concept that evidence-based measures to reduce harm are an important component
of balanced drug policies is largely accepted. The contexts within which harm reduction
services operate, the evidence base that supports them, and what constitutes standards for
quality of care in this area therefore remain key areas for further development and policy
consideration. Looking forward, the evolving threats to public health arising from Europe’s
dynamic illicit drugs markets highlight the growing need to evaluate new and evolving models
of service provision that may be needed to protect the health of people at risk of adverse
outcomes arising from more complex consumption patterns, new substances and mixtures,
or associated with particular subgroups or settings.
The EMCDDA’s Health and Social Responses to Drug Problems: A European Guide contains
detailed information for those wanting to find out more about the evidence that exists for the
relative effectiveness of harm reduction and other forms of intervention.
Key data and trends

Needle and syringe programmes
Needle and syringe programmes are also a widely available and standard component of
harm reduction services. In 2022, all EU Member States and Norway had needle and
syringe programmes in place. Needle and syringe coverage and access remain a challenge,
with only 5 of the 17 EU countries with available data reaching the WHO service provision
targets in 2022 (Figure 13.4).
Figure 13.4. Needle and syringe distribution and opioid agonist treatment coverage in
relation to WHO 2020 targets, 2022 or latest available estimate
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Opioid agonist treatment can be considered as an effective form of drug treatment and
also as a service delivery model that addresses some harm reduction objectives. Opioid
agonist treatment is a well-established intervention that is implemented in all European
countries and is acknowledged as a protective factor against overdose deaths. A range of
opioid agonist medications are prescribed in treatment clinics in Europe, but methadone is
the most widely used, with about 56 % of opioid agonist clients receiving it, while another
35 % are treated with buprenorphine-based medications.
Take-home naloxone programmes

Up to 2022, 16 European countries have reported the implementation of take-home
naloxone programmes, which includes pilot projects, to prevent overdose deaths and 10
countries report having opened at least one drug consumption room, intended to facilitate
safer use and prevent various health problems (Figure 13.5).
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Figure 13.5. Availability of take-home naloxone in Europe
Data for EU Member States, Türkiye and Norway in 2023 or most recent year.
Drug checking services

Twelve European countries report the existence of some type of drug checking service.
These services aim to prevent harms by allowing people to find out what chemicals are in
the illicit substances they have bought, and, in some cases, provide access to counselling
or brief interventions. The analytical techniques used by services range from sophisticated
technology that can provide information on strength and content of a wide variety of
substances, to methods that simply show the presence or absence of a particular drug (
Figure 13.6).
Figure 13.6. An illustration of the range of drug checking technologies available and
their relative accuracy and reliability
Drug checking technologies ranked in order of increasing accuracy and reliability of
results:
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Multiple methods(most accurate and reliable)
High-performance liquid chromatography
Fourier transform spectroscopy
Thin-layer chromatography
Reagent test kit(least accurate and reliable)
Drug consumption rooms

While drug consumption rooms have become a more accepted harm reduction response,
establishing them remains problematic in some countries. In 2023, 10 EU countries and
Norway had operational facilities (Figure 13.7). Where multicultural and new immigrant
populations are present, increased own-language harm reduction messaging is desirable
for people engaged in high-risk drug use.
Figure 13.7. Location and number of drug consumption facilities throughout Europe,
2023
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Source: European Network of Drug Consumption Rooms (ENDCR) and Correlation – European Harm ReductionNetwork
(C-EHRN).
Please note that all geographical coordinates used here are approximate only.
Interventions in prisons
EMCDDA data on harm reduction and treatment interventions available in prisons in 2022
show that continuity of opioid agonist treatment was available in all EU Member States,
apart from Slovakia, as well as in Türkiye. Initiation of opioid agonist treatment in prison
was not allowed in 2 countries (Bulgaria, Slovakia). Needle and syringe programmes were
available in prisons in 3 countries: in all prisons in Spain and Luxembourg (2 prisons), and
in one female prison in Germany. Take-home naloxone was available in 7 countries
(Germany, Estonia, Ireland, France, Italy, Lithuania, Norway) (Figure 13.8).
Figure 13.8. Availability of drug-related and other health and social care interventions
targeting people who use drugs and are in prison, Europe, 2022
Number of countries reporting the formal availability of interventions in prison
European situation by type of intervention in prison
Select an intervention from the dropdown list below

Availability of interventions in prison settings
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Source:Prison and drugs in Europe: current and future challenges (EMCDDA, 2021), updated with recent data from 2023 prison
workbooks, EMCDDA national focal points
Source data
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List of figures (European Drug

Report 2024)
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This page contains a full list of all figures and graphical

elements available in the European Drug Report 2024.
Note that, if viewing this page as part of a PDF, links will
go to the online pages, not the corresponding figures in
the PDF. Links are organised below according to the
chapter in which they appear.

Europe.
List of figures by chapter

Understanding Europe’s drug situation in 2024 – key developments
Figure. At a glance – estimates of drug use in the European Union

Figure 1.1. 'Operation Nano', 9.5 tonnes of cocaine seized in August 2023 at the Port of
Algeciras (Cadiz), Spain
Figure 1.2. Example range of drug trafficking methods previously reported by law
enforcement in Europe
Figure 1.3. Drug seizures in the European Union – quantity of drugs seized, indexed
trends (2012 = 100)
Figure 1.5a. Drug seizures in the European Union – number of seizures in 2022
Figure 1.5b. Drug seizures in the European Union – quantity seized in 2022 (tonnes)
Figure 1.6. Drug seizures in the European Union – number of drug seizures, indexed
trends (2012 = 100)
Table. Summary of seizures of EU scheduled precursors and non-scheduled chemicals

used for selected drugs produced in the European Union, 2022
Cannabis – the current situation in Europe

Figure 2.1. Operation ‘Cabalgata/Califa-Trucks’ – Spanish authorities seize 22 tonnes
of cannabis resin concealed in fake tomato packaging
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Figure 2.3. Cannabis residues in wastewater in selected European cities: most recent
dat
Cocaine – the current situation in Europe

Figure 3.2. Example range of drug trafficking methods previously reported by law
enforcement in Europe
Figure 3.3. Operation ‘Mourente’, a large-scale cocaine base paste processing

laboratory dismantled by Spanish authorities in 2023
Synthetic stimulants – the current situation in Europe


Figure 4.3. Methamphetamine residues in wastewater in selected European cities:

changes between 2022 and 2023
MDMA – the current situation in Europe

Figure 5.2. MDMA residues detected in wastewater in selected European cities: most
recent data
Figure 5.4a. Purity of MDMA powder samples submitted to drug checking services in
2022 and 2023 (percent)
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Figure 5.4b. Content of MDMA tablet samples submitted to drug checking services in
2022 and 2023 (percent)
Figure 5.5. Psychoactive adulterants detected in samples sold as MDMA to users and
tested in 12 European drug checking services in 2023
Heroin and other opioids – the current situation in Europe

Figure 6.1. Age distribution of all clients entering treatment with heroin as their primary
drug, 2010 and 2022
Figure 6.2. Age distribution of never previously treated clients entering treatment with
heroin as their primary drug, 2010 and 2022
Figure 6.3. Trends in the main route of administration of clients entering treatment with
heroin as primary drug, by treatment status
Figure 6.5a. Proportion of acute drug toxicity presentations with heroin involved in
2022, Euro-DEN Plus
Figure 6.5b. Trends in presentations with heroin involved, selected hospitals
Other drugs – the current situation in Europe

Figure 8.1. Number of formal notifications of benzodiazepines reported to the EU Early
Warning System, 2005-2023
Figure 8.3. Seizures of ketamine powder in the European Union: total quantity
(kilograms), 2006-2022
Figure 8.4. Seizures of ketamine powder in the European Union: total number, 2006-
2022
New psychoactive substances – the current situation in Europe

Figure 7.1. Number of new psychoactive substances reported for the first time to the EU
Early Warning System, by category, 2005-2023
Table 7.1. Notifications of new psychoactive substances under the terms of Regulation
(EC) no 1920/2006 (as amended) and Council Framework Decision 2004/757/JHA
(as amended) – 2023
Figure 7.2. Number of new psychoactive substances reported each year following their
first detection in the European Union, by category, 2005-2022
Figure 7.3. Number of new opioids reported for the first time to the EU Early Warning
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System, 2009-2023
Figure 7.4. Seizures of new psychoactive substances in the European Union:

percentage of total quantity seized, by substance, 2022
Figure 7.5a. Seizures of new psychoactive substances in the European Union: number
of seizures, 2005-2022
Figure 7.5b. Seizures of new psychoactive substances in the European Union: quantity
seized, 2005-2022 (kg)
Injecting drug use in Europe – the current situation

amphetamine or methamphetamine as primary drug: percentage reporting injecting as
main route of administration
Drug-related infectious diseases – the current situation in Europe

Figure 10.1. New HIV notifications linked to injecting drug use in the European Union,
2009 to 2022
Figure 10.2. Most-recent HIV outbreaks in Europe among people who inject drugs:
number of cases and the associated injected substance, 2014 to 2022
Figure 10.3. Number of sterile syringes distributed per person who inject drugs per year,
2022 or latest data
Figure 10.4. Availability of needle syringe programmes in Europe at regional level, 2022
or the most recent year available
Figure 10.6. Prevalence of active HCV infection among people who inject drugs, by
country, 2022 or latest available data
Drug-induced deaths – the current situation in Europe

Figure 11.1. Interventions to prevent opioid-related deaths, by intended aim and
evidence of benefit
Figure 11.2. Proportion of males among drug-induced deaths in the European Union,
Norway and Türkiye in 2022, or most recent year (percent)
Figure 11.3b. Drug-induced deaths in the European Union: age at death, 2022 or most
recent available data (percent)
Figure 11.3c. Trends in drug-induced deaths in the European Union, Norway and
Türkiye
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Figure 11.3d. Age distribution of drug-induced deaths reported in the European Union,
Norway and Türkiye in 2022 or the most recent year
Figure 11.4. Proportion of drug-induced deaths cases with opioids mentioned, 2022 or
most recent available data
Figure 11.5. Number of drug-induced deaths reported in the European Union in 2012
and 2022, or the most recent year, by age band
Figure 11.6. Proportion of drug-induced deaths with benzodiazepines involved, 2020 to

2022, selected countries (percent)
Opioid agonist treatment – the current situation in Europe

Figure 12.2a. Coverage of opioid agonist treatment (percent) in 2022 or the most recent
year
Figure 12.3. Number of European countries implementing opioid agonist treatment, up

to 2023
Harm reduction – the current situation in Europe

Figure 13.1. Number of European countries implementing harm reduction interventions,
up to 2023
Figure 13.2. Interventions to prevent opioid-related deaths, by intended aim and

evidence of benefit
Figure 13.6. An illustration of the range of drug checking technologies available and
their relative accuracy and reliability
Figure 13.7. Location and number of drug consumption facilities throughout Europe,
2023
Figure 13.8. Availability of drug-related and other health and social care interventions
targeting people who use drugs and are in prison, Europe, 2022
In half of the 20 countries with post-mortem toxicological data available for 2022, at least 1 in 4
drug-induced deaths involved methadone. The opioid agonist medicine was mentioned in around
a third of the cases reported in Germany, France (2021), Spain (2021) and Croatia. There is little
information available on whether the medicines were prescribed, misused or acquired on the
black market. However, the mention of the drug does not mean that it was the cause of the
poisoning, as overdoses often involve polydrug use with other opioids, alcohol and other
medicines such as benzodiazepines. In 2022, buprenorphine was identified in 56 % (107) of the
drug-induced deaths reported in Finland, in 19 % (92) in Sweden, in 7 % (20) in Denmark and in
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7 % (49) of the deaths reported by the special register in France in 2021. In all other countries
with available data, buprenorphine was reported in less than 5 % of fatal overdose cases or not
reported at all.
Tramadol, an opioid medicine used to treat moderate to severe pain, was involved in about 6 %
(177) of reported overdose deaths in 12 European countries in 2022. However, it was involved in
47 % of the deaths reported by the French registry of medicine misuse-related deaths in 2020,
suggesting that improving surveillance and toxicological investigation might increase the
detection of deaths associated with opioid-containing medicines.
Where available, data indicate that fentanyl and fentanyl derivatives were linked to 163 overdose
deaths in 2022. Germany reported the largest number of deaths with the drug involved (73).
However, some of these fatalities might be associated with diverted fentanyl medicines rather
than illicit fentanyl. The other cases were reported in 2022 in Lithuania (33 deaths), followed by
Denmark (20), Sweden (17), Estonia (8), Austria (4), Finland (3), Latvia (4), Türkiye (1).
Preliminary 2023 data from Estonia and Latvia indicate that the number of drug-induced deaths
involving new synthetic opioids further increased. In drug-induced deaths involving nitazenes, the
most prominent nitazenes detected in Estonia in 2023 were protonitazene (38 of 56, 68 %) and
metonitazene (27 of 56, 48 %); isotonitazene (32 of 38, 84 %) was most common in Latvia.
Figures for 2023 are preliminary and might be underestimates. In countries with available data,
between 2021 and 2022, oxycodone was reported as being involved in 327 drug-induced deaths,
mainly in Denmark, Estonia, Finland and Sweden.
Consuming opioids in combination with benzodiazepines increases the risk of overdose. In 2022,
benzodiazepines, together with other substances, primarily opioids, were detected in the majority
of overdose deaths in Denmark, Luxembourg, Austria and Finland, and in more than 4 out of 10
cases in Portugal and Slovenia (Figure 11.6). In addition, benzodiazepines were detected in high
proportions of the overdose deaths reported in the most recent data available for Spain, Cyprus
and Romania. In Bulgaria, where the total numbers of overdose deaths are small and caution is
warranted due to year on year fluctuations, benzodiazepines are rarely detected. In many
countries, this information is not available and in others, post-mortem toxicology findings are not
reported for all cases.
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Figure 11.6. Proportion of drug-induced deaths with benzodiazepines involved, 2020 to

2022, selected countries (percent)
Few countries report information on the involvement of pregabalin in drug-induced deaths.

Among those that do, Finland reported 87 deaths in 2022 (90 in 2021). Several countries
reported an increase in the number of deaths with pregabalin mentioned: Denmark (from 48
deaths in 2021 to 58 in 2022), Austria (from 37 in 2021 to 54 in 2022), Spain (from 41 in 2020 to
81 in 2021), and Türkiye (from 5 in 2021 to 25 in 2022).
Deaths linked to synthetic cannabinoids declined to 8 in Türkiye in 2022 (46 in 2021). Seven
countries with available data reported 27 deaths with synthetic cathinones involved in 2022,
mainly in Finland (13 cases), Estonia (5 cases), Portugal (4 cases), Austria (2), Romania (2) and
Slovenia (1). Where data are available for 2021 and 2022, the numbers increased in Estonia
(from 3 to 5), Finland (from 6 to 13), Portugal (from 0 to 4), Romania (from 1 to 2) and Slovenia
(from 0 to 1), and decreased in Austria (from 7 to 2).
All-cause drug-related mortality

Cohort studies show that all-cause mortality is much higher among people who use drugs than
among their peers in the general population. Examples include the finding that between 2018
and 2022 the excess mortality risk of people who inject drugs in two Greek cities was 17 times
that of the general population. Between 2010 and 2019, patients with opioid use disorders in
Croatia had an excess mortality risk 17 times higher in females and 8 times higher in males
compared with the general population.
Source data
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Opioid agonist treatment – the

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Opioid users represent the largest group undergoing

specialist drug treatment, mainly in the form of opioid agonist
treatment. On this page, you can find the latest analysis of
the provision of opioid agonist treatment in Europe, including
key data on coverage, the number of people in treatment,
pathways to treatment and more.

Treating opioid-related problems still consumes

most treatment resources
While there is now greater heterogeneity in the characteristics of those seeking help for drug
problems, due to the long-term nature of opioid agonist treatment, those receiving it still probably
account for the greatest share of the resources invested in drug treatment services in most
countries. An estimated 1.7 million people received treatment for problems related to the use of
illicit drugs in the European Union in 2022 (2.0 million, including Norway and Türkiye). Specialist
drug treatment encompasses a range of medical (including pharmacological), psychological, social
and behavioural approaches to stop or reduce drug use and injecting. Generally, the majority will
receive some form of opioid agonist treatment, which is the main pharmacological treatment
approach and is typically combined with psychosocial interventions. The available evidence
supports this approach, with positive outcomes found with respect to treatment retention, illicit
opioid use, reported risk behaviour, drug-related harms and mortality. Recent guidance from the
EMCDDA and ECDC on the prevention and control of infectious diseases among people who inject
drugs recommends the provision of opioid agonist treatment in both community and prison settings
to prevent transmission of HCV and HIV and to help reduce injecting risk behaviour and injecting
frequency. The guidance also recommends the provision of sterile injecting equipment alongside
opioid agonist treatment to maximise the coverage and effectiveness of the interventions among
people who inject opioids.
There remain, however, important differences between countries in the settings and form in which
treatment is provided and the extent to which the availability of opioid agonist treatment is sufficient
to meet the needs of those requiring this form of care. The provision of opioid agonist treatment is
still clearly insufficient in some countries (see Key data and trends, below). The relative importance
of outpatient and inpatient provision within national treatment systems also varies greatly between
countries. Almost a fifth of drug treatment in Europe is provided in inpatient settings, mainly
hospital-based residential centres (e.g. psychiatric hospitals), but this can also include therapeutic
communities and, in some countries, specialist residential treatment centres in prisons. Overall,
however, opioid agonist treatment is more commonly provided in outpatient settings. These can
include specialist drug treatment centres, low-threshold agencies, and primary healthcare centres,
which can include general practitioners’ surgeries.
The available data suggest that the provision of opioid agonist treatment did not drop significantly
during the COVID-19 pandemic, when public health-based restrictions on movement were in place.
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During that period, however, service delivery models may have been adapted. Examples of this
include increased use of telemedicine and less restrictive approaches to providing take-home doses.
There is also some information to suggest that access to care for new clients seeking opioid agonist
treatment may have been disrupted temporarily during the pandemic period.
Meeting the more complex needs of an ageing cohort

of opioid treatment clients
The long-term nature of opioid problems is underlined by the data available on the characteristics of
those receiving opioid agonist treatment. The data also indicate that Europe’s cohort of those who
have had problems with heroin is ageing. This is illustrated by the fact that almost 70 % of clients in
opioid agonist treatment are now aged 40 or older, while less than 10 % are under 30 years old. This
has important implications for service delivery, with services having to address a more complex set
of healthcare needs in a population that is becoming ever more vulnerable. An important
consideration here is the need to ensure the existence of effective referral pathways to more generic
services offering treatment for other conditions associated with the ageing process. This is
becoming increasingly necessary in order to support older opioid treatment clients in need
of geriatric care due to the long-term effects of illicit drug use, but also tobacco and alcohol use, on
their physical health. The treatment of this marginalised group also needs to respond to a complex
and often long-established set of problems related to mental health issues, social isolation,
employment and housing. The development of integrated, multidisciplinary and age-specialised
care services for this group will remain an important consideration in policy and provision as the
demographics of opioid use in Europe continue to change.
Polydrug use and the appearance of highly potent new synthetic opioids on local drug markets can
increase the risks from opioid use, especially for older people and those with complex healthcare
needs. Where highly potent opioids have become an established feature of drug markets, more
research is needed to determine if adaptations are needed to ensure that current approaches to
providing opioid agonist treatment remain optimal. In addition, as noted elsewhere in this report,
should we see the reduced availability of heroin on the European market, this may increase the
demand for care in this area.
More information on health and social responses to opioid use, including among older people, can
be found in the EMCDDA’s Health and social responses to drug problems: A European guide.
Key data and trends

Number of people in treatment
A comparison with current estimates of the number of high-risk opioid users in Europe would
suggest that, overall, opioid agonist treatment was received by about half of the number of high-
risk opioid users in the European Union in 2022, an estimated 513 000 (526 000 including
Norway and Türkiye) (Figure 12.1). However, there are differences between countries. In those
countries where data from 2011 or 2012 are available for comparison, there was generally an
increase in coverage. Levels of provision, however, remain low and insufficient in some countries
estimated to have significant numbers of high-risk opioid users, such as Latvia, Lithuania, Poland,
Romania and Slovakia (Figure 12.2).
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Number in treatment Gender breakdown Trends in the number in opioid agonist treatment
(percent)
Age distribution Treatment duration (months)
Type of medication
Trends in the number of opioid agonist clients are based on 26 countries. Only countries with data for at least 7 of the 10 years
are included in the trends graph. Missing values are interpolated from adjacent years. Data for age distribution are based on 16
countries representing 28 % (141 164) of all registered clients in the European Union. Data for gender are based on 17 countries
representing 18 % (93 612) of all registered clients. Data for treatment duration are based on 7 countries representing 7 % of all
- 196 -
registered clients (34 300).
Distribution of OAT clients by type of medication: SROM is slow-release oral morphine and DHC is dihydrocodeine.
Figure 12.2a. Coverage of opioid agonist treatment (percent) in 2022 or the most recent year
Coverage is defined as the share of high-risk opioid users receiving the intervention. Data are displayed as point estimates and
uncertainty intervals.
Data from countries that consistently reported on clients receiving opioid agonist treatment
between 2010 and 2022 show an overall stable trend in treatment levels during this period, with
little fluctuation in the number of clients receiving this treatment. The reasons for this stability
vary. In countries with high treatment provision, it may reflect the often chronic, relapsing nature
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of opioid dependence and the need for treatment over a prolonged period; in others (e.g. Latvia),
it may reflect the low capacity of treatment systems.
At the onset of the COVID-19 pandemic, EU Member States sought to ensure continued access
to opioid agonist treatment for people engaged in high-risk drug use. Comparing treatment data
between 2019 and 2022 indicates that the number of clients remained stable, with only Croatia
and Hungary reporting a decrease greater than 10 % of their opioid agonist treatment population
during this period. These reductions may be partly due to decreased access to treatment during
the pandemic.
In some countries, the number of people receiving opioid agonist treatment has increased,
reflecting increased treatment provision, with 11 countries reporting an increase between 2016
and 2022, including Denmark (37 %), Poland (54 %), Romania (17 %) and Sweden (21 %).
Pathways to treatment
Client pathways through drug treatment are often characterised by the use of different services,
multiple entries and varying lengths of stay. Self-referral continues to be the most common route
into specialist drug treatment for opioid clients. This form of referral, which also includes referral
by family members or friends, accounted for about two thirds (66 %) of those with primary opioid
problems entering specialist drug treatment in Europe in 2022. Almost one fifth (23 %) of clients
were referred by health, education and social services, including other drug treatment centres,
while 7 % were referred by the criminal justice system.
Opioid agonist medications

The provision of more than one opioid agonist treatment medication in 2022 is reported by 26
countries. Methadone is the most commonly prescribed medication, received by more than half
(56 %) of opioid agonist treatment clients across Europe. Another 35 % are treated with
medications based on buprenorphine, which is the principal medication reported to be used in 8
countries. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are
more rarely prescribed, being received by almost 10 % of opioid agonist clients in Europe, with 5
countries reporting some provision of heroin-assisted treatment, if pilot projects are included (
Figure 12.3).
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Figure 12.3. Number of European countries implementing opioid agonist treatment, up to

2023
Alternative treatment options

Although less common than opioid agonist treatment, alternative treatment options for opioid
users are available in all European countries. In the 11 countries for which data are available,
between 5 % and 47 % of all opioid users in treatment receive interventions not classified as
opioid agonist treatment, such as medically assisted detoxification and outpatient or inpatient
abstinence-oriented interventions.
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Source data
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Harm reduction – the current

Drug Report 2024)
- 201 -
Harm reduction encompasses interventions, programmes

and policies that seek to reduce the health, social and
economic harms of drug use to individuals, communities and
societies. On this page, you can find the latest analysis of
harm reduction interventions in Europe, including key data on
opioid agonist treatment, naloxone programmes, drug
consumption rooms and more.

Evolving drug problems pose a broader set of

challenges for harm reduction
The use of illicit drugs is a recognised contributor to the global burden of disease. Interventions
designed to reduce this burden include prevention activities, intended to reduce or slow the rate at
which drug use may be initiated, and the offer of treatment to those who have developed drug
problems. A complementary set of approaches goes under the general heading of harm reduction.
Here the emphasis is on working non-judgementally with people who use drugs in order to reduce
the risks associated with behaviours that are mostly associated with adverse health outcomes, and
more generally to promote health and well-being. Probably the best known of these is the provision
of sterile injecting equipment to people who inject drugs, with the aim of reducing the risk of
contracting an infectious disease. Over time these sorts of approaches appear to have contributed
to the relatively low rate, by international standards, of new HIV infections now associated with
injecting drug use in Europe. Over the last decade, as patterns of drug use have changed and the
characteristics of those who use drugs have also evolved, to some extent, harm reduction
interventions have also needed to adapt to address a broader set of health outcomes and risk
behaviours. Prominent among these are reducing the risk of drug overdose and addressing the
often-considerable and complex health and social problems faced by people who use drugs in more
marginalised and socially excluded populations.
A spectrum of responses is needed to reduce changing drug-

related harms
Chronic and acute health problems are associated with the use of illicit drugs, and these can be
compounded by factors such as the properties of the substances, the route of administration,
individual vulnerability and the social context in which drugs are consumed. Chronic problems
include dependence and drug-related infectious disease, while there is a range of acute harms, of
which drug overdose is perhaps the best documented. Although relatively rare at the population
level, the use of opioids still accounts for much of the morbidity and mortality associated with drug
use. Injecting drug use also increases risks. Correspondingly, working with opioid users and those
who inject drugs has been historically an important target for harm reduction interventions and also
the area where service delivery models are most developed and evaluated.
- 202 -
Reflecting this, some harm reduction services have become increasingly integrated into the
mainstream of healthcare provision for people who use drugs in Europe over the last three decades.
Initially, the focus was on expanding access to opioid agonist treatment and needle and syringe
programmes as a part of the response to high-risk drug use, primarily targeting injecting use of
heroin and the HIV/AIDS epidemic. Recent joint EMCDDA-ECDC guidance on the prevention and
control of infectious diseases among people who inject drugs recommends providing opioid agonist
treatment to prevent hepatitis C and HIV, as well as to reduce injecting risk behaviours and injecting
frequency, in both the community and prison settings. The guidelines also recommend the provision
of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and
effectiveness of the interventions among people who inject opioids.
In the last three decades, approaches to harm reduction have been broadened in some EU countries
to encompass other responses, including drug consumption rooms and take-home naloxone
programmes intended to reduce fatal overdoses (Figure 13.1). Interventions to reduce opioid-
related deaths include those aimed at preventing overdoses from occurring and those aimed at
preventing death when an overdose does occur (Figure 13.2).
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Figure 13.1. Number of European countries implementing harm reduction interventions, up

to 2023
- 204 -
benefit
Note: Interventions where there is evidence of benefit and where we can have high or reasonable confidence in the available evidence are
highlighted in a bolder frame. Much of the current evidence on interventions listed in this figure is either emerging or deemed insufficient,
in part because of the practical and methodological difficulties of conducting research, especially in developing randomised controlled
trials (see Spotlight on... Understanding and using evidence) and also because service delivery models often differ considerably.
In some countries, there are drug checking facilities, which have been established with the aim of
enabling people to understand better what substances the illicit drugs they have bought contain.
Tablets, for example, purchased as MDMA, may also contain adulterants and other drugs, such as
synthetic cathinones. With many synthetic stimulants and new psychoactive substances now
available on the illicit market in similar looking powders or pills, consumers may be increasingly at
risk of being unaware of what particular stimulant or mixture of substances they may be consuming.
The increasing integration of the markets for new psychoactive substances and illicit drugs is
creating new public health challenges, such as herbal cannabis mixed with synthetic cannabinoids,
stimulants mixed with cathinones and ketamine or new synthetic opioids mixed with or mis-sold as
heroin. As poisoning events can evolve rapidly, understanding what constitutes the delivery of
effective of risk communication has become more important. Although the range of services
provided may differ, all drug checking services undertake some form of health risk communication
activity, often by issuing alerts on analysed drug products and sharing data with other stakeholders.
The aim is to prevent or reduce harm at the level of the individual (the person submitting the
substance for checking) and of the population (others who may be exposed to the same substance).
Future steps in this field may include moves towards harmonisation and the building of consensus
among European drug checking services on the determination of criteria and thresholds for when
and how to issue alerts, as well as the adoption of evidence-based standard operating procedures
for health risk communication. These issues are explored in a recent manual developed by the
EMCDDA and the Trans-European Drug Information project on health risk communication strategies
.
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Some of these interventions remain controversial for reasons that include their legal status and the
evolving nature of their evidence base. Coverage of these newer interventions therefore remains
uneven within and between countries, and where they do exist, they are often most commonly found
only in large cities. Overall, coverage and access to harm reduction services more generally,
including those service models that are long-established and relatively well evidenced, varies
considerably between EU countries, and in some countries remains inadequate in comparison to
estimated needs.
Increasing preparedness to reduce the harm from potent

synthetic drugs and unintentional consumption
Potent synthetic substances have a growing potential to cause drug-related harms in Europe, as
inadvertent consumption of these substances in powders or mixtures sold as other drugs can lead
to poisonings and deaths. This, together with more complex patterns of polydrug consumption, adds
to the already considerable challenges of developing effective responses to reduce drug overdose
deaths and drug-related poisonings. An example of this growing complexity, albeit currently on a
relatively small scale, was seen in Estonia in 2022, where mixtures were identified containing new
synthetic opioids and new benzodiazepines and also the tranquilliser xylazine. Known respectively
as ‘benzo-dope’ and ‘tranq-dope’, these sorts of mixtures have been linked to increases in overdose
deaths and other negative health-related outcomes in the United States and Canada. More recently,
the highly potent benzimidazole opioids (nitazenes), which are more potent than fentanyl, have also
been involved in localised poisoning outbreaks in parts of Europe (see also New psychoactive
substances – the current situation in Europe).
During a recent outbreak in Ireland, a rapid risk communication exercise was undertaken, with the
support of low-threshold services, which included leaflet drops to open drug scenes and distribution
of information on social media and news platforms. This is an example of how services may need to
respond both more rapidly and more intensively to outbreaks of drug poisoning than in the past (
Figure 13.3). The presence of such mixtures and mis-sold substances on the market highlights the
need to review current approaches to the delivery of some harm reduction interventions. For
example, the distribution and administration of the opioid antagonist naloxone may need to be
reviewed in the context of these mixtures and mis-sold substances.
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More generally, given possible developments in the synthetic opioid market, it would be prudent to
review current plans to prepare for and respond to any possible increase in the availability and use
of synthetic opioids or in the harm associated with these substances. This could include enhancing
toxicological analysis capabilities, alert messaging and frontline responder preparedness. Where
drug consumption rooms are operational, the possible benefits and risks from also providing drug
checking services may be an issue for consideration. Most drug consumption rooms in Canada, for
example, offer drug checking for fentanyl. This is currently uncommon in the European Union, but a
consumption room in Copenhagen has recently started providing this service, and other pilot
projects are reported to be in development elsewhere in Europe.
Stimulant-related harms linked to different patterns of use

Reducing the risks associated with injecting drug use has always been an important target for harm
reduction interventions, and the service models are relatively well developed and evidenced.
However, even in this area, changes in drug consumption are creating new challenges for effective
service delivery. In the last decade, there have been HIV outbreaks associated with the injection of
illicit synthetic stimulants in 7 European cities, across 6 EU countries. A potentially increased
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frequency of injection is associated with stimulant use compared with heroin use, while crushing
and dissolving crack cocaine and other tablets for injection also brings with it additional health risks.
These consumption patterns raise questions regarding, for example, the type and adequacy of
needles and syringes provided to people in street-based open drug scenes, which now are typically
characterised by polydrug use. An additional concern exists that service restrictions during COVID-
19 lockdowns adversely impacted on testing for drug-related infections, such as HIV and HCV, and
on conduits to care among more vulnerable and marginalised populations of people who use drugs,
including those experiencing homelessness.
Synthetic stimulants and various other substances are consumed to facilitate and enhance sex in
the context of sexualised drug use by various groups, but mainly among men who have sex with
men, when it is known as ‘chemsex’. While this definition is imprecise, it is usually used to refer to
settings or events where both high-risk drug taking and high-risk sexual behaviour may occur. The
drugs involved can range from stimulants, such as methamphetamine, cocaine and synthetic
cathinones, to alcohol, depressants such as GHB/GBL and dissociatives such as ketamine. While it
is difficult to estimate the prevalence of chemsex, information from research studies suggests it is
an issue that is present, albeit at a small scale and among specific subgroups of people who use
drugs, across Europe. Engaging with and providing effective harm reduction responses for people
engaged in these forms of high-risk behaviours remains a challenge, and the development of
tailored harm-reduction interventions is likely to be needed. Also likely to be needed in this area are
strong multi-agency partnerships between those providing sexual health services and those
services providing drug-related harm reduction.
New challenges and opportunities to reduce harm

Despite cannabis being Europe’s most commonly consumed illicit drug, an argument can be made
that it is also an area in which harm reduction advice and interventions are often lacking. Cannabis
users in Europe commonly smoke the drug with tobacco, and an undeveloped area for the
development of harm reduction approaches is the consideration of what might constitute effective
inventions to reduce smoking-related harm in this group. More generally, as the types and forms of
cannabis products available in Europe continue to change, so too have considerations about the
implications this has for harm reduction responses. Overall, cannabis products, both resin and
herbal, are now of a higher potency – they contain more THC – than they were historically, and high-
potency cannabis products are associated with more acute and chronic harms. In addition, the
diversity of product types has expanded, with edibles, e-liquids and extracts all now available. These
changes create new potential challenges to identify what constitutes effective harm reduction
interventions and opportunities to implement them to reduce harm.
Cannabis is not the only area in which harm reduction approaches have the potential to play a
greater role. As noted elsewhere in this year’s European Drug Report, there are also signs of
increasing consumer interest in less commonly known substances, including dissociative drugs and
psychedelics such as nitrous oxide and ketamine. These substances do have the potential to cause
possible harm, and some patterns of use are likely to increase the risk of adverse consequences
occurring, creating potential opportunities for harm reduction approaches.
While some harm reduction responses remain controversial in some countries in Europe, the overall
concept that evidence-based measures to reduce harm are an important component of balanced
drug policies is largely accepted. The contexts within which harm reduction services operate, the
evidence base that supports them, and what constitutes standards for quality of care in this area
therefore remain key areas for further development and policy consideration. Looking forward, the
evolving threats to public health arising from Europe’s dynamic illicit drugs markets highlight the
- 208 -
growing need to evaluate new and evolving models of service provision that may be needed to
protect the health of people at risk of adverse outcomes arising from more complex consumption
patterns, new substances and mixtures, or associated with particular subgroups or settings.
The EMCDDA’s Health and Social Responses to Drug Problems: A European Guide contains
detailed information for those wanting to find out more about the evidence that exists for the relative
effectiveness of harm reduction and other forms of intervention.
Key data and trends

Needle and syringe programmes
Needle and syringe programmes are also a widely available and standard component of harm
reduction services. In 2022, all EU Member States and Norway had needle and syringe
programmes in place. Needle and syringe coverage and access remain a challenge, with only 5 of
the 17 EU countries with available data reaching the WHO service provision targets in 2022 (
Figure 13.4).
- 209 -

Opioid agonist treatment can be considered as an effective form of drug treatment and also as a
service delivery model that addresses some harm reduction objectives. Opioid agonist treatment
is a well-established intervention that is implemented in all European countries and is
acknowledged as a protective factor against overdose deaths. A range of opioid agonist
medications are prescribed in treatment clinics in Europe, but methadone is the most widely
used, with about 56 % of opioid agonist clients receiving it, while another 35 % are treated with
buprenorphine-based medications.
Take-home naloxone programmes

Up to 2022, 16 European countries have reported the implementation of take-home naloxone
programmes, which includes pilot projects, to prevent overdose deaths and 10 countries report
having opened at least one drug consumption room, intended to facilitate safer use and prevent
various health problems (Figure 13.5).
Data for EU Member States, Türkiye and Norway in 2023 or most recent year.
- 210 -
Drug checking services

Twelve European countries report the existence of some type of drug checking service. These
services aim to prevent harms by allowing people to find out what chemicals are in the illicit
substances they have bought, and, in some cases, provide access to counselling or brief
interventions. The analytical techniques used by services range from sophisticated technology
that can provide information on strength and content of a wide variety of substances, to methods
that simply show the presence or absence of a particular drug (Figure 13.6).
Figure 13.6. An illustration of the range of drug checking technologies available and their
relative accuracy and reliability
Drug checking technologies ranked in order of increasing accuracy and reliability of results:
Multiple methods(most accurate and reliable)
High-performance liquid chromatography
Fourier transform spectroscopy
Thin-layer chromatography
Reagent test kit(least accurate and reliable)
Drug consumption rooms

While drug consumption rooms have become a more accepted harm reduction response,
establishing them remains problematic in some countries. In 2023, 10 EU countries and Norway
had operational facilities (Figure 13.7). Where multicultural and new immigrant populations are
present, increased own-language harm reduction messaging is desirable for people engaged in
high-risk drug use.
- 211 -
Figure 13.7. Location and number of drug consumption facilities throughout Europe, 2023
Source: European Network of Drug Consumption Rooms (ENDCR) and Correlation – European Harm Reduction Network (C-
EHRN).
Please note that all geographical coordinates used here are approximate only.
Interventions in prisons
EMCDDA data on harm reduction and treatment interventions available in prisons in 2022 show
that continuity of opioid agonist treatment was available in all EU Member States, apart from
Slovakia, as well as in Türkiye. Initiation of opioid agonist treatment in prison was not allowed in 2
countries (Bulgaria, Slovakia). Needle and syringe programmes were available in prisons in 3
countries: in all prisons in Spain and Luxembourg (2 prisons), and in one female prison in
Germany. Take-home naloxone was available in 7 countries (Germany, Estonia, Ireland, France,
Italy, Lithuania, Norway) (Figure 13.8).
- 212 -
Figure 13.8. Availability of drug-related and other health and social care interventions targeting
people who use drugs and are in prison, Europe, 2022
Number of countries reporting the formal availability of interventions in prison
European situation by type of intervention in prison
Select an intervention from the dropdown list below

Availability of interventions in prison settings
- 213 -
Source:Prison and drugs in Europe: current and future challenges (EMCDDA, 2021), updated with recent data from 2023 prison
workbooks, EMCDDA national focal points
Source data
- 214 -
List of figures (European Drug

Report 2024)
- 215 -
This page contains a full list of all figures and graphical

elements available in the European Drug Report 2024. Note
that, if viewing this page as part of a PDF, links will go to the
online pages, not the corresponding figures in the PDF. Links
are organised below according to the chapter in which they
appear.

List of figures by chapter

Understanding Europe’s drug situation in 2024 – key developments
Figure. At a glance – estimates of drug use in the European Union

Figure 1.1. 'Operation Nano', 9.5 tonnes of cocaine seized in August 2023 at the Port of
Algeciras (Cadiz), Spain
Figure 1.2. Example range of drug trafficking methods previously reported by law enforcement
in Europe
Figure 1.3. Drug seizures in the European Union – quantity of drugs seized, indexed trends
(2012 = 100)
Figure 1.5a. Drug seizures in the European Union – number of seizures in 2022
Figure 1.5b. Drug seizures in the European Union – quantity seized in 2022 (tonnes)
Figure 1.6. Drug seizures in the European Union – number of drug seizures, indexed trends
(2012 = 100)
Table. Summary of seizures of EU scheduled precursors and non-scheduled chemicals used

for selected drugs produced in the European Union, 2022
Cannabis – the current situation in Europe

Figure 2.1. Operation ‘Cabalgata/Califa-Trucks’ – Spanish authorities seize 22 tonnes of
cannabis resin concealed in fake tomato packaging
Figure 2.3. Cannabis residues in wastewater in selected European cities: most recent dat
- 216 -
Cocaine – the current situation in Europe

Figure 3.2. Example range of drug trafficking methods previously reported by law enforcement
in Europe
Figure 3.3. Operation ‘Mourente’, a large-scale cocaine base paste processing laboratory
dismantled by Spanish authorities in 2023
Synthetic stimulants – the current situation in Europe


Figure 4.3. Methamphetamine residues in wastewater in selected European cities: changes

MDMA – the current situation in Europe

Figure 5.2. MDMA residues detected in wastewater in selected European cities: most recent
data
Figure 5.4a. Purity of MDMA powder samples submitted to drug checking services in 2022
and 2023 (percent)
Figure 5.4b. Content of MDMA tablet samples submitted to drug checking services in 2022
and 2023 (percent)
Figure 5.5. Psychoactive adulterants detected in samples sold as MDMA to users and tested in
12 European drug checking services in 2023
Heroin and other opioids – the current situation in Europe
- 217 -
Figure 6.1. Age distribution of all clients entering treatment with heroin as their primary drug,
2010 and 2022
Figure 6.2. Age distribution of never previously treated clients entering treatment with heroin
as their primary drug, 2010 and 2022
Figure 6.3. Trends in the main route of administration of clients entering treatment with heroin
as primary drug, by treatment status
Figure 6.5a. Proportion of acute drug toxicity presentations with heroin involved in 2022, Euro-
DEN Plus
Figure 6.5b. Trends in presentations with heroin involved, selected hospitals
Other drugs – the current situation in Europe

Figure 8.1. Number of formal notifications of benzodiazepines reported to the EU Early
Warning System, 2005-2023
Figure 8.3. Seizures of ketamine powder in the European Union: total quantity (kilograms),
2006-2022
Figure 8.4. Seizures of ketamine powder in the European Union: total number, 2006-2022
New psychoactive substances – the current situation in Europe

Figure 7.1. Number of new psychoactive substances reported for the first time to the EU Early
Warning System, by category, 2005-2023
Table 7.1. Notifications of new psychoactive substances under the terms of Regulation (EC)
no 1920/2006 (as amended) and Council Framework Decision 2004/757/JHA (as amended)
– 2023
Figure 7.2. Number of new psychoactive substances reported each year following their first
detection in the European Union, by category, 2005-2022
Figure 7.3. Number of new opioids reported for the first time to the EU Early Warning System,
2009-2023
Figure 7.4. Seizures of new psychoactive substances in the European Union: percentage of
total quantity seized, by substance, 2022
Figure 7.5a. Seizures of new psychoactive substances in the European Union: number of
seizures, 2005-2022
Figure 7.5b. Seizures of new psychoactive substances in the European Union: quantity seized,
2005-2022 (kg)
Injecting drug use in Europe – the current situation
- 218 -
amphetamine or methamphetamine as primary drug: percentage reporting injecting as main
route of administration
Drug-related infectious diseases – the current situation in Europe

Figure 10.1. New HIV notifications linked to injecting drug use in the European Union, 2009 to
2022
Figure 10.2. Most-recent HIV outbreaks in Europe among people who inject drugs: number of
cases and the associated injected substance, 2014 to 2022
Figure 10.3. Number of sterile syringes distributed per person who inject drugs per year, 2022
or latest data
Figure 10.4. Availability of needle syringe programmes in Europe at regional level, 2022 or the
most recent year available
Figure 10.6. Prevalence of active HCV infection among people who inject drugs, by country,
2022 or latest available data
Drug-induced deaths – the current situation in Europe

benefit
Figure 11.2. Proportion of males among drug-induced deaths in the European Union, Norway
and Türkiye in 2022, or most recent year (percent)
Figure 11.3b. Drug-induced deaths in the European Union: age at death, 2022 or most recent
available data (percent)
Figure 11.3c. Trends in drug-induced deaths in the European Union, Norway and Türkiye
Figure 11.3d. Age distribution of drug-induced deaths reported in the European Union, Norway
and Türkiye in 2022 or the most recent year
Figure 11.4. Proportion of drug-induced deaths cases with opioids mentioned, 2022 or most
recent available data
Figure 11.5. Number of drug-induced deaths reported in the European Union in 2012 and
2022, or the most recent year, by age band
Figure 11.6. Proportion of drug-induced deaths with benzodiazepines involved, 2020 to 2022,
selected countries (percent)
Opioid agonist treatment – the current situation in Europe

Figure 12.2a. Coverage of opioid agonist treatment (percent) in 2022 or the most recent year
- 219 -
Figure 12.3. Number of European countries implementing opioid agonist treatment, up to

2023
Harm reduction – the current situation in Europe

Figure 13.1. Number of European countries implementing harm reduction interventions, up to
2023
benefit
Figure 13.4. Needle and syringe distribution and opioid agonist treatment coverage in relation
to WHO 2020 targets, 2022 or latest available estimate
Figure 13.6. An illustration of the range of drug checking technologies available and their
relative accuracy and reliability
Figure 13.7. Location and number of drug consumption facilities throughout Europe, 2023
Figure 13.8. Availability of drug-related and other health and social care interventions targeting
people who use drugs and are in prison, Europe, 2022
This PDF was generated automatically on 11/06/2024 from the web page located at this address:
https://emcdda.europa.eu/publications/european-drug-report/2024. Some errors may have occurred during this process.
For the authoritative and most recent version, we recommend consulting the web page.
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European Drug Report 2024: Trends and Developments

European Drug Report 2024:

Understanding Europe’s drug situation in 2024 – key developments (European Drug

Cannabis – the current situation in Europe (European Drug Report 2024)

Cocaine – the current situation in Europe (European Drug Report 2024)

MDMA – the current situation in Europe (European Drug Report 2024)

New psychoactive substances – the current situation in Europe (European Drug

Drug-related infectious diseases – the current situation in Europe (European Drug

List of figures (European Drug Report 2024)

Drug supply, production and precursors

Heroin and other opioids

New psychoactive substances

Injecting drug use

Drug-related infectious diseases

Opioid agonist treatment

PDF version of full report

Data visualisations and list of figures

European Drug Report 2024 annex tables

Reitox national focal points

About this page

HTML: TD-AT-24-001-EN-Q ISBN: 978-92-9497-975-9 DOI: 10.2810/91693

Understanding Europe’s drug

The EMCDDA’s latest analysis of the European drug

This page is part of the European Drug Report 2024, the

Last update: 11 June 2024

EVERYWHERE, EVERYTHING, EVERYONE

The European Union Drugs Agency – providing Europe with

The drug situation in Europe in 2024 – an overview

Targeting of commercial infrastructure is linked to high drug

Policy concerns grow about drug-related violence and the

Polydrug consumption and drug mis-selling increase risks to

Forensic, toxicological and innovative new data sources are

Addressing a more diverse and complex set of needs

Greater diversity of substances injected increases health risks

HIV notifications return to pre-pandemic levels

Signs that ketamine is increasingly available and may be causing

‘Pink cocaine’: an example of new synthetic drug mixtures

Europe’s response to cannabis

Monitoring and evaluation are key to assessing the impact of

Changing cannabis markets create new challenges for drug

Cocaine and synthetic stimulants now play a greater

Cocaine production sites in Europe reveal how trafficking groups

Impact of high cocaine availability on public health becoming

Europe remains a significant producer of synthetic drugs

Methamphetamine production and trafficking highlight the

Seizures of glycidic derivatives of BMK, a precursor used for large-scale methamphetamine

Synthetic cathinones represent a growing challenge

Developments in the opioid area create new

Concern is growing that highly potent synthetic opioids pose a

Appearance of nitazene opioids already associated with harm in

New challenges for policy, practice and research

Could a decline in heroin availability lead to a larger market for

Could Myanmar replace Afghanistan as a source of heroin for

At a glance – estimates of drug use in the European Union

22.8 million 85.4 million 4.0 million 15.4 million

Young adults (15-34) Young adults (15-34)

15.1 million 2.5 million

2.9 million 12.3 million 2.3 million 10.3 million

Young adults (15-34) Young adults (15-34)

2.2 million 1.5 million