Overall cocaine is the most commonly used stimulant in Europe, though in some countries MDMA, amphetamine or methamphetamine may be the dominant stimulant.
Many of the harms from using stimulants are associated with intensive, high-dose or long-term consumption. Route of administration is an important mediating factor, with both stimulant injecting and the smoking of crack cocaine or methamphetamine particularly associated with more problematic patterns of use. However, acute problems can affect even experimental or occasional stimulant users.
Stimulants may be used functionally, for example, to stay awake when driving, working long hours, or when socialising in nightlife settings. This means that some of the responses appropriate to stimulant use are setting specific, or overlap with more generic public health measures. The settings in which they are used and the fact that stimulants are sometimes used in a sexual context also mean that drug-related responses may overlap with responses to sexual health issues, particularly in some groups.
- Cocaine is the main stimulant drug for which people seek treatment in Europe (63 000 people in 2015), with the majority of these cases in Spain, Italy and the United Kingdom. The number of new treatment entrants is stable. A further 7 400 entered treatment for primary crack cocaine problems, mostly in the United Kingdom.
- About 34 000 people entered treatment for problems with use of amphetamine in 2015, and 9 000 for methamphetamine, mostly in Czech Republic and Slovakia. There has been an increase in first-time treatment entrants for amphetamines since 2009.
- Very few people enter specialised drug treatment for MDMA use; harm reduction responses in festival and nightlife settings are more relevant to this group.
Summary of the available evidence
Implications for policy and practice
- Problems associated with stimulant use vary depending on patterns of use, the groups who are using them and the setting in which they are used. Responses therefore need to be tailored to the local patterns of use and problems experienced.
- Core responses for stimulant problems currently include psychosocial treatment or brief interventions and harm reduction for people who inject drugs.
- Improving links between sexual health and drug treatment services could improve efficiency and effectiveness of both.
- Harm reduction interventions for stimulant users need development and evaluation.
- Research into effective pharmacological treatments for stimulant dependence should be prioritised at EU level.