EMCDDA releases Annual report 2008

Opioids are still at the heart of Europe’s drug phenomenon. And signs of change in our heroin and synthetic opioid problem mean that countries need to be vigilant and prepared to respond. These were among the key points stressed by the EMCDDA as it launched its Annual report 2008: the state of the drugs problem in Europe on 6 November in Brussels.

Estimates show that there are between 1.3 and 1.7 million problem opioid users in the EU and Norway, with heroin responsible for Europe’s largest drug-related health and social costs. New data published in the report call into question previous EMCDDA assessments of a slowly improving heroin situation and point to a 'stable, but no longer diminishing problem'. Record opium production in Afghanistan in 2007 has also heightened the agency’s worries over a potential knock-on effect on Europe’s heroin problem.

'Current evidence does not point to an epidemic growth in heroin problems as experienced by most of Europe in the 1990s', said EMCDDA Director Wolfgang Götz. 'Nonetheless, we cannot ignore the threat posed by the glut of heroin now available on the world market, the concerns raised by indicators of heroin use, or the warning signs that synthetic opioids may be a growing problem. Vigilance is clearly required. But to ensure that Europe is ready to respond rapidly, there is a critical need to improve the sensitivity of our information systems to changes in the availability and use of these most damaging substances'.

In most EU countries, opioid use accounts for between 50 % and 80 % of all treatment demands. At least 7 000 to 8 000 drug-induced deaths occur in Europe every year, with drug overdose one of the leading causes of death among young Europeans. Around 80 % of fatal overdoses are associated with opioid use, and the injection of these drugs is a major vector for spreading drug- related infectious diseases. It is estimated that some 3 000 new cases of drug-related HIV occur every year in Europe, and countries report that typically over 40 % of injectors are infected with HCV (hepatitis C virus). Substitution treatment for opioid use is now available in all EU Member States, Croatia and Norway, with around 600 000 opioid users receiving it annually.

According to the report, although heroin use remains stable, indicators of opioid trends point to some worrying developments. For example, the number of heroin seizures in most reporting countries increased by over 10 % in the period 2003–06. And the quantity of heroin seized in Turkey, an important transit country, more than doubled during this period. Overall, heroin seizures reached an estimated 19.4 tonnes (48 200 seizures) in Europe in 2006.

Also, across Europe, data suggest that new recruitment to heroin use is still occurring 'at a rate that will ensure that the problem will not decline significantly in the foreseeable future'. New demands for treatment with heroin as the primary drug increased in around half of the countries reporting data in 2006. Particular concern is raised by studies in some countries which suggest that initiation to opioid injection is still occurring. And in Estonia, Lithuania, Austria and Romania, over 40 % of injectors were under 25.

In contrast to an overall falling trend in drug-induced deaths between 2000 and 2003, data now suggest a static or even growing problem, with most Member States since reporting increases. Heroin is the drug most associated with drug-related deaths, but other opioids are also being reported. While, overall, the average age of those dying from overdose is rising in Europe (mid-30s), a number of countries report a relatively high proportion of overdose deaths among the under-25s.

Highlighted this year are also the increased reports of problems related to synthetic opioids. In Latvia and Estonia, for example, there are indications of a growing problem caused by the availability of 3-methylfentanyl (fentanyl). Due to the strength of this drug — it is considerably more potent than heroin — use can be particularly risky. This is reflected in the over 70 fentanyl-related fatal poisonings reported in Estonia in 2006.

Research shows that the risk of overdose decreases substantially when heroin users are in substitution treatment. Nevertheless, methadone is identified in the toxicological reports of some deaths in Europe. Evidence exists that good prescribing practices can reduce these deaths, highlighting the need for overdose prevention issues to be taken into account when developing clinical practice in this area. Methadone deaths do not appear to be directly related to overall levels of substitution treatment.

Wolfgang Götz said: 'Reducing drug-related deaths is an explicit goal of most national drug strategies but our actions are yet to match our words. We cannot tolerate the fact that one of our young citizens dies every hour from an overdose that could have been avoided. We must prioritise overdose prevention measures and target high-risk groups, such as those leaving prison or relapsing after treatment'.