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Please note that the information on this page is based on the EMCDDA Annual report 2010: the state of the drugs problem in Europe. Most statistical data relate to the year 2008 (or the last year available).


Annual report 2010: the state of the drugs problem in Europe
Opioid use and drug injection

Published: 10 November 2010

Prevalence estimates of problem opioid use

Data in this section are derived from the EMCDDA problem drug use (PDU) indicator, which includes mainly injecting drug use and the use of opioids, although in a few countries users of amphetamines or cocaine constitute an important component. Given the relatively low prevalence and the hidden nature of problem drug use, statistical extrapolations are required to obtain prevalence estimates from the available data sources (mainly drug treatment data and law enforcement data). Most countries are able to provide specific estimates of ‘problem opioid users’, but it is worth noting that these are often polydrug users, and prevalence figures are often much higher in urban areas and among socially excluded groups.

Estimates of the prevalence of problem opioid use in European countries during the period 2003–08 range roughly between one and eight cases per 1 000 population aged 15–64 ('Figure 10: Estimates of the annual prevalence of problem opioid use (among population aged 15–64)'); overall prevalence of problem drug use is estimated to range from two to ten cases per 1 000. The countries reporting the highest well-documented estimates of problem opioid use are Ireland, Malta, Italy and Luxembourg, while the lowest are reported by the Czech Republic, Cyprus, Latvia, Poland and Finland ( both the Czech Republic and Finland have large estimates of problem users of amphetamines). Only Turkey reports figures of less than one case per 1 000 population aged 15–64.

The average prevalence of problem opioid use in the European Union and Norway is estimated to be between 3.6 and 4.4 cases per 1 000 population aged 15–64. This corresponds to some 1.35 million (1.2–1.5 million) problem opioid users in the European Union and Norway in 2008 (1). This estimate includes users in substitution treatment, but prisoners, especially those with longer sentences, may be under-represented.

Opioid users in treatment

Opioids continued to be cited as the primary drug by the majority (53 %) of those entering specialised drug treatment in 2008 in Europe, with heroin being cited by 48 % of all clients (1). However, considerable differences exist across Europe in the proportion of drug users entering treatment for problems related to these drugs; with opioid clients accounting for more than 90 % of those entering treatment in Bulgaria, Estonia and Slovenia, between 50 % and 90 % in 15 countries, and between 10 % and 49 % in a further nine (2). In addition to the about 200 000 treatment entrants declaring opioids as their primary drug in 2008, a further 47 000 users of other drugs cited opioids as a secondary drug (3).

Many opioid users are enrolled in programmes providing long-term care, in particular substitution treatment. This is reflected in the higher proportion of primary opioid users among drug users already in treatment from previous years. A recent analysis of data provided by nine countries found that primary opioid users accounted for 61 % of all reported clients in treatment, while they accounted for only 38 % of those entering treatment for the first time (5).

Trends in problem opioid use

The limited number of repeated estimates of the incidence and prevalence of problem opioid use, together with the statistical uncertainty around individual estimates, contributes to the difficulty of monitoring time trends. Data from eight countries with repeated prevalence estimates during the period 2003–08 suggest, however, a relatively stable situation. An apparent increase observed in Austria up to 2005 is not supported by the most recent estimate, which is now below the 2003 level. Ireland reported an increase between 2001 and 2006, which was less marked in Dublin (21 %) than outside the capital (164 %) (6).

Where adequate and up to date estimates of the incidence and prevalence of problem opioid use are not available, it may still be possible to analyse trends over time using data from other, mainly indirect, indicators such as treatment demand. Based on a sample of 19 countries, the overall number of primary heroin users entering treatment, and of those entering treatment for the first time, increased between 2003 and 2008 (7). Focusing on a more recent time frame, the number of primary opioid users entering treatment increased in 11 countries between 2007 and 2008. For those entering treatment for the first time, the overall upward trend levelled off in 2008, though six countries still reported increased numbers (8).

Data on drug-induced deaths in 2008, which are mostly associated with opioid use, provide no indication of a return to the decreasing trend observed until 2003 (see Drug-related infectious diseases and drug-related deaths). Over half of the reporting countries recorded increasing numbers of drug-induced deaths between 2007 and 2008 (9). The number of heroin seizures in Europe has also increased since 2003, while the quantities seized have decreased in the European Union. The change from a downward to an upward trend reported last year in heroin-related offences is now confirmed, with increases over 2003–08 in most European countries reporting sufficient data.

The use of heroin and opioid medicines by new groups, including socially integrated individuals and visitors to ‘techno’ parties, was reported by the French ‘TREND’ system, which relies both on qualitative and quantitative data. Other qualitative studies (Eisenbach-Stangl et al., 2009) also reported a small proportion of heroin users among targeted samples of socially integrated individuals. These may include experimental users, and persons who are able to control their use of the drug (Shewan and Dalgarno, 2005; Warburton et al., 2005).

The available data suggest that the downward trend in opioid indicators observed until 2003 has levelled off. This is perhaps most clearly visible since 2003 among seizures and drug-induced deaths, and after 2004 in new treatment demands related to heroin use. These changes have occurred alongside increased opium production in Afghanistan until 2007, raising concerns that these events might be linked through increased availability of heroin on the European market.

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(1) This estimate has been adjusted from 1.4 to 1.35 million on the basis of new data. Because of large confidence intervals and the fact that the estimate is based on data from different years, it is not possible to conclude that there was a decrease in the prevalence of problem opioid use in Europe.

(2) See Figure TDI-2 (part ii), Tables TDI-5 and TDI-113 in the 2010 statistical bulletin.

(3) See Table TDI-5 (part ii) in the 2010 statistical bulletin.

(4) See Table TDI-22 in the 2010 statistical bulletin.

(5) See Table TDI-38 in the 2010 statistical bulletin.

(6) See Tables PDU-6 (part ii) and PDU-102 in the 2010 statistical bulletin for full information about the studies, including confidence intervals.

(7) See Figures TDI-1 and TDI-3 in the 2010 statistical bulletin.

(8) Some of the variation over time may be due to changes in data coverage or treatment availability, and overall trends can be strongly influenced by Italy and the United Kingdom, which provide the highest numbers of new heroin clients.
See Tables TDI-3 and TDI-5 in the 2009 and 2010 statistical bulletin.

(9) See Table DRD-2 (part i) in the 2010 statistical bulletin.

Bibliographic references

Eisenbach-Stangl, I., Moskalewicz, J. and Thom, B. (Eds.) (2009), Two worlds of drug consumption in late modern societies, Ashgate, Farnham (UK).

Shewan, D. and Dalgarno, P. (2005), ‘Evidence for controlled heroin use? Low levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland)’, British Journal of Health Psychology 10, pp. 33–48.

Warburton, H., Turnbull, P.J. and Hough, M. (2005), Occasional and controlled heroin use: not a problem?, Joseph Rowntree Foundation, York.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>

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Page last updated: Tuesday, 26 October 2010