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

Published: 10 November 2010

Injecting drug use

Injecting drug users are among those at highest risk of experiencing health problems from their drug use, such as blood-borne infections (e.g. HIV/AIDS, hepatitis) or drug overdoses. In most European countries, injection is commonly associated with opioid use, although in a few countries, it is associated with use of amphetamines. Only 14 countries were able to provide recent estimates of the prevalence of injecting drug use (1), despite their importance for public health. Improving the level of information available on this special population continues to be an important challenge for the development of health monitoring systems in Europe.

The available estimates suggest large differences between countries in the prevalence of injecting drug use. Estimates range from less than one to five cases per 1 000 population aged 15–64 for most of the countries, with an exceptionally high level of 15 cases per 1 000 reported in Estonia. When the latter is excluded as an outlier, the weighted average is about 2.6 cases per 1 000 population aged 15–64 (2), which, if extrapolated to the population of the European Union, would correspond to between three quarters of a million and one million active injecting drug users. The number of former injecting drug users is likely to be larger (Sweeting et al., 2008), but is not known for most EU countries.

Opioid users entering specialised drug treatment often report injecting as the usual mode of administration. This is the case for more than half of opioid clients in 16 countries, between 25 % and 50 % in six countries, and under 25 % in another five countries. The lowest proportions of injectors among opioid users entering treatment are reported by the Netherlands (5 %) and Spain (19 %), while the highest are reported by Lithuania (99 %), Romania (95 %), Estonia (91 %) and Slovakia (86 %)(3).

Drawing conclusions on time trends in the prevalence of injecting drug use is difficult because of the lack of data and the wide confidence intervals of the estimates. Available data suggest, however, a stable situation in the Czech Republic, Greece, Cyprus and Norway (4). A statistically significant decrease was observed in the United Kingdom, between the years 2004 and 2006. Among heroin users entering treatment, the proportion of injectors has overall decreased in the last years, with statistically significant decreases between 2002 and 2007 reported by 13 countries. Increases over this period were reported by only three countries (Bulgaria, Lithuania, Slovakia) (5). The proportion of injectors is also overall slightly lower among opioid users entering treatment for the first time (38 %) than among all opioid users entering treatment (42 %). This is the case in 20 out of 23 reporting countries. More detailed analysis of the prevalence and trends of injecting drug use is provided elsewhere (EMCDDA, 2010).


(1) See Table PDU-2 in the 2010 statistical bulletin.

(2) The weighted average is 0.26 %, with an uncertainty range (weighted averages of lower and upper limits of the country estimates) of 0.23 % to 0.30 %, resulting in an estimate of 886 606 (788 778–1 040 852) for 2008. This estimate must be considered with caution as it is based on data available from only 12 of the 27 EU Member States and Norway.

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

(4) See Table PDU-6 (part iii) in the 2010 statistical bulletin.

(5) See Table PDU-104 in the 2010 statistical bulletin.

Bibliographic references

EMCDDA (2010), Trends in injecting drug use in Europe, EMCDDA Selected issue, Publications Office of the European Union, Luxembourg.

Sweeting, M.J., De Angelis, D., Ades, A.E. and Hickman, M. (2008), ‘Estimating the prevalence of ex-injecting drug use in the population’, Statistical Methods in Medical Research 18, pp. 381–95.

About the EMCDDA

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