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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).


Annual report 2011: the state of the drugs problem in Europe
Opioid use and drug injection

Published: 15 November 2011

Problem drug use

Problem drug use is defined by the EMCDDA as injecting drug use or long duration/regular use of opioids, cocaine and/or amphetamine. Injecting drug use and the use of opioids form the greater part of problem drug use in Europe, although in a few countries users of amphetamines or cocaine are important components. It is also worth noting that problem drug users are mostly polydrug users, and that prevalence figures are much higher in urban areas and among socially excluded groups.

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). Overall prevalence of problem drug use is reported to range from two to ten cases per 1 000 population aged 15-64. Such estimates may have large uncertainty ranges and specific limitations. For example, while users in treatment are generally included, drug users currently in prison, especially those with longer sentences, may be under-represented in the estimates.

Problem opioid use

Most European countries are now able to provide prevalence estimates of 'problem opioid use'. Recent national estimates vary between one and eight cases per 1 000 population aged 15-64 (Figure 11). The countries reporting the highest well-documented estimates of problem opioid use are Ireland, Italy, Luxembourg and Malta, while the lowest are reported by the Czech Republic, the Netherlands, Poland, Slovakia and Finland. Only Turkey and Hungary report less than one case per 1 000 population aged 15-64.

The average prevalence of problem opioid use in the European Union and Norway, computed from national studies, is estimated to be between 3.6 and 4.4 cases per 1 000 population aged 15-64. This corresponds to some 1.3 million (1.3-1.4 million) problem opioid users in the European Union and Norway in 2009. By comparison, estimates for Europe's neighbouring countries are high, with Russia at 16 per 1 000 population aged 15-64 (UNODC, 2009), and Ukraine at 10-13 cases per 1 000 population aged 15-64 (UNODC, 2010). Estimates of problem opioid prevalence that are higher than the European average are reported elsewhere in the developed world, where the number of cases per 1 000 population aged 15-64 is 6.3 in Australia (Chalmers et al., 2009), 5.0 in Canada and 5.8 in the USA (UNODC, 2010). Comparisons between countries should be made with caution, as definitions of the target population may vary.

Opioid users entering treatment

Opioids, mainly heroin, are cited as the primary drug for entering treatment by around 216 000 or 51 % of all those reported entering specialist drug treatment in 29 European countries in 2009. However, considerable differences exist across Europe, with opioid clients accounting for more than 80 % of those entering treatment in six countries, between 60 % and 80 % in seven, and with only two of the remaining 16 countries reporting opioid clients accounting for less 20 % of treatment entrants (Figure 12). In addition, a further 30 000 users (9 % of drug clients) of other drugs cited opioids as a secondary drug (1).

Opioid users entering specialist treatment are on average 34 years old, with female clients and those entering treatment for the first time being younger in most countries. Across Europe, male opioid clients outnumber their female counterparts by a ratio of about three to one, with generally lower male to female ratios in northern countries. In general, opioid users entering treatment have higher rates of unemployment, lower levels of educational attainment and higher levels of psychiatric disorders than clients reporting other primary drugs (2).

Almost half of opioid clients reported first using the drug before the age of 20 (47 %) and the great majority have done so by the age of 30 (88 %). Opioid clients report an average interval of nine years between first use of opioids and entering treatment for the first time, with female clients reporting a shorter average time lag (seven years) (3). Injecting the drug is reported as the usual mode of administration by about 40 % of opioid clients entering treatment in Europe; the remaining 60 % report that they snort, inhale or smoke the drug. Almost two-thirds of opioid clients (64 %) report daily use of the drug in the month prior to entering treatment (4), and most use a secondary drug, often alcohol, cannabis, cocaine or other stimulants. The combination of heroin and cocaine (including crack) is quite common among clients, either injected together or used separately.

Trends in problem opioid use

During the period 2004-09, data from eight countries with repeated prevalence estimates in problem opioid use suggest a relatively stable situation. Based on a sample of 17 European countries where data were available for the period 2004-09, there has been an overall increase in the reported number of clients entering specialist drug treatment in Europe, including those entering treatment for primary heroin use (from 123 000 to 143 000). This increase may, however, be largely due to heroin users re-entering treatment rather than to first-time treatment entrants (5). For clients entering treatment for the first time, the number of heroin users has remained almost stable (around 32 000 in a sample of 18 countries) (6). Data on drug-induced deaths over the 2004-09 period, which are mostly associated with opioid use, were stable or increasing in the majority of reporting countries until 2008. Provisional data for 2009 now point to a stable or decreasing number of deaths (7).

Despite indications of an overall stable situation, the characteristics of Europe's opioid problem are changing. Opioid treatment clients have become older on average, while the proportion of injectors among them has decreased and the proportion of users of opioids other than heroin and of polydrug users has increased (8).


(1) See Figure TDI-2 (part ii) and Tables TDI-5 and TDI-22 in the 2011 statistical bulletin. Data from outpatient and inpatient treatment centres.

(2) See Tables TDI-10, TDI-12, TDI-13, TDI-21, TDI-32 and TDI-103 in the 2011 statistical bulletin.

(3) See Tables TDI-11, TDI-33, TDI-106 (part i) and TDI-107 (part i) in the 2011 statistical bulletin.

(4) See Tables TDI-18 and TDI-111 in the 2011 statistical bulletin.

(5) See Figures TDI-1 and TDI-3 in the 2011 statistical bulletin.

(6) See Tables TDI-3 and TDI-5 in the 2009 and 2011 statistical bulletin.

(7) See Table DRD-2 (part i) in the 2011 statistical bulletin.

(8) See Table TDI-113 in the 2008, 2009, 2010 and 2011 statistical bulletins and Table TDI-114 in the 2009 statistical bulletin. Data available with a breakdown by type of opioid for the years 2005 and 2009. See also EMCDDA (2010), Treatment and care for older drug users, Selected issue, Publications Office of the European Union, Luxembourg.

Bibliographic references

UNODC (2009), World drug report 2009, United Nations Office on Drugs and Crime, Vienna.

UNODC (2010), World drug report 2010, United Nations Office on Drugs and Crime, Vienna.

Chalmers, J., Ritter, A., Heffernan, M. and McDonnell, G. (2009), Modelling pharmacotherapy maintenance in Australia: exploring affordability, availability, accessibility and quality using system dynamics, Australian National Council on Drugs research paper.


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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: Friday, 28 October 2011