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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

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). The available data suggest large differences between countries, with estimates ranging 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. Taking these 14 countries together as a whole, it can be calculated that there are about 2.6 injecting drug users per 1 000 population aged 15-64. In addition to active injectors, there are a large number of former injecting drug users in Europe (Sweeting et al., 2008), but figures are not available for most EU countries.

About 41 % of primary opioid clients entering specialist drug treatment, mainly heroin users, report injecting as the usual mode of administration. Levels of injecting among opioid users vary between countries, from 8 % in the Netherlands to 99 % in Latvia and Lithuania (Figure 13), which may be explained by factors such as the history of heroin use in the country, the type of heroin available (white or brown), price, and user culture.

Drawing conclusions on time trends in the prevalence of injecting drug use based on repeated prevalence estimations is difficult because of the lack of data and, in some cases, the wide uncertainty ranges of the estimates. Available data indicate an overall decrease in opioid injection, particularly heroin injection, in Europe. In some countries, however, injecting levels appear to have remained relatively stable (Greece, Cyprus, Hungary, Croatia, Norway), while the Czech Republic reported an increase of injectors, mostly methamphetamine users, between 2004 and 2009 (2).

Most European countries have reported a decrease of the proportion of injectors among primary heroin clients between 2004 and 2009. The few countries where this is not the case report the highest proportions of heroin users among clients entering treatment.


(1) See Figure PDU-2 in the 2011 statistical bulletin.

(2) See Table PDU-6 (part iii) in the 2011 statistical bulletin.

Bibliographic references

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.

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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