Drug market dynamics in Europe: global influences and local differences
The importance of global factors on drug supply and policy discussions are evident in this year’s analysis
The main findings of the EMCDDA’s latest analysis of the drug problem in Europe point to a situation where longterm patterns and trends continue, but new developments in patterns of use and responses are emerging. The importance of global factors on drug supply and policy discussions are evident in this year’s analysis, while local patterns of use and responses to problems are both at the forefront of new trends. The boundary between the market categories of ‘old’ and new drugs is becoming harder to define, and just as new drugs increasingly mimic established substance types, so responses to new drugs may mirror evidence-based responses to problems with established drugs.
Cannabis in the spotlight
While initiatives being undertaken in the Americas on the regulated sale of cannabis and cannabis products are generating international interest and debate, in Europe, discussion on cannabis remains largely focused on the potential health costs associated with this drug. New data highlight the major role played by cannabis in drug-related crime statistics, with the drug accounting for 80 % of seizures and cannabis use or possession for personal use accounting for over 60 % of all reported drug law offences in Europe (see figure). In addition, the production and trafficking of this drug is recognised as an area of growing importance for law enforcement efforts due to the increased involvement of organised crime. Considerable diversity exists, however, between countries in sentencing practices for cannabis-related supply offences, with national experts indicating that penalties for a first-time offence of supplying one kilogram of cannabis may range from less than 1 year to 10 years in prison.
New data also show the growing importance of cannabis within drug treatment systems in Europe, with an increase in the number of treatment demands for cannabis-related problems. This increase needs to be understood in the context of service provision and referral practice. For example, in some countries, directive referrals from the criminal justice system account for a high proportion of treatment entrants. The data are also influenced by differing national definitions and practices in respect to what constitutes treatment for cannabis-related disorders, which can range from a brief intervention session delivered online to admission to residential care. The availability of treatment for cannabis users appears also to be changing, probably in response to both a greater awareness of the need for services and, in some countries, treatment capacity becoming available due to a decline in demand for services for other types of drug use. Irrespective of treatment type, for cannabis-related problems, the evidence supports psychosocial interventions — these approaches are explored in an analysis accompanying this report. In addition, evidence is emerging from studies in accident and emergency settings of increasing cases of acute health problems associated with high-potency cannabis products. Against a background of the greater availability of high-potency cannabis products, improvements are clearly now required in the monitoring of acute problems associated with the use of this drug.
Is market competition leading to higher strength products?
This year’s round of data collection found evidence of purity or potency increases in the medium or short term for all the most commonly used drugs in Europe. The reasons for this are likely to be complex, but appear to include both technical innovation and market competition. In the case of cannabis, where domestically produced, high-potency herbal products have taken an increasing market share in recent years, the data now point to an increase in the potency of imported resin, which is likely to be associated with changes in production practices. Innovation in the market and increased purity are also evident in the case of MDMA. After a period in which tablets sold as ‘ecstasy’ had a reputation among consumers for poor quality and product adulteration, which was supported by forensic evidence, high-purity MDMA powder and tablets are now more commonly available. The introduction of high-purity powder or crystal MDMA appears to be a deliberate strategy for differentiating this form of MDMA and making it more attractive to consumers. Similarly, high-dose tablets with distinctive shapes and logos are appearing, presumably with the same marketing objective. Over the last year, the EMCDDA and Europol have issued an alert warning of health risks linked to the consumption of very high purity MDMA products. In addition, alerts have also been issued about tablets sold as ecstasy, but containing PMMA, sometimes in combination with MDMA. The pharmacology of this drug makes it particularly worrying from a public health point of view.
For MDMA, and synthetic substances in general, product quality and supply is largely driven by the availability of precursor chemicals. Innovation in this area is also apparent, particularly in relation to production practices. This can be seen in respect to routes of chemical synthesis and in the high capacity of some of the production sites recently detected. It has also been suggested that, in some countries, the availability of new psychoactive substances may play a role. For example, the availability of high-quality synthetic cannabinoids and cathinones has sometimes been reported as offering direct competition to low-quality, and relatively more expensive, established drugs.
MOST DRUG LAW OFFENCES RELATE TO CANNABIS
Changes in the European heroin market
Problems related to heroin still account for a large share of the drug-related health and social costs in Europe, although recent trends in this area have been relatively positive. Recent data continue to show declining treatment demand and heroin-related harms, but a number of market indicators raise concern. UN estimates suggest a substantial increase in opium production in Afghanistan, the country supplying most of the heroin consumed in Europe. A potential knock-on effect in availability is therefore possible, and it is worrying that estimates of the purity of heroin available in Europe are on the rise. In some countries where purity increases have been observed, overdose deaths have also increased in recent data. It is unclear if these increases are linked, but this question warrants research attention. The clandestine nature of the drug market means that any analysis of its dynamics must be made with caution. Nonetheless, evidence is emerging of innovation in the supply of heroin to markets in Europe, and potential for a resurgence of the drug exists. Signs of change in heroin supply include the detection of heroin processing laboratories in Europe — not seen before — as well as evidence of adaptation in heroin trafficking routes and in the modus operandi of criminal groups. The transit of heroin from Pakistan and Afghanistan into Europe through Africa continues to cause concern. Seizure data also point strongly to the role that Turkey plays as a geographical gateway for drugs being shipped into and out of the European Union, and heroin seizures in that country have partially recovered from a low point recorded in 2011. These issues are explored in an analysis on heroin trafficking accompanying this report.
Older clients bringing new challenges to services
Any potential increases in heroin availability must be viewed in the context of the overall stagnation in demand for this drug, driven in a large part by both a decline in recruitment into heroin use and the enrolment of many of those with heroin problems into treatment services. In addition to the therapeutic benefits of treatment provision, Europe’s overall high rate of treatment coverage, estimated at 50 % of cases or more, is likely to make the European Union a smaller and potentially less attractive market for those supplying this drug. Heroin dependence is a chronic condition, and earlier predictions that services would need to adapt to the needs of an ageing cohort are borne out in the analysis presented in this report. Provision of an appropriate health and social service response for this group is therefore a growing challenge for drug services. Responses are complicated by problems experienced by this cohort related to long-term use of other substances, including tobacco and alcohol. Less well documented, but explored in a new analysis accompanying this report, is misuse of benzodiazepines among high-risk drug users. The misuse of benzodiazepines in combination with opioids is associated with elevated risk of drug overdose. Formulating effective responses to reduce overdose deaths remains a key policy challenge in Europe. Developments in this area include the introduction of targeted strategies, the provision of naloxone programmes and prevention initiatives targeting high-risk groups. Some countries have a long-established practice of providing ‘supervised drug consumption rooms’, with the intention of engaging with hard-to-reach drug users and reducing drug-related harms, including overdose deaths. A review of services delivered in these settings accompanies this report.
Historically, a main driver for drug policy and responses in respect to heroin, particularly injecting use, was the need to reduce HIV risk behaviour and transmission. Recent outbreaks and the situation in a few European countries underline the need for continued vigilance and ensuring that service provision levels are adequate. Nonetheless, the long-term picture shows clear improvement overall and illustrates the impact that provision of appropriate services can have. This message is relevant to efforts to address the relatively high rates of hepatitis C infection still found among injecting drug users. Here, new and effective treatments are becoming available, although treatment costs are high. The EMCDDA notes, however, that in some countries, and with support at European level, efforts are being made to improve the situation.
Combination of sexual and drug risk-taking behaviour: a growing area of concern
Situational analyses provided here often focus on comparing differences between countries. It is important to remember, however, that some drug-taking behaviour is linked to socio-cultural factors that are not necessarily country-specific. An example of this can be seen in some large European cities, where concerns exist about the spread of stimulant injection among small groups of men who have sex with men. Practices involving the so-called slamming of methamphetamine, cathinones and other substances in the context of ‘chem-sex’ parties have implications for both HIV transmission and sexual health services and highlight a need for joined-up responses in this area. This phenomenon runs contrary to the overall European trend in injecting drug use, which is declining in most populations, and underlines a general need to increase the attention given to the link between drugs and sexual risk-taking behaviour.
The Internet and apps: emerging virtual drug markets
Reflecting developments elsewhere, there is a growing trend for both drug and sexual health services to utilise the Internet and apps as platforms for delivering services. Information provision on drugs, prevention programmes and outreach services are, in varying degrees, relocating from physical spaces to virtual environments. Following suit, many drug treatment programmes are now established online, increasing their accessibility to both new and existing target groups.
Awareness is also growing of the potential role of the Internet in drug supply and marketing. Both new psychoactive substances and established drugs are being offered for sale on the surface and deep web, although the extent to which this occurs is unknown. Bearing in mind that in most other fields of commerce, consumer activity is moving from physical to online marketplaces, online drug markets may become an important area for focusing our monitoring activity in the future. This is also likely to be a challenging area for drug control policies, as developments can occur rapidly, such as the introduction of new marketplaces and cryptocurrencies. Existing regulatory models will need to be adapted to perform in a global and virtual context.
Prevalence of new psychoactive substances: the need to improve our understanding
The Internet has also been an important driver for the development of the market for new psychoactive substances, both directly, through online stores, and indirectly, by allowing producers easy access to research and pharmaceutical data, and by providing potential consumers with a forum for information exchange. Public and policy concern about the use of new psychoactive substances has grown considerably in a short time. However, our understanding of both the extent of use and the associated harms has not kept pace with developments. This is beginning to change, with more countries attempting to estimate the prevalence of use of these substances. Estimation in this area is challenging for methodological reasons; to date, national estimates have been difficult to compare. Some comparable data are available, however. While acknowledging that the recent Flash Eurobarometer on young people and drugs has methodological limitations as a prevalence estimation tool, it does provide data from all EU Member States, using a standardised questionnaire. The study results would suggest that lifetime use of new psychoactive substances remains at low levels among young people in most countries.
Other studies now becoming available provide windows on particular forms of new psychoactive substance use. Although these studies cannot be considered representative, they show that the use of new psychoactive substances occurs among groups as diverse as school students, party-goers, psychonauts, prisoners and injecting drug users. There is a growing understanding of motivations for use. Again, these are diverse, and include factors such as legal status, availability and cost, as well as the desire to avoid detection and user preferences for particular pharmacological properties. There is also evidence to suggest that new psychoactive substances have functioned as market substitutes at times of low availability and poor quality of established illicit drugs. For example, the popularity of mephedrone in some countries at the start of this decade has been attributed in part to the poor quality of illicit stimulants such as MDMA and cocaine. It will be interesting to see whether the increases now being observed in the potency and purity of established drugs will have implications for the consumption of new psychoactive substances.
AT A GLANCE — ESTIMATES OF DRUG USE IN THE EUROPEAN UNION
NB: For the complete set of data and information on the methodology see the accompanying online Statistical Bulletin.
Number of new psychoactive substances identified on the drug market continues to increase
While the use of new psychoactive substances appears to be limited overall, the pace of emergence of new drugs has not diminished. Reports to the EU Early Warning System indicate that both the variety and the quantity of new psychoactive substances on Europe’s market are still increasing. In 2014, 101 new psychoactive substances were detected for the first time, and it is interesting to note how the new drugs coming onto the market, mainly synthetic cannabinoids, stimulants, hallucinogens and opioids, mirror the established substances. Also in this report, the EMCDDA presents new data on the seizure of these substances. An important clarification here is that the method of data collection differs from that used for the regular monitoring of drug seizures, and the two datasets cannot be directly compared.
An unprecedented six risk assessments were conducted in 2014; a reminder of the importance of keeping a focus on the substances that cause particular harm. This achievement was helped by the improved availability of information on both hospital emergencies and toxicology. Despite improvements in the monitoring of acute drugrelated harms, the limited capacity in this area continues to restrict our view of the public health consequences related not just to new psychoactive substances but, more generally, to contemporary drug consumption patterns.
Health and social responses to the challenges posed by new drugs have been piecemeal and slow to emerge, but are now gathering momentum. These include a wide range of efforts mirroring the full spectrum of responses to established illicit substances, from drug education and training activities, to user-led consumer protection interventions on the Internet and needle and syringe exchange programmes based in low-threshold services.