As noted above, amphetamine, methamphetamine and MDMA are part of a wider market for stimulant drugs, in which there is variation in the ‘stimulant of choice’ between countries and user groups. In Europe, amphetamine and MDMA are used much more extensively than methamphetamine, but there is also evidence of polydrug use and shifts in established patterns. For example, amphetamine, methamphetamine and MDMA may be substituted for each other or replaced by other stimulants such as cocaine or new psychoactive substances, in particular synthetic cathinones, which are closely chemically related to amphetamines.
There are two main groups of amphetamine and methamphetamine users: those who are considered casual users, who use the drug in a recreational environment or to improve performance; and those who would be considered high-risk users, who may inject or smoke the drug and may eventually seek treatment. The most recent estimates indicate that about 12 million Europeans have tried amphetamines at some point in their lifetime, and an estimated 1.3 million 15- to 34-year-olds have used the drug at least once in the last year. Prevalence rates for last-year use in most countries in Europe have remained fairly stable since about 2000. Exceptions are Spain and the United Kingdom, where there has been a statistically significant decrease in prevalence since 2000 (EMCDDA, 2015a).
Patterns of use vary between countries, although in general most recreational users use infrequently. Recreational use is mainly in a social context; an online study of drug users in six EU countries found that in the Czech Republic and Sweden users most often consumed amphetamines in their own home, whereas in Bulgaria, Italy, the Netherlands and the United Kingdom (England and Wales) use was most commonly at a music concert or festival or other place of entertainment (Frijns and van Laar, 2013).
Problems relating to long-term, chronic and injecting amphetamine use have historically mostly been observed in northern European countries. In contrast, long-term methamphetamine problems have been most apparent in the Czech Republic and Slovakia. In the Czech Republic, a marked increase in the estimated number of people with problem or high-risk use of amphetamines, mainly by injection, was observed between 2007 to 2013 (from around 20 000 to over 34 000) (Czech Republic: Reitox, 2015). Very few other countries have identified significant numbers of problem methamphetamine users, although a recent trend of injecting use of methamphetamine among small groups of men who have sex with men in large cities such as London and Paris has also been noted (EMCDDA, 2014b).
Consumers may have difficulty in distinguishing between amphetamine and methamphetamine. There is some evidence from seizures to suggest that there may be increasing amounts of methamphetamine on the retail market in some Nordic countries, resulting in users ‘switching’ from amphetamine, perhaps unwittingly, to methamphetamine. For example, whilst methamphetamine seizure figures clearly indicate the drug’s presence in the market in Norway, there are still very few, if any, indications that it is particularly sought after. It appears that at present the two drugs are sold interchangeably and users do not necessarily know what they are getting (Norway: Reitox, 2015).
Ecstasy use has historically been linked to the electronic dance music scene, and in most countries its use is concentrated among young adults, particularly young males. A web survey of drug users in six European countries found that almost half (46 %) of users said that they usually used ecstasy at a music concert or festival and one-third (34 %) said they used it at another place of entertainment (Frijns and van Laar, 2013). Use is generally relatively infrequent; this same survey found that only 5 % of respondents reported using ecstasy once a week or more.
The diversification of the drug markets described earlier in this report and in Chapter 7 also extends to amphetamines. Although most NPSs appear to be quite transient, it is possible that some may have effects that meet particular user needs and they may then become established on the market, as may be the case for 4-fluoroamphetamine (4-FA), which has reportedly taken a share of the amphetamine and MDMA market in the Netherlands (Linsen et al., 2015; see Case study 12, Chapter 7).
The estimated annual value of the retail market for amphetamines in the EU is at least EUR 1.8 billion, with a likely range of EUR 1.2–2.5 billion, while the estimate for ecstasy is at least EUR 0.67 billion (range EUR 0.61–0.72 billion). Together they make up about one-tenth of the total illicit market in drugs. Our estimates of amounts used suggest that in 2013 about 76 tonnes of amphetamines (range 52 to 102 tonnes) and 87 million tablets (79 to 94 million tablets) of ecstasy were consumed.
In reaching these estimates we have used information on numbers of users from the general population surveys conducted in most countries but, recognising that some groups of drug users are unlikely to be represented in these surveys, we have supplemented these with estimates of the use of amphetamines by problem users. However, this almost certainly underestimates problem use. There are a number of other limitations to these estimates (see box 'The challenge of estimating the size of the illicit drug market') and further details of the estimation methods are given in the technical report published alongside this report (EMCDDA, 2016a).