Heroin and other opioids — Introduction (EU Drug Markets Report)

Introduction

Opioid use, and in particular heroin use, continues to be a major part of the drug problem in Europe, and has been for over 40 years. Heroin is the second largest contributor to the overall illicit drug market after cannabis, and the trafficking of heroin remains a significant source of revenue for OCGs. Although there has been a stabilisation or decline in the extent of opioid use in many countries in recent years, the illicit use of opioids remains responsible for a disproportionately large proportion of the health problems and mortality associated with drug use in Europe. High levels of dependence and associated, largely acquisitive, crime are common features of heroin use. Primary heroin users still represent one-third of all drug users entering specialised treatment, and in a number of countries there are signs of increasing use of a range of other opioids, mainly methadone, buprenorphine and fentanyl. Opioids, in particular heroin, are also still implicated in the majority of reported overdose deaths in Europe, and injecting heroin is associated with high levels of blood-borne virus infections and other health harms. There remain a significant number of problem opioid users in Europe with long-term polydrug use histories who are now aged in their 40s and 50s. The cumulative effects of this polydrug use, overdose and infections over many years accelerate physical ageing among these users, with growing implications for health and social support services, and the cost of treating opiate users will remain a significant burden on health budgets for many years to come.

Criminal justice costs associated with drug-related offending by opioid users and dealers also remain important. In spite of some law enforcement success in recent years, there are signs of recovery in the heroin market in the EU. Exceptionally large heroin seizures are now frequent in the EU, and seizures in Turkey are increasing. There are also signs of an increase in the purity of heroin on the streets of Europe. Since increased production in Afghanistan and elsewhere is also reported and the trafficking routes to Europe are diversifying, it is important that vigilance is maintained and the situation is carefully monitored, as there is a risk that greater availability will result in increased risks to users and the potential for new heroin outbreaks. 

Opiates, opioids and heroin

Opiates are drugs that originate from naturally occurring alkaloids found in poppies. Opiates include opium, heroin, morphine and codeine. The term opioid generally refers to any substance that binds to the body’s opioid receptors and therefore also includes synthetic drugs that produce opiate-like effects, such as fentanyl and oxycodone.

Heroin is another name for diamorphine. It is a semisynthetic product obtained by acetylation of morphine, which occurs as a natural product in opium, the dried latex of certain poppy species, especially Papaver somniferum. Although opium has been smoked for centuries, diamorphine was first synthesised in the late 19th century. Diamorphine is a narcotic analgesic used in the treatment of severe pain and usually comes as tablets or an injectable liquid. Illicit heroin is usually an off-white or brown powder that may be smoked, snorted or solubilised with a weak acid and injected.

Heroin purity has been classified into four grades. No 4 is the purest form — the purified hydrochloride salt, which is a white powder that can be easily dissolved and injected. No 3 is the purified base, ‘brown sugar’, used for smoking (base). No 1 and No 2 are unprocessed raw heroin (salt or base). 

Table 4.1

Notes:

1. Estimate of the extent of problem opioid (mainly heroin) use within the EU.
2. Drug users entering treatment for heroin. Units coverage may vary across countries.
3.
The 2014 figures should be considered as estimates; where not available, most recent data were used in place of 2014 data, except for the number of seizures for the Netherlands, France and Poland where no recent data is available so they are not included. An additional 0.9 tonnes and 353 000 tablets of other opioids were seized (7 000 seizures) in Europe, including Norway and Turkey, in 2014.
4. 
IQR: interquartile range, or range of the middle half of the reported data.

Data presented are for the EU unless stated otherwise. All trend lines shown in this table cover a 5-year period, 2010–14. All trends reflect absolute numbers except for trends on price and on potency which reflect averages of mean values. In the case of treatment, price and purity, trends are based only on data from those EU countries that have consistently submitted data since 2010.

Source: EMCDDA/Reitox national focal points. 

Short title: 
Introduction