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Cocaine-Related Health Emergencies in Europe: A Review of Sources of Information, Trends and Implications for Service Development


Cocaine use and seizures of cocaine have increased during the last decade in Europe, with cocaine now being the most-used illegal drug after cannabis. More than 14.5 million Europeans, or 4.3% of adults aged 15–64 have reportedly used cocaine at least once in their lifetime. However, patterns of cocaine use in Europe vary considerably with a high prevalence in a restricted group in mainly Western European countries. During 2010, the highest prevalence of cocaine use among young males (15–34 years) was reported by Spain, Ireland, Italy and the UK, as well as in Denmark (16–34 years).

The most common adverse health consequences associated with cocaine are cardiovascular and cerebrovascular disorders and neurological impairments, which may be associated with both acute and chronic cocaine use. Regular cocaine use, independently of the route of administration, is also associated with accidents and with the transmission of infectious diseases (through unprotected sex). Recent concerns have also been raised regarding the association between cocaine use and violent crimes in the night-time economy. There is also an increased mortality risk for cocaine users admitted for treatment, compared to the general population.

The health consequences of cocaine may be underestimated due to the often unspecific or chronic nature of the pathologies arising from long-term use and the difficulty in establishing causal links between an illness and the use of cocaine. Despite some limitations , hospital emergency departments and other health emergency settings may be an important source of information on drug-related health consequences. Even when classic indicators of drug use exist, such as mortality, prevalence estimates or treatment demand, some aspects of drug consumption can easily be missed. This can be a particular problem for stimulant drugs like cocaine. Information obtained from drug-related health emergencies could provide insight on new drugs, new patterns of use and health problems or consequences that may not be identified by other indicators. Furthermore, a closer link between the emergency departments and addiction services could help in guiding problematic cocaine users towards appropriate treatment at an earlier stage in the addiction process.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the designated hub for drug-related information in the European Union. The EMCDDA collates annually drug-related information from 30 national drug monitoring centers (Reitox Network), including data and reports on the national drug situation. A section of these reports focuses on health consequences related to illegal drug use which includes data on illegal-drug-related problems including acute health problems from hospital emergency services, hospital wards and/or other settings.

These sources of information are mapped here and the number of cases with cocaine-related health problems reported in emergency settings in European countries during the period from 2007 to 2010 is analyzed. Longer-term data are presented where available. The nature and extent of cocaine-related health problems and their implications for prevention and monitoring are discussed.

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Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources. Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007–2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends. Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.