Policies and responses must be fit to face the challenges of the next decade, says drugs agency chief

The Annual report 2011: the state of the drugs problem in Europe is ‘one of contrasts’, says the EU drugs agency (EMCDDA). Launched today in Lisbon, the report shows drug use to be relatively stable in Europe, with some positive signs that cocaine use may have peaked and that cannabis use continues to decline among young people. But signs of stability with some of the more established drugs are offset by new threats. Explored in the report are developments in the synthetic drugs market, the rapid appearance of new substances and widespread polydrug use. Delivering the agency’s annual assessment, EMCDDA Director Wolfgang Götz said: ‘Europe’s drug policies and responses must now be configured to face the challenges of the next decade’.

Cocaine — has the bubble burst?

Over the last 10 years, cocaine has established itself as the most commonly used illicit stimulant drug in Europe, although most users are found in a restricted number of western EU countries. Around 14.5 million Europeans (15–64 years) have tried cocaine in their lifetime, around 4 million having used it in the last year (Chapter 5, Table 9). But new data presented today raise the question as to whether its popularity has now peaked.

Recent surveys of cocaine use reveal some positive signs in countries most affected. Denmark, Spain, Italy and the UK for example — four of the five countries with highest levels of use — report some decline in last-year cocaine use among young adults (15–34 years), echoing the trend observed in Canada and the United States (Chapter 5, Figure 10; Figure GPS-14, part ii) (1). Recent targeted surveys in recreational settings in some countries have also shown a decrease in cocaine use.

‘The financial burden associated with regular cocaine use may make it a less attractive option in countries where austerity is now the order of the day’, states the report. The average retail price of cocaine in most EU countries ranges between EUR 50 and EUR 80 per gram (Chapter 5, Table 8; Table PPP-3, part i). The drug’s ‘positive image’ as part of an affluent lifestyle, is also being challenged by a growing recognition of cocaine-related problems (e.g. hospital emergencies, treatment demand and deaths).

Around 17 % of drug users entering specialised treatment report cocaine as their main problem drug (Figure TDI-2, part ii). And around 1 000 cocaine-related deaths are reported annually in Europe. Cocaine use and heavy episodic (‘binge’) drinking often go hand in hand. Recent studies found that over half of the cocaine dependent users in treatment were also alcohol dependent (see box, Chapter 5) (2). Member States are now reporting improved therapeutic responses and positive experiences in treating problem cocaine users.

The number of cocaine seizures continues to rise in Europe (from 56 000 in 2004 to around 99 000 in 2009 — Table SZR-9), yet the volume seized and purity of the drug have fallen considerably in recent years. The total quantity of cocaine intercepted in Europe peaked in 2006, and since then has halved to an estimated 49 tonnes in 2009 (Chapter 5, Table 8). While cocaine trafficking routes via west Africa may be on the decline, there is evidence of increased activity in the east of Europe.

Cannabis — declining trend explored 

Around 78 million Europeans — one in five adults aged 15–64 years — have tried cannabis in their lifetime, around 22.5 million of them having used it in the last year (Chapter 3, Table 4). This makes cannabis still Europe’s most commonly consumed illicit drug. But the latest European data confirm the general stabilising or downward trend in cannabis use among young adults (15–34 years) cited in previous EMCDDA Annual reports (Chapter 3, Figure 5). Surveys of schoolchildren (15–16 years) mirror this decline (Health behaviour in school-aged children/HBSC survey 2006–10, Table EYE-10).

Decreases in tobacco smoking may be exerting some influence on cannabis trends in Europe, where the two substances are commonly used together (Chapter 3, Figure 6). A comparison between the last two ESPAD school surveys (2003 and 2007) in 23 EU countries showed an overall reduction in last-month cigarette smoking (from 33 % to 28 %) and cannabis use (from 9 % to 7%). Other possible explanations include lifestyle, fashion, replacement with other drugs and current attitudes to cannabis. A recent Eurobarometer survey published by the European Commission in July 2011 showed that regular cannabis use was rated a ‘high risk’ to health by 67 % of the young respondents (15–24 years) (3). The extent to which changes in drug policy influence cannabis use is a much debated question. Data presented in the report show no simple association between recent drug law changes and levels of cannabis use (see box, Chapter 3).

Regular cannabis use in Europe remains a cause for concern: some 9 million young Europeans (15–34 years) have used cannabis in the last month. Young men appear to be at most risk of becoming frequent cannabis users (Chapter 3, Figure 7), a factor which can be addressed in targeted prevention activities.

Europe’s appetite for cannabis is reflected in annual seizures of around 700 tonnes of the drug (approximately 600 tonnes resin; 100 tonnes herbal) (Chapter 3, Table 3) (4). Over the last decade, European cannabis policies have often tended to direct law-enforcement efforts towards traffickers rather than users. Yet offences related to cannabis use continue to rise, suggesting a possible disparity between policy and practice (Chapter 2, Figure 4).

Synthetic drugs — an increasingly complex market

Previous EMCDDA Annual reports have shown how suppliers of ‘legal highs’ keep one step ahead of controls by quickly offering new alternatives to banned products. Today’s report reveals a similar cat-and-mouse game in the area of precursors, the chemicals used to manufacture illicit drugs (see box, Chapter 4).

Synthetic drugs, including ecstasy (MDMA, MDEA, MDA) and amphetamine are manufactured illegally in Europe from imported precursor chemicals. The report shows how producers are using sophisticated techniques to bypass regulations intended to prevent the diversion of these precursors. These include: synthesising precursors from ‘pre-precursors’ or masking them as non-controlled chemicals, to be reconverted after importation.

Recent fluctuations in the ecstasy market illustrate this phenomenon. Following successful measures to limit the diversion of its precursor PMK, it now appears that manufacturers are using a range of pre-precursors, including safrole, as their starting material for MDMA. Some 1 050 litres of safrole and safrole-rich oils were seized in 2009/10, mostly in Lithuania.

Following a scarcity of MDMA in ecstasy tablets reported in the last two EMCDDA Annual reports, there are now signs that it may be on the rebound. Recent reports show increasing availability of MDMA — for example in the Netherlands, the country most closely associated with ecstasy production, high-dosage tablets have been found.

Around 11 million Europeans have tried ecstasy in their lifetime, 2.5 million in the last year (Chapter 4, Table 7). And around 12.5 million Europeans (15–64 years) have tried amphetamines in their lifetime, around 2 million in the last year (Chapter 4, Table 6). Latest five-year trend data show last year use of ecstasy and amphetamines among young adults (15–34 years) to be overall stable or declining (Chapter 4, Figure 8).

Europe is still the biggest producer of amphetamine in the world. Significant methamphetamine use and supply in Europe, however, has historically been restricted to the Czech Republic and Slovakia. But as reported in previous Annual reports, methamphetamine now appears to be becoming more available in parts of northern Europe (e.g. Norway, Sweden and Latvia), where it may be partially replacing amphetamine.

Rapid emergence of new drugs and growing interplay between the ‘legal highs’ and illicit drug markets

The rapid emergence of new non-controlled psychoactive substances (often sold as ‘legal highs’) represents a growing challenge, both in Europe and internationally (5). Following the record 41 new drugs notified to the EMCDDA and Europol in 2010 (compared to 24 in 2009), preliminary data for 2011 presented today show that there are no signs of decline. So far in 2011, 39 substances have been reported via the European early warning system (EWS). Measures to identify new substances are increasingly proactive — over 150 substances are now monitored through the EWS (see box, Chapter 8).

The most recent EMCDDA snapshot of online retailers of ‘legal highs’ (July 2011) identified a record 600 online shops purportedly selling psychoactive products (6) and revealed a wide variety of new products on offer. More sites also appeared to exercise caution via restrictions on deliveries or disclaimers and warnings (e.g. health, legal).

Highlighted today is the growing interplay between the ‘legal highs’ and illicit drug markets. Non-controlled psychoactive substances (e.g. mixtures of cathinones, piperazines or phenethylamines) may be tableted as ecstasy and sold on the illicit market. While recently the controlled drug PMMA has been identified in some products sold as ‘legal highs’. Mephedrone, a drug being placed under control in the EU (7), appears to ‘cross to both sides’, being sold as both a ‘legal high’ online and also, in some countries, via the same illicit supply networks as used for drugs such as ecstasy and cocaine.

The rapid spread of new drugs is pushing Member States to rethink and revise some of their standard responses to the drugs problem. In 2010, both Ireland and Poland rapidly passed legislation to limit the open sale of psychoactive substances not controlled under drug laws. Other countries have responded via existing health protection or medicines legislation. The European Commission is currently reviewing how Europe monitors and acts on new substances to ensure that responses remain up-to-date and fit for purpose (8).

‘The fast moving and increasingly joined-up world we live in is mirrored by an increasingly fast moving and joined-up drug market which appears quick to adapt to both threats and opportunities’, says Wolfgang Götz commenting at today’s launch. ‘This is reflected, not only in the sheer number of new substances appearing on the market, but also in their diversity and in how they are produced, distributed and marketed’.

The Director concluded: ‘We need a proactive strategy that allows us to rapidly identify new drugs and emerging trends so that we can anticipate their potential implications. We also need to coordinate our responses across Europe as, without doing so, individual national efforts are likely to prove ineffective. These two factors are crucial if we are to stay ahead in this rapidly developing game of cat and mouse’.