EU drugs agency raises concerns over complex stimulant market and plethora of powders and pills

Annual report 2012: Highlights 1

Europe is faced with an increasingly complex stimulant market, in which consumers are confronted with a wide variety of powders and pills. While cocaine, ecstasy and amphetamines continue to be the main players on the stimulant scene, they are now competing with a growing number of emerging synthetic drugs, such as cathinones, one of the largest groups of new  drugs being reported in Europe today. Other stimulants are also under scrutiny, and there are signs of methamphetamine making further inroads into the market. Developments in the European stimulant market are described today in the Annual report 2012: the state of the drugs problem in Europe, launched by the EU drugs agency (EMCDDA) in Lisbon (1).

In the eyes of the consumer, these drugs are, to some extent, ‘interchangeable products’, says the agency, with factors such as availability, price and purity influencing consumer choices and making for a volatile market. The report also describes how users may often be unaware of what they are actually purchasing.

Cecilia Malmström, European Commissioner with responsibility for the EMCDDA, says: ‘Stimulant and synthetic drugs play a central role in the European drug situation, creating a market which is fast moving, volatile and difficult to control. More than ever before, young people are exposed to a plethora of powders and pills. Data from emergency rooms, toxicology reports and drug treatment centres indicate that the associated risks are not always well known by the users.’

‘In addressing these new challenges’, adds EMCDDA Director Wolfgang Götz, ‘it is critical that we improve our understanding of the health and social impact of emerging trends and develop measures to reduce demand. To do this, better forensic and toxicological analysis is essential; as is the need to proactively engage with those most at risk’.

Cocaine — further signs of falling use and status

Over the last decade, cocaine has established itself as the most commonly used illicit stimulant drug in Europe, although most users are found in a small number of western EU countries. Around 15.5 million Europeans (15–64 years) have tried cocaine in their lifetime, around 4 million having used it in the last year (Chapter 5, Table 8). While cocaine use remains a major part of the stimulant drug problem, today’s data confirm the analysis in last year’s report that its popularity and image as a ‘high-status drug’ may be declining.

While some countries still report rising cocaine consumption, recent surveys of cocaine use reveal some positive signs in high-prevalence countries. Denmark, Ireland, Spain, Italy and the UK for example — 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 in Canada and the United States (Chapter 5, Figure 10; Figure GPS-14, part ii). Potential users may now be more aware of the negative consequences that can accompany cocaine consumption. Low cocaine purity may also be causing some users to switch to other stimulants. Of the 23 countries providing trend data on cocaine purity, 20 reported a decline between 2005 and 2010. The EMCDDA index of average cocaine purity in the EU fell by 22 % in this period (Figure PPP-2).

The report shows that the number of cocaine seizures in Europe continues to fall, reaching around 88 000 in 2010 compared with 100 000 in 2008 (Table SZR-9). The quantities of cocaine seized are also on the decline at  European level. Having peaked at around 120 tonnes in 2006, they fell by around half to 61 tonnes in 2010 (Table SZR-10) (Chapter 5, Table 7). This rather dramatic fall in the volume seized probably reflects a diversification in cocaine trafficking operations that has made cocaine interception more challenging. It may also reflect changes in drug law-enforcement resources and priorities in key seizing countries.

Evidence that fewer drug users are seeking treatment for cocaine problems also suggests that its popularity may be waning. Around 15 % of drug users entering specialised treatment report cocaine as their main problem drug (Figure TDI-2, part ii). Recent data on trends in those entering treatment for cocaine problems now show a modest drop in numbers (Figure TDI-3, part ii).

Further signs of MDMA making a comeback on the ‘ecstasy’ market

Around 11.5 million Europeans (15–64 years) have tried ‘ecstasy’ in their lifetime, around 2 million in the last year (Chapter 4, Table 6). Today’s data confirm the analysis in last year’s report that MDMA — the best-known member of the ‘ecstasy’ group of drugs — is making a comeback (2). This follows a shortage of MDMA in recent years when tablets sold as ‘ecstasy’ often contained other substances (e.g. mCPP, BZP, mephedrone). The drop-off in the manufacture of MDMA has been linked to successful measures to limit the diversion of PMK, the precursor chemical needed to make it. But manufacturers are now finding alternative chemicals as their starting material for MDMA. While the contents of tablets sold as ‘ecstasy’ remain diverse, powders and tablets containing high doses of MDMA appear to be becoming more common.

Methamphetamine makes further inroads into Europe’s stimulant market

Use of amphetamines (a term encompassing amphetamine and methamphetamine) remains overall lower than that of cocaine in Europe. Around 13 million Europeans (15–64 years) have tried amphetamines in their lifetime, around 2 million in the last year (Chapter 4, Table 5). Latest trend data show last-year use of amphetamines among young adults (15–34 years) to be overall stable or declining (Chapter 4, Figure 7). Of the two drugs, amphetamine is more commonly used. But methamphetamine use, historically low in Europe and mainly limited to the Czech Republic and Slovakia, now appears to be spreading.

Recent EMCDDA Annual reports have pointed to rising availability of methamphetamine and its edging into new territory in the north of Europe, where it has partially been replacing amphetamine as the stimulant drug of choice (Latvia, Sweden, Norway, Finland). In addition, the EMCDDA notes that, in 2010, Germany, Greece, Cyprus, Hungary and Turkey also reported signs of problem methamphetamine use, although estimated at low levels.

Data on seizures published today suggest that production is scaling up and that methamphetamine is making further inroads into Europe’s stimulant market. Between 2005 and 2010, the quantity of methamphetamine seized in Europe (25 EU countries) rose from around 100 kg to around 600 kg (Table SZR-18). Meanwhile, the number of methamphetamine seizures more than tripled in this period from around 2 200 to around 7 300. Countries witnessing marked rises in the number of seizures of this drug between 2009 and 2010 include Germany, Estonia, Latvia and Austria (Table SZR-17).

Further concerns highlighted today relate to the first, albeit sporadic, reports of methamphetamine smoking in Europe and to the availability of ‘crystal meth’. Methamphetamine smoking, to date extremely rare in Europe, is known to be particularly damaging to health. Early in 2013, in response to recent developments, the EMCDDA will launch a ‘trendspotter’ review of this drug which has caused considerable problems outside Europe (e.g. Australia, Japan, New Zealand, USA).

4-MA — new amphetamine-type stimulant now under scrutiny in the wake of deaths

Europe has responded to rising concern over the use of the stimulant drug 4-methylamphetamine (4-MA) by formally requesting an investigation into the health and social risks of the substance (including the involvement of organised crime). The risk-assessment exercise will be carried out in Lisbon this week by the EMCDDA Scientific Committee with experts from the European Commission, Europol and the European Medicines Agency. Currently, the substance is not controlled under drug control legislation in most of the EU Member States (see Joint report)(3).

The exercise is the second stage of a three-step legal procedure through which Europe monitors and acts on new drugs. It was prompted by deaths linked to this substance in Belgium, the Netherlands and the UK (the two latter  control the substance) and reports of seizures in 14 European countries. A risk-assessment report will be submitted to the European Commission and Council of the EU after the meeting, on the basis of which the Council may decide to subject the drug to control measures across the EU.

4-MA belongs to the group of synthetic phenethylamines and is closely related to amphetamine. On the illicit market, it appears to be sold as amphetamine or mixed with it. This suggests that, while there is little evidence of a specific demand for 4-MA, amphetamine users may be at greater risk of exposure to the drug if it becomes more available.

Over 50 new drugs already detected in 2012 — substances more diverse and more obscure

New drugs continue to be reported in the EU at the rate of around one per week. A total of 49 new psychoactive substances were officially notified for the first time in 2011 via the EU early-warning system (EWS)(4). This represents the largest number of substances ever reported in a single year, up from 41 substances reported in 2010 and 24 in 2009. And preliminary data for 2012 show no signs of a decline, with over 50 already detected.

Synthetic cathinones (e.g. mephedrone, MDPV), which can mimic the effects of cocaine, are one of the two largest drug groups monitored by the EWS (the other being synthetic cannabinoids — e.g. found in ‘Spice’ products)(5). Particularly noteworthy in 2011 was the rising number and diversity of substances reported. All new drugs notified last year, and so far those notified in 2012, have been synthetic.

Alongside rising diversity within the more common new drug groups, the EMCDDA reveals that more obscure chemical groups being reported (see Chapter 8, Figure 20 — ‘Other substances’). It also informs that: ‘The number of products containing multiple psychoactive substances appears to be rising’, with seizures and test purchases revealing samples to contain both controlled and uncontrolled substances. One example is the detection of PMMA in products sold as ‘legal highs’. Placed under control in Europe following an EU risk assessment in 2002, this drug carries high risks of overdose and poses a serious threat to users (6). 

To date, says the EMCDDA, data have been scarce on levels of use of these substances, but with countries now carrying out representative surveys including new drugs (e.g. Ireland, Spain, UK), preliminary prevalence data are emerging. Whilst the reported levels of the overall use of these drugs remain relatively low, there is potential for  increased uptake in use amongst certain groups. A 2011 Eurobarometer survey on young people’s attitudes to drugs estimated that, on average, 5 % of the young respondents (15–24 years) reported to have used ‘legal highs’ at some point in their life, although levels varied between countries (7).

Record number of online shops selling ‘legal highs’

Today’s report presents the results of the 2012 EMCDDA snapshot of online retailers of ‘legal highs’ which identified a record 693 online shops purportedly selling psychoactive products to EU countries — up from 170 in January 2010. Although three natural products — kratom, salvia and hallucinogenic mushrooms — lead the Top 10 ‘legal highs’ most frequently offered online, the other seven substances were synthetic (see Chapter 8, Table 10).

The snapshot identified a marked rise in the number of Internet shops offering synthetic cathinones (e.g. MDPV,  4-MEC), suggesting that online operators are seeking a replacement for mephedrone, now controlled in the EU. To date, most new drugs have been targeted at recreational drug users. Yet, in some countries, problem drug users are also using new drugs. Reports from Hungary show opioid users injecting synthetic cathinones (mephedrone, MDPV) in times of heroin shortage.

‘Older-new’ drugs must not be overlooked

As attention focuses on old established drugs or the emergence of new substances, a number of the ‘older-new’ drugs have established themselves on the market and should not be overlooked, warns the EMCDDA. These now include GHB, GBL, ketamine, mephedrone and PMMA (8) for which pockets of high use, or increased availability, are reported. Negative health effects, including dependence among chronic users, have been linked to these drugs, while unexpected problems have surfaced, such as bladder disease in ketamine users. These developments underline the need for countries’ drug information systems to be more sensitive to emerging trends and health problems relating to these substances.

Proactive response: countries devise range of tools to tackle threat of emerging drugs

Across Europe, a variety of measures are being developed to reduce the demand for, and supply of, new drugs (see Chapter 8). The speed at which new psychoactive substances can appear and be distributed challenges countries’ established legislative procedures for drug control (9). The Annual report describes how several countries have responded with ‘innovative changes to their legislation or enforcement policies’ (see Chapter 1). The main trend in many countries appears to be to focus on penalising supply rather than use.     

Ireland (2010), Romania (2011) and Austria (2012) have introduced new criminal laws penalising the unauthorised distribution, sale or advertising of new psychoactive substances. Other countries have modified existing laws to strengthen or speed up drug control procedures. Poland (2010), for example, has modified its drug law to prohibit the distribution of new substances, while Hungary (2010) and Finland (2011) have set up risk-assessment panels to inform decision-making. In 2011 and 2012 respectively, the UK and Hungary enacted new procedures, becoming the latest countries to bring in ‘temporary controls’ on a substance. These controls are introduced pending further consideration of the harms associated with the drug concerned and a decision on permanent sanctions.

Controls on chemical families of substances (generic controls) rather than individual substances have been introduced in a number of countries’ drug laws in recent years. New developments in this area are reported from: Luxembourg (2009, synthetic cannabinoids); Italy (2011, synthetic cannabinoids and cathinones); Cyprus (2011, synthetic cannabinoids, cathinones, phenethylamines), Denmark (2012, synthetic cannabinoids, cathinones, phenethylamines, tryptamines) and France (2012, cathinones).

But drug laws are not the only means used to meet the challenges posed by these new substances. Countries are also turning to their medicines and consumer safety laws, for example, to tackle the issue. Consumer safety regulations requiring that goods on sale are accurately labelled in relation to their expected use have been invoked to confiscate ‘Spice’ products in Italy, and mephedrone labelled as ‘bath salts’ and ‘plant food’ in the UK (before mephedrone was controlled under the country’s drug law).

Looking to the future, the European Commission, supported by the EU Member States, the EMCDDA, Europol and the European Medicines Agency is working on new legislation to better address the emergence of new psychoactive substances in the EU (10).

Commenting further on the report, European Commissioner for Home Affairs Cecilia Malmström, noted: ‘This new analysis from the EMCDDA is particularly welcome as it highlights the drug problems we share across the European Union and informs the work we are currently undertaking to strengthen Europe’s strategic and operational approach to drug trafficking and use. I am particularly struck by the speed of developments we are now seeing in the area of synthetic drugs. I think it is clear to all that strong and coordinated actions are required if we are to respond effectively in this area’.