Europe’s drugs problem is in a ‘state of flux’, with new threats emerging that challenge current models of policy and practice. This is according to the European Drug Report 2013: Trends and developments, published today by the EU drugs agency (EMCDDA) in Lisbon (1).  In its annual review, the agency describes positive developments in relation to the more established drugs, such as fewer new users of heroin, less injecting and declining use of cannabis and cocaine in some countries. But these are offset by concerns over synthetic stimulants and new psychoactive substances, offered both on the illicit, and so-called ‘legal highs’, market.

Also highlighted in today’s report is a drug market that is ‘more fluid and dynamic’ and ‘less structured around plant-based substances shipped over long distances to consumer markets in Europe’. Here globalisation             and information technology are important drivers of change, with the Internet creating new connections in drug use and supply.

European Commissioner for Home Affairs Cecilia Malmström says: ‘I am both encouraged and concerned by the findings in the EMCDDA’s European Drug Report 2013. I am encouraged by the fact that, thanks to robust drug policies and record levels of treatment, use of heroin, cocaine and cannabis appears to be waning in some countries and drug-related HIV continues to decline. But I am also concerned that a quarter of European adults — or 85 million people — have used an illicit drug and that, by historical standards, drug use in Europe remains high. Emerging challenges add to my concerns — we are faced with an ever more complex stimulant market and a relentless supply of new drugs which are increasingly diverse. The fact that over 70 new drugs have been detected in the last year is proof in itself that drug policies need to adapt to changing drug markets’.

‘Signs that current policies have found traction in some important areas must be viewed in the light of a drugs problem that never stands still’, says EMCDDA Director Wolfgang Götz. ‘We will need to continue to adjust our current practices if they are to remain relevant to emerging trends and patterns of use in both new drugs and old. The new EU drugs strategy 2013–20 will need to address a drugs problem in a state of flux and a dynamic and rapidly-evolving drugs market. I believe that this report provides a valuable resource for responding to the challenges that lie ahead’.

The main findings of the report in relation to different substances are set out below.

Cannabis: a robust and diverse market, concerns over high-risk use, rising demand for treatment

An estimated 77 million European adults (15–64 years) have tried cannabis in their lifetime; around 20 million reporting to have used it in the last year. Despite national differences, recent survey data suggest overall stable or decreasing trends in use (Figure 2.2). Nevertheless, today’s report notes that cannabis use remains high by historical standards and that a ‘large and relatively robust market’ exists for this substance, with a greater diversity of cannabis products available.

Latest data show how herbal cannabis (‘marijuana’), sometimes of high potency, is becoming more common in Europe, with almost all of the EMCDDA countries now reporting some domestic cultivation of this product.     Over the past 10 years, the number of seizures of herbal cannabis in Europe has overtaken that of resin and now represents more than half of all cannabis seizures (Figure 1.3). And in 2011, herbal cannabis accounted for 41% of all drug seizures in Europe, while cannabis resin accounted for 36% (Figure 1.1). 

Trends in cannabis consumption need to be viewed alongside different patterns of use, says the EMCDDA, with public health concerns greatest for the estimated 3 million Europeans (15–64 years) who use the drug on a daily, or almost daily, basis (around 1% of European adults). Europe has seen the numbers of clients entering treatment for the first time for cannabis problems rise by around one third in recent years, from an estimated 45 000 reported in 2006 to 60 000 in 2011, making cannabis now the most frequently mentioned drug among first-time clients. A new analysis released today (see ‘Perspectives on drugs’/POD) looks at the characteristics of frequent and high-risk cannabis users and reflects on how examination of this group can help design adequate responses for those most at risk.

Heroin — evidence of declining use and supply

Today’s report describes how latest data on demand for treatment and on seizures point to a downward trend in the use and availability of heroin. Across Europe, the number of those entering specialist drug treatment for the first time for heroin problems fell from a peak of 59 000 in 2007 to 41 000 in 2011, with reductions most apparent in western European countries. Understanding heroin use trends is a priority due to the public health impact of this drug. A new analysis of long-term trends in heroin use is released today (see POD) and confirms a decrease in first-time demand for treatment for heroin use over the last decade.

Data from treatment clients also continue to show a decline in injecting the drug. The EMCDDA reports that between 2006 and 2011, there was an ‘overall decrease in the proportion of injectors among heroin clients entering drug treatment for the first time’. Along with the impact of interventions (e.g. substitution treatment) this fall in injecting is likely to have contributed to the decline in new drug-related HIV infections in Europe. But recent HIV outbreaks in Greece and Romania have interrupted this positive trend, underlining the need to provide adequate harm-reduction and treatment services (Figure 2.10).

Latest figures on seizures reveal that the quantity of heroin seized in the EU and Norway in 2011 (6.1 tonnes) was the lowest reported in the last decade and equivalent to about half the quantity seized in 2001 (12 tonnes). (Substantial declines in quantities seized are reported by Turkey — Figure 1.5). The number of seizures reported in this period also fell, from 63 000 in 2001 to an estimated 40 500 in 2011.

Cocaine — use and seizures down, trafficking routes diversifying

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 14.5 million Europeans (15–64 years) have tried cocaine in their lifetime; around 3.5 million reporting to have used it in the last year. But today’s report shows that, overall, cocaine use and supply are now both trending downwards.

While some countries still report rises in estimated cocaine consumption, recent surveys show signs of falling use among young adults (15–34 years) in the five highest-prevalence countries (Denmark, Ireland, Spain, Italy and UK) (Figure 2.4). And fewer drug users are seeking treatment for cocaine problems. The number of clients reported to be entering treatment for primary cocaine use for the first time fell from 37 000 in 2009 to 31 000 in 2011. Yet acute and chronic problems related to cocaine use continue to be reported. Emergency health consequences of cocaine use come under the spotlight in a new EMCDDA analysis today (see POD), which explores the potential of using hospital emergency data to monitor acute problems linked to the drug. At least  475 deaths related to cocaine were recorded in 2011, although this may be an underestimate.

On the supply side, dramatic decreases are reported in the quantity of cocaine seized (Figure 1.7). In 2011, 62 tonnes of the drug were intercepted, an almost 50% drop from the 120 tonnes of cocaine seized in the peak year 2006. The number of cocaine seizures has also fallen from a peak of 100 000 in 2008 to 86 000 in 2011 (Figure 1.7). The drop in the volume seized has been particularly noticeable in the Iberian Peninsula where the total quantity of cocaine intercepted by Spain and Portugal fell from 84 tonnes in 2006 to 20 tonnes in 2011.   But recent signs of diversification of cocaine trafficking routes into Europe — including large individual seizures in ports in Bulgaria, Greece, Romania and the Baltic countries — raise concerns over further diffusion of use.

Synthetic stimulants — growing importance, new challenges

According to today’s report: ‘Understanding overall trends in the use of synthetic stimulant drugs is complicated by the fact that they are often substituted for each other, as consumers make choices influenced by availability, price and perceived quality’. Amphetamines and ecstasy remain the most commonly used synthetic stimulants in Europe, competing to some extent with cocaine.

Around 12.7 million Europeans (15–64 years) are estimated to have tried amphetamines in their lifetime (a term encompassing amphetamine and methamphetamine), around 2 million reporting to have used them in the last year. Recent data show use of amphetamines to be stable or declining among young adults (Figure 2.5). Of the two drugs, amphetamine has been more common in Europe, but there are now signs of rising availability and use of methamphetamine.

Methamphetamine seizures, although still small both in number and quantity, rose between 2002 and 2011, suggesting increased availability of the drug (Figure 1.11). (Amphetamine seizures in 2011 returned to levels found in 2002 — Figure 1.10). And methamphetamine use, historically low in Europe and mainly limited to the Czech Republic and Slovakia, now appears to be spreading, with indications of problem use noted in Germany, Greece, Cyprus and Turkey.

An estimated 11.4 million Europeans (15–64 years) have tried ‘ecstasy’ (MDMA) in their lifetime, around 2 million reporting to have used it in the last year. In recent years, the popularity of this drug appears to have declined, probably reflecting the poor ‘quality’ (purity or MDMA content) of tablets sold as ‘ecstasy’. This appears now to be changing, with some evidence that greater MDMA availability is encouraging renewed interest in this drug.

Synthetic drug production is examined today in a new EMCDDA analysis (see POD). This looks at the main producing areas in Europe, the precursors and pre-precursors used to make synthetic drugs and current trends in production. The POD shows that ‘the most serious challenge now facing law enforcement in amphetamine and methamphetamine manufacturing countries’ relates to the chemical alpha-phenylacetoacetonitrile (APAAN), a precursor of BMK (the chemical precursor used to make amphetamine and methamphetamine). Since 2009, a large number of APAAN shipments totalling dozens of tonnes have been seized or stopped in Europe. This chemical is now placed on the European Commission’s voluntary monitoring list as a substance known to be used to manufacture synthetic drugs, but is not placed under international control. 

New drugs — a fast moving market, substances more diverse, concerns over ‘synthetic cannabis’

In 2012, 73 new psychoactive substances were officially notified for the first time via the EU Early warning system (EWS) (Figure 1.14). Of these substances, 30 were synthetic cannabinoids, which mimic the effects of cannabis. ‘These products, which can be extremely potent, have now been reported in virtually all European countries’, says the report. A new EMCDDA analysis out today (see POD), provides an update on the current knowledge on these substances, which now represent the largest group of compounds monitored by the EWS. The POD explores new trends in this area including: the emergence of resinous products containing these substances; the presence of these chemicals in samples of herbal cannabis; and their detection in mixtures containing other, unrelated chemicals (e.g. tryptamines, synthetic cathinones).

Of the other compounds detected in 2012, 19 substances were from ‘less known or more obscure chemical groups’. Also of note were the 14 new substituted phenethylamines (the chemical group that includes amphetamine and 'ecstasy'), the highest number reported since 2005. A full annual review of the work of the EU Early warning system on new drugs — released today by the EMCDDA and Europol (see news release 5/2013) — shows that there is no sign of a slowing down in the number of new drugs being reported in Europe. The agencies stress, however, that monitoring new drugs is not only about ‘counting numbers’, but also about informing on the harms they can cause and ensuring that prompt action is taken to protect public health when required.