High-risk opioid users: heroin still dominates

In Europe, the most commonly used illicit opioid is heroin, which may be smoked, snorted or injected. A range of synthetic opioids such as methadone, buprenorphine and fentanyl are also misused.

Europe has experienced different waves of heroin addiction, the first affecting many western countries from the mid-1970s and a second wave affecting other countries, especially those in central and eastern Europe, in the mid to late 1990s. In recent years, the existence of an ageing cohort of high-risk opioid users, who are likely to have been in contact with substitution treatment services, has been identified

The average prevalence of high-risk opioid use among adults (15–64) is estimated at 0.4 % of the EU population, the equivalent of 1.3 million high-risk opioid users in Europe in 2015. At national level, prevalence estimates of high-risk opioid use range from less than 1 to more than 8 cases per 1 000 population aged 15–64. Five countries account for three quarters (76 %) of the estimated high-risk opioid users in the European Union (Germany, Spain, France, Italy, United Kingdom). Of the 10 countries with multiple estimates of high-risk opioid use between 2007 and 2015, Spain shows a statistically significant decrease.

National estimates of annual prevalence rate of high-risk opioid use: selected trends and most recent data (Cases per 1 000 population)


In 2015, 191 000 clients who entered specialised treatment in Europe reported opioids as their primary drug, 37 000 of whom were first-time entrants. Primary heroin users accounted for 79 % of first-time primary opioid users entering treatment.