The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published European drug report 2014: trends and developments on 27 May.1 The report summarises the latest trends across the 28 EU member states, and Norway and Turkey.  Accompanying the report is a series of online interactive Perspectives on Drugs (PODs) providing deeper insights into important issues. The Health Research Board (HRB) provides the Irish figures for the EMCDDA report. 

The EMCDDA reports an overall stable situation and decreases in the use of the more established drugs.  In the case of synthetic drugs, including stimulants, new psychoactive substances and medicinal products, the situation is becoming increasing complex as these drugs become more prominent in drug markets in Europe.   Both the quantity of heroin and the number of seizures have fallen considerably in recent years and the numbers entering treatment for heroin use continues to decline. There are an estimated 1.3 million problem opioid users in Europe and increasing numbers of those entering treatment for the first time are using synthetic opioids.  Opioids were implicated in most of the 6,100 overdose deaths in Europe in 2012.   There are wide national variations in both the number of overdose deaths and the proportion of deaths attributable to synthetic opioids. 

Commenting on the report, European Commissioner for Home Affairs Cecilia Malmström said:  ‘This annual analysis from the EMCDDA provides us with a critically important window on Europe’s evolving drugs problem. I am deeply concerned that the drugs consumed in Europe today may be even more damaging to users' health than in the past. There are signs that the ecstasy and cannabis sold on the street are getting stronger. I also note that the EU Early Warning System, our first line of defence against emerging drugs, is coming under growing pressure as the number and diversity of substances continue to rise sharply.’ 

EMCDDA Director Wolfgang Götz added: ‘We see that progress has been made in Europe on some of the major health policy objectives of the past. But the European perspective can obscure some important national differences. Our latest data show how encouraging overall EU trends on overdose deaths and drug-related HIV infections, for example, sit in sharp contrast to worrying developments in a few Member States.’ 

Cannabis

• The EMCDDA estimates that around 14.6 million young Europeans (aged 15–34), used cannabis in the last year, 8.5 million of these aged 15–24 (13.9% of this age group).
• The use of cannabis in Europe has stabilised or is declining, especially among younger age groups. The situation does vary between countries.       Of the 13 countries that have conducted new surveys since 2011, five reported an increase in last-year prevalence among young people (aged 15–34) and eight reported a decrease.
• Around 1% of European adults (aged 18–64) use cannabis on a daily, or almost daily, basis. In 2012 clients entering drug treatment for the first time identified cannabis as their main problem drug more frequently than any other drug.
• In Europe more than three-quarters of reported drug offences involve cannabis.       While the focus has been on controlling the supply and trafficking of cannabis rather than on personal use, the numbers of reported possession and use offences have increased steadily over the past decade.
• Public opinion surveys in Europe show that attitudes are polarised around the legal status of cannabis. Regulatory changes in some states in the US and in some Latin American countries have contributed to this debate. 

Opioids (mainly heroin)

• The average prevalence of problem opioid use among adults (aged 15–64) in 2012 is estimated at around 0.4%. This is the equivalent of 1.3 million problem opioid users in Europe.
• In Europe 46% (180,000) of all clients who entered treatment in 2012 were users of opioids (mainly heroin).
• The number entering specialist drug treatment for the first time for heroin use fell from a peak of 59,000 in 2007 to 31,000 in 2012, accounting for 26% of all clients entering treatment for the first time.
• In 17 European countries more than 10% of first-time opioid clients entering specialised treatment in 2012 were misusing opioids other than heroin, including methadone, buprenorphine and fentanyl. In some countries, these drugs now represent the most common form of opioid use.
• The number of opioid users for whom injecting is the main route of administration has fallen since 2006. Of the opioid clients entering treatment in 2012, 38% reported injecting the drug.
• Injecting continues to play a major role in the transmission of blood-borne infectious diseases such as hepatitis C and, in some countries, HIV/AIDS. There were 1,788 newly reported HIV diagnoses attributed to injecting drug use in 2012, slightly more than in 2011 (1,732), continuing the upward trend observed since 2010. Across the 18 countries for which data are available for the period 2011–12, injecting drug use accounts for an average of 64% of all hepatitis C virus (HCV) diagnoses and 50% of the acute diagnoses notified (where the risk category is known).
• Drug use is one of the major causes of mortality among young people in Europe. Heroin or other opioids are present in the majority of reported fatal overdoses. Most countries reported an upward trend in the number of overdose deaths from 2003 up to 2008/09, when overall levels first stabilised and then began to decline. Overall, around 6,100 overdose deaths were reported in 2012. This is similar to the number reported in 2011, which represented a decrease from the 6,400 cases in 2010 and 7,100 in 2009. Typically, those dying of drug overdoses are in their mid-thirties or older, and their average age at death is rising, suggesting an ageing cohort of problem opioid users.
• The quantity of heroin seized in 2012 (5 tonnes) was the lowest reported in the last decade, and equivalent to only half of the quantity seized in 2002 (10 tonnes). Declining seizures in the EU have been accompanied by increasing seizures in Turkey where, each year since 2006, more heroin has been seized than in all EU countries combined. 

Cocaine

• Cocaine is the most commonly used illicit stimulant drug in Europe, although most users are found in a small number of countries. It is estimated that about 2.2 million young adults aged 15–34 (1.7% of this age group) used cocaine in the last year.
• Denmark, Spain and the United Kingdom, countries which have had highest prevalence rates for cocaine use among young adults over the past few years, reported a peak in use in 2008 and a steady decline since then. Recent data from 11 of the 12 countries reporting on surveys between 2011 and 2013 show a fall in prevalence.
• Cocaine was the main problem drug for 55,000 (14%) clients entering specialised drug treatment in 2012. The number of clients entering treatment for the first time who cited cocaine as their primary drug has been decreasing in recent years, from a peak of 38,000 in 2008 to 26,000 (18% of all first-time entrants to treatment) in 2012.
• Across the 19 countries reporting data, at least 500 deaths related to cocaine use were recorded in 2012. This is a slight increase from 2011 when there were 475 deaths recorded.
• In 2012, around 75,000 seizures of cocaine were reported in the European Union. There has been a continuous decline in the number of such seizures since 2008, when 95,000 were reported. The quantity of cocaine seized has also declined, from a peak of 120 tonnes in 2006 to 71 tonnes in 2012. 

Other stimulants and new psychoactive substances

• Data on new psychoactive substances (NPS) are based on notifications by member states to the EU Early Warning System (EWS). During 2013 the EWS identified 81 NPSs, 29 of which were synthetic cannabinoids, 13 were new substituted phenethylamines, seven were synthetic cathinones, one was a tryptamine and one a piperazine, and 30 were compounds which did not conform to the readily recognised chemical groups (including plants and medicines).
• Since 2005 the EWS has identified more than 50 substituted cathinones, the best known example of which is mephedrone, controlled in Europe since 2010 and becoming increasingly important in the stimulants market in some countries.       Cathinones are generally snorted but there is evidence of increased rates of injecting among high-risk users in some countries.
• Around 1.5 million Europeans used amphetamines during the last year.  There appears to be some geographical spread in the use of methamphetamines beyond the Czech Republic and Slovakia, but use remains low.
• Ecstasy refers to the synthetic substance MDMA. The quantity of ecstasy tablets seized in Europe has been increasing slowly since 2009 after a steady decline over the previous seven years. Ecstasy producers have reportedly responded to strengthened controls and the targeted seizure of PMK, the main precursor chemical for the manufacture of MDMA, by using non-controlled substances and converting them into the precursor chemicals necessary for MDMA production.

EMCDDA Perspectives on Drugs

Along with its European drug report 2014 the EMCDDA provides additions to its Perspectives on drugs (PODs) series, published online.2 These PODs provide reviews of key aspects of the European drug situation. The new PODs explore:  

• Emerging concerns relating to stimulant use, with a focus on cathinones detected in the last few years and trends in injecting of these drugs;

• New developments in Europe’s cannabis market, with particular interest in the increasing dominance of domestically-cultivated herbal products and the rise in potency of both herbal and resin forms of the drugs;

• Internet-based treatment, noting the developments in this area over the past 10 years and the integration of tested psychosocial techniques into new web-based delivery systems;

• Medications to treat cocaine dependence, which reports on a study of a number of reviews. The study concludes that psychosocial interventions remain the mainstay of treatment for problem cocaine use.

1. European Monitoring Centre for Drugs and Drug Addiction (2014) European drug report 2014: trends and developments. Luxembourg: Publications Office of the European Union. www.drugsandalcohol.ie/21957

2. The PODs and national data and statistics are also available at www.emcdda.europa.eu/edr2014