This year’s analysis once more highlights how Europe increasingly faces a more complex drug problem, in which stimulants, new psychoactive substances, misused medicines and problematic cannabis use all play a greater part. The report also reminds us that some of the problems of the past remain with us — even if the challenges they are now presenting for both policy and practice are changing. Europe’s opioids problem remains a central issue in the 2016 analysis, reflecting the significant impact these drugs still have on mortality and morbidity. We see now an increasingly complex relationship between use of heroin and synthetic opioids, accompanied by a worrying increase in overall estimates of opioid-related deaths. Treatment services in Europe are also now having to respond to the more complex health needs presented by an ageing cohort of heroin users, and policymakers wrestle with the difficult question of what constitutes the most appropriate long-term therapeutic goals for this group. At the same time, new heroin epidemics reported in other parts of the world remind us this is an area in which vigilance is required and ongoing surveillance remains essential.