The stimulants miniguide provides an overview of what to consider when planning or delivering health and social responses to stimulant-related problems and reviews the available interventions and their effectiveness. It also considers implications for policy and practice.

This miniguide is one of a larger set, which together comprise Health and social responses to drug problems: a European guide 2021. The guide supports practitioners and policymakers in tackling the negative consequences of drug use.

Key issues

Cocaine is the most commonly used illicit stimulant in Europe, and in recent years use appears to have been increasing. Among cocaine consumers, a broad distinction can be made between those who snort powder cocaine (cocaine hydrochloride), and may be relatively more socially integrated, and more marginalised groups, where patterns of use are more likely to feature injecting, the smoking of crack cocaine (cocaine base) or the co-use of opioids.

Amphetamine and methamphetamine, two closely related stimulants, are both consumed in Europe, although amphetamine is more commonly used than methamphetamine. Methamphetamine use has historically been restricted to Czechia and, more recently, Slovakia, although increased use has also been noted in a number of other countries. With some data sources it is not possible to distinguish between these two substances, so the generic term amphetamines is used to cover both. The two drugs can be taken orally or nasally, while injection is a common route of administration among marginalised groups in some countries and methamphetamine can be smoked, although this appears to be rare in Europe.

In many countries, use of the stimulant MDMA (historically marketed as ‘ecstasy’) has stabilised in recent years; however, this has been accompanied by higher than average content levels of MDMA in both tablet and powder forms of the drug. In particular, the high doses of MDMA found in some tablets have been linked with harms to health and deaths.