Europe’s drugs problem 'increasingly complex'
28 May 2014 03:36 PM
Europe’s drugs
problem is becoming increasingly complex with new challenges emerging that
raise concerns for public health, according to the European Drug Report 2014:
Trends and developments released this week.
In its annual review of the
drugs problem, the agency again describes an overall stable situation, with
some positive signs in relation to the more established drugs. But this is
counter-balanced by new threats posed by synthetic drugs, including stimulants,
new psychoactive substances and medicinal products, all of which are becoming
more prominent in a changing European drug market.
European Commissioner
for Home Affairs Cecilia Malmström says: ‘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. The system has already reviewed this year four new substances
linked to acute intoxications and deaths in the Member
States’.
Commissioner
Malmström adds: ‘Europe’s law-enforcement bodies are
increasingly faced with the fact that small, easily transported packages of
seemingly innocuous powders can contain many thousands of individual doses.
This annual analysis from the EMCDDA provides us with a critically important
window on Europe’s evolving drugs problem. But this information must now
feed into law-enforcement, prevention and treatment. It is essential that we
use these data to ensure that the response by European authorities keeps pace
with the evolving challenges we face’.
EMCDDA Director Wolfgang
Götz says: ‘Looking at the big picture, 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’.
Recognising this complexity, the
report provides a top-level overview of the long-term drug-related trends and
developments at European level, while also homing in on emerging problems in
some countries.
Heroin in decline, but
replacement substances cause concern
Although global heroin
production remains high and quantities seized
in Turkey are rising (Figures 1.4; 1.5), latest data
on the demand for treatment and on seizures in Europe point to a downward trend
in the use and availability of this drug. The number of reported first-time
entrants to specialist drug treatment for heroin problems fell from a peak of
59 000 in 2007 to 31 000 in 2012. Data on drug supply show that the quantity of
heroin seized in 2012 (5 tonnes) was the lowest reported in the last decade,
half the amount seized in 2002 (10 tonnes). The number of heroin seizures also
fell from some 50 000 in 2010 to 32 000 in 2012.
There are an estimated 1.3
million problem opioid users in Europe, mostly heroin users. The report raises
concerns over heroin being replaced by other substances, such as synthetic
opioids. Illicitly produced or diverted from medical sources, these include
highly potent fentanyls and substances used in opioid substitution treatment
(OST) (e.g. methadone, buprenorphine). In 2012, 17 countries reported that over
10% of first-time opioid clients entering specialist treatment were misusing
opioids other than heroin (Figure 2.9).
Drug-related deaths: overall
reduction, but rises in some countries
Drug use is one of the major
causes of mortality among young people in Europe, both directly through
overdose (drug-induced deaths) and indirectly through drug-related diseases,
accidents, violence and suicide. Overall, around 6 100 overdose deaths, mainly
related to opioids, were reported in Europe in 2012. This compares to 6 500
reported in 2011 and 7 100 cases in 2009. Progress made in this area may be
partly attributed to the scaling up of treatment and harm reduction (e.g. OST).
Nevertheless, in contrast to an overall encouraging European trend, overdose
deaths remain high, or are increasing, in some countries.
The average mortality rate due
to overdoses in Europe is estimated at 17 deaths per million population
(15–64 years), but with wide national variations. Rates of over 50 deaths
per million were reported in five countries, with the highest rates reported
in Estonia (191 per million)
and Norway (76 per million), followed
by Ireland (70 per
million), Sweden (63 per million)
and Finland (58 per million) (Figure 2.13)
(2).
While heroin is still involved
in many fatal overdoses, deaths relating to this drug are generally falling and
those linked to synthetic opioids are on the rise in some countries. Overdose
deaths rose sharply (by 38%) in Estonia in 2012,
with fentanyl and its derivatives present in most cases. Non-controlled
fentanyl derivatives and a range of other potent synthetic opioids (e.g.
AH-7921) have been increasingly reported on the illicit market through
the EU Early Warning System
(EU–EWS).
HIV: outbreaks in some countries
impact negatively on EU trend
Over the last decade, large
gains have been made within the EU in addressing HIV infection among people who
inject drugs — these include a greater coverage of prevention, treatment
and harm-reduction measures. Latest findings show, however, that developments
in some countries, are impacting negatively on the long-term decline in the
number of new HIV diagnoses in Europe. ‘Outbreaks of HIV among drug users
in Greece and Romania,
together with ongoing problems in some Baltic countries,
have stalled Europe’s progress in reducing the number of new drug-related
HIV infections’, states the report.
The average rate of newly
reported HIV diagnoses attributed to injecting drug use was 3.1 per million
population in 2012. InEstonia, the rate of new diagnoses
remains high (53.7 cases per million in 2012), while
in Latvia, annual rates have been rising since 2009 (up
from 34.5 cases per million in 2009 to 46.0 in 2012). There were 1 788 newly
reported HIV cases in 2012, slightly more than in 2011 (1 732), continuing the
upward trend observed since 2010 (Figure 2.11). Whereas in
2010, Greece and Romania c
ontributed just over 2% of the total number of newly reported diagnoses among
those infected through injecting drug use in the EU, by 2012 this figure had
increased to around 37% (with Greece reporting a
rate of 42.9 cases per million population
and Romania 8.0 cases).
Despite Europe’s success
in fighting HIV transmission among drug users, the virus retains the potential
to spread rapidly in certain groups. A
2013 EMCDDA–ECDC risk-assessment exercise to
examine countries vulnerable to new HIV outbreaks revealed that one or more
risk indicators were present in around one-third of the 30 countries examined
(3). This suggests a need for continued vigilance and better coverage of HIV
prevention measures (Figure 3.5).
Stimulants: cocaine stable or
declining, but concerns around methamphetamine and MDMA
Cocaine remains the most
commonly used illicit stimulant drug in Europe, although most users are found
in a small number of western EU countries. An estimated 14.1 million European
adults (15–64 years) have ever used the drug; 3.1 million in the last
year (see ‘At a glance’ table). Recent data suggest declining use
of cocaine, with 11 out of 12 countries running surveys between 2011 and 2013
reporting falls in prevalence among young adults (15–34 years). Looking
at long-term trends in cocaine use, decreases were seen
in Denmark, Spain and
the UK (all reporting relatively high prevalence
rates), following a peak in 2008 (Figure 2.5). Most other countries show stable
or declining trends.
Use of amphetamines
(encompassing amphetamine and methamphetamine) remains overall lower than that
of cocaine in Europe, with around 11.4 million adults reporting lifetime use
and 1.5 million last-year use. Of the two drugs, amphetamine is more commonly
used, but there are growing concerns around the availability and use of
methamphetamine in Europe. Yesterday’s report describes how
methamphetamine seizures, while still small in number and quantity, have
increased over the last decade, suggesting increased availability of the drug
(Figure 1.10). In 2012, 7 000 seizures amounting to 343 kg were reported in the
EU. A further 4 000 seizures, amounting to 637 kg, were reported
by Turkey and Norway (almo
st twice the amount seized in the entire EU).
Methamphetamine use,
historically low in Europe and mainly limited to the Czech
Republic and Slovakia, now appears to be
spreading (e.g. in Germany). Worrying reports are
emerging from south-east Europe
(Greece, Cyprus, Turkey) that crystal methamphetamine smoking is a limited, but emerging, problem,
with the possibility of a spread among vulnerable populations. And
methamphetamine injecting has been reported as a new trend among small groups
of men who have sex with men in some large European cities
(4).
Also highlighted are concerns
over the re-emergence of high-quality ecstasy (MDMA) powders and pills.
Seizures and reports of adverse health events have
prompted Europol and
the EMCDDA to release a joint warning on the
availability of high-potency products containing MDMA
(5). Europol reports the dismantling
in Belgium in 2013 of the two largest drug
production sites ever found in the EU, capable of rapidly
producing large volumes of MDMA.
New psychoactive substances: EU
Early Warning System ‘under increasing pressure’
The rise in the number, type and
availability of new psychoactive substances (NPS or ‘new drugs’) in
Europe shows no signs of abating, says the EMCDDA. In
2013, 81 new drugs were notified for the first time to the EU
Early Warning System (EU–EWS) (6). This brings the number
of new substances monitored by the agency to over 350. According to
yesterday’s report, the system is ‘coming under increasing pressure
from the volume and variety of new drugs appearing on the market’. Almost
250 substances were detected in the last four years.
New psychoactive substances, not
controlled under international law, are often sold on the market as
‘legal highs’ and produced with the intention of mimicking the
effects of controlled drugs. Twenty-nine of the drugs detected last year were
synthetic cannabinoids, the largest group currently monitored by
the EU–EWS. The speed at which recently controlled
drugs have been replaced by new substances has prompted a variety of innovative
legal responses across Europe (Chapter 4).
New drugs may be produced in
clandestine laboratories inside Europe. More commonly, however, they are
sourced legally as powders mostly
from China and India, and
imported into Europe where they are processed, packaged and sold as
‘legal high’ products or ‘research chemicals’, as well
as sold directly on the illicit drug market. The Internet continues to play a
key role in shaping the NPS market. In 2013,
the EMCDDA identified some 650 websites selling
these substances to Europeans. In addition, purchasing new and
‘old’ drugs via ‘darknets’ — underground, online
networks permitting anonymous communication — represents a new challenge
for law enforcement.
Highlighted yesterday were signs
that, in some countries, these substances are now targeting the main segments
of the drug market. In April 2014, the EMCDDA Scientific
Committee risk-assessed four potent and harmful new substances:
25I-NBOMe, AH-7921, MDPV and methoxetamine. These are being sold as
replacements for, and could even be more harmful than, the drugs they aim to
mimic, respectively: LSD (hallucinogen), morphine (opiate), cocaine (stimulant)
and ketamine (a medicine with analgesic and anaesthetic properties).
Risk-assessment reports on the four substances have been submitted to
the European Commission and the Council
of the EU, on the basis of which decisions for EU-wide control
measures may be taken.
The emergence of highly potent
synthetic substances is a concern flagged by notifications to
the EU–EWS. This has implications for both users
and law enforcement — such substances can be toxic at very low doses and
even small quantities of these drugs can be used to make many individual
doses.
Cannabis: controversies,
contrasts, contradictions
Attitudinal surveys from the EU
(7) suggest that cannabis is still the drug that polarises public opinion the
most. This contributes to a lively public debate, which has recently been
fuelled by international developments in how cannabis availability and use are
controlled (e.g. regulatory changes in some states of the US and in parts
of Latin America). European discussions on cannabis
control have tended to focus on targeting drug supply and trafficking rather
than on personal use. However, the overall number of possession and use
offences related to cannabis has been rising steadily for nearly a decade
(Figure 4.1).
Around 73.6 million Europeans
have tried cannabis in their lifetime, 18.1 million in the last year. An
estimated 14.6 million young Europeans (15–34 years), report last-year
use. Cannabis use in Europe appears overall to be stable or declining,
especially in young age groups. National trends appear more divergent, however,
as shown by the fact that of the countries reporting new surveys since 2011,
eight reported decreases and five reported increases in last year prevalence
(15–34 years) (Figure 2.1).
Public health concerns are
greatest for Europeans who use the drug on a daily, or almost daily, basis
(around 1% of European adults, 15–64 years). In 2012, cannabis was the
drug most frequently reported as the main reason for entering drug treatment by
first-time clients. ‘The lack of systematic monitoring in the area of
drug-related health emergencies represents a blind spot in Europe’s
surveillance of emerging health threats’, says
the EMCDDA. From the limited data available,
cannabis-related medical emergencies appear to be a growing problem in some
high-prevalence countries.
EMCDDA Director Wolfgang
Götz concludes: ‘I am proud of the insights provided
by this report into both established problems and emerging threats. Sound
information is at the heart of Europe’s response to drug problems and our
interventions are all the more effective because of this. Over 15 years ago,
great vision was shown by the EU institutions and Member States in investing in
an EU Early Warning System on new psychoactive substances that is now globally
respected. I believe that the system — which has repeatedly demonstrated
its value for sharing information and rapidly responding to threats — can
be strengthened further. I am deeply concerned, however, that this mechanism is
under increasing strain and may be at risk if inadequately
resourced’.
Notes
(1) The European Drug
Report 2014: Trends and developments (available in 23 languages)
and Perspectives on drugs(PODs) (English) can be found here . Data presented in the
report relate to 2012 or the last year available. Figures cited in this news
release appear in the report itself. Additional figures and tables may be found
in the European Drug Report: Data
and statistics .
(2) Due to differences in reporting practices and methodology, caution is
needed when comparing countries.
(3) Eurosurveillance, Volume 18, Issue 48, 28 November 2013
(4) Exploring methamphetamine trends in Europe
(5) Dangerous synthetic drugs hit the EU market
(6) EMCDDA–Europol 2012 Annual Report on the implementation of Council
Decision 2005/387/JHA (New drugs in Europe, 2012)
(7) Youth attitudes on drugs