On 7 June 2018, the EMCDDA has published the European Drug Report 2018:Trends and Developments. The report presents a top-level overview of the drug phenomenon in Europe, covering drug supply, use and public health problems as well as drug policy and responses.
The European Drug Report 2018: Trends and Developments provides a timely insight into Europe’s drug problems and responses. It is designed to equip the stakeholders with a comprehensive overview. It will also provide an early warning of new drug trends, help identify priorities for national and local strategic planning, enable comparisons between countries and support evaluations through the provision of data on trends.
Full Report is available here.
On the EMCDDA official page you can also access top-level overviews of the drug situation by country in all EMCDDA reporting countries, covering drug supply, use and public health problems as well as drug policy and responses.
Signs of increased drug production in Europe
Developments in European countries are both influenced by and impact on global drug trends. For some synthetic stimulant drugs like MDMA, Europe is a major producer, exporting products and expertise to other parts of the world.
For cannabis, European production has to some extent displaced importation and appears to have impacted on the business models of external producers. One consequence of this can be seen in the increased potency of the cannabis resin now being trafficked into Europe.
For cocaine and heroin, the two other major plant-based illicit drugs, production remains centred in Latin American and Asian countries, respectively. Global data suggests that for both substances production has been increasing.
How this impacts on Europe merits scrutiny. In the case of heroin, despite the relatively high purity of the drug at street level, overall use remains stable with rates of initiation into use appearing to be low. For cocaine, in contrast, several indicators are now trending upwards. For heroin, a new development is that laboratories converting morphine to heroin have been detected and dismantled in several European countries. The driver of this is likely to be the greater availability and considerably lower cost in Europe of acetic anhydride, a key precursor chemical for heroin production, at a time when opium poppy harvests are increasing.
Similarly, while European and international efforts to restrict the production and availability of new psychoactive substances appear to be now having some impact, there have also been reports of the tableting and manufacture of these substances within European borders.
Internet sales: Europe in a global market
The sale of drugs on the internet represents another good example of how change can occur rapidly, posing challenges for existing policy and response models and for drug monitoring. A recent joint EMCDDA-Europol report analysed the role European suppliers and consumers play in this global market. EU suppliers were estimated to be responsible for nearly half of ‘darknet’ drug sales between 2011 and 2015. Online sales are currently small in relation to the overall illicit drug market, but they appear to be growing. While attention is often focused on the darknet, it is also apparent that for new psychoactive substances and misused medicines, social media and the surface web may be equally important. Of particular concern here is the emergence of new benzodiazepine-related substances.
Since 2015, 14 new benzodiazepines have been reported to the EU Early Warning System. These substances are not licensed medicines in the European Union, and very little is known about their toxicology; however, risks are likely to increase when they are used alongside illicit drugs or alcohol. The availability of both established and new benzodiazepines on the illicit drugs market appears to be increasing in some countries, and these substances are known to play an important but often overlooked role in opioid overdose deaths. Recent signs that use of these substances might be growing among young people are particularly worrying, and this is an area requiring further investigation, policy consideration and prevention efforts.
The use of benzodiazepines among high-risk drug users is a topic explored in an online supplement to this report.
The consequences of increased cocaine supply
Rising cocaine production in Latin America now appears to be making itself felt on the European market. In some countries, wastewater analysis has provided an early warning of increased availability and use of the drug, which are now also reflected in other data sources. While cocaine prices have remained stable, drug purity is currently at the highest level for over a decade in Europe. Historically, most cocaine entering Europe has come through the Iberian peninsula. Recent large seizures elsewhere suggest the relative importance of this route may have declined slightly, with cocaine increasingly also now trafficked into Europe through large container ports. It is noteworthy in this respect that, in 2016, Belgium surpassed Spain as the country with the largest volume of cocaine seized.
Overall, the public health implications of cocaine use are difficult to measure, as its role in both acute problems and long-term health harms is difficult to monitor and may often go unrecognised. Problems can be expected to increase, however, if prevalence of use, and particularly high-risk patterns of use, increases. One of the signs that this may be happening is an increase observed in the number of first-time admissions to specialised treatment related to cocaine, although these have not returned to the high levels last seen a decade ago. Troublingly, while still rare, there is also some increase in reported crack cocaine use, and concerns exist that this may be beginning to affect more countries. Overall there still remains a need to better understand what constitutes effective treatment for cocaine users, including how best to respond to cocaine problems that may coexist with opioid dependence.
New psychoactive substances continue to challenge public health
The importance of being prepared for new challenges is highlighted by the success of the EU Early Warning System for new psychoactive substances. This system has been internationally recognised as providing Europe with a capacity to identify and respond to the emergence of drugs that has been lacking elsewhere. Enhanced EU legislation in this area has been recently adopted, increasing the speed of reporting, while new information providers continue to join the system. New psychoactive substances present an evolving challenge to drug policy. Overall, some 670 substances are monitored by the system, with the presence of around 400 of these being reported each year. The list of substances appearing on the drug market continues to grow, with about one additional new psychoactive substance being reported every week in Europe. Although the number of new substances making their debut is down from the peak reached in 2015, the negative public health implications of the use of these drugs remain high.The appearance in Europe of synthetic opioids and synthetic cannabinoids linked to deaths and acute intoxications led to the EMCDDA assessing an unprecedented number of substances for their risks to public health. This process can trigger a fast-track legislative response across the European Union. Data were also provided to the World Health Organization in 2017, and some of these substances are now being considered for international control. Five fentanyl derivatives were investigated in 2017. These substances were available in a number of novel forms including nasal sprays. They were also sometimes found mixed with other drugs, such as heroin, cocaine or fake medicines, with the consequence of users often being unaware that they were consuming the substance. The emergence of these potent drugs, often purchased on the internet, raises significant challenges for both health and law enforcement services. The substances are easy to transport and conceal, with small volumes often representing many hundreds of thousands of potential street doses. From a health perspective, they add to the already considerable burden attributed to other opioid deaths. In the United States, fentanyl derivatives now make a major contribution to the current opioid crisis, and over a short period of time they have become the substances most associated with overdose mortality. In Europe we are not facing a problem of the same scale but nonetheless reports to the EMCDDA of deaths and non-fatal overdoses associated with fentanyl and non-controlled fentanyl derivatives underline the need for continued vigilance.
Synthetic cannabinoids are increasingly linked to health problems
Reports of health harms linked to new synthetic cannabinoids led to a further four risk assessments by the EMCDDA in 2017. Synthetic cannabinoids have been associated with deaths and acute intoxications. A recent EMCDDA report drew attention to the growing health and security problems the use of these substances is causing in some European prisons. It was also apparent that these issues may sometimes go unobserved, due to the ease with which these substances can be smuggled into prisons and the challenges that exist in detecting their use.
Synthetic cannabinoids were first marketed as legal alternatives to natural cannabis products, but in many ways they are different. Initially associated more with recreational use, synthetic cannabinoids are now being used problematically by more marginalised social groups, such as the homeless, although overall our understanding of patterns of use of these drugs remains limited. Where information exists it shows that the prevalence of synthetic cannabinoid use is generally low, but the potential of these substances to cause harm is considerable. An indication of this can be seen in recent data from Turkey, where an overall increase in drug-induced deaths appears to be partly driven by use of synthetic cannabinoids. Synthetic opioids and synthetic cannabinoids linked to deaths and acute intoxications
The changing cannabis market brings new policy challenges
Cannabis remains the most widely used illicit drug in Europe. The drug’s prominence is evident from its place in seizures, drug law offences, prevalence estimates and new treatment demands. Developments in the Americas, which include the legalisation of the drug in some jurisdictions, have led to the rapid development of a commercial cannabis market. This is resulting in innovation in the forms of the drug available and delivery systems for its consumption. These include high-potency strains of cannabis, e-liquids and edible products. The legal recreational market has been accompanied by regulations allowing access to cannabis for medical or therapeutic purposes in some jurisdictions. The EMCDDA is monitoring these developments and providing explanatory policy summaries to highlight some of the issues they raise for discussions in Europe. Among these is the possibility that some of the new forms of this drug may appear on the European drug market.
Developments in North America have prompted renewed interest in the role played by cannabis in drug-impaired driving. In 2017 the EMCDDA hosted the third international symposium on drug-impaired driving. The report from international experts attending this meeting highlighted the difficulties in developing effective policy responses in this area, a topic that is relevant to countries regardless of the legal status of the drug. Other important policy questions in this area include what constitutes appropriate treatment for cannabis-related disorders, how to ensure policy synergies with tobacco reduction strategies, and what constitutes effective harm reduction approaches in this area. The prevalence of cannabis consumption in Europe remains high by historical standards, and recent increases have been noted in some EU Member States. Also at a high level, having risen markedly in the past decade, is the potency of the drug, in both herbal and resin forms. In addition to the public health issues, there are concerns about how this major illegal market impacts on community safety and may help finance organised crime. Considering the many issues involved, defining what constitutes the most appropriate response to cannabis use is a task of both growing complexity and increasing importance. The EMCDDA is committed to improving the understanding of these issues and providing the accurate, scientific and impartial information necessary for an informed debate on this challenging policy topic.
Responding to opioid overdose: the role of naloxone
Drug overdose deaths remain high in Europe, and opioids are implicated in the majority of cases. The emergence of fentanyl derivatives on the European drug market adds weight to the already considerable arguments for increasing the access to the opioid antagonist naloxone. There is growing evidence that the wider availability of this substance, combined with training in overdose recognition and response, can help prevent deaths among those using opioids. Naloxone provision is therefore being increasingly recognised in many countries as an important element in their overdose reduction strategy.
The availability of fentanyl derivatives increase the risks in this area further, because of their potency and because they may be used by opioid-naive individuals or put at risk those accidentally exposed to them through their occupation — such as law enforcement officers. These developments point to an urgent need to review current naloxone policies and increase training and awareness-raising for both drug users and professionals who may encounter the drug. These reviews also need to take into account that new non-injectable formulations, such as nasal sprays, may facilitate use of naloxone in a wider range of settings. Cannabis remains the most widely used illicit drug in Europe
Prisons: an important setting for implementing responses
Responding to drug use in criminal justice settings is one of the topics addressed in the EMCDDA publication Health and social responses to drug problems: a European guide. Release from prison is a particularly high-risk period for those with a history of opioid use. To address this, a number of countries have developed innovative programmes that provide naloxone and training for those being released from prison. Alongside naloxone provision, referral to appropriate community treatment and social support services are recognised as key responses in this area. This highlights the role of the criminal justice system generally and the prison setting in particular as a critical location for addressing problems for high-risk drug users. A significant community dividend can accrue from assessing drug users and addressing their health and social needs prior to their release from prison.
An example of this is the potential value that can be derived from scaling up the testing and treatment of infectious diseases among the prison population. This has gained particular importance as a result of the European Union’s commitment to eliminate the hepatitis C virus. Drug injection is the predominant form of transmission of this infection. New effective therapies are now available, but ensuring that those infected have access to them remains a challenge. Prisons and drug treatment services are important for identifying those with HCV infection. In 2018, the EMCDDA will support a new initiative to increase awareness and encourage access to hepatitis C testing and treatment in order to address this major drug-related problem.
Ensuring monitoring remains sensitive to changing drug problems
Although data on the availability of new psychoactive substances are improving, it remains very difficult to estimate the demand for these substances in Europe. These difficulties are amplified when we consider the misuse of diverted, fake or unlicensed medicines. An important observation here is that our existing monitoring tools may be insensitive to some important changes occurring in drug consumption patterns. Further investment in established and new monitoring approaches, such as wastewater analysis, web-based surveys and trendspotting studies, is needed in order to keep pace with these changes.
The EMCDDA recently released the findings from an annual assessment of drug residues in wastewater collected in cities in 19 European countries, which demonstrated the utility of these complementary information sources in providing more timely window on drug trends than that provided by more traditional data sources.As well as supporting data collection within Europe, the European Union is also working to help third countries develop their monitoring capacity. Initiatives towards this end include European Commission-funded technical assistance projects for EU candidate, potential candidate and neighbouring countries. These activities are important not only because drug problems are complicating the health and security problems experienced by the countries bordering the EU, but also because developments in these countries interact with, and impact on, the drug problems we face in our own Member States.
The analysis reported in this year’s European Drug Report therefore explicitly recognises that to understand the current and future challenges that drug use poses to Europe’s health and security policy agenda, it is also necessary to understand the global dimensions of this issue.