Rising overdose deaths, the continued availability of new psychoactive substances and the growing health threat of highly potent synthetic opioids are among the issues highlighted by the EU drugs agency (EMCDDA) in the European Drug Report 2017.
In its annual overview, the agency also explores: signs of rising cocaine availability; developments in cannabis policies; and substance use among school students. As the drug problems facing Europe are increasingly influenced by developments occurring internationally, the analysis is placed in the global context.
Overdose deaths on the rise for third consecutive year
The report highlights concern over the increasing number of drug overdose deaths in Europe, which has risen for the third consecutive year. A total of 8 441 overdose deaths, mainly related to heroin and other opioids, are estimated to have occurred in Europe in 2015, a 6% increase on the estimated 7 950 deaths in the 30 countries in 2014. Increases were reported in almost all age groups. Europe’s 1.3 million problem opioid users are among the most vulnerable.
Opioids used in substitution treatment — primarily methadone and buprenorphine — are also regularly found in toxicological reports. Latest data show that the number of recorded methadone-related deaths exceeded heroin-related deaths in Denmark, Ireland, France and Croatia, underlining the need for good clinical practice to prevent diversion of these substances from their legitimate use.
Interventions to prevent overdoses in Europe include supervised drug consumption room (DCRs) and the provision of ‘take-home’ naloxone (opioid overdose-reversal drug) to opioid users, their peers and families.
New drugs emerging at a slower pace, but overall availability still high
New psychoactive substances (NPS) remain a considerable public health challenge in Europe. Not covered by international drug controls, they include a broad range of synthetic substances, including cannabinoids, cathinones, opioids and benzodiazepines.
In 2016, 66 NPS were detected for the first time via the EU Early Warning System (EWS) — a rate of over one per week. Although this number points to a slowing of the pace at which new substances are being introduced onto the market — 98 substances were detected in 2015 — the overall number of substances now available remains high. By the end of 2016, the EMCDDA was monitoring more than 620 NPS (compared with around 350 in 2013).
The slower rate of new detections in Europe may be attributed to a number of factors. New legislation in some Member States (e.g. blanket bans, generic and analogue-based controls) has created a more restrictive legal environment, in which there may be less incentive for producers to engage in a ‘cat-and-mouse game’ with regulators, where innovation is used to keep ahead of controls. Law-enforcement operations and control measures targeting NPS laboratories in China may also be contributing to the slowdown.
In 2015, almost 80 000 seizures of NPS were reported through the EWS. Together, synthetic cannabinoids and synthetic cathinones accounted for over 60% of all seizures of new substances in 2015 (over 47 000). In July 2016, MDMB-CHMICA became the first synthetic cannabinoid to be risk-assessed by the EMCDDA after harmful effects (including around 30 deaths) related to its use were reported via the EWS. This resulted in a decision in February 2017 to subject the substance to Europe-wide control measures.
Accompanying the European Drug Report 2017 is a new analysis of High-risk drug use and new psychoactive substances, which focuses on the problematic use of NPS among a range of demographic groups, including: opioid and amphetamine injectors; prisoners; the homeless; and men who have sex with men. The report explores, in particular, the use of synthetic cathinones, synthetic cannabinoids and new synthetic opioids, as well as related harms and responses.
New synthetic opioids — highly potent and a growing health threat
In Europe, as in North America, highly potent synthetic opioids, which mimic the effects of heroin and morphine, are a growing health threat. While representing a small share of the market, there are increasing reports of the emergence of these substances and of the harms they cause, including non-fatal intoxications and deaths. Twenty-five new synthetic opioids were detected in Europe between 2009 and 2016 (18 of these were fentanyls).
With only small volumes needed to produce many thousands of street doses, new synthetic opioids are easy to conceal and transport, posing a challenge for drug control agencies and a potentially attractive commodity for organised crime. They are found in various forms — mainly powders, tablets and capsules — with some now available as liquids and sold as nasal sprays.
Fentanyls are subject to particular scrutiny. These exceptionally potent substances — some many times more potent than heroin — accounted for over 60% of the 600 seizures of new synthetic opioids reported in 2015. Eight new fentanyls were reported through the EWS for the first time in 2016 alone. These substances pose a serious risk of intoxication, not only to users but also to those who may be accidentally exposed to these drugs (e.g. via skin contact, inhalation), such as postal and customs workers and emergency service personnel.
Signs of rising cocaine availability
Europe’s most commonly used illicit stimulant drugs are cocaine, MDMA (sometimes referred to as ‘ecstasy’ in tablet form) and amphetamines (amphetamine and methamphetamine). Cocaine use is higher in western and southern European countries — reflected in ports of entry and trafficking routes — while use of amphetamines is more prominent in northern and eastern Europe. The stimulant market has become increasingly complex in recent years, with the arrival of new stimulants (e.g. phenethylamines and cathinones).
Data from wastewater monitoring and on seizures, price and purity suggest that the availability of cocaine may be rising again in parts of Europe. Both the number of seizures and the quantity seized increased between 2014 and 2015. Some 87 000 seizures of cocaine were reported in the EU in 2015 (76 000 in 2014).
Global cannabis policy developments: what implications for Europe?
Recent changes in the regulatory framework for cannabis occurring in parts of the Americas have generated interest among policymakers and the public in Europe. ‘There is a need to wait for robust evaluations before the relative costs and benefits of differing cannabis policy approaches can be assessed’, states the report. Within the 28 EU Member States, current approaches to cannabis regulation and use are diverse, ranging from restrictive models to the tolerance of some forms of personal use. However, no national government in Europe has currently expressed support for the legalisation of cannabis for recreational use.
Regardless of any wider impact on drug policy, the existence of a commercially regulated cannabis market in some countries outside Europe is fuelling innovation and product development (e.g. vaporisers, e-liquids, edible products), which may, in time, impact on patterns of use in Europe. Here the report underlines the importance of monitoring and the need to evaluate the potential health implications of any future changes.