EUROPEAN DRUG REPORT 2023: HIGHLIGHTS

EUROPEAN DRUG REPORT 2023: HIGHLIGHTS

Greater diversity in drug supply and use creates new challenges for Europe

Greater diversity in drug supply and use is creating new challenges for drug policy and healthcare in Europe. This is among the issues highlighted today by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) as it launches its European Drug Report 2023: Trends and Developments in Brussels (¹). The report delivers the latest overview of the drug situation in Europe, exploring key trends and emerging threats.

Drug availability remains high across all substance types and the scale and complexity of illicit drug production within Europe continue to grow. People who use drugs are now exposed to a wider range of psychoactive substances, often of high potency and purity. As these may be sold in similar-looking powders or pills, consumers may be unaware of what they are taking. The report underlines the need for effective risk communication strategies to alert consumers to the health harms associated with new substances,
drug interactions and high-potency products.

The analysis covers a wide range of illicit drugs, from opioids and stimulants to new cannabis products and dissociative drugs (e.g. ketamine). It also provides an update on new psychoactive substances (NPS), which continue to pose a public health challenge in Europe. In 2022, 41 new drugs were reported for the first time through the EU Early Warning System EWS), bringing the total number of NPS monitored by the EMCDDA to 930.

says: 'Drug-related organised crime poses a major threat to society, and I am deeply concerned that the substances consumed in Europe today may be even more damaging to health than in the past. The European Drug Report 2023 describes how Member States are seizing record amounts of illicit drugs. My recent visits to European sea ports, and to Latin America, highlighted that drug traffickers continue to infiltrate supply chains, exploiting workers and negatively impacting communities through violence and corruption. It is crucial that the EU cooperate with third countries in the global fight against drug trafficking. It is also timely that the EMCDDA is now being given a stronger mandate and international role to keep pace with this evolving drug problem'.

The report highlights the need for improved forensic and toxicological data to better understand the threats from new and potent synthetic substances, drug mixtures, adulterated substances, changing drug markets and patterns of use. Under its new mandate in 2024, the agency will launch a European network of forensic and toxicological laboratories to strengthen capacity in this area (²).

EMCDDA Director Alexis Goosdeel says: 'This year's report provides us with a stark reminder that illicit drug problems can be found throughout our society. I summarise this with the phrase: Everywhere, Everything, Everyone. Established illicit drugs are now widely accessible and potent new substances continue to emerge. Almost everything with psychoactive properties can appear on the drug market, often mislabelled or in mixtures. This is why illicit drugs can affect everyone, whether directly through use, or indirectly, through their impact on families, communities, institutions and businesses. They also increasingly expose our citizens to drug-related violence and its consequences. Today, we are highlighting the challenges posed by stimulants, synthetic drugs and new cannabis products. It is crucial that we increase forensic and toxicological testing to better detect emerging threats and safeguard public health. We also need to invest more in services, which are now called upon to meet more diverse and complex needs'.

The scope of cannabis policies in Europe is gradually widening, now covering not only illicit cannabis control, but also the regulation of cannabis and cannabinoids for therapeutic and other uses (e.g. cosmetics, food).

Today, five EU Member States (Czechia, Germany, Luxembourg, Malta and the Netherlands) plus Switzerland are introducing, or planning to introduce, new approaches to regulate the supply of cannabis for recreational use. These changes, outlined in the report, highlight the need to invest in monitoring and evaluation to fully understand their impact on public health and safety (³).

Cannabis remains the most commonly used illicit drug in Europe. Around 8 % (22.6 million) of European adults (15-64 years) are estimated to have used cannabis in the last year. In 2021, the quantities of cannabis resin (816 tonnes) and herbal cannabis (256 tonnes) seized in the EU reached their highest level in a decade, suggesting high availability of this drug. In Europe, an estimated 97 000 clients entered some form of drug treatment for problems related to cannabis use in 2021.

New cannabis products are posing public health challenges. Some products sold on the illicit market as natural cannabis may be adulterated with potent synthetic cannabinoids, creating risks of poisoning.
And high-potency extracts and edibles .

In 2022, hexahydrocannabinol (HHC) became the first semi-synthetic cannabinoid reported in the EU.
It was identified in two thirds of the Member States and, in some EU countries, is sold as a 'legal' alternative to cannabis (⁴). EWS) in order to better understand the potential risks to Europe.

The trafficking of large volumes of cocaine through European seaports in commercial containers is driving the drug's high availability today. There are concerns that this situation might contribute to increased cocaine use, health harms and drug-related crime.

. Belgium (96 tonnes), the Netherlands (72 tonnes) and Spain (49 tonnes) accounted for almost 75 % of the total quantity seized.
Preliminary data for 2022 show that the quantity of cocaine seized in Antwerp, Europe's second-largest seaport, rose to 110 tonnes from 91 tonnes in 2021. Evidence suggests that organised crime groups are
also increasingly targeting smaller ports in other EU nations, as well as in countries bordering the EU.
Illicit cocaine manufacturing in the EU is gaining importance, with 34 cocaine laboratories dismantled in
2021 (23 in 2020), some of which were large-scale.

-64 years) in the last year. It was the most common substance associated with acute poisoning presentations in hospital emergency departments in 2021, mentioned in of cases. There
are also some signs that cocaine injection and crack cocaine use are becoming more common among marginalised groups in some countries, requiring harm reduction responses to be scaled up.

The wider variety of synthetic stimulants now available on the illicit market is increasing risks to public health. Historically, amphetamine has been the most commonly used synthetic stimulant in Europe. However, there are signs that both methamphetamine and synthetic cathinones are now contributing more significantly than in the past to Europe's overall stimulant-related problems.

The report also states that stimulants are now more commonly injected, sometimes combined with heroin or other opioids. Understanding the harms linked to changing patterns of injecting drug use will be key to designing interventions that reduce the harms associated with this behaviour.

Potential health risks of lesser-known substances

Ketamine, used as an anaesthetic and painkiller in medicine, has become a more established recreational drug of choice in some settings. It is commonly snorted and is sometimes found added to other drug mixtures, including MDMA powders and tablets. Long-term ketamine users can experience health problems (e.g. bladder damage).

The rise in the recreational use of nitrous oxide ('laughing gas') in some parts of Europe is raising health concerns. A recent EMCDDA review (⁵) pointed to the risks associated with the drug, which now appears to be more accessible, cheaper, and popular among some young people. These risks can include and, in some cases of prolonged use, nerve damage. There is a strong argument for drug prevention and harm reduction services to address this substance in their work. Regulatory approaches to the sale and use of this substance vary between countries.

Today's report also discusses the growing interest in the therapeutic potential of psychedelic drugs. While there is promising research into the potential of these substances to treat different mental health conditions, the report highlights the risk of unregulated programmes being operated within the EU and elsewhere.
Growing interest in this topic may encourage greater experimental use of these substances without medical support, potentially putting some vulnerable individuals at risk.

Europe's opioid problems are evolving

Heroin remains Europe's most commonly used illicit opioid, but there is also growing concern about the use of synthetic opioids in some areas. Many synthetic opioids are highly potent and pose a risk of poisoning and death. Only small quantities are needed to produce thousands of doses, making them a potentially more lucrative substance for organised crime groups.

New uncontrolled synthetic opioids continue to appear on the European drug market, with a total of 74 identified since 2009. In recent years, most of the newly identified opioid substances reported to the EWS have been highly potent benzimidazole (nitazene) opioids. Compared with North America, new synthetic opioids (e.g. fentanyl derivatives and nitazenes) currently play a relatively small role in Europe's drug market overall, although they are a significant problem in some countries.

New synthetic opioids (including benzimidazoles and fentanyl derivatives) have been linked to a rise in overdose deaths in the Baltic countries. In Estonia, new synthetic opioids have been found in mixtures containing a benzodiazepine and the animal sedative xylazine. These combinations, respectively known as 'benzo-dope' and 'tranq-dope', have been linked to overdose deaths in North America. The report states: '... even if problems in this area are relatively limited at present, this group of substances represents a threat, with the potential to impact more significantly on European health and security in the future'.

Heroin availability appears to remain high at present. The quantity of heroin seized by EU Member States more than doubled in 2021 to 9.5 tonnes, while Türkiye seized a record 22.2 tonnes. Almost all heroin consumed in Europe comes from Afghanistan, where the Taliban announced a ban on opium poppy cultivation in April 2022. While it is too early to say how Europe's heroin market will be affected by the ban, there are fears that any shortage in the availability of the drug could be associated with an increase in the supply of, and demand for, synthetic opioids.

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concludes: 'Today's report is an essential resource for gaining strategic insight into the European drug situation and its implications for public health and security. The launch of the report comes at a pivotal time, as the EMCDDA prepares for a new mandate and a new future. We look forward to the implementation of this promising new mission, which will see the agency expand its monitoring capabilities, boost EU preparedness and help develop competence for better interventions in the drugs field'.