Drug supply and use bounce back after COVID-19 disruption


The rapid bounce back of drug supply and use following COVID-19 disruption is among the issues highlighted today by the EU drugs agency (EMCDDA) as it launches its European Drug Report 2022: Trends and Developments (1). The report delivers the latest overview of the drug situation in Europe, exploring long-term trends and emerging threats. At a time when the international situation raises new challenges, the report also looks at how ongoing global events may affect the dynamics of Europe’s drugs problem in future.

The annual review describes how Europe’s drug problems continue to evolve and how innovation is driving the drug market. Drug availability remains at high levels across the EU (in some cases, such as cocaine, surpassing pre-pandemic levels) and potent and hazardous substances are still appearing. The report also reveals how cannabis products are becoming increasingly diverse and how the production of synthetic drugs within Europe is on the rise.

For drug use, there are also signs of a return to pre-pandemic levels. Wastewater analysis, for example, reveals increases in the use of cocaine, crack, amphetamine and methamphetamine in some cities between 2020 and 2021 (2). And, as COVID-19 restrictions have been relaxed across Europe, drug treatment and other services appear to have returned to ‘business as usual’, while maintaining some of the innovative practices adopted during lockdown (e-health services, telemedicine).

European Commissioner for Home Affairs Ylva Johansson says: ‘The continued escalation of synthetic drug production within the EU shows us the relentless drive by organised crime groups to profit from the illegal drugs trade, placing public health and security at risk. It is of particular concern that the partnerships between European and international criminal networks have given rise to record availability of cocaine and industrial-scale methamphetamine manufacturing within Europe. This brings with it the potential for increased use and harms. The EU and its Member States will continue to counter these developing threats through a collaborative effort, based on the EU’s crime priorities and drug and security strategies.’

EMCDDA Director Alexis Goosdeel adds: ‘The take-home message from this report can be summarised in three words: Everywhere, Everything, Everyone. Established drugs have never been so accessible and potent new substances continue to emerge. Today, almost anything with psychoactive properties can be a drug, as the lines blur between licit and illicit substances. And everyone can be affected, whether directly or indirectly, as drug problems exacerbate most of the other important health and social challenges we face today. This report arrives at a time when major global events are touching upon all areas of our lives. Through its analysis of current trends and emerging threats, the report explores how these developments may influence drug problems in Europe in the future. I firmly believe that we can only address the complex policy issues in the drugs field if we base our responses on a balanced and evidence-based understanding of the problem’.

Hazardous new psychoactive substances continue to appear — cathinones in the spotlight

New psychoactive substances (NPS) continue to appear in Europe at the rate of one per week, posing a public health challenge. In 2021, 52 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 880. In 2021, 6 new synthetic opioids, 6 synthetic cathinones and 15 new synthetic cannabinoids were reported for the first time. A new report on the achievements of the EWS is published today as the network celebrates its 25th anniversary (3).

Record amounts of NPS were seized in Europe in 2020 (27 EU, Turkey and Norway), totalling 6.9 tonnes (41 100 seizures). Of the material seized, 65 % (3.3 tonnes) were synthetic cathinones, often sold as replacements to established stimulants (e.g. cocaine, MDMA). Following controls on synthetic cathinones in China, most bulk quantities of these substances trafficked to Europe in 2020 originated in India, probably reflecting market adaptation to legal controls and supply disruptions. At the end of 2021, the EMCDDA was monitoring 162 synthetic cathinones, making it the second largest category of NPS under observation after synthetic cannabinoids (224 monitored). Record synthetic cathinone trafficking to Europe and reports of harms (e.g. poisonings) have prompted new responses. Two synthetic cathinones 3-MMC and 3-CMC were risk assessed in 2021 and the European Commission has proposed their control across the EU.

Cannabis — new developments for Europe’s most popular illicit drug

Developments in the cannabis area are creating new challenges for how countries respond to Europe’s most commonly consumed illicit drug. Cannabis products are becoming increasingly diverse, including extracts and edibles (high THC content) and CBD products (low THC content). Europe’s cannabis policy environment is also changing, with the scope of policies gradually widening. In addition to illicit cannabis control, policies now cover the regulation of cannabis for medical and other uses.

In 2020, the average THC content of cannabis resin was 21 %, almost twice that of herbal cannabis (11 %), reversing the trend seen in recent years, when herbal cannabis was typically of higher potency. This reflects market innovation as resin producers, usually from outside the EU, appear to have responded to competition from herbal cannabis produced inside Europe. Also highlighted in the report are concerns around illicit cannabis products being adulterated with synthetic cannabinoids, which can be highly potent and toxic. Users who believe they have purchased natural cannabis products may be unaware that a product contains synthetic cannabinoids and that they are exposed to greater health risks.

Signs of rising drug production, trafficking and availability in Europe

Over 350 illegal drug production laboratories were dismantled in 2020, including some large-scale cocaine, methamphetamine and cathinone production sites. The latest analysis suggests the availability of cocaine in Europe remains high, bringing with it a range of health threats. A record 213 tonnes of cocaine were seized in the EU in 2020 (202 tonnes in 2019), while 23 laboratories were dismantled (15 in 2019) (4).

The availability of amphetamine is also high and may be on the rise. In 2020, EU Member States seized a record 21.2 tonnes (15.4 tonnes in 2019) and 78 amphetamine laboratories were dismantled (38 in 2019). The report points to a growing number of medium- and large-scale methamphetamine production facilities dismantled in Europe. Methamphetamine production and supply has changed recently in Europe. This development poses a risk of wider availability and the potential for increased use.

The number of MDMA laboratories dismantled (29) remained relatively stable in 2020. In addition, 15 cathinone production sites were dismantled (5 in 2019) and 860 kg of chemical precursors for cathinone production were seized (438 in 2019). Although less common, illicit laboratories producing heroin, ketamine, GBL and DMT were also dismantled in the EU in 2020.

A key question raised in the report is whether darknet drug markets are in decline. A number of factors appear to have influenced activity on these markets (e.g. law-enforcement activity, delivery problems, scams). At the end of 2021, estimated revenues fell dramatically to just under EUR 30 000 per day (compared with EUR 1 million per day in 2020). Social media and instant messaging apps appear to be favoured as a safer and more convenient source of supply, underlining the need for responses in this area.

Need to scale up treatment and harm reduction services

Today’s report underlines the need to scale up treatment and harm reduction services in Europe for people who inject drugs. In 2020, only Czechia, Spain, Luxembourg and Norway reported meeting the World Health Organization’s (WHO) 2020 targets of providing 200 syringes per year per person who injects drugs and having 40 % of the population of high-risk opioid users in opioid agonist treatment (OAT), a protective factor against drug overdose. In 2020, there were an estimated one million high-risk opioid users in the EU and 514 000 clients in OAT, suggesting an overall treatment coverage of 50 %. Large differences exist between countries, however, and treatment provision still remains insufficient in many EU Member States.

Injecting drug use is associated with serious health problems, such as infectious diseases, overdose and deaths. While heroin injecting is in decline, there are growing concerns around the injecting of a broader range of substances, including amphetamines, cocaine, synthetic cathinones, prescribed opioids and other medicines.

An estimated 5 800 overdose deaths, involving illicit drugs, occurred in the EU in 2020. Most of these fatalities were associated with polydrug toxicity, which typically involves combinations of illicit opioids, other illicit drugs, medicines and alcohol (5). Alongside high cocaine availability in Europe, reports indicate that crack use may be increasing and is now seen among vulnerable drug users in more cities and countries. Crack is usually smoked, but can also be injected, and is linked to a range of health and social harms (e.g. infectious diseases and violence). Long-term trends point to an estimated 7 000 clients entering drug treatment for crack problems in Europe in 2020, triple the number in 2016.

International situation: new challenges and potential threats

Drug problems in Europe can be influenced by developments occurring internationally. Today’s report considers the recent developments in Afghanistan and Ukraine and the potential implications for the drugs field. While it is too early to assess the full impact of these events, targeted monitoring of the situation will be needed to inform policy and responses.

Despite the 2022 Taliban ban on the production, sale and trafficking of illicit drugs in Afghanistan, poppy cultivation appears to continue. The country’s current financial problems might make drug revenues a more important source of income, which could lead to an increase in heroin trafficking to Europe. Another key issue is whether Europe will become a consumer market for methamphetamine produced in Afghanistan. European producers currently supply the EU market with this drug. However, large-scale ephedra-based methamphetamine production in Afghanistan has also been noted recently, as well as increased seizures of this drug along some established heroin trafficking routes.

The war in Ukraine has added to the uncertainty of Europe’s drug situation. People who access drug treatment in Ukraine will account for a small proportion of those seeking refuge in the EU. These individuals will need continuity of treatment as well as services tailored to their specific needs and language. More generally, those fleeing conflict are likely to have suffered severe psychological stress, making them potentially more vulnerable to substance misuse problems in the future. The war could also cause shifts in trafficking routes, as criminals exploit vulnerabilities or avoid affected areas.

Chair of the EMCDDA Management Board Franz Pietsch concludes: ‘Today’s report provides us with a strategic and holistic overview of the European drug situation and its implications for public health and security. It is an essential resource to help policymakers and professionals in the drugs field improve their preparedness and response. This week, we see the EU Early Warning System on new psychoactive substances celebrate its 25th anniversary. As new drugs continue to appear, more support is needed for national early-warning systems and for forensic and toxicological testing in order to better detect and respond to emerging threats and safeguard public health.’