European Drug Emergencies Network (Euro-DEN Plus): data and analysis

Introduction

On this page you can explore data from hospitals participating in the European Drug Emergencies Network (Euro-DEN — Euro-DEN Plus)  project. This project involves the collection of data on emergency department presentations (or visits) with acute drug toxicity in participating countries in Europe. More centres are currently being recruited to increase the European value, representativeness and utility of this data source.

The project aims to provide detailed information on the nature and extent of harm associated with the use of drugs such as (but not limited to) cannabis, cocaine, heroin and other opioids, amphetamines, polydrug use with alcohol, as well as non-medical (recreational) use of prescription and over the counter medicines, and new psychoactive substances.

Data from all centres can be explored through an interactive tool, and a detailed analysis of the findings of the most recent data, from 2022, is presented.

Page last updated: 16 January 2024

Data explorer: acute drug-toxicity presentations to emergency services by year, hospital and reported drug

In this section you can explore the data from the most recent year (2022), as well as from previous years starting from the last quarter of 2013. Bubble sizes on the map show the percentage of presentations with the selected substance present. The sum of the percentages can be over 100% because several drugs can be mixed. More information on the patterns of polydrug use will be added latter on this page. Clicking on a bubble on the map will show numbers, some break-down of the presenattions by sex, age band and admission to intensive care unit, as well as more detailed information for the service . You can also select a hospital from the drop-down menu.

 

Notes

  • The Source data section below provides a table containing the data shown in this tool and a description of each centre’s characteristics.
  • The Limitations section includes general notes on the specificity of this surveillance system and the caveats and limitations of this data. More details on the limitations are available here (see the Frequently-asked questions (FAQ) on drug-related hospital emergencies).
  • Because of the size of the dataset, this data explorer may be slow or unresponsive. If this is the case, we recommend trying another browser, such as Firefox, Safari or Chrome.

Caveats

Most presentations involve reported use of more than one drug. Mixing drugs can result in some interactions and can potentiate the effects of a single drug. It might therefore be difficult to determine the effect of a particular drug.

Alcohol-only acute toxicity presentations are not included in Euro-DEN Plus (see the inclusion and exclusion criteria in the Euro-DEN Plus FAQ pages). Therefore, the mention of alcohol in the table below refers only to those presentations that involved illicit drugs, misuse of prescription medicines for recreational purposes or new psychoactive substances (NPS). These particular presentations represent only a small proportion of all the acute alcohol toxicity presentations seen in hospital emergency services.

Another limitation and possible bias of these data is that information on whether or not alcohol has been co-reported is not systematically collected in all centres. The proportion of presentations for which this information is available is reported in the table below. This needs to be kept in mind when comparing the proportion of presentations in which alcohol was involved, across centres and over time. Based on the available data, half of the centres in 2022 had 49% or more acute drug toxicity presentations with alcohol involved.

Acute drug toxicity presentations with a medicine are included only when licensed pharmaceutical preparations (both prescription and over-the-counter medicines) are misused.

Analysis and results from the Euro-DEN Plus Sentinel network

A summary of the data from the Euro-DEN Plus network is presented in this section. The results provide a valuable sentinel-based surveillance of acute drug-related harms. These findings reveal marked geographical variations and changes over time (see data explorer) and provide a unique insight into the public health implications of drug use in Europe.

Euro-DEN started enhanced monitoring of acute drug toxicity presentations in European hospitals in October 2013. The sentinel network of hospital emergency services provides timelier and more accurate information on the harms associated with drug use than the routine national data reported in some countries (see the FAQ on drug-related hospital emergencies for a more detailed list of the strengths and limitations of this source of information). The network has published more than 25 papers by January 2024.

The findings presented here (from 28 active centres in 2022 in the European Union, Switzerland and the United Kingdom) show that the number of presentations varied considerably across study locations. Hospitals in Oslo, Msida, London, Amsterdam, Dublin, and Mallorca had the highest numbers of presentations reported. This reflects the large size and catchment area of the hospitals, but also the prevalence of drug use around the hospitals. The type of drugs involved in the presentations varied across centres — reflecting local markets and patterns of use — although the main drugs were reported in most of the participating centres.

This section provides:

  • Key findings on the most recent analysis in the European Union, Norway, Türkiye, Switzerland and the United Kingdom (2022). Centres from other countries are not included in this summary but data are presented in the map.
  • A summary of the variations across centres of the drugs most commonly involved in the presentations, including cannabis, stimulants (cocaine, amphetamine, methamphetamine, MDMA), opioids (heroin, methadone), selected prescription medicines (benzodiazepines, pregabalin), alcohol, GHB/GBL and new psychoactive substances (NPS)

2022 key findings

  • Most acute drug toxicity presentations were among males.
  • Proportions of young people (younger than 25 years) were higher in centres in the south and east of Europe.
  • Polydrug use was frequent. It may be underestimated.
  • Most presentations were discharged from the emergency department; admission to critical care units was uncommon.
  • The median value of the proportion of presentations by drug or group of drugs shows that the most frequently reported drugs or groups of drugs included cocaine, cannabis, opioids, heroin, MDMA, amphetamine, GHB/GBL, NPS, and methamphetamine.
  • Alcohol was commonly co-reported in acute drug toxicity presentations.
  • Prescription medicines were a significant group of drugs involved in acute drug toxicity presentations.
  • Opioids were the most common group of drugs involved in acute drug toxicity presentations.
  • Cannabis involvement was widespread in Europe in acute drug toxicity presentations.
  • Cocaine largely dominated the other stimulant drugs, and was widespread. Local signals of crack involvement in acute drug toxicity presentations are confirmed.
  • The involvement of stimulants other than cocaine — amphetamine-type drugs — was quite geographically defined, with a higher proportion of presentations reported in centres in the north and east of Europe.
  • On the whole, NPS were rarely involved in acute drug toxicity presentations and were reported in a limited number of centres.
  • The patterns in the drugs involved and the demographics of those presenting varied by centre, highlighting the value of these data for local monitoring. Local findings should not be generalised, but should rather be seen as parts of a whole and considered in the context of other local indicators.
  • Several countries participating in 2022 had two or more centres (Belgium, Ireland, the Netherlands, Spain, Norway, Switzerland and the United Kingdom). The Euro-DEN Plus data highlight differences between these centres within the same country, which may be explained in part by the different social and demographic characteristics of the cities or parts of the cities (universities, deprived or nightlife areas and age distribution of the population), and other factors such as the pre-hospital referral pathways of the presentations.
  • Sixteen centres have participated since the start of the network in 2013; of the 28 centres that participated in 2022, 25 had participated in 2020; 17 centres have reported continuously since 2016, four centres since 2017 and five since 2018; this allows for time trend analysis of acute drug toxicity presentations.

Drugs

Cannabis

Cannabis is frequently reported in Euro-DEN Plus acute drug toxicity presentations. Acute cannabis toxicity can be associated with a range of health problems, including neuropsychiatric and physical effects (1-4). Although outside the scope of the Euro-DEN Plus network, which focuses on the adult population, paediatric hospitals signal that unintentional paediatric cannabis intoxications are common and are on the rise in certain regions (5). Cannabis was the second most commonly reported illicit drug in this series.

The median percentage of presentations involving cannabis was 22.8% across the reporting hospitals in 2022. The highest proportion of presentations with cannabis involved was reported in Nicosia — 7 in 10 cases — followed by other centres in the south and east of Europe, including Bucharest, Mallorca and Msida. There is no information reported on the type of cannabis used (resin, herb, oil, edible) nor on the route of administration (smoked, vaporised, ingested). Cannabis was reported in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving cannabis increased in ten of these centres in relation to other substances in the previous year. In six centres, this share decreased and in 12 centres it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Alcohol (in the context of polydrug use)

Alcohol can interact with other drugs and increase the risks associated with acute drug toxicity, such as those associated with GHB/GBL, opioids and central nervous system depressant drugs or prescription medicines. This has been confirmed in previous studies from the Euro-DEN Plus network (6,7). Alcohol was reported in the context of polydrug use (i.e. together with illicit drugs or prescription medicine misuse). A patient who presents with only alcohol-related toxicity symptoms would not be included in the Euro-DEN Plus dataset (see exclusion criteria in the Euro-DEN Plus FAQ pages).

The median percentage of presentations involving alcohol was 49% across the reporting hospitals in 2022. The highest proportions of acute drug toxicity presentations in which alcohol was mentioned were reported in centres in the north of Europe, including Oslo, London, Dublin, Vilnius, Ghent, Parnu, Munich as well as in Ljubljana, Rozzano and Geneva.

Cocaine

Acute cocaine toxicity can be associated with physical— in particular cardiovascular and neurological — and neuropsychiatric effects (8-12). Increases in cocaine availability, use and harms are reported in many countries in Europe (13-14). Cocaine is the most commonly reported stimulant drug in Euro-DEN Plus presentations.

The median percentage of presentations involving cocaine was 22.9% across the hospitals in 2022. The proportion of presentations with cocaine involved was highest in hospitals in western and southern Europe, including in Rozano and Mallorca where half or more of the presentations involved cocaine, followed by Drogheda, Basel, Antwerp, Nicosia and Msida. Similar to previous years, the lowest proportions of presentations with cocaine mentioned were reported in centres in eastern European cities including Bucharest, Gdansk and Vilnius. Cocaine was reported across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving cocaine increased in six centres compared with those for other substances in the previous year. In seven centres, this share decreased and in 15 it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Crack cocaine: a few centres (including those in Paris, Drogheda and London for the north and west of Europe, and those in Msida and Barcelona for the south of Europe) reported presentations involving the use of crack cocaine (not shown on the map) (8). Crack was reported by 12 centres in 2022.

In 2022, the share of emergency room presentations involving crack increased in seven of these centres compared with those for other substances in the previous year. In one centre, this share decreased and in four it remained stable.  Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Amphetamine and amphetamine-type stimulants

Amphetamine and amphetamine-type stimulants (such as MDMA and methamphetamine) are central nervous system stimulants that cause hypertension and tachycardia, agitation, psychosis and feelings of increased confidence, sociability and energy (15). Amphetamine is the second most commonly reported stimulant drug, far behind cocaine.

The median percentage of presentations involving amphetamine was 4.6% across the reporting hospitals in 2022. The frequency of presentations involving amphetamine varied considerably across study locations. As in previous years, the highest proportions were reported in cities in the north and east of Europe, in particular Riga, Sofia and Parnu, where around a third or more of the presentations involved amphetamine. The drug was involved in a smaller proportion of presentations in centres in the south and west of Europe in countries such as Ireland, Cyprus, Malta and Italy. Amphetamine was reported by 25 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving amphetamine increased in eight centres compared with those for other substances in the previous year. In 12 centres, this share decreased and in five it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

There are many other ‘amphetamine-type stimulants’, and those most frequently reported in the presentations in this series include MDMA and methamphetamine.

MDMA

MDMA (ecstasy) has been being reported in a similar proportion of presentations as amphetamine in previous analysis (16). The median percentage of presentations involving MDMA was 5.1% across the reporting hospitals in 2022. The highest proportions of presentations with MDMA involved were in the centres in Utrecht, Paris, Ghent and Amsterdam. MDMA was reported by 24 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving MDMA increased in 12 of these centres compared with those for other substances in the previous year. In five centres, this share decreased and in seven it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Methamphetamine

Methamphetamine was reported less frequently than other drugs and in specific centres only. The median percentage of presentations involving methamphetamine was 2.5% across the reporting hospitals in 2022. In only in a small number of centres — Bratislava, Nicosia and Sofia — methamphetamine was involved in more than a quarter of presentations. Riga, two centres in London and Barcelona reported that methamphetamine was involved in more than one in ten cases. Other centres reported no or negligible proportions of presentations in which methamphetamine was involved. Methamphetamine was reported by 22 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving methamphetamine increased in nine of these centres compared with those for other substances in the previous year. In ten centres, this share decreased and in three it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Opioids

The term ‘opioids’ includes compounds that are extracted from the poppy seed as well as semisynthetic and synthetic compounds that bind with opioid receptors. Opioids are depressants of the central nervous system and cause breathing difficulties. Acute opioid toxicity can involve different types of opioids and can lead to death (17). This section presents the data on the selected single opioids: heroin (illicit drug) and methadone (prescription medicine).

Heroin

The median percentage of presentations involving heroin was 5.3% across the reporting hospitals in 2022. Roughly a fifth to a quarter of the presentations involved heroin in one centre in Oslo, in Drogheda in Ljubljana and in Dublin. In contrast, very small proportions of the presentations involved heroin in the centres in Ghent, Amsterdam, Vilnius and — in the southern and western parts of Europe — in Paris and Barcelona. Heroin was reported by 24 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving heroin increased in seven centres compared with those for other substances in the previous year. In five centres, this share decreased and in twelve it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Methadone

The median percentage of presentations involving methadone was 2% across the reporting hospitals in 2022. Methadone wasinvolved in more than one in ten presentations in Sofia, Riga, Dublin and Ljubljana. It was reported by 22 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving methadone increased in nine centres compared with those for other substances in the previous year. In nine centres, this share decreased and in four it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Benzodiazepines 

Benzodiazepines are prescribed to treat a range of conditions, including anxiety, insomnia, epilepsy and alcohol withdrawal. They are also commonly misused for a variety of reasons. Benzodiazepines are central nervous system depressants and can potentiate the effect of acute toxicity with other depressant drugs, including alcohol and opioids (18,19).

The median percentage of presentations involving any benzodiazepine was 11.8% across the reporting hospitals in 2022. Munich, Drogheda and Dublin, Oslo, Paris and Gdansk were the centres with the highest proportion of presentations involving prescription medicines of this group. In contrast, Amsterdam, Msida, Bratislava reported the smallest proportion of presentations involving benzodiazepine, possibly reflecting a more recreational pattern of use compared to the centres where this prescription medicine was more frequently involved in the presentations. ‘New benzodiazepines’ are included in the NPS section below.

Other drugs — GHB/GBL and new psychoactive substances

Caveats: for this and other drugs, there are small numbers of presentations reported in some years for some centres, and the percentages should be interpretated with caution.

GHB/GBL

GHB/GBL ((Gamma hydroxybutyrate/Gamma butyrolactone) are a central nervous system depressant. Acute toxicity with these drugs can be associated with somatic problems, including coma, respiratory depression and death (7,21). The proportion of acute drug toxicity presentations involving GHB/GBL varied considerably across hospitals. The highest levels in 2022 were reported in Parnu (small numbers) and Oslo with more than half of the presentations, and in the centres in the Amsterdam, Utrecht London and Barcelona with more than one in five.

The median percentage of presentations involving GHB/GBL was 3.7% across the reporting hospitals in 2022. In 2022, GHB/GBL was reported by 22 centres across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving GHB/GBL increased in six centres compared with those for other substances in the previous year. In nine centres, this share decreased and in five it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Ketamine

The median percentage of presentations involving ketamine was 2.4% across the reporting hospitals in 2022. Ketamine was reported by 23 centres across all 28 centres that reported data for that year. In 2022, the share of emergency room presentations involving ketamine increased in 15 centres compared with those for other substances in the previous year. In three centres, this share decreased and in five it remained stable. Numbers are small are interpretation of the increasing trend in some centres should be cautious. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable (not shown on the map).

New psychoactive drugs (NPS)

The NPS identified in this series are mainly synthetic cannabinoids and synthetic cathinones (22). The median percentage of presentations involving NPS was 3.3% across the reporting hospitals in 2022. The centres in Rozzano, Gdansk, Bucharest and Msida reported the highest proportion of cases with NPS involved (noting that due to the small numbers, the proportion needs to be interpreted with caution). The NPS most frequently reported in these centres were unspecified ‘legal highs’, synthetic cannabinoids and synthetic cathinones.

A recent large multicentre series of NPS presentations to European emergency departments showed marked geographical variations and changes over time in the proportion of presentations involving NPS, as well as the proportion of NPS subgroups (22).

The other individual drugs most frequently reported (apart from those mentioned above) varied by country, reflecting the diversity of the local patterns of high-risk drug use. For several years the centres in Tallinn and Vilnius have been reporting fentanyl and fentanyl analogues, as the drug has replaced heroin in the local markets; the centres in Paris, London, Msida have been reporting crack; both centres in Ireland have been reporting the benzodiazepine medicine alprazolam; and centres in Oslo have been reporting clonazepam and other benzodiazepines. For the past few years, centres in London have reported ketamine, crack and mephedrone, and Barcelona has reported ketamine, poppers and lysergic acid diethylamide (LSD). Centres in London and in Amsterdam have reported acute drug toxicity involving nitrous oxide, mirroring the recent data from other indicators across Europe (23).

Sex, gender, age and outcome

There are differences in the drugs involved in acute drug toxicity presentations according to age and sex (24).

Sex and gender

Most presentations were among males. Half of the centres reported than 25% or more of their presentations were among women. There was no clear geographical distribution of the centres according to the proportion of men and women, and some centres in the same country (e.g. Spain) reported quite different proportions of women, suggesting a local drug scene. For example, the proportion of women in Mallorca was around 1 in 3 compared to around 1 in 5 in Barcelona. Data on gender have recently been added to the data collection on sex and will be available later.

Age

The centre in Bucharest is an outlier as it is based in a paediatric hospital and has seen only presentations in patients aged less than 25 years.

The highest proportion of young cases was reported in centres in the eastern part of Europe such as those in Parnu, Gdansk Bratislava and Sofia, where at more than 60% of the cases were aged less than 25 years. In contrast, the highest proportions of presentations aged over 45 years were reported in centres in Mallorca, Dublin and Rozanno, Oslo and centres in Switzerland. This is consistent with an ageing cohort of high-risk drug users that has been reported for some years in the west of Europe (25,26).

Outcome

A minority of the presentations required admission to critical care*. This indicator is used as a proxy for severity, although it is potentially biased by the organisation of the services and potential variation in thresholds for critical care admission around Europe. Oslo (9 in 10) and Utrecht (4 in 10) are outliers, with higher proportions of presentations being hospitalised in critical care units than those in other centres. This difference is in part explained by the selection bias and the referral of the most severe presentations to these rather than to other local centres. 

* ‘Admission to critical care’ covers both admissions to an intensive care unit (ICU — Level 3) and to a high-dependency unit (HDU — Level 2), as they are called in some countries. HDUs are wards for people who need more intensive observation, treatment and nursing care than is possible in a general ward but slightly less than that given in intensive care. In this series, depending on the local organisation of care, some patients will have been admitted to HDU (Level 2) — for example for intravenous naloxone infusion — rather than critical care (Level 3). In some centres, short-term (invasive) procedures (e.g. intubation, short-term administration of vasopressors) take place in the emergency department, while in other centres this is an indication of critical care.

** Oslo OAEOC does not have a critical care unit, and patients considered too sick for primary care management are transferred to other hospitals, including Oslo OUH

Limitations

There are both strengths and limitations affecting comparability, generalisability and interpretation, and these should be kept in mind when using these data (see the FAQ on drug-related hospital emergencies):

  • Recording and reporting bias (inter-centre differences): The use of a common protocol ensures common practices across the participating centres. However, there might be various ways of recording and retrieving the data across hospitals as the source depends on local practices and capacities.
  • Representativeness: A hospital within a city is not necessarily representative of the city as a whole, of the region or of the country. Local factors — such as proximity to high concentrations of night-time economy venues and levels of social deprivation — may impact the types of presentations seen in the sentinel centre. This is illustrated by the case mix differences in centres within the same city.
  • Selection bias (pre-hospital management and inter-hospital referral procedures): The referral and triage procedure at a city level implies a different case mix (i.e. when a hospital is ‘Level 1’, or entry door to the emergency service, while another is ‘Level 2’ or ‘Level 3’, which might be accessible only to severe cases that are referred to this level). Most of the participating emergency services are based in hospitals for adults; therefore, they rarely or never see paediatric cases for acute drug toxicity. Other surveillance would be necessary to monitor the real burden and trends in acute drug toxicity among children and adolescents.
  • Interpretation of polydrug use presentations: For most cases, more than one drug is reported. Thus, the impact of an individual drug in this context can be difficult to assess.
  • Distortion (possible over-representation of high-risk severe cases who might present more repeatedly): The dataset includes presentations, not patients. It is likely to include repeat presentations in the same patient and, thus, the observations may not all be independent. No information is collected to flag and count whether a person has presented in the past.
  • Limited statistical power (in some centres): Numbers of cases are small in some hospitals, and some hospitals have reported over a short period of time only. Therefore, interpretation of percentages, interpretation of changes and comparisons over time and across centres should be made cautiously. A small number of sizable centres collect a large part of the total dataset, and this should be kept in mind when interpreting the overall data. In this respect, local analysis can be more informative than global analysis.
  • Access to emergency settings: The proportion of acute drug toxicity presentations over the total number of emergency presentations depends on the denominator of all emergency presentations. This number of presentations to the hospital and other emergency settings can be affected by factors conditioning access to the emergency department. This is not shown in this analysis but was described during the COVID-19 confinements (27,28).
  • Limited information collected: Some drugs are reported as groups of drugs rather than individual drugs (e.g. ‘synthetic cannabinoids’ or ‘benzodiazepines’). More ad hoc and enhanced laboratory confirmation for some cases could be envisaged in the future to gain more specific insights into the drugs reported in these groups.
  • Lack of additional information: There is no additional information on the drugs, such as route of administration, quantity taken or possible adulteration, nor on the person, such as history of use, drug treatment, place and circumstances of the acute toxicity episode, pre-hospital care or previous medical history.
  • Lack of toxicological analysis: One important limitation is that data on the drug(s) involved in the presentations are based largely on patient reports combined with the impression of the treating clinician. If laboratory toxicological analysis is performed as part of routine clinical care, these data are collected. Only a minority of Euro-DEN Plus presentations have data on toxicological analysis reported. This might affect, in particular, the completeness of the data related to relatively rare drugs, and those in which there is reported variation in drug content, such as NPS (29,30). However, a high level of agreement was found between self-reported and analytically confirmed substances among the most commonly reported drugs (including heroin and cocaine in particular) in a previous Euro-DEN Plus study (31).

The study highlights the differences between centres, which are explained in part by the different social and demographic characteristics of the people who are using drugs, drug use patterns and settings (e.g. nightlife areas compared with more deprived suburbs), and the local drug market (including availability and potency of illicit drugs, and prescribed medicines). This monitoring underlines the value of the local data, but also the need to avoid generalisation beyond the hospital, the city, and especially the country.

In 2020 and 2021, any comparison with previous years and between centres should take into consideration the context of the COVID-19 pandemic. Drug availability and drug-using habits have been impacted by the pandemic, which, in turn, has impacted the nature and number of acute drug toxicity presentations. Further, the general access to hospital emergency services was disrupted and might have prevented some patients from presenting to hospital, even if they would have come to hospital under normal circumstances.

New developments and the future

The Euro-DEN Plus sentinel-based network has established itself as an important tool for monitoring acute drug-related harms, including those related to NPS, ‘established drugs’, and, in the context of polydrug use, alcohol and prescription medicines.

The data from the network can contribute to city-level monitoring, along with other indicators, including ESCAPE (monitoring of syringe residues), TEDI (monitoring through drug checking services) and SCORE (monitoring of wastewater), all of which are supplementary and anchored in the national monitoring systems coordinated by the European Reitox network (25). The data can also cross-check and complete the data on acute drug toxicity presentations reported at national level in some countries. This is useful, as national routine data are known to largely underestimate the number of drug-related presentations to hospital emergency departments (29,32-34). Finally, other types of drug-related presentations could be monitored through Euro-DEN Plus or a similar network, including drug-related trauma, driving accidents, other drug-related violence, including homicide or drug-facilitated sexual assault, and acute drug toxicity with suicidal intent.

The network will continue to contribute to the European Drug Report (25) and to the European Drug Market Report, as well as answer ad hoc requests (including from national bodies) and risk assessments, and contribute to other outputs such as Trendspotters.

The Euro-DEN Plus network of sentinel hospitals has demonstrated its potential as a useful complement to established monitoring tools in the drugs area for providing important data on the public health implications of drug use in Europe. This sentinel network also has the potential to provide timely information on geographical and temporal trends. Its ability to rapidly detect new trends and to inform on demographics and patterns of use can help to target local or national public health programmes and policy initiatives for specific groups of people and in specific settings and cities.

References

1.            Dines AM, Wood DM, Galicia M, Yates CM, Heyerdahl F, Hovda KE, et al. Presentations to the Emergency Department Following Cannabis use-a Multi-Centre Case Series from Ten European Countries. J Med Toxicol. 2015;11(4):415-21.

2.            Schmid Y, Galicia M, Vogt SB, Liechti ME, Burillo-Putze G, Dargan PI, et al. Differences in clinical features associated with cannabis intoxication in presentations to European emergency departments according to patient age and sex. Clin Toxicol (Phila). 2022;60(8):912-9.

3.            World Health Organization. The health and social effects of nonmedical cannabis use. Geneva: WHO Press; 2016.

4.            Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, et al. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016;16:293.

5.            Wong KU, Baum CR. Acute Cannabis Toxicity. Pediatr Emerg Care. 2019;35(11):799-804.

6.            Heier EC, Eyer F, Rabe C, Geith S, Dargan PI, Wood DM, et al. Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs. Eur J Emerg Med. 2022;29(4):291-300.

7.            Galicia M, Dargan PI, Dines AM, Yates C, Heyerdahl F, Hovda KE, et al. Clinical relevance of ethanol co-ingestion in patients with GHB/GBL intoxication. Toxicol Lett. 2019;314:37-42.

8.            Miro O, Dargan PI, Wood DM, Dines AM, Yates C, Heyerdahl F, et al. Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases. Clin Toxicol (Phila). 2019;57(8):718-26.

9.            Miro O, Burillo-Putze G, Schmid Y, Salgado E, Liechti ME, Dines AM, et al. Severity of emergency department presentations due to acute drug toxicity in Europe: longitudinal analysis over a 6-year period (2014-2019) stratified by sex. Eur J Emerg Med. 2023;30(1):21-31.

10.          Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol. 2017;70(1):101-13.

11.          Giraudon I, Mena G, Matias J, Vicente J. Emergency health consequences of cocaine use in Europe. A review of the monitoring of drug-related acute emergencies in 30 European countries. EMCDDA Technical report Luxembourg: Luxembourg: Publications Office of the European Union; 2014 [updated 4/1/2014. 1-59].

12.          EMCDDA. Perspective on Drugs. Emergency health consequences of cocaine use in Europe 2013 [updated 2013. 1-5].

13.         Observatoire Français des Drogues et des substances Addictives. (OFDT)eds. La cocaine : un marché en plein essor. Evolutions et tendances en France (2000-2022). Paris: OFDT; 2023

14.          EMCDDA, Europol. EU Drug Market Report: Cocaine — In-depth analysis. Luxembourg; 2022

15.          EMCDDA. Amphetamine drug-profile Lisbon, 2023.

16.          Noseda R, Schmid Y, Scholz I, Liakoni E, Liechti ME, Dargan PI, et al. MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014-2017. Clin Toxicol (Phila). 2021;59(2):131-7.

17.          Layne KA, Dargan PI, Dines AM, Leaper C, Yates C, Hovda KE, et al. Acute Toxicity Related to Misuse (Non-Medical Use) of Tramadol: Experience of the European Drug Emergencies Network Plus (Euro-DEN Plus) Project. Br J Clin Pharmacol. 2020.

18.          Lyphout C, Yates C, Margolin ZR, Dargan PI, Dines AM, Heyerdahl F, et al. Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data. Eur J Clin Pharmacol. 2019;75(1):77-85.

19.          Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, et al. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol. 2019;15(1):4-11.

20.          EMCDDA. New benzodiazepines in Europe – a review. Luxembourg; 2021.

21.          Miro O, Galicia M, Dargan P, Dines AM, Giraudon I, Heyerdahl F, et al. Intoxication by gamma-hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse. Toxicol Lett. 2017;277:84-91.

22.          Crulli B, Dines AM, Blanco G, Giraudon I, Eyer F, Liechti ME, et al. Novel psychoactive substances-related presentations to the emergency departments of the European drug emergencies network plus (Euro-DEN Plus) over the six-year period 2014-2019. Clin Toxicol (Phila). 2022;60(12):1318-27.

23.          EMCDDA. Recreational use of nitrous oxide — a growing concern for Europe. Luxembourg: Publications Office of the European Union; 2022.

24.          Miro O, Waring WS, Dargan PI, Wood DM, Dines AM, Yates C, et al. Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments. Clin Toxicol (Phila). 2021;59(10):896-904.

25.          EMCDDA. European Drug Report 2023: trends and developments. Luxembourg; 2023

26.          EMCDDA. Frequently asked questions (FAQ): drug overdose deaths in Europe Lisbon 2022 [updated 30/08/2022.

27.          EMCDDA. Impact of COVID-19 on drug markets, use, harms and drug services in the community and prisons. Lisbon; 2021 04/2021.

28.          Hondebrink L, Zammit M, Hogberg LCG, Hermanns-Clausen M, Lonati D, Faber K, et al. Effect of the first wave of COVID-19 on Poison Control Centre activities in 21 European countries: an EAPCCT initiative. Clin Toxicol (Phila). 2022;60(10):1145-55.

29.          Heyerdahl F, Hovda KE, Giraudon I, Yates C, Dines AM, Sedefov R, et al. Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations. Clin Toxicol (Phila). 2014;52(10):1005-12.

30.          Wood DM, Heyerdahl F, Yates CB, Dines AM, Giraudon I, Hovda KE, et al. The European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila). 2014;52(4):239-41.

31.          Liakoni E, Yates C, Dines AM, Dargan PI, Heyerdahl F, Hovda KE, et al. Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series. Medicine (Baltimore). 2018;97(5):e9784.

32.          Shah AD, Wood DM, Dargan PI. Survey of ICD-10 coding of hospital admissions in the UK due to recreational drug toxicity. QJM. 2011;104(9):779-84.

33.          Wood DM, Conran P, Dargan PI. ICD-10 coding: poor identification of recreational drug presentations to a large emergency department. Emerg Med J. 2011;28(5):387-9.

34.           Wood DM, De La Rue L, Hosin AA, Jurgens G, Liakoni E, Heyerdahl F, Hovda KE, Dines A, Giraudon I, Liechti ME, Dargan PI. Poor Identification of Emergency Department Acute Recreational Drug Toxicity Presentations Using Routine Hospital Coding Systems: the Experience in Denmark, Switzerland and the UK. J Med Toxicol. 2019;15:112-120

Recommended citation

Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (January 2024), European Drug Emergencies Network (Euro-DEN Plus): data and analysishttps://www.emcdda.europa.eu/publications/data-factsheet/european-drug-…

Source data

Click on the 'Show source tables' button below to access all of the data used to generate the data explorer on this page. 

In addition to the data below, a yearly snapshot of data from this Euro-DEN plus project is published as part of the Statistical Bulletin. This also includes further methodological notes. Please see the Hospital emergencies data set in the Statistical Bulletin 2023

Jump to a table:

Table 1. Euro-DEN Plus drug-related emergencies main data table
Country City Hospital Year All presentations Age: <25 years (%) Age: >45 years (%) Female (%) Severity: Admitted to intensive care unit (more severe) (%) Cannabis (%) Heroin (%) Amphetamine (%) MDMA (%) Methamphetamine (%) Cocaine (%) GHB/GBL (%) Alcohol (% recorded) Alcohol (% reporting co-ingestion) Any benzodiazepine (%) Pregabalin (%) Methadone (%) Any NPS (%) 1st other drug: name 1st other drug: % 2nd other drug: name 2nd other drug: % 3rd other drug: name 3rd other drug: % 4th other drug: name 4th other drug: % 5th other drug: name 5th other drug: %
Albania Tirana Tirana 2022 165 26.7 4.2 17 3 20 11.5 0 1.2 0 64.8 0 81.2 64.2 9.1 0 4.8 0 Ketamine 1.8 Ssri (not known) 1.8 Antidepressant (not known) 1.2 Crack 1.2 Diazepam 1.2
Albania Tirana Tirana 2021 226 30.1 3.1 15.9 8 27 20.8 0 0 0 48.7 2.7 73.5 85.5 10.6 0 5.8 0 Crack 10.2 Ketamine 0.9            
Algeria Bab El Oued Bab El Oued 2022 44 50 0 22.7 4.5 36.4 9.1 0 22.7 0 2.3 0 100 6.8 34.1 52.3 0 0 Carbamazepine 13.6 Amitriptyline 9.1 Clonazepam 9.1 Clorazepate 4.5 Haloperidol 4.5
Algeria Bab El Oued Bab El Oued 2021 130 52.3 1.5 23.1 12.3 13.1 4.6 0 10.8 0 3.8 0 98.5 2.3 36.2 49.2 0 0 Clonazepam 17.7 Tramadol 10 Amitriptyline 7.7 Carbamazepine 7.7 Prazepam 5.4
Algeria Oran Oran 2021 29 44.8 6.9 44.8 0 6.9 0 0 13.8 0 13.8 0 96.6 3.6 37.9 24.1 0 0 Bromazepam 17.2 Amitriptyline 10.3 Clonazepam 10.3 Prazepam 6.9 Risperidone 6.9
Belgium Antwerp Antwerp 2022 329 26.2 13.2 16.7 7 23.4 4 14 8.2 3 43.5 12.8 80.2 52.3 11.2 1.5 3 3.6 Ketamine 5.2 Crack 3.6 Bromazepam 2.4 Clonazepam 1.8 Nitrous oxide 1.5
Belgium Antwerp Antwerp 2021 670 22.1 14.9 23 4.8 31.8 5.5 8.5 4.5 0.7 36.6 4.6 100 42.7 13.3 1.8 2.2 2.5 Ketamine 3.7 Diazepam 3.3 Nitrous oxide 3 Bromazepam 2.8 3MMC 2.1
Belgium Antwerp Antwerp 2020 591 17.8 11.9 19.8 7.1 24.9 5.8 14 5.1 1.2 28.3 8.1 99.5 43 9.3 0.3 1.4 2.7 Ketamine 3.2 Nitrous oxide 3.2 3MMC 2.2 Diazepam 2 Tramadol 1.4
Belgium Antwerp Antwerp 2019 654 24.3 12.4 20.5 5.8 26 7.3 12.8 10.7 0.9 36.4 9 100 50 10.6 0.2 1.4 1.2 Ketamine 5.4 Nitrous oxide 3.8 Bromazepam 1.8 Tramadol 1.7 LSD 1.4
Belgium Antwerp Antwerp 2018 592 23.3 12.3 21.6 5.9 27.4 6.8 14.9 9.3 1 35 8.3 97.3 48.4 14.4 0 1 1 Ketamine 2.7 Bromazepam 1.7 Diazepam 1.5 Tramadol 1.5 LSD 1.2
Belgium Antwerp Antwerp 2017 500 24 10 22.6 4.4 22.2 7.4 13.8 10.6 0.2 31.4 8.4 98.8 51.4 7 0 1.6 0.8 Ketamine 3.2 Bromazepam 2 Poppers 1.8 Diazepam 1.4 LSD 1.4
Belgium Ghent Ghent 2022 48 33.3 8.3 25 0 16.7 2.1 14.6 12.5 8.3 37.5 6.2 100 62.5 12.5 2.1 4.2 12.5 Ketamine 20.8 Mephedrone 6.2 ALPHA-PVP 4.2 Alprazolam 4.2 3-HO-PCP 2.1
Belgium Ghent Ghent 2021 68 25 5.9 22.1 2.9 26.5 2.9 20.6 10.3 1.5 29.4 11.8 100 36.8 11.8 0 1.5 14.7 Mephedrone 7.4 Diazepam 5.9 Ketamine 5.9 Bromazepam 4.4 Zolpidem 4.4
Belgium Ghent Ghent 2020 126 27.8 11.1 21.4 7.1 23.8 7.9 24.6 7.9 2.4 22.2 7.1 100 48.4 19 0 4 2.4 Alprazolam 6.3 Diazepam 6.3 Stimulant (not known) 5.6 Ketamine 3.2 Lorazepam 2.4
Belgium Ghent Ghent 2019 202 39.6 6.9 22.8 6.4 29.7 6.4 18.3 10.9 3.5 27.7 5.4 100 55.4 7.4 0 3 5.9 Ketamine 10.4 Stimulant (not known) 4 LSD 2.5 Mephedrone 2 2CB 1
Belgium Ghent Ghent 2018 127 37.8 11.8 19.7 3.1 21.3 8.7 19.7 6.3 3.1 34.6 8.7 98.4 64 15 0 1.6 4.7 Ketamine 7.9 LSD 3.9 Alprazolam 2.4 Diazepam 2.4 2CB 1.6
Belgium Ghent Ghent 2017 113 32.7 10.6 31 6.2 38.1 4.4 23 13.3 3.5 32.7 14.2 99.1 44.6 12.4 0 7.1 0.9 Ketamine 4.4 Clorazepate 2.7 Trazodone 2.7 LSD 1.8 Paracetamol 1.8
Bulgaria Sofia Sofia 2022 35 62.9 0 40 0 54.3 5.7 31.4 0 25.7 11.4 2.9 100 20 8.6 0 22.9 0 LSD 5.7 Amitriptyline 2.9 Ketamine 2.9        
Bulgaria Sofia Sofia 2021 30 36.7 13.3 26.7 0 23.3 16.7 26.7 0 6.7 33.3 0 100 26.7 10 0 16.7 0 Alprazolam 3.3                
Bulgaria Sofia Sofia 2020 45 31.1 2.2 26.7 0 37.8 6.7 31.1 4.4 13.3 20 0 100 40 4.4 0 15.6 2.2 Clonazepam 2.2 Diazepam 2.2 Tfmpp 2.2        
Bulgaria Sofia Sofia 2019 72 51.4 1.4 30.6 0 44.4 6.9 25 5.6 2.8 16.7 0 100 23.6 9.7 0 15.3 0 Clonazepam 6.9 LSD 4.2 Clozapine 2.8 Alprazolam 1.4 Antidepressant (not known) 1.4
Bulgaria Sofia Sofia 2018 80 53.8 0 26.2 0 42.5 12.5 38.8 3.8 3.8 12.5 0 100 31.2 5 0 7.5 0 Diazepam 2.5 Ayahuasca 1.2 Biperiden 1.2 Codeine 1.2 Phencyclidine 1.2
Bulgaria Sofia Sofia 2017 87 52.9 2.3 39.1 0 51.7 10.3 25.3 2.3 3.4 14.9 0 100 23 2.3 0 9.2 0 Diazepam 2.3 LSD 1.1 Melatonin 1.1 Oxycodone 1.1 Zopiclone 1.1
Bulgaria Sofia Sofia 2016 49 53.1 0 34.7 0 38.8 16.3 26.5 4.1 6.1 16.3 0 98 33.3 4.1 0 6.1 0 Biperiden 4.1 Caffeine 2 Clonazepam 2 Clonidine 2 Diazepam 2
Cyprus Nicosia Nicosia 2022 7 42.9 0 14.3 0 71.4 0 0 0 28.6 42.9 0 100 42.9 0 0 0 0                    
Cyprus Nicosia Nicosia 2021 8 25 0 25 0 25 0 12.5 0 25 50 0 100 12.5 0 0 12.5 0 Crack 25                
Czech Republic Prague Prague 2018 18 16.7 16.7 22.2 0 27.8 5.6 5.6 0 16.7 0 16.7 100 50 11.1 0 11.1 5.6 Stimulant (not known) 16.7 4CMC 5.6 5F-MDMB-2201 5.6 Baclofen 5.6 Buprenorphine 5.6
Czech Republic Prague Prague 2017 26 30.8 7.7 50 0 19.2 3.8 11.5 23.1 15.4 3.8 3.8 100 84.6 38.5 0 0 3.8 Alprazolam 11.5 Clonazepam 11.5 Dextromethorphan 3.8 Quetiapine 3.8 Synthetic cannabinoid (not known) 3.8
Czech Republic Prague Prague 2016 26 7.7 26.9 38.5 30.8 19.2 3.8 0 7.7 23.1 0 11.5 100 73.1 53.8 0 3.8 7.7 Alprazolam 19.2 Clonazepam 15.4 Diazepam 15.4 3-MEO-PCP 3.8 Bromazepam 3.8
Denmark Copenhagen Copenhagen 2014 155 46.5 9 30.3 9 32.9 5.2 9.7 13.5 0 25.2 9 74.8 73.3 7.1 1.9 9 3.2 LSD 5.2 Ketamine 3.2 Zopiclone 3.2 Morphine 1.9 Oxazepam 1.9
Denmark Copenhagen Copenhagen 2013 47 48.9 8.5 27.7 4.3 21.3 4.3 6.4 19.1 0 42.6 6.4 85.1 45 2.1 2.1 14.9 2.1 Ketamine 6.4 Methylphenidate 6.4 Clonazepam 2.1 Khat 2.1 LSD 2.1
Denmark Roskilde Roskilde 2016 66 57.6 9.1 36.4 12.1 24.2 3 27.3 9.1 0 34.8 15.2 68.2 66.7 18.2 0 4.5 0 Quetiapine 7.6 LSD 6.1 Diazepam 4.5 Morphine 4.5 Chlorprothixene 3
Denmark Roskilde Roskilde 2015 89 55.1 10.1 19.1 11.2 22.5 2.2 18 18 3.4 38.2 15.7 69.7 72.6 12.4 0 13.5 1.1 Psychotropic agent (not known) 5.6 Chlorprothixene 4.5 Clonazepam 3.4 LSD 3.4 Methylphenidate 3.4
Estonia Parnu Parnu 2022 14 71.4 0 57.1 0 7.1 0 28.6 7.1 7.1 21.4 57.1 85.7 58.3 0 0 0 0 Tricyclic antidepressant (not known) 7.1                
Estonia Parnu Parnu 2021 18 50 0 44.4 11.1 16.7 0 38.9 27.8 38.9 11.1 5.6 83.3 40 33.3 0 5.6 0 LSD 16.7 Phencyclidine 5.6            
Estonia Parnu Parnu 2020 14 21.4 14.3 21.4 28.6 14.3 0 35.7 0 28.6 21.4 0 85.7 58.3 28.6 0 0 0 Tricyclic antidepressant (not known) 14.3 Alprazolam 7.1 Levomepromazine 7.1        
Estonia Parnu Parnu 2019 18 44.4 5.6 27.8 22.2 22.2 0 22.2 5.6 16.7 0 0 72.2 46.2 33.3 5.6 16.7 0 Tricyclic antidepressant (not known) 11.1                
Estonia Parnu Parnu 2018 24 37.5 4.2 58.3 29.2 8.3 0 20.8 4.2 8.3 25 25 87.5 47.6 29.2 0 4.2 0 Phencyclidine 8.3 Alprazolam 4.2            
Estonia Parnu Parnu 2017 25 72 0 60 4 32 0 36 32 36 4 16 88 77.3 20 0 0 0 Tricyclic antidepressant (not known) 16 Alprazolam 8 Barbiturate (not known) 4 Buprenorphine 4    
Estonia Parnu Parnu 2016 28 50 3.6 42.9 3.6 10.7 0 14.3 21.4 21.4 10.7 0 71.4 70 35.7 0 10.7 0 Alprazolam 17.9 Antidepressant (not known) 3.6 Fluoxetine 3.6 Gabapentin 3.6 Oxcarbamazepine 3.6
Estonia Parnu Parnu 2015 31 32.3 9.7 54.8 3.2 19.4 0 9.7 3.2 3.2 6.5 12.9 77.4 54.2 38.7 0 0 0 Quetiapine 6.5 Tricyclic antidepressant (not known) 6.5 Alprazolam 3.2 Mirtazapine 3.2 Mushroom (not known) 3.2
Estonia Parnu Parnu 2014 13 30.8 15.4 53.8 0 7.7 0 7.7 0 0 0 0 84.6 63.6 53.8 0 0 0 Alprazolam 23.1 Escitalopram 15.4 Diazepam 7.7 Levodopa 7.7 Oxazepam 7.7
Estonia Parnu Parnu 2013 6 50 16.7 16.7 16.7 33.3 0 16.7 0 0 16.7 16.7 66.7 75 16.7 0 0 0 Chlorprothixene 16.7 Zolpidem 16.7            
Estonia Tallinn Tallinn 2020 77 32.5 10.4 23.4 7.8 33.8 0 36.4 16.9 26 15.6 15.6 87 37.3 23.4 0 10.4 0 Fentanyl 9.1 Alprazolam 2.6 LSD 2.6 Clonazepam 1.3 Melperone 1.3
Estonia Tallinn Tallinn 2019 65 23.1 7.7 27.7 15.4 24.6 0 35.4 26.2 21.5 27.7 9.2 92.3 26.7 12.3 1.5 7.7 0 Fentanyl 7.7 LSD 3.1 Oxycodone 3.1 Tricyclic antidepressant (not known) 3.1 Alprazolam 1.5
Estonia Tallinn Tallinn 2018 61 31.1 1.6 18 8.2 24.6 0 39.3 16.4 26.2 18 18 83.6 41.2 14.8 0 4.9 1.6 Fentanyl 16.4 LSD 8.2 Quetiapine 3.3 Nbome (not known) 1.6    
Estonia Tallinn Tallinn 2017 113 29.5 8 27.4 10.6 16.8 0.9 31 9.7 8.8 11.5 34.5 89.4 45.5 19.5 0 4.4 0 Fentanyl 21.2 Barbiturate (not known) 1.8 Tricyclic antidepressant (not known) 1.8 LSD 0.9 Quetiapine 0.9
Estonia Tallinn Tallinn 2016 97 25.8 5.2 20.6 7.2 25.8 0 26.8 11.3 10.3 13.4 29.9 88.7 31.4 22.7 0 7.2 0 Fentanyl 27.8 LSD 2.1 Barbiturate (not known) 1 Quetiapine 1 Tramadol 1
Estonia Tallinn Tallinn 2015 91 20 5.6 33 3.3 13.2 0 26.4 5.5 5.5 13.2 25.3 89 37 27.5 0 11 0 Fentanyl 25.3 Tricyclic antidepressant (not known) 6.6 Tramadol 3.3 Alprazolam 1.1 Barbiturate (not known) 1.1
Estonia Tallinn Tallinn 2014 115 29.6 6.1 22.6 0 25.2 0 15.7 5.2 6.1 12.2 11.3 87 34 24.3 0 9.6 0 Fentanyl 22.6 Tricyclic antidepressant (not known) 3.5 Zopiclone 2.6 Alprazolam 1.7 Escitalopram 1.7
Estonia Tallinn Tallinn 2013 14 35.7 0 14.3 14.3 28.6 0 35.7 0 28.6 7.1 14.3 71.4 30 21.4 0 0 0 Fentanyl 42.9                
Finland Helsinki Helsinki 2017 253 33.6 4.7 26.5 0 6.7 0.8 15 2.4 1.2 1.6 43.5 79.4 53.7 24.5 9.1 1.6 3.2 Buprenorphine 20.6 Alprazolam 6.7 Clonazepam 6.3 Quetiapine 2.8 LSD 2
France Paris Paris 2022 317 20.2 10.4 27.4 8.8 38.8 2.8 0.9 15.8 2.8 18.9 12.9 90.5 41.5 24.6 1.6 6.9 6.3 Crack 14.8 Morphine 6.9 3MMC 3.8 Buprenorphine 3.2 Diazepam 2.5
France Paris Paris 2021 228 18.9 14.5 16.2 10.1 21.5 1.8 1.8 9.6 2.6 18.9 18.9 78.9 42.8 24.1 3.9 5.7 16.7 Crack 18 3MMC 14.5 Ketamine 3.5 Buprenorphine 2.2 Morphine 2.2
France Paris Paris 2020 251 28.7 14.3 17.9 8.4 27.9 2.8 3.6 8.8 1.6 16.3 12.7 90 39.4 24.7 5.2 8 9.2 Crack 15.1 3MMC 6.8 Buprenorphine 4 Poppers 3.6 Morphine 3.2
France Paris Paris 2019 297 27.7 14.9 20.5 8.1 20.2 2.7 3.7 17.2 4 19.2 14.1 82.5 42 17.5 2.4 10.4 7.7 Crack 11.8 3MMC 6.1 Morphine 4 Buprenorphine 3.4 Poppers 3
France Paris Paris 2018 351 23.4 7.4 25.9 8.3 21.1 3.1 2.8 19.7 1.4 20.5 13.4 82.1 50.3 11.4 0.6 10.8 6.3 Crack 16.2 Morphine 6.8 3MMC 3.4 Poppers 3.4 Buprenorphine 3.1
France Paris Paris 2017 273 20.1 10.3 25.3 9.2 30 4.8 2.9 18.7 1.5 25.6 5.5 90.1 47.6 15.4 0 8.4 3.3 Crack 16.5 Morphine 7.7 Buprenorphine 5.5 Ketamine 3.3 Poppers 2.9
France Paris Paris 2016 243 20.2 9.5 23 5.8 21.8 4.5 2.9 18.9 0 23.9 8.2 95.5 53 15.2 0 5.8 3.3 Crack 15.2 Buprenorphine 10.7 Morphine 7 Poppers 3.3 Bromazepam 2.1
France Paris Paris 2015 261 19.2 15.3 26.4 5.7 29.5 7.3 4.6 17.6 1.5 29.1 7.3 98.5 49.4 17.2 0 7.3 5.7 Crack 11.9 Buprenorphine 4.6 Morphine 4.6 MDPV 3.1 Bromazepam 1.9
France Paris Paris 2014 377 18.6 13.8 35.8 8.5 26.8 4.8 1.1 8 0 19.6 3.2 99.5 47.2 33.2 0 6.9 0.8 Crack 11.9 Diazepam 8 Bromazepam 6.4 Buprenorphine 6.4 Zopiclone 5
France Paris Paris 2013 155 25.8 26.5 41.9 5.8 13.5 3.9 1.3 3.2 0 16.8 4.5 97.4 43 31 0 1.3 0 Crack 10.3 Diazepam 9 Zolpidem 5.8 Alprazolam 5.2 Bromazepam 5.2
Georgia Tblisi Tblisi 2019 11 18.2 0 27.3 0 81.8 0 9.1 0 0 0 0 100 63.6 0 0 0 9.1 Psychotropic agent (not known) 18.2 Baclofen 9.1 Gabapentin 9.1 NPS/legal high crystal 9.1    
Georgia Tblisi Tblisi 2018 49 40.8 6.1 6.1 0 38.8 6.1 8.2 6.1 0 0 0 100 42.9 2 0 4.1 26.5 Baclofen 26.5 NPS/legal high (not known) 20.4 Gabapentin 14.3 Mephedrone 4.1 Psychotropic agent (not known) 4.1
Georgia Tblisi Tblisi 2017 8 50 0 0 0 25 0 0 0 0 0 0 100 37.5 0 0 0 25 Baclofen 25 NPS/legal high (not known) 25            
Germany Munich Munich 2022 43 14 9.3 20.9 0 30.2 16.3 7 4.7 2.3 16.3 2.3 100 58.1 48.8 34.9 9.3 4.7 Levomethadone 11.6 Dextromethorphan 4.7 Fentanyl 4.7 Quetiapine 4.7 2,4-fluorophenylmethylpiperidine 2.3
Germany Munich Munich 2021 74 17.6 13.5 20.3 0 20.3 6.8 17.6 1.4 5.4 24.3 6.8 100 35.1 40.5 31.1 1.4 8.1 Levomethadone 10.8 Alprazolam 4.1 Buprenorphine 4.1 Fentanyl 4.1 Lorazepam 4.1
Germany Munich Munich 2020 125 20.8 10.4 28 0 19.2 3.2 12 2.4 0.8 15.2 2.4 100 44 44.8 32.8 4.8 14.4 Levomethadone 12.8 Buprenorphine 6.4 Synthetic cannabinoid (not known) 4.8 Methylphenidate 4 Alprazolam 2.4
Germany Munich Munich 2019 130 25.4 12.3 29.2 0 11.5 5.4 10 3.1 2.3 13.8 3.1 100 46.2 35.4 32.3 4.6 18.5 Synthetic cannabinoid spice 13.8 Buprenorphine 8.5 Levomethadone 7.7 LSD 3.8 Bupropion 2.3
Germany Munich Munich 2018 133 24.8 9 24.1 0 11.3 13.5 3.8 4.5 1.5 8.3 3.8 100 41.4 21.1 15.8 3 18.8 Buprenorphine 15.8 Synthetic cannabinoid spice 9.8 Levomethadone 4.5 Bupropion 3.8 Diazepam 3
Germany Munich Munich 2017 113 18.6 10.6 22.1 0 10.6 6.2 10.6 2.7 7.1 7.1 1.8 100 46.9 24.8 22.1 8 16.8 Buprenorphine 11.5 NPS/legal high bath salts 8 Lorazepam 6.2 Methylphenidate 4.4 Synthetic cannabinoid spice 4.4
Germany Munich Munich 2016 115 17.4 12.2 24.3 0 20 13 6.1 3.5 0 7 3.5 100 41.7 23.5 20 11.3 32.2 NPS/legal high bath salts 16.5 Buprenorphine 13.9 Synthetic cannabinoid spice 6.1 Fentanyl 4.3 ALPHA-PVP 3.5
Germany Munich Munich 2015 152 22.4 6.6 30.9 0 30.9 16.4 15.8 5.9 0.7 11.8 2 100 30.9 41.4 28.3 16.4 33.6 Buprenorphine 14.5 NPS/legal high bath salts 9.2 Synthetic cannabinoid (not known) 9.2 Fentanyl 4.6 MDPV 3.3
Germany Munich Munich 2014 213 18.8 5.6 32.9 1.4 30 15.5 17.8 5.2 1.9 12.7 6.1 100 38 41.3 27.2 23.5 24.4 Buprenorphine 14.1 MDPV 10.3 Fentanyl 9.9 Tramadol 5.2 3MMC 4.2
Germany Munich Munich 2013 49 24.5 2 32.7 0 34.7 18.4 28.6 4.1 2 12.2 6.1 93.9 41.3 38.8 12.2 34.7 10.2 MDPV 10.2 Buprenorphine 6.1 Dextromethorphan 6.1 Fentanyl 4.1 MDEA 4.1
Ireland Drogheda Drogheda 2022 52 40.4 3.8 26.9 0 9.6 38.5 1.9 3.8 0 46.2 0 100 36.5 30.8 0 0 0 Diazepam 15.4 Alprazolam 9.6 Ketamine 3.8 LSD 1.9 Tramadol 1.9
Ireland Drogheda Drogheda 2021 43 32.6 9.3 20.9 0 27.9 23.3 0 0 0 44.2 0 93 50 18.6 2.3 9.3 0 Alprazolam 7 Crack 4.7 Diazepam 4.7 Amitriptyline 2.3 Codeine 2.3
Ireland Drogheda Drogheda 2020 87 39.1 2.3 11.5 4.6 11.5 35.6 1.1 5.7 1.1 26.4 0 100 47.1 42.5 5.7 3.4 0 Alprazolam 28.7 Diazepam 6.9 Tramadol 3.4 Zopiclone 3.4 Gabapentin 1.1
Ireland Drogheda Drogheda 2019 82 31.7 13.4 19.5 8.5 11 35.4 1.2 4.9 0 24.4 0 100 48.8 43.9 1.2 9.8 1.2 Alprazolam 35.4 Diazepam 7.3 Morphine 3.7 Zopiclone 3.7 LSD 2.4
Ireland Drogheda Drogheda 2018 26 38.5 23.1 34.6 19.2 11.5 3.8 0 7.7 3.8 30.8 0 100 61.5 61.5 3.8 7.7 0 Alprazolam 26.9 Baclofen 7.7 Diazepam 7.7 Gabapentin 7.7 Morphine 7.7
Ireland Drogheda Drogheda 2017 20 45 10 50 10 30 0 0 35 5 50 0 95 89.5 40 0 0 0 Morphine 25                
Ireland Drogheda Drogheda 2016 24 43.5 4.3 29.2 4.2 33.3 12.5 0 29.2 8.3 37.5 0 95.8 87 41.7 0 0 0 Diazepam 4.2 Fluoxetine 4.2 Morphine 4.2 St john's wort 4.2    
Ireland Drogheda Drogheda 2015 11 18.2 0 27.3 18.2 27.3 54.5 0 0 0 27.3 0 36.4 50 45.5 0 0 0 Alprazolam 36.4 Diazepam 18.2            
Ireland Drogheda Drogheda 2014 29 58.6 10.3 6.9 6.9 31 13.8 13.8 13.8 3.4 20.7 0 72.4 61.9 41.4 0 0 0 Alprazolam 13.8 Chlordiazepoxide 3.4 Clonazepam 3.4 Escitalopram 3.4 Flurazepam 3.4
Ireland Drogheda Drogheda 2013 13 38.5 7.7 15.4 0 38.5 0 0 23.1 7.7 23.1 0 100 84.6 61.5 0 7.7 0 Alprazolam 23.1 Diazepam 15.4 Flurazepam 7.7 Sertraline 7.7 Zopiclone 7.7
Ireland Dublin Dublin 2022 565 17.5 24.5 20.7 2.8 9.9 20 0 3.5 1.8 30.6 8 43.7 66.4 28.1 5 13.3 0.5 Alprazolam 18.6 Zopiclone 6.2 Diazepam 4.6 Ketamine 4.1 Poppers 0.9
Ireland Dublin Dublin 2021 588 16.8 20.9 26.7 2.4 11.2 18.7 0.3 1.7 2.6 23.3 5.4 65.1 56.1 31.5 7.3 10.7 0.2 Alprazolam 17.3 Diazepam 8.2 Zopiclone 7.1 Crack 5.4 Mirtazapine 1.7
Ireland Dublin Dublin 2020 528 16.9 20.4 31.6 3.8 12.7 23.9 0.6 3.4 1.3 14.8 3.8 50 55.3 29.9 6.8 11.9 0.4 Alprazolam 19.7 Zopiclone 7.6 Diazepam 6.2 Crack 6.1 Ketamine 2.8
Ireland Dublin Dublin 2019 511 21.1 11.4 32.7 2.7 14.1 31.1 0.6 6.5 2 20.4 4.1 56.9 55.3 26 4.9 9.8 0.8 Zopiclone 11.9 Alprazolam 10.8 Diazepam 6.3 Crack 3.5 Ketamine 2.5
Ireland Dublin Dublin 2018 589 25.9 12.5 25.8 0.5 10.5 33.8 1.4 9 0.8 19.7 2.7 41.1 72.3 25.8 5.4 8 2.9 Alprazolam 13.8 Zopiclone 6.6 Diazepam 2.9 Synthetic cannabinoid spice 2.2 Ketamine 1.9
Ireland Dublin Dublin 2017 586 24 7.2 32.4 3.8 9.9 34 0.7 7 0.7 20.5 1.5 52.4 70 18.9 7.2 7.7 1.5 Zopiclone 11.6 Alprazolam 7.7 Diazepam 4.9 Crack 2.4 Ketamine 2.2
Ireland Dublin Dublin 2016 436 23.5 7.6 28.4 1.1 10.3 33.9 0 8.7 0.7 18.8 1.1 57.6 63.3 22.9 7.8 9.9 7.3 Zopiclone 12.8 Alprazolam 8.9 Diazepam 5.7 Mephedrone 5.7 Flurazepam 1.6
Ireland Dublin Dublin 2015 543 22 6.3 27.1 0.9 10.1 35 1.7 8.7 2 16.2 0.7 45.7 69.8 18.4 1.8 10.7 13.1 Zopiclone 20.1 Mephedrone 12 Diazepam 9.4 Alprazolam 2.2 Ketamine 1.1
Ireland Dublin Dublin 2014 524 27.8 4.3 29.2 1.1 8.4 33.2 0.2 11.6 5.2 18.7 0.6 50.4 53.4 10.5 1.3 5.5 13.5 Mephedrone 13 Zopiclone 7.1 Diazepam 4.8 Alprazolam 2.1 Ketamine 2.1
Ireland Dublin Dublin 2013 135 34.6 3.8 19.3 0.7 17.8 33.3 0.7 11.9 0 17.8 0.7 42.2 68.4 8.1 0 3.7 9.6 Mephedrone 8.9 Ketamine 3.7 LSD 3 Zopiclone 2.2 Alprazolam 1.5
Israel Haifa Haifa 2021 60 18.6 39 30 5 13.3 3.3 1.7 1.7 1.7 5 0 90 16.7 6.7 3.3 5 0 Fentanyl 5 Clonazepam 3.3 Methylphenidate 3.3 Paracetamol 3.3 Antihistamine (not known) 1.7
Italy Monza Monza 2018 95 36.8 12.6 27.4 1.1 43.2 5.3 6.3 0 0 65.3 0 98.9 36.2 14.7 0 5.3 0 Amanita muscaria 1.1 Ayahuasca 1.1 Butalbital 1.1 Oxolamine 1.1 Propyphenazone 1.1
Italy Monza Monza 2017 113 36.3 15 21.2 0.9 49.6 9.7 2.7 0 1.8 54 0 97.3 36.4 23 0 2.7 0 Butalbital 0.9 Caffeine 0.9 Chlorpromazine 0.9 LSD 0.9 Morphine 0.9
Italy Rozzano Rozzano 2022 18 27.8 22.2 22.2 0 11.1 0 0 0 0 55.6 0 83.3 53.3 0 0 0 44.4 Synthetic cannabinoid (not known) 44.4                
Italy Rozzano Rozzano 2021 26 38.5 26.9 15.4 3.8 30.8 0 3.8 3.8 7.7 34.6 0 88.5 52.2 11.5 0 0 23.1 Synthetic cannabinoid (not known) 19.2 Cathinone (not known) 3.8            
Latvia Riga Riga 2022 35 20 5.7 22.9 8.6 22.9 0 37.1 0 20 11.4 0 100 45.7 22.9 2.9 14.3 0 Propofol 8.6 Fentanyl 5.7 Thiopental 5.7 Alprazolam 2.9 Atropine 2.9
Latvia Riga Riga 2021 41 9.8 14.6 22 0 14.6 2.4 2.4 2.4 26.8 17.1 0 100 26.8 26.8 0 14.6 0 Tramadol 9.8 Clozapine 7.3 Clonazepam 4.9 Diphenhydramine 4.9 Ketamine 4.9
Latvia Riga Riga 2020 56 25 5.4 25 0 32.1 1.8 7.1 5.4 17.9 5.4 0 100 28.6 26.8 1.8 10.7 8.9 Propofol 7.1 Trihexyphenidyl 7.1 Carbamazepine 5.4 Diphenhydramine 5.4 Amitriptyline 3.6
Latvia Riga Riga 2019 43 30.2 7 16.3 0 18.6 2.3 7 16.3 7 2.3 0 100 41.9 25.6 0 25.6 0 Tramadol 20.9 Clozapine 11.6 Alprazolam 7 Diphenhydramine 4.7 Lorazepam 4.7
Latvia Riga Riga 2018 51 15.7 5.9 15.7 0 21.6 11.8 2 3.9 13.7 3.9 3.9 100 58.8 17.6 0 11.8 2 Tramadol 7.8 Clonazepam 5.9 Diphenhydramine 5.9 Barbiturate (not known) 2 Crack 2
Latvia Riga Riga 2017 81 19.8 4.9 11.1 0 16 11.1 8.6 1.2 6.2 6.2 2.5 100 56.8 12.3 0 9.9 3.7 Fentanyl 6.2 Carbamazepine 4.9 Tramadol 4.9 Diazepam 3.7 Morphine 3.7
Lebanon Beirut Beirut 2021 5 25 0 0 0 40 0 0 20 0 40 20 100 40 20 0 0 0 Clonazepam 20                
Lithuania Kaunus Kaunus 2017 164 22.1 16.6 20.7 0.6 7.9 7.3 3 3 0.6 1.8 0 95.1 44.2 17.7 0 3.7 3.7 Psychotropic agent (not known) 32.3 Clonazepam 3.7 NPS/legal high (not known) 3.7 Alprazolam 3 Bromazepam 3
Lithuania Vilnius Vilnius 2022 118 31.4 7.6 16.9 5.9 22 0.8 16.9 2.5 1.7 6.8 0 90.7 64.5 0 0.8 3.4 9.3 Fentanyl 21.2 LSD 3.4 NPS/legal high crystal 2.5 Synthetic cannabinoid (not known) 2.5 Carfentanyl 1.7
Lithuania Vilnius Vilnius 2021 142 23.2 4.9 13.4 4.2 25.4 4.9 13.4 2.8 0.7 6.3 0 89.4 48 1.4 0 2.1 7 Fentanyl 15.5 Stimulant (not known) 6.3 LSD 2.8 Synthetic cannabinoid spice 2.8 Alprazolam 1.4
Lithuania Vilnius Vilnius 2020 94 37.2 6.4 18.1 3.2 30.9 5.3 13.8 4.3 0 7.4 0 90.4 42.4 6.4 0 3.2 2.1 Fentanyl 9.6 LSD 3.2 Bromazepam 2.1 Caffeine 2.1 Alprazolam 1.1
Lithuania Vilnius Vilnius 2019 112 33 4.5 17.9 13.4 20.5 8 14.3 10.7 2.7 6.2 0.9 92.9 50 4.5 1.8 4.5 5.4 Fentanyl 11.6 Stimulant (not known) 3.6 LSD 2.7 Psilocybe mushroom 2.7 Synthetic cannabinoid spice 2.7
Lithuania Vilnius Vilnius 2018 135 28.4 4.5 19.3 11.9 14.8 22.2 8.1 6.7 2.2 11.1 3.7 86.7 44.4 5.2 0 3.7 8.9 Fentanyl 7.4 Synthetic cannabinoid (not known) 3.7 Synthetic cannabinoid spice 3.7 Clonazepam 3 Psychotropic agent (not known) 3
Lithuania Vilnius Vilnius 2017 203 19.8 6.4 17.7 5.4 15.3 48.3 9.4 0.5 3 4.4 1.5 74.9 56.6 10.3 0 3.9 7.9 Clonazepam 4.9 Diazepam 3.9 Synthetic cannabinoid (not known) 3 Synthetic cannabinoid spice 2.5 Alprazolam 2
Malta Msida Msida 2022 1134 26.9 13.4 19.7 1.2 48.4 13.9 0.3 3.5 0 40.8 0.3 99.7 29 2.9 0 0.1 13.2 Synthetic cannabinoid (not known) 12 Crack 7.5 Diazepam 1.1 AB-PINACA 1 Ketamine 1
Malta Msida Msida 2021 568 26.3 13.4 21 0.7 32.2 19.4 0.5 4.8 0.2 46.3 0.2 100 32.4 7.2 0.2 0.2 19.5 Synthetic cannabinoid (not known) 16.5 Crack 10.4 Lorazepam 2.5 Quetiapine 2.3 Alprazolam 1.6
Malta Msida Msida 2020 579 22.1 9.7 20 1.6 34.5 18.1 0.7 6 0.5 53.2 0.7 100 30.6 8.3 0.2 2.1 10.9 Synthetic cannabinoid (not known) 10.7 Crack 5 Diazepam 2.4 Clonazepam 2.2 Quetiapine 2.2
Malta Msida Msida 2019 563 25.4 7.7 25.4 3 28.4 17.4 0.4 9.8 0.2 48.7 0.4 100 25.9 6.7 0 1.1 19.9 Synthetic cannabinoid (not known) 17.4 Crack 3.4 Diazepam 3.2 Quetiapine 2.1 Ketamine 1.8
Malta Msida Msida 2018 490 30.4 9.4 20.6 2.7 23.7 20.2 0 6.5 0.2 47.3 0 100 25.5 3.7 0 0.8 27.3 Synthetic cannabinoid (not known) 26.7 Clonazepam 2.2 Quetiapine 2.2 LSD 1.6 Ketamine 1.4
Malta Msida Msida 2017 369 23.8 12.7 21.7 1.9 27.9 25.2 0.5 4.6 0 45 0.3 99.7 29.9 3 0 0.3 24.9 Synthetic cannabinoid (not known) 24.1 Diazepam 2.2 Quetiapine 1.6 LSD 0.8 Paroxetine 0.8
Malta Msida Msida 2016 218 30 11.5 18.3 4.1 19.3 27.5 1.4 11.9 0 50.5 1.4 95.9 36.4 3.7 0 1.4 19.3 Synthetic cannabinoid (not known) 17.9 Ketamine 2.8 LSD 1.8 Clonazepam 1.4 Diazepam 1.4
Netherlands Amsterdam Amsterdam 2022 670 27.9 14.8 24.6 0 35.2 2.1 6.3 12.4 1.2 20.3 19.7 100 36 0.4 0 0.3 6 Ketamine 7.2 Nitrous oxide 3.1 3MMC 2.7 LSD 1.8 2CB 1.5
Netherlands Amsterdam Amsterdam 2021 492 25 12.8 26.4 0.6 28.7 3 7.9 9.3 2 28.7 30.3 100 35.4 1.2 0 0.6 6.3 Nitrous oxide 6.1 Ketamine 4.7 3MMC 3.7 LSD 1.8 Mushroom (not known) 1.6
Netherlands Amsterdam Amsterdam 2020 639 29.5 11.6 22.5 2 36.5 3.8 8.5 11.1 0.8 23.2 23.6 100 30.2 0 0 1.9 2.2 LSD 3 Nitrous oxide 2.3 Psilocybin 1.7 Ketamine 1.3 Psilocybe mushroom 1.1
Netherlands Amsterdam Amsterdam 2019 1222 30 12.2 27.3 0.4 49.8 2.3 7.8 14.8 1.1 21.8 16 100 36.4 0.3 0 0.8 1.7 Psilocybin 4.9 LSD 1.2 4FA 0.7 3MMC 0.5 2CB 0.2
Netherlands Amsterdam Amsterdam 2018 1208 25.7 12.9 26 6.5 55.3 2.3 6.7 13.2 0 20.2 15.3 100 38.5 0.2 0 1.2 1.4 Psilocybin 6.4 LSD 1.4 4FA 0.7 2CB 0.3 Caffeine 0.2
Netherlands Utrecht Utrecht 2022 23 17.4 8.7 17.4 39.1 13 4.3 21.7 30.4 0 21.7 30.4 82.6 47.4 4.3 4.3 0 13 Ketamine 21.7 3MMC 8.7 Baclofen 4.3 Clonazepam 4.3 Crack 4.3
Netherlands Utrecht Utrecht 2021 21 23.8 14.3 38.1 42.9 0 4.8 9.5 19 4.8 14.3 38.1 76.2 18.8 19 0 4.8 19 LSD 9.5 O-desmethyl tramadol 9.5 Acetic acid 4.8 ALPHA-PHP 4.8 Bromazolam 4.8
Netherlands Utrecht Utrecht 2020 32 40.6 9.4 21.9 21.9 15.6 0 15.6 15.6 0 31.2 40.6 96.9 48.4 3.1 0 0 3.1 LSD 15.6 Ketamine 6.2 3FPM 3.1 Methylphenidate 3.1 Nitrous oxide 3.1
Netherlands Utrecht Utrecht 2019 32 34.4 9.4 15.6 18.8 25 6.2 12.5 9.4 0 34.4 40.6 78.1 36 15.6 0 6.2 3.1 Nitrous oxide 9.4 Baclofen 6.2 Diazepam 6.2 ALPHA-PVP 3.1 Alprazolam 3.1
Netherlands Utrecht Utrecht 2018 50 40 10 26 34 16 0 10 18 2 26 38 94 55.3 8 0 4 4 Oxazepam 6 Crack 4 Ketamine 4 LSD 4 Nitrous oxide 4
North Macedonia Skopje Skopje 2022 93 27.8 8.9 18.3 11.8 30.1 18.3 8.6 2.2 0 36.6 0 98.9 22.8 34.4 0 15.1 0 Diazepam 19.4 Alprazolam 5.4 Buprenorphine 5.4 Tramadol 5.4 Energy drink 4.3
Norway Oslo Oslo OAEOC 2022 1568 19.2 21.1 27 0 16.1 36.4 20.4 3.6 0.4 15.3 13.1 100 33.2 27.3 1.2 1.8 0.2 Alprazolam 13.7 Clonazepam 4.4 Diazepam 3.7 Ketamine 2.7 LSD 2
Norway Oslo Oslo OAEOC 2021 1562 20.3 18.7 27.7 0 16.9 29.5 22.8 4 0.8 12.8 12.5 68.7 52.1 25.2 1.8 4.4 0.6 Alprazolam 9.5 Clonazepam 6.1 Diazepam 5.8 Oxazepam 3.7 LSD 2.1
Norway Oslo Oslo OAEOC 2020 2114 18.4 19.3 23.7 0 11.4 34.4 22.3 4.6 0.8 7.9 10.9 81.3 33.9 20.1 1 2 0.1 Clonazepam 11 Alprazolam 4.4 Sedative (not known) 3.5 Diazepam 2.5 Stimulant (not known) 2.1
Norway Oslo Oslo OAEOC 2019 1860 15.5 22.5 20.4 0 13 34.6 20.6 3.8 0.8 8.2 11.4 32.6 87 20.6 1 2.7 0.5 Clonazepam 12.4 Diazepam 3.9 Alprazolam 2.2 LSD 1.9 Oxazepam 1.7
Norway Oslo Oslo OAEOC 2018 1971 14.8 20.6 22.9 0 14.2 33.9 21.9 3.8 0.5 9 11.8 80.3 35.5 21.2 0.7 2.2 0.4 Clonazepam 7.4 LSD 2.3 Diazepam 2.2 Oxazepam 1.4 Morphine 1.2
Norway Oslo Oslo OAEOC 2017 1593 17.4 18.4 24.7 0 14.2 32.9 23.9 4.2 0.7 6.2 12.3 61.2 43.5 24.7 1.4 4.5 0.1 Clonazepam 16.1 Diazepam 4.1 Oxazepam 2.3 Alprazolam 1.9 Buprenorphine 1.4
Norway Oslo Oslo OAEOC 2016 1303 17.4 17.7 23.9 0 12.6 46.8 23.4 4.7 0.2 5.6 10.3 80.3 33.1 29.2 0.4 3.7 0.2 Clonazepam 18.3 Diazepam 5.1 Alprazolam 3.6 Oxazepam 2.4 Stimulant (not known) 2.1
Norway Oslo Oslo OAEOC 2015 1576 15.1 21.9 23 0 14.1 43.9 22.3 3 0.6 6.8 9.8 66.4 42.5 30.8 0.1 3.3 0.2 Clonazepam 17.3 Diazepam 4.8 Oxazepam 3.4 Alprazolam 2.9 Buprenorphine 1.5
Norway Oslo Oslo OAEOC 2014 1529 16.8 22.5 21.9 0 11.8 45.9 19.3 2.6 0.6 6.1 9 34.3 78.1 32.1 0.4 2.7 0.6 Clonazepam 18.8 Diazepam 4.6 Alprazolam 4.3 Oxazepam 2.7 Buprenorphine 2.5
Norway Oslo Oslo OAEOC 2013 331 22.3 21.4 22.4 0 10.3 44.4 23 2.1 0.6 5.1 10.9 33.2 81.8 31.4 0 3 0 Clonazepam 17.8 Diazepam 6.6 Alprazolam 4.5 Oxazepam 3.6 Flunitrazepam 1.5
Norway Oslo Oslo OUH 2022 171 14.1 17.1 25.7 94.7 5.3 15.8 11.7 4.7 0 9.9 50.9 45 98.7 5.8 0 2.9 0.6 Alprazolam 1.2 Ketamine 1.2 Crack 0.6 DMT 0.6 Lisdexamfetamine 0.6
Norway Oslo Oslo OUH 2021 141 13 26.8 27.7 93.6 2.8 15.6 7.8 5.7 0.7 7.8 42.6 55.3 94.9 9.9 0.7 2.1 0 Alprazolam 0.7 LSD 0.7 Mushroom (not known) 0.7 Nitrous oxide 0.7 Olanzapine 0.7
Norway Oslo Oslo OUH 2020 216 19.2 16.4 23.1 93.5 2.8 13.4 13.9 4.2 0 5.1 52.3 44 88.4 8.8 0 0.9 0 LSD 1.4 Alprazolam 0.5 Diazepam 0.5 Mushroom (not known) 0.5 Quetiapine 0.5
Norway Oslo Oslo OUH 2019 195 18 18 27.7 93.8 2.1 19 16.4 5.6 0 10.3 44.1 46.7 89 1.5 0 1 0 Buprenorphine 0.5 Diazepam 0.5 LSD 0.5        
Norway Oslo Oslo OUH 2018 213 15.1 14.2 23 93 8 17.8 8.5 6.6 0.5 6.6 53.5 58.7 88 7 0 1.9 0 Ketamine 1.4 LSD 1.4 Alprazolam 0.9 Mushroom (not known) 0.5    
Norway Oslo Oslo OUH 2017 196 17.5 11.9 30.1 87.8 6.6 13.8 16.8 4.6 0.5 6.6 53.1 63.3 95.2 10.2 0 1 0 Clonazepam 2.6 Flunitrazepam 1 Alprazolam 0.5 Antihistamine (not known) 0.5 Morphine 0.5
Norway Oslo Oslo OUH 2016 194 19.1 11.3 26.8 91.2 6.2 19.1 17.5 6.2 1.5 6.2 51 62.9 95.1 11.9 0 1.5 2.1 Clonazepam 5.7 2CB 1.5 LSD 1 Psilocybe mushroom 1 2CD 0.5
Norway Oslo Oslo OUH 2015 180 24.2 8.4 29.4 89.4 6.1 23.3 25.6 5.6 0 10 55.6 60 84.3 7.2 0 0.6 3.9 Clonazepam 3.9 25B-NBOME 1.7 Ayahuasca 1.1 DMT 1.1 2CB 0.6
Norway Oslo Oslo OUH 2014 192 25.1 8 25.5 88 12.5 26 29.2 3.1 1 14.6 45.8 57.3 70.9 14.1 0 0.5 0.5 Clonazepam 8.9 LSD 3.1 Alprazolam 1 2CL 0.5 Alimemazine 0.5
Norway Oslo Oslo OUH 2013 40 25.6 20.5 20 82.5 15 37.5 30 5 0 7.5 35 75 40 42.5 0 0 0 Alprazolam 5 Clonazepam 5 Diazepam 5 Alimemazine 2.5 Barbiturate (not known) 2.5
Poland Gdansk Gdansk 2022 59 64.4 3.4 25.4 0 18.6 8.5 18.6 6.8 3.4 6.8 0 100 30.5 23.7 13.6 3.4 25.4 NPS/legal high (not known) 20.3 Clonazepam 13.6 Alprazolam 10.2 Zolpidem 10.2 Dextromethorphan 5.1
Poland Gdansk Gdansk 2021 50 56 4 16 0 18 6 30 6 2 6 0 100 44 12 4 4 28 NPS/legal high (not known) 22 Dextromethorphan 8 Codeine 6 Oxycodone 6 Tramadol 6
Poland Gdansk Gdansk 2020 69 47.8 2.9 18.8 0 18.8 2.9 44.9 8.7 5.8 8.7 0 100 31.9 15.9 1.4 4.3 21.7 NPS/legal high (not known) 18.8 Codeine 13 Clonazepam 10.1 Alprazolam 7.2 Dextromethorphan 5.8
Poland Gdansk Gdansk 2019 101 38.6 6.9 22.8 1 20.8 8.9 30.7 5.9 3 6.9 0 100 35.6 7.9 2 2 30.7 NPS/legal high (not known) 28.7 Clonazepam 4 Buprenorphine 3 Dextromethorphan 3 Alprazolam 2
Poland Gdansk Gdansk 2018 93 53.8 0 20.4 0 17.2 3.2 25.8 0 4.3 8.6 0 100 33.3 12.9 0 0 39.8 NPS/legal high (not known) 14 Synthetic cannabinoid (not known) 6.5 Mephedrone 5.4 Dextromethorphan 4.3 Alprazolam 3.2
Poland Gdansk Gdansk 2017 103 49.5 1.9 18.4 0 18.4 1 25.2 3.9 2.9 8.7 1.9 100 35 1.9 0 1 48.5 Synthetic cannabinoid (not known) 14.6 NPS/legal high (not known) 12.6 Psychotropic agent (not known) 10.7 Cathinone (not known) 5.8 Mephedrone 4.9
Poland Gdansk Gdansk 2016 125 56.9 2.4 16 0 14.4 4.8 20 4.8 4 9.6 3.2 98.4 28.5 0.8 0 0.8 56 Synthetic cannabinoid (not known) 20.8 NPS/legal high (not known) 13.6 Mephedrone 9.6 Psychotropic agent (not known) 3.2 Cathinone (not known) 2.4
Poland Gdansk Gdansk 2015 236 60.6 2.5 15.3 0.4 10.2 2.5 15.3 2.1 2.5 2.1 2.1 100 20.8 4.2 0 2.1 65.7 NPS/legal high (not known) 47 Mephedrone 10.6 Dextromethorphan 4.2 Synthetic cannabinoid magic tobacco 2.5 Psychotropic agent (not known) 2.1
Poland Gdansk Gdansk 2014 158 51.3 3.8 20.3 0 10.8 11.4 15.2 0.6 3.8 5.7 1.9 100 21.5 4.4 0 5.1 34.8 NPS/legal high (not known) 16.5 Dextromethorphan 10.8 Mephedrone 8.9 Psychotropic agent (not known) 7 25B-NBOME 1.3
Poland Gdansk Gdansk 2013 39 64.1 0 20.5 2.6 15.4 5.1 15.4 2.6 2.6 0 2.6 100 35.9 0 0 5.1 35.9 NPS/legal high (not known) 25.6 Dextromethorphan 7.7 Datura stramonium 5.1 LSD 5.1 Tramadol 5.1
Romania Bucharest Bucharest 2022 61 100 0 31.1 0 63.9 3.3 1.6 3.3 6.6 1.6 0 100 32.8 19.7 0 0 19.7 NPS/legal high (not known) 14.8 NPS/legal high pure by magic 4.9 Alprazolam 3.3 Oxycodone 3.3 Clonazepam 1.6
Romania Bucharest Bucharest 2021 31 100 0 19.4 0 32.3 0 6.5 6.5 6.5 12.9 0 96.8 13.3 12.9 0 0 38.7 NPS/legal high (not known) 38.7 Clonazepam 6.5 Alprazolam 3.2 Levomepromazine 3.2 Oxycodone 3.2
Romania Bucharest Bucharest 2020 27 100 0 48.1 0 70.4 0 3.7 3.7 0 0 0 100 22.2 3.7 0 0 14.8 NPS/legal high (not known) 14.8 Bilastine 3.7 Diazepam 3.7 LSD 3.7 Metoclopramide 3.7
Romania Bucharest Bucharest 2019 45 100 0 42.2 0 68.9 6.7 2.2 0 2.2 0 0 100 31.1 2.2 0 0 17.8 NPS/legal high (not known) 15.6 LSD 4.4 Benzydamine 2.2 Ketamine 2.2 NPS/legal high zombie 2.2
Romania Bucharest Bucharest 2018 30 100 0 50 0 73.3 3.3 0 0 0 3.3 0 100 13.3 6.7 0 0 23.3 NPS/legal high (not known) 23.3 Datura stramonium 6.7 Alprazolam 3.3 Barbiturate (not known) 3.3    
Serbia Belgrade Belgrade 2022 114 22.1 6.2 23.7 6.1 23.7 22.8 20.2 4.4 0 21.1 3.5 97.4 36.9 8.8 6.1 7.9 0 Buprenorphine 3.5 Diazepam 3.5 Lorazepam 2.6 Bromazepam 1.8 Clonazepam 1.8
Serbia Belgrade Belgrade 2021 204 16.2 7.8 18.1 2.9 14.7 37.3 16.7 2 2 9.3 2.5 100 28.9 13.2 1.5 10.8 0 Buprenorphine 8.3 Bromazepam 4.9 Diazepam 3.9 Clonazepam 2.9 Alprazolam 2
Slovakia Bratislava Bratislava 2022 82 63.4 2.4 30.5 2.4 25.6 4.9 1.2 4.9 32.9 7.3 3.7 67.1 47.3 3.7 0 1.2 6.1 Ketamine 4.9 Toluene 4.9 Psilocybe mushroom 3.7 Alprazolam 2.4 Hexahydrocannabinol 2.4
Slovakia Bratislava Bratislava 2021 59 54.2 5.1 25.4 3.4 32.2 1.7 6.8 3.4 44.1 3.4 5.1 79.7 48.9 3.4 0 0 1.7 Cannabis (CBD) 1.7 Datura stramonium 1.7 Ephedrine 1.7 LSD 1.7 Morphine 1.7
Slovakia Bratislava Bratislava 2020 57 57.9 5.3 33.3 7 36.8 5.3 7 10.5 36.8 7 0 68.4 61.5 5.3 0 1.8 1.8 Tramadol 7 Alprazolam 3.5 LSD 3.5 Morphine 3.5 Amanita muscaria 1.8
Slovakia Bratislava Bratislava 2019 82 67.1 4.9 30.5 3.7 42.7 4.9 12.2 12.2 36.6 8.5 1.2 96.3 53.2 13.4 0 2.4 4.9 Alprazolam 3.7 Synthetic cannabinoid herba 3.7 Datura stramonium 2.4 Psilocybe mushroom 2.4 Tramadol 2.4
Slovakia Bratislava Bratislava 2018 63 71.4 1.6 41.3 6.3 36.5 3.2 1.6 30.2 41.3 11.1 1.6 100 50.8 14.3 0 0 4.8 Alprazolam 9.5 Tramadol 4.8 Datura stramonium 3.2 Dextromethorphan 3.2 Morphine 3.2
Slovakia Bratislava Bratislava 2017 56 62.5 0 28.6 3.6 48.2 0 5.4 16.1 44.6 14.3 0 100 37.5 1.8 0 0 3.6 Tramadol 10.7 Energy drink 3.6 4-MEO-PCP 1.8 Dextromethorphan 1.8 LSD 1.8
Slovakia Bratislava Bratislava 2016 91 68.1 3.3 36.3 8.8 48.4 1.1 4.4 15.4 47.3 2.2 0 98.9 37.8 13.2 0 2.2 1.1 Tramadol 5.5 LSD 3.3 Morphine 3.3 Alprazolam 2.2 Buprenorphine 2.2
Slovenia Ljubljana Ljubljana 2022 159 18.2 15.7 15.1 12.6 17.6 24.5 6.9 6.9 1.3 34.6 10.1 74.2 55.9 22.6 1.3 11.3 0 Midazolam 7.5 Diazepam 4.4 Alprazolam 2.5 Clonazepam 2.5 Psychotropic agent (not known) 2.5
Slovenia Ljubljana Ljubljana 2021 141 17.7 15.6 15.6 16.3 18.4 24.1 3.5 4.3 0.7 33.3 14.2 63.8 47.8 24.1 3.5 13.5 5.7 Midazolam 10.6 Alprazolam 4.3 Clonazepam 2.8 LSD 2.8 MDMB-4EN-PINACA 2.1
Slovenia Ljubljana Ljubljana 2020 113 26.5 9.7 23 13.3 23.9 31 5.3 2.7 0.9 35.4 10.6 72.6 52.4 15.9 0.9 12.4 1.8 Alprazolam 3.5 Clonazepam 3.5 LSD 2.7 Midazolam 2.7 Diazepam 1.8
Slovenia Ljubljana Ljubljana 2019 134 34.3 5.2 26.1 20.1 22.4 20.1 8.2 11.2 1.5 37.3 23.1 82.8 62.2 21.6 0 12.7 2.2 Midazolam 7.5 Alprazolam 4.5 Clonazepam 3 Diazepam 3 LSD 3
Slovenia Ljubljana Ljubljana 2018 154 24.7 8.4 24.7 17.5 19.5 20.8 12.3 9.7 1.3 36.4 25.3 70.1 63 12.3 0 14.9 2.6 Stimulant (not known) 5.8 Midazolam 5.2 Alprazolam 3.2 Buprenorphine 3.2 3MMC 1.9
Slovenia Ljubljana Ljubljana 2017 156 23.1 8.3 21.2 17.3 17.9 13.5 6.4 7.1 1.9 30.8 9.6 77.6 53.7 21.8 0.6 16 3.2 Midazolam 7.7 Alprazolam 3.8 Clonazepam 3.8 Bupropion 2.6 Morphine 2.6
Spain Barcelona Barcelona 2022 253 22.7 11.6 19.4 4.3 20.2 2.4 13.8 9.9 11.9 24.1 21.3 88.9 51.6 7.1 3.2 0.4 7.9 Ketamine 4.7 Clonazepam 3.6 2CB 3.2 Crack 3.2 Mephedrone 3.2
Spain Barcelona Barcelona 2021 209 20 12.2 11.5 1.9 25.8 1 12.9 11 14.8 33.5 26.8 84.7 53.7 3.8 0.5 0.5 5.7 Ketamine 4.3 2CB 2.9 Crack 2.4 Mephedrone 1.9 LSD 1.4
Spain Barcelona Barcelona 2020 184 19.1 10.4 16.8 2.7 12.5 1.1 18.5 9.2 18.5 32.1 27.2 87 50.6 0 0 0 3.3 Ketamine 3.8 Poppers 3.3 LSD 2.2 2CB 1.6 Mephedrone 1.6
Spain Barcelona Barcelona 2019 248 24 12.2 18.5 5.2 22.6 3.2 11.3 10.9 16.5 31 27 91.1 58.4 0.8 0 0 1.6 Ketamine 6.9 Poppers 3.6 LSD 3.2 Caffeine 0.8 Mephedrone 0.8
Spain Barcelona Barcelona 2018 227 19.6 10.2 14.1 2.2 20.7 0.4 15.4 7 22 37 22 85.5 57.2 1.3 0 0 1.3 Ketamine 7 Ayahuasca 1.3 LSD 1.3 Mephedrone 0.9 Poppers 0.9
Spain Barcelona Barcelona 2017 224 19.5 5.4 17.4 4.9 23.2 0.9 21.9 5.4 11.2 45.5 25 81.7 71.6 0 0 0.4 1.8 Ketamine 8.9 Poppers 3.6 LSD 1.8 Mephedrone 1.8 Hallucinogen (not known) 0.9
Spain Barcelona Barcelona 2016 147 27.2 5.4 25.2 1.4 22.4 2.7 19.7 11.6 12.2 43.5 27.2 81.6 70 0.7 0 0.7 2.7 Ketamine 6.8 Poppers 5.4 Mephedrone 2 LSD 1.4 Damiana 0.7
Spain Barcelona Barcelona 2015 108 23.4 15 13.9 3.7 15.7 4.6 23.1 4.6 4.6 51.9 25 86.1 72 0 0 0.9 0.9 Ketamine 6.5 Poppers 4.6 LSD 1.9 MDA 0.9 Mephedrone 0.9
Spain Barcelona Barcelona 2014 182 20.9 7.7 26.4 2.7 22.5 1.6 23.1 3.3 1.1 49.5 22 95.1 66.5 0.5 0 0.5 1.1 Ketamine 2.7 Caffeine 2.2 Poppers 1.6 LSD 1.1 2CB 0.5
Spain Barcelona Barcelona 2013 46 18.2 18.2 17.4 2.2 23.9 4.3 28.3 4.3 0 47.8 26.1 95.7 77.3 6.5 0 0 0 Ketamine 6.5 Poppers 4.3 Alprazolam 2.2 Fentanyl 2.2 Fluoxetine 2.2
Spain Mallorca Mallorca 2022 539 21.5 25.8 31.2 0.7 55.5 8 1.7 8.7 0.2 54.5 1.5 100 49 16.7 0 0.7 0.4 Alprazolam 4.6 Diazepam 2.8 Ketamine 2.2 Poppers 1.1 Clonazepam 0.9
Spain Mallorca Mallorca 2021 464 18.8 17.5 28 0.6 59.1 9.3 1.5 2.8 0.6 53.9 1.1 100 50.6 17.9 0.6 0.4 0.6 Alprazolam 3.7 Diazepam 3.7 Clonazepam 3 Ketamine 1.5 Clorazepate 0.4
Spain Mallorca Mallorca 2020 412 19.4 25 30.1 1.5 56.6 6.6 1.7 3.6 0.7 53.4 0 100 46.6 19.7 0 2.2 0.7 Alprazolam 6.6 Diazepam 4.6 Ketamine 1.9 Clonazepam 1.5 Clorazepate 0.5
Spain Mallorca Mallorca 2019 415 34.9 16.9 28 0.7 51.8 7.2 2.4 14 1.7 48.2 0.7 100 65.3 8.9 0.5 0.5 1 Alprazolam 2.9 Ketamine 1.7 Diazepam 1.2 Energy drink 1.2 Clonazepam 0.7
Spain Mallorca Mallorca 2018 405 27.4 18.5 24.9 2 42.7 7.9 5.9 14.3 0.7 48.6 0.7 100 66.7 9.9 0.2 0.2 1.2 Alprazolam 2.5 Diazepam 1.5 Ketamine 1.5 Clonazepam 1 Energy drink 1
Spain Mallorca Mallorca 2017 350 27.1 16.9 26 1.4 39.7 13.4 7.4 6.6 0.9 51.4 0.3 99.4 64.4 11.1 0 0.6 0.9 Alprazolam 2.9 Ketamine 2.6 Diazepam 1.7 Clonazepam 0.6 Energy drink 0.6
Spain Mallorca Mallorca 2016 249 30.1 14.1 17.7 0.4 31.7 13.3 1.2 13.3 1.6 44.2 1.6 93.2 64.7 11.6 0.4 1.2 5.2 Synthetic cannabinoid spice 4.8 Alprazolam 3.2 Diazepam 3.2 Ketamine 3.2 Stimulant (not known) 1.2
Spain Mallorca Mallorca 2015 237 35.4 16 23.2 0.8 31.2 12.2 1.7 13.5 0 45.1 0.4 96.6 73.8 16 0.8 1.7 2.5 Alprazolam 10.5 Diazepam 3.4 Lorazepam 2.1 Stimulant (not known) 2.1 Clonazepam 1.3
Spain Mallorca Mallorca 2014 190 26.3 8.9 24.7 1.1 22.1 18.9 5.3 5.8 0 47.9 0 81.6 61.9 16.8 1.6 1.6 2.6 Alprazolam 11.6 Stimulant (not known) 2.6 Clonazepam 1.6 Diazepam 1.6 Hallucinogen (not known) 1.1
Spain Mallorca Mallorca 2013 28 25 10.7 21.4 3.6 25 21.4 3.6 14.3 0 64.3 3.6 78.6 77.3 10.7 0 0 0 Alprazolam 7.1 Ketamine 7.1 Amitriptyline 3.6 Diazepam 3.6 MDA 3.6
Switzerland Basel Basel 2022 323 28.1 14.7 21.4 11.1 32.2 9.3 2.8 5.3 3.7 44.3 3.7 97.8 43.4 13.6 1.9 2.2 0.3 Alprazolam 3.1 Morphine 2.8 Midazolam 2.2 Diazepam 1.9 LSD 1.9
Switzerland Basel Basel 2021 278 32.7 18.2 23 8.6 36.3 10.8 3.2 4 2.5 52.2 3.6 97.5 48 20.9 1.8 2.5 0.7 Diazepam 2.9 Lorazepam 2.9 Midazolam 2.5 LSD 2.2 Alprazolam 1.8
Switzerland Basel Basel 2020 287 27.7 19.6 23 4.2 34.8 7 8 1 3.5 51.6 3.8 89.5 51.4 15.3 0.3 3.5 0.3 LSD 3.8 Alprazolam 2.8 Diazepam 2.8 Morphine 2.1 Lorazepam 1.7
Switzerland Basel Basel 2019 167 29.3 17.4 18 6.6 41.3 9.6 4.8 4.2 4.2 55.7 3.6 88.6 55.4 15 0.6 3 0 Ketamine 2.4 Methylphenidate 2.4 LSD 1.8 Midazolam 1.8 Nitrous oxide 1.8
Switzerland Basel Basel 2018 255 19.3 20.5 26.3 5.1 38 12.2 6.3 4.7 2.7 47.5 6.3 93.7 54 14.9 0 4.3 0.4 Morphine 2.7 LSD 2.4 Poppers 2 Diazepam 1.6 Methylphenidate 1.6
Switzerland Basel Basel 2017 275 24.1 20.4 29.8 5.8 42.5 9.8 4.4 4.4 0.7 40.7 2.9 78.9 73.3 12.7 0 5.8 0.4 Lorazepam 2.5 Morphine 2.5 Diazepam 2.2 Ketamine 1.5 Methylphenidate 1.5
Switzerland Basel Basel 2016 244 31.4 14.5 27.9 10.7 33.6 4.5 7.8 8.2 2.5 33.6 1.2 55.3 83.7 12.3 0 2.5 0 Diazepam 4.5 Lorazepam 3.7 Methylphenidate 2.9 Morphine 2 LSD 1.6
Switzerland Basel Basel 2015 210 27.6 18.6 27.6 7.6 30 13.8 5.7 7.1 2.9 38.6 1.4 48.1 92.1 11 1 1.9 1.4 Diazepam 4.8 Morphine 2.9 Midazolam 2.4 Lorazepam 1.9 Alprazolam 1.4
Switzerland Basel Basel 2014 224 35.3 13.4 29.5 7.1 39.3 8.9 5.4 9.8 0.4 31.7 1.3 54.5 94.3 8.9 0 6.2 0.4 LSD 3.6 Diazepam 1.8 Methylphenidate 1.3 Morphine 1.3 Tramadol 1.3
Switzerland Basel Basel 2013 44 38.6 13.6 34.1 4.5 22.7 4.5 11.4 2.3 0 52.3 0 56.8 80 6.8 0 0 2.3 LSD 9.1 Methylphenidate 4.5 2CB 2.3 Alprazolam 2.3 Bromazepam 2.3
Switzerland Bern Bern 2021 66 21.2 18.2 22.7 13.6 30.3 16.7 15.2 13.6 9.1 47 1.5 87.9 79.3 9.1 1.5 1.5 3 Clonazepam 4.5 Alprazolam 3 LSD 3 Psilocybe mushroom 3 2CB 1.5
Switzerland Bern Bern 2020 71 38 14.1 29.6 5.6 45.1 18.3 7 5.6 0 36.6 2.8 90.1 65.6 11.3 0 2.8 0 Alprazolam 4.2 Cannabis (CBD) 2.8 Diazepam 2.8 Ketamine 2.8 LSD 2.8
Switzerland Bern Bern 2019 217 30 12.9 23.5 4.6 36.4 14.7 7.4 8.3 2.3 41.5 0.9 79.3 73.3 11.1 0.5 0.9 1.4 Alprazolam 3.7 LSD 2.3 Cannabis (CBD) 1.4 Codeine 1.4 Ketamine 1.4
Switzerland Bern Bern 2018 236 28.4 14.4 30.1 8.5 19.1 16.5 11.9 6.8 0.8 38.6 6.8 60.6 80.4 14 0.8 0.4 0 Diazepam 4.7 Lorazepam 3.8 LSD 3.8 Midazolam 3.4 Alprazolam 2.5
Switzerland Bern Bern 2017 259 25.5 15.8 29 9.3 31.3 19.7 13.5 3.5 0.4 39 3.5 62.9 76.7 12.4 0 2.7 1.2 Diazepam 3.5 Lorazepam 3.1 Zolpidem 2.3 Methylphenidate 1.9 Alprazolam 1.5
Switzerland Bern Bern 2016 206 23.8 14.1 34.5 11.2 23.8 15.5 10.2 5.3 1.9 35.9 3.4 62.1 79.7 7.8 0 1.5 1 Diazepam 2.9 LSD 2.9 Midazolam 2.4 Alprazolam 1 Lorazepam 1
Switzerland Geneva Geneva 2022 397 22.4 20.2 26.4 6.8 22.7 9.8 0.8 6.8 1.5 49.4 2.8 96 53 16.1 1.3 5.5 1.3 Crack 5.8 Midazolam 3.3 Ketamine 2.5 Clonazepam 2 Zolpidem 1.5
Switzerland Geneva Geneva 2021 480 19.4 19.6 25 7.7 28.3 14.4 2.7 5.6 0.8 43.5 1.7 91.2 55.7 27.1 2.1 7.1 2.3 Midazolam 6.5 Clonazepam 3.3 Quetiapine 2.5 Morphine 2.3 Cannabis (CBD) 1.7
Switzerland Geneva Geneva 2020 355 28.2 17.2 20.8 4.5 31.3 14.1 3.1 8.7 4.8 42.3 3.9 96.1 56.9 28.5 1.4 7 1.4 LSD 2.5 Ketamine 1.7 Morphine 1.7 Quetiapine 1.1 3MMC 0.8
Switzerland Lugano Lugano 2022 84 36.9 21.4 27.4 10.7 32.1 4.8 2.4 4.8 0 34.5 0 95.2 51.2 14.3 1.2 3.6 0 Diazepam 3.6 Oxazepam 3.6 Oxycodone 3.6 Alprazolam 2.4 Clomethiazole 2.4
Switzerland Lugano Lugano 2021 108 33.3 17.6 27.8 5.6 43.5 4.6 0 2.8 0 35.2 0 99.1 45.8 16.7 0.9 4.6 0 Clonazepam 2.8 Alprazolam 1.9 Codeine 1.9 Zolpidem 1.9 Clomethiazole 0.9
Switzerland Lugano Lugano 2020 195 27.2 25.6 25.6 8.2 38.5 11.8 1 4.1 1 35.4 0.5 99.5 46.9 13.3 1 5.1 0 Clonazepam 4.6 Clomethiazole 2.6 Oxazepam 2.1 LSD 1.5 Midazolam 1.5
Switzerland Lugano Lugano 2019 267 32.6 20.2 28.1 15 46.8 7.1 1.5 3.7 0.7 31.5 0.4 99.3 50.9 13.9 0.4 4.5 0 Midazolam 1.9 Alprazolam 1.5 Codeine 1.5 Diazepam 1.5 Oxycodone 1.5
Switzerland Lugano Lugano 2018 227 36.1 18.5 29.1 10.6 40.1 5.3 3.5 2.2 0.4 29.1 0 99.1 52 11.9 0.4 2.6 0 LSD 3.1 Clomethiazole 2.2 Lorazepam 2.2 Clorazepate 1.8 Diazepam 1.8
Switzerland Lugano Lugano 2017 105 22.9 18.1 27.6 16.2 44.8 7.6 1.9 0 0 37.1 0 98.1 52.4 16.2 1 2.9 0 Oxazepam 4.8 Clomethiazole 3.8 Midazolam 3.8 Diazepam 1.9 Ketamine 1.9
Tunisia Tunis Tunis 2022 174 49.4 4.6 8.6 7.5 54 12.1 0 25.3 0 24.1 0 100 20.7 13.2 5.7 0 0 Buprenorphine 5.2 LSD 2.9 Trihexyphenidyl 2.9 Clonazepam 2.3 Meprobamate 2.3
Tunisia Tunis Tunis 2021 87 46 5.7 10.3 9.2 63.2 4.6 2.3 43.7 0 12.6 0 100 25.3 0 0 1.1 0 Buprenorphine 6.9 Trihexyphenidyl 2.3 Carbamazepine 1.1 Codeine 1.1 LSD 1.1
Türkiye Izmir Izmir 2019 54 42.6 13 33.3 3.7 5.6 0 1.9 25.9 0 1.9 0 87 31.9 3.7 20.4 0 22.2 Sedative (not known) 22.2 Synthetic cannabinoid (not known) 14.8 Synthetic cannabinoid bonzai 7.4 Antipyretic (not known) 3.7 Alprazolam 1.9
UK London London KCH 2020 506 23.3 16.5 22.3 3.6 21.5 10.7 1 6.7 20.6 19.2 26.1 58.1 75.2 5.7 1.4 1.4 4.9 Crack 11.5 Ketamine 6.3 Diazepam 4 LSD 3.2 Synthetic cannabinoid spice 3.2
UK London London KCH 2019 509 20.9 14.2 21.6 2.9 19.8 12 2.4 9.6 14.7 19.4 23.6 59.9 82.6 3.1 1.2 1.6 4.7 Crack 12 Ketamine 6.1 Synthetic cannabinoid spice 3.5 LSD 2.8 Diazepam 2
UK London London KCH 2018 439 24.4 13 24.1 3.6 16.4 15.3 2.5 12.1 13.7 15.3 24.6 58.8 81.8 6.6 0.9 1.6 7.1 Crack 12.1 Ketamine 5.2 Synthetic cannabinoid spice 3.9 Diazepam 3.6 Alprazolam 2.5
UK London London KCH 2017 434 24.6 11.8 21.7 4.6 13.8 14.3 2.8 13.4 15.7 20.7 24.4 49.3 85.5 4.4 0.9 1.2 6.7 Crack 11.8 Ketamine 5.1 LSD 3 Synthetic cannabinoid spice 3 Diazepam 2.8
UK London London KCH 2016 379 21.9 9.9 25.6 4.5 15.6 16.9 3.2 14.5 14.2 18.2 23 63.9 90.5 6.1 1.1 1.3 10.3 Crack 13.7 Ketamine 5.3 Diazepam 2.9 Mephedrone 2.9 Synthetic cannabinoid spice 2.9
UK London London KCH 2015 439 21.6 10.9 20.5 4.6 14.6 13.9 3 11.2 9.3 25.1 24.8 45.1 93.4 3.9 0.5 1.1 13.2 Mephedrone 8.7 Ketamine 4.1 Diazepam 3.4 Synthetic cannabinoid spice 3.2 LSD 1.6
UK London London KCH 2014 405 29 9.9 25.4 2.2 18.3 16.8 3.5 13.8 10.1 20.2 20.2 61 81 7.4 1.2 3 16 Crack 8.4 Mephedrone 8.1 Methedrone 5.9 Diazepam 5.4 Ketamine 4
UK London London KCH 2013 97 36.1 10.3 24.7 4.1 17.5 16.5 5.2 15.5 8.2 29.9 22.7 62.9 80.3 2.1 0 1 11.3 Crack 9.3 Ketamine 9.3 Mephedrone 5.2 Diazepam 2.1 Amitriptyline 1
UK London London STH 2022 990 22.9 16.1 21 3.8 17.3 12.1 1.2 8.2 17.7 21.5 19.9 59.4 78.9 4.4 0.9 0.9 7.6 Crack 9.2 Synthetic cannabinoid spice 6.6 Ketamine 6.5 Nitrous oxide 3.1 Diazepam 1.9
UK London London STH 2021 1083 24.6 16.4 19.8 4 19.2 12.1 1.3 8.6 18.7 21.5 21.2 56.8 78.5 4.8 1.6 2.5 10.7 Synthetic cannabinoid spice 9.4 Crack 8.1 Ketamine 4.5 Diazepam 3 Alprazolam 1.8
UK London London STH 2020 1427 17 19.8 14.6 3.9 15.1 13 0.8 5.5 17.7 15.3 20 45 85 4.9 1.7 2.3 25.7 Synthetic cannabinoid spice 24.5 Crack 11.9 Diazepam 3.2 Ketamine 3.1 Alprazolam 1.2
UK London London STH 2019 1477 22.3 17.5 17.5 4.5 15 13.9 0.9 7.8 15.4 19.1 20.1 49.2 91.3 5.3 2.5 2 15 Synthetic cannabinoid spice 14.2 Crack 11.8 Ketamine 5.4 Diazepam 2.9 Alprazolam 2.1
UK London London STH 2018 1413 22.4 13.9 18.2 5.4 13.9 13.4 2.4 12 15.4 19 22 49.3 92.7 5 1.4 2.3 14.8 Synthetic cannabinoid spice 13.2 Crack 12.5 Ketamine 5 Diazepam 2.4 Alprazolam 2.3
UK London London STH 2017 1040 19.8 13.9 16 5.1 9.3 12.7 1.1 11.7 14.8 19.2 20.6 48 86.6 4.4 1.7 3.6 19.8 Synthetic cannabinoid spice 17 Crack 8.8 Ketamine 3.6 Alprazolam 2.2 Diazepam 1.9
UK London London STH 2016 960 21.7 11.6 15.2 4.7 9.6 13 1.4 15.4 11.2 15.9 25.3 95 86.6 3 1.8 2.1 25.6 Synthetic cannabinoid spice 15.6 Crack 6.2 Mephedrone 5.4 Ketamine 3.5 Diazepam 2.2
UK London London STH 2015 921 22 10 17.6 7.4 9.6 11.4 2.2 11.7 9.9 14.3 33.6 57.1 83.1 3.8 0.9 2 24.2 Mephedrone 13.1 Crack 5.2 Synthetic cannabinoid spice 2.9 Ketamine 2.8 Methedrone 2.7
UK London London STH 2014 934 25.9 8.4 16.7 5.7 10 11.7 2.7 16.7 10.1 17.8 32.1 49.8 82.2 3.6 0.3 1.9 20.9 Mephedrone 12.8 Methedrone 6 Ketamine 5.2 Crack 3.6 Diazepam 2.5
UK London London STH 2013 241 29.5 8.3 20.7 6.6 12 12 2.9 13.7 7.5 19.1 29 56.8 89.1 2.5 1.2 2.5 23.7 Mephedrone 15.8 Ketamine 7.5 Crack 7.1 Methedrone 5.4 LSD 2.5
UK London London STMW 2022 756 27.5 15.3 23.7 0.9 23.8 11.1 2.1 7.1 14.6 29.1 11.8 71.6 54 5.6 1.6 0.9 3 Crack 9.8 Ketamine 6.2 Nitrous oxide 5.6 Diazepam 3.3 Alprazolam 1.6
UK London London STMW 2021 675 28.9 12.6 23.7 1.5 23.6 9.8 1.2 7.1 16.9 28.3 13.6 84.9 42.2 6.7 1.6 1.5 6.7 Crack 7.9 Ketamine 5.2 Synthetic cannabinoid spice 5.2 Alprazolam 3.9 Diazepam 3
UK York York 2018 96 32.3 7.3 26 2.1 16.7 43.8 3.1 10.4 0 8.3 0 79.2 60.5 32.3 7.3 1 8.3 Diazepam 28.1 Synthetic cannabinoid spice 7.3 Alprazolam 4.2 LSD 4.2 Fentanyl 3.1
UK York York 2017 76 57.9 3.9 35.5 0 25 23.7 3.9 25 0 27.6 1.3 89.5 60.3 11.8 3.9 7.9 5.3 Diazepam 11.8 Ketamine 9.2 Synthetic cannabinoid spice 5.3 Paracetamol 2.6 Amitriptyline 1.3
UK York York 2016 124 53.7 6.5 25 0 20.2 16.9 12.9 18.5 1.6 17.7 1.6 82.3 31.4 9.7 2.4 0.8 24.2 NPS/legal high (not known) 12.9 Diazepam 9.7 Synthetic cannabinoid spice 6.5 Mephedrone 4.8 Codeine 1.6
UK York York 2015 180 58.9 2.2 31.7 0 21.1 10.6 15 23.3 1.7 10.6 1.1 91.7 45.5 3.9 1.1 2.2 34.4 Mephedrone 13.3 NPS/legal high (not known) 10.6 Diazepam 3.9 Synthetic cannabinoid spice 3.3 LSD 1.7
UK York York 2014 204 42.4 8.4 23 2.5 13.7 37.7 9.8 7.4 0 8.3 0 93.6 44 11.3 1 4.4 30.9 Mephedrone 13.7 Diazepam 10.3 NPS/legal high (not known) 6.9 Crack 2 Synthetic cannabinoid psyclone 2
UK York York 2013 54 31.5 7.4 31.5 9.3 16.7 37 14.8 7.4 1.9 11.1 0 87 34 11.1 1.9 7.4 16.7 Diazepam 11.1 Mephedrone 7.4 Ketamine 5.6 Caffeine 3.7 Synthetic cannabinoid pandora's box 3.7
Table 2. Euro-DEN Plus centre information table
Country City Coordinates Centre short name Centre full name Type of service Catchment area Type of people using drugs Number of beds Estimates population served (n) Emergency department and referral Other comment
Algeria Bab El Oued 36.791,3.053 Bab El Oued Mohamed Liamine Debaghine Hospital, Bab El Oued University Hospital Center Not available Not available Not available Not available Not available Not available Not available
Algeria Oran 35.704,-0.650 Oran University Hospital of Oran ED in teaching hospital affiliated with the University of Oran Not available Not available 1000 Not available Not available Not available
Albania Tirana 41.328,19.818 Tirana University hospital centre "Mother Teresa" ED in Albania's largest university hospital  Mainly from Tirana and surroundings, but also severe cases from the whole country All type of drug users, including at night time venues, private parties and solo users ~1450  and 21 in the Toxicology Unit 1.6 million One of clinical toxicology doctors is 24/7 in hospital. All patients coming to ED is first checked by the emergency doctor and upon their request by clinical toxicology doctor. Not available
Belgium Antwerp 51.2,4.4 Antwerp ZNA Stuivenberg ED in general hospital Central and northern. Antwerp Metropolitan Area 40 km² Urban ED. With both long-term drug users and recreational use 250 500000 Patients managed by ED. With referral to ICU, internal medicine or psychiatry as required. Part of Ziekenhuis Netwerk Antwerpen (ZNA), a 2500 bed hospital on 10 sites in Antwerp Metropolitan Area
Belgium Ghent 51.1,3.7 Ghent Ghent University Hospital ED in university hospital City of Ghent Located in city with very large student population (63 000 students on a population of 263 000), very active party scene (week and weekends), a few large night clubs in the area. 1000 200,000 All poisonings are treated by the emergency physicians in the ED, if needed admitted to ITU and treated by intensivists. No dedicated toxicology department, though two toxicologists in the ED team.
Bulgaria Sofia 42.7,23.3 Sofia The University Multidisciplinary Hospital for Active Treatment and Emergency Medicine N. I. Pirogov Specialist toxicology clinic and teaching facility. Referral clinic for toxicology pathology for the country. Located in the centre of Sofia, the hospital is located near night life settings. Mostly young people - heroin users, recreational stimulant users, party goers, but there are also older people with long-term drug addiction, included clients in methadone programs. 38 (includes 10 paediatric) 1,500,000 The staff specialises in Internal Diseases, Clinical Toxicology and Emergency Medicine. The Toxicology Clinic is a teaching facility for Medical University of Sofia.  
Cyprus Nicosia 35.2,33.4 Nicosia Nicosia General Hospital ER in the main public hospital of the capital city City of Nicosia The centre is located in the main public hospital of the capital city, however it is not located near an open drug scene or nightlife settings. The users more commonly presenting are recreational stimulant users (cocaine), cannabis users as well as people with high risk use (such as heroin and methamphetamine) 419 ~200,000 Poisoned patients are initially managed within the ER and, if further treatment is needed, admitted to the general medicine wards or intensive care unit  
Czechia Prague 50.1,14.4 Prague Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University and General University Hospital, Prague Emergency Department in university hospital Central part of Prague and part of Central Bohemian Region (surrounding Prague) Use of marihuana, methamphetamine and alcohol most common 1900 About 250 000 people (25% of Prague) Emergency Room physician and intensivist  
Denmark Copenhagen 55.7,12.6 Copenhagen Bispebjerg Hospital ED in teaching hospital Copenhagen and Frederiksberg     400000 Emergency patients are seen by internists or anesthesiologists. The Danish Poison Information Centre (Giftlinjen, Bispebjerg Hospital) provides advice on complex or unusual cases. The Danish Poison Information Centre has no day-to-day responsibility for patient care in the ED.
Denmark Roskilde 55.6,12.1 Roskilde Clinical Pharmacology Unit, Zealand University Hospital, Roskilde Emergency Department in teaching hospital            
Estonia Pärnu 58.4,24.5 Parnu Pärnu Hospital ED in general hospital Western part of Estonia. Population served increases significantly in the summer with tourists from other parts of Estonia and abroad.     100,000 Poisoned patients are initially managed within the Emergency Room and, if further treatment is needed, may be admitted to the general medicine wards or intensive care unit.  
Estonia Tallinn 59.4,24.7 Tallinn North Estonia Medical Centre ED in general hospital Outside the town centre so recreational drug users may be admitted to one of the other two hospitals   1230   Patients are initially treated by the emergency medicine doctors in ER and if further treatment is needed, the patients are transferred to intensive care or general medicine wards. In Estonia opioid overdoses are mainly treated on scene and patients are rarely admitted to ED.
Finland Helsinki 60.2,24.9 Helsinki Malmi Hospital ER in general hospital Eastern, south-eastern, north-eastern, and northern areas of Helsinki.   3000 2.2 million Treated by ER clinicians and referred to medical wards or ICU if required For patient >16 years
France Paris 48.9,2.3 Paris Emergency Department, Lariboisière Hospital, Assistance Publique – Hôpitaux de Paris ED in teaching hospital Central Paris Next to ‘Gare du Nord’ (the largest and most crowded railway station in Europe), poor North-east area of Paris, located near a safe consumption room (next door). The area is a usual open drug scene with opioid users 1200 >3 million Poisoned patients are seen by the Emergency Medicine Physicians on a 24/7 day-basis. Specialists on-call from the Paris Poison Centre and the medical and toxicological intensive care unit are consulted for specific or severe cases, respectively.
Georgia Tblisi 41.693,44.801 Tblisi Archangel St. Michael Multiprofile Clinical Hospital Not available Not available Not available Not available Not available Not available Not available
Germany Munich 48.1,11.6 Munich Department of Clinical Toxicology, Klinikum rechts der Isar, School of Medicine,Technical University Munich. Specialist department in a tertiary teaching hospital City of Munich and the surrondings Area of ~ 665 km2, the hospital is ~ 2 km from a party scene, an open consumption scene is near the main and eastern railway station, both ~<3 km. Users prefer sympathomimetics (NPS, cocaine, amphetamines, etc.). Among opioids, heroin does not play a dominant role, rather fentanyl and methadone. Cannabinoids and pregabalin are in the foreground. ChemSex, due to the proximity of a gay neighborhood). 1161 (28 in department: 5 in a fully equipped ICU, 13 in a high dependency unit and 10 in a general ward In the city and district of Munich: about 1.9 million Poisoned patients are admitted directly and treated separately from the general medical ER at the department of Clinical Toxicology Provides a toxicological laboratory service and the Munich´s Poison Control Center with about 44,000 inquiries per year
Ireland Drogheda 53.7,-6.4 Drogheda Emergency Department, Our Lady of Lourdes Hospital ED in general hospital North East of the Republic of Ireland. Mixed urban and rural population Large rural town population of 41,000 (2016). Large catchment area. Drugs ingested in context of parties and nightclubs primarily. Main drug groups are heroin, cocaine and stimulants. 340 350,000 Patients treated in the ED and admitted to hospital or discharged as appropriate  
Ireland Dublin 53.3,-6.3 Dublin Emergency Department, The Mater Misericordiae University Hospital . Teaching hospital ED in teaching hospital North inner city serving a domiciled population   600 185000 Initial management of toxicological emergencies is in the ED with admission under general medicine or critical care if required.  
Israel Haifa 32.799,34.990 Haifa Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology ED in tertiary academic hospital Northern Israel Night-time economy venues, street homeless and hostel dwellers. The north district is known for its low socioeconomic status. Nearby is the main psychiatric hospital of the Northern Israel. Mainly wide cannabis usage in the area, but also heroin and cocaine. 1100 >2.5 million Patients seen by ER Physician during office hours in the ED. Out of office hours by ER Physician or internal physician.  Intensive care and Toxicology specialist are 24/7 on-call. (During office hours Toxicology Service are on site) The Israel Poison Information Center - the only service of its kind in the country -   located at Rambam Health Care Campus and provides expert advice on poisonings to the healthcare system and the general public. available 24/7.
Italy Monza 45.6,9.3 Monza Emergency Department – Ospedale San Gerardo Emergency Room in teaching hospital North-eastern region of Milan Monza is a quiet, wealthy medium-sized city with no special problems about drugs, although wealth may contribute to the use of recreational drugs. The type of users is very different: heroin users, recreational stimulant users, party goers with cannabis most used. 600 500,000 These patients are seen by ER medical staff and the consultant toxicologist is on-call by telephone from Poison Control Centre Poison Control Centre : CAV/CNIT (Centro Antiveleni – Centro Nazionale di Informazione Tossicologica) of Pavia.
Italy Rozzano 45.4,9.2 Rozzano Humanitas Research Hospital, via Manzoni 56, 20089 ER in teaching hospital South Milan Lombardy Outskirts south of Milan, near night clubs and discos. Several patients with psychiatric problems and substance abuse who do not usually belong to our ER because they do not have psychiatry 780. (565 National Health Service,215 private healthcare) 178 764 (Rozzano and neighbouring municipalities) Toxicology patients are seen by ER medical staff and the consultant toxicologist is on-call by telephone from Poison Control Centre CAV/CNIT Poison Control Centre CAV/CNIT (Centro Antiveleni – Centro Nazionale di Informazione Tossicologica) of Pavia H24.
Latvia Riga 56.9,24.1 Riga Riga East Clinical University Hospital, Riga ER in university hospital City of Riga       Patients treated in the ED, Toxicology Department or ICU  
Lebanon Beirut 33.889,35.503 Beirut American University of Beirut Medical Center ED in tertiary care hospital Beirut and Mount Lebanon governorates Not available 358 Up to half Lebanese population Not available Not available
Lithuania Kaunas 54.9, 23.8 Kaunas Hospital of Lithuanian University of Health Sciences ER in university hospital Quiet area of the city with no safe consumption rooms nor night life settings   2000 387,000 in Kaunas (but for some areas of medicine 699,000) Treated by ER clinicians and referred to medical wards or ICU if required In working time consultations of clinical toxicologists are available.
Lithuania Vilnius 54.7,25.3 Vilnius Toxicology Centre, Republic Vilnius University Hospital ED in university hospital City of Vilnius No particular characteristic and the hospital is the main emergency hospital in Vilnius 657 500000 Patients are seen by the Clinical Toxicology doctor in the ER 24/7. 1000 patients per year are hospitalized in the toxicology centre. This is a clinical department which consists of 6 ICU beds and 15 general ward beds. Alongside is a psychiatry ward with 17 beds.
Malta Msida 35.9,14.5 Msida Emergency Department, Mater Dei Hospital The sole public, general, teaching hospital in Malta Malta A nearly whole country catchment area. Malta is the smallest national capital in the EU. A tourist destination with its warm climate with numerous recreational areas. Most common recreational overdoses are cocaine (crack on the rise), cannabis, synthetic cannabinoids, and heroin. Party goers presentations tend to be highest from April-Sept with another small peak in November 1000 516000 There is no formal toxicological service, with poisoned patients being treated in the Emergency Department, intensive care, paediatric wards or general medical wards.  
North Macedonia Skopje 41.996,21.432 Skopje University Clinic of Toxicology, Clinical campus Mother Theresa, Ss Cyril and Methodius University ED in teaching hospital Skopje (the capital) and North Macedonia territory From night-time economy venues and private parties/residences 29 800 000 (population of Skopje) and sometimes from other cities in NMK (1.8million, patients  in severe clinical presentation) Patients are treated in the ED, ICU or PIC Centre includes a Poisons Information Centre and Detoxification department (admission only during office hours).
Norway Oslo OAEOC 59.9,10.7 Oslo OAEOC Oslo Accident and Emergency Outpatient Clinic (OAEOC) Main casualty clinic in Oslo. Primary care emergency institution City of Oslo Located in the city centre, close to both main nightlife areas, safe consumption room, and open opioid addict scene. Main patient groups: ethanol (both binge drinking and chronic high alcohol consumption), injecting opioid and amphetamine users, and club scene drug users. 15 beds for short time observation (max 6 hours) of recreational drug/ethanol toxicity patients. 18 beds in general 24-hour observation unit. 700000 Poisoned patients are treated at the Emergency General Practice Department, mostly by registrar/resident-level general practitioners. 15% of poisoned patients presenting are referred on to another hospital In Norway patients cannot present directly to hospitals, but have to be assessed in primary care or by the ambulance service first.
Norway Oslo OUH 59.9,10.7 Oslo OUH Department of Acute Medicine, Oslo University Hospital (OUH) Emergency hospital with local, regional and national responsibility of a variety of assignments The most severe poisoned patients in the region. OUH is the region`s trauma hospital and consists of several acute specialities. All kind of people elder than 18 years are attending. People below 18y attend to a child-Hospital also located in the OUH-area. After stabilization, patients are sometimes continued to local hospitals. The area around centre is a settlement area where people live and work and in connection to several travelling possibilities: bus, tram and subways. Type of people using drugs: young people attending to private parties and from the city night-life, and people in all ages using drugs in combining also because of addiction. Young and elder heroin users, GHB users, recreational stimulant users, party goers etc. In the medical clinic:~ 200 beds. In our Department of Acute Medicine, the intensive care unit has 10 beds and the Observational unit has 17 beds for observational use for several medical needs. Most severely poisoned patients from a catchment area of approximately 3 million people. The Department consists of an observational unit of 17 beds with a medical intensive care unit of 12 beds and it hosts the Norwegian CBRNe Centre of Medicine. All five Clinical consultants for the National Poisons Control Centre are also employed at the same department.
Poland Gdansk 54.4,18.6 Gdansk Pomeranian Centre of Clinical Toxicology (PCT) and Department of Clinical Toxicology Medical University of Gdansk Specialist toxicology hospital Centre of Gdansk but patients are from 25 hospitals in the Pomeranian province and~12 in Warmian-Masurian and Kuyavian-Pomeranian provinces of north Poland. The cities of Gdansk, Gdynia and Sopot (Triplecity) form a large port with numerous night clubs and a large academic centre (about 100, 000 people). 17 in PCT, including 7 intensive care beds Combined population in 3 regions covered:~. 5,8 million Staff specialises in internal diseases, clinical toxicology and emergency medicine. PCT serves as a Poison Control Centre and Toxicological Information Centre. Toxicology reference hospital - operates 24/7. Only cases with serious toxicity are admitted.
Romania Bucharest 44.4,26.1 Bucharest Pediatric Poisoning Centre, Emergency Clinical Hospital for Children “Grigore Alexandrescu” Reference toxicology unit for children in Romania within a teaching hospital City of Bucharest and four counties around Teenagers and young people using especially cannabis and recreational drugs, in clubs, private parties, street, school or universities 440 5m The patients are managed by the six paediatricians and 24 nurses working here. Patients under 18 years old with acute overdoses are admitted to the centre. 25 beds in the unit
Serbia Belgrade 44.818,20.457 Belgrade The National Poison Control Centre, Military Medical Academy, Belgrade Emergency Department (ED) in a teaching hospital which is the reference institution in the country for clinical toxicology Not available Not available 1200 Not available Seen in the Emergency and Clinical Toxicology Clinic by specialists of internal medicine with sub-specialisation in clinical toxicology. 24 hour service. Mobile Toxicological Chemical Unit staffed by NPCC used for chemical accidents.
Slovakia Bratislava 48.2,17.1 Bratislava National Toxicological Information Centre, University Hospital (NTIC) Teaching hospital. Largest medical facility in Slovakia Wider city centre of Bratislava and one of three EDs in the University Hospital located in this city area The common public area of the capital of Slovakia, city of Bratislava 2500 500000 NTIC, is a national clinical toxicology service providing advice and information to the health care providers, the general public, and other national organizations. NTIC has about 6500 toxicological consultations per year. NTIC operates on a 24/7 - basis
Slovenia Ljubljana 46.1,14.5 Ljubljana Medical emergency unit and Centre for Clinical Toxicology, University Medical Centre Emergency Department in teaching hospital Central Ljubljana Urban area with discos/dance clubs + a couple of squatter areas and an outpatient methadone clinic with a bustling drug using and trading community. Stimulant drugs more common than heroin and opioids.A high use of cannabis and GHB. 2100 300 000 residents. Serves as a tertiary reference hospital for ~ 1.3 million people. Patients in the ER are seen by internists, with consultant toxicologist on-call. Centre for Clinical Toxicology has 6 monitored beds and 15 beds in a general ward. Excluding infectious disease, paediatric, surgical, neurological and psychiatric emergencies. Psychiatric evaluation and treatment is provided by a detached Psychiatric clinic. Toxicology Laboratory of the Institute of Forensic Medicine performs toxicological analyses.
Spain Barcelona 41.4,2.2 Barcelona Emergency Area, Clinical Toxicology Unit, Hospital Clinic ED in teaching hospital Central Barcelona Centre of the city, with many nightlife venues around. Many of our patients are recreational drug users and also participants in chemsex sessions. 600 550000 Patients are treated in the emergency area, intensive care or general medical wards.  
Spain Palma de Mallorca 39.6,2.9 Mallorca Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases Teaching hospital Leading tourist destination - large migrant population of tourists and seasonal workers especially during summer months, with over 8 million foreign tourists each year. Near a) shelter for low/no income people where intravenous heroin and cocaine are used, along with other drugs. b) an area of pubs & clubs used all year round but especially in the summer and c) beach area with large influx of visitors in the summer and in both these areas MDMA, cocaine, cannabis and synthetic cannabinoids or other new drugs are used 750 Primary hospital for a resident population of about 400,000 and as a reference hospital for over a million people The ER treats poisoned patients on arrival; poisoned patients are reviewed by a member of the Clinical Toxicology Unit when on-duty or during office hours. No formal reference consultant is on-call for toxicology
Switzerland Basel 47.6,7.6 Basel Division of Clinical Pharmacology and Toxicology University Hospital Primary care and referral centre North-western Switzerland Several safe consumption rooms in Basel, opioid abuse often, recreational stimulant users, no open drug scene in Basel. 780 1000000 Patients seen by the emergency physician with the clinical pharmacologist & toxicologist on-call when specialised advice is needed.  
Switzerland Bern 46.9,7.5 Bern Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital Primary care facility (walk-in patients) and tertiary referral centre for hospitals in the greater Bern area City of Bern and greater Bern area A small city and there are some local night clubs and a drug treatment facility in the vicinity. 1230 2 millions Poisoned patients are seen by the emergency physicians with clinical pharmacologists and toxicologists on-call when specialised advice is needed. Patients ≥16 years of age)
Switzerland Geneva 46.2,6.1 Geneva Geneva University Hospitals (HUG) ED in university hospital Canton of Geneva From night-time economy venues. Geneva has a safe consumption place called “Quai 9”, located nearby the central train station. It works with an association called “nuit blanche” (“sleepless night”) which was also created in order to reduce harm associated with drug consumption. This last association has staff present during certain nightlife events and propose a safe place to discuss about drugs, information and support.  ~2000 508 774 residents of the Geneva district and because of its proximity to the French border, the inhabitants of some nearby French cities. Patients treated in the ED and discharged or admitted as appropriate  
Switzerland Lugano 46.0,8.95 Lugano Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale Specialized clinical pharmacology and toxicology unit providing consultancy to and collecting data from EDs of a network of 4 public academic teaching hospitals in Southern Switzerland. Urban and rural areas. ER located near open drug scene and night life settings; commonly seen in ER are mostly recreational stimulant users. 1000 Almost 350 000 people. Serves as referral centre for Southern Switzerland. Management of poisoned patients involves the emergency physician, supported by the consultant clinical pharmacologist and toxicologist when needed. If required, management continues in medicine or critical care wards.
The Netherlands Amsterdam 52.4,4.9 Amsterdam Emergency department, OLVG Hospital ED in teaching hospital Central Amsterdam OLVG is a city centre hospital in Amsterdam. Many of the drug related patients are national or international tourists. Drug use is mostly related to social events, although people with chronic use are also seen. 400 1 million Toxicology patients are mostly seen (under supervision) by emergency physicians. In case of severe toxicity, intensive care medicine, internal medicine, the hospital pharmacist and a clinical toxicologist will be involved.
The Netherlands Utrecht 52.1,5.1 Utrecht University Medical Center (UMC) ER in university hospital Not located near open drug scene or safe consumptions rooms. Outside the city center of Utrecht though close (~10 km). However, the city center also has a hospital with an ED. The hospital is located within Utrecht Science park. There are student housing facilities on the park and one restaurant, but other than that there is little to do and it is surrounded by grass-lands. The type of people are mostly recreational stimulant users and partygoers 1100 The UMC Utrecht is the regional referral center (also known as a level 1 trauma center) for the Central Netherlands region with a catchment area of 1.1 million inhabitants.  These patients are seen in the ED by specialists on call from acute internal medicine or intensive care. The Dutch National Poisons Information Center is located within the UMC Utrecht
Tunisia Tunis 33.844,9.400 Tunis Centre Mahmoud Yacoub d'assistance médicale urgente ED in a tertiary teaching hospital and national centre for toxicology Central  Tunis Drugs used in the local streets, abandoned squatted  houses and private residences and in local night-time economy venues 21 3 million Seen by the Emergency  or, if necessary, intensive care physicians. 24 hour service. Not available
Türkiye Izmir 38.4,27.1 Izmir İzmir Medical Sciences University, Tepecik Training and Research Hospital ED in teaching hospital City of Izmir Deprived area with low income and education attainment households where whole families may use and deal drugs, usually synthetic cannabinoids 600 350,000 These patients are seen by the emergency medicine specialty program residents and their instructors. Patients seen 24 hours/7 days in the ER, and consulted on in intensive care or general medical wards.
United Kingdom London 51.5,-0.1 London STH Clinical Toxicology Service, Guy’s & St Thomas’ (STH) NHS Foundation Trust ED in teaching hospital Central and south east London with a number of small and large night time economy venues nearby, particularly those catering for men who have sex with men (MSM, “gay”). Recreational/NPS toxicity presentations are mostly commonly from those night-time economy venues, as well as privately held “chemsex parties” and private residences. Additionally, presentations are from street homeless and hostel dwellers. 1100 1,6 million Patients are seen by the Clinical Toxicology service during office hours in the ER, intensive care or general medical wards and out of hours a consultant toxicologist is on-call.  
United Kingdom London 51.4,-0.0 London KCH Emergency Department, King’s College Hospital (KCH) NHS Foundation Trust ED in teaching hospital. No formal toxicology service but strong links with the service at GSTT London. South east London. It has a diverse socioeconomic resident population. Recreational drug/NPS toxicity presentations are most commonly from local night-time economy venues, privately held “chemsex parties”, private residences, hostels and those who are street homeless. 900 1 million    
United Kingdom London STMW 51.5,-0.2 London STMW St Mary's Hospital, Imperial College Healthcare NHS Trust ER in teaching hospital and inner-city major trauma centre. Central west and northwest London High numbers of stimulant recreational drug users, patients using drugs for chemsex and high rates of homelessness in the local area. 495 2 million    
United Kingdom York 54.0,-1.1 York York Teaching Hospital NHS Foundation Trust ED in teaching hospital Semi-rural population, living in or near York and North Yorkshire   700 800000 Patients are managed initially within the Emergency Room and, if needed, may be admitted to the Acute Medical Unit or critical care areas under the care of a General Physician. Support from a local liaison psychiatry team.

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