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

Introduction

On this page you can explore data from the hospitals participating in the  European Drug Emergencies Network (Euro-DEN — Euro-DEN Plus)  project.

Since 2013, the project has been collecting data on acute drug toxicity presentations in an expanding network of sentinel hospitals across Europe and beyond. Euro-DEN Plus aims to provide detailed information on the nature and extent of acute harm associated with the use of illicit drugs, such as cannabis, cocaine, heroin and other opioids, amphetamines, and new psychoactive substances, used alone or in combination with other drugs, prescription medicines, over the counter medicines and alcohol.

Data from all centres can be explored, by year and selected substances, through our interactive data explorer. In addition, we present a detailed analysis of the 2024 data available from the centres in 19 countries in the European Union and Norway. You can find out more about the Euro-DEN Plus project and the network of participating hospitals here: European Drug Emergencies Network (Euro-DEN — Euro-DEN Plus).

Page last updated: 17 December 2025

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 last quarter of 2013, then on an annual basis through to 2024. Bubble sizes on the map show the percentage of presentations associated with the use of the selected substance. The data should be interpreted with caution, as some centres report small numbers of presentations and are not representative of all acute intoxication cases in the hospital or region. Note, too, that the sum of the percentages for all drugs at a centre can be greater than 100%, as many presentations are associated with more than one substance. More information on the patterns of polysubstance use is presented in the summary.

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.

In summary: 2024 key findings

In 2024, a total of 5320 acute drug toxicity presentations to the emergency departments of 29 participating sentinel hospitals in 19 countries in the European Union and Norway were reported. The number of presentations varied between study locations (Figure 1). This reflects the large variation between hospitals in their size and catchment areas and differences between those areas in the prevalence and patterns of substance use.

Key findings

• Demographic characteristics: sex and age
  The majority of acute drug toxicity presentations were among males (75%). The median age of those presenting was 32 years (30 years among females and 33 years among males). Among presentations aged 10 to 19 years, the proportion of females was higher (38%) compared to the overall presentations (25%) (Figures 1 and 2).
• Most frequently reported drugs
  Cocaine was the most commonly reported substance, mentioned in 26% of presentations. Cannabis (24%) and amphetamine (14%) were the second and third most commonly reported substances. Heroin and methadone were the most commonly reported opioids in most centres. However, potent synthetic opioids such as fentanyl and fentanyl derivatives, and nitazenes were reported in some centres (Figure 1).
• Hospital arrival, stay and discharge
  The majority of presentations arrived at the hospital by ambulance (69%). Most presentations were medically discharged from the emergency department (67%). Individuals typically stayed in the hospital for 11 hours (median), and the median stay in the emergency department was 6 hours (Figures 3 and 4).
  The presentations peaked during the weekends (Saturdays and Sundays) and were lowest in the middle of the week: 33% of presentations occurred during weekends (Figure 5).
• Polysubstance use
  Overall, polysubstance use was reported in 65% of presentations. Specifically, the combination of alcohol and one additional substance was reported in 22% of presentations, while 43% of presentations involved at least two substances other than alcohol. Alcohol was reported to be co-ingested in at least 36% of presentations with acute drug toxicity (Figures 6a and 6b).
• Changes in overall numbers, proportion of females and presentations with specific substances Among the 15 centres that provided data for both entire years 2024 and 2023, the number of presentations increased in 7, decreased in 5, and remained stable in 3. The proportion of female presentations increased in 6, decreased in 7, and remained stable in 2; and the proportion of presentations younger than 25 years old increased in 5, decreased in 7, and remained stable in 3.
  Data for both the years 2023 and 2024 for cocaine were available from 15 hospitals. The number of presentations with cocaine increased in 6 of these centres, decreased in 7, and remained stable in 2. Data for both 2023 and 2024 for cannabis were available from 14 hospitals. The number of presentations with cannabis increased in 7 of these centres and decreased in 7. Data for both 2023 and 2024 for heroin were available from 14 hospitals. The number of presentations with heroin increased in 6 of these centres, decreased in 6, and remained stable in 2 (Figure 11).
• Demographic characteristics (sex) by selected substances
  Females represented at least 25% of the presentations that reported heroin, 21% of the presentations that reported cocaine, and 26% of the presentations that reported cannabis.

Description by participating centres and presentations

The majority of acute drug toxicity presentations were among males (75%). The median age of those presenting was 32 years (30 years among females and 33 years among males).

Overall, and among females, those aged 20 to 29 years formed the largest age group, representing 30% of all presentations (33% of all female presentations). Among males, those aged 30 to 39 formed the largest age group, representing 31% of all male presentations (Figure 2).

Overall distribution by outcome

The majority of presentations with a known outcome were medically discharged from the emergency department (67% overall, 67% among males, 66% among females), with the next most common outcome being admission to a unit other than intensive care or psychiatric care (11%) and self-discharge (10%) (Figure 3).

Arrival and average length of stay in the hospital

Overall, 69% of presentations were brought to the hospital by ambulance. Three quarters of the presentations (75%) were discharged directly from the emergency department, whether by self-discharge (10%) or medical discharge (65%). The median length of stay in the emergency department was 6 hours.

The median length of stay in the hospital for all presentations (those discharged from the emergency department and those admitted to other departments) was 11 hours. Overall, the most common duration of stay in the hospital was 4-12 hours (39% of presentations).

Presentations by day of the week

Among females and males, drug-related presentations to emergency departments peaked at the weekends (Saturday and Sunday), which accounted for 33% of all presentations. The highest numbers of presentations were reported on Sundays (918) and Saturdays (857), followed by Fridays (779) (Figure 5).

The proportions of presentations with cocaine, cannabis and amphetamine did not change much between the weekend and the rest of the week. However, the proportion of presentations with MDMA was higher during the weekend (9% versus 5%).

Overall, 53% of presentations were admitted during the evening and night (20:00-07:59); of these, 26% were among females.

Description by substances

Polysubstance use is the norm rather than the exception among people who use drugs. Due to the synergistic effects of some substance combinations, their co-use can cause additional problems and increase the risk of severe outcomes. For example, opioids taken with other central nervous system depressants, such as alcohol and benzodiazepines, may cause respiratory depression. Polysubstance use can result in more complex clinical management and treatment, longer stays in the emergency department and an increased need for hospital admission.

In 2024, 35% of presentations were associated with the use of a single drug, 22% with the co-use of a single drug and alcohol, and 43% with the co-use of two or more substances (Figures 6a and 6b). The proportion of presentations with a single drug, with one drug only plus alcohol, and with other patterns of polysubstance use varied by drug (Figure 6b).

Single-substance use

Most common substances

This section describes the presentations that involved a single substance reported alone, which account for 35% of all presentations. Among the substances reported alone in 2024, cannabis (22%) was the most frequently mentioned, followed by cocaine (15%) and GHB/GBL (10%) (Figure 7).

Clinical outcome by substances

Among the presentations reporting single-substance use, those with GHB/GBL had the highest proportion of admission to the critical care unit (28%), followed by those with heroin (12%) and with an unspecified benzodiazepine (6%) (Figure 8). Amphetamine was the drug associated with the highest proportion of admissions to the psychiatric unit (15%), followed by cannabis (9%), and cocaine and an unspecified benzodiazepine (both 8%).

Polysubstance use

In 2024, overall polysubstance use (co-use of at least two substances) was reported in 65% of presentations (Figure 6a). Among these presentations, some involve only one drug and alcohol (22% of the total presentations), and this proportion varies by drug (Figures 6a and 6b). The substances that are most commonly used in combination with alcohol alone are cocaine (10% of all presentations with overall polysubstance use), cannabis (7%), amphetamine, alprazolam and GHB/GBL (all 2%).

In the section below, we focus on the 43% of all presentations reporting the co-use of at least two substances other than alcohol. A proportion of these presentations may also include alcohol as an additional substance. 

Polysubstance use patterns

Among presentations reporting polysubstance use with at least two non-alcohol substances, the most frequently reported combination was cannabis, cocaine and alcohol, followed by cannabis and cocaine, and by amphetamine and heroin, all reported by 2% of presentations with overall polysubstance use (Figure 9).

Alcohol in the context of polysubstance use

Co-ingestion of alcohol was reported in 42% of the presentations for which information on the presence or absence of alcohol is available. Among the presentations with alcohol co-ingestion, the majority reported the co-use of alcohol and only one other substance (62%), followed by alcohol and two other substances (25%). Similarly, among the presentations reporting polysubstance use with no alcohol, most (58%) involved only two substances (Figure 10).

Clinical outcome by substances and their combinations

The majority (66%) of presentations reporting any form of polysubstance use were medically discharged and a further 10% self-discharged. The remainder were admitted to the critical care unit (3%), the psychiatric unit (7%), or to a medical unit other than the critical care or psychiatric unit (10%).

Changes over time

To assess the changes between 2023 and 2024, we focused on the 15 hospitals that reported for both entire years and with at least 20 presentations overall in both years. We compared the number of presentations reporting specific drugs and, counting only changes of at least 10%, we defined the following categories: increased, decreased, stable. Hospitals reporting no cases in one of the two years were not considered in the comparison.

Among the 15 centres that provided data for both 2024 and 2023, the overall number of presentations increased in 7, decreased in 5, and remained stable in 3.

Among the 15 centres, the number of presentations mentioning the use of cocaine increased in 6, decreased in 7 and remained stable in 2. Similarly, among the 14 centres where presentations involving cannabis were reported for both 2024 and 2023, the number of presentations mentioning the use of cannabis increased in 7 and decreased in 7. Finally, among the 14 centres where presentations involving heroin were reported for both 2024 and 2023, the number of presentations mentioning the use of heroin increased in 6, decreased in 6 and remained stable in 2.

Among the 16 centres that provided data for both 2024 and 2023, the proportion of female presentations increased in 6, decreased in 7, and remained stable in 2; the proportion of presentations younger than 25 years increased in 5, decreased in 7, and remained stable in 3.

In focus

This section summarises the findings per drug for the 29 centres in the European Union and Norway that provided data for 2024. As the data are for substances taken alone or with other substances, and some presentations may be counted under more than one drug, totals should not be computed.

• Cocaine. Use of cocaine was reported in 26% of all presentations. The median age of those presenting was 33 years, and 79% were males. Co-ingestion of alcohol was reported in 51% of presentations with information on alcohol use. The median length of stay in the emergency department for cocaine-related presentations was 6 hours. Overall, 4% of all presentations with cocaine were admitted to critical care.
• Cannabis. Use of cannabis was reported in 24% of all presentations. The median age of those presenting was 28 years, and 74% were males. Co-ingestion of alcohol was reported in 40% of presentations with information on alcohol use. The median length of stay in the emergency department for cannabis-related presentations was 6 hours. Overall, 3% of all presentations with cannabis were admitted to critical care.
• Amphetamine. Use of amphetamine was reported in 14% of all presentations. The median age of those presenting was 34 years, and 78% were males. Co-ingestion of alcohol was reported in 34% of presentations with information on alcohol use. The median length of stay in the emergency department for amphetamine-related presentations was 6 hours. Overall, 6% of all presentations with amphetamine were admitted to critical care.
• Heroin. Use of heroin was reported in 10% of all presentations. The median age of those presenting was 37 years, and 75% were males. Co-ingestion of alcohol was reported in 18% of presentations with information on alcohol use. The median length of stay in the emergency department for heroin-related presentations was 6 hours. Overall, 8% of all presentations with heroin were admitted to critical care. The majority of the presentations with heroin were recorded in the Oslo OAEOC centre (69% of the heroin presentations).
• GHB/GBL. Use of GHB/GBL was reported in 9% of all presentations. The median age of those presenting was 35 years, and 80% were males. Co-ingestion of alcohol was reported in 34% of presentations with information on alcohol use. The median length of stay in the emergency department for presentations with GHB/GBL was 4 hours. Overall, 23% of all presentations with GHB/GBL were admitted to critical care.
• MDMA. Use of MDMA was reported in 6% of all presentations. The median age of those presenting was 25 years, and 68% were males. Co-ingestion of alcohol was reported in 51% of presentations with information on alcohol use. The median length of stay in the emergency department for MDMA-related presentations was 5 hours. Overall, 5% of all presentations with MDMA were admitted to critical care.
• Ketamine. Use of ketamine was reported in 4% of all presentations. The median age of those presenting was 30 years, and 81% were males. Co-ingestion of alcohol was reported in 43% of presentations with information on alcohol use. The median length of stay in the emergency department for presentations with ketamine was 4 hours. Overall, 5% of all presentations with ketamine were admitted to critical care.
• Methamphetamine. Use of methamphetamine was reported in 4% of all presentations. The median age of those presenting was 32 years, and 81% were males. Co-ingestion of alcohol was reported in 23% of presentations with information on alcohol use. The median length of stay in the emergency department for presentations with methamphetamine was 7 hours. Overall, 4% of all presentations with methamphetamine were admitted to critical care.

Limitations and footnotes

There are important methodological limitations to consider when interpreting this data set.

• A hospital within a city is not necessarily representative of the city, the region or the country. Local factors such as proximity to high concentrations of night-time economy venues or social deprivation may have an impact on the types of presentations seen in the sentinel centre.
• The emergency services participating in the project are mostly based in hospitals for adults. Therefore, they rarely or do not see paediatric cases of acute drug toxicity. Other surveillance would be necessary to monitor the real burden and trends in acute drug toxicity among children and adolescents.
• The data are mostly self-reported and based on the clinician’s report, rather than analytically confirmed.
• For most cases, more than one drug is reported; thus, the effect of a particular drug in this context is difficult to assess.
• Presentations with lone alcohol toxicity (without drugs) are known to be more common than drug toxicity presentations. However, presentations with lone alcohol toxicity are not collected by Euro-DEN Plus. Therefore, the mention of alcohol in this data set is an underestimate of the overall number of presentations to emergency departments with alcohol involved. Furthermore, in this data set, the completeness of the reporting of alcohol varies. Thus, these numbers are minimum estimates.
• The dataset consists of reports of presentations rather than patients. It may include repeat admissions of the same patient and, therefore, the observations may not be fully independent. No information is collected to flag and count whether a person has presented in the past. If there are factors that predispose patients to present repeatedly, such patients will be over-represented in the sample of presentations.
• Numbers of cases are small in some hospitals. Therefore, caution should be exercised in the interpretation of percentages, the interpretation of changes and comparisons over time and across centres.
• We define a change in the number of presentations for a given drug as an increase or decrease of at least 10% compared with the previous year. Centres not registering increases or decreases of at least 10% are reported as stable.
• A small number of centres account for a large portion of the overall data, and this should be kept in mind when interpreting the overall data. Local analysis is more informative than the global analysis.
• This monitoring is based on hospital emergency services and provides information only on presentations to these settings. Other acute drug toxicity episodes that do not result in hospital emergency presentations are not captured. Presenting to emergency services may depend on the severity of the adverse effects, but also on the organisation of pre-hospital care and referrals to hospitals in the country.
• The 2024 data collection was incomplete for the centres in Antwerp and Dublin. For 2024, the centre in Tenerife provided data for only 5 months.
• The centres in the Western Balkans and Southern Neighborhood countries (project funded by the European Union under the EUDA-implemented technical cooperation projects EU4MD II  and IPA8) provided data in 2024 only for a six-month period from July-December.
• Centres with fewer than 12 presentations are not shown in the explorer. For reasons of data protection, we do not show subgroups of 5 or fewer individuals in the age and sex pyramids (Figure 1).

Source data

The complete set of source data for the European Drug Emergencies Network (Euro-DEN Plus) data explorer is available in our data catalogue but may also be downloaded below.

In addition to the data below, a yearly snapshot of data from the 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 2024.