Other drugs – the current situation in Europe (European Drug Report 2023)
Alongside the more well-known substances available on illicit drugs markets, a number of other substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include LSD, hallucinogenic mushrooms, ketamine, GHB and nitrous oxide. On this page, you can find the latest analysis of the situation regarding these substances in Europe, including seizures, prevalence and patterns of use, treatment entry, harms and more.
This page is part of the European Drug Report 2023, the EMCDDA's annual overview of the drug situation in Europe.
Last update: 16 June 2023
Concerns of growth in use and possible harms prompt a need for improved monitoring of more-novel and less well-known substances
Alongside the more well-known substances available on illicit drugs markets, a number of other substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include LSD (lysergic acid diethylamide), hallucinogenic mushrooms, ketamine, GHB (gamma-hydroxybutyrate) and nitrous oxide. The data available suggest that, overall, the prevalence of use of hallucinogenic and dissociative drugs remains generally low in Europe. However, an important caveat here is that these substances are not well monitored by existing surveillance systems, meaning that it is hard to comment with confidence on either the prevalence of use or on recent trends. The information available does suggest, however, that in some countries, subgroups, or settings, the use of these sorts of substances has become more common.
The quantity of ketamine seized and reported to the EU Early Warning System on new psychoactive substances has varied over time, but has remained at relatively high levels in recent years, suggesting that this drug is likely to be consistently available in some national drug markets and may have become an established drug of choice in some settings. Ketamine is commonly snorted, but can also be injected, and has been linked to various dose-dependent acute and chronic harms, including neurological and cardiovascular toxicity, mental health problems, such as depression, and urological complications, such as bladder damage from intensive use or the presence of adulterants. Ketamine may also be added to other drug mixtures, including MDMA powders and tablets, although 2021 data from drug checking services show that these are generally less adulterated than other illicit drugs. It can also be found in mixtures sold as ‘pink cocaine’ or ‘tucibi’, which are more likely to contain ketamine and other synthetic drugs, such as amphetamines or MDMA, but less likely to contain the synthetic drug 2C-B. As noted elsewhere in the 2023 European Drug Report, people using mixtures of drugs may be unaware of the substances they are consuming, and drug interaction effects can expose them to elevated health risks. While the numbers of clients entering treatment for problems related to ketamine use remain low overall, some EU Member States have seen increases and there is a strong case for improving the monitoring of both the use of this drug and the extent to which it is associated with negative health outcomes.
Nitrous oxide, commonly known as laughing gas, has been linked to various health problems, including poisonings, burns and lung injuries and, in some cases of prolonged exposure, neurotoxicity from vitamin B12 deficiency. There is, however, a debate on the extent to which this substance is associated with negative health risks, especially in episodic users, although given its apparent growing popularity among young people this is clearly an important area for further research and monitoring. In some European cities, discarded nitrous oxide gas canisters have become a relatively common sight, and the disposal of the smaller stainless steel canisters has been identified as a drug-litter issue in some countries. A recent EMCDDA review identified a number of EU Member States, including Denmark, Ireland, France, Lithuania, the Netherlands and Portugal, that have seen signs of an increase in the availability and recreational or episodic use of nitrous oxide. This drug appears to have become more accessible and cheaper, with the increased availability of larger gas canisters aimed at recreational use. However, high-volume cylinders may also increase the risk of lung damage, due to the higher pressure of their contents and, in general, inhaling directly from gas bottles is reported to be associated with a greater risk of harm. Nitrous oxide has various commercial users, for example, it is used by the catering industry. Regulatory approaches to the sale and use of this substance vary between countries, with the gas legally available for sale in some countries.
Figure. Seizure of over 59 000 nitrous oxide canisters worth over EUR 1.9 million in Ireland by Revenue in December 2021
Non-controlled and new benzodiazepines also continued to be available in some European countries but, again, current monitoring approaches make it difficult to comment on the scale of their use, although signals exist that these substances may have important consequences for health, especially when consumed in combination with other drugs. They are often very cheap and may be used by young people in combination with alcohol, sometimes resulting in potentially serious health reactions or aberrant behaviour. These substances have also been linked to overdose deaths among people who use opioids, and reports in 2021 show that the proportion of overdose deaths involving benzodiazepines increased in several countries. However, a lack of toxicological information currently means the role that benzodiazepines play in opioid-related deaths is not sufficiently understood. Mixtures containing new benzodiazepines and sedatives, respectively known as ‘benzo-dope’ and ‘tranq-dope’, have been linked to increases in overdose deaths in Canada and the United States. In 2022, the Estonian police reported seizing mixtures containing the new synthetic opioid metonitazene and bromazolam, a new benzodiazepine, and mixtures containing the new opioids protonitazene and metonitazene and the animal sedative and analgesic xylazine.
Both clinical and public interest has been growing in the therapeutic use of some novel substances, particularly psychedelic substances, but also dissociative drugs such as ketamine. A growing number of clinical studies are exploring the potential of a range of psychedelic substances to treat different mental health conditions. Generalising in this area is difficult, and much of the research remains in its infancy, but some research in this area appears promising. These developments have also received considerable media attention. An associated concern here is that this may encourage greater experimental use of these substances without medical support, potentially putting some vulnerable individuals at risk of suffering adverse consequences. At the same time, there are signs of unregulated programmes being operated in the European Union and elsewhere, in which the use of psychedelic substances is included as part of a wellness, therapeutic or spiritually oriented intervention.
Together, these developments have placed a renewed emphasis on the need to obtain a better understanding of the availability of both non-controlled and less common substances, as well as their impact on public health, in Europe. In particular, there are concerns about chronic harms from some of these substances, such as ketamine, and risks associated with more intensive patterns of use in certain niche settings and contexts, including the use of GHB in the chemsex scene. The presence of combinations of new synthetic opioids and new benzodiazepines further complicates overdose prevention efforts, potentially raising the need for reviewing the delivery methods of overdose-fatality prevention measures such as naloxone. There is an urgent need to improve our monitoring of the use and harms associated with these substances and to develop forensic and toxicological information sources in this area. Drug checking services will also continue to be an important sentinel data source. This information is needed to support the development and evaluation of effective harm reduction and other interventions appropriate to the settings and contexts in which these drugs are being consumed and the risks they may pose.
Key data and trends
Prevalence and patterns of use of other drugs
- Among young adults (aged 15 to 34), recent national surveys show last year prevalence estimates for both LSD and hallucinogenic mushrooms equal to or less than 1 %. Exceptions for hallucinogenic mushrooms include Czechia (2.7 % in 2021), Finland (2.0 % in 2018), the Netherlands (1.9 % in 2021), Estonia (1.6 % in 2018, 16–34), Denmark (1.5 % in 2021), Spain (1.1 % in 2022) and Germany (1.1 % in 2021). Exceptions for LSD include Ireland (2.4 % in 2019), Finland (2.0 % in 2018), Estonia (1.7 % in 2018, 16–34), Latvia (1.4 % in 2020), Norway (1.3 % in 2021) and the Netherlands (1.2 % in 2021).
- Among respondents to the European Web Survey on Drugs, 20 % of those who had used drugs within the last 12 months had used LSD, while 13 % had used ketamine.
- Recent estimates of last year prevalence of ketamine use among young adults (15–34) range from 0.4 % in Denmark (2021, 16–34) to 0.8 % in Romania (2019). The Netherlands reported that ketamine use has increased among young people in nightlife settings.
- In 2022, generally very low levels of ketamine residues in municipal wastewater were reported by 15 cities, with the highest mass loads being detected in cities in Denmark, Spain, Italy and Portugal (see the figure Ketamine residues in wastewater in selected European cities, 2022, below).
Mean daily amounts of ketamine in milligrams per 1000 population. Sampling was carried out over a week in March and April 2022.
Source: Sewage Analysis Core Group Europe (SCORE).
Treatment entry for ketamine use
- Increases were observed in the number of clients entering treatment for problems related to ketamine use in Belgium, Spain, France and Italy in 2021, with the overall number rising from 93 in 2015 to 414 clients in 2021 in these countries.
Harms related to use of other drugs
- GHB was the fourth most common drug reported by Euro-DEN Plus hospitals in 2021. GHB was present in 11 % of acute drug toxicity presentations and 27 % of critical care admissions, reflecting overdose risks. LSD was present in 1.5 % of acute drug toxicity presentations, while ketamine was present in 2.0 %.
- Drug toxicity data suggest recent increases in the use of nitrous oxide. Increases in presentations involving nitrous oxide were reported by Euro-DEN Plus hospitals in Amsterdam (30 in 2020, from 15 in 2019) and Antwerp (64 in 2019/2021, from 6 in 2017/2018), while in 2021, French poison centres reported 358 notifications involving the drug (120 in 2020, 37 in 2019) and Dutch poison centres reported 144 (128 in 2019).
- In 2021, the proportion of overdose deaths involving benzodiazepines increased in several countries and was present in more than half of the cases in Denmark, Austria, Portugal and Finland (see figure Proportion of drug-induced deaths with benzodiazepines involved in selected countries, 2019–2021 in Drug-induced deaths in Europe).
Market data for other drugs
- Seizures of hallucinogenic and dissociative drugs are not consistently monitored across Europe. Different EMCDDA monitoring systems provide the limited information available, which is incomplete, divergent and difficult to generalise.
- In 2021, 1 800 seizures of LSD (lysergic acid diethylamide), amounting to 67 600 units, 2 kilograms and 2 litres were reported in Europe. Eighteen countries reported 900 seizures of hallucinogenic mushrooms, amounting to 38 kilograms. Fourteen EU countries reported 200 seizures of DMT (dimethyltryptamine), amounting to 1.1 tonnes, mainly in the Netherlands (971 kilograms) and Italy (75 kilograms).
- In 2021, 22 EU countries, Norway and Türkiye reported seizures of ketamine to the EMCDDA amounting to more than 1.1 tonnes. Seizures of ketamine have remained at these relatively high levels (typically over 1 tonne) for several years, since their peak in 2018 when more than 1.7 tonnes was seized in Europe (see the figure Seizures of ketamine powder in the European Union, below).
- In 2021, the Netherlands reported the dismantling of one ketamine laboratory. Given ketamine’s common use in veterinary medicine as an anaesthetic, the theft and diversion of the drug from legitimate purposes remains a problematic issue.
- An increasing number of samples of mixtures containing ketamine, MDMA and cocaine have been reported to the EU Early Warning System on new psychoactive substances since about 2018, mostly by Spain. Some of these appear to be sold as ‘pink cocaine’ or ‘tucibi’, with people consuming it potentially unaware they may be consuming ketamine.
- Ten EU countries reported 270 seizures of the psychedelic drug 2C-B, amounting to 29 000 tablets or units and 0.12 kilograms. Open-source monitoring indicates that it is sometimes added to mixtures sold as pink cocaine in Europe and elsewhere, alongside MDMA powder and ketamine, which may or may not contain cocaine.
- Seventeen European countries reported 2 000 seizures of GHB (gamma-hydroxybutyrate) or its precursor GBL (gamma-butyrolactone), amounting to 100 kilograms and 850 litres. GBL has many industrial purposes, making the data challenging to interpret.
Based on reports to the EU Early Warning System on new psychoactive substances.
Based on reports to the EU Early Warning System on new psychoactive substances.
Source data
The data used to generate infographics and charts on this page may be found below.
About this page
Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2023), European Drug Report 2023: Trends and Developments, https://www.emcdda.europa.eu/publications/european-drug-report/2023_en
Identifiers:
HTML: TD-AT-23-001-EN-Q
ISBN: 978-92-9497-865-3
DOI: 10.2810/161905