Heroin and other opioids – the current situation in Europe (European Drug Report 2025)
Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large share of the health burden attributed to illicit drug consumption. Europe’s opioid problem, however, continues to evolve in ways that are likely to have important implications for how we address issues in this area. On this page, you can find the latest analysis of the drug situation for heroin and other opioids in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
This page is part of the European Drug Report 2025, the EUDA’s annual overview of the drug situation in Europe.
Last update: 5 June 2025
Europe’s heroin and opioids market still driving harm reduction and treatment challenges
Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large proportion of the health burden attributed illicit drug consumption. Europe’s opioid phenomenon, however, continues to evolve in ways that are likely to have important implications for how we respond to problems in this area.
Data on entry into drug treatment and other indicators show that, overall, the cohort of heroin users in Europe is ageing. Between 2013 and 2023, the mean age of all clients entering specialist drug treatment for heroin use and for those doing so for the first time increased, as did the proportion of older clients (see Figure 6.1 and Figure 6.2). Changes in the characteristics of those seeking help increasingly mean that services are now addressing a more complex range of health and social support needs. As well as directly responding to drug-related problems, these include prevention and treatment of age-related illness and a corresponding requirement to establish effective multi-agency partnerships and referral pathways with general health and social support services.
While heroin continues to be involved in many opioid-related deaths (see Drug-induced deaths – the current situation in Europe), other opioids have become more prominent. In addition, although heroin remained the most commonly reported opioid in acute drug toxicity presentations at Euro-DEN sentinel hospitals in 2023, in some cities, other opioids – opioid agonist medicines, pain relief medicines or potent new synthetic opioids – have overtaken heroin as a driver of presentations. While this data set is not nationally representative, it provides a window on how opioid problems may be changing at the local level. Moreover, the data needs to be interpreted with care, as some changes in this area appear to reflect the positive impact of long-term policies to reduce the demand for heroin, discourage new initiation and provide adequate and effective treatment responses. Nonetheless, greater attention may now be merited on measures to reduce the risk that opioids intended for therapeutic use may be diverted onto the illicit market. An important caveat here is that the pursuit of this objective should not create additional barriers to the provision of opioid agonist treatment, the coverage of which remains inadequate in a number of countries.
Changes in the route of administration of heroin have also been observed. Among presentations to treatment services, injecting among both first-time and previously treated heroin clients has decreased over the last decade. The most recent data, however, suggest a slowing of the downward trend (see Figure 6.3 and Injecting drug use in Europe – the current situation). The transition from injecting to other routes, mainly smoking/inhaling, could reflect the influence of various factors, including the impact of harm reduction and prevention efforts and changes in drug availability that may affect patterns of use. Only 20 % of new clients entering treatment for heroin-related problems now report injection as their main route of administration. This development is important, as injecting drug use is particularly associated with a range of negative health outcomes. Less positively, as discussed elsewhere in this report, overall, people who inject drugs appear to be injecting a more diverse range of substances, with stimulants, which tend to be injected more frequently than opioids, being more commonly reported. Also, concern exists around the low, and in some cases decreasing, levels of provision of sterile syringes observed in some EU Member States (see also Injecting drug use in Europe – the current situation).
Alongside the presence of a more diverse range of opioids and other substances on Europe’s drug market, polysubstance use by people who primarily use opioids remains a key health concern, as it increases various risks. Importantly, data from several indicators suggest that heroin and other opioids are often used in combination with other substances, including alcohol, benzodiazepines or stimulants such as cocaine, crack cocaine and amphetamines. Polysubstance use involving opioids and other respiratory depressants increases the risk of fatal overdose, and data from both established and leading-edge sources give an indication of how the simultaneous use of multiple substances is a feature of local drug consumption patterns. In 2023, three out of five clients entering specialised drug treatment in Europe who cited an opioid as their primary problem drug reported a secondary substance. At the local level, in 2023, more than a third of the emergency episodes reported by 13 drug consumption rooms in 9 EU Member States in the European Network of Drug Consumption Rooms were linked to polysubstance use. Data from ESCAPE – the European Syringe Collection and Analysis Project Enterprise – show that patterns of polysubstance use differ between countries and by opioid injected. While heroin was frequently detected in syringes alongside other drugs or adulterants, in sites in Vilnius (Lithuania) and Tallinn (Estonia), new synthetic opioids were often the only active compound detected in syringes. In Thessaloniki (Greece) and Prague (Czechia), buprenorphine was often found alone or with naloxone, likely reflecting the composition of pharmaceutical preparations.
Production and trafficking shifts might alter Europe’s heroin market
The ban on opium poppy cultivation, introduced by the Taliban in April 2022, has greatly reduced the production of opium and heroin in Afghanistan, the main source of the drug in Europe, with the United Nations Office on Drugs and Crime (UNODC) estimating a 95 % drop in opium cultivation in 2023, to 10 800 hectares, down from 232 000 hectares in 2022. More recent UNODC figures suggest that poppy cultivation remained at very low levels in 2024, at 12 800 hectares. If sustained, a decrease in opium and heroin production in Afghanistan is likely to affect heroin availability in Europe, although it remains challenging to predict when this might happen and how it might be experienced in different EU Member States. Various factors affect the trafficking of illicit heroin from Afghanistan to Europe, some of which are poorly understood, such as the socioeconomic situation of Afghanistan’s rural farmers and landowners, and the likely presence of opium and heroin stockpiles, which are difficult to estimate, or shifts in trafficking routes. Given the economic and humanitarian crises in Afghanistan, the Taliban may face domestic pressure to rescind the ban, as opium cultivation was previously an important income source. Taken together, these developments underscore the need to improve the monitoring of Afghanistan’s drug situation. The EUDA has launched a new project in this area to enhance preparedness and provide strategic insights for EU policymakers.
Within Europe, a number of indicators suggest that the heroin market has been shrinking over the past 10 years. Despite wide fluctuations in the amounts seized, the long-term trends in price and purity and in the number of seizures suggest that supply may have increased relative to demand, over the period (see Heroin and other opioids market data, below). However, this may be changing as indicated by the most recent seizure data from key countries along the main trafficking route, Türkiye and Bulgaria, and possibly also by a notable fall in heroin purity in 2023. While the data may be suggestive of shifts currently taking place in Europe’s heroin market dynamics, further monitoring is needed to determine whether the most recent developments are a direct consequence of supply disruptions from Afghanistan or other geopolitical factors, and how they may further develop and impact heroin availability.
Beyond supply constraints, market resilience and adaptation remain key considerations for better understanding signals of change in Europe’s heroin market. For example, reports indicate that opium stockpiles within Afghanistan may have helped buffer the immediate impact of the ban (Understanding the impact of the Taliban drug ban). In conjunction, the high value of the European heroin market might make supplies to Europe somewhat resilient in the short to medium term, while a decrease in availability for other, less lucrative markets may be more immediate. Moreover, trafficking networks are highly adaptable and may be shifting routes as a result of Russia’s full-scale invasion of Ukraine and conflicts in the Middle East – particularly recent developments in Syria. Downstream at Europe’s external and internal borders, trafficking networks continue to use a range of modi operandi to bring heroin into EU countries. These include the concealment of larger loads within equipment and machinery, as seen in a recent Bulgarian seizure and the use of light aircraft and the targeting of regional and smaller airfields to move wholesale loads within the European Union, as observed in a recent Irish seizure (see Figure 6.4, Figure 6.5 and Drug supply, production and precursors – the current situation in Europe).
Note: Drugs seized by the Garda National Drugs and Organised Crime Bureau and Revenue’s Customs Service.
Note: Drugs seized by the National Customs Agency of Bulgaria.
Faced with a possible sustained reduction in the supply of heroin from Afghanistan, criminal networks involved in drug trafficking may seek alternative sources. It would, however, be difficult to fully replace heroin from Afghanistan with supplies from other producer countries, such as Myanmar, given the amount of opium and heroin produced and trafficked from Afghanistan prior to the current ban. While not a new development, it is interesting to note that quantities of white heroin, adding up to 60 kilograms, presumably manufactured in or near Myanmar, were seized on different occasions from commercial airline passengers flying from Thailand to EU Member States in 2024 and early 2025. This may indicate that some trafficking networks are exploring alternative sources of heroin in anticipation of a future shortage in Afghanistan. This is at a time when commercial trade between the European Union and South-East Asia is set to expand.
Health concerns over possible increased supply and use of new synthetic opioids
Currently, new synthetic opioids play a relatively small role in the drug market in Europe overall, but they are a significant problem in some countries, and there are signals that they could have the potential to play a larger role in Europe’s drug problems in the future. Synthetic opioids, such as fentanyl and its derivatives, including carfentanil, which are typically much more potent than heroin, have been reported to the EU Early Warning System for many years now. More recently, a new class of synthetic opioids, nitazenes, some of which are significantly more potent than fentanyl, has appeared in Europe. Since 2019, the EU Early Warning System has received reports of the presence of nitazenes on the drug markets of at least 21 EU Member States (see New psychoactive substances – the current situation in Europe). Seizures of nitazenes in Europe have risen rapidly, with the quantity detected in powder form tripling to 10 kilograms in 2023. Significantly, the availability of fake medicines containing nitazenes has also increased, with an increasing quantity of seized tablets being reported to the EU Early Warning System by at least 12 countries in 2024. These products typically mimic legitimate prescription medications, particularly oxycodone and, to a lesser extent, benzodiazepines such as diazepam and alprazolam. While generally taken by high-risk opioid users, there are concerns about their potential to spread to broader populations without opioid tolerance, including young people. In 2023, new synthetic opioids were detected by the EU Early Warning System on new psychoactive substances in at least 20 EU Member States, Norway and Türkiye. In the same year, 8 countries reported harms associated with nitazene opioids, including non-fatal and fatal poisonings, as well as outbreaks. There were also reports of nitazene opioids being mis-sold as heroin in Ireland and France, and in 2024, as benzodiazepines in Ireland that were linked to poisonings in the community and prison settings among vulnerable groups of people who use drugs.
With the exception of some Baltic countries, new synthetic opioids do not currently figure prominently in the routine data available at EU level. Nonetheless, developments in this area are worrying because of the potential of these substances to impact negatively on public health in Europe in the future. An increase in the availability of synthetic opioids and associated harms, including drug-related deaths, was reported in 2022 and 2023 by some northern and Baltic countries, including Estonia and Latvia. Clusters or significant numbers of deaths and acute toxicity linked to nitazenes were reported in 2023 in France, in 2024 in Germany and in 2023/2024 in Sweden and Norway. Due to their high potency and novelty, there are concerns that nitazene opioids may not be routinely detected in procedures commonly used for post-mortem toxicology. This raises the possibility that the number of deaths reported could be an underestimate.
Enhancing preparedness remains critical to Europe’s ability to respond rapidly to poisoning outbreaks related to potent synthetic opioids. The EUDA’s health and security threat assessment system is currently under development, with its first pilot assessment conducted in late 2024, focusing on nitazenes and carfentanil in the Baltic region. Among the key findings, the assessment noted that nitazenes have become an increasingly prominent feature of the drug market in Estonia and Latvia, whereas carfentanil remained dominant in Lithuania. These substances appear to have filled a vacuum following the decline of fentanyl and heroin, highlighting the adaptability of local drug markets. Estonia is one of the few EU Member States to have undergone a long-term shift in its opioid market following a reduction in the availability of heroin around 2001, when an earlier Taliban ban on opium cultivation was enacted. However, the ban was eventually allowed to lapse, resulting in the return of heroin to most other EU Member States with significant markets for the drug.
There has been speculation that a reduction in the availability of heroin in Europe, as a result of the Taliban’s ban on opium cultivation in Afghanistan, could create the conditions for greater availability and use of synthetic opioids. Given the potential negative consequences of this, Europe needs to improve its preparedness for the harm reduction and other challenges that such a market shift could bring.
Concerns in this area include the adulteration of heroin with new synthetic opioids, the mis-selling of new synthetic opioids and the replacement of heroin by new synthetic opioids. Such developments could increase the risk of overdose and drug-induced deaths among opioid consumers. It is of note in this context that North America has seen a dramatic increase in opioid-related mortality in recent years, driven by potent synthetic opioids, principally fentanyl derivatives. However, based on previous examples of shocks to the heroin market, it is also possible that stimulants such as cocaine and synthetic cathinones may also have the potential to be used as replacement substances for heroin.
While increased polysubstance use and substance-switching are likely outcomes of any reduction in heroin availability, a key means to pre-empt this scenario would be to expand rapid access to opioid agonist treatment and related supports, as well as needle and syringe programmes. It also remains important to develop sufficient access to naloxone to reverse overdoses and prevent drug-induced deaths. Monitoring the drugs available at retail level in local drug markets remains important to rapidly identify changes in the substances for sale and the presence of dangerous batches of drugs. The EU Early Warning System will continue to play a key role in this regard, as will the EUDA’s new drug alert and threat assessment systems.
Most supplies of new synthetic opioids, such as nitazenes, are believed to originate in China and to be trafficked to Europe. However, some limited synthetic opioid production is known to have occurred within Europe, and it is not impossible to imagine that existing illicit synthetic drug production capacity could potentially be used for the production of synthetic opioids, should market conditions become favourable.
For a more detailed insight into the dynamics of heroin supply in the European Union, see the 2024 EUDA-Europol EU Drug Market: Heroin and other opioids – In-depth analysis; see also the EUDA’s Opioids: health and social responses.
Key data and trends
Prevalence of opioid use
- It is estimated that 0.3 % of the EU adult population, or around 860 000 people, used opioids in 2023 (stable compared to 2022).
Treatment entry for use of heroin and other opioids
- Opioid use was reported as the main reason for entering specialist drug treatment by 72 000 clients in 2023, representing 23 % of all those entering drug treatment in Europe. Heroin was the primary drug for 12 000 (61 %) of the 19 000 first-time entrants who reported a specific opioid as their main problem drug. Another 3000 first-time opioid clients did not specify their primary drug.
- The majority of those seeking treatment for problems related to opioids are men, who accounted for 80 % of all clients entering treatment with opioids as their main problem drug in 2023. This proportion has been relatively stable, with little variation between 2018 and 2023.
- Due to service disruptions during the COVID-19 pandemic, treatment entry data for 2020-2022 should be interpreted with caution. Nevertheless, the data suggest that the long-term downward trend in the number of people entering treatment for heroin use has continued (Figure 6.6).
- The latest European data show a time lag of 15 years (13 for women and 16 for men) between first heroin use, on average at the age of 23, and first treatment for heroin-related problems, on average at the age of 38. Between 2018 and 2023, the time lag increased by 5 years for women and by 6 years for men.
- National data from 26 EU Member States show that an estimated 511 000 clients received opioid agonist treatment in 2023 (510 000 in 2022).
Harms related to opioid use
- Opioids, including heroin and its metabolites, often in combination with other substances, were present in 7 out of 10 cases of fatal overdose in 2023 for which toxicological information is available (see Drug-induced deaths – the current situation in Europe). A caveat is that data are available for only 19 EU Member States.
- In 2023, heroin remained the third most frequently reported drug in acute drug toxicity presentations in Euro-DEN Plus hospitals in the European Union and Norway, accounting for 13 % of all cases. Heroin was found in 18 of the 22 hospitals participating in 2023 in the European Union and Norway (Figure 6.7).
- Heroin was reported in more than a fifth of the drug-related presentations at the hospital in Drogheda (Ireland) and the two hospitals in Oslo (Norway). Most presentations with heroin involved were among men aged 25 to 45 years: in 7 of the 18 hospitals in 2023, no cases were younger than 25 years. In half of the hospitals reporting heroin, women represented less than 7 % of the presentations with heroin involved. Depending on the hospital, the drugs most commonly reported together with heroin were benzodiazepines, cocaine and amphetamine.
Heroin and other opioids market data
- Following an increase in heroin seizures in 2021 (to 9.5 tonnes), the quantity seized by EU Member States fell by 16 % to 8.0 tonnes in 2022 and dropped by a further 33 % to 5.4 tonnes in 2023. Overall, EU Member States reported 17 000 heroin seizures in 2023 (21 500 seizures in 2022). Belgium (2.9 tonnes), France (1.1 tonnes), Spain (322 kilograms) and Italy (260 kilograms) reported the largest quantities. Türkiye seized 3.3 tonnes of heroin in 2023, 58 % less than in 2022 (8 tonnes).
- The average purity of brown heroin at the retail level ranged from 5 % to 40 % in 2023, with half of the countries reporting an average purity between 13 % and 21 %. Indexed trends indicate the average price of brown heroin dropped by 25 % between 2013 and 2023. The purity of the drug fluctuated during this period and fell markedly in 2023 (Figure 6.8).
- In 2023, 20 countries reported 927 seizures of new synthetic opioids, amounting to 22 kilograms, to the EU Early Warning System, an increase from the 17 kilograms seized in 2022. Notably, the quantity of nitazenes seized in 2023 tripled, from 3 to 10 kilograms. Of the 927 seizures of new opioids reported in 2023, 24 % contained carfentanil, 24 % contained protonitazene, 23 % contained metonitazene and 20 % contained tramadol. Carfentanil accounted for 32 % (7.0 kilograms) of the 22.0 kilograms of seized material, followed by protonitazene at 29 % (6.4 kilograms) and tramadol at 22 % (4.8 kilograms). Most of the reported seizures occurred in northern Europe, with Estonia, Latvia and Lithuania together accounting for 77 % of the seizures and 76 % (16.7 kilograms) of the quantity seized.
- Approximately 22 000 offences for heroin use or possession were reported in 2023.
- Fourteen heroin production sites were dismantled in the European Union in 2023 (10 in the Netherlands, 3 in Greece and 1 in France). All locations appeared to operate as cutting and packaging sites for blocks of heroin, likely for sale to both EU and non-EU countries, especially the United Kingdom. In addition, Czechia reported dismantling 2 unspecified opioid sites.
Source data
The data used to generate infographics and charts on this page may be found below.
The complete set of source data for the European Drug Report 2025, including metadata and methodological notes, is available in our data catalogue.
A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.