Other drugs – the current situation in Europe (European Drug Report 2025)
Alongside the more well-known substances available on illicit drug 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. 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 2025, the EUDA’s annual overview of the drug situation in Europe.
Last update: 5 June 2025
Less-commonly used substances adding to drug market complexity and health risks
Alongside the more well-known illicit substances available on drug markets, a number of other drugs with stimulant, hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include khat leaves (from the Catha edulis plant), LSD (lysergic acid diethylamide), hallucinogenic mushrooms, ketamine, GHB (gamma-hydroxybutyrate) and nitrous oxide. A number of these substances appear to have become well established in some countries, cities or specific populations, although overall their relative prevalence may remain low in comparison to some other better-known illicit drugs. However, for a variety of methodological and historical reasons, our current monitoring approaches often perform poorly in identifying patterns and trends in the use of these less well-known substances. This makes it difficult to comment with confidence on the prevalence of use and related harms.
Wider ketamine availability brings risk of increased harms
In the European Union, ketamine is an authorised medicine mostly used for anaesthesia. However, it may be subject to different regulatory controls at national level, such as controlled drugs or medicinal products legislation. This differing legal status is one of several factors that make monitoring the availability of ketamine challenging. Despite this, there are signs from a number of indicators that ketamine appears to be increasingly available on the EU drug market.
In 2023, ketamine was seized, mostly as powder, throughout the European Union, but more frequently in Spain and in larger quantities in the Netherlands, which accounted for almost three quarters of the quantity reported. Most of the ketamine seized in Europe is thought to originate from India. The drug is likely imported in bulk to EU Member States with less stringent legal controls and then distributed within and outside the European Union. Available information suggests that production of the drug in Europe remains limited. Given ketamine’s use in both human and veterinary medicine as an anaesthetic, and as esketamine for treatment-resistant depression, the theft and diversion of the drug from legitimate purposes remains a concern.
Overall, there is evidence to suggest that ketamine is likely to be consistently available in some national drug markets and may have become an established drug of choice in some settings. It is also reported to be used in combination with other substances, such as alcohol and various stimulants. In Ireland, for example, the intentional mixing of cocaine and ketamine has been identified at music festivals, as have ketamine-related medical incidents during 2022 and 2023. In 2023, Euro-DEN sentinel hospital emergency departments in Europe reported that cocaine was the substance most often reported in combination with ketamine in acute toxicity presentations. 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. Reflecting the challenges to healthcare systems posed by the increasing episodic use of the drug, in 2024 a Dutch study called for its inclusion in routine toxicological screenings in order to improve diagnosis.
Ketamine may also be added to other drug mixtures, including MDMA powders, potentially making inadvertent consumption an issue. Ketamine has also been found in mixtures sold as ‘pink cocaine’ or ‘tucibi’, which are typically mixtures of ketamine, MDMA and a third substance (such as cocaine, amphetamines or new psychoactive substances). Mixtures sold as ‘pink cocaine’ or ‘tucibi’ are not likely to contain the synthetic drug 2C-B, which is sometimes associated with ‘tucibi’ given the phonetic similarities in their names. In 2024, at least three countries reported detections of ‘tucibi’ or ‘pink cocaine’ to the EU Early Warning System’s database on new drugs, with most of the cases reported by Spain and Italy. The substance is usually seized in powder form, characterised by its pink colour and sweet smell derived from food colouring. In 2023, Dutch police detected several mixing and processing facilities producing ‘pink cocaine’. In addition, at least two criminal networks trafficking ‘tucibi’ mixtures from Spain to non-EU destinations were disrupted by law enforcement operations.
The number of clients reported to receive treatment for problems related to ketamine use remains low. However, it has risen from around 300 cases reported in 2018 to 1380 in 2023, and more than doubled between 2022 and 2023. The majority of these cases are reported by six countries, which may reflect the higher availability of ketamine in some parts of Europe and the potential lack of treatment options suitable for this emerging population elsewhere. Moreover, this data set is not likely to capture all those experiencing health problems related to this drug. For example, those who have developed urological problems may be poorly represented overall. In this regard, it is notable that the Netherlands has established clinics specialising in the treatment of patients experiencing urological problems resulting from chronic, intensive use of ketamine.
Nitrous oxide use still a concern in some EU Member States
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 among 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. An EMCDDA review published in 2022 identified a number of EU Member States, including Denmark, Ireland, France, Lithuania, the Netherlands and Portugal, that had observed signs of an increase in the availability and recreational or episodic use of nitrous oxide. More recent data from some of these countries, notably the Netherlands, indicate that nitrous oxide use has since declined. The drug has become more accessible and cheaper, available online and with an 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 uses; 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. Several EU Member States, including Denmark, France, Lithuania, the Netherlands and Portugal, have restricted the availability of nitrous oxide in recent years. There is limited evaluative information about the effectiveness of legislative or other approaches to restricting access to nitrous oxide.
Poisoning risks linked to new benzodiazepines remain a challenge
Insomnia and anxiety are among the conditions treated by doctors with benzodiazepines, as they act as central nervous system depressants. However, a market for new and illicit benzodiazepines, which are in some cases manufactured by criminal networks, exists in Europe. Non-controlled and new benzodiazepines also continued to be available in more than two thirds of European countries but, again, more sophisticated monitoring approaches would be needed to comment with confidence on the scale of their use. Nonetheless, signals exist that these substances may have important consequences for health, especially when consumed in combination with other drugs. A key challenge is that the seemingly legitimate appearance of fake medicines can potentially create a false sense of security among consumers regarding their consumption (see Figure 8.1). In some countries, benzodiazepines continue to be linked to poisoning and overdose outbreaks, which can escalate rapidly, with vulnerable populations potentially experiencing disproportionate levels of risk. During 2024 in Ireland, for example, there were three poisoning and overdose outbreaks in prisons, the first two of which involved high-potency nitazene opioids being mis-sold as heroin and benzodiazepines, with the third incident involving a new benzodiazepine, clobromazolam. Overdoses from new synthetic opioids can be reversed with naloxone, but those caused by benzodiazepines cannot and may, in some cases following evaluation by first responders, require hospitalisation, as was the case in Ireland. The Irish Health Service Executive and the Irish Prisons Service have issued risk alert communications regarding the circulation of these drugs (see Harm reduction – the current situation in Europe). These substances are often very cheap and may also be used by young people in combination with alcohol, sometimes resulting in potentially serious health reactions or aberrant behaviour. Benzodiazepines have also been linked to overdose deaths among people who use opioids. A lack of toxicological information means the role that benzodiazepines play in opioid-related deaths is not sufficiently understood. A total of 38 new benzodiazepines were notified to the EU Early Warning System between 2007 and 2024 (Figure 8.2), with 19 of these appearing on the drug market in 2023 in 22 EU Member States, Norway and Türkiye (see New psychoactive substances – the current situation in Europe). A limited number of new benzodiazepines were analysed by drug checking services in the first half of 2024 in 3 EU Member States. Unless integrated within a drug consumption room, these services are not typically accessed by more marginalised sub-groups of people who use drugs. Instead, they are more generally availed of by people who take drugs episodically, often at nightlife and music events. Ongoing monitoring of the substances appearing on drug markets can help rapidly identify and respond to the circulation of dangerous batches of drugs, and the EUDA’s Early Warning System remains a key resource in this respect.
Source: HSE Emerging Drug Trends Laboratory.
Growing interest in potential therapeutic uses of psychedelics raises health and regulatory questions
Public and clinical interest in psychedelics continues to grow, particularly regarding their potential therapeutic applications. Research into therapies assisted by substances such as psilocybin, MDMA, DMT and LSD for difficult-to-treat neuropsychiatric disorders like post-traumatic stress disorder and treatment-resistant depression is progressing rapidly. There have also been some developments in funding for trials involving psychedelics in the European Union. In Czechia, for example, the Drug Action Plan 2023-2025 has earmarked funding for research with psychedelics in addiction treatment. At EU level, in early 2024, the Horizon Europe programme awarded EUR 6.5 million in funding for psychedelic therapy research for treatment-resistant mental disorders in palliative care. While some psychedelics have shown promise in alleviating specific symptoms associated with these disorders, generalising in this area remains difficult, partly because of the large number of substances under review and partly because of the wide range of conditions that are being studied.
Some jurisdictions outside the European Union have begun regulating the use of psychedelics for medical and therapeutic purposes, bringing significant commercial interest. At the same time, the available data show that some changes are evident in the use of psychedelics in Europe. Notably, this includes an increase in unregulated or illegal practices in which these substances are used as part of wellness, therapeutic or spiritually oriented interventions.
Organised events involving psychedelics, including wellness-oriented ceremonies, appear to be present in all EU Member States. These practices typically involve the use of substances such as psilocybin, ayahuasca (N,N-dimethyltryptamine or DMT), and 5‐methoxy‐N,N‐dimethyltryptamine (5-MeO-DMT). The events often involve group settings led by various facilitators, shamans or coaches. In some countries, they operate relatively openly, but in others they remain underground. While some of these retreats claim to integrate elements of therapeutic support, most operate outside formal healthcare structures, often in illegal, unregulated or legally ambiguous spaces.
These developments have raised concerns at policy level. The apparent growing demand for these psychedelic practices may reflect a wider public interest in alternative mental health and self-development approaches. However, there are risks involved in these emerging practices, particularly for vulnerable individuals and those with pre-existing mental health conditions. This, together with the lack of research-driven best practices or standardised guidelines, further complicates issues of safety and oversight.
If organised, unregulated psychedelic practices continue to spread, a key challenge for policymakers and health professionals will be to better understand the scope and impact of these activities, as well as the associated health risks and harm reduction responses. Strengthening monitoring efforts will be crucial in addressing the evolving landscape of psychedelic use in Europe. A recent EUDA publication addresses the therapeutic use of psychedelics.
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 (3.8 % in 2023), Finland (2.7 % in 2022), Estonia (2.6 % in 2023, 16-34), the Netherlands (2.2 % in 2023), France (2.0 % in 2023, 18-34), Denmark (1.7 % in 2023, 16-34) and Germany (1.1 % in 2021). Exceptions for LSD include Czechia (2.6 in 2023), Ireland (2.4 % in 2019), Estonia (2.3 % in 2023, 16-34), France (1.6 % in 2023, 18-34), Germany (1.5 % in 2021, 18-34), Latvia (1.4 % in 2020), Finland (1.3 % in 2022) and Denmark (1.1 % in 2023).
- Recent estimates of last year prevalence of ketamine use among young adults (15-34) range from 0.8 % in Romania (2019) to 3.2 % in the Netherlands (2023).
- The 2024 ESPAD school survey estimated that among 15- to 16-year-old school students in the European Union, lifetime use of LSD and other hallucinogens ranged from 0.7 % to 6.8 % and from 0.3 % to 3.4 % for GHB.
- Among respondents to the European Web Survey on Drugs in 2024, a non-representative survey of people who use drugs, 18 % of those who had used drugs within the last 12 months had used hallucinogenic mushrooms, 14 % reported having used ketamine, 10 % LSD or other hallucinogens, 8 % nitrous oxide and 3 % GHB/GBL (gamma-hydroxybutyric acid/gamma-butyrolactone) and ‘tucibi’. Of those who used ketamine, 97 % mostly snorted it and used powders/crystals. On average, 0.3 grams was consumed per day of use. Signalling the potential scale of associated polysubstance use, only 11 % of respondents reported using ketamine without another substance, including tobacco and alcohol; a third used it with MDMA/ecstasy and a quarter with herbal cannabis. Of the participants who used ketamine, 80 % reported that they used it to ‘get “high”/for fun’ and a third ‘out of curiosity / to experiment’.
- In 2024, relatively low levels of ketamine residues in municipal wastewater were reported by 82 cities, with the highest mass loads being detected in cities in Belgium, the Netherlands, Hungary and Norway (Figure 8.3). Among the 42 cities with data available for 2023 and 2024, 14 showed an increase (of at least 10 %), 15 were relatively stable and 13 showed a decrease.
Treatment entry for ketamine use
- Increases were observed in the number of clients entering treatment for problems related to ketamine use in Belgium, Germany, Italy and the Netherlands in 2023 and France and Spain in 2022 (most recent data), with the overall number rising from 289 in 2018 to an estimated 1329 clients in 2023 in these countries.
Harms related to use of other drugs
- GHB/GBL was the fifth most common drug reported by Euro-DEN Plus hospitals in 2023. Overall, it was reported by 13 emergency departments in 9 EU Member States and Norway in 2023. The drug was involved in an estimated 3.8 % of presentations (median) across the 22 participating hospitals in the 15 EU Member States and Norway that reported 2023 data. The hospitals with the highest proportions of cases reporting GHB/GBL use were in Oslo (44 %), Utrecht (26 %), Barcelona (22 %), Tallinn (17 %) and Ghent (16 %) (Figure 8.4). Alcohol use was noted in one third of the GHB/GBL cases for which such data were available. One in 6 (16 %) of the cases reporting GHB/GBL was admitted to intensive care.
- Ketamine was reported by 13 Euro-Den Plus hospitals in 9 EU Member States and Norway in 2023 and was involved in an estimated 1.8 % of presentations (median) across the 22 hospitals that reported 2023 data. In 2023, almost 2 out of 3 cases (63 %) were aged between 25 and 45 years, three quarters (75 %) were males. Half of all the cases presented to the emergency services on Saturdays and Sundays. Alcohol use was noted in just over half (55 %) of the ketamine cases for which such data were available. Some 4.5 % of the cases reporting ketamine were admitted to intensive care.
- Nitrous oxide was reported in acute drug-toxicity presentations to emergency services of 6 sentinel hospitals in 5 EU Member States and Norway in 2023. Reported cases were young (median age, 21 years), more commonly males (62 %), and presented on weekdays (60 %). In 3 out of the 6 hospitals, cannabis was the most frequent substance reported as used in combination with nitrous oxide. Alcohol use was noted in just under one fifth of the nitrous oxide cases for which such data were available.
- LSD was reported by 17 Euro-Den Plus hospitals in 13 of the participating EU Member States and Norway in 2023 and was involved in an estimated 1.4 % of presentations (median) across all the hospitals that reported data. Almost all cases (94 %) were males; the median age was 23.5 years. Alcohol use was noted in one quarter of the LSD cases for which such data were available.
Market data for other drugs
Seizures of hallucinogenic and dissociative drugs are not consistently monitored across Europe. Different EUDA monitoring systems provide the limited information available, which is incomplete, divergent and difficult to generalise. Sources contributing to the data presented here include the EU Early Warning System on new psychoactive substances, national reporting systems and, for drug checking, the Trans European Drug Information network (TEDI).
- In 2023, almost 2000 seizures of LSD, amounting to 361 900 units and about 1 kilogram and 1 litre, were reported in Europe (Table 8.1). Twenty-four countries reported 3750 seizures of hallucinogenic mushrooms, amounting to 333 kilograms. Seventeen countries reported 145 seizures of DMT, amounting to 36.2 kilograms, mainly in Portugal (26.7 kilograms) and 17.1 litres (Portugal 16.01 litres; Sweden 1.06 litres).
- In 2023, ketamine seizures reported to the EU Early Warning System amounted to 2.7 tonnes of powders (2.8 tonnes in 2022), with the Netherlands seizing 72 % of the total quantity. Seizures of ketamine have fluctuated at levels above 0.5 tonnes since 2017 (Figure 8.5), while the number of ketamine seizures has doubled (Figure 8.6).
- Six ketamine laboratories were dismantled in the European Union in 2023. These sites were typically engaging in the crystallisation of bulk ketamine powders.
- Out of 704 samples submitted as ketamine to drug checking services in 10 EU Member States, 91 % (639) contained only the expected substance without any adulterants, with an average purity of 86 %. This likely reflects the increased availability of the drug and its deliberate purchase by consumers. Also during the first half of 2024, 6 drug checking services in 6 EU Member States reported 74 samples of the ‘tucibi’ mixture, containing ketamine and other substances, typically MDMA, cocaine or a cathinone. This is reflective of consumers also intentionally seeking to purchase drug mixtures that contain ketamine.
- Samples of mixtures containing ketamine, MDMA and cocaine continue to be reported to the EU Early Warning System at levels comparable to previous years, mostly by Spain. Some of these appear to be sold as ‘pink cocaine’ or ‘tucibi’.
- In 2023, 15 EU Member States reported 944 seizures of the psychedelic drug 2C-B, amounting to 3685 tablets or units and 18.6 kilograms.
- Eighteen European countries reported 1269 seizures of GHB or its precursor GBL, amounting to 51.5 kilograms and almost 740 litres. GBL has many industrial purposes, making the data challenging to interpret.
- In 2023, 11 European countries reported 256 seizures of khat amounting to 15 tonnes (30 tonnes in 2022), with France, Germany, Sweden, Italy and Denmark seizing the largest quantities.
- In 2023, EU Member States reported 531 seizures of new benzodiazepines to the EU Early Warning System, representing approximately 1.5 % of the total number of seizures of new psychoactive substances. Of the 38 new benzodiazepines ever reported to the Early Warning System, 19 were detected in drug seizures in 22 EU Member States, Norway and Türkiye in 2023.
Additional information can be found in the joint EUDA-Europe EU Drug Markets: In-depth analysis and the EUDA Health and social responses to drug problems.
Source data
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.