Injecting drug use in Europe – the current situation (European Drug Report 2026)
Despite representing a small share of all drug use in the European Union, injecting drug use is responsible for a disproportionate level of both acute and chronic health harms associated with the consumption of illicit drugs. On this page, you can find the latest analysis of injecting drug use in Europe, including key data on prevalence at national level and among people entering specialised treatment, as well as insights from studies on syringe residue analysis.
This page is part of the European Drug Report 2026, the EUDA’s annual overview of the drug situation in Europe.
Last update: 9 June 2026
Harms from injecting fuelled by range of drugs and polysubstance use
Harms and risk environment
Injecting drug use is a high-risk behaviour associated with a range of serious acute and chronic harms. The health risks from injecting drug use are heightened by the potential for sudden shifts in the availability of different substances on Europe’s drug markets. Half a million Europeans are estimated to have injected an illicit drug in the last year, underlining the scale of injecting harms as a public health priority.
Over the last decade, Europe has seen a gradual downward trend in the proportion of people entering drug treatment who report injecting their primary drug. However, this assessment is complicated by changing patterns of use, including increased stimulant use and polysubstance use, and by the time lag between initiation of drug use and treatment entry.
People who inject drugs are at greater risk of becoming infected by blood-borne viruses, including HIV, hepatitis B and C viruses, or of dying from a drug overdose. Injecting can also be a cause of abscesses, septicaemia and nerve damage. Additional long-term risks arise when people inject substances that are difficult to dissolve and may introduce insoluble particles into the bloodstream, such as crushed medicine tablets, capsules and crack cocaine. Injection of these substances is associated with vascular damage, infective endocarditis and other bacterial infections.
Drug market signals
Historically, heroin has been the main drug associated with injecting in Europe, but other drugs, including cocaine, amphetamines, synthetic cathinones, opioid agonist medications and various new psychoactive substances, may also be injected, either alone or in combination. Syringe residue analysis conducted in cities across Europe shows a diverse range of substances present in used syringes, including illicit drugs, new psychoactive substances and medicines. Combinations of substances, including those used as adulterants, are commonly detected. The injection of multiple substances, for example both stimulants and opioids, can increase health risks, including overdose, and complicates the delivery of appropriate responses.
New synthetic opioids continue to be integrated into Europe’s illicit drug markets, with syringe residue analysis from 2024 indicating they are prevalent in some Baltic countries, although the substances involved vary. Data suggest that nitazenes have become established on the drug market in some Estonian and Latvian cities, and there are signals of their use in some Lithuanian cities. Carfentanil continues to be detected in syringes in Latvia and Lithuania, while orphines were detected in syringes in Riga (Latvia) in 2024. In addition, evidence from Estonia and Latvia appears to suggest that nitazenes are being adulterated by potent veterinary medicines, such as xylazine. In other countries, fentanyl and its derivatives are sometimes detected, but at much lower levels. For example, the detection of fentanyl in Thessaloniki (Greece) in 2024 is concerning given the fentanyl-related deaths reported in neighbouring Bulgaria the same year. The presence of these potent opioids in European cities further escalates the risk of overdoses and deaths and raises preparedness challenges.
Stimulants and other substances
The injection of stimulant drugs, such as cocaine and synthetic cathinones, tends to be associated with a higher frequency of injecting and at-risk sexual practices, and has been associated with local HIV outbreaks in the last decade in Europe. Recent syringe residue analysis confirms the presence of this pattern of use in some European cities. More frequent patterns of injecting may also result in a higher risk of infection and re-infection with HCV, presenting a potential challenge to the positive impact of HCV treatment now being reported by some countries (see also Drug-related infectious diseases – the current situation in Europe). Methamphetamine injecting carries similar risks; in 2024, the drug continued to be detected at high levels in used syringes in several European cities. This is a concern, as various signals continue to indicate that stimulant injecting is increasing among people who inject drugs.
In 2024, the most frequently detected benzodiazepines in analysed used syringes were diazepam, alprazolam and desmethyldiazepam. Various opioid agonist medications, either diverted or illicitly manufactured, were also detected.
Public health response and service coverage
Although by international standards, harm reduction interventions, such as the provision of sterile injecting equipment, are relatively well developed in Europe, coverage and access to this cost-effective intervention remain a challenge in some EU Member States. Concern exists around the low, and in some cases decreasing, levels of provision of sterile syringes reported in Bulgaria, Cyprus, Lithuania, Hungary, Poland and Slovakia (see also Drug-related infectious diseases – the current situation in Europe).
Alongside reducing the transmission of blood-borne infectious diseases, reducing overdose deaths as well as the broader range of health harms associated with injecting drug use are key objectives of interventions in this area. However, changing patterns of drug injecting, the increasing diversity of substances used and persistent gaps in the adequacy and coverage of existing responses continue to pose major challenges for Europe’s frontline responders and policymakers.
Key data and trends
Prevalence of injecting drug use
- The number of people who inject drugs is estimated through indirect statistical methods such as capture-recapture studies and treatment multiplier studies and comes with a high degree of uncertainty.
- The overall prevalence of injecting drug use in the European Union is estimated at 1.8 cases per 1 000 population aged 15 to 64 years (Figure 9.1). This suggests there were an estimated 522 000 people who inject drugs in the European Union in 2024, or 530 000 if Norway is included.
- Injecting drug use estimates range from 0.1 per 1 000 population in the Netherlands to 10 per 1 000 population in Estonia, with particularly high levels also reported in Finland (8.2 per 1 000), Latvia (6.1 per 1 000), Czechia (6.1 per 1 000) and Lithuania (4.6 per 1 000) (Figure 9.1).
- Italy (105 652), France (102 648) and Germany (84 606) reported the highest estimated numbers of people who inject drugs in the European Union (Figure 9.2).
Injecting drug use among people entering specialised treatment
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Based on data from 24 countries, among first-time clients entering specialised drug treatment in 2024 reporting heroin as their primary drug, 19% reported injecting as their main route of administration (20% in 2023, down from 37% in 2013). Injecting is reported as the main route of administration by less than 1% of first-time cocaine clients, 1% of first-time amphetamine clients and 6% of first-time methamphetamine clients (Figure 9.3).
Syringe residue analysis
- ESCAPE – the European Syringe Collection and Analysis Project Enterprise – aims to identify the range of substances being used by people who inject drugs in a sentinel network of 21 cities in the European Union and Norway.
- The results are based on a sample of syringes and reflect local specificities of the drug markets and sub-populations of users accessing the participating harm reduction services: they are not necessarily representative of the national situation.
- A total of 3 256 used syringes tested positive for at least one drug category in the participating cities. A total of 96 substances from 19 drug categories were detected, while an additional 33 substances were classified as adulterants, metabolites or degradation products (Figure 9.4).
- Half of the syringes collected contained residues of two or more drug categories, which may indicate that people who inject drugs often inject more than one substance or that syringes are reused. The most frequent combination was a mix of a stimulant and an opioid.
Opioids
- Heroin was detected in over 50% of analysed syringes in 8 of the participating cities (Amsterdam, Athens, Barcelona, Cologne, Cork, Dublin, Limerick, Oslo).
- Carfentanil – a fentanyl derivative – was commonly found in syringes in Lithuania and Latvia: Vilnius (93%), Klaipeda (66%) and Riga (16%). Fentanyl was found in syringes in Riga and Klaipeda, but at lower levels (4% and 2%). Low levels of fentanyl were detected in syringes in Thessaloniki (2%), Oslo (1%) and Madrid (1%).
- Nitazenes were detected in multiple cities. In Tallinn, metonitazene was found in 35% of syringes and protonitazene in 35%. In Riga, N-desethyletonitazene was found in 23% of syringes, isotonitazene in 21%, metonitazene in 20% and protonitazepyne in 4%. In Lithuania, 4% of syringes in Klaipeda were positive for protonitazene and 1% for etonitazene.
- Orphines, potent synthetic opioids, first detected by ESCAPE in 2024, included spirochlorphine (7% of syringes in Riga) and cychlorphine (6% in Riga).
- Opioid agonist medications detected in syringes included buprenorphine (more than 10% of syringes in Helsinki, Paris, Patras, Prague, Thessaloniki, Volos) and methadone (more than 10% of syringes in Barcelona, Cork, Klaipeda, Madrid, Patras, Riga). Morphine was detected in 13% of syringes in Paris.
Stimulants
- Cocaine was detected in over 50% of syringes in 10 cities: Thessaloniki (95%), Barcelona (94%), Limerick (91%), Split (87%), Dublin (70%), Madrid (69%), Cork (69%), Volos (68%), Cologne (62%) and Athens (61%).
- Amphetamine was commonly detected in Tallinn (69%), Oslo (69%), Riga (52%), Budapest (28%) and Helsinki (21%).
- Methamphetamine detection was highest in Brno (72%), Prague (68%), Riga (38%), Amsterdam (37%), Tallinn (28%) and Paris (25%).
- Synthetic cathinones were most frequently detected in Paris (71%), Budapest (58%), Madrid (30%), Riga (30%) and Helsinki (23%). A total of 27 distinct cathinones were identified across participating cities in 2024, with 2-MMC being the most frequently detected.
Other substances
- Benzodiazepines were detected in more than 10% of syringes in Athens (54%), Dublin (46%), Limerick (35%), Volos (29%), Cork, Helsinki (each 21%), Thessaloniki (17%), Patras (13%) and Riga (10%). Overall, the most commonly detected benzodiazepines were diazepam, alprazolam and desmethyldiazepam.
- Potent tranquillisers were also found in syringe residues. Xylazine, most likely as an adulterant, was detected in 7% of syringes in Riga in 2024 (previously detected in Riga in 2021-22). In preliminary 2025 data for Tallinn (Estonia), medetomidine was found in 8% of syringes and xylazine in 2%.
- Ketamine was detected in notable levels in Dublin (15%), Split (13%), Paris (6%), and at low levels in 6 other cities.
- Other substances detected for the first time in 2024 included the antipsychotic drug promazine (10% in Riga). Also detected for the first time was the synthetic cannabinoid ADB-4en-PINACA, found in 3% of syringes in Cologne in the presence of heroin. This combination was associated with poisoning outbreaks during 2023 in France and Lithuania.
Additional information can be found in Drug-related infectious diseases: health and social responses.
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 2026, 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.