Europe: ‘new era’ of declining heroin use and complex stimulant market

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Europe could be moving into a ‘new era’ in which heroin will play a ‘less central role’ in the continent’s drug problem, according the annual report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), while the stimulants market becomes ever more complex and volatile.

‘New recruitment’ into heroin is falling, along with availability of the drug in many countries, says the report. Although opioids were cited as the primary drug by more than 200,000 treatment clients across the EU and Norway, the number of people entering treatment for the first time for heroin fell from 61,000 to 46,000 between 2007 and 2010. Overall injecting rates are also continuing to decline, along with the numbers of newly reported HIV cases –particularly when compared to countries like Russia and Ukraine. In Greece, however, where harm reduction services have fallen victim to austerity measures, infection rates increased from less than 20 per year before 2010 to 241 in 2011, the result of ‘a local, but large, epidemic’ among injectors in Athens.

‘The difficult financial situation in Europe, which forms the backdrop of our reporting, means that resources for addressing health and social problems are in short supply,’ said EMCDDA director Wolfgang Götz. ‘Ensuring the highest treatment quality and best treatment outcome for the lowest possible cost are therefore priorities in the current climate. It is essential to ensure that the available funds are invested in well-targeted activities of proven effectiveness.’

The report also highlights ‘an increasingly complex’ stimulant market with a ‘wide variety of powders and pills’, and where cocaine, amphetamines and ecstasy increasingly compete with new synthetic drugs. These continue to be reported at the rate of around one per week, with more than 50 already detected via the EU’s early-warning system this year, in addition to the 49 in 2011 and 41 in 2010. The agency has also identified nearly 700 online ‘legal high’ retailers, compared to 170 two years ago. 

To many consumers, the new drugs are effectively ‘interchangeable’, says EMCDDA, creating a ‘volatile market’ influenced by price and purity, with ‘obscure chemical groups’ being reported alongside increasing numbers of products containing multiple psychoactive substances, both controlled and uncontrolled. Better forensic and toxicological analysis is vital, says the agency, as is the need to ‘proactively engage with those most at risk’.

Cocaine use has continued to fall in ‘high prevalence’ countries like the UK, Italy and Spain, possibly influenced by low levels of purity, with the EMCDDA’s index of average purity in the EU falling by 22 per cent between 2005 and 2010. However the document reports increasing rates of methamphetamine use – historically limited to parts of Eastern Europe – in Scandinavia and elsewhere on the continent. 

Meanwhile, a report from the NTA reveals that more people in England are seeking treatment for ‘club drugs’ like mephedrone, methamphetamine, ketamine and GHB/GBL. Around 6,500 people – 2,000 of whom were under 18 – were treated for a club drug last year, compared to around 4,600 in 2005/06, says Club drugs: emerging trends and risks.

While the numbers remain low compared to those needing treatment for heroin or crack they are further evidence of shifting patterns of use, as overall UK drug use continues to decline (DDN, November, page 5). Club drug users make up around 10 per cent of young people in specialist services, and 2 per cent of adults, and ‘stand a strong chance of benefitting from treatment as they tend to have the personal resources to recover from their problems’, says the agency. 

There were 751 presentations for ketamine treatment this year compared to 114 six years ago, and 900 for mephedrone. Ecstasy remains the most commonly treated club drug in the UK, but the numbers of new adults seeking treatment has halved to just over 1,000 in the last six years. ‘With new substances arriving on the drugs market all the time, treatment services need to remain vigilant to new trends and adapt their treatment approaches accordingly,’ says the report. 

‘Whilst overall the drug treatment system has made tremendous gains in recent years, particularly in tackling heroin and crack, newer club drug use is a significant challenge and we are still learning the full extent of the resulting harms,’ said founder of Chelsea and Westminster hospital’s club drugs clinic Dr Owen Bowden Jones. 

Meanwhile, police in Strathclyde have issued a warning about a batch of pink pills with a cherry logo being sold as ecstasy but containing potentially toxic stimulants AMT or 5-IT. AMT and 5-IT had been implicated in deaths in Europe, said senior specialty doctor in emergency medicine at Glasgow Royal Infirmary, Dr Richard Stevenson. ‘Early assessment and intervention is paramount to prevent fatalities. Most cases experience a life threatening rise in body temperature and extremely fast heart rate and can display a range of bizarre behaviours as well as being extremely confused.’

 

Annual report 2012: the state of the drugs problem in Europe at www.emcdda.europa.eu

Club drugs: emerging trends and risks at www.nta.nhs.uk