Drug use in Europe sharply increased

A European multi-city study shows an increase in illicit drugs or metabolites in waste water. Berlin was far ahead of other German cities for cocaine consumption.

Wastewater analyses proves very informative overall

Conventional epidemiological methods to measure drug abuse relied on questionnaires and therefore had the classic sources of error, risking underestimation of the phenomenon. Waste water analyses offer the possibility of real-time monitoring of trends in illicit drug use at the population level. An important exception is the specific metabolite of heroin, 6-monoacetylmorphine, which has been shown to be unstable in wastewater. The only alternative would be to use morphine, but this is not a specific biomarker and may also be excreted in the context of therapeutic use.

In the largest European project of its kind to date, the EMCDDA studied wastewater in 104 European cities and towns to map the drug use patterns of their 45 million inhabitants. The results, published in March 2023, provide a valuable snapshot of drug flows in the participating cities and show clear geographical differences: speed was most popular in the north, meth in the east and cocaine in the west.2,3

Cocaine supply and demand at record levels worldwide

According to a report by the United Nations Office on Drugs and Crime, cocaine production reached an alarming all-time high after the COVID-19 crisis. From 2020 to 2021, coca cultivation increased by 35 per cent.4 The number of cocaine shipments intercepted by authorities has also increased sharply worldwide, with seizures reaching a record high of almost 2,000 tonnes in 2021. Cocaine is the second most commonly used illicit drug in Europe, as confirmed again by wastewater analysis. Cannabis remains in first place in Europe, with an estimated 22.6 million users last year.

The current analysis of the EMCDDA shows that Berlin is in the lead in Germany in terms of cocaine consumption. Since 2018, this has increased by 58 percent. Cocaine is detected via its metabolite benzoylecgonine (BE). The BE levels found in wastewater indicate that cocaine use remains highest in Western and Southern European cities, particularly in cities in Belgium, the Netherlands, Portugal and Spain. Low levels were found in most eastern European cities, although recent data show some signs of increase.2,3

Ketamine was also analysed for the first time, but only for some cities. The substance, which is used in the party scene, seems to be most prevalent in Spain (Barcelona was the frontrunner), Denmark, Italy and Portugal, but overall the residues were low.2,3

A problematic development: crystal meth 

A particularly strong increase was recorded in many places for methamphetamine ("crystal meth"), which is classified by drug experts as one of the most dangerous drugs.5 In Berlin, consumption has increased even more than that of cocaine since 2018, namely by 70 percent.3 Methamphetamine is highly concentrated and therefore has a much stronger effect and is more addictive than amphetamines such as speed and ecstasy, and can destroy the body and psyche frighteningly quickly.5

Analogous to previous measurements, crystal is most heavily used in Czechia, as there is a tradition of self-production there that goes back to the time before the revolution. For about twenty years, drugs were self-produced here. In all three Czech cities measured, the values increased again compared to the previous year, followed by Chemnitz, Dresden and Erfurt, presumably due to geographical proximity.3 For amphetamine ("speed"), on the other hand, Nordic countries, such as Sweden, were ahead.2,3

Amphetamine and metamphetamine use were more evenly distributed across weekdays in 2022 than in other years. This may reflect more regular use of these drugs in a cohort of high-risk users, the analysis concludes.2

  1. Negro, F. & Baggio, U. Wastewater analysis and drug consumption: useful assessment tool. Clin Ter 173, 526–527 (2022).
  2. Wastewater analysis and drugs — a European multi-city study | www.emcdda.europa.eu. https://www.emcdda.europa.eu/publications/html/pods/waste-water-analysis_en.
  3. Only in German: Drogenanalyse in 104 Städten: Koks in Europa auf dem Vormarsch – Crystal Meth ebenfalls. Tagesspiegel https://interaktiv.tagesspiegel.de/lab/drogenanalyse-in-104-staedten-koks-in-europa-auf-dem-vormarsch-crystal-meth-ebenfalls/.
  4. Cocaine trafficking diversifying through new hubs and groups, with global supply at record levels, says new report from the United Nations Office on Drugs and Crime. United Nations Office on Drugs and Crime release: unodc.org/unodc/en/frontpage/2023/March/cocaine-trafficking-diversifying-through-new-hubs-and-groups--with-global-supply-at-record-levels--says-new-report-from-the-united-nations-office-on-drugs-and-crime.html.
  5. Only in German: Partydroge: Crystal macht extrem schnell süchtig. Der Tagesspiegel Online.