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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Key findings and threat assessment. Global context. Trafficking and supply. Criminal networks. Prices, purities and offences. Retail markets. Actions to address current threats and increase preparedness. In most countries in the EU, it appears that the number of people who use heroin is relatively stable. In , the prevalence of high-risk opioid use among adults aged 15 to 64 is estimated to be around 1 million. The countries estimated to have the highest number of users per 1 inhabitants aged 15 to 64 are Finland at 7. Conceptually, there are two main strategies for assessing the size of the drug market, namely a demand-based or bottom-up approach and a supply-side or a top-down approach. The strengths and limitations of these strategies are reviewed in a background paper Udrisard et al. Using the methodology established by the EMCDDA , it is possible to estimate the size of the heroin retail market based on the number of users and their use patterns, including how much they use per year and the average price paid at retail level. While the overall prevalence of high-risk opioid use among adults aged 15 to 64 in was estimated to be around 1 million people in the EU, there was considerable variation between countries, and whereas some countries specified the main opioid used, others did not. As such, for some countries an estimate is available for high-risk heroin users rather than for high-risk opioid users. Where there is no estimate of high-risk heroin users available, this is imputed, based on high-risk opioid user estimates in combination with treatment data. Using the latest available data, the minimum estimated annual retail value of the heroin market is EUR 5. Estimates of amounts used suggest that about tonnes of heroin at retail-level purity range While this approach has a sound scientific basis, demand-based estimates are prone to underestimation due to misreporting and underreporting of prevalence and use, as self-reported data rarely reflect reality Udrisard et al. Obtaining information on the number of users and the amount of heroin they use is challenging. This is primarily because a large number of people who use heroin are dependent on the drug and may be living on the margins of society, and are thus unlikely to be included in surveys of the general population. Wastewater analysis, another source of information on drug use, cannot be performed for heroin because morphine, the most abundant metabolite of heroin, which can be used as a target residue to estimate heroin consumption, may also be an indicator of the commonly used medicines morphine and codeine. Many other potential indicators of heroin use have some time lag. For example, treatment indicators will detect opioid users only after approximately 13 years of use, and the number of opioid users entering treatment could be influenced by financial priorities and the availability and accessibility of services. Based on previous research, a ratio of 3. Further limitations include the lack of coverage of specific subgroups, such as prisoners, homeless people and other marginalised populations, in the current EU heroin market size estimate. This is due to a lack of data on the prevalence of drug use and the quantities used by these populations, which may be considerable. It would therefore be appropriate to consider these subpopulations specifically in demand-based estimates in the future Udrisard et al. It is also possible to produce an estimate of the size of the heroin market using a top-down approach. There are two main models that can be used for this, namely a production-based approach and a seizure-based approach. The first involves assessing the amount of heroin available for consumption in a given country or region by taking global production estimates, subtracting the amount seized by law enforcement authorities or otherwise lost spoiled, etc. The amount available can then be multiplied by the local price adjusted for purity, to account for adulteration to arrive at the retail market value. There are several challenges with this approach, such as the accuracy of global production estimates and global seizure data, and how the national and EU market share can be assessed. The seizure-based approach simply uses the amount of drug seizures and an estimated seizure rate to assess the quantities of drugs available on the market. However, no data are available that would allow an assessment of the seizure rate. An alternative supply-side approach is based on estimates of the number of dealers and the average number of doses they sell Rossi, Making such assessments may be possible. However, further studies are needed, initially at city level, to test this method and assess its suitability for use at national and EU level. In Europe, the opioid market is becoming increasingly complex, incorporating new potent synthetic opioids, prescription opioid medicines and mixtures see Section Synthetic opioid trafficking. While heroin remains by far the most common illicit opioid on the market at the EU level, this is not the case for all Member States. Ongoing monitoring and law enforcement action is needed to prevent further spread of synthetic opioids, some of which are relatively inexpensive and easy to manufacture or to divert from legitimate sources. While fentanyl and its derivatives, along with potent benzimidazole nitazene opioids, are still relatively niche in most places, they are increasingly available as part of the EU opioid market. Information on their use in Europe is limited, although existing evidence points to diverse national situations where there are signs of clusters of use limited to particular geographical locations. Historically, fentanyl and fentanyl derivatives have been the most common form of opioids used in Estonia. An increase in the availability of these substances was also observed in neighbouring markets, including Latvia, Lithuania and Sweden see Section Synthetic opioid trafficking. An important caveat is that current monitoring systems may not accurately document trends in synthetic opioid use, and this is therefore an area that needs improvement. Composite products, including heroin-fentanyl mixtures, have also been reported, as has the adulteration of illicit opioids with a range of potentially dangerous substances see Box Adulteration of illicit opioids with xylazine and new benzodiazepines. The availability of these products represents a significant change in the risk environment for users of opioids and people who inject drugs, posing additional challenges for health responses. While individual studies and monitoring data indicate that the misuse of prescription opioid medicines in the EU is limited, there is insufficient information to allow a more thorough assessment. For example, the diversion of methadone and buprenorphine from opioid agonist treatment is reported to be a significant problem in some countries see Section Synthetic opioid trafficking. There is also some evidence to suggest that the number of prescriptions for opioids used for pain management has been increasing. The same study assessed several proxies for misuse and identified a similar increasing trend. The number of opioid-related hospital admissions tripled from 2. Further, while opioid-related mortality remained stable between and , at 0. An increase in the use of prescription opioids affects the illicit market in a number of ways. For example, people who become dependent on opioid medications may turn to the illicit market to top up their medications or when their prescriptions expire. Also, an increase in the number of prescription opioids in circulation may provide new opportunities for diversion into the illicit market. Similar dynamics have been seen in the United States, where prescription opioids have fuelled the ongoing opioid epidemic. In addition to the diversion of opioids from legitimate sources, falsified and counterfeit opioid medicines are available, raising issues of their own. Reports and public notices have emerged in a number of EU Member States in recent years, alerting users about new opioids mis-sold as fake medicines, such as oxycodone tablets containing nitazenes. The EU is currently far from experiencing the opioid epidemic faced by the United States. Heroin is a central nervous system depressant. The immediate effects of heroin use include a rush of euphoria, a warm flushing of the skin, dry mouth and a heavy feeling in the limbs. However, these effects are short-lived, and the drug quickly leads to a state of drowsiness, slowed breathing and clouded mental function. It can also cause nausea, vomiting and severe itching. The long-term effects of heroin use are numerous and can be severe. These include physical and psychological dependence, overdose and death. Chronic heroin use can cause a range of physical and mental health problems, including liver disease, kidney disease, collapsed veins, chronic pneumonia, and infections of the heart lining and valves. In addition to the physical and mental health effects of heroin use, there are also a number of social and economic harms associated with the drug. These include increased crime rates, lost productivity, healthcare costs, and strained family and community relations. In particular, the broader social costs associated with long-term dependence on heroin include higher rates of homelessness and criminality, particularly acquisitive crime. The use of heroin is associated with a disproportionate amount of acute and chronic harm, and this is compounded by factors that include the properties of the drug, the route of administration, individual vulnerability and the social context in which heroin is consumed. Although the number of people reporting use of heroin in the EU is low compared with drugs such as cannabis and cocaine, a large proportion of people who use heroin are dependent on the drug. This means that they use it more frequently and in larger amounts than is the case for other drugs. In Europe, heroin is predominantly sold in the base form as brown powder, while white powder hydrochloride salt and black tar are rare. While the availability of various preparations of heroin may influence the mode of use, the drug is most frequently smoked or injected. Heroin that is smoked is usually in the base form, which is appreciably more volatile than the salt i. For injecting use, citric acid solution is added to prepare heroin base as it is poorly soluble in water. Injecting heroin is associated with many local and systemic complications, including increased risk of overdose, increased risk of infectious disease transmission such as HIV and hepatitis C via needle sharing , vein damage, skin abscesses and infections. Although heroin has historically been the main drug associated with injecting in Europe, this has been changing in recent years. Opioids are reported as the main injected drugs in 19 out of 24 countries for which data are available for clients entering treatment in While these data are not nationally representative, they can be viewed as indicative of local-level drug use dynamics. In this sample of used syringes, heroin was the most commonly detected drug in five out of the 12 participating cities. Overall, a third of syringes contained residues of two or more drug categories, often including both opioid and stimulant drugs. This indicates frequent polydrug use or reuse of injecting equipment. Recognising the increasing complexity of injecting practices in Europe and the prominence of polydrug consumption in this context is therefore likely to have important implications for both understanding the harms associated with this mode of administration and the interventions designed to reduce such harms. The most serious risk from overdose with opioids is rapid respiratory depression slow and shallow breathing , which can lead to death. With heroin, this risk may be increased by a number of individual as well as contextual, especially social, factors, including the following:. While the data available have limitations in respect of quality and coverage, the information available suggests that opioids, usually in combination with other substances, remain the group of substances that are most commonly implicated in drug-related deaths. Overall, trends in deaths where opioids are implicated appear stable. Meanwhile, in the north of Europe, less than one in six overdose deaths in Finland, Sweden and in the Baltic countries was reported to involve heroin in As such, while it remains the case that heroin is involved in a large proportion of opioid-related deaths, the data available increasingly suggest that other opioids are playing a more important role. Available data suggest that polydrug toxicity is the norm and that opioids other than heroin, including methadone and, to a much lesser extent, buprenorphine, with the exception of Finland and France , oxycodone and fentanyl, are associated with a substantial share of overdose deaths in some countries. In half of the 22 countries with post-mortem toxicological data available for , at least one in five drug-induced deaths involved methadone. In countries with available data, oxycodone was reported as being involved in drug-induced deaths between and , mainly in Denmark, Estonia, France and Finland EMCDDA, a. While available data indicate that fentanyl and fentanyl derivatives were linked to 49 deaths in Europe in , this excludes figures from Germany. With the inclusion of data from Germany, this number appears to be much higher, rising to a minimum estimate of deaths. Preliminary analysis, however, suggests that many of these fatalities might be associated with diverted fentanyl medicines rather than illicit fentanyl. Potent synthetic opioids, such as the fentanyl derivative carfentanil and benzimidazole nitazene opioids, consumed in the context of polydrug use, do not currently feature prominently in the data available at EU level but are observed to be causing an increasing number of deaths in the Baltic countries, including in Estonia and Lithuania in Preliminary data indicate that in , Estonia experienced an increase in drug overdose deaths involving isotonitazene, metonitazene and protonitazene. In Latvia, both the national statistics and the forensic registers have reported a three-fold increase in the number of drug-induced deaths in compared with Part of this reported increase relates to improved laboratory capacity in As such, the increase should be interpreted cautiously, although recent shifts in the opioid market are also likely to have played a role. Nitazenes appeared to be involved in a number of fatalities in and xylazine was identified in one case. Preliminary first-quarter data for from Latvia also suggest that benzimidazole opioids were involved in a number of drug-related deaths. The adulteration of heroin with fentanyl and isotonitazene, leading to fatal overdoses among users, has been reported to Europol by UK authorities since mid The UK Home Office is aiming to tighten controls on two other synthetic opioids, namely brorphine and metonitazene. Opioids were found in 20 of the 24 European hospitals participating in In contrast, small proportions of the presentations involved heroin in the hospitals in Belgium, the Netherlands, Estonia, Latvia and Lithuania and in the centres in Paris France and Barcelona Spain. Most presentations with heroin were among middle-aged men, and in 12 of the 20 centres no cases were aged less than 25 years. The use of heroin and other opioids during pregnancy has been linked to a number of neonatal complications, including opioid withdrawal, postnatal growth deficiency, neurobehavioural problems and a fold increase in sudden infant death syndrome Minozzi et al. Repeated use of heroin and withdrawal symptoms are associated with increased neonatal mortality Jansson et al. High rates of intrauterine growth retardation have also been reported in heroin-dependent mothers Binder and Vavrinkova, , in addition to elevated risk of low-birthweight infants from maternal heroin use compared to those from non-drug-using mothers, and prematurity and small-for-gestational-age babies Bell and Harvey-Dodds, ; Madgula et al. Among pregnant women who continue illicit intravenous heroin consumption, the risks of medical complications such as infectious diseases, endocarditis, abscesses and sexually transmitted diseases are also increased Winklbaur et al. There is a well-established, albeit complex, relationship between illicit opioid use and crime. Although high-risk opioid users are much more prevalent in the criminal justice system than in the general population, the relationship between opioid use and crime differs between individuals, and for the same individual over time. There is strong evidence that problem heroin use can amplify offending behaviour, particularly related to economic-compulsive crime, whereby users of heroin or other opioids engage in economically oriented crime to support a compulsive pattern of use Goldstein, A meta-analysis of studies on the relationship between drugs and crime concluded that the likelihood of committing crimes that were not drug possession offences is up to eight times greater for people who use drugs than for those who do not Bennett et al. Few opioid users resort to violence to acquire money for drugs, though some may engage in violent crime, such as assault, homicide or robbery. However, the extent to which opioid dependence is associated with these more serious forms of crime is less apparent White and Gorman, There is limited research examining the prevalence of drugs other than alcohol in penetrating injuries such as gunshots, explosive devices and stab wounds , and most of the published research originates from the United States Lau et al. Although heroin-using offenders have high rates of offending, they also have high rates of a range of other problems, such as homelessness, unemployment, low educational attainment and disrupted family backgrounds, making the relationship between drugs and crime more complex. The association between opioid use and crime highlights the importance of addressing use as a means of reducing criminal behaviour and improving public safety. Treatment for opioid-dependent individuals can help to reduce the demand for illicit drugs and decrease associated crime. Heroin can also be associated with an increased risk of being a victim of violence, due to altered perceptions and impaired judgement Gilbert et al. It is important to note that the risk of experiencing heroin-related violence is likely to be influenced by a range of situational factors, such as setting, socioeconomic status, other drug use, and a history of mental illness and trauma. Women involved in the sex trade have been identified as a sub-group who are particularly at risk of experiencing gender-based violence in the context of drug use, through engagement in the sex trade or in their intimate relationships EMCDDA, b. Many women who trade sex for drugs have limited power to practise safe sex or follow safe injecting practices and are at risk of experiencing violence and imprisonment. These women also face a greater degree of stigma, through both their drug use and their involvement in the sex trade EMCDDA, b. The available evidence strongly supports enrolment in opioid agonist treatment as a protective factor against opioid overdose and some other causes of death, with positive outcomes also found with regard to the use of illicit opioids and other drugs, reported risk behaviours, offending and drug-related harms EMCDDA, d, a; Mayet et al. In the EU, opioid users represent the largest group undergoing specialised drug treatment, mainly in the form of opioid agonist treatment, typically combined with psychosocial interventions EMCDDA, a. Overall, opioid agonist treatment was received by about half of all high-risk opioid users in the EU in , an estimated individuals. However, there are differences between countries. Trends from countries that consistently report data on clients receiving opioid agonist treatment between and show an overall stable trend of treatment levels during this period, with little fluctuation in the number of clients. This has important implications for service delivery, with services having to address a more complex set of healthcare needs in a population that is becoming more vulnerable due to other age-related health and social issues. Alongside opioid agonist treatment, needle and syringe exchange programmes and other harm reduction interventions were in place in all EU Member States and Norway in However, coverage and access to these programmes remains a challenge, with only five of the 17 EU countries with available data reaching the World Health Organization service provision targets in Currently, 15 countries report the provision of take-home naloxone to prevent overdose deaths and 10 countries report having at least one supervised drug consumption room. Naloxone works as a safe and effective antidote to reverse the respiratory depression caused by opioids Boyer, ; Britch and Walsh, ; Strang et al. However, coverage of these interventions remains uneven within and across countries in the EU. In addition, 12 countries have some type of drug checking service, which can help prevent harms by allowing users to find out what substances are present in the drug they have acquired and intend to consume. However, as with other drugs, opioids are also distributed across the EU via a range of digital channels, including darknet markets. The quantities offered online are typically small, and purchases are usually delivered using post and parcel services see Section Fluidity of routes, methods of transportation and modi operandi. In addition to parcel delivery, user-level distribution takes place by means of personal handover or by agreeing on a location where the drugs are left for pick-up. Although online retail distribution of heroin appears to remain marginal compared with other supply methods, it is important to understand its scope. A total of 2 listings sale offers of opioids excluding new opioids were identified based on data from eight major darknet markets, namely Versus , World , Dark0de Reborn , ASAP , Hermes 71 , Alphabay-v3 66 , Cypher 51 and Royal 23 ; these were reported as being shipped from an EU country. To put this in context, although not directly comparable, a similar scanning exercise conducted in found 13 listings for cannabis and 6 for amphetamine products For more information on the data source, see Section Overview of data and methods. The source data for this graphic is available in the source table on this page. Caution is needed in interpreting these data, as neither the number of individual sellers offering heroin on these marketplaces nor the number of transactions can be extrapolated from the number of listings alone. Nonetheless, the number of listings has been used as a valid indicator of the scope of activity on darknet markets. However, these findings should be viewed with caution due to an absence of forensic testing and evidence on the actual substances sold in these listings. In addition, heroin-fentanyl combinations appear to be available on darknet markets. An example of this can be found in a listing reportedly shipping from the Netherlands see Screenshot Fentanyl-heroin mixture listed on a darknet market, shipping from the Netherlands. The availability of such products represents a significant change in the risk environment for people who inject drugs. New benzimidazole nitazene opioids, including isotonitazene, etazene, etomethazene, metonitazene and protonitazene, also appear to be available on darknet drug markets. Listings for these substances have been associated with several EU Member States Czechia, France, Germany, Hungary, Poland and Sweden , which were noted as shipping origins on major darknet markets in Of particular concern is the online marketing of new opioids mis-sold as falsified fake medicines. In recent years, reports and public notices have been issued in a number of EU Member States to alert people about new opioids mis-sold as fake medicines, such as oxycodone tablets containing new opioids. The criminal use of the online environment to trade synthetic opioids, or medicines containing or adulterated with such compounds, could further increase in the EU as criminals act upon new opportunities, such as an increased demand for these products see Box Operation Earphones disrupts the trafficking of fentanyl into Italy. In addition to falsified medicines, there is also an online market for opioid medicines diverted from legitimate pharmacy supplies and sold on the surface web see Box Poland-based online market supplying illegally diverted opioid medicines to the United States and the United Kingdom. Consult the list of references used in this module. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. Table of contents Search within the book. Introduction Introduction Key findings and threat assessment Key findings and threat assessment Global context Global context Production Production Trafficking and supply Trafficking and supply Criminal networks Criminal networks Prices, purities and offences Prices, purities and offences Retail markets Retail markets Actions to address current threats and increase preparedness Actions to address current threats and increase preparedness. Search within the book Operator Any match. Exact term match only. Main subject. Target audience. Publication type. EU Drug Market: Heroin and other opioids — main page. On this page.
Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review
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Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review
Buying MDMA pills online in Riga
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Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review
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Buying MDMA pills online in Riga