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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.

Prevalence of injecting drug use in Estonia 2010–2015: a capture-recapture study

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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. However, this decline is registered from a relatively high baseline, as in the number of seizures reported in the EU was at its highest level recorded 31 The number of seizures remained largely stable until around 28 , gradually declining thereafter and reaching 18 in This decline in the number of seizures may be due to a number of factors, one of which is a deprioritisation of law enforcement actions against retail-level interdiction. In , there was a stable number of heroin seizures but a considerable drop in the quantities seized, reflecting a temporary reduction in trafficking and a reprioritisation of law enforcement activities during the COVID crisis. Despite the marked decline in the number of seizures between and , the quantities of heroin seized in the EU more than doubled in this period from 4. This indicates that large quantities of heroin are trafficked in individual shipments and reflects a reprioritisation of wholesale-level rather than retail-level interdiction. Over 9. Furthermore, a record quantity of The source data for this graphic is available in the source table on this page. This suggests that large quantities of the drug are still reaching consumer markets. Historically, the trafficking of heroin to the EU from Afghanistan and neighbouring countries — Iran and Pakistan in particular — has been concentrated along a few established routes. However, the intensity of use of particular routes has varied over time and the combinations of routes used by traffickers appears to be increasing. This is driven by a range of factors, such as geopolitical, social and economic conditions, including the level of perceived or actual risk of interdiction along the routes, the volume of migration flows, the state of the transportation infrastructure, the level of corruption vulnerability and market size. Four routes are commonly documented for heroin trafficking from Afghanistan to Europe see Figure Indicative heroin trafficking routes :. Since late , two major political and security changes have occurred that have implications for the production and trafficking of opiates to Europe. The collapse of the Afghan government and the Taliban takeover of Afghanistan in August and the subsequent ban on opium cultivation announced in April may significantly influence the production of opiates in Afghanistan and, by extension, the availability of heroin on the EU market see Section Key developments in the opiate trade in Afghanistan. On this route, heroin usually enters the EU at land border crossing points in Bulgaria or Greece. This is an established corridor for the trafficking of heroin to the EU and of acetic anhydride in the opposite direction see Section Acetic anhydride: the key chemical used for the production of heroin. Preliminary data for , however, indicate a sharp drop to 7. A proportion of the heroin smuggled along the southern and central branches may be diverted for local consumption or temporarily stored in warehouses in the Western Balkans region, before being transported to the EU markets EMCDDA, a. As a gateway to the EU, Bulgaria is particularly important for this trafficking route. Until recently, law enforcement authorities have regularly reported sizeable amounts of heroin at border crossing points, particularly at the Kapitan Andreevo crossing National Customs Agency of the Republic of Bulgaria, a,b, a,b, b-d. In , the National Customs Agency in Bulgaria reported 10 seizures amounting to 1 kilograms. In addition to using the established land entry points to the EU, trafficking groups appear to be increasingly transporting heroin to Turkish ports on the Mediterranean Sea, where ferries and cargo vessels carry the consignments onward to EU ports in Croatia, Italy and Slovenia. The apparent reasons for the shift to trafficking via maritime transportation include a lower perceived risk and the increased cost-effectiveness of this modus operandi, particularly for large shipments. Exploiting this existing intramodal shipping infrastructure allows traffickers to smuggle larger quantities of heroin in single shipments than they could in the historical modus operandi of moving smaller consignments through concealment in vehicles on other land routes. This apparent recent shift in trafficking also increases the complexity of monitoring and disrupting illicit heroin flows to the EU. Over the past decade, the importance of the Southern route for the EU heroin market has grown. This can be seen in the large quantities of heroin departing from ports on the Iranian or Pakistani sides of the Makran Coast, such as Chabahar and Bandar Abbas Iran and Gwadar Pakistan. These heroin consignments are either transported by traditional sailing vessels dhows or, increasingly, concealed in maritime containers from commercial ports. Overall, a range of modi operandi and transhipment points are combined on the Southern route to smuggle heroin to Europe. The growing importance of the Southern route is driven by several factors. First, increased use of maritime containers allows more efficient transportation of large quantities of heroin. The main commercial maritime routes from east to west are exploited for these purposes. In addition, intensified trafficking along the Southern route may be due to the perception or reality of stricter border controls on the Balkan route. The Netherlands continues to be a hub for the consolidation and distribution of heroin for EU consumer markets, including for maritime heroin consignments trafficked along the Southern route see Section Heroin trafficking within the EU. Similar to other drugs, heroin shipments are stored in distribution and wholesale centres in the Netherlands before being broken down and smuggled to criminal networks that supply other EU Member States and the United Kingdom see Box Transhipment of heroin in containerised shipments to the United Kingdom. Heroin may be shipped to the EU using the various branches of the Southern route, all departing from Iran or Pakistan. The first branch of the Southern route appears to have seen increased activity since , facilitating containerised trafficking of large consignments of heroin to the EU. This can be seen in a number of large heroin seizures shipped in maritime containers, originating from ports in Iran and Pakistan and bound for the European market see Box Large-scale direct heroin shipments to European ports. While the ratio of consignments that are successfully delivered to those that are seized is unknown, this development presents a clear threat of increased access to heroin in Europe. Large shipments of heroin along the second branch of the Southern route have also been observed see Table Examples of large maritime heroin seizures in the EU, Based on the available information, the UAE in particular appears to have emerged as a hub for heroin transhipment to Europe, and possibly a storage point where the origin of the drugs may be obscured. Seizures indicate that heroin consignments trafficked from key source countries on one route are in some cases switched to another route at transhipment points. This provides greater flexibility for traffickers and allows them to exploit new opportunities. Heroin trafficked along the third branch of the Southern route departs from the Makran Coast, typically in dhows, and is unloaded in several countries along the east coast of Africa. From there, the drugs are transported overland to South Africa or to other countries in East or West Africa. However, it appears that heroin is also increasingly being transported in container ships, which, unlike the dhows, can sail directly from the Makran Coast to South Africa. In addition, some of the drugs trafficked along this route are destined for local consumption, owing to sustained demand for heroin and other opioids in some African countries Cousins, ; Harker et al. This established heroin trafficking route appears to be increasingly exploited for the co-trafficking of methamphetamine to global markets, including the EU GITOC, This may be due to the recent surge in methamphetamine production in Afghanistan see Methamphetamine module. Routes used for further transportation from the East African coast to other countries in Africa and to Europe are complex. Note: This graph is based on the frequency of reports and not on heroin seizure quantities. Given that the data are incomplete, this graph does not present a ranking of countries. There is also evidence of large quantities of heroin arriving in the EU from countries in Africa by sea. In May , 2. Other methods employed to bring heroin from Africa to the EU include postal and parcel services and the use of air passengers as drug couriers. Several large heroin seizures on this route in recent years confirm that it is used to smuggle large amounts of opiates from Iran to Europe via Armenia or Azerbaijan and Georgia Customs. A number of recent seizures in Azerbaijan have involved heroin trafficked in trucks with legal goods from Iran. Iranian authorities also routinely report seizures of heroin in liquid form near the borders with Afghanistan and Pakistan, some of which appear to have been intended for onward trafficking IRNA, This phenomenon warrants awareness, including in the EU, where heroin seizures in liquid form have not been reported. Heroin trafficked on this route appears to be destined mainly for consumer markets in Central Asia, Belarus, Russia and Ukraine Bobokhodzhiev, Significant heroin seizures have recently been reported by countries along the Northern route, such as kilograms seized by Kyrgyzstan in This suggests that criminal networks active on this route may be able to smuggle large quantities of heroin towards consumer markets in Russia and beyond Kadyrov, EU Member States rarely seize heroin trafficked via the Northern route. Nonetheless, a proportion of the heroin shipped on the Northern route may eventually enter the EU from Russia and through Poland and the Baltic countries, and from Ukraine to Hungary, Romania and Slovakia. Some heroin seized in Belarus, Romania and Ukraine in recent years was reported as having originated from Central Asia and being intended for Western European markets. The analysis shows that large heroin consignments arrive in the EU through various entry points and that the established trafficking routes are flexible and fluid, as are the methods of transportation and concealment. An example of this is the growing practice of combining trafficking routes, whereby criminal networks move heroin consignments from one means of transport to another at transhipment points see Box Key transhipment points for heroin trafficking. When heroin is trafficked by land, it is typically hidden in concealed compartments or among legal goods. While typically trafficked in powder form, traffickers also dissolve heroin in liquids to conceal it and minimise the risk of checks. In recent years, heroin trafficking by maritime routes appears to have increased see Section Southern route. Roll-on roll-off ferries and pleasure boats also appear to be used in some places, although this method is not well understood. One of the most frequently used methods for trafficking heroin by sea involves concealment in maritime containers and among legal goods through the use of fake labelling, documentation or packaging. Heroin is also trafficked by air, albeit in smaller quantities than in other modes of transport. While limited data are available on trafficking using private aircraft, heroin is regularly trafficked to Europe by couriers travelling on commercial flights from African countries see Box Heroin trafficked from Africa by air couriers. Another method employed to bring heroin into the EU is through mail consignments. The online trade relies heavily on post and parcel shipping, including through express courier services, and criminals take advantage of the large volume of parcels passing through mail distribution centres. As in the case of other drugs, criminals exploit the services of parcel delivery providers operating across the world to smuggle heroin. While the data available are limited, there is evidence of heroin trafficking through the postal system both within and to the EU from Africa and the Middle East see Box Heroin trafficked through mail consignments. Trafficking routes connect heroin production and consumer markets in the EU and may vary over time due to various factors. Importantly, criminal networks seek to maximise profits while minimising costs see Box Comparison of heroin markups on selected European wholesale markets. Based on the present analysis, three factors of particular importance emerge. First, globalisation has facilitated rapid connection and transportation between heroin production and consumer markets. Continuing international developments in transport infrastructure, such as the Chinese-led Belt and Road Initiative, courier services and containerised shipping, offer a range of new opportunities to traffickers to conceal heroin consignments while hampering the efforts of law enforcement. Ongoing developments in this area can influence changes in the relative preference for different routes. Second, changes in law enforcement activity and the availability and use of new sources of information on criminal activity, such as intercepting encrypted communications, may cause traffickers to adapt their modi operandi. Overall, law enforcement knowledge on heroin trafficking has improved considerably over recent years, with information being obtained from the lawful interception of encrypted communication platforms, such as Sky ECC. However, decryption and the translation and analysis of information present an ongoing challenge for law enforcement in the EU. It is also important to note that changes in law enforcement approaches and priorities may result in the discovery of trafficking routes and methods that have been in existence for some time rather than newly established routes and methods. Third, unexpected events, such as global crises, instability and armed conflicts, and significant political or economic changes, may affect drug trafficking. Criminal networks will strive to adapt to these events, both to overcome any difficulties they create and to exploit opportunities they present. For example, armed conflicts often lead to the displacement of populations and a breakdown of social structures, which can lead to vulnerable populations becoming more susceptible to exploitation for drug trafficking or use. Understanding how drug trafficking continuously adapts to global or regional crises can help to anticipate changes in trafficking patterns. Once smuggled into the EU, heroin is then distributed to consumer markets across Europe. Therefore, large quantities of heroin are likely to be trafficked to these countries to meet local demand. Consumer markets for heroin appear to remain stable, with only limited fluctuation in the number of users in the short term. However, there are several caveats that might suggest that recent changes in heroin use are not fully captured in current monitoring systems see Section The consumer market. The market for illicit synthetic opioids in the EU is supplied by both medicines intended for therapeutic purposes diverted from the legal market and a broad range of illicitly manufactured opioids. Synthetic opioids intended for therapeutic purposes enter the illicit drug supply chain in a number of ways. For example, they may be stolen or diverted from the legitimate supply chain including from manufacturers, wholesalers and pharmacies ; from healthcare systems from hospitals or through corrupt healthcare professionals or forged prescriptions ; or from licit use stolen directly from patients or when users sell or give away a proportion of their prescribed opioids. The illicit production of synthetic opioids in the EU remains uncommon see Section Synthetic opioid production in Europe: a marginal phenomenon. Generally, synthetic opioids are produced outside the EU and enter Europe through key logistics hubs. Typically, producers and traffickers of these substances ship small quantities anonymously through freight forwarders and postal or express courier services. Darknet markets, e-commerce and social media platforms are also exploited by sellers. Because of their potential presence in very small quantities, synthetic opioids may be difficult to detect using routine analytical methods and techniques currently employed by forensic laboratories. Another issue is the emergence of new synthetic opioids that are not controlled by international drug control agreements, as these may also pose particular difficulties in terms of detection see Box Detections and seizures of new synthetic opioids. This therefore remains an area requiring vigilance and some precautionary measures. Falsified or counterfeit opioid-containing medicines are a growing cause for concern as they are associated with high public health risks. Falsified medicines contain different quantities of the active substances than claimed, or different active substances entirely. Counterfeit medicines have the composition that is claimed but they infringe trademark rules European Medicines Agency, n. Overall, more information is needed on the diverse sources of these medicines. To gain a better understanding of this situation would require both forensic analysis of reported seizures to determine their source, and consistent reporting of the number of seizures and quantities seized. Based on reports to the EMCDDA from the Reitox national focal points, which do not necessarily contain results from forensic analyses, it has been possible to analyse seizures of some synthetic opioids in the EU. However, the number of reporting countries has varied from year to year, limiting the comparability of results see Table Seizures of selected synthetic opioids in the EU, The trafficking of fentanyl and its derivatives, such as carfentanil, is a particular concern for the EU. These extremely potent substances have high associated morbidity and mortality, posing serious and complex public health and law enforcement challenges. Information made available to Europol indicates that parcels containing fentanyl, some of which were connected to sales on darknet markets, have been sent to the EU from the United States. Although the problem of fentanyl and other synthetic opioids in the EU is much less severe than the opioid crisis in North America, the high potency of some of these substances means that small-scale suppliers can have a significant harmful impact. As with other synthetic opioids, fentanyl derivatives are produced mainly in clandestine laboratories outside the EU. Their distribution, primarily to the Baltic and Nordic countries, occurs in two strands. In one strand, fentanyl derivatives are distributed by criminal networks operating in EU destination countries, although there is an intelligence gap regarding their composition and nationalities. In the other strand, they are purchased directly by consumers and retail-level distributors via online platforms on the surface web and the darknet. On the Estonian market, fentanyl has replaced heroin as the main opioid consumed since An increase in the availability of fentanyl derivatives was also seen in neighbouring markets, especially Latvia, Lithuania and Sweden, until around , after which it declined. New fentanyl derivatives not covered by fentanyl controls were also detected in Europe in and New non-fentanyl synthetic opioids, including benzimidazole nitazene opioids, have also appeared on the drug market in the EU, posing concerns. Isotonitazene has been detected on the market in Latvia and Estonia, substituting for other opioids that are in short supply LSM. Ten EU Member States consistently provide seizure data on fentanyl derivatives. Only Austria reported an increase, from four seizures in to 11 in see Figure Number of seizures of fentanyl derivatives in 10 EU Member States, However, due to the low number of seizures, caution should be exercised in interpreting this increase. While the data give strong evidence of a decrease in the number of seizures of fentanyl derivatives, less data are available to draw firm conclusions regarding quantities seized see Table Seizures of selected synthetic opioids in the EU, Although the quantity reported by weight seized in was lower than in previous years, a wide range of fentanyl derivatives were reported to have been seized. This included carfentanil in combined seizures with fentanyl, and sometimes with methadone reported by Latvia in and Lithuania in , and remifentanil and alfentanil reported to have been seized in Slovakia in Furthermore, following a significant drop in the reported number of tablets seized, from 19 in five reporting countries to 91 in four reporting countries , the number rose to 5 in five reporting countries. These changes in the reported number of tablets seized were almost exclusively driven by Sweden. The overall decline in the number of seizures of fentanyl derivatives is probably driven by two key factors. These are the targeting, both offline and online, of fentanyl derivative distribution networks by law enforcement in affected EU Member States and controls placed on new psychoactive substances in China. Other European countries have systematically targeted criminal networks involved in the distribution of these substances. Despite the notable decrease in the number of seizures in the 10 EU Member States that consistently provided data between and , there is evidence of continued trafficking of fentanyl derivatives. For example, Estonian police reported the seizures of grams and grams of carfentanil in two operations near the Latvian border in April and May , respectively. The drugs were trafficked from Latvia by Latvian nationals, allegedly for distribution on the Estonian market see Photos Carfentanil seized in two operations in Estonia, April and May Efforts at national level have been boosted by the generic control measures on fentanyl derivatives imposed in in China, historically one of the main source countries for new psychoactive substances. This measure covers the illicit production, export and sale of all fentanyl derivatives. In , the INCB noted that this legislation had led to a sharp drop in the quantity of fentanyl-related substances of alleged Chinese origin being seized globally INCB, a. However, traffickers and producers appear to have adapted by using new methods, such as the use of non-scheduled chemicals and chemically masked fentanyl precursors, to circumvent the ban INCB, a. The long-term impact of these developments on Europe needs to be monitored. A number of other synthetic opioid medicines, including methadone, buprenorphine, tramadol and oxycodone, continue to be seized in the EU. In addition to illicit production both outside and inside the EU, medicinal products containing synthetic opioids are also diverted from legitimate supplies. Synthetic opioids are key active pharmaceutical ingredients in many medicines prescribed and sold in the EU and come in a variety of forms, including tablets, patches, sprays and lozenges. Fentanyl-containing medicines diverted from legal supply are most commonly seized as patches, sprays and lozenges see Box Operation Chimera: diversion and trafficking of fentanyl and other opioids in Romania. In some countries, such as France, the diversion of opioid medicines, such as methadone and buprenorphine, is reported to be the main source for their illicit drug markets. Some of the opioid medicines seized in the EU are intended for use outside the region. For example, seizures of tramadol reported in a number of EU countries appear to have been in transit to the Middle East and Africa. Despite high availability in the EU, tramadol currently has a low rate of misuse across European countries with the possible exception of France; see Section Overdose deaths related to heroin and other opioids Iwanicki et al. This is in contrast to data from some countries in Africa and Middle East, where no other prescription opioids are available and where rates of non-medical tramadol use have been rising UNODC, ; WHO, Of concern is the recent increase in oxycodone seizures in the EU. Developments have also been seen in the illicit buprenorphine trade. The misuse of buprenorphine in some EU Member States is considerable. For example, buprenorphine has been the main opioid misused in Finland for a number of years, with France being consistently reported as the source. It appears that relatively large buprenorphine shipments are moved from France via Germany, Sweden and Estonia to Finland. Following an increase in the number of seizures between and , a drop was noted in The decline was driven by fewer seizures reported by Austria, Finland, Greece and Sweden. However, this analysis is hampered by a lack of data from France and Germany see Figure Number of buprenorphine seizures in 11 EU Member States, Fourteen EU Member States consistently provide methadone seizure data. This large increase was driven mainly by seizures in Spain, where methadone seizures amounted to less than 10 kilograms per year between and , but increased to kilograms in The number of reported methadone tablets or capsules seized remained stable in this period, based on reporting from five EU Member States. 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. 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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.

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