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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. 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.

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Official websites use. Share sensitive information only on official, secure websites. Research on adolescent substance use is of utmost importance. Using local toxicological data, both prevalence and pattern of substance use SU and substance-related death SRD can be assessed to design effective prevention programs. A retrospective study of toxicology investigations of all adolescents referred to the medico-legal section of the Toxicology Unit of the University Hospital of Lille, France, for a 2-year period from to In the total sample of cases, adolescents accounted for 3. Among the adolescents, About Cocaine and amphetamines were detected in Polysubstance use was common between alcohol and THC and among males. About one-third of deaths were due to substance use. It is recommended that illicit substances, ethanol, and prescription substances are targeted for testing among adolescents in order to provide appropriate prevention. Keywords: forensic toxicology, alcohol, illicit substances, prescription substances, substance-related death. Substance use SU represents a preventive medicine dilemma in any society. The users may consume different types of substances that have been legal or accepted for public use alcohol , shared for conditions other than medical use without prescription prescription substances , or prohibited by law for public use illicit substance \[ 1 \]. SU is considered a risk factor for morbidity and mortality. Substance users suffer a significant risk of premature death in comparison with their contemporaries as previous studies revealed a 6—38 higher mortality rate among substance users \[ 2 , 3 \]. According to the definition by the World Health Organization, an adolescent is an individual who is aged between 10—19 years \[ 4 \]. Adolescence is a tumultuous time full of experimentation and confusion. More often during this period, the acquired habits are accompanied until adulthood, making this time of great importance for preventive intervention \[ 5 \]. The prevalence of adolescent SU is rampant and creates a conundrum for medical professionals. Initiation of SU at an early age has been associated with long-term physical, behavioral, social, and health risks \[ 6 , 7 \]. SU may lead to neurological changes and behavioral consequences that differ from those that happen in adults due to rapid brain development and maturity during this tenuous period \[ 1 \]. Research based on a postmortem database introduces a complementary and different perspective on SU. It includes those persons who do not usually participate in self-reporting studies, and the results depend on actual toxicological analysis; the results of the measurements could temporally connect the toxic substance effect and the fatality \[ 8 \]. Deceased adolescents offer a picture of the substance-related fatalities which may be helpful to estimate the SU problem in a certain population, identify trends in drug use patterns, and cause of death among the substance users. The number of substance-related deaths SRDs could be used to determine SU which is difficult to be estimated in adolescents. Moreover, the toxicological results of living adolescents are another source to estimate the SU among this age group. A systematic retrospective review of adolescent cases from 10 to 19 years old; deceased and living , who were referred to the medico-legal section of the Toxicological Unit of the University Hospital of Lille North of France , was carried out over 2 years to Figure 1. Autopsy findings and police department records were used to identify the cause of death, as well as additional relevant information related to drug use, regular treatment, or pathological conditions. The samples were collected either by a forensic pathologist during autopsy in deceased cases or by a medical examiner in living cases. Toxicological analyses of the cases were performed on blood, urine, or other matrices as indicated by case specifics. Flow chart showing the selection of adolescent cases referred to the medico-legal section of the Toxicology Unit, University Hospital of Lille North of France during — Systematic toxicological investigations that were performed in the collected cases included general unknown screenings using liquid chromatography with the high-resolution mass spectrometry method LC-HRMS previously reported \[ 9 , 10 , 11 \]. The therapeutic, toxic, and fatal concentrations were determined according to the published reference tables \[ 12 \]. The cause of death variable has 2 categories, including SRDs and non-substance-related deaths. The data analysis is mainly descriptive in nature. Statistics consisted of frequencies and crosstab analysis. In the total sample of cases referred to the medico-legal section of the Toxicology Unit of the University Hospital of Lille, France, during —, adolescents constituted 3. Characteristics of adolescents referred to the medico-legal section of the Toxicology Unit, University Hospital of Lille, France — Among the adolescents in the present study, There were 40 deceased cases whose biological samples were investigated during — 14 in , 26 in Meanwhile, there were 25 living cases that were investigated during — 11 in , 14 in In this study, SRDs accounted for Toxicological data was compiled using all available data from each individual and considered positive if the threshold for positivity was achieved \[ 12 \]. This age group consisted of five males and six females. The exclusive cause of death among early adolescents was not related to any substance. Out of the total number of males in the present study, there were 29 deceased The most common substance detection was THC in Ethanol was included in the cause of death for two cases. The detected substances under this class were morphine, methadone, and codeine. Five cases were males three died and two living cases and the last one was a deceased female. The blood analysis of one of them detected morphine For the other living case, blood analysis revealed methadone 2. The concentration of morphine in the blood of deceased cases in the present study ranged from 5. Tramadol was detected in only one case—a year-old deceased male. The concentrations of TR and their metabolites N -desmethyltramadol, O -desmethyltramadol were , , and 5. The cause of death was not substance-related. Only Of the positive adolescents for prescription substances, Four cases 6. The positive amphetamine findings occurred equally in both sexes. Amphetamine 2. The positive cocaine findings occurred in three males and two females. In the present study, the blood concentration of cocaine was 3. For benzoylecgonine BE , the blood concentrations ranged from 3. The blood concentrations of ecgonine methyl ester ranged from 1. Males comprised The THC blood concentration ranged from 0. In this study, there were 16 cases six living and 10 deceased positive for multiple substance detection. The most common polysubstance detection was found between alcohol and THC The males dominated by a margin of in comparison with female cases. The death due to substance overdose among adolescents is diagnosed as SRD which is different from positive substance detection Table 1. The SRD was diagnosed in SU is a prevalent problem in adolescence \[ 1 , 13 \]. The focus on adolescents is of great importance because of their vulnerability \[ 6 , 14 \]. The early initiation of SU is highly associated with substance use disorders in adulthood, causing substantial harm to the user and society \[ 6 \]. Moreover, SU among adolescents has short and long-term repercussions such as poor academic performance, injury, unintended pregnancy, mental disorders, and addiction \[ 15 \]. The reasons for SU were for getting high, increasing performance, because of peer pressure, or for purposes of self-medication \[ 13 \]. This is a retrospective study of toxicology investigations of deceased and living adolescents 10—19 years old referred to the medico-legal section of the Toxicological Unit of the University Hospital of Lille North of France for 2 years from to The present study displayed that more than two-thirds The variance in prevalence could be justified due to the difference in time period and place of study within France. In addition, it has been reported that the postmortem prevalence rates exceed those found with self-reported data. Although the cases in the present study are at high risk of SU due to their forensic referral, it is confirmed that the accuracy of self-reported data is variable and may undermine the magnitude of this epidemic \[ 1 \]. This is in agreement with the World Drug Report , which revealed that SU is typically initiated in late adolescence and peaks in young adulthood \[ 17 \]. In polysubstance use, males also dominated by a margin of in comparison to females. The SRDs occurred more likely among males than females. This is in the same direction as previous studies that confirmed the dominance of males either in SU and its consequences \[ 8 \]. Regardless of smoking, a previous French study is in agreement with the present study as it reported that the most consumed products by adolescents are alcohol and cannabis \[ 13 \]. Another French study revealed the highest prevalence for THC The main risk of THC is its potential for being a gateway substance to more harmful substances. Moreover, the adolescents who are THC regular users performed poorer on performance tests of learning, cognitive flexibility, visual scanning, error commission, and working memory after 4 weeks of abstinence \[ 1 \]. This was also in line with a previous Italian study that showed that A study from Poland declared that Other illicit substances, such as cocaine and amphetamines, were detected in Furthermore, a previous study found minimal use of cocaine 0. The difference could be attributed to the change of trend of SU through time and even in different places within the same country. According to an earlier French study, 1. Another French study considered that opiates and methadone are the most dangerous treatments when misused \[ 13 \]. The most common polysubstance detection Of the positive adolescents for prescription substances, more than three-fourths were also positive for illicit substances or other prescription substances. Polysubstance use is a common pattern among both recreational and regular users. In Europe, a wide variation in the patterns of polysubstance use among drug users was reported, ranging from occasional alcohol and cannabis use to the daily use of combinations of heroin, cocaine, alcohol, and BZ \[ 6 , 17 \]. In the present study, about one-third of deaths These results are in agreement with previous reports that revealed the extreme outcome of SU is death. The top two ranks for recorded deaths among different age groups including adolescents were Europe followed by the Americas \[ 6 , 17 \]. Updated revision regarding commonly used substances and identifying the danger directed at adolescent health is needed to provide appropriate prevention. SU becomes a major problem as the adolescent moves into adulthood. If problems persist, polysubstance use and addiction may occur and increase the complexity of the problem. For this reason, increased supervision and effective prevention programs against SU for adolescents are justified, both for surveillance and reduction of harm. Conceptualization, S. All authors have read and agreed to the published version of the manuscript. The anonymized data presented in this study are available on request from the corresponding author. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Find articles by Sanaa M Aly. Find articles by Ahmed Omran. Find articles by Jean-Michel Gaulier. Find articles by Delphine Allorge. Elisabetta Bertol : Academic Editor. Antonina Argo : Academic Editor. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

How can I buy cocaine online in Suez