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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. Alongside the more well-known substances available on illicit drug markets, a number of other substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include LSD lysergic acid diethylamide , hallucinogenic mushrooms, ketamine, GHB gamma-hydroxybutyrate and nitrous oxide. On this page, you can find the latest analysis of the situation regarding these substances in Europe, including seizures, prevalence and patterns of use, treatment entry, harms and more. European Drug Report — home. The drug situation in Europe up to Drug supply, production and precursors. Synthetic stimulants. Heroin and other opioids. Other drugs. New psychoactive substances. Injecting drug use in Europe. Drug-related infectious diseases. Drug-induced deaths. Opioid agonist treatment. Harm reduction. Some of these substances appear to have become well-established in some countries, cities or specific populations, although overall their relative prevalence may remain low in comparison to some other better-known drug classes. However, for a variety of methodological and historical reasons, our current monitoring approaches often perform poorly in identifying patterns and trends in the use of less well-known substances. This makes it difficult to comment with confidence on the prevalence of use or recent trends, or on the extent to which these drugs are associated with health or social problems. The information available suggests, however, that in some countries, subgroups or settings, the use of these sorts of substances has become more common. As patterns of drug use can change rapidly and many of the drug-related problems we face are increasingly influenced by the co-consumption of multiple substances, there is a strong argument for increasing investment in the surveillance of substances with hallucinogenic, anaesthetic, dissociative or depressant properties. The quantity of ketamine seized and reported to the EU Early Warning System on new psychoactive substances has varied over time, but has remained at relatively high levels in recent years, tripling from just under a tonne in to 2. Seizures were reported by 17 countries in both years, with both Denmark and the Netherlands reporting large seizures, and these two countries together accounted for two thirds of the overall quantity of ketamine seized in Most of the ketamine seized in Europe is thought to originate from India, but there is some evidence that the drug may also be sourced from Pakistan and China. Available information suggests that production of the drug in Europe remains limited. Overall, there is evidence to suggest that ketamine is likely to be consistently available in some national drug markets and may have become an established drug of choice in some settings. It is also reported to be used in combination with other substances, such as stimulants. In Ireland, for example, the intentional mixing of cocaine and ketamine has been identified at music festivals, as have ketamine-related medical incidents during and In , Euro-DEN sentinel hospital emergency departments in Europe reported that cocaine was the substance most often reported in combination with ketamine in acute toxicity presentations. Ketamine is commonly snorted, but can also be injected, and has been linked to various dose-dependent acute and chronic harms, including neurological and cardiovascular toxicity, mental health problems, such as depression, and urological complications, such as bladder damage from intensive use or the presence of adulterants. Ketamine may also be added to other drug mixtures, including MDMA powders and tablets, potentially making inadvertent consumption an issue. In contrast to some other parts of the world, mixtures sold as pink cocaine are less likely to contain the synthetic drug 2C-B, which has historically been associated with this product. It is also interesting to note that while the overall figure remains low, both the quantity of 2C-B seized and the number of countries reporting seizures increased in , with 14 countries reporting seizures amounting to just under 6 kilograms of this drug. The number of clients reported to receive treatment for problems related to ketamine use remains low. However, it has risen from around cases reported in to in Moreover, this data set is not likely to capture all those having health problems with this drug. For example, those who have developed urological problems may be poorly represented. Nitrous oxide, commonly known as laughing gas, has been linked to various health problems, including poisonings, burns and lung injuries and, in some cases of prolonged exposure, neurotoxicity from vitamin B12 deficiency. There is, however, a debate on the extent to which this substance is associated with negative health risks, especially among episodic users, although given its apparent growing popularity among young people, this is clearly an important area for further research and monitoring. In some European cities, discarded nitrous oxide gas canisters have become a relatively common sight, and the disposal of the smaller stainless steel canisters has been identified as a drug-litter issue in some countries. The drug has become more accessible and cheaper, available online and with the increased availability of larger gas canisters aimed at recreational use. However, high-volume cylinders may also increase the risk of lung damage, due to the higher pressure of their contents and, in general, inhaling directly from gas bottles is reported to be associated with a greater risk of harm. Nitrous oxide has various commercial uses, for example, it is used by the catering industry. Regulatory approaches to the sale and use of this substance vary between countries, with the gas legally available for sale in some countries. Several EU countries, including Denmark, France, Lithuania, the Netherlands and Portugal have restricted the availability of nitrous oxide in recent years. There is limited evaluative information about the effectiveness of legislative or other approaches to restricting access to nitrous oxide. Non-controlled and new benzodiazepines also continued to be available in some European countries but, again, current monitoring approaches make it difficult to comment on the scale of their use, although signals exist that these substances may have important consequences for health, especially when consumed in combination with other drugs. They are often very cheap and may be used by young people in combination with alcohol, sometimes resulting in potentially serious health reactions or aberrant behaviour. These substances have also been linked to overdose deaths among people who use opioids. A lack of toxicological information means the role that benzodiazepines play in opioid-related deaths is not sufficiently understood. So far, seizures of benzo-dope have been reported by Estonia and Latvia. In both countries, the same mixtures have also been identified in residues analysed from used syringes. Both clinical and public interest has been growing in the therapeutic use of some novel substances, particularly psychedelic substances, but also dissociative drugs such as ketamine. At the same time, a growing number of clinical studies, both internationally and in Europe, are exploring the potential of a range of psychedelic substances to treat different mental health conditions. The evidence base in this area is growing rapidly, and some studies have produced evidence to support the view that some substances may have value in the treatment of specific neuropsychiatric disorders, such as post-traumatic stress disorder or treatment-resistant depression and major depressive disorder. However, the interpretation of the results is complicated by a range of methodological issues, and generalisation remains difficult as much of the research in this area remains at an early stage. Nonetheless, these developments have received considerable media attention, raising concerns that this may encourage greater experimental use of a range of potent psychoactive substances without appropriate medical support, potentially putting vulnerable individuals at risk of suffering adverse consequences. At the same time, there are signs of unregulated programmes being operated in the European Union and elsewhere, in which the use of psychedelic substances is included as part of a wellness, therapeutic or spiritually oriented intervention. Strengthening monitoring in this area will be important, as a growth of unlicensed therapeutic uses of psychedelics may adversely affect vulnerable individuals with pre-existing mental health conditions. Mean daily amounts of ketamine in milligrams per population. Sampling was carried out over a week in March and April For the complete data set and analysis, see Wastewater analysis and drugs — a European multi-city study. Increases were observed in the number of clients entering treatment for problems related to ketamine use in Belgium, Germany and Italy in and Spain in most recent data , with the overall number rising from in to an estimated clients in in these countries. Show source tables. The complete set of source data for the European Drug Report including metadata and methodological notes is available in our data catalogue. A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below. 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. Search within the book Operator Any match. Exact term match only. Main subject. Target audience. Publication type. European Drug Report main page. On this page.
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Zalika Klemenc-Ketis 1 assist. Danijela Mitrovic 2 MD, medical doctor. Klemenc-Ketis Z, Mitrovic D. Patients' use of and attitudes towards self-medication in rural and remote Slovenian family medicine practices: a cross-sectional multicentre study. Rural and Remote Health ; Cited by. Introduction: Self-medication is very common in the general population, but its prevalence can differ according to the place of residence. The aim of this study was to determine the prevalence of self-medication in patients attending rural and remote family physicians, and to detect the important factors that are associated with it. Methods: A cross-sectional multicentre study was performed in 24 rural and remote family medicine practices in Slovenia was performed. The aim was to include patients who visited their family physicians on a particular day. The authors used a validated questionnaire on self-medication, which consisted of questions about demographic characteristics sex, age, education and working status , questions about health status, questions about self-medication practices, and questions about attitudes towards self-medication. The level of participants' trust in different sources of medical information was measured by a five-point Likert scale. The participants were asked to take into account the year when completing the questionnaire. Results: Of invited patients, There were The mean age of the participants was Self-medication was practised by In multivariate analysis, the variables independently associated with self-medication were information on self-medication obtained from pharmacists, and information on self-medication obtained from relatives. Additionally, some other variables had high odds ratios such as information on self-medication obtained from books, information on self-medication obtained from media, and reason for self-medication: burdening physicians. Conclusions: The practices of self-medication in rural Slovenia as reported by patients can be defined as moderately safe. People tend to seek more information on self-medication but the main sources for this are lay informants. Further studies are needed to explore the safety of such practices. Self-medication is defined as the use of medicines without medical supervision to treat one's own ailment 1. It is therefore obvious that the majority of patients in family medicine use self-medication when experiencing a deterioration in their health. The general public's view on the safety of self-medication is that drugs and remedies for self-medication are completely safe and can be used without any precautions 6. However, this can result in inappropriate use, a manifestation of serious side effects, or dangerous interactions with conventional medicines 7 , 8. In Slovenia, the national healthcare system is based on a combination of the Beveridge and Bismarck models; the Bismarck insurance model of financing healthcare is used, but for political reasons there is only one insurance company in Slovenia - the National Health Insurance Institute. Every resident of Slovenia is insured through their employment status, or, if unemployed, through local communities. Preparing the network of healthcare institutions is the responsibility of the state, comprising public primary healthcare centres, private family physicians and dentists, pharmacies, specialist services and public hospitals 9 , Primary healthcare in Slovenia consists of family physicians, paediatricians, gynaecologists and dentists. Family physicians serve as partial gatekeepers, as the majority of secondary and tertiary healthcare is available only through a referral 9. The drug market in Slovenia is regulated by state legislation and most drugs are available only on prescription. The medications and remedies available freely in pharmacies and specialised stores are herbal drugs, vitamins and minerals, topical anti-rheumatics, lower strength oral non-steroidal anti-inflammatory drugs, lower strength oral antihistamines, and some non-opioid analgesics ie paracetamol 3. People in Slovenia can therefore practise self-medication with over-the-counter OTC drugs, which can be bought only in pharmacies, as well as different herbal remedies, which can be bought in pharmacies as well as in some specialist shops 4. Some remedies and OTC drugs can also be bought on the internet In addition, it has been shown that people practise self-medication with prescribed drugs which were only partly used at the time of prescription and were then stored in home medicine chests It is known that the place of residence significantly affects assessment of health status, healthcare utilisation and health-related behaviour It can therefore be expected that self-medication behaviour could also differ between urban and rural areas It was found that self-medication was associated with several demographic characteristics such as female sex 15 , the absence of chronic diseases 15 , lower education 14 and younger patients However, previous studies did not explore factors such as the reasons for self-medication and its sources in rural areas. As previous Slovenian studies on self-medication showed that people practise it very often, and sometimes not in a safe way 3 , 4 , 20 , 21 , the authors wanted to explore these issues in rural populations as well. In this study the authors wanted to determine the prevalence of self-medication in patients attending rural and remote family physicians and detect the important factors that were associated with it. A cross-sectional multicentre study in rural and remote family medicine practices in Slovenia was performed. The term 'rural' in health care is difficult to define, as it differs in different countries; several other similar terms are also used, such as 'remote', 'peripheral' and 'isolated' In general, rural and remote practices are defined as practices outside urbanised areas, where primary health care is provided by a small number of family physicians, with limited access to specialists and advanced diagnostic equipment In Slovenia, there is no official definition of rural practice. The study took place from 1 May to 30 June All the participants gave informed consent for their participation in the study. The study took place in rural and remote family medicine practices in Slovenia. According to data from the Slovenian Section for Family Physicians working in Rural and Remote Areas, there are currently family medicine practices in rural and remote parts of Slovenia. These practices were contacted through email. In cases of no response, one of the researchers made personal contact by phone. The participants were patients coming to their family physician on a particular day. The inclusion criteria were as follows: age 18 years or more, and informed consent for their participation in the study. Participation was voluntary and anonymous. The exclusion criteria were as follows: patients with dementia, psychosis, or in an emergency situation, and age less than 18 years. A validated questionnaire on self-medication was used, which had been used previously in Slovenian studies 3 , 4. It consisted of questions about demographic characteristics sex, age, education and working status , questions about health status, questions about self-medication practice, and questions about attitudes towards self-medication. The questionnaires were sent by post to the family physicians that had agreed to participate in the study. Each family physician was asked to distribute 30 questionnaires to consecutive patients on one practice day. The patients filled in the questionnaires themselves in the doctor's surgery and returned them to a practice nurse. The physicians then returned the questionnaires to the researchers by post. The statistical analysis was carried out using the Statistical Package for Social Sciences v Also carried out was a binary logistic regression, including all the variables that were statistically significant in the bivariate analyses. Of the 50 invited family physicians, 24 In , the participants had on average of 2. Almost half of the participants, In , self-medication was practised by Most of the participants reported using herbal drugs for self-medication, decided to self-medicate on the basis of their own experience, got the information on self-medication from friends, bought the substances for self-medication in drugstores, self-medicated because they did not want to bother their physician, self-medicated when experiencing health problems, and thought that self-medication was safe only with appropriate information Table 2. The participants' trust in their family physician as a source of medical information was the highest, followed by trust in pharmacists, and the lowest in the media and traditional healers Table 3. Associations between variables and self-medication. Self-medication was also more prevalent in participants with higher education, in those who thought that self-medication was safe only with the appropriate information, those who obtained information from pharmacists, friends, relatives, books and the media, those who practised self-medication due to low trust in their physicians, those who did not want to burden their physicians, those who already knew the course of their disease, those who used self-medication for prevention, and those who used self-medication when symptoms occurred Table 4. Other variables did not show any statistically significant differences in bivariate analyses. In multivariate analysis, the variables independently associated with self-medication were information on self-medication obtained from pharmacists and information on self-medication obtained from relatives. Also, some other variables had high odds ratios such as information on self-medication obtained from books, information on self-medication obtained from the media and reason for self-medication: burdening the physicians Table 5. Table 1: Demographic characteristics of the sample Table 2: Self-medication practices Table 3: Levels of trust in different sources of medical information Table 4: Associations between self-medication and some characteristics of the sample Table 5: Multivariate analysis? This study showed that self-medication is a very common practice in rural settings and that people mostly use herbal drugs and remedies and OTC drugs. It also showed that advice from pharmacists and lay people ie relatives, friends plays an important role when deciding to practice self-medication. This is the first study in Slovenia on self-medication practice in rural patients in primary health care. In Slovenia, there is a rich tradition of knowledge of herbal medicines, which is present mostly in rural areas and among older people Because of this, high self-medication practices in those areas were expected. Most of the participants said that self-medication was safe only with appropriate information, which is also in line with other studies 3 , 4 , Even though this is a value judgement, because an individual's perception of safety level may differ from that of a professional, it still shows that people are aware of the possible dangers of self-medication and seek information prior to its use. This gives hope that, despite the fact that self-medication in Slovenian rural areas is very common, people use it with caution. Based on other studies it seems that this is a worldwide problem Unused prescription drugs accumulated in homes may be misused for recreation, used inappropriately for self-medication of future ailments, or ingested accidentally On the other hand, chronic patients also keep prescription drugs for their chronic diseases in home medicine chests. Obviously, there is a need for in-depth studies on the reasons for and practices of retaining prescription drugs at home. An important reason for practising self-medication was the statement not to burden their physician with their health problems, which was found also in other studies 3 , 4 , 7. Several other studies showed that responsible self-medication ie taking medicines that do not require prescriptions to treat symptoms might reduce the burden on health care systems 26 , On the other hand, previous studies also showed that people thought that self-medication was completely safe Despite the finding that a lot of participants said that they practise self-medication when faced with self-limiting symptoms or diseases, this could present a problem. In Slovenia, there is a shortage of family physicians, especially in rural areas 29 , which could lead to a wish by people not to burden their physicians. Of course, this could be potentially dangerous as important medical conditions could be recognised late. The present study also showed that the participants valued advice on self-medication from different sources, especially from pharmacists and relatives, as was also shown in the Slovenian study 3. A study from Pakistan 14 , on the other hand, showed that people in rural areas seek advice mainly from their physicians. It seems that, in Slovenia, lay advice from relatives and friends is an important source of information. This could be potentially dangerous as lay people may not have the right information, and their advice could therefore be a potential source of health risk. This study has several limitations. The first is the problem of the definition of rural family medicine practices in Slovenia. As there is no formal definition, and no formal list of rural practices exists, the researchers had to rely on the data in the Section for Rural and Remote Family Physicians. It is possible that their data are incomplete, so the authors might have missed some rural practices when inviting them to participate. This could therefore be a possible source of selection bias. Another limitation that could also present a potential selection bias is the fact that only half of the invited patients participated, and it is also possible that the physicians did not invite 30 patients, but fewer. As data on the non-respondents was not collected, possible differences could not be analysed. Therefore, one should be careful when generalising the results to the whole rural population of Slovenia. People residing in the rural areas of Slovenia very commonly practise self-medication. In fact, the prevalence of self-medication in these areas is one of the highest in the world. Most people reported that self-medication was safe only with the appropriate information, but on the other hand they commonly used prescription drugs of their own volition and they frequently did not go to see their physicians when ill because they did not want to burden them. The researchers therefore conclude that self-medication in rural Slovenia is moderately safe. This study was partially supported by an unrestricted program grant from the National Research Agency P3 Saint Arnault D. Cultural determinants of help seeking: a model for research and practice. Research and Theory of Nursing Practice ; 23 4 : Self-medication in a Portuguese urban population: a prevalence study. Pharmacoepidemiology and Drug Safety ; 11 5 : Klemenc-Ketis Z, Kersnik J. The effect of demographic characteristics on self-medication patterns: a cross-sectional nationwide study from Slovenia. Collegium Antropologicum ; 35 4 : An overview of self-treatment and self-medication practices among Slovenian citizens. Blenkinsopp A, Bradley C. Over the counter drugs: patients, society and the increase in self-medication. Pharmacy customers' knowledge of side effects of purchased medicines in Mexico. Tropical Medicine and International Health ; 14 1 : Herbal medicine: women's views, knowledge and interaction with doctors: a qualitative study. Self-medication with antibiotics: questionnaire survey among primary care center attendants. Pharmacoepidemiology and Drug Safety ; 18 12 : Family medicine in post-communist Europe needs a boost. Exploring the position of family medicine in healthcare systems of Central and Eastern Europe and Russia. BMC Family Practice ; 13 : Kersnik J. An evaluation of patient satisfaction with family practice care in Slovenia. International Journal for Quality in Health Care ; 12 2 : Seeking health advice on the internet in patients with health problems: a cross-sectional population study in Slovenia. Informatics for Health and Social Care ; 38 : Souces and predictors of home-kept prescription drugs. International Journal of Clinical Pharmacology and Therapeutics ; 48 11 : Understanding and representing 'place' in health research: a relational approach. Social Science and Medicine ; 65 9 : Prevalence of self-medication among urban and rural population of Islamabad, Pakistan. Tropical Journal of Pharmaceutical Research ; 62 5 : Petrovcic R. Defining rural, remote, and isolated practices: example of Slovenia. Rourke J. In search of a definition of 'rural'. Canadian Journal of Rural Medicine ; 2 3 : Investigating factors of self-care orientation and self-medication use in a Greek rural area. Rural and Remote Health Internet ; 14 : Available: www. Prevalence and pattern of self-medication practices in a rural area of Barabanki. Prevalence of self-medication in rural areas of Portugal. Pharmacy World and Science ; 28 1 : Self-medication and non-doctor prescription practices in Pokhara valley, Western Nepal: a questionnaire-based study. BMC Family Practice ; 3 : Complementary and alternative medicine in rural communities: current research and future directions. Journal of Rural Health ; 28 1 : Self-medication among healthcare and non-healthcare students at the University of Ljubljana, Slovenia. Medical Principles and Practice ; 19 5 : A cross sectional study of sex differences in self-medication practices among university students in Slovenia. Collegium Antropologicum ; 35 2 : Klemenc-Ketis Z, Verovnik F. The use of the medicinal herbs in the city of Velenje. Unused prescription drugs should not be treated like leftovers. Canadian Medical Association Journal ; 11 : Content of home pharmacies and self-medication practices in households of pharmacy and medical students in Zagreb, Croatia: findings in with a reference to Croatian Medical Journal ; 46 1 : World Health Organization. The benefits and risks of self-medication. WHO Drug Information ; 14 : Societal perspectives on over-the-counter OTC medicines. Family Practice ; 22 2 : Factors related to consultation time: experience in Slovenia. Scandinavian Journal of Primary Health Care ; 26 1 : Rural and Remote Health. Cited by download PDF. Tweet this article. Key words: cross-sectional study, prevalence, self-medication, Slovenia. Methods Type of study A cross-sectional multicentre study in rural and remote family medicine practices in Slovenia was performed. Settings The study took place in rural and remote family medicine practices in Slovenia. Participants The participants were patients coming to their family physician on a particular day. Statistical analysis The statistical analysis was carried out using the Statistical Package for Social Sciences v Results Of the 50 invited family physicians, 24 Sample description There were Self-medication practices In , self-medication was practised by Conclusions People residing in the rural areas of Slovenia very commonly practise self-medication. Acknowledgements This study was partially supported by an unrestricted program grant from the National Research Agency P3 References 1. This PDF has been produced for your convenience.
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