Most drug-related deaths caused by ‘polysubstance’ use, EU report finds

Synthetic opioids continue to worry European medicines agencies. New report says “polydrug use” poses new health risks. However, data on cannabis since legalization in Germany remains scarce.

The main takeaway from the 2024 European Drug Report: Drug users in Europe are increasingly using drugs at the same time – a practice known as “polydrug use” or “polysubstance”. And synthetic opioids remain a major concern for drug and addiction monitoring agencies.

These trends may or may not be intentional, as powerful synthetic opioids are often mis-sold or mixed with medications and other drugs, and cannabis products are adulterated with synthetic cannabinoids – so users do not don’t always know what they’re taking.

Polydrug use is the consumption of two or more psychoactive substances, licit or illicit, simultaneously or sequentially. It is possible to sell substances containing one or more drugs other than that expected by the buyer, either mixed with the substance he intended to purchase, or even as a replacement for it. (Source: Understanding the drugs situation in Europe in 2024 – key developments/European Drugs Report 2024)
“Multiple drug use can increase the risk of overdose,” indicates the report published by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) on June 11, 2024. “The majority of fatal overdoses involve the use of more than one drug . substance (…) cannabis was the drug most frequently reported in cases of toxicity linked to polydrug use.

Heroin remains the most commonly used illicit opioid in Europe. Cocaine use is second only to cannabis.

Synthetic opioids play a smaller role in Europe than in North America, the report said, but their use is also increasing in Europe. And they are “often very potent and carry a significant risk of poisoning and death.”

Six of the seven new synthetic opioids first reported to the EU Early Warning System (EWS) in 2023 were nitazenes.

EU drug reports lack data on synthetic opioids

By its own admission, and despite its 177 pages, the report lacked data in a number of key areas essential for assessing public health effects and measures to reduce drug addiction rates and overdoses.

Take nitazenes, for example: the report said that in 2023, nitazenes were associated with a “sharp increase” in deaths in Estonia and Latvia and localized poisoning outbreaks in France and Ireland.

But nitazenes and similar substances are not always detected in routine post-mortem toxicology tests in some countries, “so associated deaths may be underestimated.”

This means that the EMCDDA is simply not getting the data it needs, particularly when EU states are not checking for new and evolving medicines on the market.

“As patterns of drug use become increasingly complex, it also becomes increasingly necessary to improve our understanding of the impact of changes in patterns of polydrug use on mortality,” the report states. .

Another key area lacking data was the impact of cannabis legalization. This contrasts with two facts stated by high-level speakers at an EMCDDA briefing:

Ylva Johanssen, European Commissioner for Home Affairs, said: “After cannabis, cocaine is the second most consumed drug in the EU. »

Alexis Goosdeel, director of the EMCDDA, said the concentration of THC, the psychoactive element in cannabis resin, had “doubled over the past ten years” and continues to rise, according to the written report. The average THC was 22.8% in 2022.

The report suggests that “any policy developments in this area”, i.e. the legalization or tolerance of cannabis, for example, “should be accompanied by an assessment of the impact of any changes introduced. This type of assessment will depend on the existence of good baseline data; highlighting once again the need to improve our monitoring of current patterns of consumption of Europe’s most commonly consumed illicit drug.

The EMCDDA’s “national focal point” in Germany is the “Deutsche Beobachtungsstelle für Drogen und Drogensucht” (DBDD), or the German Drug and Drug Addiction Monitoring Office.

DBDD director Eva Hoch told DW that the problem of missing baseline data – an agreed “starting point” from which to assess any changes or developments – could affect Germany’s ability to assess the impact of the legalization of cannabis in April 2024.

“German researchers said a year ago that scientific evaluation should start before legalization, because we need baseline data,” Hoch said.

Cannabis use had been increasing for a decade before legalization, Hoch said, and that needed to be taken into account to properly track the impact of legalization.

“The picture is cracked in Germany,” Hoch said. “There are many anecdotes on the Internet and on social networks, but we do not have systematic data. It is not clear how the law was adopted in the country’s 16 Länder (…). There is no systematic data on the immediate impact of the new law. We cannot say whether cannabis use has increased in the two months since legalization, whether demand has increased, or whether there have been more road accidents since legalization in April.

These factors are just the beginning. Studies in the United States and Canada have shown, Hoch said, that there are more than 100 factors that can help gauge the effect of cannabis legalization. The German government had planned to assess the impact of cannabis legalization, she said, but that process has not yet started, and it is unclear when it will begin.