Most drug deaths due to 'polysubstance' use, EU report

Synthetic opioids continue to concern European drug agencies. A new report states that 'polydrug' use is leading to new health risks. Data on cannabis since Germany's legalization, however, is still sparse.

The top takeaway from the European Drug Report 2024 : Drug users in Europe are increasingly using more than one drug at the same time — a practice known as "polydrug" or "polysubstance" use. And synthetic opioids remain a top-level concern for drug monitoring and drug addiction agencies.

These trends may or may not be voluntary as potent synthetic opioids are often being mis-sold or mixed with medicines and other drugs, and cannabis products are being adulterated with synthetic cannabinoids — so users don't always know what they are taking.

Polydrug use is the use of two or more psychoactive substances, licit or illicit, simultaneously or sequentially. Substances may be sold that contain one or more drugs other than the one the purchaser was expecting, either in a mixture with the substance they intended to buy or even as a replacement for it. (Source: Understanding Europe's drug situation in 2024 — key developments/European Drug Report 2024)
"Polydrug use can increase the risk of a drug overdose," stated the report, published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on June 11, 2024. "The majority of fatal overdoses involve the use of more than one substance […] cannabis was the drug most commonly reported in the cases of polydrug use toxicity."

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

Synthetic opioids play a smaller role in Europe than they do in North America, according to the report, but their use is increasing in Europe, too. And they are "often highly potent and carry a significant risk of poisoning and death."

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

EU Drug Reports lacks data on synthetic opioids

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

Take nitazenes, for example: The report stated that in 2023, nitazenes were associated with a "sharp rise" in deaths in Estonia and Latvia and with 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 under-estimated."

That means that the EMCDDA simply isn't getting the data it needs, especially when EU states fail to check for new and evolving drugs on the market.

"As drug consumption patterns are becoming ever more complex, there is also a growing need to improve our understanding of how changes in patterns of polydrug use are impacting on mortality," stated the report.

Another key area that lacked data was the impact of cannabis legalization. This is striking against two facts stated by top-level speakers at an EMCDDA briefing:

Ylva Johanssen, European Commissioner for Home Affairs said: 'After cannabis, cocaine is the second most common drug used in the EU.'

Alexis Goosdeel, EMCDDA Director said that the concentration of THC, the psychoactive element in cannabis resin had 'doubled in the last ten years' and it continues to rise, according the written report. Average THC was at 22.8% in the year 2022.

The report suggests that 'any policy development in this area' meaning legalization or toleration of cannabis, for instance 'should be accompanied by an assessment of the impact of any changes introduced. This sort of evaluation will depend on the existence of good baseline data; underlining again the need to improve our monitoring of current patterns of use 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 observation office for drugs and drug addiction.

DBDD Director Eva Hoch told DW that the issue of missing baseline data — an agreed "starting point" from which to evaluate any changes or developments — could affect Germany's ability to evaluate the impact of its legalizing cannabis in April 2024.

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

Cannabis consumption had been on the rise for a decade before legalization, said Hoch, and this needed to be taken into account to properly track the impact of legalization.

'The picture is cracked in Germany,' said Hoch. 'There are many anecdotes on the internet and social media, but we don't have systematic data. It's unclear how the law has been adopted across the country's 16 federal states […]. There is no systematic data on the immediate impact of the new law we can't say whether cannabis consumption has increased in the two months since legalization or whether demand has increased, or whether there have been more traffic accidents since legalization in April.'

Those factors are just the start. Studies in the US and Canada had shown, said Hoch, that there were more than 100 factors that can help evaluate the effect of cannabis legalization. The German government had planned to evaluate the impact of the legalization of cannabis, she said, but that process had yet to start, and there was no sign of when it would begin.