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The authors talk about the opioid problems in Europe. They discuss the signals that synthetic opioid use is occurring within the European Union (EU) and causing harm, the outbreaks of deaths associated with these substances, and the future threat to public health posed by changes in the availability and use of synthetic opioids.

The article observes changes in opioid problems in Europe with alarming signs of the potential role of synthetic opioid in the future and the need for better preparedness to respond to changes in patterns of opioid consumption. Signals of synthetic opioid use causing harm include increased prescribing of opioid-containing pain medicines, diverted use of fentanyl from medical use, increased availability of nitazene opioids and outbreaks of drug-associated and overdose deaths.

Introduction: Wastewater-based epidemiology (WBE) has emerged as a timely, non-invasive, and cost-effective indicator of illicit drug consumption. It is increasingly used by international organizations as a proxy measure for estimates of drug prevalence and related trends. Nevertheless, the literature exploring the limitations of WBE remains limited. This paper aims to shed further light on important shortcomings of WBE with recommendations on moving forward. Method: Utilizing case study and statistical analysis, the paper critically reviews methodological challenges associated with WBE results related to (i) levels, (ii) trends, and (iii) between-city comparisons of drug use. Data from raw influent wastewater samples from wastewater plants in the cities of Oslo, Bergen and Stavanger/Sandnes were analysed for amphetamine, methamphetamine, MDMA, and cocaine (benzoylecgonine) over a 3-year period. Normalized population loads were calculated and variation in daily loads analysed with plots and estimation of means, confidence intervals, and coefficient of variation. Linear regression models examined trends and between-city differences. Results: Plots and statistical analyses revealed extensive variation in daily loads, with min/max values of 6.1/453.9 mg/day per 1,000 inhabitants 15–64 years for amphetamine and correspondingly 9.4/675.9 mg for methamphetamine. Substantial differences in load levels and patterns across time and plants were also observed. A carefully designed sampling procedure and a relatively large number of daily samples are required to obtain estimates of sufficient precision for determining trends in space or time. Cross-referencing with alternative trend variables can improve the interpretation of WBE trend indicators. Finally, when using mean load levels for different wastewater-treatment plants to assess spatial variation in drug use, the representativeness of the catchment area should be evaluated before interpreting observed changes as city differences. Conclusion: Although WBE is a useful supplementary indicator of illicit drug consumption, important methodological issues and potential shortcomings should be taken into account when designing sampling procedures and interpreting the analytical results. [ABSTRACT FROM AUTHOR]

Since early 2020, the COVID-19 pandemic has had a dramatic impact on the way we live, with European countries having to introduce unprecedented measures to protect public health. As with all areas of life, drug consumption, related harms and drug markets have been impacted, as have the drug services established to respond to drug-related problems. Since the start of the pandemic in March 2020, the European Monitoring Centre for Drugs and Drug Addiction instigated three rapid assessment studies to identify the initial impact and implications of COVID-19 on drug markets, use, harms and drug services in the community and in prisons. Findings from these studies revealed that the pandemic and associated health prevention measures implemented by the countries impacted drug markets and use differently depending on the different periods and events throughout the pandemic, but also according to particular drugs or user characteristics. Most drug services remained operational throughout the pandemic in order to assure continuity of care. This was achieved by innovation and adaptation of their services, especially during the different lockdown periods. Thus, the results from these rapid assessments provide a glimpse into new developments in the drugs field across European countries emerging both during and in response to the pandemic, and which could have important implications for the future. [ABSTRACT FROM AUTHOR]

Aims: To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)‐related death rates across Australia, Finland, Portugal and Turkey and to analyse the toxicology and causes of death across countries. Design Analysis of MDMA‐related deaths extracted from a national coronial database in Australia (2001–19) and national forensic toxicology databases in Finland (2001–17), Portugal (2008–19) and Turkey (2007–17). Presentation of MDMA use and seizure data (market indicators). Setting: Australia, Finland, Portugal and Turkey. Cases All deaths in which MDMA was considered by the forensic pathologist to be contributory to death. Measurements Information collected on cause and circumstances of death, demographics and toxicology. Findings A total of 1400 MDMA‐related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13–25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey. Conclusions: Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March -June 2020).Design/methodology/approach: The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies.Findings: The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expressed around reduction of drug-related interventions, including group activities, services by external agencies, interventions in preparation for release and continuity of care.Practical Implications: Innovations aimed at improving drug service provision included telemedicine, better partnership between security and health staff and an approach to drug treatment more individualised. Future developments must be closely monitored.Originality/value: The paper provides a unique and timely overview of the main issues, challenges and initial adaptations implemented for drug services in European prisons in response to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This paper addresses the question of whether Europe is facing an opioid epidemic and utilizes data from the European monitoring system on opioid use, harms and availability, to help assess the situation. Data sources covering the last decade on overdose deaths, drug treatment entrants and drug‐related emergencies suggest that the health burden associated with opioid use is mostly related to the consumption of heroin – and to a lesser extent diverted opioid substitution treatment medications – and that it is primarily affecting an ageing cohort of vulnerable users, with little evidence of an increase in initiation. While opioid‐related deaths are currently at much lower levels than in the United States, they still represent a large preventable health burden with differences across EU countries. There is also increasing concern related to the high availability of heroin, illicitly produced synthetic opioids and diverted opioid pain medications on the European drugs market. Trends in the latter categories are poorly monitored and we may miss signs of emerging problems. Moreover, the economic recession following the COVID‐19 pandemic has a potential to lead to resurgence in opioid use and harms. Significance: This paper looks at data from the European monitoring system to address the question of whether Europe is facing an opioid epidemic. It reviews available health and supply side indicators, considering the limitations of each data source. A summary of the available evidence would suggest that while opioid‐related deaths in Europe represent a large preventable health burden with differences across EU countries, Europe as a whole is not facing an opioid crisis of the size and nature seen in the US. [ABSTRACT FROM AUTHOR]

The ongoing COVID-19 pandemic is likely to have a profound impact on the lives of high-risk drug users and on the services responding to their needs in at least two important ways: first, through the restrictive measures introduced to mitigate the spread of the virus and, second, as a result of extensive economic downturn. Currently there is great uncertainty as to the future intensity and duration of the pandemic. In addition, the lessons we have been able to learn from previous economic downturns may be of limited applicability to the current situation, which differs in a number of significant respects. Experience nevertheless suggests that the potential consequences for drug users' health and well-being may be severe. The ongoing uncertainty serves to underline the importance of close monitoring of the drug situation and preparing flexible and innovative solutions to be able to meet new challenges which may arise. [ABSTRACT FROM AUTHOR]

This paper explores European and national trends in specialised drug treatment entry for cannabis-related problems. The analysis is based on data for the years 2003-2014 from 22 European countries. Between 2003 and 2014, the overall number and proportion of primary cannabis-related first-time entrants increased significantly. A joinpoint regression analysis indicates that the overall increase of cannabis treatment entries is continuous, although country-related differences are observed. Possible explanations for the increase and different time trends are discussed including an increase in cannabis prevalence and cannabis-related problems, changes in risk perception, increases in cannabis potency, changes in referral practices and increased availability and accessibility of treatment services. [ABSTRACT FROM AUTHOR]

Commentary to: Illicit fentanyls in the opioid street market: desired or imposed? [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the relationship between the marketing of cannabidiol (CBD) and the European Union's (EU's) CBD regulations, and it mentions issue involving consumer safety, industries, and public health. Sales of cannabis plants and extracts are examined, along with tetrahydrocannabinol (THC) limits for hemp crops, EU laws, and product labeling concerns.

Aim A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. Methods The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. Results The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. Conclusions Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014. [ABSTRACT FROM AUTHOR]

Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the designated hub for drug-related information in the European Union. The organization's role is to provide the European Union (EU) and its Member States with a factual overview of European drug problems and a common information framework to support the drugs debate. In order to achieve its mission, the EMCDDA coordinates and relies on a network of 30 national monitoring centres, the Reitox National Focal Points. The Centre publishes on a wide range of drug-related topics, across epidemiology, interventions, laws and policies. Every November, the EMCDDA publishes its Annual Report, providing a yearly update on the European drug situation, translated into 23 EU languages. In line with its founding regulation, the EMCDDA has a role acting as an interface between the worlds of science and policy. While not a research centre in the formal sense, the results the Centre generates serve as catalysts for new research questions and help to identify priorities. Current challenges facing the agency include continuing to increase scientific standards while maintaining a strong institutional role, as well as supporting European efforts to identify, share and codify best practice in the drugs field. [ABSTRACT FROM AUTHOR]

Within the drug trend monitoring arena, there is an increasing emphasis on the need for more timely identification and reporting of new patterns in drug consumption for policy-making purposes. However, there are documented problems with establishing the reliability and validity of results from emerging drug trend monitoring systems (EDTMS), which tend to be multi-indicator and use mixed methods. The aim of this article is to present a standardised and sequential approach to EDTMS development and refinement, i.e. grounded in the key elements of psychometrics, and illustrate its application using an established city level EDTMS. A five-step process is presented and exemplified, incorporating: (1) theoretical conceptualisation of the construct to be measured; (2) score construction; (3) weighting of indicators; (4) exploration of the prospect of categories (subscales); and (5) checking for external validity. The practical application of these validity enhancing stages are demonstrated using the Bergen Earlier Warning System. For non-traditional systems operating in a fast changing environment, an iterative review and refinement process (rather than a standardised system or instrument) has clear benefits, and can be adopted to enhance validity in existing EDTMS, or be used in the development of new models. [ABSTRACT FROM AUTHOR]

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim In 2002 the Bergen Clinics Foundation established 'Føre Vat', a city-wide 'early warning' system geared towards the identification, monitoring and reporting of drug and alcohol trends in the city of Bergen, Norway, on a six-monthly basis. The primary goal for the system was the dissemination of earlier, more reliable information on new and emerging trends to enable timely and more effective interventions by policy makers and practitioners in the drug and alcohol field. METHODS The Føre Var system triangulates and cross-references a wide range of statistical and quantitative data, including drug seizures data, treatment figures, alcohol sates and a school survey, with information from a number of 'leading edge' or sensitive data sources, including Internet sites. youth and local media, cultural mapping and key informants. Data is collected from sources every six months, analysed for identifiable patterns and trends, and then disseminated widely. RESULTS & CONCLUSION This paper details the system's developmental stages and methodologies, in addition to summarizing results from the first three Fare Vat reports. Finally, the strengths and weaknesses of the model, its replicability as well as the potential advantages of a city-level network are discussed. [ABSTRACT FROM AUTHOR]

In 2002 the Bergen Clinics Foundation established Føre Var, a citywide 'earlier warning' system geared towards the identification, monitoring and reporting of drug and alcohol trends in the city of Bergen, Norway, on a six-monthly basis. The primary goal for the system was the dissemination of earlier, more reliable information on new and emerging trends to enable timely and more effective interventions by policy makers and practitioners in the drug and alcohol field. The Føre Var system triangulates and cross-references a wide range of statistical and quantitative data including seizures data, treatment figures, alcohol sales and a school survey, with information from a number of 'leading edge' or sensitive data sources, including Internet sites, youth and local media, cultural mapping and key informants. Data is collected from sources every six months, analysed for identifiable patterns and trends and disseminated widely. This paper details the system's developmental stages and methodologies, in addition to summarizing results from the first three Føre Var reports. In conclusion, the strengths and weaknesses of the model, its replicability as well as the potential advantages of a city-level network are discussed. [ABSTRACT FROM AUTHOR]

No one knows what the future holds. Not least for substance use and addictions. Few predicted the psychedelic movement in the 1960s, the crack 'epidemic' in the 1980s and the 'E' generation of the 1990s - all of which had a profound influence on our culture, youth and our health. So what of the Naughties, Teenies and Twenties? With increased globalisation, new technologies, increasing spending power and the scope for increased pleasure-seeking we are destined for more and new addictions. In this groundbreaking article, Jane Mounteney applies the technique of scenario planning to investigate a future dominated by technology, smart and nano-drugs and an ever-increasing availability of drugs.With the emergence of the super nerd and groovy geek, who will be there to help the fallen? [ABSTRACT FROM AUTHOR]

Authoritative policy advice in Britain in the 1980s challenged drug agencies to reduce the rate of transmission of HIV through work with drug users in relation to their drug use and sexual behaviour. Focusing upon safer sex advice by drug agencies, this paper explores the applicability of such advice to younger people who approach the agency in relation to their non-injecting drug use. A short series of interviews with drug agency staff in England and Wales, deployed with a reading of relevant published literature, suggests that there are obstacles to such safer sex advice. The younger, `recreational' non-injecting drug user who comes to a drug agency for drugs advice finds it strange to discover this translated into a request for sexual counselling. Training the drug worker cannot change this and indeed, mistakes the problem. The role of drug agencies as providers of safer sex advice for young non-injectors may be quite limited. [ABSTRACT FROM PUBLISHER]

The term ‘quality’ is ambiguous when referring to illicit drug sales, and cautious use is required in the context of a discussion of harms. Monitoring of the future trajectories for darknet markets and their implications will be important going forward. [ABSTRACT FROM AUTHOR]

The author discusses the changes that have come about in the availability of heroin in Europe in the last decade. Recent evidence has demonstrated that Europe recently experienced a heroin shortage; and included reports of injectors switching to new substances, including, cathinones, benzodiazepines and synthetic opiates. Several reasons responsible for the shortage include reduced production due to unfavorable weather and poppy blight, floods in Pakistan and fighting in Afghanistan. He state that demand and supply side factors may be creating conditions that could see a significant decline in Europe's heroin market. He opines that synthetic opiates and the injection of synthetic stimulant drugs will become an important part of Europe's drug problem, instead of heroin.