Most drug deaths due to ‘polysubstance’ use: EU report

Synthetic opioids remain a concern for European drug agencies. A new report says that ‘polydrug’ use is posing new health risks. However, there is little data on this so far since cannabis was legalized in Germany.

Key findings 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 powerful synthetic opioids are often mislabeled or mixed with prescription drugs and other medications, and cannabis products are adulterated with synthetic cannabinoids — so users don’t always know what they are taking.

• Polydrug Use means the use of two or more psychoactive substances, legal or illegal, simultaneously or sequentially. Substances may be sold that contain one or more drugs other than the substance the buyer intended, either in a mixture with the substance they wanted to buy or 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 drug overdose,” states the report published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on June 11, 2024. “Most fatal overdoses involve the use of more than one substance. […] “Cannabis was the drug most commonly reported in cases of multi-drug toxicity.”

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

Synthetic opioids have a smaller role in Europe than in North America, but their use is also increasing in Europe, according to the report. And they are “often highly potent and carry a significant risk of toxicity and death.”

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

EU drug report lacks data on synthetic opioids

By its own admission, and despite being a hefty 177 pages, the report lacked data in several key areas needed to assess the public health impacts and take measures to curb rates of addiction and drug overdose.

Take Nitagen, for example: The report says that in 2023, Nitagen was linked to a “sharp increase” in deaths in Estonia and Latvia, and local poisoning outbreaks in France and Ireland.

But in some countries, routine post-mortem toxicology tests do not always detect nitrates and similar substances, “so the number of related deaths may be underestimated.”

This means that the EMCDDA is not getting the data it needs, especially when EU countries fail to check new and developing medicines on the market.

“As patterns of drug use become more complex, there is a growing need to improve understanding of how changes in patterns of poly-drug use are affecting mortality,” the report states.

Another key area in which data was lacking was the impact of cannabis legalization. This contradicts two facts pointed out by top-level speakers at the EMCDDA briefing:

• Ylva Johannsen, European Commissioner for Home Affairs He added: “After cannabis, cocaine is the second most common drug used in the EU.”
• Alexis Goosdiel, EMCDDA Director said the concentration of THC, the psychoactive element in cannabis resin, has “doubled in the past ten years” – and continues to rise, according to the written report. In 2022, the average THC was 22.8%.

The report recommends that “any policy developments in this area” – for example the legalisation or toleration of cannabis – “should be accompanied by an assessment of the impact of any changes. Such an assessment will depend on the existence of good baseline data; this again underlines the need to improve our monitoring of current patterns of use of the most widely consumed illicit drug in Europe.”

The “national focal point” of the EMCDDA in Germany is the “German Observatory for Drugs and Drug Addiction” (DBDD) or German Observatory Office for Drugs and Drug Addiction.

DBDD director Eva Hoch told DW that the issue of a lack of baseline data — an agreed “starting point” from which any changes or developments can be evaluated — could impact Germany’s ability to evaluate the impact of legalizing cannabis in April 2024.

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

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

“The picture in Germany is somewhat different,” Hoch said. “There are many anecdotes on the internet and social media, but we don’t have systematic data. It’s not clear how the law has been adopted in the country’s 16 federal states. […]There is no systematic data on the immediate impact of the new law – we cannot say that there has been an increase in cannabis consumption or demand in the two months since legalisation, or that there have been more traffic accidents since legalisation in April.”

These factors are just the beginning. Hoch said studies done in the US and Canada have shown that there are more than 100 factors that can help evaluate the impact of cannabis legalization. He said the German government planned to evaluate the impact of cannabis legalization, but that process has yet to begin and there is no indication of when it will start.