The European Union
The European Union (EU) is an economic and political union of 27 countries that are mostly located in Europe. This union was created after World War II in an attempt to foster economic cooperation and peace. It began with 6 countries in 1951: Belgium, Germany, France, Italy, Luxembourg, and the Netherlands. Since then, many other countries have become members. As of June 2020, they are:
The EU began as an economic union but has since broadened to cover a large number of policy topics, such as issues in human rights and democracy, health, agriculture, food safety, education, and research and innovation. The values of the EU consist of tolerance, inclusion, justice, and non-discrimination. According to the European Union’s website, they are the world’s largest exporter of manufactured goods and services and encourage free trade among its members. In 1973, the United Kingdom (UK) joined the EU, but left on January 31, 2020 after a 2016 vote where 17.4 million UK citizens voted to leave the EU. This event is referred to as Brexit. There are many reasons why this decision was made but they include rules on border controls and currency.
Addiction in the EU
Drug and alcohol addiction is a problem around the world, and the EU has its own unique struggles. Across the EU, cannabis is the most commonly used drug with over a quarter of the population using it at some point in their lifetime. Between 2015 and 2017, over 11% of the population in France used cannabis at some point, giving France the highest prevalence of use among adults in Europe. The second highest population was Italy at 10.5%, followed by Spain at 9.5%. The second most commonly used drug in the EU was cocaine, with 5% of the population using it at some point in their lifetimes. After cocaine is amphetamines at 3.6%. Addiction in the EU varies across the countries that make up the European union.
Staying consistent with the drug use trends of the EU as a whole, Austria’s most frequently used substance is cannabis. The people who use illicit substances in Austria is mostly made up of young adults. There has been reported cocaine, amphetamine, and MDMA use across the country with a higher percentage in the age group of 15 to 24. High risk drug use in Austria mostly consists of opioid addiction and abuse. Heroin is common as well as medication used as an opioid substitution. The European Monitoring Centre for Drugs and Drug Addiction reports that there are between 35,764 and 38,122 high-risk opioid users in the country, with most of them living in Vienna.
Like in Austria, the most commonly used illicit substance in Belgium is cannabis. Among those who sought treatment, cannabis was the most frequently reported primary substance that patients used and was more prevalent in males than females. MDMA/ecstasy has been gaining in popularity, as well as new psychoactive substances (NPS) in the nightlife scene. NPS are drugs that are manufactured to mimic the effects of drugs like cocaine and MDMA. The chemicals used in NPS are often chemicals that have yet to be banned, making it a constantly changing formula. The lack of regulation of these drugs makes them a dangerous alternative to other illicit drugs.
Bulgaria joined the European Union in 2007 and plays its own role in addiction in the EU. Cannabis is the most commonly used substance, followed by MDMA/ecstasy. The main organizer for drug treatment in Bulgaria is The National Centre for Addictions (NCA), and most of the treatment in this country is focused on opioid users. Those seeking treatment can choose from inpatient and outpatient treatment and choose to attend a private or public institution. Generally, patients do not have to pay for public treatment but must pay for private institutions. The most common form of treatment in Bulgaria is opioid substitution treatment (OST).
Croatia continues the trend of common cannabis use, with 1 out of every 5 adults in Croatia using it at least once in their lifetime. The most commonly used stimulant is amphetamines, with 1 out of every 50 adults using it at some point. Heroin is the main problem drug for those seeking treatment in Croatia, but within the last decade, the number of people seeking treatment for heroin use has decreased by almost 90%. The country has enacted harm reduction interventions such as offering free counseling and testing, as well as providing needles and syringes that come with information on safer drug use.
Cyprus, an island country in the Eastern Mediterranean, joined the EU in 2004. With 1 in 10 adults in Cyprus using cannabis at some point in their lives, marijuana is the most common illicit substance used on the island, with use of other substances being less common. Local cultivation of cannabis is rare, with the majority of drugs being shipped into the country coming from the Netherlands. Other drugs that have been seized entering the country include cocaine, heroin, methamphetamine, and MDMA, but those numbers have been decreasing over the years. Most people seeking treatment in Cyprus are there for cannabis or opioid use.
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The Czech Republic, also known as Czechia, has a population of 10.69 million. The main substance linked to problem drug use in this country is methamphetamine, called “pervitin” in Czechia. Pervitin is often homemade and then injected. This homemade drug is a major component of addiction in the EU, with 9 out of 10 home production labs across the EU being found in Czech territory. These Czech labs play a role in addiction in the EU. It is estimated that there are 34,700 meth users in Czechia, with many of them mixing meth with opioids. Smuggling pervitin across the borders into Germany has been an ongoing issue, and police from both countries are cooperating to try and crack down on the gangs transporting the drugs.
Cannabis is the most commonly used drug in Denmark, and although it is illegal for recreational use, some medical marijuana use is legal for patients with certain types of cancer and multiple sclerosis. The Copenhagen district, Christiania, is known for tolerating marijuana use. Although it remains illegal, it is commonly used and sold in this area. Drug-induced deaths in Denmark are mostly due to opioids, primarily heroin, morphine, and methadone. Denmark has integrated many harm reduction interventions into its treatment repertoire, more than most other countries in the EU. This includes needle and syringe programs, take-home naloxone programs, medication-assisted treatment for opiate addicts, and drug consumption rooms. These drug consumption rooms offer a safe and clean place for users to inject their drugs without fear of prosecution. Nurses are on staff, ready to assist if an overdose occurs and administer Naloxone. While overdoses do occur, there has not been any deaths in the drug consumption rooms, making a dent in the country’s overdose deaths. Users are provided with resources for treatment when they choose to seek help.
Estonia , previously part of the Soviet Union, joined the European Union in 2004. An ongoing issue in Estonia has been the emergence of the synthetic opioid fentanyl. According to the Economist, more of Estonia’s citizens die from a drug overdose than any other European country. After a bust in 2017 where some of the main suppliers of fentanyl to Estonia were cut off, users started injecting a mixture of other black-market substances. Nine out of 10 patients who seek treatment in Estonia report opioids as their primary drug of use, with the majority using fentanyl.
Relative to the population, Finland has the 7th highest number of drug deaths in the EU. Opioids, mainly buprenorphine, and amphetamines are the drugs linked to high-risk drug use in the country, with users typically injecting the substances. Buprenorphine addiction is the most common reason patients seek treatment in Finland. Often, buprenorphine is used with other illicit substances and is most commonly combined with cannabis. Cannabis is the most commonly used illicit substance, mainly by young adults between the ages of 15 and 34.
France, the largest country in the European Union, was one of the original countries to come together and form the EU. In the last 2 decades, cannabis and cocaine use has increased, with cocaine use increasing in 2017 and 2018. Alcohol addiction and abuse is an issue among French citizens, with 41,000 people dying from alcohol-related causes in 2017. It’s especially an issue in French men, with 11% of them dying every year from alcohol-related causes compared to 4% of women.
The most common stimulant used by Germans is amphetamines, with high-risk drug use in the country being mostly linked to amphetamines and cocaine. The number of people seeking treatment for an amphetamine addiction has increased and is now higher than the number of people seeking treatment for an opioid addiction. Germany has not experienced the opioid epidemic as badly as other countries, like America. Three times as many Americans have experienced an opioid addiction than Germans. This may be because opioids are not as commonly prescribed in Germany, with doctors opting to try other forms of treatment before prescribing opioids.
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The most commonly used and most frequently seized drug in Greece is cannabis, and cannabis is also the main illicit substance produced in the country. Heroin is often abused in Greece, with it being the most common reason people seek treatment in Greece. There were an estimated 14,462 high-risk heroin users in the country in 2017. According to the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) which measures teen addiction in the EU, drug use among 15 to 16-year-old Greeks is similar to other counties in the EU, except in one area. Lifetime inhalant use is more prevalent among this population. Long-term inhalant use can lead to brain damage, hearing loss, and liver and kidney damage.
Located in central Europe, Hungary has a population of 9.773 million. New psychoactive substances (NPS), like synthetic cannabinoids, synthetic cathinones, or amphetamine derivatives, have become as popular as other illicit drugs in the country. There has been a shift from people injecting heroin and amphetamines to mainly injecting NPS. A common drug seen in Hungary is synthetic cathinones, known as bath salts. Bath salts can be smoked, snorted, swallowed, and injected, but they are typically injected in Hungary. The number of people seeking treatment for bath salts has increased, while the number of people seeking treatment for heroin has decreased since 2010.
When some people think of Ireland, they may think of the country’s drinking culture. However, in terms of alcohol consumption per capita, Ireland is 5th on the list of EU members with Lithuania, Czechia, Germany, and Luxembourg consuming more alcohol per capita. Alcohol consumption in Ireland has increased in the last 4 decades, with the average consumption being 4.9 liters in 1960 and 14.3 liters in 2001. There are about 19,000 opioid users in Ireland, with two thirds of them living in Dublin. Over half of opioid users in Ireland are aged 35 years old or older, which researchers say this means the population of users is aging out.
One third of Italian adults has used a psychoactive substance at least once in their lives, with 1 in 10 adults using a psychoactive substance in the past year. Cannabis is the most commonly used substance, but cocaine, opioids, and spice are also seen in the country. Of people entering treatment for an addiction, the most common reason was powdered cocaine, followed by heroin and cannabis. To try to offset addiction in the EU, Italy’s prevention strategies consist mostly of education. Preventing the use of NPS in young people is currently a priority in Italy. Teachers, local law authorities, and local health authorities are used to educate people on the dangers of using drugs.
Latvia declared its independence from the Soviet Union in 1991 and joined the EU in 2004. The country located on the Baltic Sea has a population of 1.92 million, and cannabis use among its adult population has remained steady as the most commonly used drug. For every 1,000 adults, 5.6 are high-risk opioid users, and 1.8 are high-risk amphetamine users. Small amounts of illicit drugs are considered an administrative offense and may receive a warning or fine. Larger amounts of drug possession for personal use can land someone up to 3 years in prison. The court can offer drug treatment that some may choose instead of accepting their criminal charge.
Drug use in Lithuania is mostly found among young adults, and the most common illicit stimulant used was MDMA/ecstasy in 2016. A study from 2017 and 2018 found that two thirds of adults in nightclubs had used an illicit substance in their lifetime, doubling the number from a similar 2012 study. Most people seeking treatment in Lithuania reported heroin as their primary drug of use. Patients may choose from outpatient or inpatient treatment. There are 5 public specialized centers to treat addiction, 27 hospital-based residential drug treatment units, and 13 therapeutic communities that Lithuania citizens can attend.
Luxembourg is a small country, with a population of only 613,894. Out of those numbers, there are about 1,738 high-risk opioid users and 1,500 people who inject drugs in the country. Opioids, mainly heroin, is the most common reason someone in Luxembourg seeks treatment. The drug treatment infrastructure in Luxembourg relies on government oversight and support and receives annual funding from the Ministry of Health. This means that outpatient treatment is offered free of charge, and inpatient treatment is covered by health insurance. This is a trend that several countries in the European Union use to tackle addiction in the EU. The majority of patients getting treatment in this country are treated in an outpatient setting.
The island country of Malta is the world’s 10th smallest country in area and has a population of about 493,559. Cannabis is the most commonly used illicit drug, with the average age to start using the drug being just under 19. One-point 4 percent of the population uses other illicit drugs, such as MDMA, cocaine, amphetamines, LSD, NPS, heroin, and mephedrone. Among those, MDMA was the most commonly used. The most common reason for someone to seek first-time treatment in Malta is for cocaine that is snorted; very few patients inject it instead.
The most common illicit substance used in the Netherlands is cannabis, which may be surprising to some considering the reputation of one of its capitals: Amsterdam. Amsterdam has become known for its coffeeshops that sell marijuana (essentially dispensaries). However, cannabis is not legal in the Netherlands, but it is decriminalized, meaning it is tolerated and consequences are unlikely. It is still illegal to grow marijuana or distribute it. High-risk drug use in the country consists mainly of heroin and crack cocaine, as well as some reports of gamma-hydroxybutyrate (GHB) use.
The ESPAD found that students in Poland have a higher use of illicit drugs like NPS and cannabis than the European average. Polish students were also found to have more heavy episodic drinking and more cigarette use than other European students, when examining addiction in the EU. Cannabis is the most commonly used drug, and is followed by MDMA, amphetamines, and cocaine, and drug use is concentrated among young adults between 25 and 34 years of age. Males are more likely to report drug use, and are also more likely to be seen in treatment, with 1 out of every 5 patients entering treatment being female.
Addiction in the EU is a problem that each country is trying to tackle to the best of its abilities. Portugal has taken a slightly different approach by decriminalizing the consumption, acquisition, and possession of drugs for personal consumption since 2001. The amount of drugs cannot exceed a set number of grams that equates to what is required for 10 days of consumption. If a person is found to exceed this amount, they will be evaluated by the local Commission for Dissuasion of Drug Addiction which is made up of 2 people who are either sociologists, psychologists, medical doctors, or social workers, and the third person is a legal expert. They will then decide on punishment or explore treatment options.
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Compared to other European countries, Romania’s use of illicit substances is low, but it has been increasing in recent years. Cannabis is the most common, but 2.5% of Romanian adults report that they have tried an NPS at least once in their lives. There were over 3,000 drug-related emergencies in Romania in 2017, with one third of them being linked to NPS. In one fifth of the emergencies, alcohol or more than one drug was involved. Combining drugs or combining drugs and alcohol is unwise, causing unpleasant symptoms like nausea and vomiting, and sometimes dangerous symptoms like cardiovascular issues.
The most commonly used stimulant used in Slovakia is MDMA/ecstasy, followed by methamphetamine. High-risk drug use in the landlocked country is mainly linked to methamphetamine, as the number of people seeking treatment for a meth addiction has increased since 2006. The number of people who inject meth is decreasing, and the number of people who smoke the drug to achieve their high has steadily increased. Meth is both produced inside the country, as well as imported from Czechia by organized crime groups, much like other countries struggling with addiction in the EU. Most of the domestically produced meth is produced in small kitchen-type laboratories.
With a population of 2,078,938 people, there are about 4,900 high-risk opioid users in Slovenia, most of them being users who inject heroin. Most of the heroin in Slovenia comes along from the Balkan route, a path that begins in Turkey, winds through Bulgaria, and goes to Western Europe, which impacts addiction in the EU. This is the main pathway for drug trafficking of heroin and cannabis, and the illicit drugs are transported via land travel. After a decrease in users seeking treatment for heroin in recent years, the number of people entering first time treatment for heroin in Slovenia increased in 2016 and 2017. The number of patients entering treatment for a substitution medication is also increasing.
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Spain is the second largest country by area in the EU, with only France having a larger surface area. Although the most commonly used illicit substance in Spain is cannabis, heroin causes the most serious adverse health and social consequences. For the last 20 years, human immunodeficiency virus (HIV) infection has been a main problem linked to drug users in the country. In one study, it was found that one third of people who inject drugs in Spain are hepatitis C virus (HCV) positive.
Sweden joined the European Union in 1995 and has a zero-tolerance policy on the use and possession of illicit drugs. Using or possessing drugs is considered a criminal offense and can be classified as minor, ordinary, serious, or particularly serious. Depending on the amount and substance, a minor offense can result in up to 6 months imprisonment, an ordinary offense up to 3 years imprisonment, a serious offense ranges from 2 to 7 years imprisonment, and a particularly serious offense is anywhere from 6 to 10 years imprisonment. Cannabis is the most commonly used substance, but a number of high-risk drug users in Sweden inject opioids and amphetamines.
Getting Treatment for Addiction in the EU
Wherever someone may live, there are options for treatment for a person struggling with addiction in the EU. Citizens also may have the option to travel to countries outside the EU to seek treatment but should take cost into consideration as some countries may cover all of the costs for their citizens to get help. To talk to someone about treatment options for a drug or alcohol addiction, call a treatment provider, available 24/7.