Intended for healthcare professionals

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Cannabis, heroin, and cocaine dominate Europe’s €24bn illegal drugs market

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2017 (Published 07 April 2016) Cite this as: BMJ 2016;353:i2017

Rapid Response:

Re: Cannabis, heroin, and cocaine dominate Europe’s €24bn illegal drugs market

As pointed out in the recent news item1 concerning the EMCDDA and EUROPOL report on the drug markets in the EU, cannabis, heroin, and cocaine dominate Europe’s €24bn illegal drugs market. These drugs should be prioritised when thinking of impacts on health. However, whilst the breakdown of main drugs in the report2 did not include the impact of new psychoactive substances (NPS), they are drugs that are increasing in prevalence, and they are changing the face of the drug scene. Over 100 new substances were reported in 2015 in Europe alone2. They bring new challenges in their constant adaption to legislation and the associated harms. A challenge for health professionals is how to respond to adverse events associated with one of hundreds of new NPS without guidance or prior medical research.

It has been demonstrated that some individuals are using NPS in order to substitute for poor quality drugs, such as new fentanyl analogues in place of heroin, or mephedrone in place of MDMA and cocaine3. In addition, NPS use relates to a lull in production of controlled drugs or when used as cutting agents in controlled drugs. For example, in the past, tablets that hold the same logos as ecstasy pills have contained NPS such as mCPP that produced similar subjective effects as MDMA4. In addition, synthetic cannabinoids have been found in cannabis, suggested to be used to increase the potency or reduce harvesting time5. From looking at NPS available on the darknet, synthetic opioids are currently increasing in availability, such as acetyl fentanyl, W-18, and U-47700. These compounds have already been the source of overdoses in the US and Canada6. The extent to how much NPS have displaced illicit drugs in the market is unknown, but, clearly, there are some uncertainties regarding the actual content of drugs.

The fluidity between controlled and non-controlled substances makes it difficult for users to dose correctly and this could be reflected in drug overdoses and A&E admissions. The increase in use of NPS alone has already presented itself in an increase in admissions to health services. The removal of national borders by the Internet means that the popularity of these drugs could not just be restricted to individual nations. Whereas the focus on controlled drugs is important, information and knowledge about NPS are essential for the medical community to inform treatment of adverse events.

1. Watson, R. Cannabis, heroin, and cocaine dominate Europe’s €24bn illegal drugs market. BMJ 2016;353: i2017
2. European Monitoring Centre for Drugs and Addiction. EU drug markets report 2016. www.emcdda.europa.eu/start/2016/drug-markets (accessed 19 Apr 2016).
3. Winstock, A. Mitcheson, L. R. Deluca, P. et al. Mephedrone, new kid for the chop? Addict 2011; 106(1): 154-161.
4. Bossong, M. Brunt, T. Van Dijk, J. P. et al. mCPP: an undesired addition to the ecstasy market. J Psychopharmacol 2010; 24(9):1395-401.
5. European Monitoring Centre for Drugs and Addiction. EU drug markets report: a strategic analysis. www.emcdda.europa.eu/publications/joint-publications/drug-markets (accessed 19 Apr 2016).
6. Zalkind, S. Synthetic opiate makers stay step ahead of US drug laws as overdose cases rise. The Guardian. [Online] 2016 Apr 11. www.theguardian.com/world/2016/apr/11/synthetic-opiates-drug-laws-w-18-f... (accessed 19 Apr 2016).

Competing interests: No competing interests

21 April 2016
Elle Wadsworth
Research Assistant
King's College London
National Addiction Centre, 4 Windsor Walk, London, SE5 8BB