Heroin and other opioids – the current situation in Europe (European Drug Report 2023) (2024)

Heroin remains Europe’s most commonly used illicit opioid and is also the drug responsible for a large share of the health burden attributed to illicit drug consumption. Europe’s opioid problem, however, has evolved over the last decade in ways that have important implications for how we respond to problems in this area. On this page, you can find the latest analysis of the drug situation for heroin and other opioids in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.

This page is part of theEuropean Drug Report 2023, the EMCDDA's annual overview of the drug situation in Europe.

Last update: 16 June 2023

Heroin and other opioids continue to challenge harm reduction and treatment

Heroin remains Europe’s most commonly used illicit opioid and is also the drug responsible for a large share of the health burden attributed to illicit drug consumption. Europe’s opioid problem, however, has evolved over the last decade in ways that have important implications for how we respond to problems in this area.

Data on entry to drug treatment, as well as data from other indicators, support the conclusion that Europe’s cohort of heroin users is ageing, with little current evidence to suggest that the rate of recruitment into this behaviour is growing. Between 2010 and 2021, the mean age of all clients entering specialist drug treatment for heroin use and for those doing so for the first time increased, as did the proportion of older clients (see the figures Age distribution of all clients entering treatment with heroin as their primary drug, 2010 and 2021 and Age distribution of never previously treated clients entering treatment with heroin as their primary drug, 2010 and 2021, below). These changes in the characteristics of those seeking help raise important policy and service-level challenges. Services are faced with the need to respond to clients who present with a more complex and more chronic set of mental and physical health, employment and social care needs. As well as directly responding to drug-related problems, services are also increasingly faced with the need to provide care for older opioid users who may require additional support to prevent or treatage-related illness and disability. This signals the need to reorient existing models of care and services to these challenges and for increased emphasis on establishing effective multi-agency partnerships and referral pathways with general health and social support services.

Based on data from 19 EU countries and Türkiye.

Based on data from 20 EU countries and Türkiye.

While heroin continues to be involved in the majority of opioid-related deaths overall, the number of countries in which this is the case has decreased; at the same time, other opioids have become more prominent.Acute drug toxicity presentations to sentinel hospital emergency departments show that, in 2021, in some cities, other opioids – often those used for opioid agonist treatment – have overtaken heroin as a driver of presentations. In addition, in presentations to treatment services, a move away from injecting (see the Injecting drug use section) among both first-time and previously treated heroin clients has also been observed over the last decade, possibly reflecting the effect of safer-use messaging and harm reduction and prevention efforts (see the figure Trends in the main route of administration of clients entering treatment with heroin as primary drug, by treatment status). Only 19% of new clients entering treatment for heroin-related problems now report injection as their main route of administration. This is important, as this mode of administration is particularly associated with a range of negative health outcomes.

Although demand side data are not indicative of any observable increase in heroin prevalence, supply side indicators of availability have returned to or even surpassed the pre-pandemic levels. Following a drop in heroin seizures in 2020, the quantity seized by EU Member States more than doubled in 2021, while seizures in Türkiye increased to record levels (see the Heroin market infographic, below). These increases are associated with large amounts of this drug trafficked in individual shipments, reflecting a more general trend in drug trafficking practices. Despite the greater quantities seized in 2021, there is little evidence to suggest that this has significantly reduced availability, as only marginal changes are observable in indexed trends on retail level prices or purity, and the drug remains relatively affordable by historical standards.

While heroin or, to a lesser extent, medications used for opioid agonist treatment remains the focus for discussion on opioid-related problems in Europe, there are concerns that synthetic opioids may represent a growing threat for the future. New synthetic opioids (see the New psychoactive substances section) currently play a relatively small role in the drug market in Europe overall, although they are a significant problem in some countries. There is, for example, information to suggest an increase during 2022 in availability and harms, including drug-related deaths, associated with synthetic opioids in some northern and Baltic countries. Up to now, most concern in this area has been focused on the availability and use of fentanyl derivatives, such as carfentanil. However, more recently, the appearance of highly potent benzimidazole (nitazene) opioids, including protonitazene, metonitazene and isotonitazene, has been noted, as well as the detection of opioid mixtures containing new benzodiazepines and tranquilisers, albeit on small scale. These substances are discussed in more detail in the new psychoactive substance section of this report.

Key data and trends

Prevalence of opioid use

  • Overall, the available indicators suggest that heroin use remained stable in 2021 compared with previous years. It is estimated that 0.33% of the EU population, around 1million people, used opioids in 2021.

Treatment entry for use of heroin and other opioids

  • Opioid use was reported as the main reason for entering specialised drug treatment by 71000 clients in 2021, representing 25% of all those entering drug treatment in Europe. Heroin was the primary drug for 10000 (74%) of the 16000 first-time entrants who reported a specific opioid as their main problem drug. Another 2100 first-time opioid clients did not specify their primary drug.
  • Because of disruptions to services due to the pandemic, 2020 and 2021 treatment entry data must be interpreted with caution. Nevertheless, the data suggest that the decline in the number of people entering treatment for heroin use continued. The latest European data reveal a time lag of 13years between first heroin use, on average at the age of 23, and first treatment for heroin-related problems, on average atthe age of 36.
  • National data from 23 EU Member States show an estimated 419000 clients received opioid agonist treatment in 2021 (417000 in 2020).

Data are for all treatment entrants with heroin as the primary drug – 2021 or the most recent year available.

Trends in first-time entrants are based on 25 countries. Data for Germany are for entrants with ‘opioids’ as primary drug. Only countries with data for at least 5 of the 6 years are included in the trends analysis. Missing values are interpolated from adjacent years. Because of disruptions to services due to COVID-19, data for 2020 and 2021 should be interpreted with caution. Missing data were imputed with values from the previous year for Spain and France (2021) and Germany (2019).

'Other routes' includes eating/drinking, sniffing and unspecified routes. Due to COVID-19 restrictions within specialised drug treatment services, 2020 and 2021 data should be interpreted with caution. Trends are based the 19 EU Member States providing data over the period; only those with data for at least 8 of the 9 years are included. Missing values are interpolated from adjacent years.

Harms related to opioid use

  • Heroin remained the third most commonly reported drug in acute drug toxicity presentations in Euro-DEN Plus hospitals in 2021, accounting for 15% of all reported cases. Opioids were found in 19 of the 23 European hospitals participating in 2021 (see the figures Proportion of the acute drug toxicity presentations with heroin involved in 2021, Euro-DEN Plus and Trends in presentations with heroin involved, selected hospitals). Of these, half of the hospitals reported that 6% or more of their presentations involved heroin (i.e. the median value of heroin presence was 6%, across the 19 hospitals in 2021). Heroin was reported in a fifth to a quarter of the drug-related presentations at centres in Drogheda and Dublin (Ireland), Ljubljana (Slovenia) and Msida (Malta) and one of the two centres in Oslo (Norway). Most presentations with heroin involved were among middle-aged men: in 12 of the 20 centres in 2021, no cases were aged less than 25 years. In half of the centres, women represented 11% or less of the presentations with heroin involved. Depending on the centres, the other drugs most commonly reported in these presentations included benzodiazepines, cocaine and amphetamine.
  • Opioids were found in an estimated 74% of fatal overdoses reported in the European Union. It should be noted that multiple drugs are commonly found in toxicology reports from suspected drug-induced deaths.

Source: European Drug Emergencies Network (Euro-DEN Plus).

Heroin and other opioids market data

  • EU Member States reported 19000 heroin seizures amounting to 9.5tonnes in 2021 (4.4tonnes in 2020). Belgium (1.5tonnes), Romania (1.4tonnes), France (1.3tonnes), Bulgaria (1.2tonnes) and Italy (0.6tonnes) reported large quantities. Türkiye seized over 22.2tonnes of heroin in 2021 (13.4tonnes in 2020).
  • The average purity of heroin at the retail level ranged from 13% to 47% in 2021, with half of the countries reporting an average purity between 16% and 24%. Indexed trends indicate the average purity of heroin rose by 38% between 2011 and 2021, while its price dropped by 16%. Slight increases in average price and falls in purity are observable in the most recent data(see the Heroin marketinfographic, below).
  • Available data show that almost 11100 seizures of opioids other than heroin were reported in 2021, amounting to over 1.3tonnes, almost 33litres (mostly methadone) and 2.5million tablets (including, tramadol, buprenorphine, oxycodone, morphine, methadone and codeine) (see the table Other opioids: number of seizures and quantities seized, 2021). In the same year, 5.5kilograms and 5500 tablets of fentanyl derivatives were seized in Europe.
  • Approximately 23500 offences for heroin use or possession were reported in 2021.

EU+2 refers to EU Member States, Norway and Türkiye.

Price and purity of 'brown' heroin: national mean values – minimum, maximum and interquartile range. Countries covered vary by indicator.

Table. Other opioids: number of seizures and quantities seized, 2021
SubstanceCountriesNumber of seizuresWeight (kg)TabletsLitresPatches
Tramadol1045590.3122738071.65
Buprenorphine1528544.98127449<0.1
Methadone17939251.734658829.91
Morphine127446.11128230.28
Oxycodone98240.1366721
Opium145551053.22<0.1
Codeine/dihydrocodeine114294.9116130.74
Fentanyl derivatives121875.495444<0.1217
Total110911326.8254444532.65217

Source data

The data used to generate infographics and charts on this page may be found below.

Show source tables

List of tables

  • Table 1 (age distribution of all clients entering treatment with heroin as their primary drug, 2010 and 2021)
  • Table 2 (age distribution of never previously treated clients entering treatment with heroin as their primary drug, 2010 and 2021)
  • Table 3 (users entering treatment)
  • Table 4 (trends in first-time heroin entrants for treatment)
  • Table 5 (Trends in the main route of administration of clients)
  • Table 6 (heroin market seizures data)
  • Table 7 (heroin market seizures trends —numbers)
  • Table 8 (heroin market seizures trends —weight)
  • Table 9 (heroin market price and purity data)
  • Table 10 (heroin market price and purity indexed trends)
  • Table 11 (hospital emergencies: proportion of the acute drug toxicity presentations with heroin)
Table 1. Age distribution of all clients entering treatment with heroin as their primary drug, 2010 and 2021 (%)
Age range<1515-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465+
201003132020171483100
2021015111418181410621
Table 2. Age distribution of never previously treated clients entering treatment with heroin as their primary drug, 2010 and 2021 (%)
Age range<1515-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465+
201005202218141162100
2021021117171614108311
Table 3. Treatment demand indicator (TDI) source data, European Drug Report, 2023. Percentages except where otherwise stated.
CountryMales (%)Females (%)First- timePreviously treatedUnknown treatment statusAge at first use (mean)Age at first treatment (mean)Daily (%)4 to 6 days per week (%)2 to 3 days per week (%)Once a week or less (%)Not used in the last 30 days (%)SubstanceInjectingSmoking/inhalingEating/drinkingSniffingOther
EU8317547823215710366162651811822Cannabis
EU84162542625627250823332713231621Cocaine2282681
EU83171011239452023365979620Heroin30511171
EU76244963455782621302815151329Amphetamine7815700.3
EU76245214521038625323412161226Methamphetamine26382340.2
EU84163522766125302815232212Cathinones29955735

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Table 4. Trends in first-time cannabis treatment entrants
Country201620172018201920202021
Germany361420331972197215591696
Spain235322592223238417711771
Italy683855673942401533202878
France1184959939768651651
Other613157505448505536083409

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Table 5. Trends in the main route of administration of clients entering treatment with heroin as primary drug, by treatment status (%)
Treatment statusRoute201320142015201620172018201920202021
Previously treatedInjecting424440393536343633
Previously treatedSmoking/inhaling393942434546474749
Previously treatedOther191718181919191719
First-timeInjecting353732292625232319
First-timeSmoking/inhaling434548525457595962
First-timeOther221819192018181819

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Table 6. Heroin market seizures source data
ScopeSubstanceTypeNumber of seizuresQuantity seized (tonnes)
EUHeroin190009.5
EU+2Heroin3400031.8

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Table 7. Trends in the number of heroin seizures (x 1000)
Scope20112012201320142015201620172018201920202021
EU+23575332266331623389741629326593621041812361183433734143
EU3113326849258742559528180234822265022733191701849918709

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Table 8. Trends in the quantities of heroin seizures (tonnes)
Countrysubstance>Type20112012201320142015201620172018201920202021
TürkiyeHeroin7.29413.30113.4812.7568.2945.58517.38517.81120.16513.37622.202
BelgiumHeroin0.140.1121.1820.1490.1210.0990.0534.5371.9290.6841.554
FranceHeroin0.8830.7010.570.990.8181.080.6581.1151.0731.1321.3
BulgariaHeroin0.3850.2850.1570.940.2650.5820.6981.0330.7870.2691.158
ItalyHeroin0.8130.940.8820.9310.7680.4970.610.9750.6150.5120.568
GreeceHeroin0.3070.3310.2352.5290.5670.2190.3590.2070.4030.30.364
SpainHeroin0.4120.2820.2910.2440.2560.2530.5240.2510.2340.1730.235
Other countriesHeroin1.2891.9110.9864.1161.6270.9752.1531.4744.041.5814.376

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Table 9. Price, purity data
SubstanceTypeRetail price [low, 25%, 75%, high] (EUR/g)Wholesale price [low, 25%, 75%, high] (EUR/g)Purity/potency [low, 25%, 75%, high] (%)
Heroin19,24,45,9320160,,,3118013,16,24,47
Table 9b. Heroin wholesale price range EUR
SubstanceLowHigh
Heroin2016031180

Not enough sample points were available to provide interquartile values for wholesale heroin prices.

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Table 10. Price and purity/potency indexed trends
SubstanceTypeIndex for20112012201320142015201620172018201920202021
CannabisResinPrice10010199101101109108102100109103
CannabisResinPotency100126137151157169177194224227291
CannabisHerbalPrice100999799101100103101969694
CannabisHerbalPotency100105126131126128135129128133157
CocainePrice1009798101102106104102989898
CocainePurity100102112106112126131133138137143
HeroinPrice100102979295969492859084
HeroinPurity100101120147145137137142154144138

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Table 11a. Proportion of the acute drug toxicity presentations with heroin involved in 2021
CountryCitylat,lonHospitalYearAll presentationsHeroin (%)
BelgiumAntwerp51.221,4.400Antwerp20216705.5
BelgiumGhent51.054,3.725Ghent2021682.9
BulgariaSofia42.698,23.322Sofia20213016.7
CyprusNicosia35.175,33.364Nicosia202180
EstoniaParnu58.384,24.508Parnu2021180
FranceParis48.853,2.348Paris20212281.8
GermanyMunich48.137,11.575Munich2021746.8
IrelandDrogheda53.712,-6.333Drogheda20214323.3
IrelandDublin53.350,-6.260Dublin202158818.7
ItalyRozzano45.383,9.154Rozzano2021260
LatviaRiga56.949,24.105Riga2021412.4
LithuaniaVilnius54.687,25.283Vilnius20211424.9
MaltaMsida35.896,14.489Msida202156819.4
NetherlandsAmsterdam52.373,4.892Amsterdam20214923
NetherlandsUtrecht52.081,5.128Utrecht2021214.8
NorwayOslo59.913,10.739Oslo OAEOC2021156229.5
NorwayOslo59.913,10.739Oslo OUH202114115.6
PolandGdansk54.371,18.613Gdansk2021506
RomaniaBucharest44.436,26.103Bucharest2021310
SlovakiaBratislava48.152,17.109Bratislava2021591.7
SloveniaLjubljana46.050,14.507Ljubljana202114124.1
SpainBarcelona41.383,2.177Barcelona20212091
SpainMallorca39.613,2.883Mallorca20214649.3
Table 11b. Trends in the proportion of the acute drug toxicity presentations with heroin involved in selected hospitals in Europe
Hospital201620172018201920202021
Dublin33.93433.831.123.918.7
Msida27.525.220.217.418.119.4
Oslo OAEOC46.832.933.934.634.429.5
Riga11.111.82.31.82.4
Tallinn00.9000
Vilnius48.322.285.34.9

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Hidden tables for page

IDTerm
0Close
1Substance
2Prevalence type
3Age
4Gender
5prevalence of drug use
6percentage (%)
7Breakdown by substance
8prevalance all available countries
9Trends
11Males and females
14Country
15Prevalence data presented here are based on general populaton surveys submitted to the EMCDDA by national focal points. For the latest data and detailed methodological information please see the Statistical Bulletin 2023: Prevalence of drug use.
Graphics showing the most recent data for a country are based on studies carried out between 2013 and 2022. Age ranges are 16–34 for Denmark, Estonia, Sweden and Norway; 18–34 for Germany, Greece, France and Hungary.
16About these data
17Currently not available for individual countries
101prevalence of cannabis use
102prevalence of cocaine use
103prevalence of MDMA use
104prevalence of amphetamine use
105prevalence of methamphetamine use
231Gender breakdown: all treatment entrants
232Mean age: all treatment entrants
233Client status —number of clients
234First-time entrants
235Previously treated entrants
236Unknown status
237Route of administration (%): all treatment entrants
238Injecting
239Smoking/inhaling
240Eating/drinking
241Sniffing
242Other
243Frequency of use in the last month (%): all treatment entrants
2444 to 6 days per week
2452 to 3 days per week
246Once a week or less
247Not used in the last 30 days
248Trends in first-time treatment entrants
250Cannabis market: data and trends
260Cannabis type
261Daily
265COVID-19 pandemic
312Geographical coverage (selected graphs)
315Number of seizures
324Price retail (EUR/g) (EU)
325Price wholesale (EUR/kg) (EU)
330Quantity seized (tonnes)
360Cannabis type
370Potency (%)
372Purity (%) (EU)
375Indexed trends: retail (2011=100) (EU)
385Trends in number of seizures (x 1000)
386Trends in quantity seized (tonnes)
400mg/1000 population/day
500Treatment status
550Share of presentations with
heroin involved (percent)
100200Mean use: 4.7 days per week
TermFilter sort
Cannabis-1
Cocaine-1
Heroin1
Amphetamine-1
Methamphetamine-1
Cathinones-1
Country information
CategoryFilter sort
EU1
EU+2-1
Austria101
Belgium102
Bulgaria103
Croatia104
Cyprus105
Czechia106
Denmark107
Estonia108
Finland109
France110
Germany111
Greece112
Hungary113
Ireland114
Italy115
Latvia116
Lithuania117
Luxembourg118
Malta119
Netherlands120
Norway121
Poland122
Portugal123
Romania124
Slovakia125
Slovenia126
Spain127
Sweden128
Türkiye129

About this page

Recommended citation:European Monitoring Centre for Drugs and Drug Addiction (2023), European Drug Report 2023: Trends and Developments, https://www.emcdda.europa.eu/publications/european-drug-report/2023_en

Identifiers:

HTML:TD-AT-23-001-EN-Q
ISBN: 978-92-9497-865-3
DOI:10.2810/161905

Heroin and other opioids – the current situation in Europe (European Drug Report 2023) (2024)

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