Signals of spreading methamphetamine use in Europe

 

Methamphetamine use in Europe is much lower than in other regions of the world, and is generally concentrated in Czechia and Slovakia. Three EU Member States have recent estimates of high-risk methamphetamine use, ranging from 0.55 per 1 000 population (330 high-risk users) in Cyprus to 5.04 per 1 000 (34 600 high-risk users) in Czechia (EMCDDA, 2021a). According to estimates by the Czech authorities, 6.5 tonnes of methamphetamine is produced annually in Czechia, with this quantity, excluding amounts seized by law enforcement, believed to be consumed by users in and around Czechia.

Monitoring the methamphetamine situation is complicated by the different forms of the drug available and patterns of use. Methamphetamine powder is a mixture of finely ground methamphetamine hydrochloride and other ingredients, such as lactose, dextrose or caffeine, that is taken orally or nasally, or less commonly injected. Large crystals of highly pure methamphetamine hydrochloride, known as ‘ice’ or ‘crystal meth’ suitable for smoking, are also available, although this is a less commonly reported route of administration. Most harms are associated with intensive, high-dose or long-term consumption, and injection and smoking present particular challenges. Some men who have sex with men (MSM) engage in ‘chemsex’, which may involve injecting methamphetamine to enhance sexual pleasure and, while apparently uncommon, this practice has been reported in a number of major European cities. Hence, methamphetamine may be used in a recreational or functional context, but also in a high-risk manner.

Although methamphetamine remains much less commonly used than amphetamine and cocaine in Europe, there are signs of increasing use in some countries. Information from drug consumption rooms in Barcelona and Oslo has signalled an increase in the use of methamphetamine (smoking and injecting) among their clients (¹). In Athens, there have also been reports of a growing problem of ‘sisa’ (crystal methamphetamine) use. Overall, there have been concerns over recent years that methamphetamine use may be spreading to other parts of Europe where it has been less common.

Work to assess the impact of COVID-19 on methamphetamine use has suggested that it may have also become more popular in some user groups. This includes some groups of people who inject drugs in Ireland and Spain, and among those involved in the chemsex scene in Portugal (Chone et al., 2021). Methamphetamine does not figure prominently in data from 10 sentinel hospitals providing data on drug-related hospital emergency presentations. A slight drop was seen in acute drug toxicity presentations of methamphetamine in 2020 compared with 2019, but the overall low number of methamphetamine reports makes this observation difficult to generalise (EMCDDA, 2021d).

Methamphetamine presents a unique set of effects and harms

Methamphetamine use is associated with a range of physical and mental health problems, and the form of the drug and choice of route of administration strongly influences the harms experienced by the user. Methamphetamine causes hypertension and tachycardia and creates feelings of increased confidence, sociability and energy. It suppresses appetite and fatigue and leads to insomnia. Following oral use, the effects usually start within 30 minutes and last for many hours. As the effects wear off, users may feel irritable, restless, anxious, depressed and lethargic.

Fatalities directly attributed to methamphetamine are rare, but acute intoxication causes serious cardiovascular disturbances as well as behavioural problems that include agitation, confusion, paranoia, impulsivity and violence. Chronic use of methamphetamine causes neurochemical and neuroanatomical changes. Dependence — as shown by increased tolerance — results in deficits in memory, decision-making and verbal reasoning, and some of the symptoms resemble those of paranoid schizophrenia. These effects may outlast drug use, although often they eventually resolve themselves.

Methamphetamine has a higher potency than amphetamine, but the effects are almost indistinguishable when orally ingested, since methamphetamine is converted to amphetamine in the body.

When methamphetamine is smoked it reaches the brain much more quickly than by oral or nasal administration. Routes of administration that result in rapid bio-availability of a drug, such as smoking or injection, tend to be associated with greater risk of developing dependence or other health problems. Injection of methamphetamine carries the same viral infection hazards (e.g. HIV and viral hepatitis infection) as other injectable drugs such as heroin. Injection also delivers the drug quickly to the brain, though not as quickly as smoking, and also leads to dependence (EMCDDA, no date).

Injection is the most common route of administration used by high-risk users in Czechia and Slovakia, presenting an increased risk of transmission of viral infections such as hepatitis C and HIV. Methamphetamine smoking is associated with particular problems for users’ health, including respiratory damage and dental corrosion. In some drug markets, Norway for example, methamphetamine is present alongside amphetamine and users may be unaware which of the two substances they are using. Methamphetamine is used in recreational settings in some countries.

Methamphetamine may be used to increase self-esteem and feelings of acceptance and attractiveness (Haltikis et al., 2001); it is also used for its disinhibitory qualities and ability to prolong sexual pleasure and activity and to enhance the perceived quality of sex (Weatherburn et al., 2017). Use of the drug on its own or in association with other substances in a sexual context may increase high-risk sexual behaviours like having unprotected sex, multiple sexual partners and rougher sexual activities. The injection of stimulant drugs in a sexual context, known as ‘slamming’, may involve additional risky practices, such as reusing or sharing syringes, that contribute to the transmission of blood-borne viruses (OFDT, 2017).

A study published in 2022 about a survey conducted in Germany between August 2016 and January 2017 among MSM with drug experiences (N = 597) showed that 13.8 % used methamphetamine during the past 12 months (6.6 % during the past 30 days). Moreover, according to the answers on the substances used and the context of use, the authors distinguished four different patterns of use: ‘poppers only’, ‘club-druggers’, ‘chemsex-users’ and ‘polyvalent users’. Following this categorisation, methamphetamine use in a sexual context was reported by 53 % of ‘chemsex-users’ and 56 % of ‘polyvalent users’ (Scholz-Hehn et al., 2022).

Methamphetamine possession and use offences

Looking into the reported offences of methamphetamine possession or use by all EMCDDA reporting countries (EU Member States, Norway and Turkey), a steep increase in cases was observed between 2015 and 2020. This increase is linked to a twentyfold increase reported by Turkey in this time interval (from 1 375 cases in 2015 to 28 089 cases in 2020). It has been reported that in Turkey, the use of MDMA, cocaine and cannabis significantly decreased during the COVID-19 lockdown while the use of methamphetamine increased significantly and continued afterwards. The researchers linked this to accessibility and low prices (Öztürk et al., 2022). Looking at the data from the EU Member States alone, this increasing trend is less pronounced, with an increased number of cases reported by Czechia, Germany and Austria. The number of reported methamphetamine possession or use cases dropped in most other EU Member States in 2020. However, data on drug law offences may reflect priorities, efforts and focus of law enforcement activities on certain phenomena in a given timeframe, which might explain this trend, particularly in light of the COVID-19 pandemic.

Treatment service data point to a slowly expanding market

The overall number of first-time treatment entrants for methamphetamine problems remains low in most EU Member States; however, a gradual increase has been observed since 2015 in most countries with available data. A total of 637 first-time entrants were reported in 2015 in 14 countries with available data, which increased to 797 entrants in 2020 (25 % increase) among these 14 countries. Czech data between 2016 and 2020 confirm high and increasing numbers of methamphetamine clients (599 entrants in 2016 and 1 287 in 2020). Slovakia remains the country with the second highest number of methamphetamine entrants (534 entrants in 2015 and 551 in 2020). The remaining 13 countries with available data between 2015 and 2020 show a gradual increase from 103 clients in 2015 to 246 in 2020, representing a doubling during the period. Almost 80 % of these clients were reported by Austria, Belgium, Cyprus, Italy and Spain.

Overall, about 9 400 clients entering specialised drug treatment in Europe in 2020 reported methamphetamine as their primary drug, of whom about 4 200 were first-time clients. Four European countries account for more than 90 % of the treatment clients reporting methamphetamine as their main problem drug in 2020, namely Czechia, Germany, Slovakia and Turkey. Injecting is reported as the main route of administration by 33 % of first-time methamphetamine clients entering treatment; however, this figure is disproportionately influenced by Czechia (n=774) and Slovakia (n=146), which account for more than 95 % of first-time methamphetamine clients injecting the drug in Europe (EMCDDA, 2021a).

Latest treatment demand data on methamphetamine >>

Further insights about the role of methamphetamine in European consumer markets

Wastewater monitoring

Data from wastewater analyses conducted in European cities are useful to visualise the pattern of methamphetamine consumption across the continent; however, the coverage is not uniform across the EU (see Figure Relative geographical distribution of methamphetamine metabolite as detected in European cities). The latest data confirm that methamphetamine use is still concentrated in Czechia and Slovakia, but is also established in Belgium, Cyprus, the east of Germany, Spain, Turkey and also in northern Europe (Denmark, Finland, Latvia, Lithuania and Norway). In 2021, methamphetamine use was found to be distributed more evenly over the whole week, possibly reflecting the drug being associated with more regular consumption by a cohort of high-risk users (EMCDDA, 2021c). While the use of methamphetamine in Europe is relatively low, based on wastewater measurements, the consumer market may be larger than indicated by the prevalence and treatment demand data (See Box Methamphetamine market size estimate). Of the 58 cities with data on methamphetamine residues in municipal wastewater for 2020 and 2021, 27 reported an increase, 9 a stable situation and 22 a decrease. The 5 cities with the highest loads are all situated in Czechia, followed by cities in Latvia, Slovakia, Germany, the Netherlands, Belgium, Turkey, Estonia and Lithuania.

 

The source data for this graphic is available in the source table on this page.

Relative geographical distribution of methamphetamine metabolite as detected in European cities, 2021 (daily mean)

Country	City	Coords	Daily mean (mg/1000p/day)
AT	Graz	47.1,15.4	13.09
AT	Hall-Wattens	47.3,11.6	3.96
AT	Innsbruck	47.3,11.4	5.8
AT	Kapfenberg	47.4,15.3	1.64
AT	Kufstein	47.6,12.2	1.27
AT	Purgstall	48.1,15.1	2.66
AT	Strass im Zillertal	47.4,11.8	5.64
BE	Antwerp Zuid	51.2,4.4	92.49
BE	Brussels	50.8,4.4	17.58
CH	Basel	47.6,7.6	53.6
CH	Berne	46.9,7.5	42.34
CH	Geneva	46.2,6.1	16.24
CH	St. Gallen Hofen	47.3,9.0	15.42
CH	Zurich	47.4,8.5	74.02
CY	Agia Napa	35.0,34.0	3.28
CY	Larnaca	34.9,33.6	5.64
CY	Limassol	34.7,33.0	9.24
CY	Nicosia (2)	35.1,33.4	10.44
CY	Paphos	34.8,32.4	13.96
CZ	Brno	49.2,16.6	545.74
CZ	Budweis	49.0,14.5	507.33
CZ	Karlovy Vary	50.2,12.9	339.12
CZ	Ostrava	49.8,18.3	684.14
CZ	Prague (2)	50.1,14.4	328.77
DE	Chemnitz	50.8,12.9	82.69
DE	Dortmund	51.5,7.5	1.83
DE	Dresden	51.0,13.7	120.71
DE	Dülmen	52.4,5.0	1.46
DE	Erfurt	51.0,11.0	112.63
DE	Magdeburg	52.1,11.6	48.67
DE	Munich Gut Großlappen	48.2,11.6	4.94
DE	Nuremberg	49.5,11.1	57.61
DE	Saarbrücken	49.2,7.0	1.46
DK	Copenhagen	55.7,12.6	42.91
DK	Odense	55.4,10.4	4.78
ES	Barcelona	41.4,2.2	62.13
ES	Tarragona	41.1,1.3	6.78
FI	Espoo	60.2,24.7	1.55
FI	Helsinki	60.2,24.9	2.94
FI	Tampere	61.5,23.8	1.09
FI	Turku	60.5,22.3	2.45
GB	Bristol	51.5,-2.6	6.94
GR	Athens	38.0,23.7	10.61
IT	Bozen	46.5,11.4	1.74
IT	Milan	45.5,9.2	12.67
LT	Kaunas	54.9,23.9	43.73
LT	Klaipeda	55.7,21.1	13.97
LT	Vilnius	54.7,25.3	29.25
LV	Riga	56.9,24.1	225.56
NL	Amsterdam	52.4,4.9	38.18
NL	Utrecht	52.1,5.1	5.7
NO	Oslo	59.9,10.7	13.75
PL	Krakow P	50.1,19.9	3.97
PT	Almada	38.7,-9.2	1.03
PT	Lisbon	38.7,-9.1	7.92
SE	Gävle	60.7,17.1	3.1
SE	Sandviken	60.6,16.8	0.73
SE	Söderhamn	61.3,17.1	4.56
SE	Stockholm (2)	59.4,17.8	7.2
SE	Uppsala	59.9,17.6	2.54
SI	Domžale-Kamnik	46.2,14.6	0.64
SI	Koper	45.5,13.7	1.14
SI	Ljubljana	46.1,14.5	3.75
SI	Velenje	46.4,15.1	2.7
SK	Bratislava C	48.2,17.0	187.35
SK	Piestany	48.6,17.8	151.15
TR	Adana	37.0,35.3	18.67
TR	Istanbul (II-VII)	41.0,29.0	72.49

Latest wastewater data on methamphetamine >>

Syringe residue data

Data from a study on the analysis of drug residues in used syringes collected in needle and syringe exchange programmes in a small group of European cities (ESCAPE project) show that methamphetamine has been detected in used syringes in Amsterdam, Helsinki, Oslo, Paris, Prague, Riga and Vilnius (see Table Positivity rate of methamphetamine detected in syringes). Data from Prague confirm information from treatment services that injection is a common route of administration. Only Paris and Helsinki have data available to enable analysis of trends in methamphetamine use. In Helsinki, a decrease in detection of methamphetamine in the syringes was noted; in Paris, a slight increase was noted between 2017 and 2019, followed by a slight decrease in 2020. However, additional data collected in Paris from sites not participating in the ESCAPE project suggest an increased presence of methamphetamine in the total number of syringes tested, probably related to injecting in a sexual context, especially among MSM. Likewise, in Amsterdam, the relatively high positivity rate in 2019 is due in part to the sampling campaign, which included collecting syringes from MSM, a group known to be more likely to use methamphetamine than other people who use drugs.

Latest data on syringe residue analysis >>

Positivity rate of methamphetamine detected in syringes (% syringes), 2017-2020

City	2017	2018	2019	2020
Amsterdam	0	0	68.38	–
Helsinki	47.89	24.81	9.79	8.33
Oslo	–	–	4.46	4.76
Paris	1.16	0	12.42	7.25
Prague	–	–	–	72.22
Riga	–	–	–	15.03
Vilnius	–	–	2.27	0

European Web Survey on Drugs (EWSD)

Web-based surveys can be a useful tool for collecting information on drug-related issues. They are quick and cheap to set up and can directly reach large numbers of people who use drugs. This means that they can paint a detailed and timely picture of drug use and drug markets and are a useful complement to traditional data-collection methods.

Across the 21 EU countries and Switzerland that were covered in the 2021 EWSD, 48 469 respondents reported having used drugs in the past 12 months. Of these, 4 488 reported the use of methamphetamine. The responses of this group provide insights into the retail market and consumption patterns in Europe for this drug.

A smaller subset of these respondents answered the question related to the form of methamphetamine used (N = 1 751). Most of those (92 %) reported that they consumed the drug in powder or crystal form, and 10 % reported the use of methamphetamine in tablet form. On average, respondents (N = 1 478) reported using 0.5 grams of the drug on a typical day of use.

The most common motivation for use of the drug was ‘to get high/for fun’, reported by 70 % of methamphetamine users (N = 1 751), followed by ‘to socialise’ (30 %) and ‘to enhance performance (school/work/sport/etc.)’ (27 %) (see Figure Motivations for methamphetamine use).

 

Source: European Web Survey on Drugs, 2021, n = 1 751, 21 EU countries and Switzerland (²). The source data for this graphic is available in the source table on this page.

Source table. Motivations for methamphetamine use: In the last 12 months, why did you use methamphetamine?

Motivation to use	% respondents
To get high/for fun	70
To socialise	30
To enhance performance (school/work/sport/etc.)	27
To reduce stress/relax	26
Out of curiosity/to experiment	21
To treat depression/anxiety	18
Other	10
To reduce pain/inflammation	5
To improve sleep	3

A smaller number of respondents (1 088) also answered how they usually bought the drug and how it was usually delivered to them. The majority usually bought the drug from a dealer (83 %), although some also reported using the darknet (12 %) and social media (7 %) as their sources (see Figure Sources of acquiring methamphetamine). The majority reported meeting their dealer as the usual delivery method (80 %), with the drug being delivered to their home in-person the second most common option (23 %) (see Means of delivery of methamphetamine). It was more common for respondents to report that the methamphetamine was delivered to a drop-off location without any contact (8 %) than receiving the drug through the regular postal service (4 %).

 

Source: European Web Survey on Drugs, 2021, n = 1 088, 21 EU countries and Switzerland (²). The source data for this graphic is available in the source table on this page.

Source table. Sources of acquiring methamphetamine: In the last 12 months, how did you usually buy methamphetamine?

Source	% respondents
I directly contact my source/dealer (in person, via phone, mail or text message)	83
On encrypted internet market/darknet (e.g. using Tor or another browser)	12
Other	8
I find the source on social media (such as Snapchat, Facebook or Instagram)	7
In a shop on surface internet	1

 

Source: European Web Survey on Drugs, 2021, n = 1 088, 21 EU countries and Switzerland (²). The source data for this graphic is available in the source table on this page.

Source table. Means of delivery of methamphetamine: In the last 12 months, how is the methamphetamine usually delivered to you?

Delivery method	% respondents
I met my source/dealer outside	80
Home (in person) delivery	23
I picked it up without any personal contact (from another location)	8
Other	5
Regular mail/postage	4

Retail availability on darknet markets

European consumers can access methamphetamine on darknet markets. In 2020, analysis of several major darknet markets (³) identified 1 362 listings of methamphetamine reported as being shipped from an EU country. The available data suggest that most of those listings were for small quantities (between 0.5 and 10 grams) and originated from Germany (72 %) and the Netherlands (20 %) (Figure Reported EU shipping countries for methamphetamine listings on major darknet markets).

 

Notes: * Multiple denotes where several EU countries are mentioned as shipping origin.
Source: EMCDDA analysis based on Web-IQ data. The source data for this graphic is available in the source table on this page.

Source table. Reported EU shipping countries for methamphetamine listings on major darknet markets, 2020

Country	%
Germany	71
Netherlands	20
Europe	5
Multiple*	3
Other EU countries	1

Darknet markets are just one digital outlet, and social media and legitimate e-commerce platforms are being increasingly misused for drug sales. Factors such as convenience of use for both vendors and buyers are driving the increasing popularity of these channels.

(1) Information from EMCDDA focus groups with drug consumption room staff, January 2021.
(2) '21 EU countries and Switzerland' includes: Austria, Bulgaria, Cyprus, Czechia, Estonia, Finland, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden.
(3) White House Market (n = 539), DarkMarket (n = 376), Versus Market (n = 251), DarkBay (n = 113), Square Market (n = 49), BitBazaar (n = 13), Empire Market (n = 10), Cypher Market (n = 8) and Yellow Brick Market (n = 3).

References

Consult the list of references used in this resource.