European Drug Emergencies Network (Euro-DEN Plus): data and analysis

Introduction

Data explorer: acute drug-toxicity presentations to emergency services by year, hospital and reported drug

In this section you can explore the data from the most recent year (2022), as well as from previous years starting from the last quarter of 2013. Bubble sizes on the map show the percentage of presentations with the selected substance present. The sum of the percentages can be over 100% because several drugs can be mixed. More information on the patterns of polydrug use will be added latter on this page. Clicking on a bubble on the map will show numbers, some break-down of the presenattions by sex, age band and admission to intensive care unit, as well as more detailed information for the service . You can also select a hospital from the drop-down menu.

Notes

• The Source data section below provides a table containing the data shown in this tool and a description of each centre’s characteristics.
• The Limitations section includes general notes on the specificity of this surveillance system and the caveats and limitations of this data. More details on the limitations are available here (see the Frequently-asked questions (FAQ) on drug-related hospital emergencies).
• Because of the size of the dataset, this data explorer may be slow or unresponsive. If this is the case, we recommend trying another browser, such as Firefox, Safari or Chrome.

Caveats

Most presentations involve reported use of more than one drug. Mixing drugs can result in some interactions and can potentiate the effects of a single drug. It might therefore be difficult to determine the effect of a particular drug.

Alcohol-only acute toxicity presentations are not included in Euro-DEN Plus (see the inclusion and exclusion criteria in the Euro-DEN Plus FAQ pages). Therefore, the mention of alcohol in the table below refers only to those presentations that involved illicit drugs, misuse of prescription medicines for recreational purposes or new psychoactive substances (NPS). These particular presentations represent only a small proportion of all the acute alcohol toxicity presentations seen in hospital emergency services.

Another limitation and possible bias of these data is that information on whether or not alcohol has been co-reported is not systematically collected in all centres. The proportion of presentations for which this information is available is reported in the table below. This needs to be kept in mind when comparing the proportion of presentations in which alcohol was involved, across centres and over time. Based on the available data, half of the centres in 2022 had 49% or more acute drug toxicity presentations with alcohol involved.

Acute drug toxicity presentations with a medicine are included only when licensed pharmaceutical preparations (both prescription and over-the-counter medicines) are misused.

Analysis and results from the Euro-DEN Plus Sentinel network

A summary of the data from the Euro-DEN Plus network is presented in this section. The results provide a valuable sentinel-based surveillance of acute drug-related harms. These findings reveal marked geographical variations and changes over time (see data explorer) and provide a unique insight into the public health implications of drug use in Europe.

Euro-DEN started enhanced monitoring of acute drug toxicity presentations in European hospitals in October 2013. The sentinel network of hospital emergency services provides timelier and more accurate information on the harms associated with drug use than the routine national data reported in some countries (see the FAQ on drug-related hospital emergencies for a more detailed list of the strengths and limitations of this source of information). The network has published more than 25 papers by January 2024.

The findings presented here (from 28 active centres in 2022 in the European Union, Switzerland and the United Kingdom) show that the number of presentations varied considerably across study locations. Hospitals in Oslo, Msida, London, Amsterdam, Dublin, and Mallorca had the highest numbers of presentations reported. This reflects the large size and catchment area of the hospitals, but also the prevalence of drug use around the hospitals. The type of drugs involved in the presentations varied across centres — reflecting local markets and patterns of use — although the main drugs were reported in most of the participating centres.

This section provides:

• Key findings on the most recent analysis in the European Union, Norway, Türkiye, Switzerland and the United Kingdom (2022). Centres from other countries are not included in this summary but data are presented in the map.
• A summary of the variations across centres of the drugs most commonly involved in the presentations, including cannabis, stimulants (cocaine, amphetamine, methamphetamine, MDMA), opioids (heroin, methadone), selected prescription medicines (benzodiazepines, pregabalin), alcohol, GHB/GBL and new psychoactive substances (NPS)

2022 key findings

• Most acute drug toxicity presentations were among males.
• Proportions of young people (younger than 25 years) were higher in centres in the south and east of Europe.
• Polydrug use was frequent. It may be underestimated.
• Most presentations were discharged from the emergency department; admission to critical care units was uncommon.
• The median value of the proportion of presentations by drug or group of drugs shows that the most frequently reported drugs or groups of drugs included cocaine, cannabis, opioids, heroin, MDMA, amphetamine, GHB/GBL, NPS, and methamphetamine.
• Alcohol was commonly co-reported in acute drug toxicity presentations.
• Prescription medicines were a significant group of drugs involved in acute drug toxicity presentations.
• Opioids were the most common group of drugs involved in acute drug toxicity presentations.
• Cannabis involvement was widespread in Europe in acute drug toxicity presentations.
• Cocaine largely dominated the other stimulant drugs, and was widespread. Local signals of crack involvement in acute drug toxicity presentations are confirmed.
• The involvement of stimulants other than cocaine — amphetamine-type drugs — was quite geographically defined, with a higher proportion of presentations reported in centres in the north and east of Europe.
• On the whole, NPS were rarely involved in acute drug toxicity presentations and were reported in a limited number of centres.
• The patterns in the drugs involved and the demographics of those presenting varied by centre, highlighting the value of these data for local monitoring. Local findings should not be generalised, but should rather be seen as parts of a whole and considered in the context of other local indicators.
• Several countries participating in 2022 had two or more centres (Belgium, Ireland, the Netherlands, Spain, Norway, Switzerland and the United Kingdom). The Euro-DEN Plus data highlight differences between these centres within the same country, which may be explained in part by the different social and demographic characteristics of the cities or parts of the cities (universities, deprived or nightlife areas and age distribution of the population), and other factors such as the pre-hospital referral pathways of the presentations.
• Sixteen centres have participated since the start of the network in 2013; of the 28 centres that participated in 2022, 25 had participated in 2020; 17 centres have reported continuously since 2016, four centres since 2017 and five since 2018; this allows for time trend analysis of acute drug toxicity presentations.

Drugs

Cannabis

Cannabis is frequently reported in Euro-DEN Plus acute drug toxicity presentations. Acute cannabis toxicity can be associated with a range of health problems, including neuropsychiatric and physical effects (1-4). Although outside the scope of the Euro-DEN Plus network, which focuses on the adult population, paediatric hospitals signal that unintentional paediatric cannabis intoxications are common and are on the rise in certain regions (5). Cannabis was the second most commonly reported illicit drug in this series.

The median percentage of presentations involving cannabis was 22.8% across the reporting hospitals in 2022. The highest proportion of presentations with cannabis involved was reported in Nicosia — 7 in 10 cases — followed by other centres in the south and east of Europe, including Bucharest, Mallorca and Msida. There is no information reported on the type of cannabis used (resin, herb, oil, edible) nor on the route of administration (smoked, vaporised, ingested). Cannabis was reported in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving cannabis increased in ten of these centres in relation to other substances in the previous year. In six centres, this share decreased and in 12 centres it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Alcohol (in the context of polydrug use)

Alcohol can interact with other drugs and increase the risks associated with acute drug toxicity, such as those associated with GHB/GBL, opioids and central nervous system depressant drugs or prescription medicines. This has been confirmed in previous studies from the Euro-DEN Plus network (6,7). Alcohol was reported in the context of polydrug use (i.e. together with illicit drugs or prescription medicine misuse). A patient who presents with only alcohol-related toxicity symptoms would not be included in the Euro-DEN Plus dataset (see exclusion criteria in the Euro-DEN Plus FAQ pages).

The median percentage of presentations involving alcohol was 49% across the reporting hospitals in 2022. The highest proportions of acute drug toxicity presentations in which alcohol was mentioned were reported in centres in the north of Europe, including Oslo, London, Dublin, Vilnius, Ghent, Parnu, Munich as well as in Ljubljana, Rozzano and Geneva.

Cocaine

Acute cocaine toxicity can be associated with physical— in particular cardiovascular and neurological — and neuropsychiatric effects (8-12). Increases in cocaine availability, use and harms are reported in many countries in Europe (13-14). Cocaine is the most commonly reported stimulant drug in Euro-DEN Plus presentations.

The median percentage of presentations involving cocaine was 22.9% across the hospitals in 2022. The proportion of presentations with cocaine involved was highest in hospitals in western and southern Europe, including in Rozano and Mallorca where half or more of the presentations involved cocaine, followed by Drogheda, Basel, Antwerp, Nicosia and Msida. Similar to previous years, the lowest proportions of presentations with cocaine mentioned were reported in centres in eastern European cities including Bucharest, Gdansk and Vilnius. Cocaine was reported across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving cocaine increased in six centres compared with those for other substances in the previous year. In seven centres, this share decreased and in 15 it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Crack cocaine: a few centres (including those in Paris, Drogheda and London for the north and west of Europe, and those in Msida and Barcelona for the south of Europe) reported presentations involving the use of crack cocaine (not shown on the map) (8). Crack was reported by 12 centres in 2022.

In 2022, the share of emergency room presentations involving crack increased in seven of these centres compared with those for other substances in the previous year. In one centre, this share decreased and in four it remained stable.  Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Amphetamine and amphetamine-type stimulants

Amphetamine and amphetamine-type stimulants (such as MDMA and methamphetamine) are central nervous system stimulants that cause hypertension and tachycardia, agitation, psychosis and feelings of increased confidence, sociability and energy (15). Amphetamine is the second most commonly reported stimulant drug, far behind cocaine.

The median percentage of presentations involving amphetamine was 4.6% across the reporting hospitals in 2022. The frequency of presentations involving amphetamine varied considerably across study locations. As in previous years, the highest proportions were reported in cities in the north and east of Europe, in particular Riga, Sofia and Parnu, where around a third or more of the presentations involved amphetamine. The drug was involved in a smaller proportion of presentations in centres in the south and west of Europe in countries such as Ireland, Cyprus, Malta and Italy. Amphetamine was reported by 25 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving amphetamine increased in eight centres compared with those for other substances in the previous year. In 12 centres, this share decreased and in five it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

There are many other ‘amphetamine-type stimulants’, and those most frequently reported in the presentations in this series include MDMA and methamphetamine.

MDMA

MDMA (ecstasy) has been being reported in a similar proportion of presentations as amphetamine in previous analysis (16). The median percentage of presentations involving MDMA was 5.1% across the reporting hospitals in 2022. The highest proportions of presentations with MDMA involved were in the centres in Utrecht, Paris, Ghent and Amsterdam. MDMA was reported by 24 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving MDMA increased in 12 of these centres compared with those for other substances in the previous year. In five centres, this share decreased and in seven it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Methamphetamine

Methamphetamine was reported less frequently than other drugs and in specific centres only. The median percentage of presentations involving methamphetamine was 2.5% across the reporting hospitals in 2022. In only in a small number of centres — Bratislava, Nicosia and Sofia — methamphetamine was involved in more than a quarter of presentations. Riga, two centres in London and Barcelona reported that methamphetamine was involved in more than one in ten cases. Other centres reported no or negligible proportions of presentations in which methamphetamine was involved. Methamphetamine was reported by 22 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving methamphetamine increased in nine of these centres compared with those for other substances in the previous year. In ten centres, this share decreased and in three it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Opioids

The term ‘opioids’ includes compounds that are extracted from the poppy seed as well as semisynthetic and synthetic compounds that bind with opioid receptors. Opioids are depressants of the central nervous system and cause breathing difficulties. Acute opioid toxicity can involve different types of opioids and can lead to death (17). This section presents the data on the selected single opioids: heroin (illicit drug) and methadone (prescription medicine).

Heroin

The median percentage of presentations involving heroin was 5.3% across the reporting hospitals in 2022. Roughly a fifth to a quarter of the presentations involved heroin in one centre in Oslo, in Drogheda in Ljubljana and in Dublin. In contrast, very small proportions of the presentations involved heroin in the centres in Ghent, Amsterdam, Vilnius and — in the southern and western parts of Europe — in Paris and Barcelona. Heroin was reported by 24 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving heroin increased in seven centres compared with those for other substances in the previous year. In five centres, this share decreased and in twelve it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Methadone

The median percentage of presentations involving methadone was 2% across the reporting hospitals in 2022. Methadone wasinvolved in more than one in ten presentations in Sofia, Riga, Dublin and Ljubljana. It was reported by 22 centres in 2022 across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving methadone increased in nine centres compared with those for other substances in the previous year. In nine centres, this share decreased and in four it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Benzodiazepines 

Benzodiazepines are prescribed to treat a range of conditions, including anxiety, insomnia, epilepsy and alcohol withdrawal. They are also commonly misused for a variety of reasons. Benzodiazepines are central nervous system depressants and can potentiate the effect of acute toxicity with other depressant drugs, including alcohol and opioids (18,19).

The median percentage of presentations involving any benzodiazepine was 11.8% across the reporting hospitals in 2022. Munich, Drogheda and Dublin, Oslo, Paris and Gdansk were the centres with the highest proportion of presentations involving prescription medicines of this group. In contrast, Amsterdam, Msida, Bratislava reported the smallest proportion of presentations involving benzodiazepine, possibly reflecting a more recreational pattern of use compared to the centres where this prescription medicine was more frequently involved in the presentations. ‘New benzodiazepines’ are included in the NPS section below.

Other drugs — GHB/GBL and new psychoactive substances

Caveats: for this and other drugs, there are small numbers of presentations reported in some years for some centres, and the percentages should be interpretated with caution.

GHB/GBL

GHB/GBL ((Gamma hydroxybutyrate/Gamma butyrolactone) are a central nervous system depressant. Acute toxicity with these drugs can be associated with somatic problems, including coma, respiratory depression and death (7,21). The proportion of acute drug toxicity presentations involving GHB/GBL varied considerably across hospitals. The highest levels in 2022 were reported in Parnu (small numbers) and Oslo with more than half of the presentations, and in the centres in the Amsterdam, Utrecht London and Barcelona with more than one in five.

The median percentage of presentations involving GHB/GBL was 3.7% across the reporting hospitals in 2022. In 2022, GHB/GBL was reported by 22 centres across all 28 centres that reported data for that year.

In 2022, the share of emergency room presentations involving GHB/GBL increased in six centres compared with those for other substances in the previous year. In nine centres, this share decreased and in five it remained stable. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable.

Ketamine

The median percentage of presentations involving ketamine was 2.4% across the reporting hospitals in 2022. Ketamine was reported by 23 centres across all 28 centres that reported data for that year. In 2022, the share of emergency room presentations involving ketamine increased in 15 centres compared with those for other substances in the previous year. In three centres, this share decreased and in five it remained stable. Numbers are small are interpretation of the increasing trend in some centres should be cautious. Substances are ranked by the share of presentations in which they are involved and the trend analysis is based on these ranks. No year-to-year change in ranks is defined as stable (not shown on the map).

New psychoactive drugs (NPS)

The NPS identified in this series are mainly synthetic cannabinoids and synthetic cathinones (22). The median percentage of presentations involving NPS was 3.3% across the reporting hospitals in 2022. The centres in Rozzano, Gdansk, Bucharest and Msida reported the highest proportion of cases with NPS involved (noting that due to the small numbers, the proportion needs to be interpreted with caution). The NPS most frequently reported in these centres were unspecified ‘legal highs’, synthetic cannabinoids and synthetic cathinones.

A recent large multicentre series of NPS presentations to European emergency departments showed marked geographical variations and changes over time in the proportion of presentations involving NPS, as well as the proportion of NPS subgroups (22).

The other individual drugs most frequently reported (apart from those mentioned above) varied by country, reflecting the diversity of the local patterns of high-risk drug use. For several years the centres in Tallinn and Vilnius have been reporting fentanyl and fentanyl analogues, as the drug has replaced heroin in the local markets; the centres in Paris, London, Msida have been reporting crack; both centres in Ireland have been reporting the benzodiazepine medicine alprazolam; and centres in Oslo have been reporting clonazepam and other benzodiazepines. For the past few years, centres in London have reported ketamine, crack and mephedrone, and Barcelona has reported ketamine, poppers and lysergic acid diethylamide (LSD). Centres in London and in Amsterdam have reported acute drug toxicity involving nitrous oxide, mirroring the recent data from other indicators across Europe (23).

Sex, gender, age and outcome

There are differences in the drugs involved in acute drug toxicity presentations according to age and sex (24).

Sex and gender

Most presentations were among males. Half of the centres reported than 25% or more of their presentations were among women. There was no clear geographical distribution of the centres according to the proportion of men and women, and some centres in the same country (e.g. Spain) reported quite different proportions of women, suggesting a local drug scene. For example, the proportion of women in Mallorca was around 1 in 3 compared to around 1 in 5 in Barcelona. Data on gender have recently been added to the data collection on sex and will be available later.

Age

The centre in Bucharest is an outlier as it is based in a paediatric hospital and has seen only presentations in patients aged less than 25 years.

The highest proportion of young cases was reported in centres in the eastern part of Europe such as those in Parnu, Gdansk Bratislava and Sofia, where at more than 60% of the cases were aged less than 25 years. In contrast, the highest proportions of presentations aged over 45 years were reported in centres in Mallorca, Dublin and Rozanno, Oslo and centres in Switzerland. This is consistent with an ageing cohort of high-risk drug users that has been reported for some years in the west of Europe (25,26).

Outcome

A minority of the presentations required admission to critical care*. This indicator is used as a proxy for severity, although it is potentially biased by the organisation of the services and potential variation in thresholds for critical care admission around Europe. Oslo (9 in 10) and Utrecht (4 in 10) are outliers, with higher proportions of presentations being hospitalised in critical care units than those in other centres. This difference is in part explained by the selection bias and the referral of the most severe presentations to these rather than to other local centres. 

Limitations

There are both strengths and limitations affecting comparability, generalisability and interpretation, and these should be kept in mind when using these data (see the FAQ on drug-related hospital emergencies):

• Recording and reporting bias (inter-centre differences): The use of a common protocol ensures common practices across the participating centres. However, there might be various ways of recording and retrieving the data across hospitals as the source depends on local practices and capacities.
• Representativeness: A hospital within a city is not necessarily representative of the city as a whole, of the region or of the country. Local factors — such as proximity to high concentrations of night-time economy venues and levels of social deprivation — may impact the types of presentations seen in the sentinel centre. This is illustrated by the case mix differences in centres within the same city.
• Selection bias (pre-hospital management and inter-hospital referral procedures): The referral and triage procedure at a city level implies a different case mix (i.e. when a hospital is ‘Level 1’, or entry door to the emergency service, while another is ‘Level 2’ or ‘Level 3’, which might be accessible only to severe cases that are referred to this level). Most of the participating emergency services are based in hospitals for adults; therefore, they rarely or never see paediatric cases for acute drug toxicity. Other surveillance would be necessary to monitor the real burden and trends in acute drug toxicity among children and adolescents.
• Interpretation of polydrug use presentations: For most cases, more than one drug is reported. Thus, the impact of an individual drug in this context can be difficult to assess.
• Distortion (possible over-representation of high-risk severe cases who might present more repeatedly): The dataset includes presentations, not patients. It is likely to include repeat presentations in the same patient and, thus, the observations may not all be independent. No information is collected to flag and count whether a person has presented in the past.
• Limited statistical power (in some centres): Numbers of cases are small in some hospitals, and some hospitals have reported over a short period of time only. Therefore, interpretation of percentages, interpretation of changes and comparisons over time and across centres should be made cautiously. A small number of sizable centres collect a large part of the total dataset, and this should be kept in mind when interpreting the overall data. In this respect, local analysis can be more informative than global analysis.
• Access to emergency settings: The proportion of acute drug toxicity presentations over the total number of emergency presentations depends on the denominator of all emergency presentations. This number of presentations to the hospital and other emergency settings can be affected by factors conditioning access to the emergency department. This is not shown in this analysis but was described during the COVID-19 confinements (27,28).
• Limited information collected: Some drugs are reported as groups of drugs rather than individual drugs (e.g. ‘synthetic cannabinoids’ or ‘benzodiazepines’). More ad hoc and enhanced laboratory confirmation for some cases could be envisaged in the future to gain more specific insights into the drugs reported in these groups.
• Lack of additional information: There is no additional information on the drugs, such as route of administration, quantity taken or possible adulteration, nor on the person, such as history of use, drug treatment, place and circumstances of the acute toxicity episode, pre-hospital care or previous medical history.
• Lack of toxicological analysis: One important limitation is that data on the drug(s) involved in the presentations are based largely on patient reports combined with the impression of the treating clinician. If laboratory toxicological analysis is performed as part of routine clinical care, these data are collected. Only a minority of Euro-DEN Plus presentations have data on toxicological analysis reported. This might affect, in particular, the completeness of the data related to relatively rare drugs, and those in which there is reported variation in drug content, such as NPS (29,30). However, a high level of agreement was found between self-reported and analytically confirmed substances among the most commonly reported drugs (including heroin and cocaine in particular) in a previous Euro-DEN Plus study (31).

The study highlights the differences between centres, which are explained in part by the different social and demographic characteristics of the people who are using drugs, drug use patterns and settings (e.g. nightlife areas compared with more deprived suburbs), and the local drug market (including availability and potency of illicit drugs, and prescribed medicines). This monitoring underlines the value of the local data, but also the need to avoid generalisation beyond the hospital, the city, and especially the country.

In 2020 and 2021, any comparison with previous years and between centres should take into consideration the context of the COVID-19 pandemic. Drug availability and drug-using habits have been impacted by the pandemic, which, in turn, has impacted the nature and number of acute drug toxicity presentations. Further, the general access to hospital emergency services was disrupted and might have prevented some patients from presenting to hospital, even if they would have come to hospital under normal circumstances.

New developments and the future

The Euro-DEN Plus sentinel-based network has established itself as an important tool for monitoring acute drug-related harms, including those related to NPS, ‘established drugs’, and, in the context of polydrug use, alcohol and prescription medicines.

The data from the network can contribute to city-level monitoring, along with other indicators, including ESCAPE (monitoring of syringe residues), TEDI (monitoring through drug checking services) and SCORE (monitoring of wastewater), all of which are supplementary and anchored in the national monitoring systems coordinated by the European Reitox network (25). The data can also cross-check and complete the data on acute drug toxicity presentations reported at national level in some countries. This is useful, as national routine data are known to largely underestimate the number of drug-related presentations to hospital emergency departments (29,32-34). Finally, other types of drug-related presentations could be monitored through Euro-DEN Plus or a similar network, including drug-related trauma, driving accidents, other drug-related violence, including homicide or drug-facilitated sexual assault, and acute drug toxicity with suicidal intent.

The network will continue to contribute to the European Drug Report (25) and to the European Drug Market Report, as well as answer ad hoc requests (including from national bodies) and risk assessments, and contribute to other outputs such as Trendspotters.

The Euro-DEN Plus network of sentinel hospitals has demonstrated its potential as a useful complement to established monitoring tools in the drugs area for providing important data on the public health implications of drug use in Europe. This sentinel network also has the potential to provide timely information on geographical and temporal trends. Its ability to rapidly detect new trends and to inform on demographics and patterns of use can help to target local or national public health programmes and policy initiatives for specific groups of people and in specific settings and cities.

References

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18.          Lyphout C, Yates C, Margolin ZR, Dargan PI, Dines AM, Heyerdahl F, et al. Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data. Eur J Clin Pharmacol. 2019;75(1):77-85.

19.          Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, et al. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol. 2019;15(1):4-11.

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25.          EMCDDA. European Drug Report 2023: trends and developments. Luxembourg; 2023

26.          EMCDDA. Frequently asked questions (FAQ): drug overdose deaths in Europe Lisbon 2022 [updated 30/08/2022.

27.          EMCDDA. Impact of COVID-19 on drug markets, use, harms and drug services in the community and prisons. Lisbon; 2021 04/2021.

28.          Hondebrink L, Zammit M, Hogberg LCG, Hermanns-Clausen M, Lonati D, Faber K, et al. Effect of the first wave of COVID-19 on Poison Control Centre activities in 21 European countries: an EAPCCT initiative. Clin Toxicol (Phila). 2022;60(10):1145-55.

29.          Heyerdahl F, Hovda KE, Giraudon I, Yates C, Dines AM, Sedefov R, et al. Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations. Clin Toxicol (Phila). 2014;52(10):1005-12.

30.          Wood DM, Heyerdahl F, Yates CB, Dines AM, Giraudon I, Hovda KE, et al. The European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila). 2014;52(4):239-41.

31.          Liakoni E, Yates C, Dines AM, Dargan PI, Heyerdahl F, Hovda KE, et al. Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series. Medicine (Baltimore). 2018;97(5):e9784.

32.          Shah AD, Wood DM, Dargan PI. Survey of ICD-10 coding of hospital admissions in the UK due to recreational drug toxicity. QJM. 2011;104(9):779-84.

33.          Wood DM, Conran P, Dargan PI. ICD-10 coding: poor identification of recreational drug presentations to a large emergency department. Emerg Med J. 2011;28(5):387-9.

34.           Wood DM, De La Rue L, Hosin AA, Jurgens G, Liakoni E, Heyerdahl F, Hovda KE, Dines A, Giraudon I, Liechti ME, Dargan PI. Poor Identification of Emergency Department Acute Recreational Drug Toxicity Presentations Using Routine Hospital Coding Systems: the Experience in Denmark, Switzerland and the UK. J Med Toxicol. 2019;15:112-120

Recommended citation

Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (January 2024), European Drug Emergencies Network (Euro-DEN Plus): data and analysis, https://www.emcdda.europa.eu/publications/data-factsheet/european-drug-…

Source data

Click on the 'Show source tables' button below to access all of the data used to generate the data explorer on this page. 

In addition to the data below, a yearly snapshot of data from this Euro-DEN plus project is published as part of the Statistical Bulletin. This also includes further methodological notes. Please see the Hospital emergencies data set in the Statistical Bulletin 2023. 

Show source tables