Unveiling the Risks: Synthetic Drug Use's Unknown Health Impact in Europe

An EU drug report shows synthetic substances are on an upward trend. Drugs like cathinones are now made in Europe to keep up with demand. The health risks are largely unknown.

What you need to know:

Synthetic stimulants like cathinones continue to rise in Europe Researchers lack knowledge about the long-term health risks of synthetic drug use Cocaine remains Europe’s illicit

drug of choice

, and it’s moving from big cities to small towns Fentanyl and nitazene use are increasing, driven by a ban on opium poppy cultivation in Afghanistan

The European Union Drugs Agency (EUDA) monitored 1,000 new psychoactive substances at the end of 2024 and found that local drug users were increasingly consuming new forms of synthetic drugs.

This has been the dominant trend in Europe
over the past 5-10 years
.

But what is new is that increasing amounts of these synthetic drugs are now being produced in Europe — previously, they were largely trafficked from India, China or the Middle East.

“This is a result of the demand for taking synthetic [drugs],” said Andrew Cunningham, head of policy, crime and markets at the EUDA in Lisbon, Portugal.

Cocaine
, however, is still Europe’s most popular illicit stimulant drug. Imported from Latin American countries like Ecuador and Colombia, about 4.6 million Europeans used cocaine in 2024.

The report also shows more Europeans are taking multiple drugs at the same time. As in previous years, so-called
polysubstance use
is the leading cause of drug deaths in Europe.

The findings were published in the

European Drug Report 2025

, June 5.

Why is synthetic drug use a problem?

Synthetic drug use is a major public health concern. Many synthetic substances have very high potency, and because they are relatively new and ever-evolving, scientists have not been able to track the long-term effects.

The report shows that Europeans are increasingly using cathinones, either in combination with, or instead of, amphetamines and MDMA.

Cathinones, such as 3-MMC (mephedrone), are synthetic stimulants, which have “gained recreational popularity over the past 20 years in Europe,” said Jan Ramaekers, a psychopharmacologist at Maastricht University in the Netherlands.

Ramaekers said the long-term health effects of cathinones were not well known. Researchers needed to better understand consumption patterns among users: What is a “normal” dose? How does it range? What is lethal?

“We need controlled studies with 3-MMC in these ‘normal’ dose ranges that focus on health risks, but also on potential health benefits,” said Ramaekers.

Most cathinones were imported from India and China, primarily through the Netherlands. But production has steadily moved to Central Asia and Europe, “influenced by the Ukraine war,” said Cunningham.

Cocaine spreading from cities to smaller towns

A significant amount of global cocaine product
ends up in Europe
.

For the seventh year in a row, record quantities of cocaine were seized by EU countries, amounting to 419 tons in 2023, up from 323 tons in 2022.

“It’s a very significant amount considering global cocaine production is estimated at 2,600 tons per year,” he said.

But it’s not just cocaine: Wastewater analysis in 128 European cities found overall increases in cocaine, but also MDMA and amphetamine use in 2024.

The analysis suggests that urban patterns of drug use in big cities may be spreading to smaller towns.

Cunningham, whose team tracks the effects of geopolitical situations on Europe’s drug market, said most of Europe’s cocaine (70%) comes from Colombia.

“Global [cocaine] production is up every year since 2016 after the Colombian government made a
[peace] deal with FARC
,” he said. FARC, also known as the Revolutionary Armed Forces of Colombia, were a Marxist militant group, suspected of involvement in illicit drug trade.

Large seizures in Europe’s ports show drug traffickers continue to smuggle the drug in from the sea. In 2024, Spain reported its largest ever seizure of cocaine (13 tons), concealed in bananas originating in Ecuador.

Deadly synthetic opioids on the rise

The EUDA report estimates there were 7,500 drug-induced deaths in Europe in 2023, the majority of which were due to opioid drugs.

Fake medicines containing synthetic opiates called
nitazenes
increased in at least 12 European countries in 2024.

Some nitazene compounds are even stronger than
fentanyl
, which itself is 50 times stronger than heroin and has an extremely high risk of overdose.

Synthetic opioids have been a
major issue in the US for years
, but the report shows they are a growing problem on the European drug market, too.

“We fear an increase in synthetic opioids, such as fentanyl and nitazenes, on the illegal drug market, particularly as a result of the ban on opium poppy cultivation in Afghanistan,” said Daniel Deimel, an addiction expert at Nuremberg Technical University, Germany.

In recent months, there has been an increase in overdose clusters in Europe, which, Deimel said, may be a result of people mixing synthetic opioids with heroin.

“Tests in drug consumption rooms in Germany have shown evidence of
fentanyl or nitazene in heroin
. If these substances become more common, the number of overdoses and fatal overdoses is likely to increase,” said Deimel.

Drug seizures in Europe have found nitazenes in fake prescription drugs, mimicking oxycodone or benzodiazepines bought on the illegal drug market.

These fake pills have much higher potency and carry a significant risk of drug poisoning and overdose, especially as people do not know the drugs they are taking contain nitazenes.

The EUDA report shows authorities seized 10 kilograms of nitazenes powder in 2023 — potentially sufficient to make millions of pills containing enough nitazenes to cause an overdose.

Many experts are calling for more drug checking services to detect which substances are circulating on the drug scene. This allows public warnings to be issued when dangerous compounds are found in substances.

Edited by: Zulfikar Abbany