Cocaine – the current situation in Europe (European Drug Report 2023) (2024)

Historically high cocaine seizures highlight threats to health

Cocaine is, after cannabis, the second most commonly used illicit drug in Europe, although prevalence levels and patterns of use differ considerably between countries (see the Prevalence of cocaine use in Europe dashboard, below). Cocaine is usually available in two forms in Europe. The most common is cocaine powder (the salt form) and less commonly available is crack cocaine, a freebase form of the drug that can be smoked.

Cocaine is produced from the coca plant, grown in South America. It enters Europe through various channels, but the trafficking of large volumes of cocaine through Europe’s seaports in intermodal commercial shipping containers is considered a significant factor in the high availability of this drug observed today. Cocaine trafficking by this route is also associated with rising in levels of drug-related crime, including the corruption of staff along supply chains, intimidation and violence. More generally, there are concerns that in some EU countries competition within the cocaine market, both at the wholesale and retail level, is now an important driver of drug-related crime including gang-related violence and homicides.

A record 303tonnes of cocaine was seized by EU Member States in 2021. Belgium, the Netherlands and Spain continue to be the countries reporting the highest volumes of seizures, reflecting the importance of these countries as entry points for cocaine trafficking to Europe. In 2022, the quantity of cocaine seized in Antwerp, Europe’s second-largest seaport, rose to 110tonnes from 91tonnes in 2021, with volumes seized increasing annually since 2016.

As interdiction measures have been scaled up at major known entry points for this drug, it appears that cocaine trafficking groups are also now increasingly targeting smaller ports in other EU countries and countries bordering the European Union, which may be more vulnerable to drug trafficking activities. This may help explain the fact that despite the large seizures, cocaine purity at the retail level remains high by historical standards and its price is stable. Additionally, there is now a well-established secondary cocaine production industry in Europe, with 34 cocaine laboratories dismantled in 2021, an increase on the previous year. These include large-scale secondary extraction and cocaine hydrochloride manufacturing sites and an additional 14 cutting and packaging locations. The existence of these laboratories is indicative of innovation in trafficking practices where cocaine may be incorporated with other materials creating significant challenges for its detection in commercial shipments.

The historically high seizures of cocaine are an indicator of its widespread availability and raise concerns that this could potentially contribute to increasing levels of consumption and associated harms. Cocaine is the second most frequently reported drug, both by first-time treatment entrants and in the available data on acute drug toxicity presentations to sentinel hospital emergency departments. European drug checking services, although not nationally representative, reported that cocaine was the most common substance they screened in 2021. The available data also suggest that the drug was involved in about a fifth of overdose deaths in 2021. While not representative of the general population, the detection of cocaine residues in wastewater analysis increased in 37 out of 65 cities with data for both 2022 and 2021. Increased availability also appears to be associated with some signs of a possible diffusion of cocaine use into more marginalised groups, with cocaine injection and the use of crack cocaine reported in some countries. An estimated 7500 clients received treatment for crack cocaine use in 2021, and this figure appears to be increasing. Stimulants, such as cocaine, are associated with a higher frequency of injection and have been involved in localised HIV outbreaks among people who inject drugs in some parts of Europe over the last decade.

Treating people with different patterns of cocaine use is challenging, whether they are clients that are more socially integrated and involved in casual or episodic use of powder cocaine or more marginalised groups injecting the drug or smoking crack cocaine. Although our understanding of what constitutes effective treatment for stimulant problems is growing, it remains relatively limited. The current evidence available is indicative of the use of psychosocial interventions, including cognitive behavioural therapy and contingency management. Currently, there is insufficient evidence to strongly support any pharmacological treatment, although some potentially useful new pharmacotherapies are in development. Treating cocaine problems among more marginalised groups is often particularly challenging, as clients may also be experiencing problems with a range of other drugs, including opioids or alcohol. For injecting cocaine and smoking crack, existing harm reduction responses, to a large extent those originally developed for opioid problems, still require both further development and scaling-up.

Key data and trends

• Analysis of 1849 used syringes by the ESCAPE network of 12 cities in 11 EU Member States between 2021 and 2022 found that, overall, a third of syringes contained residues of two or more drug categories, indicating frequent polydrug use or re-use of injecting paraphernalia. The most frequent combination was a mixture of a stimulant and an opioid. Cocaine was detected in over 50% of syringes analysed in Athens, Cologne, Dublin and Thessaloniki, with a mixture of cocaine and heroin being the most frequent combination found.

Harms related to cocaine use