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Urine survey reveals Europe’s favorite drugs
Coke, meth, ecstasy, amphetamines: each drug has a different 'capital'
- A large-scale survey of wastewater across Europe shows which illicit drugs are popular.
- The use of four main drugs was up across the board last year, but regional variation persists.
- Cocaine is popular in the west and south, meth in the east and north.
How to trace illicit drug use
Some examples of MDMA, a.k.a. ecstasy, in pill form.
DM Trott / The Drug User's Bible - CC BY-SA 4.0
Europe's drug capitals? Antwerp for cocaine use, Stockholm for amphetamines. Prague tops the list for crystal meth, Amsterdam for ecstasy. So says a study by the EU's official drug monitory body, analysing sewage samples from 68 cities in 23 European countries. The standardised surveys of urban wastewater, conducted since 2011, are a good indicator of regional preferences in illicit drug use, and their evolution over time.
It's not easy to establish the size of Europe's appetite for illicit drugs. Most users would prefer not to discuss their habit, and seizures of drugs shipments provide only a very partial picture. Fortunately for the scientists, urine doesn't lie.
Since its original use in the 1990s to monitor the environmental impact of liquid household waste, wastewater analysis has rapidly improved, and is now able to provide near real-time data on the quantity, the geography and the evolution over time of illicit drug use.
The most recent study, published earlier this month by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), took samples in March 2019 at treatment plants processing sewage for a total of 50 million Europeans, concentrated in the continent's major urban centers.
The sewage was tested for traces of four illicit drugs: cocaine, MDMA (popularly known as ecstasy), amphetamines and methamphetamines (a.k.a. crystal meth). These leave clearly detectable biomarkers in sewage, unlike cannabis or heroin.
- Compared to previous years, consumption was on the increase for each of the four drugs.
- Residues for all four drugs were higher in larger cities – a reflection of the fact that this is where younger people tend to congregate.
- Three out of four cities reported higher levels of amphetamine, cocaine and ecstasy use during the weekend, indicating recreational use.
- Crystal meth use tended to stay even over the whole week, indicating more chronic, problematic use.
Cocaine: popular in west and south
The Belgian port city of Antwerp tops the list for highest average cocaine use
The Belgian port city of Antwerp – and in particular the district of Antwerp-Zuid – topped the list of European cities with the highest average cocaine use, both on weekdays and at weekends.
The figures – expressing average mg/day of cocaine biomarker per 1,000 persons – show the Belgians out-consuming the runners-up in Amsterdam by a considerable margin. Also remarkable: four of Europe's top 10 coke cities are Swiss; and London barely makes the list.
As recently as 2015, London was Europe's cocaine capital, with a wastewater count of 909mg of benzoylecgonine (BE) per 1,000 people. BE is the compound produced by the body when it breaks down cocaine. Other research at that time showed 4% of Londoners between 15 and 34 years of age had taken cocaine in the preceding year.
But recent figures show the BE count in London's sewage has been dropping for years now, from 895mg in 2016 to 619mg in 2019 – a reduction by nearly a third. Why is that? Wastewater research can't tell you that. But the three most likely theories are:
- The samples are non-representative anomalies.
- The London market for cocaine is saturated.
- After consistent rises in the previous years, the purity of the product has gone down.
The actual answer could be any combination of those three possibilities.Seen across the whole of Europe, cocaine use is highest in western and southern European cities, particularly in Belgium, the Netherlands, the UK and Spain. Despite some increase, cocaine use remains low in eastern Europe.
|Cocaine capitals of Europe||mg|
|3||St Gallen Hofen||Switzerland||909.8|
Ecstasy: from 'niche' to mainstream
Ecstasy is now being used by a broader range of young people in mainstream nightlife settings.
MDMA, commonly known as ecstasy, is most popular in Belgium, the Netherlands and Germany. Until recently, overall MDMA use seemed to be declining from a peak in the early to mid-2000s; however, more recent data provides a mixed picture, with MDMA consumption falling in London, for example, but remaining high in some cities. Sharp increases were noted in particular for Antwerp, Amsterdam and Eindhoven.
In fact, the study reports an increase in MDMA use for more than half of the 42 cities with comparable data for 2018 and 2019 – leading the researchers to conclude that ecstasy no longer is a 'niche' drug, linked to the sub-culture of dance clubs. It's now being used by a broader range of young people in mainstream nightlife settings, like bars and house parties.
|Ecstasy capitals of Europe||mg|
Meth: breaking out of its Czech heartland
Prague is Europe's meth central.
For years, methamphetamine was popular particularly in the Czech Republic. In recent years, the drug has made inroads in surrounding countries – Slovakia and eastern Germany – but also further afield, in various Nordic cities, in Cyprus and Spain.
Overall 21 of the 41 cities with data on meth use for both 2018 and 2019 showed an increase. Despite this, meth use remained negligible outside the established hotspots.
In 2015, Oslo and Dresden topped the meth league tables, in 2016, Slovakia's capital Bratislava took the crown. In 2019, Prague was Europe's meth capital.
|Meth capitals of Europe||mg|
Amphetamines: popular in the north
Germany, Belgium and Sweden occupy all but two spots in the amphetamine top 10.
Antwerp was Europe's amphetamine capital back in 2016, but the city has to content itself with its top spot in the cocaine ranking, having gone down a few places in this league table. Sweden rules the roost, occupying first and second place; with Belgium and Germany occupying three spots each.
No wonder then that the highest levels of amphetamine use were reported in northern European cities, with much lower levels in southern Europe.
Wastewater analysis has its limits when trying to establish quantities or patterns of illicit drug use, but it offers support to other indicators of drug consumption, for instance the amounts of drugs seized by the authorities, and it confirms the picture of a remarkably divergent market across Europe.
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Join The Daily Show comedian Jordan Klepper and elite improviser Bob Kulhan live at 1 pm ET on Tuesday, July 14!
The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
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Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
What we know about black holes is both fascinating and scary.
- When it comes to black holes, science simultaneously knows so much and so little, which is why they are so fascinating. Focusing on what we do know, this group of astronomers, educators, and physicists share some of the most incredible facts about the powerful and mysterious objects.
- A black hole is so massive that light (and anything else it swallows) can't escape, says Bill Nye. You can't see a black hole, theoretical physicists Michio Kaku and Christophe Galfard explain, because it is too dark. What you can see, however, is the distortion of light around it caused by its extreme gravity.
- Explaining one unsettling concept from astrophysics called spaghettification, astronomer Michelle Thaller says that "If you got close to a black hole there would be tides over your body that small that would rip you apart into basically a strand of spaghetti that would fall down the black hole."