Cocaine – Increasing use among the young in Europe, including the Nordic region

Recent reports from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the United Nations Office on Drugs and Crime (UNODC) on drug use globally as well as in Europe indicate that cocaine use is on the rise. This holds true particularly in Western Europe and the Nordic region. Cocaine use is more common among the young (15–30 years), and is a more urban than rural phenomenon.  Cocaine is more commonly used among males than females.

During the spring and summer of 2023, the Norwegian press reported frequently on cocaine- related matters. For example reports of several 800+ kg cocaine seizures, influencers posting pictures with small bags containing white powder and other young media profiles reporting lots of cocaine in the Oslo party scene. There were also reports of an increase in cocaine use among teenagers graduating from high school, as well as among university students. Overall, a concerning stream of reports left news consumers with the impression that cocaine had become more mainstream and normal, with a corresponding massive increase in use.

What are the facts and what is new?

Some facts first: In Europe, cocaine is the second most commonly used illicit drug after cannabis. Cocaine use as well as cocaine-related health problems are steadily increasing.

Although cocaine is primary used for its pleasurable and central stimulant effects, cocaine can cause adverse health effects after just a single dose leading to acute intoxication as well as following more long-term chronic use. Acute effects of cocaine include an increase in impulsivity and associated higher risk taking that can lead to accidents and violence. Cocaine also affects the body, with increased pulse rate, higher blood pressure, and sometimes poor temperature regulation and arrhythmias. In severe cases, cocaine use can lead to cardiac infarction, brain hemorrhage or fatal overdose. Chronic cocaine use is associated with reduced mental health, such as higher risk of anxiety, depression and psychosis as well as the high risk of developing cocaine dependence.

What is new is that the influx of cocaine into Europe was all-time high in 2022, primarily (but not limited to) via ports in Spain, Belgium and the Netherlands. Even if we exclude reports of record high cocaine seizures, the stable purity of the drug and its relatively stable price indicate a high influx of cocaine into Europe.

The most recent EMCDDA report estimates the average prevalence for past year use to be 2.3 per cent among 15–34 year olds in Europe as a whole. The EMCDDA also reported similar prevalence figures for the Nordic region, based on 2021 general population surveys: Norway (2.7 per cent), Sweden (2.8 per cent), Denmark (2.9 per cent) and Finland (1.5 per cent).

However, the recent media frenzy about cocaine use in Norway was sparked by the updated 2022 numbers for cocaine use showing an increase to 4.7 per cent for past year use in 2022 among those between 16–30 years in Norway. Similarly, a survey among Norwegian University students in early 2022 showed that six per cent had used cocaine at least once during the past year.

So where do we stand?

Cocaine use among teenagers and young adults is increasing, shown by the 2022 past year use prevalence in the range of five per cent. This means that 95 per cent of young Norwegians have not used cocaine during the past year, and most – 9 out of 10 – Norwegians have never tried it. It is, therefore, important to remember that cocaine use has not become the new normal; on the contrary, cocaine use is a relatively marginal phenomenon in the population. Still, in some subgroups of the population and within groups of friends, the perception might be that “everyone uses it, and it is not dangerous”. Nevertheless, neither of these arguments are correct.

What’s next and where are we heading?

It is not surprising that cocaine availability and use has increased in the Nordics and Norway, as this trend has been seen over some time in Western Europe already. The Nordic markets, although on the fringe of Europe, are generally financially strong, and many young people have enough money to spend on partying using illicit and expensive drugs. Thus, both the supply and the demand for cocaine seems to be increasing.

Internationally, calls for drug reform and drug law liberalization have been a trend for some time, with examples of more liberal cannabis approaches from a number of  states in the US as well as from some European countries. In Norway, there has also been a drug policy reform debate during the past several years, and many young adults have adapted a more liberal stance towards drug use. The juridical system and the police have recently adapted a slightly less restrictive practice around drug possession and use, primarily towards persons with substance use disorders. Although no real formal drug reform has taken place, many young people may believe that drug use and minor possession is not illegal anymore or at least that it presents less risk of penal consequences.

It is hard to imagine that the trend of increases in cocaine use will change without the introduction of strengthened interventions or clear political signals reinforcing the illegal nature of such drug use. Adequate resources for prevention seem important, both for public messaging around the risk associated with both acute and chronic cocaine use, as well as for supply reduction interventions such as border customs control and policing.

Both acute intoxications from cocaine and treatment demand for cocaine dependence have been on an increase in Europe. The treatment demand for cocaine use disorder was the second most common reason among first time drug treatment entrants in 2022 in Europe. We observe an increase in cocaine availability, use and harmful consequences in Europe. Without strengthened preventive measures, this trend is also likely to become more visible in the Nordics in the coming years.

Is there any hope?

For persons with cocaine use disorders, treatment is available. Often, treatment is offered at both the municipality level and the specialist health services level, but these services vary from country to country. Overall, treatment remains primarily psychosocial and counselling based.

The experience from surveys of European treatment demand indicates that among first-time treatment entrants for cocaine use disorder, the mean age at first cocaine use was 23 years, while the mean age for first time treatment was 33 years, leaving a 10-year delay from first use to first treatment. This indicates that even though we see current increases in cocaine use, at present it may take several years before we experience a surge in treatment demand, which will then build over the next decade. There seems to be an opportunity to reduce the development of chronic drug use disorders through the provision of earlier treatment, if such treatment services are available with adequate capacity and a focus on early identification and treatment. However, it is important to focus on primary prevention; keeping the numbers low for cocaine use initiation remains the ideal approach for preventing the development of cocaine-related problems.

The article is written by Professor Thomas Clausen, MD, PhD, SERAF, University of Oslo, Norway

on the request of PopNAD