Other substance use

In addition to the most known psychoactive substances, the ESPAD study investigates also the use of inhalants and pharmaceuticals for non-medical purposes (including tranquillisers or sedatives without a prescription, painkillers to get high, anabolic steroids).

Furthermore, since 2015 the ESPAD study has been one of the first international epidemiological surveys to include the use New Psychoactive Substances (NPS), that are generally defined as psychotropic drugs not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that caused by substances listed in these conventions.

The temporal trend recorded by ESPAD indicates that the lifetime use of inhalants increased steadily until 2011, with a decrease observed thereafter, to reach 7.2 % in 2019. The gender-specific curves over the period 1995-2019 reveal a progressive narrowing of the gender gap, which has almost disappeared since 2011.

The large differences between countries indicate that the use of inhalants is particularly popular in some parts of the Eastern and Central Europe, whereas it is almost non-existent in other areas.

The ESPAD data reveal that the non-medical use of prescription drugs, such as tranquilisers or sedatives, has rapidly gained popularity among adolescents, to the point that these drugs are now the second most often reported misused substance, excluding tobacco and alcohol, to get high; this is followed by painkillers.

On average, 9.2 % of the students reported lifetime use of pharmaceuticals for non-medical purposes in 2019, with quite large differences across countries.

The lifetime prevalence rate for the use of tranquillisers or sedatives without a doctor’s prescription shows a rather stable trend, with slight fluctuations between 1995 and 2007.

Differently from the other psychotropic substances, both on average and in the vast majority of ESPAD countries, girls were more likely than boys to have used pharmaceuticals for non-medical purposes.

Concerning NPS use among school students, the ESPAD study collected information at a European level for the first time in 2015. Information was collected again in 2019 for NPS in general and, in addition, specifically for synthetic cannabinoid and synthetic cathinone use. Furthermore, the investigation was extended to the most frequent form of synthetic substance (herbal, tablets etc.) reported by last-12-month users.

The latest results indicate that on average, 3.4 % of the ESPAD students surveyed in 2019 had tried NPS during their lifetime and 2.5 % had used them in the past 12 months, which indicates higher levels of use than for amphetamine, ecstasy, cocaine or LSD individually. These prevalence were in a similar range to those of 2015.

The average lifetime prevalence of synthetic cannabinoid use was 3.1 %, whereas the consumption of cathinones was lower, with 1.1 % of the ESPAD students reporting lifetime use in a subgroup of countries that run this investigation.

A salient characteristic of NPS revealed by the ESPAD study is that most users are in fact polysubstance users. In 84 % of cases NPS users had previous experience with cannabis, and in 45 % of cases NPS users had previous experience with stimulants (amphetamine/ methamphetamine or ecstasy or cocaine/crack).

These results reveal that an important challenge in monitoring drug use in Europe is that it now encompasses a wider range of substances than in the past that need to be further investigated, such as pharmaceuticals and synthetic cannabinoids and synthetic cathinones.

ESPAD is committed to continue monitoring the use of pharmaceuticals for the purpose of intoxication, which constitutes an increasing concern, both for public health and because adolescents may seek them out because they believe that these substances are more accessible and safer than illicit drugs.

While consumption levels of NPS among adolescents in Europe seem to be low, the emergence of these new substances has raised particular concerns, with the real extension in use being difficult to measure. These findings indicate that NPS use should not be viewed as an isolated, specific phenomenon, but that it needs to be seen as part of the broader phenomenon of polysubstance use.