Wastewater Analysis Reveals Europe’s Drug Use Patterns: 2025 Multi-City Study Results

Introduction: A Snapshot of Europe’s Drug Flow

How do you measure the true scale of illicit drug use across an entire continent? Traditional surveys rely on self-reports, miss hidden populations, and lag behind real-time trends. Enter wastewater epidemiology: a scientifically validated approach that analyzes sewage for drug metabolites to estimate community consumption. The 2025 European multi-city study, coordinated by the Sewage analysis CORe group—Europe (SCORE), is the largest project of its kind to date, examining wastewater from 115 cities across 25 countries. By detecting urinary biomarkers of cocaine, amphetamine, methamphetamine, MDMA, and cannabis, researchers produced a high-resolution map of Europe’s evolving drug-use landscape.

Understanding the Research: From Sewage to Statistics

Wastewater testing is not new—it was first applied in the 1990s to monitor household chemical waste. Scientists later realized that traces of drugs and their metabolites excreted in urine could be quantified in sewage, offering an objective, near-real-time measure of population-wide consumption. Since 2011, SCORE has harmonized protocols across Europe, ensuring that samples collected in Lisbon are directly comparable to those taken in Helsinki.

The 2025 study collected raw 24-hour composite samples during a single week between March and May. Analysts measured:

• Parent drugs: amphetamine, methamphetamine, ketamine, MDMA
• Specific metabolites: benzoylecgonine (BE) for cocaine, THC-COOH for cannabis

Because heroin’s primary metabolite is unstable in wastewater, morphine was used as a proxy—adjusted for known medical use via prescription data to isolate illicit heroin consumption.

Key Findings: Cocaine Surges, Amphetamine Holds Steady, Methamphetamine Spreads

1. Cocaine use jumped 22 % continent-wide

From 2024 to 2025, the average load of benzoylecgonine (BE)—cocaine’s main urinary metabolite—rose by 22 % in cities with data for both years. Western and southern Europe continue to register the highest BE levels, with peak values in Belgian, Dutch, and Spanish cities. Eastern European cities generally recorded low levels, yet subtle upward signals suggest cocaine may be gaining ground in these regions.

2. Amphetamine remains a northern and central European phenomenon

Overall amphetamine loads showed little change year-on-year, but geographical clustering is pronounced. Norwegian, Swedish, Danish, Belgian, Dutch, and German cities consistently report the highest concentrations. Southern European cities remain low, though incremental increases hint at possible diffusion.

3. Methamphetamine creeps beyond traditional hotspots

Historically concentrated in Czechia and Slovakia, methamphetamine is now detectable at notable levels in Germany, Lithuania, Norway, Türkiye, Spain, Cyprus, and the Netherlands. While absolute loads outside the traditional hotspots remain low, the direction of travel is clear: methamphetamine signals are rising in central and northern Europe.

4. MDMA and cannabis: stable with regional nuances

MDMA showed variable city-level changes but no Europe-wide surge. Cannabis metabolite (THC-COOH) levels remained stable, with highest concentrations in western and southern cities—mirroring long-standing consumption patterns.

Methodology: How Scientists Turn Sewage into Data

The SCORE protocol ensures reliability across borders:

1. Standardized sampling: Automatic samplers collect every 15 minutes over 24 hours, yielding a representative composite sample.
2. Chain-of-custody: Samples are refrigerated during collection, transported cold, and analyzed within required hold times.
3. Inter-laboratory calibration: Before each campaign, labs analyze identical QC samples; results must fall within predefined tolerance limits.
4. Back-calculation: Measured metabolite concentrations are converted to population-normalized consumption (mg/day/1000 inhabitants) using sewage flow rates and census data.
5. Uncertainty quantification: Analytical error, sewage flow variability, and population fluctuation are combined into confidence intervals for each estimate.

Implications for Public Health and Policy

Wastewater data complement traditional surveillance by offering:

• Objectivity: No self-report bias or social-desirability effects
• Timeliness: Results available within weeks, not years
• Coverage: Captures use among travelers, tourists, and homeless populations missed by household surveys
• Spatial granularity: City-level resolution enables targeted interventions

Rising cocaine loads in western Europe may foreshadow increased hospital admissions and treatment demand. Detecting methamphetamine in previously low-prevalence cities provides an early-warning system, allowing health services to expand counseling and harm-reduction capacity before acute harms surge.

Limitations and Future Directions

Wastewater analysis is powerful but not infallible:

• Metabolite stability: Some compounds degrade quickly; morphine is less specific for heroin, requiring prescription data adjustments.
• Population mobility: Tourist influxes can inflate estimates, while commuter cities may appear lower than reality.
• New psychoactive substances (NPS): Rapid emergence of synthetic drugs demands continuous analytical method updates.

Next steps include expanding NPS monitoring, coupling wastewater data with smart-phone mobility data to correct for population flux, and integrating results with hospital and forensic databases for a holistic early-warning system.

Conclusion: Toward Evidence-Based Drug Policy

The 2025 SCORE study underscores that drug consumption is dynamic and geographically patterned. Cocaine’s 22 % rise and methamphetamine’s spatial diffusion are public-health signals that policymakers cannot ignore. By delivering timely, objective, and fine-grained data, wastewater epidemiology equips European authorities to anticipate rather than react—shifting resources, tailoring prevention campaigns, and ultimately reducing the human and economic costs of illicit drug use. As methods evolve and coverage expands, the vision is clear: a continent where every flush becomes a data point guiding smarter, faster, and more compassionate drug policy.

References

European Union Drugs Agency (EUDA). Wastewater analysis and drugs — a European multi-city study. Retrieved 18 March 2026 from https://www.euda.europa.eu/publications/pods/waste-water-analysis_en