EU Drug Market: Amphetamine — Effects, risks and harms of use

This resource is part of EU Drug Market: Amphetamine — In-depth analysis by the EMCDDA and Europol.

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Last update: October 2023

Amphetamine is a central nervous system stimulant that causes hypertension and tachycardia, with feelings of increased confidence, sociability and energy. It also suppresses the user’s appetite and feelings of fatigue and leads to insomnia. Following oral use, the effects usually start within 30 minutes and last for hours. Later, users may feel irritable, restless, anxious, depressed and lethargic.

Acute intoxication causes serious cardiovascular disturbances as well as behavioural problems that may include agitation, confusion, paranoia, impulsivity and violence, or mental health issues such as psychosis and self-harming behaviour. Chronic use of amphetamine causes neurochemical and neuroanatomical changes, which may trigger anxiety, aggression and depression and somatic effects such as exhaustion, sleep disorders and weight loss. Dependence – as shown by increased tolerance – results in deficits in relation to memory, decision-making and verbal reasoning. These effects may outlast the drug use, although they often eventually resolve.

The use of amphetamine during pregnancy increases the risk of preterm birth and the delivery of babies who are small size for their gestational age (Ross et al., 2015). In utero amphetamine exposure is associated with an increased risk of adverse physical, cognitive, emotional and social effects, including the increased prevalence of attention deficit and hyperactivity disorders, aggression, and learning difficulties attributed to deficits in attention, memory and motivation (Eriksson et al., 2000).

Out of 19 countries with post-mortem data available in 2021, the highest numbers of deaths involving amphetamine-type stimulants were reported by Türkiye (184), Finland (49), Norway (47), Austria (41), Sweden (36) and Denmark (35). The total number of cases for the 17 countries that reported comparable data in all three years are 435 deaths in 2019, 512 in 2020 and 477 in 2021. The latest available data from Germany showed that 348 deaths involved amphetamine/methamphetamine in 2021, but it was not possible to compare this with previous years due to changes in monitoring procedures.

Overall, there are gaps and limitations in the data on deaths involving amphetamines, and any interpretation of changes over time should be approached with care. In addition, due to the small overall numbers of cases in some countries, fluctuations should be viewed with caution.

High-risk amphetamine use

The injection of amphetamine carries the same viral infection hazards (e.g. HIV and hepatitis) as are found with other injectable drugs such as heroin. Injection is reported as a common route of administration for amphetamine in a number of countries, including Finland, Norway, Poland and Sweden.

Analyses of the residues from used syringes collected in several European cities show that injection of amphetamine is mainly found in cities in the north of the EU (see Figure Percentage of detection of amphetamine in used syringes in selected cities in the EU, 2017-2022). In Helsinki, Finland, the detection of amphetamine in used syringes varied between 30 % in 2017 and 45 % in 2022. In Oslo, Norway, amphetamine was detected in 41 % of syringes in 2019 rising to 65 % in 2020, before falling to 58 % in 2021 and 53 % in 2022. In Tallinn, Estonia, which participated in the study for the first time in 2021, amphetamine was detected in over 65 % of syringes, rising to almost 80 % in 2022. Riga, Latvia, has witnessed a large recent increase in the share of used syringes containing amphetamine residues, rising from less than 20 % in 2021 to 47 % in 2022.

Amphetamine was also detected in a significant proportion of used syringes in Budapest, Hungary, in 2017 (15 %) and 2018 (18 %). However, the presence of the drug fell to 3 % and 0 %, respectively, in 2019 and 2020. In the other cities that participated in the study, the presence of amphetamine was found in less than 10 % of syringes, and usually in combination with other substances.

Treatment data

People who seek specialised drug treatment for stimulant use problems primarily use either cocaine or amphetamine. Of approximately 81 000 of those seeking help in 2021 reported to the EMCDDA treatment demand indicator, 10 346 reported that they use amphetamine. Around 62 % of amphetamine clients were from Belgium (1 075), Germany (3 846) and Poland (1 466).

About 7 % of amphetamine clients entering specialised drug treatment in Europe in 2021, or the most recent year available, reported injecting as the main route of administration, while 70 % reported sniffing, 8 % smoking and 15 % oral consumption.

People seeking treatment for problems associated with the use of amphetamines are heterogeneous in terms of their social conditions and modes of use. This heterogeneity among people with stimulant problems may have important implications both for devising the necessary responses and for reducing barriers to treatment access. Those in employment, for example, may benefit from services offered outside of normal working hours.

Overall, the number of first-time treatment entrants citing amphetamine or methamphetamine as their primary drug has been relatively stable since 2015. Similarly, the proportion of this group reporting injecting amphetamines has remained relatively constant, in contrast to the decrease in injecting that has been observed for other drugs.

Amphetamine-related emergency visits to sentinel hospitals

People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with their non-drug-taking peers. They have an excess risk of death, estimated at around seven times higher than people of the same age and gender in the general population. The excess risk is even higher for certain causes of deaths, including drug poisoning (24 times higher compared to the general population); homicide (12 times); suicide (12 times); cardiovascular disease (5 times) and accidental injury (5 times) (Stockings et al., 2019).

Acute amphetamine toxicity

Based on data from 24 sentinel hospitals in 18 countries (17 EU countries and Norway), forming part of the Euro-DEN Plus network, there were 5 782 acute drug-toxicity presentations at emergency services in 2021 (see Figure Proportion of the acute drug-toxicity presentations with amphetamine involved). Amphetamine was involved in the presentations at 22 of the 24 hospitals and was the fifth most common substance reported by Euro-DEN Plus hospitals in 2021, found in 11% (596) of cases. Out of the 20 centres that reported data on the number of presentations involving amphetamine in both 2020 and 2021, 15 reported a decrease, 3 an increase and 2 a stable number.

Most of the acute drug-toxicity presentations involving amphetamine in 2021 were middle-aged men. Women represented 25% of these presentations while persons aged under 25 represented 11% (based on median proportions across the sentinel hospitals). In 11 of the 22 hospitals, none of these presentations involved persons over the age of 45. Polydrug toxicity was the norm and cases with sole amphetamine toxicity were rarely reported (representing 3 % or less of all acute drug-toxicity presentations in half of the centres). The pattern of polydrug use differed across centres: in the two hospitals located in Oslo, Norway, the main drugs co-ingested with amphetamine included heroin and benzodiazepine; while the main drugs co-ingested with amphetamine in the centres in Spain and the Netherlands included cocaine, GHB/GBL, MDMA and cannabis. Alcohol was also frequently reported to be co-ingested with amphetamine, as half of the centres reported 40 % or more of these presentations as cases of alcohol co-ingestion.

Due to the COVID-19 pandemic, there were fewer emergency room presentations (overall and drug-related) in 2020 and 2021 when compared to the previous year’s Euro-DEN data. Therefore, any interpretation of changes in the numbers and in the proportions of amphetamine-toxicity presentations should be made with caution. Other limitations of this data relate to the fact that some hospitals reported low numbers of cases, and that the data from hospitals reflect their respective local drug-use patterns and are not necessarily representative of the regional or national situations.

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