4. How many people injected illicit drugs in the European Union in 2019?

Knowing the size of the population of people who inject drugs living in each country is necessary in order to quantify the burden of disease associated with injecting drug use and to plan harm reduction and health services accordingly. The objective of this work was to estimate the total number of people who have injected drugs in the last 12 months in the EU and Norway for the year 2019

Prevalence estimates, as well as information on the methods used, were reported by the national experts of the PDU network. The total for the EU and Norway was obtained by summing the most recent country-specific estimates and dividing it by 2019 Eurostat data for the population aged 15- 64 years in these countries. For countries with missing data, we imputed the estimate using the total number of high risk opioid and stimulant users adjusted by the proportion of drug treatment clients who reported injecting the drug using a linear regression model.

Preliminary results indicate that in 2019 there were a total of 556 000 [336 000 – 1 252 000] people who have injected drugs in the last 12 months, corresponding to a prevalence of 1.9 [1.2 – 4.3] per 1000 people aged 15-64 in the EU and Norway.

People who inject drugs are particularly susceptible to drug-related harms, including overdoses and blood-borne infections. A cost-effective harm reduction intervention to reduce drug-related infectious diseases is the provision of clean syringes. The quantitative target for the provision of clean syringes in the WHO Action Plan is at least 300 per person who injects drugs per year. Based on our estimate, there were only 100 clean syringes distributed per PWID in 2019, suggesting suboptimal coverage and missed opportunities to prevent morbidity and mortality among this vulnerable population.