Illicit drugs and new psychoactive substances (NPS) are commonly used across Europe.
Acute toxicity from their use, along with acute toxicity from the non-medical use (misuse) of
prescription medicines, can lead to emergency department (ED) presentations with the
potential for significant morbidity and/or mortality. For the purpose of this protocol, the term
‘recreational drug’ encompasses these three substance groups. A previous study showed
that there are limited systematic data available at a national or international level on acute
harm related to the use of recreational drugs (Heyerdahl et al., 2014). It is not possible to
easily collect these data from national/central sources because of the limitations in the
coding of acute drug toxicity using coding systems such as ICD-10 (Wood et al., 2019). This
lack of systematic data on acute drug toxicity represented a significant gap in the public
health understanding of the implications of drug use in Europe.
To address this gap, the European Drug Emergencies Network (Euro-DEN) project was set
up in 2013, originally funded for 12 months by the DPIP/ISEC Programme of the European
Union. The project has continued as the Euro-DEN Plus project, with support from the
EMCDDA/EUDA. The aim of the project is to increase knowledge on ED presentations with
acute toxicity related to the use of recreational drugs across Europe, in order to contribute,
along with other sources of information, to monitoring and act as an early warning system on
drug-related harms, as well as to inform responses and policies in Europe.
A network of sentinel centres across Europe was developed to collect systematic data on
acute drug and NPS toxicity presentations. Data are collected using a purpose-built
representative minimum dataset (Wood et al., 2014). These data are collected from routine
hospital medical records, with no additional information collected over and above that
collected as part of routine clinical care. Data were initially collected in an Excel spreadsheet
(from 2013-2022). In 2022, the project adopted the secure and EU-approved REDCap online
database for data collection. The data are collated by the Euro-DEN Plus coordinating centre
in London, UK. The EUDA provides support with data quality control for the Euro-DEN
dataset.
The initial Euro-DEN project involved 16 centres in 10 European countries. Over the lifetime
of the Euro-DEN Plus project, 53 centres in 27 countries have contributed data. In 2025,
there were 37 active centres in 21 countries, and over 90 000 presentations were recorded
in the database. The description of the centres is available in the Source table section of the
Euro-DEN Plus data explorer (EUDA, 2025). The location of the centres who reported data
for the year 2024 is presented in the map below (Figure 1).