Recreational drug poisonings reported to six European poison centres from 2021 to 2024

Introduction: Recreational drug poisonings pose a growing public health concern. European-level data remain limited, although poison centres are well placed to monitor related health incidents. This study analysed temporal trends in recreational drug poisonings reported to six European poison centres. Methods: Aggregated retrospective data were collected over four years (2021–2024) from poison centres in Austria, Freiburg (Germany), the Netherlands, Sweden, Switzerland, and the United Kingdom. Cases involving 11 recreational drugs (amfetamine, cocaine, delta-9-tetrahydrocannabinol, gamma-hydr­oxybutyrate, heroin, ketamine, lysergic acid diethylamide, 3,4-methylenedioxymetamfetamine, metamfetamine, poppers, and psilocybin) were included. Annual rates of recreational drug exposures were calculated relative to all poisoned patients, and trends were analysed using linear regression. Results: From 2021 to 2024, the six centres recorded 1,051,287 poisonings, of which 23,779 (2.3%) involved recreational drugs. The rate of recreational drug exposures increased from 1.8% (n = 4,581) in 2021 to 2.6% (n = 7,229) in 2024, mainly driven by the increases in Austria, Freiburg, and the United Kingdom. Rates ranged from 1.3% (Austria) to 2.8% (Netherlands) in 2021 and from 1.9% (Austria) to 3.6% (Freiburg) in 2024. Delta-9-tetrahydrocannabinol, cocaine, amfetamine, and 3,4-methylenedioxymetamfetamine were most frequently implicated. Increasing rates were observed for delta-9-tetrahydrocannabinol (Freiburg, Austria), cocaine (Freiburg, United Kingdom), amfetamine (Freiburg, Sweden), and ketamine (Austria, Freiburg, United Kingdom). In 2024, amfetamine poisonings peaked in Freiburg (0.63%) and Sweden (0.94%), cocaine in Freiburg (0.78%) and the United Kingdom (0.74%), and ketamine in the Netherlands (0.42%) and the United Kingdom (0.24%). Discussion: Although recreational drug poisonings comprised a small proportion of poison centre calls (∼3%), a significant increase was observed between 2021 and 2024, underscoring their value in toxicovigilance and early identification of emerging drug trends. Conclusions: Delta-9-tetrahydrocannabinol, cocaine, amfetamine, and 3,4-methylenedioxymetamfetamine were most frequently reported, with notable national differences. Coordinated European monitoring of recreational drug poisonings may support timely public health interventions and prevention strategies.