Antwerp isn’t just Europe’s diamond capital anymore, for the second year in a row, the Belgian port city topped the list of cocaine consumers in Europe, according to findings published Wednesday by the EU drugs agency (EMCDDA) and SCORE group, a Europe-wide sewage analysis network, Politico reports.

Their report, which analyzed wastewater in 88 cities in 23 EU countries and Turkey covering some 55.6 million people, found a rise in consumption of cocaine as well as ketamine and MDMA. Patterns concerning amphetamines and cannabis were less clear.

Antwerp came in as Europe’s top cocaine user with 1,721 milligrams detected per 1,000 people per day, which was a decrease from 2022 but still enough to stay at the top of the list.

Experts say wastewater analysis is a helpful way to examine the snapshot of drug use in a particular city. Alexis Goosdeel, the director of the EMCDDA, said in a statement accompanying the findings that such reports offer “early warning of emerging health threats and shifting trends.”

While Goosdeel noted that the report showed “growing similarities in drug habits between large and small cities” the biggest cocaine consuming cities are concentrated along the coast. Of the top five — Antwerp, the Spanish coastal city of Tarragona, and Amsterdam, Leeuwarden and Rotterdam in the Netherlands — four are home to large ports.

Antwerp last year saw a record 116 tons of cocaine seized, breaking the previous record of 110 set in 2022, Belgium’s finance minister said in January. Franky De Keyzer, chief of the city’s public prosecutor’s office, said last week that Dutch criminals had overrun the port of Antwerp.

Rising demand is fueling gangs to employ “unprecedented” levels of violence against each other, the EMCDDA said earlier this month. With the illicit drugs market now worth about €30 billion a year, drug traffickers are employing vicious tactics usually only seen in Latin America, including employing so-called torture rooms.

Authorities are also concerned about the increasing number of minors serving as police spotters, selling drugs and even shooting at other children with Kalashnikovs. Authorities in the ports of Antwerp and Rotterdam have caught scores of adolescents who were paid to extract cocaine loads from shipping containers.