2007 Annual report on the state of the drugs problem in Europe NB embargo 22 November 10:00 CET (Brussels time)

2007 Annual report on the state

of the drugs problem in Europe

NB embargo 22 November 10:00 CET (Brussels time)

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Latest on the drugs problem across Europe

• Overview of the European drug phenomenon in 29 countries

• Data and analyses: across Europe and by country

• Latest trends and responses

• Selected issues: • Drugs and driving• Drug use among the under 15s • Cocaine and crack cocaine use: a

growing public health issue

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A multilingual information package

2007 Annual report:

In print and online in 23 languages• http://www.emcdda.europa.eu/events/2007/annualreport.cfm

• Additional online material in English:• Selected issues • Statistical bulletin • Country data profiles • Reitox national reports

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Part I: Annual report – 2007 overview

• After over a decade of rising drug use, Europe may now be entering a more stable phase

• Heroin use and drug injecting generally less popular

• Cannabis use stabilising, signs of popularity waning among the young in some countries

• Cocaine use rising again and record amount of cocaine seized

• HIV: overall positive assessment, but around 3 500 new infections among IDUs in 2005

• High levels of drug-related deaths

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Cannabis use stabilising

• Some 70 million adults in the EU (15–64 years) have ever tried cannabis. Some 23 million have used it in the last year

• After escalating cannabis use in the 1990s, data suggest that use is stabilising overall and falling in some countries

• Among high-ranking countries, rates have stabilised or are beginning to fall in Spain and have dropped by some 3–4 percentage points in the Czech Republic, France and the UK

• Data from mid-ranking countries show a stabilisation in Denmark and the Netherlands

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Figure GPS-4: Trends in last-year prevalence of cannabis among young adults (aged 15–34), measured by national surveys

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Signs of popularity waning among the young

• Among the UK’s younger cannabis users (16–24 years), last-year use fell from 28.2% in 1998 to 21.4% in 2006

• Spanish School Survey (14–18 years): last-year use fell from 36.6% in 2004 to 29.8% in 2006

• Cannabis use still rising among young adults (15–34 years) in Hungary, Slovakia and Norway, but most rises are small

• The exception is Italy. Rates of last-year cannabis use in young adults rose from 12.8% in 2003 to 16.5% in 2005.

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Figure GPS-10: Last-year prevalence of cannabis use by age group in the UK, measured by national population surveys

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Attention turns to intensive cannabis use

• Only a relatively small proportion of cannabis users report using the drug on a regular or intensive basis

• But still ‘a significant number of individuals’, says report

• 18% of the 70 million adults who have ever tried cannabis, reported having used it in the last month, over 13 million

• Around 1% of European adults (around 3 million people) may be using the drug on a daily, or almost daily, basis

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Treatment demands for cannabis problems

• Between 1999 and 2005, numbers of Europeans demanding treatment for cannabis problems approximately trebled

• And new demands for treatment for cannabis problems rose from 15 439 to 43 677 clients

• In 2005, 29% of all new demands were cannabis-related

• Innovative interventions are now developing in Europe to meet the different needs of occasional, regular and intensive users

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Figure TDI-1, part ii: Trend in estimated number of new clients entering treatment by primary drug used (1999–2005). Trend in numbers of clients by primary drug.

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Chapter 3, Figure 4: Trends in pattern of use of treatment services (1999–2005). Principal drug for which clients ask treatment as % of all requests.

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Cocaine use rising again

• 2007 report: some 4.5 million Europeans (all adults aged 15–64 years) are likely to have used cocaine in the last year

• 2006 report: estimate of 3.5 million adults

• Second most commonly used illicit drug after cannabis

• Ahead of ecstasy and amphetamines

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Cocaine figures

• Some 12 million Europeans (4% of adults) have ever tried it

• Some 2 million have taken it in the last month, more than double the estimate for ecstasy

• Among young adults (15–34 years), increases in last-year cocaine use were registered in most reporting countries

• Some 7.5 million young adults have ever tried cocaine, 3.5 million in the last year, 1.5 million in the last month

• In highest prevalence countries (Spain, UK) recent increases were small, suggesting that prevalence may be levelling off. Clear rises were reported by Denmark and Italy.

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Chapter 5, Figure 7: Trends in last-year prevalence of cocaine use in young adults (15–34)

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Impact of cocaine on public health

• One indication of how cocaine is impacting on public health is the rise in demand for treatment for cocaine problems

• In 2005, close to a quarter (22%) of all new demands for treatment in Europe were cocaine-related: a total of 33 027 clients, compared with 12 633 in 1999

• Most treatment demands occur in a small number of countries: Spain and the Netherlands are responsible for the majority of reports of cocaine treatment in Europe

• Treatment services are faced with offering care to a broad spectrum of clients (see Selected issues, Part II below)

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Record amount of cocaine seized

• Numbers of cocaine seizures and quantities intercepted increased in Europe between 2000 and 2005

• 70 000 cocaine seizures amounting to a record 107 tonnes in 2005 (up over 45% on quantities seized in 2004)

• Around half the total number of seizures and the greatest volume seized were in Spain (48.4 tonnes in 2005; 33.1 in 2004)

• Portugal was the country with the second largest quantities intercepted (18.1 tonnes in 2005; 7.4 tonnes in 2004)

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Transit routes

• Iberian Peninsula, main point of entry of cocaine into Europe

• Most cocaine seized in Europe enters the continent from South America or via Central America and the Caribbean

• West African countries increasingly used as transit routes

• EU responds to changes in trafficking routes via enhanced coordination and cooperation between Member States

• Maritime Analysis and Operations Centre – Narcotics (MAOC-N) established in September 2007

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HIV: overall positive assessment

• Rate of HIV transmission among injecting drug users (IDUs) was low in most EU countries in 2005

• With the expansion of services, the HIV epidemics seen earlier in Europe seem largely to have been avoided

• Baltic States, also relative decrease in new infections

• But some 3 500 new infections among IDUs in the EU in 2005

• Among EU MS reporting data, Portugal has highest HIV transmission rate in IDUs (+/- 850 new infections in 2005)

• Up to 200 000 IDUs live with HIV, up to 1 million live with HCV

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High levels of drug-related deaths

• Overdose, a major cause of preventable death among young Europeans

• Deaths historically high: 7 000–8 000 overdose deaths per year and no downward trend detectable in most recent data

• Recent rises in deaths recorded in several countries, and clear rises of over 30% in: Greece (2003–2005), Austria (2002–2005), Portugal (2003–2005) and Finland (2002–2004)

• Europe lacks comprehensive approach to overdose prevention

• …and risks failing to meet targets to reduce drug-related deaths

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Drug-related deaths (continued)

• Risk factors possibly contributing to the problem: more polydrug use by opioid users and rises in heroin availability

• The sustainability of the generally stable heroin situation in Europe is called into question by rising Afghan opium production

• 6 610 tonnes of opium produced in 2006 — 92% in Afghanistan

• Estimates of global heroin production increase again: 606 tonnes in 2006, up from 472 tonnes in 2005 (UNODC, 2007)

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Chapter 8, Figure 13: Overall trend in acute drug-related deaths, 1996–2005 for all Member States with available data

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Part II: Selected issues – 2007 overview

Three in-depth reviews published alongside the 2007 Annual report

• Drugs and driving• Drug use and related problems among very

young people (under 15s) • Cocaine and crack cocaine use: a growing

public health issue

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Drugs and driving (1)

• After alcohol, cannabis and benzodiazepines are the psycho-active substances most prevalent among Europe’s drivers

• A consistent finding regardless of study type (e.g. roadside tests at random/on suspicion, in hospitals, post-mortem)

• Studies are equally divided as to which of the two substances is more prevalent

• Exceptions: in Finland, Sweden, Latvia and Norway, amphetamines are more frequently found in drivers than cannabis and benzodiazepines. In Slovenia, opioids are found more often than benzodiazepines.

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Drugs and driving (2)

• Performance tests show that use of cannabis and benzodiazepines results in impaired driving ability, varying according to dose, tolerance and delay after intake

• Risk assessment studies show that combining these drugs with alcohol significantly increases the risk of being involved in, or responsible for, a traffic accident

• Cannabis-using drivers tend to be young males while benzodiazepine-using drivers middle-aged and often female

• Alcohol: still no 1 substance endangering lives on our roads

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Drugs and driving (3)

• Many countries have tightened laws, increased penalties or altered national strategies to address the problem

• Countries’ legal responses to drug driving vary greatly, from ‘zero tolerance’ laws (sanctioning detection of the substance per se) to impairment laws (sanctioning if the person is deemed unfit to drive)

• ‘Zero tolerance’ laws for illicit drugs (e.g. cannabis) have been introduced in Belgium, Portugal and Sweden (1999) and France and Finland (2003)

• Several countries have passed laws to allow or define roadside drug testing (e.g. by saliva, sweat testing), but some draft laws await reliable test kits before enactment

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Drugs and driving (4)

• Most EU MS carry out mass media campaigns on health risks of substance use and driving, but these focus mainly on alcohol

• Only around one-fifth of EU countries target cannabis and benzodiazepines specifically

• Drug-specific prevention programmes are now a prominent feature in driving schools

• ‘One-size-fits-all’ campaigns may be unsuitable (cannabis and benzodiazepine users have quite different profiles)

• Many unaware of possible effects of medication on driving ability (5 countries use pictograms on medicinal packaging)

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Drug use among the under-15s (1)

• Illicit drug use in very young people is rare and regular use rarer • Largely found among specific groups of the population where

drug use occurs alongside other psychological/social disorders

• Cannabis is the illicit substance most commonly used, followed by inhalants (e.g. glue, aerosols)

• Of 15–16 year-old school students reporting to have used cannabis, first use by age 13 is uncommon (typically 1%–4%)

• School surveys showed that daily tobacco smoking by age 13 varied in EU countries (7%–18%). Between 5% and 36% of school students reported having ever been drunk by that age

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Drug use among the under-15s (2)

• Few under-15s enter drug treatment (less than 1% of all clients)

• Referred by family, social services or by criminal justice system

• The large majority do so for primary cannabis use, and to a lesser extent for use of inhalants

• Under-15s whose family members use psychoactive substances are known to be at higher risk of early drug use (at least 28,000 clients in drug treatment live with their children)

• In 2005, 18 drug-related deaths among the under-15s were reported in Europe (0.2% of the total number of such deaths) 

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Drug use among the under-15s (3) • Responses targeted at very young drug users range from

universal prevention approaches (e.g. schools, communities) to early interventions (e.g. counselling) when use is suspected

• Mid-way between these are prevention responses tailored to high-risk groups (e.g. families at risk)

• In most EU countries, measures to prevent the early use of licit substances are viewed as prevention against use of illicit ones later

• Promoting the use of illicit drugs among young people incurs stiff penalties in several countries

• Sale of illicit drugs near schools or locations attended by young people is also severely penalised

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Cocaine and crack cocaine use (1)

Considerable concern in recent years regarding:

• rises in cocaine use in recreational settings and among young people in general in some countries

• concurrent use of cocaine and heroin becoming more common among problem opioid users

• problem use of crack cocaine. This remains rare but causes concern in some marginalised groups in some areas

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Cocaine and crack cocaine use (2)

• Adverse health effects of cocaine use include: cardiovascular, cerebrovascular and neurological disorders

• Risk of cocaine toxicity may be influenced by concomitant use of other substances (e.g. alcohol, heroin)

• Some 400 deaths recorded as cocaine-related in 2005 – deaths from purely pharmacological overdose are relatively infrequent

• Possible under reporting of cocaine-related deaths

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Cocaine and crack cocaine use (3)

• Flexible treatment services are required that can attract and respond to the specific needs of very different cocaine users

• No effective medication exists at present to help cocaine users maintain abstinence or reduce use

• Cocaine users in treatment are generally prescribed

medications, such as anti-depressants or benzodiazepines, to provide symptomatic relief (anxiety, depression)

• New developments: experimental therapeutic drugs to reduce withdrawal symptoms/cravings have shown potential in clinical trials. Immunotherapy for cocaine dependence through a cocaine vaccine (TA-CD) is under investigation.

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Time to acknowledge progress• Now faced with a more complex and heterogeneous drug

situation in Europe than a decade ago

• Important to show where intelligent investments are paying dividends

• Drug use has stabilised in many important areas, albeit at historically high levels – some cases merit cautious optimism

• Dramatic increase in countries’ investment in prevention, treatment and harm-reduction activities and better cooperation in supply reduction

• Assessing progress is crucial right now as we enter a period of reflection on recent achievements. In 2008, the EMCDDA will contribute to the evaluation of the EU drugs action plan and UNGASS review process.